title: Healthcare planning in north-east India: a survey on diabetes awareness, risk factors and health attitudes in a rural community.
abstract: OBJECTIVE
  To determine the level of awareness and knowledge about diabetes in the community, to identify their risk factors for diabetes, the relationship between anthropometric measures and diabetes risk and estimate the burden of diabetes in this rural North-East Indian population with an objective to identify target areas for future healthcare planning.
  
  
  METHODS
  A healthcare team conducted a community-based survey of the residents of Khowai district, Tripura. All household members above the age of 25 years were eligible to participate, following voluntary consent. Survey questionnaires were administered with interpreter assistance including demographic information, diabetes knowledge, family history, smoking, diet, healthcare access and the international physical activity questionnaire (IPAQ). Anthropometric measurements were taken and blood glucose testing performed.
  
  
  RESULTS
  One hundred and forty four participants completed the survey, 66 males and 78 females with a mean age of 44.4 +/- 14.8 years Although 91% had heard about diabetes and 44% were concerned about developing it in the future, only 39% were aware of its association with overweight status and 37% knew it required long-term treatment. Nine percent were known to have pre-existing diabetes mellitus and a further 9% were newly detected to have diabetes mellitus or impaired glucose tolerance. Fifteen percent were hypertensive and 8% had a family history of diabetes. Their mean BMI was 21.2 kg/m2 and 31% were overweight, despite high levels of physical activity in 47%. For each predictor of increased risk--waist circumference (female >80 cm, male >94 cm), waist-height ratio >50% or BMI>23 kg/m2, subjects measuring above the cut-off were more likely to have abnormal glucose tolerance than those in the normal range (27% vs. 14.3% p = 0.08, 26.5% vs. 9.5% p = 0.008, 27.3% vs. 13.3% p = 0.043, respectively.) with waist-height ratio being the best predictor of an abnormal BGL: OR 3.45 CI (1.34 - 8.88).
  
  
  CONCLUSIONS
  This is the first rural survey for diabetes in North-East India. This population had a low baseline knowledge and awareness about diabetes, despite significant diabetes prevalence. A greater emphasis on health education and risk factor modification for diabetes is warranted in the North-East part of the country.
authors.affiliation: Department of Diabetes & Endocrinology, Westmead Hospital, NSW Australia.
authors.forename: Sue L
authors.initials: SL
authors.lastname: Lau
authors.forename: Rati
authors.initials: R
authors.lastname: Debarm
authors.forename: N
authors.initials: N
authors.lastname: Thomas
authors.forename: H S
authors.initials: HS
authors.lastname: Asha
authors.forename: K S
authors.initials: KS
authors.lastname: Vasan
authors.forename: R G
authors.initials: RG
authors.lastname: Alex
authors.forename: J
authors.initials: J
authors.lastname: Gnanaraj
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001364:Awareness; D015992:Body Mass Index; D016001:Confidence Intervals; D003625:Data Collection; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006285:Health Planning; D006801:Humans; D007194:India; D008297:Male; D009043:Motor Activity; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires