Original Article

Awareness of Risk Factors, Warning Signs, and Immediate

Management Measures of Noncommunicable Diseases:
A Multihospital‑based Study
Nitin Joseph, R. Srinath, Aditya Ramanathan, Ashutosh Kumar Gupta, P. Nandan, Rimsha Afnan
Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal University, Karnataka, India

Abstract
Introduction: Noncommunicable diseases (NCDs) account for more than one‑third of outpatient visits and inpatient admissions and more than
half of the proportional mortality rate from all causes of death in India. The burden of modifiable risk factors of NCDs in India is increasing
significantly over the past five decades. Therefore, the reason behind this and the preparedness of people to deal with it need to be ascertained.
Objectives: The objective of this study was to assess the awareness of people regarding risk factors, warning signs, and immediate management
practices in specific NCDs. Materials and Methods: This cross‑sectional study was conducted among people in a government and private
tertiary care hospital of Mangalore city in February 2016. Data were collected by interviewing each participant using a pretested validated
structured interview schedule. Results: All the 400 enrolled participants had heard about heart attack, hypertension, and diabetes mellitus.
However, only 250 (62.5%) had heard about stroke. Good awareness about heart attack was present among 62.5%, stroke among 57.6%,
hypertension among 59%, and diabetes mellitus among 55.8% of participants. Multivariate analysis using ordinal logistic regression analysis
found that good educational status and being vegetarian were significant predictors of good awareness level about heart attack. Similarly,
these factors along with urban residential status were significant predictors of good awareness level about stroke. Age above 55 years was a
significant predictor of good awareness level about diabetes mellitus. Conclusion: The various sociodemographic groups identified to have
poor knowledge about NCDs in this study require targeted intervention during health educational campaigns.

Keywords: Awareness, immediate management practices, noncommunicable diseases, risk factors, warning symptoms/signs

Introduction is still attributed as a reason for high prevalence of hypertension

Noncommunicable diseases (NCDs) in middle‑ and low‑income
countries account for three‑fourths of the total deaths
worldwide.[1] They account for more than one‑third of the
outpatient department (OPD) visits and inpatient admissions
and more than half of the proportional mortality rate from
all causes of death in India.[2,3] It also contributes to 44% of
disability‑adjusted life years lost.[3]
The high risk of such NCD‑related morbidity and mortality
among Indians is due to several reasons. These include genetic
predisposition to central obesity and metabolic syndrome along
with other factors such as smoking and faulty lifestyle habits.[4]
The burden of modifiable risk factors of NCDs in India is
increasing significantly over the past five decades.[5] Therefore,
the reason behind this needs to be ascertained. Low awareness
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in both urban and rural parts of India.[6‑8] A minimal reduction
in mean blood pressure levels has been reported to save
over 100,000 deaths due to stroke and coronary heart diseases
over here.[9] Awareness generation of people regarding the
warning signs of various NCDs is equally essential to enable
early diagnosis and treatment.
Very few studies in India have researched on the awareness of
people about specific NCDs.
Address for correspondence: Dr. Nitin Joseph,
Department of Community Medicine, Kasturba Medical College, Light
House Hill Road, Manipal University, Mangalore, Karnataka, India.
E‑mail: drnitinjoseph@gmail.com
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work non-commercially, as long
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How to cite this article: Joseph N, Srinath R, Ramanathan A, Gupta AK,

DOI: Nandan P, Afnan R. Awareness of risk factors, warning signs, and immediate
10.4103/jnsbm.JNSBM_187_17 management measures of noncommunicable diseases: A multihospital-based
study. J Nat Sc Biol Med 2018;9:227-35.

© 2018 Journal of Natural Science, Biology and Medicine | Published by Wolters Kluwer ‑ Medknow 227
 Joseph, et al.: Awareness of noncommunicable diseases
Hence, this study was done to assess the awareness of
risk factors and warning signs of heart attack, stroke,
hypertension, and diabetes mellitus among people visiting
various tertiary health‑care centers. It also assessed their
immediate management practices toward heart attack and
stroke.
Materials and Methods
Study settings and study design
This cross‑sectional study was conducted in a government and
private tertiary care hospital of Mangalore city of South India
in the month of February 2016.
Ethics committee approval
Institutional Ethics Committee approval was obtained before
the commencement of this study. Permission to conduct this
study at these hospitals was obtained from the respective
medical superintendents.
Sample size calculation and sampling method
Sample size was calculated based on the formula Zα2pq/d2,
where “p” was taken as 34% based on the findings of a previous
study[10] which reported that 34% of participants were aware
about the warning signs of stroke. At 95% confidence intervals,
with an allowable error (d) taken as 15% of “p” and substituting
“q” as 100‑p, the sample size was calculated as 332. It was
rounded off to 400 participants. Awareness of people about
warning signs of stroke in particular was chosen for sample
size calculation as it is usually the least understood among
various NCDs. The participants were enrolled in this study
by convenience sampling method.
Study population
Inclusion and exclusion criteria
• Patients and their attenders visiting OPD of these hospitals
were included in this study
• Participants aged below 18 years and seriously ill patients
were excluded from this study.
Consent for participation
The participants were explained the nature and purpose of
the study and were assured confidentiality of the information
provided by them. Written informed consent was taken from
all consenting participants.
Data collection methodology
Data were obtained by interviewing each participant in a
private room close to the OPD using a structured interview
schedule. The schedule was translated into the local language
Kannada and was language and content validated by experts.
It was pretested in a group of ten participants who were not
included in this study.
Sociodemographic details such as age, gender, marital status,
education, occupation, education and occupation of head of
the household, total monthly family income, type of family,
and place of residence were inquired of each participant by
228 Journal of Natural Science, Biology and Medicine  ¦  Volume 9 ¦ Issue 2 ¦ July-December 2018
interviewing them. They were also inquired about the past
history and family history of comorbidities, substance abuse,
dietary habits, and awareness of any medical emergency
number. In relation to the study objectives, the participants
were inquired whether they had heard about specific NCDs
such as heart attack, stroke, hypertension, and diabetes
mellitus. If they had heard, they were further inquired about
risk factors and warning symptoms and signs of each of the
four NCDs.
However, the awareness of participants regarding immediate
management measures was inquired only for medical
emergencies such as heart attack and stroke. If more than one
correct answer was given for each item by the participant, a
total of two points were awarded. Only one point was awarded
for a single correct answer and zero point was awarded for no
response or for an incorrect answer.
Cumulative score of 0–1 was categorized as poor, 2–3 as
moderate, and 4–6 as good awareness level regarding heart
attack and stroke. For hypertension and diabetes mellitus,
cumulative score of 0–1 was categorized as poor, 2–3 as
moderate, and 4 as good awareness. The cutoff scores 2–3
indicating moderate awareness level were based on a single
correct answer by participants to risk factors, warning
symptoms/signs, and immediate management measures for
each NCD.
Data analysis
Data entered and analyzed using Statistical Package for Social
Sciences software package (SPSS Inc., Chicago, IL, USA)
version 16.0. Univariate analysis using Chi‑square test and
multivariate analysis using ordinal logistic regression analysis
were done to identify the predictors of good awareness level
of participants. P < 0.05 was taken as statistically significant
association.
Results
The mean age of the total 400 participants was 36.9 ± 13.0 years.
Among them, 211  (52.8%) were from the government
and the rest 189  (47.2%) were from the private hospital.
Majority of participants were males  (270  [67.5%]), were
educated till high school level or above (253 [63.2%]), were
unskilled workers  (110  [27.5%]), were from upper lower
socioeconomic status  (SES)  (46.5%), and were from rural
areas (246 [61.5%]) [Table 1].
All participants had heard about heart attack, hypertension,
and diabetes mellitus. However, only 250  (62.5%) of them
had heard about stroke. The most common risk factor of heart
attack identified by the participants was stress (108 [27%]),
of stroke was hypertension  (30.8%), of hypertension was
stress (141 [35.3%]), and of diabetes mellitus was excessive
sugar intake (164 [41%]) [Table 2].
The most common warning symptom of heart attack identified
by the participants was chest pain  (228  [57%]), of stroke
was weakness of extremities  (56%), of hypertension was
 Joseph, et al.: Awareness of noncommunicable diseases

Table 1: Sociodemographic distribution of the study Table 2: Awareness of risk factors of various
participants noncommunicable diseases among participants (n=400)
Characteristics Frequency (%) Risk factors n (%)
Age group (years) Heart attack
18-25 85 (21.2) Stress 108 (27.0)
26-35 130 (32.5) Hypertension 97 (24.3)
36-45 86 (21.5) Smoking 91 (22.8)
46-55 58 (14.5) Dyslipidemia 62 (15.5)
56-65 33 (8.3) Shocking news 45 (11.3)
>65 8 (2.0) Obesity 40 (10.0)
Gender Alcohol intake 24 (6.0)
Male 270 (67.5) Diabetes mellitus 22 (5.5)
Female 130 (32.5) Poor exercising habits 15 (3.8)
Marital status Misconceptions 23 (5.8)
Married 270 (67.5) Don’t know 127 (31.8)
Unmarried 126 (31.5) Stroke (n=250)
Widow 4 (1.0) Hypertension 77 (30.8)
Educational status Stress 42 (16.8)
Graduate/postgraduate 69 (17.2) Smoking 31 (12.4)
Intermediate/posthigh school diploma 92 (23.0) Poor physical activity 13 (5.2)
High school 92 (23.0) Dyslipidemia 11 (4.4)
Middle school 43 (10.8) Obesity 9 (3.6)
Primary school 59 (14.8) Hereditary 5 (2.0)
Illiterate 45 (11.2) Misconceptions 47 (18.8)
Occupational status Hypertension
Professional 3 (0.8) Stress 141 (35.3)
Semi‑professional 36 (9.0) Increased salt intake 52 (13.0)
Clerical/shop owner/farmer 56 (14.0) Hereditary 36 (9.0)
Skilled worker 65 (16.2) Poor physical activity 20 (5.0)
Semi‑skilled 42 (10.5) Obesity 18 (4.5)
Unskilled 110 (27.5) Excessive spice intake 16 (4.0)
Unemployed 88 (22.0) Dyslipidemia 9 (2.3)
SES (n=387) Misconceptions 18 (4.5)
Upper 2 (0.5) Don’t know 205 (51.3)
Upper middle 81 (20.9) Diabetes mellitus
Lower middle 100 (25.9) Excessive sugar intake 164 (41.0)
Upper lower 180 (46.5) Hereditary 82 (20.5)
Lower 24 (6.2) Obesity 36 (9.0)
Type of family Stress 29 (7.3)
Nuclear 245 (61.3) Poor physical activity 21 (5.3)
Joint 93 (23.2) Junk foods 19 (4.8)
Three generation 62 (15.5) Dyslipidemia 12 (3.0)
Place of residence Misconceptions 19 (4.8)
Urban 154 (38.5)
Rural 246 (61.5)
The most common immediate management practice for heart
Total 400 (100.0)
attack and stroke as stated by over 70% of participants was
medical assistance [Table 4].
anger  (133  [33.3%]), and of diabetes mellitus was delayed
Good awareness level about heart attack, stroke, hypertension,
wound healing (165 [41.3%]) [Table 3].
and diabetes mellitus was seen among 62.5%, 57.6%, 59%,
In this study, 241 (60.3%), 265 (66.3%), and all participants and 55.8% participants, respectively [Table 5].
were aware of at least one warning sign or symptoms about heart Education, occupation, SES, place of residence, and type of
attack, diabetes mellitus, and hypertension, respectively. With diet were associated with awareness level about heart attack
respect to stroke, awareness of at least one sign or symptom among participants. Educational status, place of residence,
was present among 179 (71.6%) out of 250 participants who and type of diet were associated with awareness level about
had heard about stroke [Table 3]. stroke among participants. Educational status was associated

Journal of Natural Science, Biology and Medicine  ¦  Volume 9 ¦ Issue 2 ¦ July-December 2018 229
 Joseph, et al.: Awareness of noncommunicable diseases

Multivariate analysis identified several predictors of good

Table 3: Awareness of warning symptoms/signs
awareness level among participants regarding individual
of various noncommunicable diseases among
types of NCDs. Educational status of high school level and
participants (n=400)
above and being a vegetarian were significant predictors of
Signs and symptoms n (%) good awareness level about heart attack, taking illiterate and
Heart attack nonvegetarians as the reference population, respectively.
Chest pain 228 (57.0) Educational status of intermediate level and above, being a
Breathlessness 71 (17.8) vegetarian, and from an urban area were significant predictors
Pain in the upper limbs 51 (12.8) of good awareness level about stroke, taking illiterate,
Fatigue 49 (12.3)
nonvegetarians, and rural residents as the reference population,
Sweating 46 (11.5)
respectively. Age above 55 years was a significant predictor
Dizziness 21 (5.3)
of good awareness level about diabetes mellitus, taking
Vomiting 7 (1.8)
18–25 years as the reference population [Table 7].
Abdominal discomfort 3 (0.8)
Misconceptions 5 (1.3)
Don’t know 159 (39.8) Discussion
Stroke (n=250) Good awareness level was seen among a greater proportion
Weakness of extremities 140 (56.0)
of participants (62.5%), regarding heart attack compared to
Numbness 97 (38.8)
other NCDs. Among the total number of various risk factors
Difficulty with speech 54 (21.6)
associated with the awareness level of different NCDs in
Difficulty with walking 52 (20.8)
this study, majority was again for heart attack. This indicates
Imbalance 29 (11.6)
Dizziness 21 (8.4)
that awareness about heart attack is quite common among
Misconceptions 27 (10.8) people. In a population‑based study done in Kuwait,[11] 40%
Don’t know 71 (28.4) of participants were not aware of any heart attack symptoms
Hypertension similar to 39.8% observed in this study. In addition, only
Anger 133 (33.3) 50.4% were aware that chest pain is a warning symptom for
Dizziness 54 (13.5) heart attack in the former study[11] compared to 57% reported
Headache 41 (10.3) here.
Blurring of vision 15 (3.8)
In a study done in Nellore, India,[10] only 35% of participants
Sweating 11 (2.8)
Breathlessness 9 (2.3)
were aware about stroke and only 30% of participants knew
Sleeplessness 6 (1.5)
limb weakness as a warning sign of stroke. These findings
Misconceptions 8 (2.0) were again lesser than that reported in the present study where
Diabetes mellitus 250 (62.5%) had heard about stroke and of them, 56% knew
Delayed wound healing 165 (41.3) that it can manifest with weakness of extremities.
Fatigue 135 (33.8)
In a multivariate analysis in the former study[10] and in a
Polyuria 49 (12.3)
systematic review,[12] high educational status was found to be
Dizziness 32 (8.0)
associated with good awareness level of stroke as also observed
Polyphagia 30 (7.5)
in this study along with other risk factors observed here such
Weight loss 28 (7.0)
Polydipsia 21 (5.3)
as being vegetarians and from urban areas.
Visual disturbances 11 (2.8) There has been a tremendous increase in stroke‑associated
Infections 7 (1.8) morbidity and mortality in India over the years to an extent
Misconceptions 23 (5.8) that it has exceeded the statistics of industrialized Western
Don’t know 135 (33.8) countries.[13] Therefore, it is a matter of concern that 37.5% of
participants in this study had not heard about stroke and among
with awareness level about hypertension among participants. those who had heard, 28.4% were not aware of its warning
Age, SES, and family history of diabetes mellitus were symptoms/signs.
associated with awareness level about diabetes mellitus among
participants [Table 6]. This infers that a greater number of risk In other studies, it was reported that 20%–50%[10,12,14] were not
factors were associated with awareness level about heart attack aware of any risk factors and 23%–80%[12,14] of the participants
among participants. were not aware of even a single warning sign for stroke. The
time within 60 minutes of onset of symptoms of stroke is called
Of the total participants, 322 (80.5%) had heard of emergency the golden hour for stroke management.[15] Hence, awareness
number which needs to be dialed during medical emergencies. of this condition and early recognition of its warning signs and
However, only 165  (51.2%) of them knew this number symptoms need further improvement for timely initiation of
correctly. treatment within this time window.

230 Journal of Natural Science, Biology and Medicine  ¦  Volume 9 ¦ Issue 2 ¦ July-December 2018
 Joseph, et al.: Awareness of noncommunicable diseases

Table 4: Awareness of immediate management practices Table 6: Contd...

in various noncommunicable diseases among participants Intermediate/posthigh 24 (26.1) 68 (73.9) 92
school diploma
Immediate management practices n (%)
High school 34 (37) 58 (63) 92
Heart attack (n=400)
Middle school 19 (44.2) 24 (55.8) 43
Call for medical help 280 (70.0)
Primary school 31 (52.5) 28 (47.5) 59
Cardiopulmonary resuscitation 97 (24.3)
Illiterate 31 (68.9) 14 (31.1) 45
Rest 48 (12)
χ2, P 44.24, <0.001
Ventilation 14 (3.5)
Occupation
Medication 10 (2.5)
Professional/ 6 (15.4) 33 (84.6) 39
Loosen clothes 11 (2.8) semi‑professional
Rub the chest 4 (1.0) Clerical/shop owner/ 15 (26.8) 41 (73.2) 56
Misconceptions 6 (1.5) farmer
Don’t know 76 (19.0) Skilled worker 18 (27.7) 47 (72.3) 65
Stroke (n=250) Semi‑skilled worker 14 (33.3) 28 (66.7) 42
Call for medical help 178 (71.2) Unskilled worker 61 (55.5) 49 (44.5) 110
Make them lie on one side 42 (16.8) Unemployment 36 (40.9) 52 (59.1) 88
Misconceptions 54 (21.6) χ2, P 29.4, <0.001
Don’t know 65 (26.0) Socioeconomic
status (n=387)
Upper/upper middle 17 (20.5) 66 (79.5) 83
Table 5: Awareness level of participants with respect to Lower middle 31 (31.0) 69 (69.0) 100
different types of noncommunicable diseases Upper lower 86 (47.8) 94 (52.2) 180
Lower 8 (33.3) 16 (66.7) 24
Type of NCD Level of knowledge Total
χ2, P 20.4, <0.001
Poor Moderate Good Type of family
Heart attack 134 (33.5) 16 (4.0) 250 (62.5) 400 Nuclear 88 (35.9) 157 (64.1) 245
Stroke 27 (10.8) 79 (31.6) 144 (57.6) 250 Joint 32 (34.4) 61 (65.6) 93
Hypertension 4 (1) 160 (40) 236 (59) 400 Three generation 30 32 62
Diabetes mellitus 4 (1) 173 (43.2) 223 (55.8) 400 χ2, P 3.78, 0.151
NCD: Noncommunicable disease Place of residence
Urban area 47 (30.5) 107 (69.5) 154
Rural area 103 (41.9) 143 (58.1) 246
Table 6: Association between sociodemographic χ2, P 5.206, 0.023
variables and other risk factors with awareness level of Type of diet
participants about various noncommunicable diseases Vegetarian 13 (21.7) 47 (78.3) 60
Risk factors Awareness level about heart Total Nonvegetarian 137 (40.3) 203 (59.7) 340
attack χ2, P 7.55, 0.006
Presence of NCDs
Poor/moderate Good
Yes 27 (38.6) 43 (61.4) 70
Age group (years)
No 123 (37.3) 207 (62.7) 330
18-25 27 (31.8) 58 (68.2) 85
χ2, P 0.042, 0.838
26-35 54 (41.5) 76 (58.5) 130
Family history of NCD
36-45 28 (32.6) 58 (67.4) 86
Present 62 (33.5) 123 (66.5) 185
46-55 22 (37.9) 36 (62.1) 58
Absent 88 (40.9) 127 (59.1) 215
>55 19 (46.3) 22 (53.7) 41
χ2, P 2.33, 0.127
χ2, P 4.37, 0.359
History of substance
Gender abuse
Male 101 (37.4) 169 (62.6) 270 Present 47 (37.3) 79 (62.7) 126
Female 49 (37.7) 81 (62.3) 130 Absent 103 (37.6) 171 (62.4) 274
χ2, P 0.003, 0.956 χ2, P 0.003, 0.956
Marital status Total 150 250 400
Married 105 (38.9) 165 (61.1) 270
Risk factors Awareness level about stroke Total
Unmarried/widow 45 (34.6) 85 (65.4) 130
χ2, P 0.684, 0.408 Poor/moderate Good
Educational status Age group (years)
Graduate/postgraduate 11 (15.9) 58 (84.1) 69 18-25 22 (46.8) 25 (53.2) 47

Contd... Contd...

Journal of Natural Science, Biology and Medicine  ¦  Volume 9 ¦ Issue 2 ¦ July-December 2018 231
 Joseph, et al.: Awareness of noncommunicable diseases

Table 6: Contd... Table 6: Contd...

26-35 33 (45.8) 39 (54.2) 72 Family history of NCDs
36-45 25 (40.3) 37 (59.7) 62 Yes 45 (38.1) 73 (61.9) 118
46-55 14 (36.8) 24 (63.2) 38 No 61 (46.2) 71 (53.8) 132
>55 12 (38.7) 19 (61.3) 31 χ2, P 1.66, 0.197
χ2, P 1.48, 0.829 History of substance
Gender abuse
Male 71 (41.8) 99 (58.2) 170 Present 36 (47.4) 40 (52.6) 76
Female 35 (43.8) 45 (56.2) 80 Absent 70 (40.2) 104 (59.8) 174
χ2, P 0.088, 0.767 χ2, P 1.1, 0.293
Marital status Total 106 144 250
Married 70 (40.5) 103 (59.5) 173 Risk factors Awareness level about Total
Unmarried/widow 36 (46.8) 41 (53.2) 77 hypertension
χ2, P 0.863, 0.353 Poor/moderate Good
Educational status
Age group (years)
Graduate/postgraduate 15 (28.8) 37 (71.2) 52
18-25 37 (43.5) 48 (56.5) 85
Intermediate/posthigh 24 (34.3) 46 (65.7) 70
26-35 57 (43.8) 73 (56.2) 130
school diploma
36-45 38 (44.2) 48 (55.8) 86
High school 29 (50) 29 (50) 58
46-55 20 (34.5) 38 (65.5) 58
Middle school 9 (47.4) 10 (52.6) 19
>55 12 (29.3) 29 (70.7) 41
Primary school 15 (51.7) 14 (48.3) 29
χ2, P 4.37, 0.358
Illiterate 14 (63.6) 8 (36.4) 22
Gender
χ2, P 12.457, 0.029
Male 118 (43.7) 152 (56.3) 270
Occupation
Female 46 (35.4) 84 (64.6) 130
Professional/ 9 (32.1) 19 (67.9) 28
semi‑professional χ2, P 2.511, 0.113
Clerical/shop owner/ 11 (26.2) 31 (73.8) 42 Marital status
farmer Married 102 (37.8) 168 (62.2) 270
Skilled worker 18 (43.9) 23 (56.1) 41 Unmarried/widow 62 (47.7) 68 (52.3) 130
Semi‑skilled worker 9 (42.9) 12 (57.1) 21 χ2, P 3.57, 0.059
Unskilled worker 32 (51.6) 30 (48.4) 62 Educational status
Unemployment 27 (48.2) 29 (51.8) 56 Graduate/postgraduate 34 (49.3) 35 (50.7) 69
χ2, P 8.69, 0.122 Intermediate/posthigh 44 (47.8) 48 (52.2) 92
Socioeconomic school diploma
status (n=242) High school 43 (46.7) 49 (53.3) 92
Upper/upper middle 22 (33.3) 44 (66.7) 66 Middle school 14 (32.6) 29 (67.4) 43
Lower middle 22 (34.9) 41 (65.1) 63 Primary school 17 (28.8) 42 (71.2) 59
Upper lower 47 (48.5) 50 (51.5) 97 Illiterate 12 (26.7) 33 (73.3) 45
Lower 9 (56.2) 7 (43.8) 16 χ2, P 13.689, 0.018
χ2, P 6.31, 0.098 Occupation
Type of family Professional/ 16 (41) 23 (59) 39
Nuclear 65 (40.9) 94 (59.1) 159 semi‑professional
Joint 22 (42.3) 30 (57.7) 52 Clerical/shop owner/ 28 (50) 28 (50) 56
farmer
Three generation 19 (48.7) 20 (51.3) 39
Skilled worker 26 (40) 39 (60) 65
χ2, P 0.788, 0.674
Semi‑skilled worker 19 (45.2) 23 (54.8) 42
Place of residence
Unskilled worker 37 (33.6) 73 (66.4) 110
Urban 36 (32.7) 74 (67.3) 110
Unemployment 38 (43.2) 50 (56.8) 88
Rural 70 (50) 70 (50) 140
χ2, P 4.85, 0.434
χ2, P 7.525, 0.006
Socioeconomic
Type of diet
status (n=387)
Vegetarian 13 (28.9) 32 (71.1) 45
Upper/upper middle 41 (49.4) 42 (50.6) 83
Nonvegetarian 93 (45.4) 112 (54.6) 205
Lower middle 46 (46) 54 (54) 100
χ2, P 4.1, 0.043
Upper lower 63 (35) 117 (65) 180
Presence of NCDs
Lower 10 (41.7) 14 (58.3) 24
Yes 17 (34.7) 32 (65.3) 49
χ2, P 6.1, 0.107
No 89 (44.3) 112 (55.7) 201
Type of family
χ2, P 1.48, 0.223
Nuclear 100 (40.8) 145 (59.2) 245
Contd... Contd...

232 Journal of Natural Science, Biology and Medicine  ¦  Volume 9 ¦ Issue 2 ¦ July-December 2018
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Table 6: Contd... Table 6: Contd...

Joint 39 (41.9) 54 (58.1) 93 Intermediate/posthigh 45 (48.9) 47 (51.1) 92
Three generation 25 (40.3) 37 (59.7) 62 school diploma
χ2, P 0.049, 0.976 High school 44 (47.8) 48 (52.2) 92
Place of residence Middle school 20 (46.5) 23 (53.5) 43
Urban area 66 (42.9) 88 (57.1) 154 Primary school 28 (47.5) 31 (52.5) 59
Rural area 98 (39.8) 148 (60.2) 246 Illiterate 14 (31.1) 31 (68.9) 45
χ2, P 0.357, 0.55 χ2, P 5.98, 0.308
Type of diet Occupation
Vegetarian 25 (41.7) 35 (58.3) 60 Professional/ 16 (41) 23 (59) 39
Nonvegetarian 139 (40.9) 201 (59.1) 340 semi‑professional
χ2, P 0.013, 0.909 Clerical/shop owner/ 21 (37.5) 35 (62.5) 56
farmer
Presence of NCDs
Skilled worker 36 (55.4) 29 (44.6) 65
Yes 28 (40) 42 (60) 70
Semi‑skilled worker 20 (47.6) 22 (52.4) 42
No 136 (41.2) 194 (58.8) 330
Unskilled worker 40 (36.4) 70 (63.6) 110
χ2, P 0.035, 0.851
Unemployment 44 (50) 44 (50) 88
Presence of
hypertension χ2, P 8.61, 0.126
Yes 14 (33.3) 28 (66.7) 42 Socioeconomic
status (n=387)
No 150 (41.9) 208 (58.1) 358
Upper/upper middle 25 (30.1) 58 (69.9) 83
χ2, P 1.14, 0.286
Lower middle 54 (54.0) 46 (46.0) 100
Family history of NCDs
Upper lower 83 (46.1) 97 (53.9) 180
Yes 71 (38.4) 114 (61.6) 185
Lower 11 (45.8) 13 (54.2) 24
No 93 (43.3) 122 (56.7) 215
χ2, P 10.8, 0.013
χ2, P 0.978, 0.323
Type of family
Family history of
hypertension Nuclear 109 (44.5) 136 (55.5) 245
Yes 41 (34.5) 78 (65.5) 119 Joint 47 (50.5) 46 (49.5) 93
No 123 (43.8) 158 (56.2) 281 Three generation 21 (33.9) 41 (66.1) 62
χ2, P 3.0, 0.083 χ2, P 4.2, 0.122
History of substance Place of residence
abuse Urban area 67 (43.5) 87 (56.5) 154
Present 50 (39.7) 76 (60.3) 126 Rural area 110 (44.7) 136 (55.3) 246
Absent 114 (41.6) 160 (58.4) 274 χ2, P 0.056, 0.813
χ2, P 0.132, 0.716 Type of diet
Total 164 236 400 Vegetarian 25 (41.7) 35 (58.3) 60
Nonvegetarian 152 (44.7) 188 (55.3) 340
Risk factors Awareness level about Total
diabetes mellitus χ2, P 0.191, 0.662
Presence of NCDs
Poor/moderate Good Yes 29 (41.4) 41 (58.6) 70
Age group (years) No 148 (44.8) 182 (55.2) 330
18-25 45 (52.9) 40 (47.1) 85 χ2, P 0.274, 0.601
26-35 64 (49.2) 66 (50.8) 130 Presence of diabetes
36-45 36 (41.9) 50 (58.1) 86 mellitus
46-55 27 (46.6) 31 (53.4) 58 Yes 12 (30) 28 (70) 40
>55 5 (12.2) 36 (87.8) 41 No 165 (45.8) 195 (54.2) 360
χ2, P 21.3, <0.001 χ2, P 3.66, 0.056
Gender Family history of NCD
Male 121 (44.8) 149 (55.2) 270 Yes 77 108 185
Female 56 (43.1) 74 (56.9) 130 No 100 (46.5) 115 (53.5) 215
χ2, P 0.107, 0.743 χ2, P 0.964, 0.326
Marital status Family history of
Married 115 (42.6) 155 (57.4) 270 diabetes mellitus
Unmarried/widow 62 68 130 Present 33 (31.4) 72 (68.6) 105
χ2, P 0.925, 0.336 Absent 144 (48.8) 151 (51.2) 295
Educational status χ2, P 9.49, 0.002
Graduate/postgraduate 26 (37.7) 43 (62.3) 69 History of substance
abuse
Contd... Contd...

Journal of Natural Science, Biology and Medicine  ¦  Volume 9 ¦ Issue 2 ¦ July-December 2018 233
 Joseph, et al.: Awareness of noncommunicable diseases

awareness among them might be due to easy accessibility

Table 6: Contd...
to medical care and health clubs, more of mass media and
Present 50 (39.7) 76 (60.3) 126
internet facilities, and better literacy rate in urban compared
Absent 127 (46.4) 147 (53.6) 274
to rural areas.
χ2, P 1.56, 0.212
Total 177 223 400 In this study, awareness of hypertension was seen significantly
NCDs: Noncommunicable diseases better among those who were illiterate or those educated up to
primary school level compared to others. The moderate‑to‑good
awareness level about hypertension in this study was 99%,
Table 7: Ordinal logistic regression analysis of predictors
which was also much higher than that reported in previous
of awareness level of various noncommunicable diseases
studies where it ranged from 36.9% to 60%.[7,8,17,18] This might
among the participants (n=400)
be because of opportunistic screening of blood pressure (for
Independent predictors Adjusted 95% CIs of P those aged above 30 years) by health‑care providers, which is
of good awareness OR adjusted OR done routinely nowadays, under the National Programme for
level
Lower Upper Prevention and Control of Cancer, Diabetes, Cardiovascular
limit limit Diseases and Stroke. This strategy under NPCDCS which was
Of heart attack implemented throughout India in 2015 might have generated
Educational status awareness about hypertension even among the less educated
Graduate/ 0.14 0.05 0.45 0.001 groups. Previous studies [17,19] reported awareness about
postgraduate hypertension to be significantly better among women, which
Intermediate/posthigh 0.25 0.1 0.61 0.003
was different from our observations where no association with
school diploma
High school 0.4 0.17 0.95 0.037
gender was observed.
Middle school 0.48 0.19 1.22 0.123 In another study[17] done in different parts of Kerala, India,
Primary school 0.56 0.24 1.34 0.192 moderate‑to‑good awareness level about diabetes mellitus was
Illiterate 0 found to be 72.2% compared to 99% reported in the present
Type of diet study. However, knowledge of particular risk factors such as
Vegetarian 0.43 0.21 0.9 0.022 physical inactivity and obesity resulting in diabetes mellitus was
Nonvegetarian 0 reported in 11.9% of participantsin a Chennai, India[20] based
Of stroke (n=250)
study which was more than our observations where only 5.3%
Educational status
and 9% of participants, respectively, knew it. This indicates the
Graduate/ 0.23 0.093 0.58 0.002
postgraduate
urgent requirement of need‑based diabetes education programs
Intermediate/posthigh 0.24 0.098 0.57 0.001 in both urban and rural India. It should target those who were
school diploma found particularly to be less aware about diabetes mellitus in
High school 0.48 0.198 1.18 0.111 the present study such as younger population groups.
Middle school 0.64 0.223 1.84 0.409
Primary school 0.69 0.257 1.84 0.455
Conclusion
Illiterate 0
Place of residence Good awareness level about various NCDs ranged from
Urban 0.55 0.351 0.86 0.01 55.8% to 62.5% among participants in this study. There is
Rural 0 thus a need for further improvement of awareness of people
Type of diet regarding various NCDs. These awareness programs should
Vegetarian 0.47 0.259 0.84 0.011 be so designed to improve awareness regarding those risk
Nonvegetarian 0 factors of NCDs which are not widely known among people
Of diabetes mellitus such as those identified in this study. This will help them in
Age group (years) the implementation of suitable preventive measures against
≥56 0.13 0.045 0.365 <0.001 these risk factors. Awareness on warning symptoms and signs
46-55 0.8 0.4 1.59 0.520 and immediate management measures will additionally ensure
36-45 0.62 0.33 1.16 0.138 early diagnosis and treatment. The various sociodemographic
26-35 0.87 0.493 1.52 0.616 groups identified to have poor knowledge in the present study
18-25 0 need to be provided targeted intervention during these health
CIs: Confidence intervals, OR: Odds ratio educational campaigns. These measures will help in containing
the current increasing burden of NCDs in India.
Awareness level regarding stroke was significantly better
among urban residents in the present study. Similarly, in a study Limitation
done in Mysore, India, awareness about diabetes mellitus, A population‑based study would have given a better estimate
hypertension, dyslipidemia, and stroke was significantly of the awareness level of various NCDs in comparison to any
higher among participants from urban area. [16] Better hospital‑based study.

234 Journal of Natural Science, Biology and Medicine  ¦  Volume 9 ¦ Issue 2 ¦ July-December 2018
 Joseph, et al.: Awareness of noncommunicable diseases
Acknowledgments
The authors thank the medical superintendents of the hospitals
for their cooperation in the conduct of this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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