National noncommunicable disease monitoring survey (NNMS) in India: Estimating risk factor prevalence in adult population

Abstract

Background The primary objective of National NCD monitoring survey (NNMS) was to generate national-level estimates of key NCD indicators identified in the national NCD monitoring framework. This paper describes survey study protocol and prevalence of risk factors among adults (18–69 years). Materials and methods NNMS was a national level cross-sectional survey conducted during 2017–18. The estimated sample size was 12,000 households from 600 primary sampling units. One adult (18–69 years) per household was selected using the World Health Organization-KISH grid. The study tools were adapted from WHO-STEPwise approach to NCD risk factor surveillance, IDSP-NCD risk factor survey and WHO-Global adult tobacco survey. Total of 8/10 indicators of adult NCD risk factors according to national NCD disease monitoring framework was studied. This survey for the first time estimated dietary intake of salt intake of population at a national level from spot urine samples. Results Total of 11139 households and 10659 adults completed the survey. Prevalence of tobacco and alcohol use was 32.8% (95% CI: 30.8–35.0) and 15.9% (95% CI: 14.2–17.7) respectively. More than one-third adults were physically inactive [41.3% (95% CI: 39.4–43.3)], majority [98.4% (95% CI: 97.8–98.8)] consumed less than 5 servings of fruits and / or vegetables per day and mean salt intake was 8 g/day (95% CI: 7.8–8.2). Proportion with raised blood pressure and raised blood glucose were 28.5% (95% CI: 27.0–30.1) and 9.3% (95% CI: 8.3–10.5) respectively. 12.8% (95% CI: 11.2–14.5) of adults (40–69 years) had ten-year CVD risk of ≥30% or with existing CVD. Conclusion NNMS was the first comprehensive national survey providing relevant data to assess India’s progress towards targets in National NCD monitoring framework and NCD Action Plan. Established methodology and findings from survey would contribute to plan future state-based surveys and also frame policies for prevention and control of NCDs.

Salt intake and salt‐reduction strategies in South Asia: From evidence to action

“…Of the 21 included studies, 3 , 15 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 a third of the studies (n = 7) were from India, followed by Nepal (n = 5), Bangladesh (n = 4), and Sri Lanka (n = 2). Afghanistan, Bhutan, and Pakistan each had one study.…”

Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS)

“…The survey adopted a stratified multistage geographically clustered, probability-based sampling design using the 2011 Census as its sampling frame to cover the age groups between 15 and 69 years, including a sub-set of adolescents between 15 and 17 years. The target study population was divided into four subgroups of urban and rural by gender (men and women) [ 12 ]. The national representative sample size of 12,000 households (equally allocated to urban and rural areas) was arrived to estimate NCD risk factors among adults (18–69 years) and adolescents (15–17 years).…”

“…To arrive at this desired national sample, the country was divided into 10 contiguous zones each with approximately 60 clusters. The 300 primary sampling units (PSUs) from the rural sampling frame and 300 wards from the urban sampling frame were selected using the probability proportional to population size (PPS) method [ 12 ]. A total of 600 PSUs (300 from urban and 300 from rural) were required considering 20 households from each PSU across the country [ 12 ].…”

“…The 300 primary sampling units (PSUs) from the rural sampling frame and 300 wards from the urban sampling frame were selected using the probability proportional to population size (PPS) method [ 12 ]. A total of 600 PSUs (300 from urban and 300 from rural) were required considering 20 households from each PSU across the country [ 12 ]. The health facility survey was also conducted simultaneously and a sample size of 300 per type of facility was adequate to provide an estimate of 50% availability of essential medicines and technologies (assumed as no prior information was available) with a relative precision of 15% at 95% confidence level (CI).…”

“…The primary objective of the survey was to generate national data on NCD risk factors in adults (18–69 years) and adolescents (15–17 years), health seeking behaviours and national health system response to NCDs. The results of the adult data are published separately [ 12 ]. This paper describes the results of the health facility preparedness assessment conducted as a part of this survey.…”