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Bear AP, Bennett WL, Katz J, Lee KH, Chowdhury AI, Bari S, El Arifeen S, Gurley ES. Associations of hypertension and antenatal care-seeking with perinatal mortality: A nested case-control study in rural Bangladesh. PLoS One 2024; 19:e0287622. [PMID: 39037995 PMCID: PMC11262631 DOI: 10.1371/journal.pone.0287622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
Maternal hypertension may be an underrecognized but important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth quintile. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Among 191 cases and 934 matched controls, hypertension prevalence was 14.1% among cases and 7.7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2.90, 95% CI 1.29, 6.57), but not among women with diagnosis during pregnancy (OR 1.68, 95% CI 0.98, 2.98). We found no association between the number of antenatal care contacts and perinatal death (p = 0.66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh.
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Affiliation(s)
- Allyson P. Bear
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United Stated of America
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Kyu Han Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Atique Iqbal Chowdhury
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sanwarul Bari
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
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Ahmmed F, Hossain MJ, Khan MTF, Manik MMR, Shahriar S, Nandi DC, Hussain MP. Mediating effect of BMI on the association of economic status and coexistence of hypertension and diabetes in Bangladesh: A counterfactual framework-based weighting approach. Health Sci Rep 2024; 7:e2063. [PMID: 38660004 PMCID: PMC11039488 DOI: 10.1002/hsr2.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels. Methods A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017-18 were utilized for this study. Survey-based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework-based weighting approach was utilized for mediation analysis. Results Middle-income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor. Conclusions The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set-up to decide on health policies regarding hypertension and diabetes.
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Affiliation(s)
- Foyez Ahmmed
- Department of StatisticsComilla UniversityCumillaBangladesh
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Md. Jamal Hossain
- Department of Pharmacy, School of Pharmaceutical SciencesState University of BangladeshDhakaBangladesh
| | | | | | - Saimon Shahriar
- Department of Pharmacy, School of Pharmaceutical SciencesState University of BangladeshDhakaBangladesh
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Sen KK, Jamee AR, Islam UN, Bari W. Unveiling the effects of living standards on diabetes and hypertension with the mediating role of overweight and obesity: a cross-sectional study in Bangladesh. BMJ Open 2023; 13:e075370. [PMID: 37963706 PMCID: PMC10649606 DOI: 10.1136/bmjopen-2023-075370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE The purpose of the study was to ascertain how the standard of living is associated with the likelihood of developing diabetes and hypertension directly as well as indirectly through overweight and obesity. STUDY DESIGN The study used 2017-2018 Bangladesh Demographic and Health Survey data. It examined the household living standard (LSD) as the main factor, and body mass index (BMI) as a mediator. Outcomes included diabetes status, hypertension status and their co-occurrence. Structural equation modelling with logistic regression and bootstrapping were used for mediation analysis and computing bias-corrected SEs. SETTING The research was carried out in Bangladesh and included both male and female adults. PARTICIPANTS The study encompassed a total of 11 961 adults (5124 males and 6837 females) aged 18 years or older. RESULTS Among the participants, 10.3% had diabetes, 28.6% had hypertension and 4.9% had both conditions. The prevalence of diabetes, hypertension or both conditions was 18.5%, 33.5% and 9.7%, respectively, among those with a high LSD. Regression analysis demonstrated that individuals with high LSD had significantly elevated risks of these conditions compared with those with low LSD: 133% higher odds for diabetes (OR 2.22; 95% CI 1.97 to 2.76), 25% higher odds for hypertension (OR 1.25; 95% CI 1.10 to 1.42) and 148% higher odds for both conditions (OR 2.48; 95% CI 1.96 to 3.14). Moreover, the indirect effects of high LSD through obesity surpassed its direct effects for developing diabetes, hypertension or both conditions. CONCLUSION This study emphasises that with the enhancement of LSD, individuals often experience weight gain, resulting in elevated BMI levels. This cascade effect significantly amplifies the risks of diabetes, hypertension or both conditions. To counteract this concerning trajectory, policy interventions and targeted awareness campaigns are imperative. These efforts must prioritise the promotion of heightened physical activity and the mitigation of the overweight/obesity surge associated with rising LSD.
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Affiliation(s)
| | | | | | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
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Bear AP, Bennett WL, Katz J, Lee KH, Chowdhury AI, Bari S, El Arifeen S, Gurley ES. Self-reported diabetes or hypertension diagnoses and antenatal care among child-bearing women in rural Bangladesh: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002175. [PMID: 37708098 PMCID: PMC10501644 DOI: 10.1371/journal.pgph.0002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
Health care systems in low- and middle-income countries may not meet the needs of pregnant women where the burden of diabetes and hypertension is rapidly increasing. We asked recently pregnant women about ever having been screened for or diagnosed with hypertension or diabetes and their ANC-seeking experiences in a cross-sectional survey. We used chi-squared tests and logistic regression to test the associations between self-reported coverage of hypertension and diabetes screening, diagnoses, and elements of ANC by age, wealth, educational attainment, and gravidity. Among 4,692 respondents, for hypertension, 97% reported having been screened and 10% of screened women reported a diagnosis. Women 30-39 years of age (aOR 3.02, 95% CI 2.00, 4.56) or in the top wealth quintile (aOR 1.70, 95% CI 1.18, 2.44) were more likely to be diagnosed with hypertension compared to reference groups. Any hypertension diagnosis was associated with reporting four or more antenatal care contacts (44% vs. 35%, p < 0.01), blood pressure measurements (85% vs. 79%, p < 0.01), and urine tests (71% vs. 61%, p < 0.01) conducted during ANC visits. For diabetes, 46% of respondents reported having been screened and 3% of screened women reported a diagnosis. Women 30-39 years of age were more likely to be diagnosed with diabetes (aOR 8.19, 95% CI 1.74, 38.48) compared to the reference group. Any diabetes diagnosis was associated with reporting four or more ANC contacts (48% vs. 36%, p = 0.04) and having blood testing during pregnancy (83% vs. 66%, p < 0.01). However, the frequency and quality of ANC was below the national guidelines among all groups. Focused efforts to ensure that women receive the recommended number of ANC contacts, coupled with improved compliance with ANC guidelines, would improve awareness of hypertension and diabetes among women in Bangladesh.
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Affiliation(s)
- Allyson P. Bear
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy L. Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kyu Han Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Atique Iqbal Chowdhury
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sanwarul Bari
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Diabetes, Hypertension, and Comorbidity among Bangladeshi Adults: Associated Factors and Socio-Economic Inequalities. J Cardiovasc Dev Dis 2022; 10:jcdd10010007. [PMID: 36661902 PMCID: PMC9863699 DOI: 10.3390/jcdd10010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Diabetes, hypertension, and comorbidity are still crucial public health challenges that Bangladeshis face. Nonetheless, very few studies have been conducted to examine the associated factors, especially the socioeconomic inequalities in diabetes, hypertension, and comorbidity in Bangladesh. This study explored the prevalence of, factors connected with, and socioeconomic inequalities in diabetes, hypertension, and comorbidity among Bangladeshi adults. We used the Bangladesh Demographic and Health Survey (BDHS) data set of 2017−2018. A total of 12,136 (weighted) Bangladeshi adults with a mean age of 39.5 years (±16.2) participated in this study. Multilevel (mixed-effect) logistic regression analysis was employed to ascertain the determinants of diabetes, hypertension, and comorbidity, where clusters were considered as a level-2 factor. The concentration curve (CC) and concentration index (CIX) were utilized to investigate the inequalities in diabetes, hypertension, and comorbidity. The weighted prevalence of diabetes, hypertension, and comorbidity was 10.04%, 25.70%, and 4.47%, respectively. Age, body mass index, physical activity, household wealth status, and diverse administrative divisions were significantly associated with diabetes, hypertension, and comorbidity among the participants. Moreover, participants’ smoking statuses were associated with hypertension. Women were more prone to hypertension and comorbidity than men. Diabetes (CIX: 0.251, p < 0.001), hypertension (CIX: 0.071, p < 0.001), and comorbidity (CIX: 0.340, p < 0.001) were higher among high household wealth groups. A pro-wealth disparity in diabetes, hypertension, and comorbidity was found. These inequalities in diabetes, hypertension, and comorbidity emphasize the necessity of designing intervention schemes geared towards addressing the rising burden of these diseases.
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Yaya S, Ghose B. Change in nutritional status among women of childbearing age in India (1998-2016). Obes Sci Pract 2020; 6:535-543. [PMID: 33082995 PMCID: PMC7556433 DOI: 10.1002/osp4.433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction In absolute numbers, India has more undernourished people than all the countries in sub‐Saharan Africa combined. In parallel with the high rates of hunger and undernutrition, the country has been undergoing rapid demographic and dietary transition marked by an increased prevalence of overweight/obesity, particularly among women. Objective To measure the changing prevalence of overnutrition during last two decades, as well as to identify the associated sociodemographic correlates among pregnant and non‐pregnant women in India. Methods This was a cross‐sectional study based on data from the latest round of National Family Health Survey (2015–2016) conducted among urban and rural women. Participants were 687,876 women (655,850 non‐pregnant and 32,026 pregnant) aged between 15 and 49 years. Nutritional status was assessed in terms of body mass index (BMI) using the cut‐off for Asian population. Results Since 1998–1999, the prevalence of underweight has decreased by 9.2%, while that of overweight (BMI = 23–27.4 kg/m2) and obesity (BMI ≥ 27.5 kg/m2) has increased by 6.7% and 3.4%, respectively. Results of multivariable regression analysis revealed significant association between nutritional status and age, parity residency, educational level, religious affiliation, household wealth quintile, and TV watching behaviour. Of those, age and wealth status appeared to be the strongest predictors among both pregnant and non‐pregnant women. Conclusion Since 1998, there has been a considerable drop in the prevalence of underweight and rise in the prevalence of overweight and obesity. Significant sociodemographic variations exist in nutritional status, notably age and financial situation, which should be highlighted in national nutrition policymaking and intervention programmes.
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Affiliation(s)
- Sanni Yaya
- Faculté de Médecine Université de Parakou Parakou Benin
| | - Bishwajit Ghose
- Institute of Nutrition and Food Science University of Dhaka Dhaka Bangladesh
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Chowdhury MZI, Rahman M, Akter T, Akhter T, Ahmed A, Shovon MA, Farhana Z, Chowdhury N, Turin TC. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clin Hypertens 2020; 26:10. [PMID: 32514373 PMCID: PMC7262759 DOI: 10.1186/s40885-020-00143-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and three-quarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I2 = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.
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Affiliation(s)
- Mohammad Ziaul Islam Chowdhury
- Department of Community Health Sciences, University of Calgary, TRW Building (3rd Floor), 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Meshbahur Rahman
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tanjila Akter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tania Akhter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Arifa Ahmed
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Minhajul Arifin Shovon
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Zaki Farhana
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Nashit Chowdhury
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Tanvir C Turin
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
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Pezeshki B, Bahramali E, Ansari A, Karimi A, Sabet M, Farjam M, Dehghan A. Impact of Physical Activity on the Incidence of Vascular Diseases in Adults with Type 2 Diabetes Mellitus. Galen Med J 2019; 8:e1549. [PMID: 34466526 PMCID: PMC8344092 DOI: 10.31661/gmj.v8i0.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/08/2019] [Accepted: 05/20/2019] [Indexed: 11/16/2022] Open
Abstract
Background Diabetes mellitus (DM) is a common metabolic disease worldwide and has many complications. Vascular events are the major complication of DM, which have an important effect on mortality and disability. Physical activity (PA) enhances the vascular function by several pathways. The aim of this study was to evaluate the relationship between PA and vascular diseases in patients with DM. Materials and Methods This study was performed as a case-control study extracted from a prospective epidemiological research study in Iran. Patients with type 2 DM for more than six months as a case group were compared to sex- and age-matched healthy control subjects. The metabolic equivalent of task score was used to evaluate the level of PA and blood glucose, lipid profile, body mass index, overweight, dyslipidemia, glomerular filtration rate, myocardial infarction, unstable angina, and stroke. Results Overall, 1242 patients with DM were extracted, and 2484 non-DM subjects were investigated. In the case group, 355 (28.6%) and 887 (71.4%) subjects were men and women, respectively, and 710 (28.6%) men and 1774 (71.4%) women were in the control group. The mean metabolic equivalent of task score was 30 and 40.97 in the DM and non-DM groups, respectively (P˂0.001). The frequency of myocardial infarction, stroke, and cardiac ischemia was 44 (3.5%), 37 (3%), and 267 (21.5%) in the DM group, and 54 (2.2%), 43 (1.7%), and 389 (15.7%) in the non-DM group, respectively. Conclusion The incidence of vascular events associated with PA level in patients with DM and adherence to regular PA reduced vascular events and DM complications.
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Affiliation(s)
- Babak Pezeshki
- Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ehsan Bahramali
- Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Correspondence to: Ehsan Bahramali, Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran Telephone Number: +989173118268 Email Address :
| | - Amir Ansari
- Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Aliasghar Karimi
- Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Student Research Committee of Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad Sabet
- Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases (NCD) Research Center, Fasa University of Medical Sciences, Fasa, Iran
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