Introduction

As per the World Health Organization, in 2015 out of the 56.1 million global deaths, seventy percent were due to non-communicable diseases (NCD) [1]. In the last few years, there has been a changing pattern of disease profile from acute infectious communicable disease to chronic NCD [2]. The recent changes in lifestyle and economy have put young and adolescents at risk of various behavioral factors predisposing to the development of NCDs and adolescents have been identified as a major at-risk population for NCDs by the WHO[3].

It has been estimated that the burden of NCDs can be reduced to half or lesser by prioritizing interventions like health education, health promotion, and disease prevention which can be achieved by focusing on modifiable risk factors the roots of which begin as early as in childhood [2]. Appropriate counseling and positive reinforcement during any age including adolescence make a significant difference in morbidity and mortality [4].

Preventive strategy to be formulated before the execution of any intervention in terms of screening and risk factor reduction, require the actual situation in the community has to be estimated [5]. The present study has been carried out to determine the prevalence of these risk factors and the proportion of modifiable risk factors to assess the co-existence of these among school-going adolescents in Ujjain.

Material and Methods

A cross-sectional study was undertaken in schools in the district of Ujjain from August 2017 to August 2019. The study was done following the international Global School Health Survey protocol (GSHS), developed by the Global School Health Survey international network of researchers. The Global School Health Survey is a cross-sectional survey, it measures among adolescents the leading cause of morbidity and mortality through the behavior and risk factors for non-communicable diseases [6].

The study was conducted in the Ujjain district situated in Madhya Pradesh. As per provisional reports of Census India, the population of Ujjain in 2011 was 1,986,864. The study was conducted among students in the adolescent age (12-14 years) group in urban and rural schools of Ujjain, which included both government and private schools.

India.

Ethical Consideration: A prior written informed consent for the study was taken from school administration and from the parents. At the time of initiating the study each participant was informed about the study protocol and voluntary participation

in the study, the anonymity of the students was also informed to them. After the completion of the questionnaire, a brief session for students was taken with regard to health education, hand washing, hygiene, diet, substance abuse, physical activity. The study was done following the international Global School Health Survey protocol (GSHS), developed by the Global School Health Survey international network of researchers. The Global School Health Survey is a cross-sectional survey, it measures among adolescents the leading cause of morbidity and mortality through the behavior and risk factors for non-communicable diseases.

Data Collection: The questionnaire was pilot studied and pretested amongst 20 school going children selected randomly among students different from the samples of the main study to have an overview of the study settings and requirements. Prior written consent for the study was taken from school administration one day before the study. In case a school refused to participate the next school was selected based on random sampling. Two schools refused to participate in the study. In the selected schools all the students in the selected classes were ready to participate.

At the time of initiating the study, each participant was informed about the study protocol and written consent was obtained. The students were also explained about the purpose and methodology of the study. The name of the schools and students were kept confidential. Participation was voluntary and anonymity was assured.

Data was collected using the self-administered questionnaire which was developed based on the WHO Global School Health Survey questionnaire. Since some of the schools were Hindi medium schools, the students were given a questionnaire that was translated to Hindi by a translator well versed with the language and rechecked by an expert of the same. The questionnaire was then explained in detail to every student to avoid misinterpretations or uncertainty of the questions. It took 60 minutes to complete the questionnaire after which the questionnaires were collected. Care was

30 days, 10.5% and 15% rarely and sometimes went hungry. In the government schools, it was noted 17.4% rarely went hungry and 7.5% sometimes went hungry. There was a significant association noted between government and private schools. 35% did not consume fruits in the past 30 days with 56.5% less than or 1 time a day and 8.5% more than 1 time a day. 58.3% reported consuming vegetables less than 2 times a day and 41.8% more than 2 times a day. 96% reported consumption of carbonated drinks less than or equal to 1 time a week and 16 % more than 1 time a week. Fast food consumption of more than 1 time a week was noted in 44.5%

As per the study, 73.6% of children reported being physically active for at least 60 minutes a day, only 28% of males and 31.7% of females responded that they perform for more than 3 days for more than 60 minutes per day. Nearly 58.6 % of males and 59% of females mentioned they used to cycle or walked to reach school for more than 2 days a week. only 3% of government school children went to a physical education class more than 2 days a week as compared to that of 6.5% in private schools.

Discussion

As the country is undergoing rapid economic development, changing lifestyles and habits have resulted in a transition in the health profile of the population [7]. Among all backgrounds, schools form an ideal setting to assess the prevalence among adolescent’s children for risk factors of NCDs, as it covers a vast population and it provides opportunities for the appropriate level of intervention at all stages and helps in formulating region-specific guidelines for the same [8].

Alcohol Use: Jaisoorya et al reported a prevalence of 9.9% among 12-13 years’ age group [9]. With similar results noted by Mohanan et al Udupi with a prevalence of 5.7% [10] Mahmood et al with results on prevalence in Bareilly, Uttar Pradesh with 3.2% children admitted to having consumed alcohol in the past 30 days and 5.2% having consumed alcohol in the past [11]. Jain et al reported a prevalence of 4.6%, of which 57.9% were males and 42.1% were females [12].

Mangalore Bukelo et al reported in their study with a similar setting that only one boy admitted to having consumed alcohol [13].

GSHS survey 2006 India did not study alcohol consumption among the risk factors for NCDs. On comparison there is a higher percentage of alcohol consumption noted in this study, a statistical significance noted in males and females could be males have easy accessibility to money for buying alcohol, peer pressure and male parent or guardian consuming alcohol

1. Dietary Behaviour: A study done in CBSE school in Delhi in 2006 using the same GSHS survey reported 3.5+-0.7 % of children went hungry due to inadequate food in 30 days [14]. Bukelo et al reported in a similar study that 21.5% of adolescents consumed fruits and vegetables more than 2 days a week. 80.1% had inadequate dietary consumption [13].

3. Physical Activity: Study by Jain et al in Mangalore a similar setting noted that adequate vigorous activity was done only by 25.6% students and adequate moderate activity was done by 66.3% students [12]. Ade et al reported similar results in Karnataka with 22.1% of students doing physical activity daily [13]. GSHS has done in Delhi in 2007 reported with similar settings that 23.2% of children spent more than 3 hours a day watching television or playing video games [6]. Ismail et al reported a lack of physical activity in 44.6 % [17]. .The present study participants, the majority fail to meet the WHO recommendation on physical activity, 60 minutes of moderate to vigorous-intensity physical activity daily. The above study cannot be adequately compared to that of other studies due to a lack of operational definitions for adequate moderate or vigorous physical activity.
4. Tobacco Use: Global youth tobacco survey reported that one in 10 students (10%) had used tobacco in any form. Kumar et al in Chennai estimated the prevalence of tobacco use to be 41.1% [11]. Mohammad et al reported a past smoking rate of 5.2%, currently smoking adolescents were 4.8%, 4.8% were also noted to be using smokeless tobacco, 2.4% used smokeless tobacco in the past(11). Puwar et al in Surat reported no adolescent smoking in their study [3]. Jain et al reported 1.2% of students all males to have smoked tobacco, and only 4 students to have smoked about 5 cigarettes three times a week in the past 30 days [12]. The GSHS Delhi in 2006, reported 1.2% of students who smoked cigarettes with 3.7% who have used tobacco in any form other than smoking and 37.1% exposed to second-hand smoking. The present study denotes an increase in smoking, tobacco use of which increase in prevalence was noted to be more in private school’s possible reason could be due to peer pressure

Violence and unintentional injury: Gururaj as per a study reported that in 2009, among children <14 y, major causes of fatal injuries were RTIs (31%) [18]. Report from 68 LMICs using GSHS survey, the overall prevalence of physical attack, physical fighting, and serious injuries during the past 12 months were 35·6%, 36·4%, and 42·9% respectively. Prevalence varied by WHO region [1]. The overall prevalence of bullying at least once in the past 30 days was 34·4%, irrespective of age,

Author’s contribution

Dr. Priyanka Sharma: Study design, concept

Dr. Jagdish Chandra Mandliya: Manuscript preparation

Dr. Mamta Dhaneria: Data analysis

Dr. Vishal Diwan: Manuscript preparation

Reference

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