Dr. Ranomal Kotak, Dr. Rozina Mistry and Intisaar Ahmed “Modifiable risk factors of cardiovascular diseases and other non-communicable diseases among urban dwellers” A community based survey at Karachi, Pakistan (2008-09) Dr. Ranomal Kotak, Dr. Rozina Mistry and Intisaar Ahmed Aga Khan Health Service, Pakistan

NCDs in Pakistan Non communicable diseases and injuries are amongst the top 10 causes of mortality and morbidity in Pakistan and account for 25% of the total deaths within the country.1,2 Existing population-based morbidity data on NCDs in Pakistan shows that one in three adults over the age of 45 years suffers from high blood pressure. 3 One in four middle-aged adults in Pakistan has prevalent Coronary Artery Diseases with the risk being uniformly high in the young and women3 Regional prevalence data reveals 11.4% prevalence of diabetes.4 Karachi reports one of the highest incidences of breast cancer for any Asian population.5 Pakistan Health Education Survey reported 40% men and 12.5% women were using tobacco in one form or the other5.

Study Objectives To estimate the prevalence of modifiable risk factors impacting cardiovascular diseases and other non communicable diseases in a community of Karachi

Study Questions and Outcome Measures Study questions relate to: Socio-economic background, Physical activity, Dietary Practices (e.g. Fruit/vegetable & salt intake) Tobacco use (Smoking & Snuffing) , Alcohol consumption, Measurements relate to: Blood pressure levels Height & Weight, Waist & Hip

Methodology Cross-sectional - population based survey

Sampling Target population Sample size Population aged 15 – 69 years registered at AKHS, P in Karachi region, residing in defined catchment of AKHS, P’s health centers. Sample size n=2006

Results

Population Profile / Characteristics Male Female Total subjects 992 1014 Mean Age (SD) 38.4 +14.71 38.0 + 14.48 % Married 66.6% 66.1%

Study population distribution according to occupation and education Male Female Occupation (%) Manual non-skilled 9.8% 1.5% Manual skilled 9.5% 2.3% Non-manual 52.3% 19.5% Unemployed 3.2% 2.0% Other 25.1% 74.8% Education (%) None 2.1% 5.2% Primary (<3) 0.5% 1.1% Secondary (3-9) 18.9% 19.3% High School (10-12) 46.4% 47.3% Tertiary 32.2% 27.0% Non-manual 52.3% 19.5% None 2.1% 5.2%

Body Mass Index Male Female BMI - Mean (SD) 24.68 + 5.76 26.37 + 8.50

Central Obesity Male Female Waist Hip Ratio - Mean (SD) 0.83 + 0.78 0.92 + 0.71

Low Levels of Physical Activity

Individuals taking less than 5 servings of fruits and vegetables per day

Additional Salt Intake

High Blood Pressure (General Population) Male Female Systolic BP (mmHg) - Mean (SD) 132.1 + 16.4 125.9 + 20.0 Diastolic BP (mmHg) - Mean (SD) 82.1 + 11.6 79.0 + 10.8

High Blood Pressure (Hypertensive Population) Male Female Systolic BP (mmHg) - Mean (SD) 147.04 + 21.0 140.5 + 21.86 Diastolic BP (mmHg) - Mean (SD) 88.28 + 12.6 84.2 + 12.0

Smoking Female Population = 0% 11.2% 88.8% Individuals who did not smoke 100 cigarettes in their lives Individuals who smoked 100 cigarettes in their lives Current Smokers Ever Smokers Female Population = 0%

Snuffing Female Population = 0% 0.7% 99.3% Individuals who did not snuff 20 times in their lives Individuals who snuffed 20 times in their lives Current Snuffers Ever Snuffers Female Population = 0%

Alcohol Consumption Female Population = 0% 2.4% 97.6% Heavy Consumption=20.8% Individuals who did not take alcohol in their life Individuals who took alcohol in their life Current Alcohol Drinkers Ever Alcohol Drinkers Female Population = 0%

Conclusion Around 64% of population is overweight i.e. at risk & obese (BMI>23Kg/m2). Prevalence of obesity is 12% and 24% in men and women respectively. Physical activity is alarmingly low in study setting. Recommended vegetable and fruit intake is very low also. Less than 5% population reported additional salt intake.. 13% of population found having blood pressure > 140/90 mmHg. 17% of population reported as known hypertensive. Very few among male population reported current smoking, snuffing and alcohol consumption .

Conclusion Prevalence of modifiable risks for non-communicable diseases especially diabetes and cardiovascular diseases in urban population is expected to increase as result of epidemiologic transition and modernization.

Recommendations for interventions Strategy for prevention and control of Non Communicable Disease should be formulated under the umbrella of health promotion framework at national and provincial level. Effective interventions should be taken immediately by public and private health agencies in accordance with that strategy.

References Hyder AA, Morrow RH. Lost healthy life years in Pakistan in 1990. American journal of public health, 2000, 90(8):1235– 40. Government of Pakistan. Pakistan demographic survey 2001. Islamabad, Federal Bureau of Statistics, 2002. Pakistan Medical Research Council. National Health Survey of Pakistan 1990–94. Islamabad, Pakistan: Pakistan Medical Research Council, Network Publication Service; 1998. Diabetes and impaired glucose tolerance in Pakistan: regional prevalence data from DAP-WHO Surveys (1994-1998) Bhurgri, Y; Bhurgri, A; Hasan, SH; Usman, A; Faridi, N; Malik, J; Khurshid, M; Zaidi, SM; Pervez, S; Kayani, N; Hashmi, KZ; Bashir, I; Isani, Z; Sethna, F; Ahsan, H; Zaidi,A; Naseeruddin, S; Zaidi, SA; Alam, SM. Cancer patterns in Karachi division (1998–1999). J Pak Med Assoc. 2002;52:244–246.

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