|Noncommunicable Disease Risk Factor Reporting in National Family Health Survey-4: A Critical Appraisal|
||Mahendra M Reddy, and Srikanta Kanungo
||Journal of Family Medicine & Primary Care, 5(2): 512-513; DOI: 10.4103/2249-4863.192316
National Family Health Survey (NFHS) is a highly viewed and cited document in Social Science and Health Research in India. The International Institute for Population Sciences has conducted this survey for first time in 1992–1993 (NFHS-1) followed by 1998–1999 (NFHS-2), 2005–2006 (NFHS-3), and recently in 2015–2016 (NFHS-4). For the first time, there was an addition of clinical component (blood pressure measurement) and biochemical component (blood sugar level assessment) along with the anthropometric assessment (height and weight measurements) in NFHS-4.
We are taking this opportunity to appreciate the efforts of NFHS-4 to include the information on noncommunicable disease (NCD) risk factors. As NCDs are emerging as a “silent killer” in India, it is necessary to know the actual burden of the risk factors. Although this fact sheets give important details, still some more important data could have being included. Also, interpretation of some of the data may create confusion among the readers. Few of them are listed as under.
The rationale for reporting the blood sugar level as >140 and >160 mg/dl is not clear to the readers, which is not in concordance with any of the guidelines followed nationally or internationally. Again, mutually exclusiveness of the two reported categories of blood sugar measurement is not clear. Exclusion of the subjects who were on antidiabetic medications would have made the high sugar level data reporting even more appropriate. Separate reporting of those who are on medications would give clue regarding the management and also adherence to treatment among the diabetic patients. The report does not explicitly state whether men/women who are on antihypertensive medication were included in the blood pressure classification.
During the survey, questions regarding whether the person had undergone any oral cavity examination in the last 1 year was asked for both men and women. But, the fact sheet missed reporting the same for males; in whom the oral cavity cancer is predominant. Also, the fact sheet creates confusion by stating that person aged =15 years to be as “adults” in expressing the burden of NCD risk factors.
The NFHS-4 fact sheet reports only the use of tobacco in any form in both men and women aged 15–49 years.3 The willingness to quit tobacco use may have been reported separately, which was captured in survey. Opportunistic advice to quit tobacco in those who are using it during any health consultation by the treating physician was captured in NFHS-4 survey but failed to incorporate this useful information in the fact sheet.[4,5] Thus, bringing a separate supplementary fact sheet for NCDs with the incorporation of all the missed information is recommended.
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