The rapid rise of Noncommunicable diseases represents one of the major health challenges to global development in the 21st century. Among the 20 Grand Challenges in Chronic NCDs the priority focuses of area is to explore the level of knowledge and perception among health professionals and its determinants

1. Original Article
Knowledge and Perception on Noncommunicable
diseases (NCDs) among Health Professionals
Azreen Momen Chowdhury1, Manzoor Kader2, Nayeemul Hasan1, Nirupama Talukder3, Rashimul
Haque4, Feroze Quader5, Matia Ahmed6 Shah Alam4
Abstract
Introduction: The rapid rise of Noncommunicable diseases represents one of the major
health challenges to global development in the 21st century. Among the 20 Grand
Challenges in Chronic NCDs the priority focuses of area is to explore the level of knowledge
and perception among health professionals and its determinants.
Methodology: A cross-sectional study was conducted among 160 doctors in different
departments of Uttara Adhunik Medical College & Hospital, Uttara in Dhaka city from July
2011 to June 2012. The respondents were selected purposively and data were collected by
face to face interview using semi-structured questionnaire. For assessing the level of
knowledge and perception, Likerts’ scale was used initially and then percentile distribution
was applied for final categorization. Data were analyzed using the SPSS soft ware (version
16.0)
Results: The mean age of the respondents was 38.9 ±10.5 years. Out of 160 respondents,
almost one-third (30%, 95% CI-22.9, 37.1) were found to have poor knowledge regarding
NCDs. The average, good and excellent level of knowledge were found in 28.0% (95% CI-
15.1, 27.9), 21.5% (95% CI-15.1, 27.9), and 20.5 %( 95% CI-14.2, 26.8) respectively.
Regarding the perception on NCDs, 30% (95% CI-22.9, 37.1) of the respondents had poor
score followed by average 30.5% (95% CI-23.4, 37.6),good 22.5% (95% CI-16.0, 29.0)
and excellent 17.0% (95%CI-11.2-22.8) respectively. Working areas were statistically
associated with the level of knowledge (p <0.05), however it showed insignificant for
perception (p>0.05).
Conclusion: The findings of this study suggest that in general the health professionals are
not up to date aware of NCDs. So, this underscores the necessity of much attention and
programs on NCDs should be taken for the doctors’ community to increase the level of
awareness for the best interest of prevention and control of Noncommunicable disease in
a low resource country like Bangladesh.
Key words: Knowledge and Perception, NCDs, Health professionals
(J Uttara Adhunik Med Coll. 2013; 3(2) : 147-153).
1. Department of Community Medicine, Uttara Adhunik Medical College
2. Senior Consultant, Cardiology, Tangail Sadar Hospital
3. Department of Forensic Medicine, Uttara Adhunik Medical College
4. Department of Neuro Medicine, Uttara Adhunik Medical College
5. Department of Surgery, Uttara Adhunik Medical College
6. Department of Physiology, Uttara Adhunik Medical College
Address for correspondence: Dr.Azreen Momen Chowdhury, Assistant Professor, Department of Community Medicine, Uttara
Adhunik Medical College
Introduction & Background Information
The rapid rise of Noncommunicable diseases
represents one of the major health challenges to global
development in the 21st century. The world is clearly
witnessing a growing man-made epidemic of NCDs
which is being aggravated by a rapidly ageing global
population. It has been estimated that by the year
2020 up to three-quarters of all deaths in the world
will result from NCDs, and Ischemic heart disease
and Depression will top the list.1
A Noncommunicable disease (NCDs) refers to
noninfectious diseases- a variety of conditions

2. including cancer, cardiovascular diseases, diabetes
mellitus, chronic respiratory diseases, musculo-
skeletal disorders and other conditions.2 The
increasing global crisis in NCDs is a barrier to
development goals including poverty reduction, health
equity, economic stability, and human security.3
Noncommunicable diseases (NCDs) are the leading
global causes of death, causing more deaths than all
other causes combined, and they strike hardest at
the world’s low- and middle-income populations.4
Most current health care systems are based on
responding to acute problems, urgent needs of
patients, and pressing concerns. Current health care
systems worldwide fall remarkably short. 5
The medical profession has a particular culture and
sets of norms - that also influence individual physician
behavior.6 Too often, health care workers fail to seize
patient interactions as opportunities to inform patients
about health promotion and disease prevention
strategies. Even more worrying is the dangerous lack
of awareness of this threat of NCDs to global health.4
As a first step care approaches, it is essential to
communicate the latest & most accurate knowledge
& information to front-line health professionals & the
public at large. 7
Noncommunicable diseases remain an area of high
public health concern among health services providers.
Targeted interventions to identify and address these
determinants and risk factors have become a public
health priority for Bangladesh. However, there exists
no accepted surveillance system for NCDs at the
national level.8
Among the 20 Grand Challenges in Chronic
Noncommunicable Diseases one of the priority
focuses of area is to “Identify the reasons for low
awareness and advocacy of chronic disease in
societies” .9
Health workers are not trained in NCDs management
in the Primary health care system. Currently NCDs
treatment comes mostly from the tertiary level.
Capacity strengthening initiatives by professionals has
been recommended - a vital investment for the
implementation of NCDs control policies &
programme.10
Though NCDs constitute a high public health priority,
from Government specific program on awareness
rising not yet implemented to tackle NCDs
consequences; even health professionals are not clear
about dealing with it.
The result of this study will focus the necessities of
primary prevention of NCDs, by awareness rising with
timely intervention to the health professionals as well
as to give baseline information on NCDs program in
our country. Thus assist the policy makers to develop
the national guide line for the health professionals on
NCDs program implementation.
Methods:
This is a cross- sectional study conducted over a
period of one year from July 2011 to June 2012; A
total of 160 doctors (male-93, female-67) working at
different departments of Uttara Adhunik Medical
College & Hospital (clinical & basic subjects)
purposively selected for the study. The research
instrument was a pre-tested, specially designed semi-
structured questionnaires focused on Knowledge and
Perception towards NCDs by interview technique. The
answers were scored by assigning marks. A SPSS
version-16 was used for statistical analysis.
Results
The aim of this cross sectional study was to assess
knowledge and perception of health professionals on
NCDsanditsdeterminants.Thefindingswereorganized
in the following sections such as Socio-economic and
professional characteristics, distribution of knowledge
and perception variables, distribution of respondents
according to knowledge and perception score.
Socio-economic characteristics of the respondents;
out of 160, about 60.6% (97) were in the age group
of 25-40 yrs.); Mean age was 38.94 with SD10.49
yrs. Majority 93 (41.9%) were male, whereas the rest
67(58.1%) were female. In respect to marital status,
majority was married 149 (93.1%) and the rest
11(6.87%) were unmarried. Most of them 150(93.8%)
were Muslim 9(5.6%) were Hindu and only one is
Buddhist. Income of the respondents 66(41.3%) were
in the range of 25001-50000 taka; Lowest 5(3.10) had
income of >75000 tk. The lowest value was 22000 tk.
(<25000). We observed that, majority 67 (41.9%) of
the respondent were only MBBS, whereas FCPS
were 24 (15%), Diploma degree 17 (10.6%), and then
M.Phil 16 ((10%), MD 6 (3.8%) MPH 5 (3.1%); And
the rest were in other category 25 (15.6%), like MCPS,
MRCOG, FRCS, MS. Distribution by designation
shows according to seniority, Professor were 19
(11.9%), Associate Prof. were 20 (12.5%),Asst. Prof.
16 (10%), Consultant were14 (8.8%).The highest
number were Medical Officer 48 (30%), whereas the
Lecturer were 24 (15%) among 160 physicians.
According to the respondents working area, out of
160, majority 120 (75%) were from Clinical division
and the rest were in Basic subject 40 (25%).
Knowledge and Perception on Noncommunicable Diseases Azreen Momen Chowdhury et al
148

3. Table-I
Socio-economic characteristics of the respondents
(n=160)
Variable (n=160) Frequency (F) Percent (%)
Age group
25-40 97 60.6
41-55 50 31.3
56-70 13 8.1
Mean±SD 38.94±10.49
Gender
Male 93 58.12
Female 67 41. 87
Marital Status
Unmarried 11 6.87
Married 149 93.1
Religion
Muslim 150 93.8
Hindu 09 5.6
Buddhist 01 0.625
Income
< 25000 33 20.6
25001-50000 66 41.3
50001-75000 21 13.1
>75000 5 3.1
Educational Status
MBBS only 67 41.9
MBBS+ MPH 5 3.1
MBBS+M.phil 16 10.0
MBBS+FCPS 24 15.0
MBBS+MD 6 3.8
MBBS+Diploma 17 10.6
Others 25 15.6
Designation
Professor 19 11.9
Assoc. Prof 20 12.5
Asst Prof 16 10.0
Consultant 14 8.8
Registrar 6 3.8
Asst. Registrar 12 7.5
Lecturer 24 15.0
MO 48 30.0
Working area
Basic 40 25.0
Clinical 120 75.0
Table-II
Distribution of respondents according to knowledge
on NCDs
Variables Frequency Percent
Meaning of NCDs(n=160) *
Non infectious 102 42.5
Non communicable 78 32.5
Chronic in nature 57 23.8
Others 3 1.3
Knowledge on the differentiating
criteria between CD and NCD (n=160)
Causative agent factor 65 40.6
Communicability 43 26.9
Duration& reversibility 39 24.4
Multi factorial 11 6.9
Others 2 1.3
Proportion of NCDs contributed
to Total death in Bangladesh (n=160)
<60% 26 16.25
60% 10 06.25
>60% 18 11.25
Don’t know 106 66.25
Severity of NCD attributing to total
disease burden (n=160)
Low 2 33.3
Medium 73 45.6
High 82 51.3
Don’t know 3 1.9
Four major NCDs reported
by WHO (n=160) *
CVD & Hypertension 159 34.12
DM 142 30.47
Cancer 74 15.87
COPD 87 18.66
Others 4 0.85
No. of disease correctly answered
among four major NCDs reported
by WHO (n=160)
2 diseases 28 17.5
3 diseases 51 31.9
4 diseases 81 50.6
No. of risk factor correctly ans
wered among four reported by
WHO (n=160) *
1 Risk factors 16 10
2 Risk factors 8 5.0
3 Risk factors 30 18.8
4 Risk factors 102 63.8
Others 4 2.5
Knowledge on preventive
approaches of NCD (n=160)
Don’t know 3 1.9
Primordial 47 29.4
Primary 87 54.4
Secondary 22 13.8
Tertiary 1 0.6
* Multiple responses
J Uttara Adhunik Med. College Vol. 03, No. 02, July 2013
149

4. Knowledge of meaning of NCDs- most of them 102
(42.5%) stated as non infectious characteristics;
followed by non communicable 78 (32.5%), chronic
in nature 57 (23.8), rest as others. It also showed
that knowledge on differentiating criteria between CD
and NCDs- 65(40.6%) respondents had knowledge
that, causative agent factors are the differentiating
criteria between CD and NCDs; followed by
communicability 43 (26.9%); duration & reversibility
39 (24.4%); multi factorial-11 (6.9%); Others 2
(1.3%). Out of 160 respondents knowledge on
proportion of NCDs contribution to total death in
Bangladesh 26 (16.25%) opines <60% death;
followed by 18 (11.25%) as >60% death and rest
60% by only 10 (06.25%); don’t know by 106
(66.25%). Knowledge on severity of NCDs attributing
to total disease burden 82 (51.3%) said as “high”;
73 (45.6%) said as “medium”, 2 (1.3%) said as “low”
and rest 3 (1.9%) said ‘don’t know”. Regarding
knowledge of name of four major NCDs reported by
WHO 159 (99.3%) said CVD & Hypertension, 142
(88.7%) said Diabetes Mellitus(DM), 87 (54.3%) said
COPD, 74 (46.2%) said Cancer and 4 (2.5%) said
others type of disease as major NCD. Out of 160
respondents correctly answered as major NCDs as
4 diseases 81 (50.6%); 3 diseases 51 (31.9%; then
28 (17.5%) as 2 diseases only. Majority 102 (63.8%)
could answer as four (4 ) risk factors; then 3 risk
factors by 30; next 8 (5.0%) as 2 risk factors and
only 1 risk factors by 16 (10%) as risk factor for
NCDs reported by WHO. Most of the respondent 87
(54.4%) knows “primary prevention” approaches of
level of diseases (NCDs) prevention and control
followed by ‘primordial prevention” 47 (29.4%),
secondary prevention’ 22 (13.8%), “tertiary” level of
prevention only 1 (0.6%) and 3 (1.9%) don’t know
any approaches of levels of disease (NCDs)
prevention and control. Out of 160 respondents
(33.75%) who answered about proportion of NCDs
contributed to total death in Bangladesh, only one
third answered correctly (33.33%).
Fig.-1: Distribution of respondents knowledge about
proportion of NCDs contributed to total death in
Bangladesh (n=160)
Table-III
Distribution of respondents according to perception of views regarding chronic NCDs (n=160)
Perception of views regarding Disagree Neutral Agree Total
Myths of chronic NCDs (n=160)
NCDs mainly affect high income countries 87(54.4%) 43(26.9%) 30(18.8%) 100(100)
NCDs mainly affects older people 86(53.8%) 40(25.0%) 33(20.6%) 100(100)
Low & middle income countries should 83(51.9%) 43(26.9%) 34(21.3%) 100(100)
control infectious disease before NCD
NCDs mainly affect rich people 94(58.80%) 39 (58.80%) 26(16.3%) 100(100)
NCDs affect male female equally 114(71.3%) 28(17.5%) 18(11.3%) 100(100)
NCDs are result of unhealthy life style 40(25.0%) 38(23.8%) 82(51.3%) 100(100)
NCDs cannot be well prevented 97(60.6%) 41(25.6%) 22(13.8%) 100(100)
NCDs prevention & control is expensive 126(78.8%) 16(10.0%) 18(11.30%) 100(100)
Knowledge and Perception on Noncommunicable Diseases Azreen Momen Chowdhury et al
150

5. NCDs “mainly affect high income countries” majority
87(54.4%) disagreed, while only 30 (18.8%) agreed
and rest 43 (26.9%) were neutral in response.
Regarding statement of NCDs “affects older people”
86 (53.8%) disagreed, 33 (20.6%) agreed and 40
(25.0%) were neutral in response. Statement of “Low
& middle income country should control infectious
disease” before NCDs - 83 (51.9%) disagreed, 34
(21.3%) agreed and the rest 43 (26.9%) were neutral
in response. NCDs “affects only rich people” 94
(58.80%) disagreed, 39 (58.80%) were neutral, while
agreed only 26 (16.3%) and NCDs “affects male,
female equally” most of them 114 (71.3%) disagreed,
28 (17.5%) were neutral and only 18 (11.3%) agreed.
NCDs are’ result of unhealthy life style”, 82 (51.3%)
agreed, 40 (25.0%) disagreed, 38 (23.8%) were neutral
in response. “NCDscannotwellprevented”,97(60.6%)
disagreed, 41 (25.6%) agreed, 22 (13.8%) were neutral
in response. Lastly statement of “NCDs prevention
and control” 126 (78.8%) disagreed, 18 (11.30%)
agreed and 16 (10.0%) were neutral in response.
Table-IV
Distribution of respondents according to Knowledge
and Perception score (n=160)
Knowledge Frequency Percentage 95% CI
Poor 48 30.0 22.9-37.1
Average 34 21.5 15.1-27.9
Good 45 28.0 21.1-35.0
Excellent 33 20.5 14.2-26.8
Total 160 100
Perception
Poor 48 30.0 22.9-37.1
Average 49 30.5 23.4-37.6
Good 36 22.5 16.0-29.0
Excellent 27 17.0 11.2-22.8
Total 160 100
Table-IV shows that knowledge scoring out of 160
respondents, was “poor” score was among 48 (30%,
95% CI-22.9, 37.1), “good” score was among 45(28%,
95% CI 15.1, 27.9), “average” score was among
34(21.5%, 95% CI-15.1, 27.9) and “excellent” score
was among 33(20.5%, 95% CI-14.2, 26.8) respectively.
Out of 160 respondents, almost one-third (30%, 95%
CI-22.9, 37.1) were found to have “poor” knowledge
regarding NCDs. The “average”, “good” and “excellent”
level of knowledge were found 28.0% (95% CI-15.1,
27.9), 21.5% (95% CI-15.1, 27.9), and 20.5 %( 95%
CI-14.2, 26.8) respectively. Regarding the “perception”
on NCDs, 30% (95% CI-22.9, 37.1) of the respondents
had “poor” score followed by 30.5% (95% CI-23.4,
37.6), 22.5% (95% CI-16.0, 29.0) and 17.0% (95%CI-
11.2-22.8) were “average”, “good” and “excellent”
perception respectively.
Table-V
Distribution of respondents according to Knowledge
and Perception & Working area (n=160)
Variables Basic Clinical P
subjects subjects value
Knowledge
Poor 5 46
Average 8 26 0.000
Good 13 32
Excellent 14 16
Perception
Poor 16 32
Average 11 38 0.201
Good 5 31
Excellent 8 19
Table-V shows there was significant relationship
between knowledge and working area (p value 0.000).
Regarding Perception between “basic” and “clinical”
doctors there was no significant association.
Discussion
The aim of this study was to focus exclusively on
knowledge and perception level of health professionals
and the determinants regarding NCDs. Though
improvement of knowledge and perception on NCDs
is an important component of NCDs promotion;
especially in low income countries- with inadequate
and insufficient health professionals.
In the context of knowledge of the respondents, as it
is one of the important components of awareness,
the questions were made exclusively on NCDs. As
the literature search on awareness of health
professionals on NCDs in developing countries yielded
rarely any study and virtually no data on a whole
population to the best of my knowledge.
J Uttara Adhunik Med. College Vol. 03, No. 02, July 2013
151

6. In relation to the knowledge about proportion of NCDs
contributed to total deaths in Bangladesh, out of 160
respondents, only 54 responds as they know, other
majority106 (66.25%) do not know. Respondents
(33.75%) who answered about proportion of NCDs
contributed to total death in Bangladesh, only one
third answered correctly (33.33%). This finding also
indicates lack of accurate knowledge regarding NCDs.
According to WHO category of four major diseases,
out of 160 respondents more than half (50.6%)
correctly answer all the four diseases as CVDs &
Hypertension, Diabetes, COPD & Cancer suggesting
that they have good knowledge on this important
component.
Similarly, for common risk factors about three-fourth
(63.8%) could answer correctly all, followed by 3 risk
factors, then 2 risk factors and only 10% as single
risk factors. These finding also suggests, that they
are well knowledgeable on these important factors.
Our study explores more than half 87(54.4%) knew
correctly the approach for the prevention & control of
NCDs as “Primary prevention’, then the newer
concepts of “Primordial prevention’ and other level of
prevention. A multicentre study (21 hospitals in
Bangladesh, Dominican Republic, Ethiopia, Indonesia,
Philippines, Tanzania and Uganda) assessed
knowledge of five important clinical problems: Three
fourths of the doctors had inadequate knowledge in at
least one area, compared with 91% of nurses and
medical assistants. Knowledge was much better
among doctors in teaching hospitals than doctors in
district hospitals, but nurses and medical assistants
had poor knowledge in both district and teaching
hospitals.11
Regarding source or media for updating knowledge in
the work place multiple answered in favor of
combination of different media, 120 by “clinical meeting
and seminar”; 100 by ‘Internet”, 27 from “ Journals”;
and only 23 from “Books” .As all were working in the
same institute availing almost same sources of
facilities like library, MEU, clinical meeting, more or
less similar.Availability of health information provides
confidence in clinical decision-making improves
practical skills and attitude to care and alleviates
professional isolation, yet this resource remains
invisible in the complex health care systems.
Regarding suggestion to overcome from the barriers,
most of them highlight for raising knowledge (30.6%)
followed by training, institutional support, provision of
resources and others. About others - Government,
political and NGO support included as remarks.
Related to this finding, the most commonly reported
barrier was heavy workload (70%), followed by lack of
guidelines (47%) and unclear objectives (40%); reveals
that heavy workload emerged as a greater problem
for all professional groups who work at primary health
care centers compared to those who work in hospitals.
As a group, physicians (84%) were most likely, and
psychologists least likely (55%), to report heavy
workload as a barrier for health promotion in practice).
In decreasing order of frequency, low priority from the
management was the fourth barrier (31%). Those
involved in teaching were more likely to report this
barrier (49%) compared to those who were not
teaching (27%).12
The results of the 5 important questions which have
been marked for the scoring of knowledge were
evaluated from the researcher’s total assessment as
study on this subject. Finally, after scoring of the
knowledge variables, it was found that- out of 160
respondentsalmostone-thirdwerefoundtohave“poor”
knowledge regarding NCDs followed by ‘average”,
‘good” and “excellent” level of knowledge; lower than
this study finding- (63%) of nutrition knowledge of
physicians in Canada (Temple, 1999).13 Health
professionals are urged to increase their knowledge
in this area on an ongoing basis. However, much
caution is necessary before generalizing these results
beyond our study population of physicians.
Regarding the perception on NCDs, 30% of the
respondents had poor score followed by 30.5%, 22.5%
and 17.0% were “average”, ‘good’ and “excellent’
perception respectively (Table- 9).These statement
were quoted from the popular myths about NCDs, by
Likert’s scale- opinion was scored.
Conclusion
The current results showed that in general the health
professionals are not up to date aware of the
importance of NCDs and few of them do not know the
current alarming situation of NCDs. There are
substantial lacunae in the knowledge about different
aspects of the NCDs updated information, such as
present situation in Bangladesh, severity of disease,
WHO classification of major diseases, risk factors,
prevention approach and national program. In respect
to perception of common beliefs, also existing
misconception and confusion found among the
Knowledge and Perception on Noncommunicable Diseases Azreen Momen Chowdhury et al
152

7. doctors. Moreover, information concerning NCDs
knowledge among practicing physicians was not
satisfactory.
Recommendations:
Considering the high unmet need for NCDs awareness
for proper work forces in the health care delivery
system, the deplorable situation of existing system
that prevails in our country as well as regionally and
globally, proposals are put forward for consideration
of the future researcher generation and policy makers.
In every medical college hospital and specialized
hospital, a centre on NCD, by NCDs specialist should
be established. There should be effective
dissemination of information regarding NCDs as a
prerequisite for any successful change in the society.
Preventive program should be integrated with clinical
services, as well as newer teaching curriculum on
NCDs to be made for MBBS and post graduation
course. More budgets and funding should be allocated
for NCDs awareness promotion. Policy maker should
develop a national guide line and plan of actions for
implementation of NCDs program for health care
providers. Well-designed, large scale analytical study
to be carried out- to explore awareness among other
groups of health professional in future.
References:
1. Murray CJL, Lopez AD, The Global Burden of Disease: A
comprehensive Assessment of Mortality & Disability from
Diseases, Injuries and risk factors 1990 & Projected to
2020. Harvard University Press. Boston. 1996
2. http.//www.biology-online.org/dictionary/Non-
communicable-Diseases-NJDIWJMJ: Wikipedia.
(Accessed, Mar 21, 2011).
3. Priority actions for the non-communicable disease
crisis.http://www.ncbi.nlm.nih.gov/pubmed/21474174
4. WHO. Global status report on noncommunicable diseases
2010- Description of the global burden of NCDs, their risk
factors and determinants. 2011.http://www.who.int/nmh/
publications/ncd_report_full_en.pdf
5. WHO. Mortality and burden of disease estimates for WHO
Member States in 2004. Geneva: World Health
Organization, 2009.
6. The burden of NCDs in developing countries.
www.equityhealthj.com/content/4/1 /2 by A Boutayeb -
2005 - Cited by 134 - Related article,(Accessed
14July,2011)
7. Fidler, David P., “After the Revolution: Global Health Politics
in a Time of Economic Crisis and Threatening Future
Trends” (2009). FacultyPublications. BMJ, Paper 145.
http://www.repository.law.indiana.edu/facpub/145.
8. Prioritized research agenda for prevention& control of
NCDs-WHO, 2010. whqlibdoc.who.int/publications/2011/
9789241564205_eng.pdf
9. Grand challenges in chronic NCDs-The top 20 Policy.
www.procor.org/research/research_show.htm?doc_id
=684149, Accessed 22 Feb 2008.
10. WHO Commission on the Social Determinants of health.
Geneva: World Health Organization, 2008.
11. Nolan T, Angos P, Cunha AJ, Muhe L, Qazi S, Simoes EA,
et al.: Quality of hospital care for seriously ill children in
less-developed countries. Lancet 2001, 357(9250):106-
10.
12. Helene Johansson et al: Reorientation to more health
promotion in health services – a study of barriers and
possibilities from the perspective of health professionals.
Journal of Multidisciplinary Health Care.25 NOV.2010.
13. Temple, N.J. Survey of nutritional knowledge of Canadian
physicians, Journal ofAmerican College of Nutrition, 1999;
18: pp. 26-29.
J Uttara Adhunik Med. College Vol. 03, No. 02, July 2013
153