24 November 2011

Epidemiological transition in a rural community of northern India

A single paper does not prove a theory but I've strongly believed for a while that there are more similarities than differences in the health, wellbeing and disease profile of high, middle and low income countries and communities. This trend particularly so in the latter half of the 20th Century.

The paper below shows that chronic non-communicable diseases are the single biggest category of deaths in a rural community in India.

But, there's at least one counterargument to my theory. Given diarrhoeal diseases have declined, it could certainly be the case that long term communicable disease interventions have significantly reduced the impact of communicable diseases in that part of rural India (e.g. clean water, sanitation, improved rural incomes, access to primary health care, etc.).

From a HIA perspective, it does strengthen the argument that it is important to consider both non-communicable as well as communicable disease outcomes/impacts in low and middle income countries.

Background Information on causes of death is vital for planning of health services. However, vital events registration systems are weak in developing countries. Therefore, verbal autopsy (VA) tools were incorporated in a community-based surveillance system to track causes of death.

Method and Findings: Trained fieldworker identified all deaths and interviewed a living relative of those who had died during 1992–2009, using VA, in eight villages of Haryana (11 864 populations). These field reports detailing events preceding death were reviewed by two trained physicians, who independently assigned an International Classification of Disease-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. Non-communicable conditions were the leading causes of death (47.6%) followed by communicable diseases including maternal, perinatal and nutritional conditions (34.0%), and injuries (11.4%). Cause of death could not be determined in 6.9% cases. Deaths due to cardiovascular diseases showed a significant rise, whereas deaths due to diarrhoeal diseases have declined (p<0.01). Majority (90.0%) of the deceased had contacted a healthcare provider during illness but only 11.5% were admitted in hospital before death.

Conclusion Rising trend of cardiovascular diseases observed in a rural community of Haryana in India calls for reorientation of rural healthcare delivery system for prevention and control of chronic diseases.

Epidemiological transition in a rural community of northern India: 18-year mortality surveillance using verbal autopsy . Rajesh Kumar, Dinesh Kumar, J Jagnoor, Arun K Aggarwal, P V M Lakshmi
J Epidemiol Community Health published 2 November 2011, 10.1136/jech-2011-200336