| ObjectiveNCDs defined as non-communicable diseases by WHO are the major health burden in the industrialized countries, and are increasing rapidly in the developing countries owing to demographic transitions and changing lifestyles among the people. In the global Burden of Disease Study, which estimated the distribution of deaths by region, NCDs ranked first as the the cause of death in developed countries, as well as in many developing countries and the world as a whole. The data reported by WHO in 2002 showed that 72% death caused by NCDs totally up to 33.4 million people in the global range happened in the developing counties. NCDs cause or exacerbate many health problems, both independently and in assosiation with other diseases. Research has already shown that NCDs have their roots in unhealthy lifestyles or adverse physical and social environment. Risk factors like unhealthy nutrition over a prolonged period, smoking, physical inactivity, excessive use of alcohol, and psychosocial stress are the major lifestyle issues.In our country, one of the greatest public health challenges in the 21st century is to prevent the epidemic of NCDs. The report of Nutrition and Health Status of the Chinese People survey data in 2002 showed that the prevalence of hypertension and diabetes has been significantly increased among adults. In Chinese adults, the prevalence of hypertension was 18.8%, and the prevalence of biabetes was 2.60%,and the estimated total numbers were 160 million and over 23 million. As our country becomes more affluent and the people's lifestye changes,the prevalence of NCDs is increasing dramatically. Many experiences gained over many years have proved that carefully planned community programmes are an important component of the strategy to help control and prevent the epidemic trend of NCDs. The trial base in Anyang city was set up by Henan Provincial center for diseases control and prevention in 2002. Anyang city has a long history in prevention and control of chronic non-communicable diseases and its Angang community is an experimental unit as a national trial base for the prevention and control of chronic non-communicable diseases in China. The population in Anyun community selected is stable, the complicance of residents is good, a consummate community service system of public health has been working. So we select this community to conduct integrated intervention study to explore the mode for prevention and control of chronic non-communicable diseases in Henan Province.MethodsWith the strategies of health education and health promotion, the community-based integrated intervention has been carried out since 2002. Three epidemiological investigations indoor were implemented in December 2002 (including 732 individuals) , Ocotober 2006 (including 848 individuals) and July 2007 (including 814 individuals) . Before and after intervention, the stratified multiple-stage sampling method was used to select the study participants who were residents aged 15-69 years old of this resident area. Data was collected by questionnaire review(demographic characteristics, medical history,behavior risk factors and knowledge, attitude and practice related to NCDs) and blood pressure measurement. Cross-sectional study was conducted with comparison to evaluate the effect of integrated intervention. t-test,ANOVA,Chi-Square test,correlation analysis,trend test(Cochran-Armitage test),and logistic regression analysis were employed to analyze the data. P value less than 0.05 was considered statistically significant.Results1. Changes of average blood pressure level of target populationThe average SBP level of target population was 126.79 mmHg in 2002, 125.03 mmHg in 2006 and 124.51 mmHg in 2007. It decreased significantly adjusted by age (F=9.44,P<0.0001) . No significant difference was identified in DBP level (F=2. 07, P =0. 1261) .2. Changes of behavioral factorsThe rate of physical training increased significantly analyzed by trend-test (Cochran-Armitage trend test,α=0. 05) (Z=14.6692, P<0.0001) . The same trend was found in the rate of going to work or school by walk on foot or by bike (Z=3.8593, P—0.0001) and the rate of quiting smoking among smokers (Z=3. 3684, P<0.0001) . The smoking rate decreased significantly analyzed by trend- test(Cochran-Armitage trend test,α=0. 05) (Z=2. 6968, P= 0.0070) . The same trend was found in the rate of drinking exposure (Z = 3. 0809, P=0.0021) and that of passive smoking exposure (Z= -5.8987, P<0.0001) .3. Improvement of Knowledge, Attitude and Practice related to chronic non-communicable diseasesAfter intervention was implemented, the scores related to chronic non-communicable diseases in target population among different years were significantly different analyzed by Kruskal—Wallis rank test(all P<0.05 ). Total scores had the same difference(X~2 =271. 958, P<0.0001) and had positive correlation with investigation time analyzed by Spearman test (r=0.353, P<0.05).Analyzed by trend-test (Cochran-Armitage trend test,α=0. 05), the rate of knowing the diagnostic criteria for hypertension increased significantly(Z = 3. 5560, P=0.0004). The proportion also increased significantly among targert population who knew high-salt diet could raise the hypertension incidence(Z= 11.6390, P<0.0001). The same trend was found in the rate of knowing the diabetic sympotoms(Z=8.6143, P<0.0001).The objects who recognized the hazard of passive smoking increased significantly (Z=14.0329, P<0.0001) . More people disapproved that men should smoke(Z=10.3292, P<0.0001). The rate of having healthy attitude towards the necessity of monitoring blood pressure level regularly increased significantly(Z=17. 7251, P<0.0001). The objects who deemed that hyperlipemia was harmful became more and more (Z=17. 0380, P<0.0001) .The rate of monitoring their blood pressure level in recent year increased significantly(Z=9.8032, P<0.0001). The same trend was found in the rate of ever having measured blood glucose level(Z=9. 4450, P<0. 0001) and blood fat level(Z=11.3298, P<0.0001). The proportion of conducting regular therapy among patients increased significantly(all P<0.05).4. Risk factors of hypertensionSocioeconomic status and lifestyle factors were potential risk factors. The results of logistic regression analysis showed that the major risk factors influencing hypertension incidence would include gender, age, physical activity, negative marriage status and passive smoking exposure. The prevalence rate of hypertension was increased significantly with age. The odds ratios were 1.47 for male vs.female, 1.41 for physical labors vs. unemployment people, 3.57 for the negative marriage status vs. unmarried, 1.35 for passive smoking exposure vs. no passive smoking exposure.Conclusions1.The study demonstrates that it is feasible and effective to carry out community-basedintegrated intervation with the strategies of health education and health promotion.2.It's necessary to take comprehensive measurements to control and prevent the epidemictrend of NCDs. |
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