Longevity Campaign, the “Silkroute-to-health” initiative

Longevity Campaign, the “Silkroute-to-health” initiative

Syed Mahboob Ali Shah, MBBS, MPH, PHD

NCDs Surveillance Specialist for WHO Emro Countries

World Heart Federation Emerging Leader for NCDs Prevention

Co-founder Silkroutetohealth

People in Gilgit Baltistan, like many developing countries, are suffering from the “double burden” of disease where they have not overcome the infectious diseases and maternal and child health issues, are now being affected by rising non-communicable or life style related illnesses such as hypertension, cardiovascular diseases, diabetes and cancer impacting the quality of their lives.
Geographical isolation of the region, lack of awareness, loss of harmony between man and nature, poor diet and hygiene and issues of availability and access to the health care services are few among the host of factors further compound the health situation.
Silkroutetohealth (www.silkroutetohealth.org) is a volunteer-centered, civil society initiative, dedicated to improve health, education and environment in Gilgit Baltistan. It aims to encourage partnerships between professionals and organizations with expertise in health, education and environment in the village and out of the village (in country or overseas) to contribute towards healthy, literate and safe villages.
The health team of silkrouetohealth has launched its longevity campaign in collaboration with local government and non-governmental organizations working to improve health in the region. The major target has been in the area of non-communicable diseases.
Non-communicable diseases (NCDs) are emerging as a major threat for survival of human life across the globe, particularly in developing countries. Based on the scientific evidence four types of NCDS, including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes account for 80% of mortality in adults.
2

In May 2013 the 66th World Health Assembly adopted the comprehensive global monitoring framework (GMF) for the prevention and control of NCDs. The Global Monitoring Framework included a set of indicators capable of application across regions and country settings to monitor trends and assess progress made in the implementation of national strategies and plans on non-communicable diseases. With the aim of reducing premature death and improve the quality of life, the action plan of the Global Strategy for the Prevention and Control of NCDs addresses surveillance as a key component in monitoring NCDs. The WHO Global Action Plan (2013-2020) and its related resolution (WHA66.10) urges countries to strengthen surveillance and monitoring systems for the prevention and control of non-communicable diseases (NCDs). It consists of three major components:
a) monitoring outcomes (mortality and morbidity);
b) monitoring exposures (NCD risk factors); and
c) assessing national health system capacity and response.
World Heart Federation agrees that if we control three important risk factors i.e. high blood pressure, dyslipidemia (low HDL-cholesterol, high total cholesterol, high LDL-cholesterol and triglycerides) and tobacco consumption and exposure, we can prevent 80% of cardiovascular disease associated mortality. Under the WHO Global Monitoring Framework, the following nine areas have been selected to be targets by WHO member countries in Emro region, including Pakistan, to be achieved by the year 2025.
3
WHO targets for developing countries including Pakistan include one mortality target (a 25% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases) and six risk factors targets (alcohol use, physical inactivity, dietary sodium intake, tobacco use, raised blood pressure, and diabetes and obesity), and two national systems targets (drug therapy to prevent heart attacks and strokes, and essential NCD medicines and technologies to treat major NCDs.
Putting NCDs on Surveillance Screen in Gilgit Baltistan
Introduction and Methods
Population-based surveillance of NCDs is the cornerstone to respond to the NCD challenge of epidemic proportion in any country or region. The surveillance includes estimation of major risk factors in representative samples of population aged 18 to 70 years, estimate the current burden and recent trends in NCD mortality and the national systems capacity to respond to the NCD challenge of epidemic proportions.
Our team of researchers, under the supervision of Dr. Syed Mahboob Ali Shah, conducted NCD surveillance studies in collaboration with local government and Aga Khan Health service, A dedicated team of medical students from Gilgit Baltistan, contributed significantly in partnership with research team to conduct population-based studies in Hunza, Nagar and Ghizar districts to collect data on NCDs and risk factors for NCDS.
Methods:
The study was completed in adults aged ≥ 18 years in a random sample of 1000 households. The questionnaire comprised an adapted version of WHO STEPwise approach to Surveillance, “STEPS”, developed by WHO for the measurement of NCD risk factors at the country level. The
4
questionnaire interview collected information that included demographic characteristics, personal and family and disease history, history of current and past consumption of cigarettes, alcohol, other forms of tobacco (history of exposure to second hand tobacco), and physical activity. Information related to the diagnosis and treatment history of hypertension and diabetes was also collected.
Information on physical activity was obtained using the International Physical Activity Questionnaire (IPAQ-short version) which measures the frequency (days per week), and duration (minutes per day) of moderate- and vigorous-intensity physical activity, in bouts of at least 10 minutes during the past 7-day period. We also measured nutritional status measuring height, weight. Waist, hip circumference using standard equipments (SECA Hamburg, Germany). The WHO cut-offs were used to classify subjects as overweight (25.0-29.9 kg/m2) or obese (30.0 kg/m2) [21]. Waist circumference and waist-to-hip ratio was used to define central obesity. Fasting blood samples were taken to measure lipid levels and blood sugar. American Diabetes Association criteria used to define prediabetes and diabetes.
We used calibrated automated sphygmomanometer (Omron HEM-705cp Intellisense Blood Pressure Monitor). We classified participants as hypertensive if they had a measured systolic blood pressure above 140, diastolic blood pressure above 90, or if they reported taking medications that treat hypertension.
RESULTS: Hunza & Nagar Districts at page 5

5
HUNZA DISTRICT
N
95.8
82.5
57.7
82.4
55
13.4
0
20
40
60
80
100
120
18-35
36-49
≥50 ≥50
Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & Participants having formal schooling (%) by age & gendergender gendergender
Male Male
FemaleFemaleFemale
40
36.1
23.9
50
25
25
0
10
20
30
40
50
60
Under secondary Under secondaryUnder secondaryUnder secondary Under secondaryUnder secondaryUnder secondaryUnder secondaryUnder secondaryUnder secondary
SecondarySecondarySecondarySecondarySecondarySecondarySecondary
College/University College/UniversityCollege/UniversityCollege/UniversityCollege/UniversityCollege/UniversityCollege/University College/UniversityCollege/University College/University College/UniversityCollege/University
Level of formal schooling (%) among participants Level of formal schooling (%) among participantsLevel of formal schooling (%) among participants Level of formal schooling (%) among participants Level of formal schooling (%) among participantsLevel of formal schooling (%) among participantsLevel of formal schooling (%) among participants Level of formal schooling (%) among participantsLevel of formal schooling (%) among participants Level of formal schooling (%) among participants Level of formal schooling (%) among participants Level of formal schooling (%) among participants Level of formal schooling (%) among participantsLevel of formal schooling (%) among participantsLevel of formal schooling (%) among participants Level of formal schooling (%) among participants Level of formal schooling (%) among participants Level of formal schooling (%) among participantsLevel of formal schooling (%) among participants Level of formal schooling (%) among participants Level of formal schooling (%) among participantsLevel of formal schooling (%) among participants
Male Male
FemaleFemaleFemale
6
12.5
41.3
63.1
9.5
28.7
61.4
0
10
20
30
40
50
60
70
18-35
36-49
≥50 ≥50
Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age Prevalence of hypertension (%) by age
Male Male
FemaleFemaleFemale
7
56
28.5
8.5
3.4
48
34.2
14.5
0
10
20
30
40
50
60
Underweight UnderweightUnderweightUnderweight UnderweightUnderweightUnderweight
NormalweightNormalweightNormalweight NormalweightNormalweightNormalweightNormalweightNormalweightNormalweight
OverweightOverweight Overweight OverweightOverweightOverweight
ObeseObeseObeseObeseObese
Nutritional Status (%) by genderNutritional Status (%) by genderNutritional Status (%) by gender Nutritional Status (%) by gender Nutritional Status (%) by genderNutritional Status (%) by gender Nutritional Status (%) by gender Nutritional Status (%) by genderNutritional Status (%) by gender Nutritional Status (%) by genderNutritional Status (%) by genderNutritional Status (%) by gender Nutritional Status (%) by genderNutritional Status (%) by gender Nutritional Status (%) by genderNutritional Status (%) by gender
Men Men
WomenWomenWomen Women
7
33.5
65.4
66.7
37.1
45.1
48.9
0
10
20
30
40
50
60
70
80
NormalweightNormalweightNormalweight NormalweightNormalweightNormalweightNormalweightNormalweightNormalweight
OverweightOverweight Overweight OverweightOverweightOverweight
ObeseObeseObeseObeseObese
Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status
Men Men
WomenWomenWomen Women
83.5
10.1
6.4
80.6
11.8
7.6
0
10
20
30
40
50
60
70
80
90
NormalNormalNormal
Prediabetes PrediabetesPrediabetesPrediabetes PrediabetesPrediabetes Prediabetes
Diabetes Diabetes DiabetesDiabetes Diabetes
Prevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetes Prevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetes Prevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetes Prevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetes Prevalence of prediabetes and diabetes Prevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetes Prevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetesPrevalence of prediabetes and diabetes
Men Men
WomenWomenWomen Women
8
10.3
7.7
35.8
64.8
14.6
10.4
27.8
72.2
0
10
20
30
40
50
60
70
80
High_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterolHigh_cholesterol High_cholesterol High_cholesterol
High_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterol High_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterolHigh_LDL_cholesterol High_LDL_cholesterol High_LDL_cholesterol
High TriglyceridesHigh TriglyceridesHigh TriglyceridesHigh TriglyceridesHigh Triglycerides High Triglycerides High TriglyceridesHigh TriglyceridesHigh Triglycerides High TriglyceridesHigh Triglycerides High TriglyceridesHigh TriglyceridesHigh Triglycerides
Low_HDLLow_HDLLow_HDLLow_HDLLow_HDLLow_HDL
Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex Prevalence of Dyslipidemia (%) by sex
Men Men
WomenWomenWomen Women
8.3
23.8
44.9
22.9
40
58.5
0
10
20
30
40
50
60
70
18-35
36-49
≥50 ≥50
Prevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by gender Prevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by genderPrevalence of abdominal obesity (%) by gender
Men Men
WomenWomenWomen Women
9
71.7
38.9
84.7
39.3
0
10
20
30
40
50
60
70
80
90
Moderate ModerateModerateModerateModerate
VigorousVigorousVigorousVigorousVigorous VigorousVigorous
Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at Proportion (%) reporting physical activity (for at least 60 minutes a day) in last one week least 60 minutes a day) in last one week least 60 minutes a day) in last one week least 60 minutes a day) in last one weekleast 60 minutes a day) in last one weekleast 60 minutes a day) in last one week least 60 minutes a day) in last one weekleast 60 minutes a day) in last one week least 60 minutes a day) in last one week least 60 minutes a day) in last one weekleast 60 minutes a day) in last one weekleast 60 minutes a day) in last one week least 60 minutes a day) in last one weekleast 60 minutes a day) in last one week least 60 minutes a day) in last one week least 60 minutes a day) in last one week least 60 minutes a day) in last one week least 60 minutes a day) in last one week
Men Men
WomenWomenWomen Women
93.5
94.8
Men Men
WomenWomenWomen Women
Reported use of salted tea %Reported use of salted tea %Reported use of salted tea %Reported use of salted tea % Reported use of salted tea %Reported use of salted tea %Reported use of salted tea %Reported use of salted tea %Reported use of salted tea % Reported use of salted tea % Reported use of salted tea % Reported use of salted tea %Reported use of salted tea %Reported use of salted tea %Reported use of salted tea %Reported use of salted tea %Reported use of salted tea % Reported use of salted tea %
(4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average) (4 cups of tea in a day on average)
10
18.3
40.5
27.6
36.5
14.2
0.6
3.7
2.2
17.9
14.9
0
5
10
15
20
25
30
35
40
45
Smoke currentSmoke current Smoke current Smoke current Smoke currentSmoke currentSmoke current Smoke currentSmoke current
Smoke pastSmoke past Smoke past Smoke past Smoke past Smoke past
Snuff or naswarSnuff or naswarSnuff or naswarSnuff or naswar Snuff or naswar Snuff or naswar Snuff or naswar Snuff or naswarSnuff or naswar
Exposure at workExposure at workExposure at workExposure at workExposure at workExposure at workExposure at work Exposure at work Exposure at workExposure at workExposure at work
Exposure atExposure atExposure atExposure atExposure atExposure atExposure at Exposure at homehomehome
Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, Proportion (%) smoke cigarette, use snuf, exposed to secondhand smokingexposed to secondhand smoking exposed to secondhand smoking exposed to secondhand smokingexposed to secondhand smokingexposed to secondhand smoking exposed to secondhand smoking exposed to secondhand smokingexposed to secondhand smoking exposed to secondhand smokingexposed to secondhand smokingexposed to secondhand smoking exposed to secondhand smoking
Men Men
WomenWomenWomen Women
11
RESULTS NCDs Nagar District
83.2
67.3
33.3
48.7
6.4
6.8
0
10
20
30
40
50
60
70
80
90
18-35
36-49
≥50 ≥50
Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in Participants Reporting Formal Schooling (%) in NagarNagar Nagar
Men Men
WomenWomenWomen Women
34.3
52.1
21.1
26.8
41.6
24.1
0
10
20
30
40
50
60
Under-secondary Under-secondaryUnder-secondaryUnder-secondary Under-secondaryUnder-secondaryUnder-secondaryUnder-secondaryUnder-secondaryUnder-secondary
SecondarySecondarySecondarySecondarySecondarySecondarySecondary
College/University College/UniversityCollege/UniversityCollege/UniversityCollege/UniversityCollege/UniversityCollege/University College/UniversityCollege/University College/University College/UniversityCollege/University
Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar Level (%) of formal Schooling in Nagar
Men Men
WomenWomenWomen Women
12
12.4
36.5
36.7
15.1
17
35.1
0
5
10
15
20
25
30
35
40
18-35
36-49
≥50 ≥50
Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and Prevalence of hypertension (%) by age and gender, Nagargender, Nagar gender, Nagargender, Nagar gender, Nagar gender, Nagar gender, Nagar
Men Men
WomenWomenWomen Women
9.5
64.4
21.1
4.9
6.6
62.6
22
8.7
0
10
20
30
40
50
60
70
Underweight UnderweightUnderweightUnderweight UnderweightUnderweightUnderweight
Normal weightNormal weightNormal weight Normal weight Normal weightNormal weightNormal weightNormal weightNormal weight
OverweightOverweight Overweight OverweightOverweightOverweight
ObeseObeseObeseObeseObese
Nutritional status (%) by genderNutritional status (%) by genderNutritional status (%) by gender Nutritional status (%) by genderNutritional status (%) by genderNutritional status (%) by genderNutritional status (%) by gender Nutritional status (%) by gender Nutritional status (%) by genderNutritional status (%) by gender Nutritional status (%) by genderNutritional status (%) by gender Nutritional status (%) by genderNutritional status (%) by gender Nutritional status (%) by genderNutritional status (%) by gender
Men Men
WomenWomenWomen Women
13
21.4
41.7
50
18.2
28.6
20
0
10
20
30
40
50
60
Normal weightNormal weightNormal weight Normal weight Normal weightNormal weightNormal weightNormal weightNormal weight
OverweightOverweight Overweight OverweightOverweightOverweight
ObeseObeseObeseObeseObese
Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional statusPrevalence of hypertension by nutritional status Prevalence of hypertension by nutritional status
Men Men
WomenWomenWomen Women
86.6
11
2.4
91.1
7.1
1.8
0
10
20
30
40
50
60
70
80
90
100
NormalNormalNormal
Prediabetes PrediabetesPrediabetesPrediabetes PrediabetesPrediabetes Prediabetes
Diabetes Diabetes DiabetesDiabetes Diabetes
Prevalence of prediabetes and diabetes (%) Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%) Prevalence of prediabetes and diabetes (%) Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%) Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%)Prevalence of prediabetes and diabetes (%) Prevalence of prediabetes and diabetes (%)
Men Men
WomenWomenWomen Women
14
7.3
10.1
18.2
1
4
6.1
0
2
4
6
8
10
12
14
16
18
20
Normal weightNormal weightNormal weight Normal weight Normal weightNormal weightNormal weightNormal weightNormal weight
OverweightOverweight Overweight OverweightOverweightOverweight
ObeseObeseObeseObeseObese
Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional statusPrevalence of diabetes (%) by nutritional status Prevalence of diabetes (%) by nutritional status
Prediabetes PrediabetesPrediabetesPrediabetes PrediabetesPrediabetes Prediabetes
Diabetes Diabetes DiabetesDiabetes Diabetes
5.7
0.5
12.1
3.6
0
2
4
6
8
10
12
14
Prediabetes PrediabetesPrediabetesPrediabetes PrediabetesPrediabetes Prediabetes
Diabetes Diabetes DiabetesDiabetes Diabetes
Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by Prevalence of Prediabetes and diabetes (%) by abdominal obesity abdominal obesityabdominal obesity abdominal obesity abdominal obesity
No abdominal obesityNo abdominal obesityNo abdominal obesity No abdominal obesityNo abdominal obesityNo abdominal obesity No abdominal obesity No abdominal obesityNo abdominal obesityNo abdominal obesityNo abdominal obesityNo abdominal obesity
Had abdominal obesityHad abdominal obesity Had abdominal obesity Had abdominal obesityHad abdominal obesityHad abdominal obesity Had abdominal obesity Had abdominal obesityHad abdominal obesityHad abdominal obesityHad abdominal obesityHad abdominal obesity
15
4.8
6.5
20.7
78.5
4.7
5.4
18.6
74.4
0
10
20
30
40
50
60
70
80
90
High total cholesterolHigh total cholesterolHigh total cholesterolHigh total cholesterolHigh total cholesterol High total cholesterol High total cholesterolHigh total cholesterolHigh total cholesterolHigh total cholesterolHigh total cholesterolHigh total cholesterolHigh total cholesterolHigh total cholesterol High total cholesterolHigh total cholesterolHigh total cholesterol
High LDL-CholHigh LDL-CholHigh LDL-CholHigh LDL-CholHigh LDL-Chol High LDL-Chol High LDL-Chol High LDL-CholHigh LDL-Chol
High triglyceridesHigh triglyceridesHigh triglyceridesHigh triglyceridesHigh triglycerides High triglyceridesHigh triglyceridesHigh triglyceridesHigh triglycerides High triglyceridesHigh triglycerides High triglyceridesHigh triglyceridesHigh triglycerides
Low HDL-CholLow HDL-CholLow HDL-CholLow HDL-Chol Low HDL-CholLow HDL-CholLow HDL-Chol Low HDL-CholLow HDL-Chol
Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender Participants with dyslipidemia (%) by genderParticipants with dyslipidemia (%) by gender
Men Men
WomenWomenWomen Women
76.8
83.4
37.2
42.8
0
10
20
30
40
50
60
70
80
90
Men Men
WomenWomenWomen Women
Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least Proportion (%) reporting physical activity (at least 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week 60 minutes in a day) last one week
Moderate physical activity Moderate physical activityModerate physical activityModerate physical activityModerate physical activity Moderate physical activity Moderate physical activityModerate physical activity Moderate physical activityModerate physical activityModerate physical activity Moderate physical activity
Vigorous physical activityVigorous physical activityVigorous physical activityVigorous physical activityVigorous physical activity Vigorous physical activityVigorous physical activityVigorous physical activity Vigorous physical activityVigorous physical activity Vigorous physical activityVigorous physical activityVigorous physical activity Vigorous physical activity
16
95.4
95.8
10
20
30
40
50
60
70
80
90
100
Men Men
WomenWomenWomen Women
Salted consumption Salted consumption Salted consumption Salted consumption Salted consumption Salted consumption Salted consumption Salted consumption Salted consumption Salted consumption
Men 3 cups a day Women dayMen 3 cups a day Women Men 3 cups a day Women dayMen 3 cups a day Women Men 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women Men 3 cups a day Women Men 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women Men 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women Men 3 cups a day Women Men 3 cups a day Women dayMen 3 cups a day Women Men 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day Women Men 3 cups a day Women Men 3 cups a day Women dayMen 3 cups a day Women dayMen 3 cups a day
Women 18.3
40.5
36.3
39.4
3.8
8.4
10.8
43.7
0
5
10
15
20
25
30
35
40
45
50
Smoker-currentSmoker-current Smoker-current Smoker-currentSmoker-currentSmoker-currentSmoker-currentSmoker-current Smoker-currentSmoker-currentSmoker-current
Smoker-pastSmoker-past Smoker-past Smoker-pastSmoker-pastSmoker-pastSmoker-past Smoker-past
Use naswar (snuff) Use naswar (snuff)Use naswar (snuff) Use naswar (snuff) Use naswar (snuff)Use naswar (snuff) Use naswar (snuff)Use naswar (snuff) Use naswar (snuff)
Secondhand smokeSecondhand smokeSecondhand smokeSecondhand smokeSecondhand smokeSecondhand smokeSecondhand smokeSecondhand smoke Secondhand smokeSecondhand smoke Secondhand smoke Secondhand smoke
Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure Reported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposureReported (%) tobacco consumption and exposure
Men Men
WomenWomenWomen Women