1. 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 ( )
Dr. Ranomal Kotak, Dr. Rozina Mistry and Intisaar Ahmed
Aga Khan Health Service, Pakistan

2. 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.

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

4. 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

5. Methodology
Cross-sectional - population based survey

6. 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

7. Results

8. Population Profile / Characteristics
Male
Female
Total subjects
992
1014
Mean Age (SD)
% Married
66.6%
66.1%

9. 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%

10. Body Mass Index
Male
Female
BMI - Mean (SD)

11. Central Obesity Male Female Waist Hip Ratio - Mean (SD) 0.83 + 0.78

12. Low Levels of Physical Activity

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

14. Additional Salt Intake

15. High Blood Pressure (General Population)
Male
Female
Systolic BP (mmHg) - Mean (SD)
Diastolic BP (mmHg) - Mean (SD)

16. High Blood Pressure (Hypertensive Population)
Male
Female
Systolic BP (mmHg) - Mean (SD)
Diastolic BP (mmHg) - Mean (SD)

17. 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%

18. 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%

19. 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%

20. 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 .

21. 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.

22. 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.

23. References
Hyder AA, Morrow RH. Lost healthy life years in Pakistan in American journal of public health, 2000, 90(8):1235– 40.
Government of Pakistan. Pakistan demographic survey 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 ( )
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.

24. Thanks