Disease Prevention And Management For Non Communicable Disease

Demographic characteristics of the specific school and surrounding community

Describe about the Disease Prevention and Management for Non Communicable Disease.

Campbelltown Public School is selected as the school for this NCD (non-communicable disease) prevention strategy. This school is located in the City of Campbelltown (New South Wales). According to 2011 Census, approximately 150000 people are living in this city. Female population (51 %) is more as compared to the male population (49 %). Aboriginal and Torres Strait Islander people comprised of approximately 3.5 % of the total population. This population is the approximately 30 % higher as compared to the Australian population of Aboriginal and Torres Strait Islander people. Median age of the people living in the City of Campbelltown was 33 yrs which was around 4 yrs less as compared to the median age of the Austalian population. In City of Campbelltown, children in the age of 0-14 comprised of 22 % of total population and people above the age of 65 yrs comprised of approximately 10 % population. Around 50 % people above the age of 15 years are married. Weekly income of the people residing in the City of Campbelltown is approximately similar to the other population of the Australia. Some of the prominent Ancestry staying in the City of Campbelltown is Australian (25 %), English (22 %), Irish (6 %), Scottish (5 %) and Indian (3 %). Some of the prominent languages used in the City of Campbelltown are Arabic, Samoan, Hindi, Bengali and Spanish. Some of the prominent religious affiliation in the City of Campbelltown are Catholic, Anglican, Islam and Hinduism. It has been observed that most of the hospitalizations in City of Campbelltown are due to obesity, coronary heart disease, asthma and COPD (chronic obstructive pulmonary disease) and diabetes. Infectious diseases observed in the City of Campbelltown were hepatitis B & C, chlamydia, gonorrhoea and infectious syphilis. Most of the common causes of death in City of Campbelltown were cardiovascular disease, cancer, respiratory disease, endocrine disease, digestive system disease and mental disorders (Swanson, 2016; Campbelltown City Counsel, 2016).

Campbelltown Public School is having students of mixed population. In this school, children between the age of 5 to 15 are studying. 45 % children studying in this school are from high socioeconomic class and 55 % children studying in this school are from low socioeconomic class. 60 % students in this school are boys and 40 % are girls. 50 % of the children in this school are basically from the urban area and 50 % are from the rural area. Childrens of different origin like Australian (30 %), English (20 %), Irish (5 %), Scottish (5 %) and Indian (5 %) are studying in this school. Most common disease observed in the children of this school were obesity (15 %), Asthma (7 %) and cold and flu (5 %) (Sáenz et al., 2015). 

Etiology and epidemiology of overweight and obesity in the target group

Etiology and epidemiology of overweight and obesity in the target group:

Conditions like overweight and obesity occurs because imbalance in the energy consumption in the form of diet and energy expenditure in the form of physical activities, exercise and bodily functions. There is increased energy consumption in the form of food in the people of City of Campbelltown. This energy consumption is specifically in the form of carbohydrates such as sweetened beverages and potato chips. It has been observed that sweetened drinks such as soft drinks, iced tea, and energy and vitamin water drinks are the main contributing factors for the increased cases of obese and overweight people. In the people of City of Campbelltown, consumption of fast food is increased by three times and energy consumption increased by four times. People with obesity generally underreport consumption of food as compared to the normal people. School going children between the age of 6-12 are more prone to obesity because there is more consumption of fast food and sweetened drink. This consumption is more in school going children because there is less control on these children. These children used to consume this high energy food both at school cafeteria and at the home. Moreover, these children have less understanding of the negative effect of this type of food. Sedentary lifestyle is also one of the main contributing factors for the rising rate of obese and overweight conditions in the people of City of Campbelltown. Specifically in he children, there is approximately 25 % reduction in the physical activity or exercise due to decreased outdoor sports and increased indoor games with less physical activity. Decreased physical activity in the children is also observed due to the increased use mechanized transportation system. Television viewing for the long duration of time is also one of the contributing factor for the obese and overweight condition in the children (Freemark, 2010; Moreno et al., 2011).        

In few cases genetic and environmental factors are also responsible for the occurrence of the obese and overweight condition in this population of City of Campbelltown. There is interplay between the genetic and environmental factors for the occurrence of obesity and overweight condition. Polymorphism in the gene which control appetite and metabolism are responsible for the occurrence of obese and overweight condition in this population. It has been established that around 40 genes of the human genome are related to the obese and overweight condition. FTO (food mass and obesity associated gene) is responsible for the occurrence of obese and overweight condition. People with two copies of FTO gene has 3-4kg more body weight and at around 1.7 fold more risk for obesity as compared to the people without risk allele. Other contributing factors responsible for the occurrence of obese and overweight condition in the children are insufficient sleep, smoking, increased use of medications and environmental factors such as pollution (Andersen, 2003).

Justification of stakeholder group selection

A survey was conducted on health status of the people of City of Campbelltown by NSW Adult Population Health Survey (SaPHaRI), Centre for Epidemiology and Evidence, NSW Ministry of Health.  From this survey, it is evident that approximately 35 % people are overweight and approximately 27 % people are obese in the City of Campbelltown. In Campbelltown Public School, approximately 15 % students are obese and 5 % students are overweight. Among these students, approximately 60 % consume junk food, 30 % are with less physical activity and 10 % are having familial history of obesity. Among these obese students approximately 20 % students and their parents are trying to control their obesity. Remaining 80 % students and parents are not at all taking care of their obesity.         

In this study stakeholder group selected were students in the age group of 13 – 15 yrs. This stakeholder group holds all the responsibilities for the implementation this intervention. 20 students were selected for this group and it comprises of 14 boys and 6 girls. These students were selected based on their academic performance in the last four years, communication skills, documentation efficiency and computer efficiency. Effective communication skills are very important aspect in this intervention because these students should convince children in the target group and their parents about the programme to control obesity in the children. Documentaion efficiency is also one of the important aspects in the selection of stakeholders because these stakeholders should document effectively all the information acquired about the children and observation made after the implementation of the prevention strategy for obesity. These senior students were selected because these students can effectively influence the less age group children as compared to the teachers, family members and other community members. Generally, children spent most of the time with their peers and they follow their senior peers. In this case also, senior students were selected to implement obesity prevention strategy in school going children (Lobstein & Swinburn, 2007).

Description of the intervention:

This intervention is for the control of obesity in the children of age group of 6 – 12 yrs. This target group comprises of 200 children with 125 boys and 75 girls. This intervention started with collection on data about body weight and BMI (body mass index) of all children in the school. After collections of BMI data, 200 children were selected and these children were divided into two groups comprising of obese (80) and overweight (120) children. Different intervention strategies were planned for obese and overweight children. After the selection of the children for this intervention, data was collected for the food consumption habit, sedentary lifestyle, habit of smoking and family history of obesity. This data was compared with BMI data and correlation was established between these etiological factors and obese and overweight condition in the children. Children were grouped in different groups based on the responsible factor for obese and overweight condition in the children and interventions were planned according to the etiological factors.

Description of the intervention

Different intervention strategies were planned for these children like peer based approach, school based strategy, family oriented strategy, canteen oriented strategy, community based strategy, classroom based strategy and school environment strategy  (Patton, et al., 2005). Peer based approach comprises of influencing junior students by senior students on the food habit and exercise.  School based strategy comprises of incorporation of the obesity prevention topic in the curriculum, monitoring canteen facility for junk food, promoting exercise and physical activity and rewarding for the children on the successful control of the obesity (Van Beurden et al., 2003). Family oriented strategy comprises of provision of healthy nutrition, restriction of food prone to the obesity, monitoring of food consumption in the canteen, promoting children for the outdoor activities, restricting TV viewing for the long duration and providing information on the control of obesity. Canteen oriented strategy comprises of restriction on the supply of high energy food, training for the canteen staff for the preparation of food with low calorie and networking among canteen staff, teachers and family members for the provision of food with low energy. Community based strategy comprises of conducting informative programmes for the obesity control and provision of playground for the children (Timperio et al., 2004; Campbell et al., 2001). Classroom based strategy comprises of incorporation of lectures on the healthy food and obesity control and provision of breaks for eating fruits. School environment strategy comprises of establishment of gardens with vegetable and fruits, provision of purified water, restriction on the local vendor with unhealthy food, incorporation of additional fund for control of obesity, provision of playgrounds for the children and fixing exact timings for meals (Wallin, 2003; Muijs and Reynolds, 2005).

Students in the stakeholder group visited each of these above mentioned places and asked to implement these strategies for the selected students in the target group. Implementation of these strategies in school, family and classroom were easy for stakeholder group however it was slight inconvenient for these stakeholders to implement in community based approach. These stakeholders maintained data for each of the children in the target group for 6 months. Data was collected about amount of consumption of food, type of food, number of playing hours, number of hours of watching TV, number of informative lectures conducted for the on healthy food and obesity control. Each stakeholder was handling 10 children in the target group. Students in the stakeholder group collected data at different places like classroom, school and home. This data was collected for each child in the target group on the weekly basis. Body weight was measured every month. Body weight and BMI data for each month was stored in the excel sheet in computer for six months (Moon et al., 1999; Greenburg, et al., 2005).

Students in the stakeholder group conducted lecturers, presentations and training programmes at school, canteen and social places. Information about these strategies was provided to family members through personal communication. There were different presentations prepared for the different kind of people like teachers, parents, community members and staff of the canteen. Special attention was given to the canteen staff and students in the stakeholders group discussed personally with these staff members. Members of the canteen staff were given training for cooking food with low calorie. Students of the stakeholder group arranged training sessions by experts in the field, for these canteen members. For teachers and parents, lectures and presentations were arranged on weekly basis for 6 months. These lectures and presentations were conducted together for parents and teachers. For each week different topics related to childhood obesity were selected and case studies were incorporated in these presentations to convince parents and teachers about the prevention and cure of obesity. As most of the parents were not educated and didn’t understand medical terminology, presentations were prepared for them in a very understandable manner. Students of the stakeholder group visited to the home of selected students in the target group and discussed about this intervention with their parents. At social places, meetings were conducted with the community people to guide them about the information. Education to the students in the target group were provided through informative posters in the school corridor, exhibiting short documentaries related to the prevention of obesity and personal discussion with them (Corcoran, 2013).         

Outline of the evaluation framework:

This intervention was evaluated in terms of three parameters like process evaluation, impact evaluation and outcome evaluation (Sahota et al., 2001). This intervention was very effectively implemented on the target children, parents and teachers. However, implementation of this intervention was difficult on canteen staff and community members. For canteen staff, it was difficult to make them understand about this process. Community members were not interested to implement these interventions. Process implementation was evaluated by asking questions to the target children. Children in the target group were asked to rate, the maximum benefit they got from each intervention strategy. It was observed that, these children got maximum benefit from the parents and followed by teachers. Children in the target group got minimal benefit from the canteen staff members and community members. As parents and teachers implemented this intervention effectively, there was more impact of this intervention on parents and teachers. It was observed, there was increased knowledge about the healthy food and management strategies for obesity in parents and children. Parents and teachers felt satisfactory about the efforts they put in and outcome they got. Impact of this intervention was more on the children in the target group. Children in the target group exhibited interest to control their obesity and convinced to take food with low calorie. Children in the target group were ready to avoid junk food and sweetened beverages (Fertman and Allensworth, 2016). This intervention had very less impact on the canteen staff members and community members. There was very less augmentation of knowledge in canteen staff and community members. This impact was evaluated by asking questions to these members.

Outcome of this intervention was evaluated by recording the type of food consumed, amount of food consumed, body weight and BMI of the children in the target group. It was evident form the analysis of these parameters that, children in the age group between 9 to 12 were more benefited. Children in the age group between 9 to 12 reduced consumption of junk food. There was decrease in the body weight and BMI with respect to consumption of type and quantity of food consumed. Children in the age group 6 to 8 were also benefited from this intervention. However, percentage of children got benefit in age groups 6 to 8 was less as compared to the children of 9 to 12 age group (Rootman, 2001).

References:

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Campbelltown City Counsel. (2016). Demographics. Retracted form Downloade from https://www.campbelltown.sa.gov.au/profile on 06.12.2016. 

Campbell, C., Waters, E., O’Meara, S. & Summerbell, C. (2001). Interventions for preventing obesity in childhood. A systematic review. Obesity Reviews, 2, 149-147. https://www.ncbi.nlm.nih.gov/pubmed/12120100.

Corcoran, N. (2013). Communicating Health: Strategies for Health Promotion. SAGE Publications. uk.sagepub.com/en-gb/eur/communicating-health/book238746.

Fertman, C. I., and Allensworth, D. D. (2016). Health Promotion Programs: From Theory to Practice. John Wiley & Sons. https://as.wiley.com/WileyCDA/WileyTitle/productCd-0470241551.html.

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