Medical devices landscape for Non-communicable diseases in India

Thesis Submitted to the NIPER Hyderabad in Partial Fulfilment for the Award of the Degree of

Master of Business Administration (Pharmaceutical Management}

in

Department of Pharmaceutical Management

by

Sanghmitra Athiya

PM/2019/426

Under the supervision of

Dr B. Laxmi

Dept. of Pharmaceutical Management

NIPER Hyderabad

1
NATIONAL INSTITUTE OF PHARMACEUTICAL EDUCATION AND
RESEARCH
HYDERABAD

Declaration

I hereby declare that dissertation work entitled’’ is based on the original work carried out by
me at Cutting Edge Medical Devices Pvt.Ltd, under the supervision of Dr. B.laxmi and Dr.
Pankaj Parashar .I also confirm that that this work is original and has not been submitted I part
of full, for any other degree of diploma to this or any other university or institution.

Student Name: Sanghmitra Athiya

Date: 23 February 2021

2
 NIPER LETTER HEAD
Certificate

This is to certify that the dissertation work entitled, “Medical devices landscape for Non-
communicable diseases in India”, submitted by Sanghmitra Athiya with Regn.No.
PM/2019/426 in partial fulfillment for the award of Master of Business Administration
(Pharm.) in NIPER Hyderabad. This work is original and has not been submitted in part or
full for any other degree or diploma to this or any other University or Institution.

Dr.B.Laxmi Dr. B.Laxmi Dr. Shrinivas Nanduri

Guide HoD DOPM Dean NIPER H

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4
 Acknowledgement

It gives me an immense pleasure and pride to express my gratitude and respect for my
teacher and guide Dr. B.Laxmi , Dr. Shashibala Singh, Director, National Institute of
Pharmaceutical Education Rsearch and Dr. Pankaj parashar at Cutting Edge Medical
Device Pvt.Ltd., for their evergreen expertise and inspiring guidance throughout the period
of my work .
I am in debited to them for enlightening me on the finer skills during the course of my
summer internships. They are the guide which help me to deliver the task within the time
period effectively. I consider myself one of the fortunate budding pharmaceutical managers
to be the part of NIPER H, which has provided me with the opportunity where I can work
through best of my capacity.
Also I am thankful to my friends at Department of pharmaceutical management which have
provide me with the best of the peer group which I will cherish during rest of my professional
journey ahead, especially Kajal Jain, Harsha kapse , Aashruti Aggarwal, Gunjan Goyal, &
Sharang Gupta, for their inspirational words during course of internship.
Also I am thankful to my parents their love and support helped me during my course of MBA
Pharm, their guidance motivation helped me to establish myself as an upcoming
pharmaceutical manager.

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CONTENTS
S.NO Title Page no.

1 Abstract 7

2 Introduction 8 -11

3 Literature review 12-14

4 Objective of work 15

5 Reports, presented work 16-49

during internship

6 Conclusion 50

7 References 51-54

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Abstract

Non-communicable disease continues to be an important public health problem in India, being

responsible for a major proportion of mortality and morbidity. Demographic changes, changes
in the lifestyle along with increased rates of urbanization are the major reasons responsible for
the tilt towards the non-communicable diseases. In India, there is no regular system for
collecting data on non-communicable diseases (NCDs) which can be said to be of adequate
coverage or quality. Lack of trained health care workers, primary care providers armed with
inadequate knowledge and skills along with ill-defined roles of various health sectors i.e.
public, private, and voluntary sectors in providing care have played key hurdles in combating
the growing burden of non-communicable diseases. Empowerment of the community through
effective health education, use of trained public health personnel along with provision of free
health care and social insurance would prove beneficial in effectively controlling the growing
prevalence of NCDs.

Keywords: Non-communicable diseases, Cardiovascular diseases, Burden, India

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Introduction

Generally, an internship is a task-specific exchange of service for experience between a student

and a business. Within internships, classroom concepts suddenly become real tools of the trade
as you interact and learn in a professional setting. Internship experiences are formal,
formative, and foundational to your career.

Developing your knowledge of workplace collaboration, business etiquette, and strong

communication tactics are among the vital “soft skills” that can only be learned on the job. In
this way, internships in your area of study will build your résumé and teach you instrumental,
career-developing qualities.

Being a student at NIPER Hyderabad in Department of pharmaceutical management I was

given the opportunity don't cross the horizons of theoretical knowledge and participate in the
practical learning at cutting edge medical devices private limited being in management intern
there I was given the responsibility to understand an analyses the medical device segment in
India and also participate in various business events such as virtual health and hygiene Expo
by ficci India and also provided me the traits to work collaboratively and wholeheartedly with
inspired students from different institutes this has provided me with the traits of confidence
building communications and business ethics.

I was supported by head of the Department at Department of pharmaceutical management

doctor B laxmi an all my team mates from Department of pharmaceutical management at
NIPER Hyderabad their constant support and guidance has helped me to work totally and
continuously to complete the task and stay motivated

I have completed my internship within the time frame of June 2020 to July 2020 in these two
months I gain a practical experience and thoughtful thinking where I was assigned to develop
and design the scientific evidence based posters for sales and promotional activities where I
have sharpened my knowledge of creative art in posters and visual aid making ranging from
World’s Environment Day to National Doctor’s Day.

The second half of the internship started from July 2020, where I was assigned with the task
to perform the disease demographic study in different states of Indian subcontinent, the core
area of research based upon the advent of Non-communicable disease such as diabetes,
hypertension, pre-eclampsia, Chronic kidney diseases and how Covid19 the global health
pandemic effected the entire humanity especially among patients who are suffering from NCDs

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States such as Madhya Pradesh, Karnataka, Goa, Uttar Pradesh, Maharashtra was covered and
studied the initiative taken by states Government to provide better health care incentives in
terms of effective well filtered insights and financial support.

Firstly, in this report diseases demography of Goa, followed by Gujarat, Karnataka, Madhya
Pradesh, Uttar Pradesh respectively is mentioned followed by Results and conclusions
separately.

Industrialization, socio-economic development, urbanization, changing age structure,

changing lifestyles has placed India at a position where it is facing a growing burden of non-
communicable diseases. In India, non-communicable diseases (NCDs) accounted for 40% of
all hospital stays and 35% of all outpatient visits in 2004 (1). Also, chronic diseases are
estimated to account for 53% of all deaths and 44% of disability-adjusted life-years (DALYs)
lost in 2005(2). As of 2005, India experienced the “highest loss in potentially productive years
of life” worldwide (3).

The four leading chronic diseases in India, as measured by their prevalence, are in descending
order: cardiovascular diseases (CVDs), diabetes mellitus, chronic obstructive pulmonary
disease (COPD) and cancer. All four of these diseases are projected to continue to increase in
prevalence in the near future (4). The projected cumulative loss of national income for India
due to non-communicable disease mortality for 2006–2015 is expected to be USD237 billion.
By 2030, this productivity loss is expected to double to 17.9 million years lost (5). In India,
there is no regular system for collecting data on non-communicable diseases (NCDs)-which
can be said to be of adequate coverage or quality. Thus, most of these estimates at best may be
taken as approximation only.

Non-communicable diseases (NCDs) mainly include:

 Cardiovascular diseases

 Stroke

 Diabetes Mellitus

 Cancer

 Chronic Lung diseases

 Accidents and Injurie

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Cardiovascular diseases

Ischemic heart disease (IHD) is the leading cause of death in economically developed countries
and is rapidly assuming serious dimensions in developing countries. It is expected to be the
single most important cause of death in India by the year 2015 A.D (6). According to the WHO,
an estimated 17 million people died from cardiovascular disease (CVD) in 2005 comprising
30% of all global deaths and of these nearly 80% of deaths took place in low and middle income
countries like India (7). According to the World Heart Federation, 35% of all CVD deaths in
India occur in those aged 35–64 years (8). Coronary heart disease (CHD) is the commonest
CVD accounting for 90–95% of all cases and deaths. Further, as can be seen from, there has
been a considerable increase in the number of cases of IHD as well as the deaths due to it.
Also, the observed increase is both in urban as well as rural areas.

Diabetes Mellitus

India is currently experiencing an epidemic of Type 2 diabetes mellitus (T2DM) and has the
largest number of diabetic patients. It is often referred to as the diabetes capital of the world
(11). International Diabetes Federation (IDF) 2009 report reveals that the total number of
diabetic subjects in India is 50.8 million (12).

In a study conducted as a part of the National non-communicable diseases (NCD) risk factor
surveillance, in different geographical locations (North, South, East, West/Central) in India,
where major risk factors were studied using modified WHO STEPS approach and diabetes was
diagnosed based on self-reported diabetes diagnosed by a physician, found that the overall
prevalence of self-reported diabetes was highest in Trivandrum in Kerala (9.2%), followed by
Chennai in Tamilnadu (6.4%) and Delhi (6.0%). This was followed by Ballabgarh in North
India (2.7%), Dibrugarh in East India (2.4%) and the lowest was observed in Nagpur in
West/Central India (1.5%) (13).

Selected Risk Factors for NCDs

The major risk factors for non-communicable diseases are smoking, alcohol abuse, a sedentary
lifestyle, and an unhealthy diet. If these could be addressed adequately, 40–50% of non-
communicable disease-related, premature deaths are preventable (4).

Tobacco use, Alcoholic beverages, Obesity and physical inactivity, Lifestyle changes and
choices.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481705/

10
The availability, accessibility, and effectiveness of medical devices are vital in achieving the
highest quality of care within health systems.

Medical devices, defined as “articles, instruments, apparatus, or machines that are used in the
prevention, diagnosis, or treatment of illness or disease, or for detecting, measuring, restoring,
correcting, or modifying the structure or function of the body for some health purpose”, are a
major part of health technologies (which also include vaccines and medicines), and an essential
building block in any functioning health system.

The World Health Organization (WHO) indicates that there are over 10,000 types and brands
of medical devices globally, ranging from basic stethoscopes to complex diagnostic imaging
machines; it estimated that the global medical devices market was over $350 billion in 2011
However, historically, the overwhelming majority (~ 90%) of health technology sales have
occurred within high- and middle-income countries.

Almost 80% of medical devices in LICs are acquired by donation. In addition to donations,
medical devices are also acquired through technology transfer: local production of devices that
resemble technology designed for use in high-income countries (HICs) or the low-cost sale of
older models of devices originally designed for use in HICs.

However, use of medical devices in LICs that were originally designed for use in HIC are not
entirely successful; one study noted that 40% of medical devices were dysfunctional in LICs
versus less than 1% in HICs. In LICs, constraints including unreliable energy supply and water,
limited distribution and infrastructure, inadequate or untrained workforces, lack of spare parts,
required consumables, and high costs affect the availability and acceptability of many devices

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Literature review

World Health Organization (WHO) estimates that more than a third of 40 million
deaths occurring due to Non-Communicable Diseases (NCDs) globally, are premature
deaths. Over 80% of them occur in low- and middle-income countries (LMIC) [1] With
around 5.87 million deaths annually, India shares more than two-third of the mortality
due to NCDs in the South-East Asia RegionFootnote1 [2].

The probability of an Indian, in the age group of 30–70 years, dying at present from
one of the four NCDs i.e. cardiovascular diseases (CVD), diabetes, cancer, and chronic
respiratory disease is 26% [3]Burden of NCDs in India is expected to worsen in the
future; diabetics will increase from 40.9 million to 69.9 million by 2025 and obesity
will affect 52.1 million by 2030 [4, 5].

CVD will be the leading cause of death contributing to 29% of all deaths by 2030.
Clearly, there is a sense of urgency to address a two-fold challenge i.e. to manage the
large cohort of NCD cases effectively and to prevent new additions into this cohort.
The sustainable development goal (SDG) 3.4 aims to reduce the premature mortality
due to NCDs by a third [6] and absence of timely and effective intervention at this
juncture may leave the hope of achieving the SDG unrealized.

Karnataka, one of the largest states in southern India. As per recent estimates, four
major NCDs constitutes around 25% of all disease burden among 15–39 aged
population in the state; this burden reaches more than 70% among people aged more
than 40 years [7]. A study done in coastal Karnataka in 2006–07 showed the prevalence
of hypertension among people over 30 years at 43.3% and out of them, only half knew
that they had hypertension, and 20.2% were newly detected during the study. The
prevalence of type 2 diabetes ranges from 3.77 to 16% [8, 9].

The Ministry of Health and Family Welfare of Government of India launched the
National Program in 2008 with the objectives to prevent and control common NCDs
through behavior and life style modification, early diagnosis and management of
common NCDs such as hypertension and diabetes, building capacity at various levels
of health care. To strengthen implementation, a national NCD cell was constituted to
develop standard operating procedures, training modules, operational guidelines,
quality benchmarks, monitoring tools and reporting formats [10]. National Health
Mission (NHM) provides an overarching umbrella, subsuming the existing NCD
control programs in both urban and rural areas. The efforts have not been effective on
the ground due to implementation level challenges. Health systems constraints in
relation to human resources, poor training quality, and poor awareness within
community have been highlighted [11]. Experts are also critical about the lack of
strategic focus on specific disease conditions within the larger NCD programs [12].

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Medical devices have a limited, yet important role in the effective delivery of health care [3].
The role of medical devices and health technology in the fight against NCDs was emphasized
in the Global Action Plan for the Prevention and Control of NCDs proposed by the WHO and
endorsed by the World Health Assembly in 2013 [23]. However, the evident mismatch between
the number of commercialized medical devices, which are specifically designed for and
accessible in LICs, and the projected burden of diseases due to NCDs in LICs is of concern.
Even though NCDs are projected to represent the greatest burden on health in the near future,
the number of medical devices designed and commercialized to prevent, diagnose, and treat
physical disability, cardiovascular diseases, diabetes mellitus, road traffic accidents, and
cancer combined is considerably smaller than the number designed and commercialized to
prevent, diagnose, and treat infectious diseases, maternal health, and infant health.

There is a critical gap between designing and developing a safe and effective medical device
and implementing and scaling that device within the target setting [7]. The total number of
concept solutions, early stage prototypes, and low-scale medical devices aimed at addressing
global health challenges greatly exceeds the number of medical devices included in this study.
Among the hundreds of medical devices designed to be low cost and contextually appropriate
that were not included, many likely failed to reach scale because they did not effectively
address an unmet need, lacked established pathways to facilitate the transition from technical
designers to organizations or individuals skilled in implementation and commercialization of
technology, lacked adequate funding, encountered challenges navigating regulatory pathways
or securing appropriate intellectual property, or insufficiently managed the supply chain (e.g.,
procurement, distribution, maintenance) [7, 24, 25]. Overcoming the complexities associated with
implementing and scaling a medical device may require modeling and simulation of scale-up,
creation of effective delivery mechanisms, pursuit of novel financing, and implementation of
evidence-based operational practices [7, 26].

The lack of medical device maintenance, a significant challenge to health systems in LICs,
negatively impacts patient care and public health [27]. Factors affecting the maintainability of
medical devices include shortages of trained biomedical technicians, limited access to spare
parts and consumables, and infrastructural constraints such as consistent power availability [27].
From a design perspective, inclusion of only essential functions, reduction of the number of
custom components, and incorporation of maintenance and troubleshooting aids can improve
the maintainability of medical devices [7]. From a health care system perspective, the practice
of preventative maintenance can extend the useful lifetime of medical devices [27], and local
production can increase the likelihood of locally available product support and the availability
of medical device consumables [7].

Successful design for LICs also depends on understanding the broader issues associated
with implementation in the early stages of the development process rather than after
the validation and production stages [28, 29]. For example, considerations regarding

13
medical device commercialization and adoption are likely to be different in LICs [25].
Therefore, novel medical device design frameworks that consider downstream
variables (e.g., manufacturing plans, regulatory pathways, etc.) as well as the broader
context during the front-end phases of design (e.g., development of
product requirements and technical specifications) are needed [28]. Design approaches
that consider local and regional constraints, cultural contexts, and stakeholder needs,
and enhance the capacity of the local health care workforce are particularly effective
[6, 8].

The limited availability of highly trained health providers presents an extraordinary

challenge in providing universal quality care. For instance, while Africa bears more
than 24% of the global burden of disease, it only has access to 2% of the global
physician supply [30]. Therefore, non-physician health care providers such as
community health workers have the potential to extend access to essential health
services, particularly in rural settings within LICs [31]. Task-shifting promotes the
efficient use of available human resources by transferring appropriate tasks typically
performed by “highly qualified health workers to health workers with shorter training
and fewer qualifications” [32]. To date, limited medical devices have been designed
specifically for task-shifting applications; such devices can play a critical role in
improving access to universal care and tackling the threat of NCDs, particularly in rural
LICs. Devices that are easy to use, have limited components, no need for spare parts,
minimal to no maintenance or need for calibration, and use reliable and readily
available energy sources may increase their suitability for community health workers
performing task-shifting duties [28].

The magnitude of the NCD epidemic illustrates the need for targeted medical device
development, considering the context and end-user environment of use. The mismatch
between the number of commercially available medical devices and the projected
global burden of disease, as well as the limited number of available devices designed
for use by community health workers to support task-shifting will require policymakers
and the global health community to provide intellectual, financial, and regulatory
support in order to develop the necessary technology in a timely manner. Although it
is not possible to separate the effects of global health technologies, in this case, medical
devices for LICs, from the effects of social, political, economic, and healthcare
measures on mortality in LICs [7], availability and accessibility of medical devices are
important and if part of a comprehensive solution, can positively impact global
mortality and morbidity trends

14
OBJECTIVE OF WORK

1. Perform disease demography research based on NCD across Indian subcontinent

2. To proactively promote the business events using digital marketing
3. To create, design the scientific evidence based posters
4. Performed the competitive analysis on medical devices in India.

In the course of two months of internship add cutting edge medical devices private limited I
was given the task to perform the disease demographic study on non-communicable diseases
which include Diabetes, hypertension, pre-eclampsia and chronic kidney diseases
I was assigned with the task to study and analyze the disease demography within Indian
population in different states of Indian sub-continent and report the findings in well-structured
reports.

Digital marketing being an important tool in the in post pandemic be being a management
intern at CEMD.PVT.LTD I have used my creative and inside full articulation for creating
various posters for the promotional purposes backed up with scientific based articulation.

The 3rd objective was to perform the competitive analysis on the medical devices in India
which work on non-communicable disease here I got the chance to apply the theoretical
knowledge in the practical real business scenario.

The 4th objective was to work in coordination with the team and participate in virtual health
and hygiene expo by FICCI India and submit the report for better decision making.

15
GOA STATE REPORT
Though one of India’s smallest states, Goa is the richest in terms of GDP. With a
progressive outlook on citizen welfare, it’s committed to universal health coverage,
especially in chronic care. The government’s belief is that making the right healthcare
investments early on is in the best interests of not only the citizen-patient but also the
economy and future of the state.

Status of Microalbuminuria in Goa

Diabetes Mellitus and Chronic Kidney Disease (CKD) is a dreadful combination. India
has the world’s largest population suffering from Diabetes Mellitus and is particularly
frequent in rural populations of India. According to the Diabetes Atlas, it is predicted
to rise to almost 70 million by the year 2025 which also makes India vulnerable to
complications like diabetic nephropathy leading to end stage renal disease.
Microalbuminuria is diagnosed at urinary albumin creatinine ratio (UACR)
between 30 and 300 mg/mg (National Kidney Foundation, 2007)
Microalbuminuria is present when there is not yet evidence of abnormal glomerular
filtration. Thus, in diabetes mellitus, microalbuminuria is an early marker of the
subsequent development of diabetic nephropathy.
Diabetic kidney disease burdens dialysis centers while CKD is also an independent risk
factor for cardiovascular disease (CVD). Microalbuminuria confers 50% risk to CVD
while microalbuminuria raises the risk of CVD by 350% and for these reasons the
International Society of Nephrology has considered CKD, a public health problem.
Studies have shown the prevalence of Diabetes in Urban India is about 14.3%.7 while
it is 13.5% in rural areas of India.8 Seven percent of Diabetics have microalbuminuria
at the time of diagnosis.9 Tertiary kidney care is not easily accessible to rural patients.
Early diagnosis is critical to ensure quality of life. Hence the present study on
nephropathy and its correlates was conducted among Type II diabetes mellitus patients
at a rural health center in Goa, India.

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This study was an Outpatient department based case series study conducted over a period of
four months from January to April 2013 at the rural health center attached to Goa Medical
College, Goa, India. All patients of Type II diabetes mellitus 18 years and above availing
treatment from the rural health center were included in the study. The total number of patients
included in the study was 241.

Total, 17.40% Male, 18.30%

Female, 16.90%
Gender based Microalbuminuria Study

Diabetic Nephropathy due to Alcohol

consumption
17.40%

47.05%
12.56%

Alcohol Hazardous drinkers Non- Hazardous Drinkers Total

Microalbuminuria due to Tobacco

17.40%
7.20%
68.90%
40%

Current user Former User Non User total

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 Diabetes in Goa

Diabetes is a chronic disease that occurs either when the pancreas does not produce
enough insulin or when the body cannot effectively use the insulin it produces. Insulin
is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a
common effect of uncontrolled diabetes and over time leads to serious damage to many
of the body's systems, especially the nerves and blood vessels.
Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from
the body’s ineffective use of insulin. The majority of people with diabetes have type 2
diabetes. This type of diabetes is largely the result of excess body weight and physical
inactivity.

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset)

is characterized by deficient insulin production and requires daily administration of
insulin. Neither the cause of Type 1 diabetes nor the means to prevent it are known.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia),

constant hunger, weight loss, vision changes, and fatigue. These symptoms may
occur suddenly.

Gestational diabetes is hyperglycemia with blood glucose values above normal but
below those diagnostic of diabetes. Gestational diabetes occurs during pregnancy.

Women with gestational diabetes are at an increased risk of complications during

pregnancy. These women and possibly their children are also at increased risk of
diabetes in the future.

Health impact
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

 Adults with diabetes have a two- to three-fold increased risk of heart attacks and
strokes
 Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases
the chance of foot ulcers, infection and eventual need for limb amputation

18
 Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term
accumulated damage to the small blood vessels in the retina. Diabetes is the cause of 2.6%
of global blindness. Diabetes is among the leading causes of kidney failure.

Diabetics No%

coronary heart disease

peripheral vascular disease
32.30%, 22%
60%, 41% cerebro vascular accident
11.50%, 8%
retinopathy
cataract
15.40%, 10%
neuropathy
20%, 14%
total subjects

6.90%, 5%

19
 120

100
100

80 75.5
66.6

60 56.8

40 33.3
25
18.2
20
10.1
7.5 6.2 5.6
4.9 5.2
1.3 2.3
0
<5 5 TO 10 YRS >10 YRS TOTAL

CHD NEUROPATHY%
CATARACT% RETINOPATHY%

The present study showed a significant association between prevalence of

complications and DM. The common complications among the diabetics were
neuropathy (60%), CHD (32.3%) and cataract (20%) while the other significant
complications included retinopathy (15.4%), PVD (11.5%) and CVA (6.9%).

In a South India, a similar high prevalence of CHD (30.3%) among the diabetic’s
retinopathy prevalence of 34.1% among diabetics, in South India.

A rising trend in the prevalence of associated diabetic complications with advancing

years of DM was found in our study.

Persons having diabetes for more than ten years were comparatively less in number in
the study population which could be either due to ‘survivor’ bias or reflection of a lower
prevalence of DM a decade earlier.

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Way forward for state of goa (Diabetes)

The prevalence of Diabetes and its associated complications was higher among the diabetic
individuals in the rural setting of Goa, India. All the diabetic complications observed need to
be addressed in prevention and control strategies in the study area. Also, community awareness
programmers need to be implemented to percolate the knowledge about the diabetic
complications, the available screening facilities for their early detection, treatment and care in
the rural population.

Government scheme for diabetes prevention in Goa:

 As a major relief to persons suffering from high diabetes, the government plans to
provide them with insulin at every health centre (2018)

 The government aims to provide better medical facilities to citizens at the grassroots
level in their vicinity so that they can avail of medical treatment immediately in times
of emergencies like cardiac diseases.

 The Goa government has decided to supply insulin free of cos to chronic disease.

 Goa is the only state in the country to take this initiative of starting a diabetes education
programmer. (2009)

 Health Minister Vishwajit Rane has disclosed that GMC will be conducting its third
kidney transplantation within one and a half month of time. Vishwajit said that under
Ayushman Bharat scheme government will start diabetic care throughout Goa. 2018

21
HYPERTENSION IN GOA

Hypertension is another name for high blood pressure. It can lead to severe health

complications and increase the risk of heart disease, stroke, and sometimes death.

Blood pressure is the force that a person’s blood exerts against the walls of their blood

vessels. This pressure depends on the resistance of the blood vessels and how hard the

heart has to work. Hypertension is a primary risk factor for cardiovascular disease,

including stroke, heart attack, heart failure, and aneurysm. Keeping blood pressure

under control is vital for preserving health and reducing the risk of these dangerous

conditions.

Signs and symptoms of hypertension:

Hypertension is defined as systolic blood pressure (SBP) of 140 mm Hg or more, or a
diastolic blood pressure (DBP) of 90 mm Hg or more, or taking antihypertensive
medication.

Based on recommendations of the JNC 7, the classification of BP (expressed in

mm Hg) for adults aged 18 years or older is as follows:

 Normal: systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg

 Prehypertension: systolic 120-139 mm Hg, diastolic 80-89 mm Hg

 Stage 1: systolic 140-159 mm Hg, diastolic 90-99 mm Hg

 Stage 2: systemic 160 mm Hg or greater, diastolic 100 mm Hg or greater.

22
Nearly 31 % of the IT workforce in Goa suffers from hypertension whereas more than 40 per
cent are either overweight or obese, a cross-sectional study of IT professionals working in
the coastal state has revealed.
The significant prevalence of lifestyle diseases is noticed among the participants in the study.
Lifestyle diseases like hypertension, diabetes, dyslipidemia and overweight/obesity are
major risk factors for the development of the cardiovascular disease," as per the study
published in the Epidemiology International journal.
The study data were collected from health records of 118 IT professionals working in four
top Information Technology firms in Goa, whose government is pitching the coastal state as
a destination for IT start-ups.

Data on Hypertension cases in

Goa
Normal BMI,
Underweight,
53.40%,
5.90%,
Overwe…
Class 1
Obesity,
5.10%,
Class 2
obesity,
1.70%,
Blood Sugar, Hypertension
58% , 31.40%

Pre
Hypertension
, 42.45%
Diabetes,
11.20% Normal BMI

Underweig
ht
Overweight

23
A majority of the 118 surveyed employees -- 63 (53.4 per cent) -- had normal range
body mass index, seven (5.9 per cent) were underweight, 40 (33.9 per cent) overweight,
six (5.1 percent) class 1 obesity and two (1.7 percent) class 2 obesity.
Thirty-seven (31.4 per cent) had hypertension, 50 (42.4 per cent) suffered from pre-
hypertension... 13 (11.2 per cent) had diabetes mellitus and three (2.5 per cent) blood
sugar in pre-diabetic range, “.
S.NO Area of study Data
1 Sample size 118
2 Normal BMI 53.4%
3 Underweight 5.9%
4 Overweight 33.9%
5 Class 1 obesity 5.1%
6 Class 2 obesity 1.7%
7 Hypertension 31.4%
8 Pre-hypertension 42.4%
9 Diabetes 11.2%
10 Blood sugar 2.5%

24
GUJARAT

POINTS TO REMEMBER:

To sum up, the present study provides an updated quantification of the growing public health
burden of diabetes in Jamnagar region. Faulty dietary and lifestyle habits may be held
responsible for increasing diabetes prevalence. As diabetes is primarily a lifestyle disorder,
thus, only by improving the daily routine and adopting suitable dietary habits, one can maintain
the metabolism to normal and curb the pathology of diabetes to a good extent. Extremely
important areas of research could be identifying the risk factors involved in diabetes in people
of different geographical regions. Type 2 diabetes is an endemic health problem; therefore,
socioeconomic, behavioral and nutritional issues relating to it should be highlighted and
addressed. It is suggested that life-style approach in accordance with the geographical habitat,
diet, physical activity and the rest should be defined as adaptation.
HYPERTENSION:
High blood pressure (BP) is ranked as the third most important risk factor for attributable
burden of disease in south Asia (2010)

AGE BASED STUDY

Age In Years Hypertension Hypertension Total
yes no
20-39 155 155 590
40-59 420 420 890
60 or above 215 305 520
Total 1120 880 2000

Gender Based:
Gender Hypertension Total
Male 491 1010
Female 389 990
Total 880 2000

25
Correlation between BMI and Hypertension
BMI Hypertension Hypertension Total
no Yes

Normal 760 405 1165

Overweight 85 160 245
Obese 275 315 590
Total 1120 880 2000

STUDY IN GUJARAT
A relation is said to exist between hypertension and Body Mass Index. However very
few studies have been carried out to establish association, if any, between body mass
index and hypertension in different Asian population.
The association of hypertension with BMI in adults from urban population of Gujarat,
India and decided BMI cutoffs to predict hypertension in this population.
A study involved 2000 adults from both genders of the different age groups of 20-70
years from the urban population of Gujarat. Blood pressure and indices for BMI were
measured and determined an optimal BMI cutoff.

The prevalence of hypertension in men from Gujarat Urban population was 48.51%
and in women was 39.39%.
The overall analyses suggested optimal BMI average of 25.6 from adults of Gujarat
urban population. The average was found high and it was 0.43 units higher in
women/men than in men/women and the average was also found high in the
older/younger (20-40 y) than in the younger/older (41-70 y) participants. It has been
observed that there is an ethnic difference in the association between BMI and
hypertension and in optimal BMI cut off for the population of urban Gujarat.

26
KIDNEY DISEASE IN GUJARAT

Parameter Total Males Females

Evaluated
Sample 2350 1438 912
Urine albumin 13.79& 208( 14.46) 116(12.72%)
>1+
Stone burden 404(17.19%) 277(19.26%) 127(13.92%)

Hemoglobin 638(27.15%) 207(14.4%) 431(47.26%)

Serum 1.02+(-)0.42 1.11-0.45 0.87-0.3
creatinine
Mg/dL
Age (years) 48 49 46

PREGNANCY INDUCED HYPERTENSION IN GUJRAT

Table 1: Basic demographic data.:

Variables
Age groups <20 11 11.57
21-25 46 48.42
26-30 14 14.73
>30 24 25.26
Parity Prime 41 43.15
Second 27 28.42
Multi 27 28.42

Gestational age <28 10 10.6

(weeks) 28-36 28 29.4
>36 57 60.0

27
Table 2
Distribution of patients according to their presenting clinical features
Clinical features No. of cases Percentage
Presentations (n=95)
Labor pains 46 48.4
No complains 10 10.5
Edema feet 9 9.5
Convulsions 11 11.6

Headache 6 6.3
Bleeding per vagina 6 6.3
Visual complaints 3 3.2
Loss of fetal 3 3.2
movements 1 1.1
Vomiting

KARNATAKA STATE REPORT

Hypertension is a major public health problem in India and its prevalence is rapidly
increasing among both urban and rural populations.3 It is estimated that the prevalence
of hypertension ranges from 20-40% in urban adults and 12-17% among rural adults
(1,2). The number of people with hypertension is projected to increase from 118 million
in 2000 to 214 million in 2025, with nearly equal numbers of men and women5
Hypertension is increasing rapidly in most low and middle income countries. The actual
burden of Hypertension in urban and rural India is often under estimated. There is a felt
need to define actual burden of the disease and to determine the geographic differences
in the prevalence of hypertension and the risk factors associated.
The present study was an across-sectional study conducted in Mysore district. Study
included a total of 793 subjects. Individuals greater than 30 years of age were included.
Data regarding basic demographic characteristics were collected along with
anthropometric measurements including height and weight.

28
Objectives:
The objectives of the study were to estimate and compare the prevalence of hypertension
among urban and Rural population; and to assess the factors associated with Hypertension
among the study population.
Mysore district lies in the Southern Plateau and it is in the southernmost part of Karnataka State. It
covers an area of 6854 sq. km. that is, 3.57 per cent of the state’s total geographical area. Study are
This study was conducted at Mysore city (urban) with all 65 wards being the sampling frame and
Villages coming under Primary health centers of Suttur and Hadinaru (Rural).

Urban (%) N=389 Rural (%) N=405

Characteristics

Age Group (Years)

31-40 114 (29.3) 125 (30.9

41-50 142 (36.5) 146 (36.0)

51-60 100 (25.7) 67 (16.5)

61-70 33 (8.5) 63 (15.6)

>70 0 4 (1)

GENDER

Male 202 (51.9) 185 (45.7)

Female 187 (48.1) 187 (48.1)

Level of education

Not literate 21 (5.4) 96 (23.8)

Primary schooling 62 (15.9) 87 (21.5)

Secondary schooling 100(25.7) 106 (26.2)

PUC/Diploma 120 120 (30.8) 100 (24.8)

(30.8)
86 (22.1) 15 (3.7)
Graduate

29
 Socio economic status

Class I 1 (0.3) 0

Class II 50 (12.9 1 (0.2)

Class III 124 (31.9) 69 (17.1)

Class IV 124 (31.9) 180 (44.6)

Class V 90 (23.1) 154 (38.1)

CATEGORY
URBAN RURAL

Hypertensive 122 (31.4) 101 (25)

303 (75)
Non-hypertensive 267 (68.6)

389 (100) 404 (100)

Total

Result The prevalence of hypertension in urban area (31.4%) was higher than rural area (25%).
The association of the prevalence of hypertension between urban and rural area was significant.
Though prevalence of hypertension in rural area is low when compared to urban, it can be
observed that it is increasing over time to match the urban rate. Present study emphasizes the
fact that various risk factors are associated with the prevalence of hypertension and there is a
significant association of these risk factors among hypertensive in urban and rural area.

30
 CHRONIC KIDNEY DISEASE IN KARNATAKA

Chronic kidney disease (CKD) is rapidly assuming epidemic proportions globally.[1,2,3] In

India too, there is a significant burden of CKD although exact figures vary.[4] This has been
attributed to the increasing prevalence of diabetes, hypertension and ischemic heart disease.
The awareness level among the people is poor. At least 70% of the people live in rural areas
with limited access to health care services with the result that CKD is often diagnosed in
advanced stages. Cost of treatment of advanced CKD is substantial. Less than 10% of end stage
renal disease patients have access to any kind of renal replacement therapy.[5,6] In a country
with limited resources, it is only appropriate that efforts are directed toward prevention of CKD
rather than the treatment. Studies on the prevalence of diseases help in focusing attention to the
magnitude of the burden and planning preventive measures. High-risk characteristics that are
associated with such prevalence can be modified.
Prevalence of chronic kidney disease (CKD) appears to be increasing in India. A few studies have
studied the prevalence of CKD in urban populations, but there is a paucity of such studies in the rural
populations. This project was undertaken to study the prevalence of CKD among adults in a rural
population near Shimoga, Karnataka and to study the risk factor profile. Door-to-door screening
of 2091 people aged 18 and above was carried out. Demographic and anthropometric data were
obtained, urine was analyzed for protein by dipstick and serum creatinine was measured in all
participants.

Stratification of the population according to the GFR (n=2091)

Characteristics of the CKD versus non-CKD group

31
Relative distribution of protein uric and non-protein uric chronic kidney disease.

Results CKD in Karnataka

Prevalence of CKD taking both decreased GFR and proteinuria into consideration was
found to be 6.3% by MDRD criteria and 16.69% by CG-BSA. There was a statistically
significant relationship of CKD with gender, advancing age, abdominal obesity,
presence of diabetes, hypertension and smoking by univariate analysis. On regression
analysis, age, gender, diabetes and hypertension were found to be predictive for CKD.
Thus, this study attempts to highlight that one in every twenty individuals is suffering
from CKD. There is a strikingly increasing prevalence of life-style diseases such as
hypertension and obesity in the villages and there is a tendency for the younger people

32
 to be affected with these diseases. There is a dismally low awareness of CKD as well
as hypertension.

DIABETES IN KARNATAKA

Karnataka is one of the top three states in having the highest prevalence of prediabetes
Individuals. On other common risk factors for non-communicable diseases–be it abdominal
obesity, hypertension or dyslipidemia (lipid anomaly) – Karnataka and Punjab are among the
top three states with the maximum prevalence. With 7.5% prevalence of diabetes, the southern
state stands at the sixth position. But it is among the top three when it comes to prediabetes
and risk factors for non-communicable diseases. Karnataka may be lower than Tamil Nadu
(10.4%) in diabetes prevalence because people in north Karnataka consume coarse cereals a
lot unlike Tamil Nadu where rice is the staple diet. But the huge number of pre-diabetic
population is a big risk as little change in lifestyle can make them diabetic,” said V Mohan of
Madras Diabetes Research Foundation.
TABLE: DIABETES ATLAS OF INDIA.

As per International Diabetic federation there were 5.1 crore in 2010 expected to increase to 8 crores
by 2030. It is estimated that the overall prevalence of diabetes is 62.47 per 1000 population of India.

33
PREECLAMPSIA in KARNATAKA
Pre-eclampsia is one of the leading causes of maternal and infant morbidity and mortality
worldwide. The aetiopathogenesis of this condition involves combination of genetic
predisposition and environmental factors. The aim of the study was to determine the socio
demographic and other risk factors of pre-eclampsia.
Pre-eclampsia is a multi-system disorder of unknown etiology characterized by development
of hypertension to the extent of 140/90 mmHg or more with proteinuria after 20 th week of
gestation in a previously normotensive and non-protein uric pregnant woman. Pre-eclampsia
has been associated with intrauterine growth retardation, preterm birth, maternal and perinatal
death [1]. The incidence of pre-eclampsia is 2- 10%, depending on the population studied and
definition of pre-eclampsia [2]. It occurs in 4-7% of pregnant women worldwide [3].
A case control study was conducted at a tertiary care hospital, Karnataka among 100 cases of
pre-eclampsia and 200 controls without pre-eclampsia. Non probability purposive sampling
technique was adopted to select the study subjects. Data was collected by using a pre tested
semi structured questionnaire which included information related to socio-demographic and
other known risk factors of pre-eclampsia. Primary data was collected by interviewing study
subjects and secondary data of cases was obtained from case records. Data was analyzed using
SPSS.

34
Socio-Demographic characters of Pre-eclampsia cases and controls

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225915/

35
Obstetric characters of Pre-eclampsia cases and controls in KN

36
MADHYAPRADESH

Objectives:
To study the difference in the prevalence of hypertension and associated risk factors in urban
and rural populations and the association of hypertension with various determinants.
The response rate was 97%. Overall prevalence of hypertension was 17%, with 21.4% in the
urban population and 14.8% in the rural population

HYPERTENSION

TOTAL, 17%
URBAN, 21.40%

RURAL, 14.80%

URBAN RURAL TOTAL

37
COMPARISION URBAN V/S RURAL: HYPERTENSION

URBAN RURAL
Characteristics

Hypertension diagnosed by health

professional 3.9 0.8
Male 7.3 1.6
Female 5.5 1.2
total

Diagnosed hypertensive
Currently taking drugs 62.4 55.8
Male 61.4 54.0
Female 61.7 60.1
Total

Advised Dietary modifications 71.5 68.3

Male 63.3 68.8
Female 66.4 68.7
Total

Advised to lose weight 45.5 31.4

Male 42.1 21.1
Female 43.4 24.7
Total

Advised to quit smoking 42.2 51.8

Male 8.0 9.4
Female 20.8 24.3
Total

Advised to increase physical 64.0 59.9

activity 52.7 31.1
Male 56.9 41.2
Female
Total

38
Increasing age, parental history of hypertension, tobacco smoking, tobacco chewing, physical
inactivity, high estimated per capita salt consumption, and BMI ≥27.5 kg/m 2 as independent
predictors for hypertension in the urban population,
In rural population, increasing age, physical inactivity, central obesity, tobacco chewing and
tobacco smoking were independent predictors for hypertension.
Among the urban respondents, the diagnosis of hypertension by health professional ranged
between 6% in Madhya Pradesh, Among the rural respondents, the diagnosis of hypertension
by health professional ranged between 1% in Madhya Pradesh.
The blood pressure is an important determinant of the risk of cardiovascular diseases, ischemic
heart disease, congestive cardiac failure and renal failure. Of those diagnosed for hypertension,
majority of them were taking prescribed medicine.

Percentage of respondents according to category of hypertension by age and place

of residence (Urban) in Madhya Pradesh.

Age Normal Prehypertension Phase 1 Phase2

Yrs. Hypertension Hypertension

15- 39.5 50.7 8.3 1.50

19

20- 34.3 48.0 15.7 1.9

24

25-- 34.4 46.8 15.1 3.8

34

45- 26.7 46.1 20.5 6.7

44

45- 16.3 41.8 30.6 11.3

54

55- 14.1 33.1 31.7 21.1

64

15- 30.2 46.0 18.1 5.7

64

39
DIABETES STATUS IN MP
Diabetes mellitus is an important marker of risk for the arterial disease of the coronary,
cerebral and peripheral arterial trees, and for micro vascular disease leading to
blindness and renal failure.
Percentage of respondents with history of raised blood sugar, treatment and life style
modification advised, seeking consultation and treatment in Madhya Pradesh:

Characteristics Madhya Pradesh Data

Raised blood sugar diagnosed

Male 2.7
Female 1.7
Total 2.2

Diagnosed diabetics
Currently taking insulin
Male 14.7
Female 20.0
Total 17.3

Currently taking oral drugs

Male 84.6
Female 68.9
Total 76.9

Advised dietary modification

Male 94.0
Female 88.6
Total 91.4

Advised to lose weight

Male 41.2
Female 55.9
Total 48.4

40
KIDNEY DISEASE STATUS IN MP

Diabetic nephropathy (DN) is the most common cause of microvascular chronic complication
of Type 2 diabetes mellitus (T2DM) which is associated with considerable morbidity and
mortality, finally leading to end-stage renal disease. According to the World Health
Organization, the prevalence of diabetes for all age-groups worldwide was estimated to be
2.8% in 2000 and 4.4% in 2030. To prevent this increase, screening for DN and early
intervention are necessary.
Chronic kidney disease (CKD) results in profound dysregulation of several key enzymes and
metabolic pathways that eventually contributes to disordered high-density lipoprotein (HDL)
cholesterol and triglyceride-rich lipoproteins. Higher total cholesterol, higher non-HDL-
cholesterol, and lower HDL-cholesterol were significantly associated with an increased risk of
developing renal dysfunction in healthy men.

Cystatin C, a cysteine protease inhibitor, is freely filtered by the renal glomeruli, metabolized
by the proximal tubule and identified as a promising marker of renal failure. Cystatin C is
produced at a constant rate by nucleated cells and released into the bloodstream with a half-
life of 2 h. Its concentration is almost totally dependent on glomerular filtration rate (GFR).
Other studies have demonstrated that serum cystatin C is an early renal marker in diabetic
patients, but not all studies have done so.

I STUDY
The study was conducted in the Department of Biochemistry at SAIMS Medical College
and Hospital, Indore, Madhya Pradesh.
The study was approved by the Ethical Committee of the Institute. Informed consent was
obtained from all patients. The study population comprised total 150 subjects in which 75
healthy control and 75 patients of T2DM, who were consecutively recruited from medicine
OPD/Nephrology OPD of the hospital between September 2012 and November 2014, in which
61 patients was microalbuminuria and remaining was norm albuminuria.
However, they all are long-term diabetic patients more than 10 years. Healthy controls were
enrolled from age- and sex-matched volunteers from the college and the hospital.

41
II STUDY
The study was conducted in the Department of Biochemistry at SAIMS Medical
College and Hospital, Indore, Madhya Pradesh, India. Approval for this study was
obtained by the ethical committee of the institute. Informed consent was obtained from
all patients. The study population comprised 81 control and 78 CKD patients who were
consecutively recruited from the nephrology clinic of the hospital between September
2014 and May 2015.

The study was conducted in 159 human subjects. The CKD patients diagnosed by
Department of Nephrology in SAIMS hospitals were included in this research work
by their consent. A structured questionnaire regarding the demographic data, such as
age, sex, height, and body weight, was measured while wearing lightweight clothing,
but not shoes. Blood pressure, smoking habit, family history of diabetes, renal disease,
and hypertension were recorded for each patient. CKD patients with advance stage (IV
and V) and from different medical conditions (cardiac disease) were not included.

5 ml of blood sample was withdrawn from the antecubital vein following overnight
fasting. The blood sample was collected in plain, fluoride, and
ethylenediaminetetraacetic acid vacutainers. The blood sample was centrifuged for 15
min. At 3000 rpm at room temperature. The serum was stored at 4°C for biochemical
investigations. Urea, creatinine, uric acid, and lipid profile were estimated by
enzymatic method. All biochemical investigation done by fully automated analyzer
Hitachi
Pregnancy induced hypertension

Background: Pre-eclampsia toxemia is pregnancy-induced hypertension (PIH)

manifesting in second trimester and affecting multiple systems. The objective was to
study the factors of pre-eclampsia in pregnant women admitted for delivery in
Bundelkhand Medical college hospital Sagar, Madhya Pradesh, India.

Methods: A case-control study was conducted at Bundelkhand Medical College

Hospital in Sagar, Madhya Pradesh, India. Criteria in selection of pregnant women with
pre-eclampsia comprised those who had hypertension after the 20th week of gestation
with associated proteinuria, and controls were pregnant women who were not
diagnosed with pre-eclampsia. Total of 100 cases and 100 controls were selected for
the year 2015. Factors in study included mother's age, parity, body mass index, history
of chronic hypertension, history of diabetes, history of renal disease, family history of
hypertension, and history of pre-eclampsia in earlier pregnancy. Crude and adjusted
odds ratio with 95% CI and Chi-square test were used for statistical analysis

42
Major risk factors identified in univariate analysis included

RISK FACTOR Overall Rate Multiple logistic

regression
analysis

Before pregnancy body mass index 11.27 7.56

History of hypertension 8.65 6.69

History of diabetes mellitus 11.0 8.66

History of renal disorders 7.98 5.6

Familial history of hypertension 5.4 5.48

History of PIH in earlier pregnancy 9.63 7.2

Twin Pregnancy 4.85 5.73

BMI>25 PIH HIGH RISK

43
1.HYPERTENSION & PIH STUDY IN UP:

Hypertensive disorders complicating pregnancy seriously endanger the safety of the

mother and fetus during pregnancy. Very few studies have explored hypertensive
disorders of pregnancy in India, even though this disease has been associated with
adverse maternal and perinatal outcomes. This study aimed to analyze the disease
pattern and risk factors associated with the disorder and assess the maternal and fetal
outcomes in cases of hypertensive disorders of pregnancy.

Subjects and methods:

This case-control study was carried out over 1 year from 2011 to 2012 at the
Department of Obstetrics and Gynecology, King George’s Medical University,
Lucknow, Uttar Pradesh, India. A total of 149 patients were enrolled in the study. As
seven were lost to follow-up, analysis was carried out on 142 cases. Patients were
further classified according to the National High Blood Pressure Education Program
Working Group (2000) as having mild preeclampsia (65 cases), severe preeclampsia
(32 cases), or eclampsia (45 cases). Thirty-one healthy pregnant non-hypertensive
women were enrolled into the study as controls.

Abbreviations: CNS, central nervous system; DBP, diastolic blood pressure; SBP,
systolic blood pressure.

44
2.Chronic kidney disease in UP:

Table 1: Profile of participants and prevalence of CKD

45
STUDY ON CHRONIC KIDNEY DISEASE IN UTTARPRADESH:

The study subjects constituted general population of Varanasi who were screened as
part of the World Kidney Day Initiative at Opal Hospital on March 12, 2015. In
total, 198 volunteers aged ≥45 years and who provided informed consent were included
in the analysis. We excluded any subject with signs and symptoms, suggestive of acute
kidney injury (e.g., history of vomiting, diarrhea, and fever) in the recent past.
Information on socio-demographic profile and personal characteristics such as age, sex,
height, weight, smoking and drug history, history of DM and HTN, and family history
of kidney disease was extensively interrogated, while clinical investigations such as
urinalysis and serum creatinine levels were recorded on a pre-structured questionnaire.
Systolic and diastolic blood pressure (BP) was measured only on one occasion, i.e., on
the day of screening.

3.DIABETES IN UTTAR PRADESH:

Diabetes is a major challenge for a resource-limited country like India. Majority of the
patients are diagnosed late in the course of illness with presence of complications.
There is limited data on diabetes from rural India. Present study is an attempt to provide
data on diabetes in rural India. The overall objective of present study was to estimate
the prevalence of Type 2 diabetes mellitus in rural population above 25 years’ age in
district Etawah and neighboring areas of Uttar Pradesh, India.

Age distribution of study population:

AGE NO. OF PARTICIPANTS PERCENTAGE

(In years)
25-39 2032 47.88%
40-49 833 19.63%
50-59 769 18.12%
60-69 458 10.79%
>70 152 4%
Total 4244 100%

46
Gender distribution of diabetes:
Gender No. of diabetes % No.of %
Prediabetes

Total 341 8.03 426 10.04

Male 173 6.79 187 7.34
Female 168 9.91 239 14.09

RESULT & DISCUSSION

In the present study, here recruited 4244 participants out of which 341 (8.03%) were diagnosed
as diabetics with prevalence of diabetes amongst males being 6.79% and females was 9.91%.
Females had a higher prevalence most probably due to poor exposure to health care facilities,
poor education and poor health care seeking behavior as evident by more females being newly
diagnosed i.e. 54% despite only being 39% of the study population. This is similar to finding
of Ahmad et al who also showed that prevalence of diabetes was higher in females.

47
VISUAL AIDS : DIGITAL MARKETING PROMOTIONAL EVENTS

48
49
CONCLUSION:

During the sales promotional activites at CEMD Pvt.Ltd, from the nation wide analysis
by concluding we can estimate that if there is a proper establisment of synergy between
Medical device industries and the government health intervention, we the future
pharmaceutical managers can built a constructive landscape with effective combination
of patient centricity,customer knowledge enhancement through cost effectiveness ;

As we all in general are familiar with the healthcare spending in India is huge and is
not pocket friendly; India being Low Income Country has various shortcomings such
as unregulated medical practices, Underdeveloped medical and healthcare
infrasturcture but here its pivitol to mention the role of COVID 19 in making India self
resilient i.e., Atmanirbhar Bharat initaiative by government has provided a ray of hope,
health insurance scheme such as AYUSHMAN BHARAT provided health insurance
cover to indian household .

During covid 19 the patients suffering from Non communicable disese got effectected
severely, lack of regular ( weekly, monthly) checkups such as regular dialysis for
chronic kidney patients, for cancer patients lack of medical counselling etc., were some
of the major loopholes which remain unnoticed.

So through this report ‘Landscape of medical devices in Non communicable disases ‘

provided a scenario where it became utmost important to provide best in cost amd use,
effective point of care medical devices to the NCDs patients to best of our capacity and
enable them to live the healthy and hustle free life.

50
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3. WHO. Non Communicable Disease, Progress Monitor; Accessed 10th Sept

2018 http://apps.who.int/iris/bitstream/handle/10665/184688/9789241509459_eng.pdf;jse
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