cardiovascular health awareness among school children in rural district of midnapore. a school based...

8/12/2019 Cardiovascular Health Awareness Among School Children in Rural District of Midnapore. a School Based Survey 02

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Cardiovascular health awareness among school children in rural district of Midnapore,

India. A school based survey

Madhab Ray, MD, MS, Santanu Guha, MD, DM, Santanu Goswami, MD, Chi Huang, MD,

Robert Goldberg, PhD

Introduction: Cardiovascular diseases (CVDs) constitute the number one cause of death in the

industrialized nations. In the developing world infectious diseases have long been considered as

the most common cause of death. With economic development and adoption of western lifestyle

CVDs are gradually becoming more important health concern and in many countries they are

closely competing for the number one cause of death if not already taken the place.

Multiple studies demonstrate that health awareness is a key instrument to fight against any

disease and this is all the more important for the emerging pandemic of CVDs. As

atherosclerosis starts in the second decade of life and many of the contributory factors are

better controlled if addressed early health awareness among the school children about CVDs

assumes a primordial role for primary prevention of the spectrum of the disease.

India is the second populous country in the world with two thirds of the population in their youth.

With all the features of a rapidly developing country a large number of people in India will be

affected by CVD. Currently there is no established school health program to promote health

education and awareness about CVD in India. This survey is an attempt to assess the present

level of health awareness about CVD in the adolescent school children with a goal to establish

school based health education, early detection of different risk factors and development of heart

healthy lifestyle.


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Methods: A school based survey will be conducted in Garbeta II block in the district of

Midnapore, West Bengal, India. There are 20 middle schools catering adolescent children in IX

and X standards. In each school there will be 200 such students with the total number of target

population being about 4000. Assuming 75% of the target population participating in the survey,

the total number of students available for survey will be about 3000.

The survey will follow a 3 step process over a period of 90 minutes: a pre-test, a short lecture

covering the essential elements under study and a post-test using the same questions as in pre-

test.

Recruitment of students: Headmasters of the 20 schools in the study have been contacted

and they agreed to participate in the study. One month prior to the study announcement will be

made in all the classes involved. There will also be information in the school notice boards and

pamphlets about the study will be made available through the school common room and

classes. Participation in the survey will be entirely on a voluntary basis. Attending the session

for the survey will be taken as assent for participation for the study. This will be explained at the

time of announcement and also in the pamphlets. There will be an option to leave the class if

any student chooses not to participate in the survey. No student will be penalized by choosing

this option.

Administration of the Survey: A total of 90 minutes will be allotted to conduct the entire

process of the survey i.e. sitting arrangements, announcement about the study including the

objectives, methods, collection of data, analysis of the results and communication of the results


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to the schools. Instructions about filling the answer sheet for the questionnaire will be read aloud

and explained so that every student understands the total number of questions, stems under

each questions, and the total time allotted. It will be also emphasized that the questionnaire for

the survey is not a test for their school performance and will not affect their grading in the

school.

For the initial survey (pre-test) on a questionnaire containing 20 questions a total period of 20

minutes will be allotted. This will be followed by a presentation for 15 minutes by the study team

on cardiovascular health addressing the different domains of the study. After an interval of 10

minutes the second component of the survey (post-test) will be conducted on the same

questionnaire over a period of 15 minutes.

Free packed lunch will be served after the post-test. The study team will be available to answer

any questions during the lunch and extend thanks to those participating and helping to conduct

the study.A free booklet on cardiovascular health and packed lunch will be distributed at the

end of the survey. For those choosing not to participate the booklet will be available free of cost

through the school library services.

Questionnaire: For this survey a questionnaire consisting 20 questions will be formed and

validated beforehand in the index population in the same area of the study. There will be 6

domains of the study:

1. Concept of coronary artery disease: what it means and its spectrum

2. Impact of the disease: how common the disease is and what is the impact of the disease

on the individual and the society

3. Multifactorial: risk factors include: age, gender, family history, diabetes, hypertension,

high cholesterol, and smoking

4. Risk factors are modifiable: healthy life style is the answer


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5. Importance of multidisciplinary approach

6. Benefit of the approach beyond coronary artery disease

Data Collection and Protection of Identity:The data will be collected in Microsoft excel and

will be stored in a password protected computer file with access only to the investigators. All the

data will be de-identified at the earliest possible time after the analysis is complete.

Statistical analysis: We will study the baseline characteristics of the participants: age, sex,

self- reported socioeconomic class, any family member with CVD, hypertension, diabetes,

hyperlipidemia and current smoking. Pre and post-test scoring will be done for each participant

and will be analyzed for performance by individual stems of the questions and domains. Any

improvement will be evaluated by Wilcoxon paired sample signed rank test. Subgroup analysis

will be performed by grade of study (i.e. IX vs. X), gender, socioeconomic status, family member

with CVD or risk factors of CVD.

Conclusions: The results of study are yet to be seen. We expect the overall awareness of

cardiovascular diseases is modest at the best. Students may not be aware about the multiple

risk factors of CVDs. The knowledge about individual risk factors may be superficial. The ability

to modify or control risk factors and thereby CVDs will be appealing to the students. The

importance of multidisciplinary approach to deal with such problem will be interesting and the

fact that attention to healthy life style may help in maintaining health beyond CVD prevention will

be particularly very promising to the young minds in their formative years. The fact that the

pathological process of atherosclerosis starts as early as the second decade of life is the main

learning point that will be emphasized in these children. They will develop some knowledge

about the disease and will understand that they ought to take responsibility to maintain good

health and build a healthy future.


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Strengths and limitations: There is hardly any data on cardiovascular health awareness

among school children in rural India. As more than 80% of Indian population live in rural area

this study has important implications. Survey of 3000 adolescent school children representing

75% of the IX and X grade students of the entire block will produce statistically meaningful

results.

India is very diverse in variety of parameters including socioeconomic strata, cultural and dietary

habits, level of education and ethnicity. Results from a single block of a rural district will be

difficult to generalize. Nonetheless this study may help generate some pilot data and help

formulate a nationwide survey directed towards better school health education to deal with the

emerging pandemic of cardiovascular diseases.


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Advertisement

Dear stud ents Tufts University, USA in c ol laboration with Kolkata Medical College would

l ike to conduct a survey on

Cardiovascular health awareness among

school children: IX and X grades.

Among 20 different schools in Garbeta II block your school has be selected for this purpose.

The study has been approved by the school administration and participation is voluntary.

The study team would be grateful for your participation in this survey.

Date and time will be announced closer to the date in June 2014.

Please do not hesitate to contact the study team if you have any questions.

Madhab Ray, MD, MS (on behalf of the study team)

Ph.: +1-781-504-9321

Email:[email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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Test 1 | 2 Student ID No:

Questionnaire on cardiovascular health awareness among school children (grade IX & X)

Instructions: Please read the questions below carefully and select the one best answer, or

answers, i f mor e than one response appears cor rect. Please circ le the letter(s) for yourresponse(s)

1. The number one cause of death in adults (more than 18 years of age) in developedcountries is:

a. coronary artery disease ( a form of heart disease)b. cancerc. infectionsd. motor vehicle accidentse. gunshot injuries

2. Which disease listed below is becoming the major cause of death in developingcountries?

a. infectionsb. motor vehicle accidentsc. coronary artery disease (a form of heart disease)d. cancere. accidental poisoning

3. Which of the following conditions are included under the broad term of coronary arterydisease (a form of heart disease)?

a. heart attack (myocardial infarction)b. angina (chest pain on exertion)c. sudden cardiac death (death within one hour because of some heart problem)d. heart block (the heart slows down or stops)e. hole in the heart (a defect from birth)

4. The cause(s) of coronary artery disease (a form of heart disease) include(s)

a. raised blood pressureb. cigarette smokingc. high cholesterold. diabetes

e. overweight/obesity

5. Which is a cause of coronary artery disease (a form of heart disease)?

a. physical inactivityb. stress,c. coffee intaked. weight liftinge. excess tea consumption


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6. The cause(s) of coronary artery disease (a form of heart disease) which can bemodified include(s):

a. high blood pressure

b. smokingc. high cholesterold. overweight/obesitye. physical inactivity

7. Risk of diabetes increases with

a. obesityb. lack of exercisec. high carbohydrate dietd. excess intake of alcohole. parents being diabetic

8. Which is TRUE about cigarette smoking?

a. smoking few cigarettes (


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12. Which of the following is/are needed to build a healthy nation?

a. Increased health awarenessb. functional health systemc. good transport and communicationd. economic development

e. womens education

13. Benefits of modifying (i.e. changing for the better) the risk factors for coronary arterydisease (a form of heart disease) may also help reduce the risk of

a. strokeb. kidney failurec. memory lossd. loss of visione. some forms of cancer

14 How long does it take before coronary artery disease develops?

a. 5 yearsb. 10 yearsc. 15 yearsd. 20 yearse. more than 20 years

15. At what age does atherosclerosis (hardening of the arteries) begin?

a. first decade of lifeb. second decade of lifec. fifth decade of lifed. seventh decade of lifee. just before one gets a heart attack

16. When does Atherosclerosis (hardening of the arteries) typically show up in adults?

a. at birthb. any timec. at 45 years and olderd. at 75 years and oldere. when one is terminally ill

17. Manifestations of diabetes (mellitus) include:

a. excessive thirstb. excessive urinationc. increased appetited. fatiguee. development of an unconscious state


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18. A Healthy diet should contain

a. carbohydrate, protein, fat, vitamins and minerals in the right proportionsb. five servings of fruits and vegetablesc. lots of sweets and sugary foodsd. less saturated fat

e. less cholesterol

19. Which is TRUE about tobacco use?

a. biri(tobacco rolled in a leaf from a plant) is as bad as a cigaretteb. tobacco chewing does not cause harm as it does not go to the lungsc. the active addictive component of tobacco is nicotined. cigarettes with filters are harmlesse. tobacco is harmless if taken with alcohol

20. Which of the following statements is/are TRUE?

a. anabolic steroids (some medicine to build muscle and enhance physical performance)are good for health

b. cocaine ( a stimulant drug) can cause a heart attackc. alcohol in excess can be a cause of heart problemsd. vitamins supplements can prevent heart attackse. practicing a healthy lifestyle is much better for ones health than having much

information about the disease.


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Table 1 Data collection form for baseline characteristics of the students (to be filled by the students)

Student ID Age Sex GradeSocioeconomic

status

M F IX X

Presence of Coronary artery disease (CAD) or risk factors in the family

CADHigh Blood

pressureDiabetes High Cholesterol Smoking

Yes No Yes No Yes No Yes No Yes No

Socioeconomic status: Low=1, Lower middle= 2, Middle middle=3, Upper middle=4

Table 2 score for individual student ID

Domain Initial survey results

(Pre-test)

Results after

presentation

(Post- test)

Changein score

1

2

3

4

5

6


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Scoring system:

Table 3 scoring the performance of individual student

Domain No.

N=6

Number of questions (N=20)

(item number(s) in questionnaire)

Maximum

Possible score (100)

% of maximum

total score

1 4 (3,14,15,16) 20 20

2 2 (1,2) 10 10

3 7 (4,5,6,17,18,19,20) 35 35

4 5 (7,8,9,10,11) 25 25

5 1 (12) 5 5

6 1 (13) 5 5


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Results:

Table 4 Baseline characteristics of the students

Age Mean (SD)

Sex (male %)

Grade IX

X

SES 1

2

3

4

Family member having

CAD

Hypertension

Diabetes

Hyperlipidemia

Smoking


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Table 5 Study results

Domains Initial survey results Subsequent test results Change in score (%)

All together

1

2

3

4

5

6

Table 6 Plan for secondary analysis

Secondary analysis according to

Sex Grade SES Family history Domain

SES = socioeconomic status

cardiovascular health awareness among school children in rural district of midnapore. a school based...

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