A step-wise evaluation strategy could detect people with metabolic disorders in the community with minimum utilisation of scarce health resources, according to a study by a group of public health experts in Kolkata.
The study, “Stepwise evaluation for the risk of metabolic unhealthiness and significant non-alcoholic fatty liver disease in India”, was published in Lancet Regional Health Southeast Asia on Thursday.
The study covered around 80,000 people in 19 blocks of Birbhum district and continued from 2015 to 2016.
“Present study, conducted in a rural community of the state of West Bengal in India, was designed to scale the magnitude of the metabolic unhealthiness utilising minimum healthcare facilities in a resource-poor setting,” the report says.
Public health experts said in India, where access to health care is limited, such tools can reduce pressure on the system and make people less dependent on tertiary care hospitals such as government medical colleges in Kolkata.
During the study, green, yellow and red cards were given to the people chosen after each step of the evaluation. They were screened for the presence of metabolic risks like overweight or obesity, hypertension and diabetes.
According to the study, subjects without any risk factor were provided with a green card signifying “no risk”. Those with at least one risk factor were provided with a yellow card signifying “potentially at risk” and were taken for a second evaluation to detect dysglycemia (blood glucose level too low or too high) by measuring fasting blood glucose level and to detect evidence of liver injury by measuring serum ALT (alanine transaminase, an enzyme in the liver).
Those detected with diabetes and liver disease were provided with a red card signifying “at risk of being metabolically unhealthy” and were taken for a third-step evaluation.
The study says that in the third step, tests were repeated to confirm the disorders.
“The study was implemented through community health workers who were trained for the purpose,” said Abhijit Chowdhury, one of the authors of the study. The other authors are Partha Sarathi Mukherjee, Sujoy Ghosh, Pradip Mukhopadhyay, Dipesh Kumar Das, Pabak Sarkar, Saibal Majumdar, Kajal Chatterjee and Kausik Das.
The health workers conducted door-to-door surveys assessing the at-risk population and conducting tests for diabetes and hypertension. In the second and third stages, the health workers were equipped with technical facilities to conduct detailed biochemical tests of blood.
“Given the urgent need for community screening policy for non-communicable disease, metabolic disorder in particular, in India and other resource-poor low-income countries, data from this study could help to plan cost-effective community programme,” the study said.
According to a public health expert, the state government should hire community health workers who can conduct door-to-door surveys and detect people suffering from metabolic unhealthiness.
“The ASHA workers are burdened with too much work and they would be unable to implement this programme. So, a new set of community workers needs to be trained,” said the expert.
Doctors said many patients from districts who are referred to medical colleges in Kolkata suffer from an advanced stage of a disease. The disease would not advanced had it been detected early at a block-level health centre.
“About 30 per cent of the patients with advanced non-alcoholic liver diseases coming to our hospital need not have come had the condition been detected early. The advancement of diseases could have been prevented. This is only possible by such community-level intervention,” said Chowdhury, who is also associated with the School of Digestive and Liver Diseases at SSKM Hospital.
