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Loh SM, Moloantoa T, Yende N, Variava E, Niaura R, Golub JE, Martinson N, Elf JL. A cross-sectional study of attitudes and behaviors of snuff use and cessation among people with and without HIV in South Africa. Tob Use Insights 2023; 16:1179173X231193890. [PMID: 37577008 PMCID: PMC10422901 DOI: 10.1177/1179173x231193890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Background Despite a high (48%) prevalence of snuff use among women with HIV in South Africa, little is known of the attitudes and behaviors of use, strategies for cessation, and potential health risks. Methods In a cross-sectional study, a questionnaire was administered to adults (≥18 years) with (HIV+) and without HIV (HIV-) who self-reported current snuff use to collect information on demographics, snuff use and cessation attempts, preferred strategies for cessation, other substance use, history of respiratory illness, and mental health. Results 150 (74 HIV+, 76 HIV-) participants were enrolled; 115 (77%) were daily snuff users, 6 (4%) were current smokers, and 17 (11%) former smokers. Top reasons for current snuff use included improving health (n = 48, 32%), reducing stress (n = 26, 16%), and "being a habit" (n = 38, 25%). Participants believed snuff use to have mostly positive (n = 68, 46%) or no (n = 54, 36%) health impacts, and 57 (38%) participants believed snuff cures headaches. 103 (69%) participants reported a previous quit attempt, and 110 (73%) indicated high interest in quitting snuff. Although 105 (70%) participants indicated that advice from a healthcare provider would aid them in quitting snuff, only 30 (20%) reported ever receiving that advice. A majority of participants (n = 141, 94%) suffer from moderate to high levels of perceived stress, and overall few differences were seen by HIV status. Conclusions Education on negative impacts of snuff, advice to quit from healthcare providers, and nicotine replacement therapy should be considered in the development of a snuff cessation program.
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Affiliation(s)
- Samantha M. Loh
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | | | | | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, Matlosana, South Africa
| | - Raymond Niaura
- Department of Epidemiology; Department of Social and Behavioral Sciences, New York University, New York, NY, USA
| | - Jonathan E. Golub
- Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Jessica L. Elf
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Bongongo T, Jeewa Y, Nzaumvila DK, Govender I. Awareness of health risks associated with smokeless tobacco use among users in Pretoria. S Afr Fam Pract (2004) 2022; 64:e1-e6. [PMID: 36453800 PMCID: PMC9724137 DOI: 10.4102/safp.v64i1.5560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Smokeless tobacco (ST) refers to all tobacco-containing products that are not smoked but rather consumed through other means. Contrary to the popular belief that ST products are safe, the use of such products exposes users to health risks. To assess the awareness of health risks associated with ST use among users in a Pretoria community, the study was conducted in Ramotse community, located in Tshwane region 2, Gauteng, South Africa. METHODS This was a cross-sectional design, using a piloted, structured and self-administered questionnaire. RESULTS Of 479 participants with a mean age of 43 years (ranging from 18 to 89 years), most were in the age group 30-39 years (148; 31.6%), followed by ≥ 50 years (138; 29.4%). There were more females (371; 77.5%), more unemployed (263; 54.9%), married (236; 49.7%), had reached the secondary level of education (270; 56.4%), did not have any chronic illness (274; 57.2%), used snuff by nose (338; 70.6%), and were unaware of health risks associated with ST use (452; 94.4%). CONCLUSION This study has demonstrated a poor awareness of health risks associated with ST use among the users in a Pretoria community. As a result, health education at various levels of the community (clinic, schools, ward-based outreach team or WBOT, etc.) could be one strategy for resolving the problem.
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Affiliation(s)
- Tombo Bongongo
- Department of Family Medicine & Primary Health Care, School of Health, Sefako Makgatho Health Sciences University, Pretoria.
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Hounkpatin SHR, Flatin MC, Bouraima AF, Amegan HN, Toukourou Adios MAF, Adjibabi W. Rhinologic signs associated with snuff taking. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:43-45. [PMID: 31699623 DOI: 10.1016/j.anorl.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study rhinologic signs associated with nasal tobacco (snuff) intake in Parakou, northern Benin. MATERIALS AND METHODS A cross-sectional descriptive comparative study included 300 tobacco snuff takers and 300 subjects who did not use tobacco at all. The sampling technique was a stratified 4-stage random sample for non-users and a convenience non-random sample for snuff takers. RESULTS The sex-ratio was 0.92 in non-users and 41.9 in snuff takers. Duration of snuff taking was more than 20 years in 24.3% of cases. The symptoms studied were significantly more frequent in snuff takers than non-users (P<0.05). Snoring was reported by 58.3% of snuff takers, versus 5.7% of non-users (P=0.000). Nasal obstruction and rhinorrhea were reported by respectively 26.3% and 22.7% of snuff takers, versus 6.3% and 5.3% of non-users (P=0.000). Hyposmia was reported by 14% of snuff takers, versus 1.3% of non-users (P=0.000). Anterior rhinoscopy found abnormalities in 81.7% of snuff takers, compared to 10.67% of non-users. Nasal hypertrichosis was more frequent in snuff takers than non-users: 40% versus 5% (P=0.000). CONCLUSION Nasal intake of tobacco is responsible for morbidity in snuff takers compared to non-users of tobacco.
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Affiliation(s)
| | - M C Flatin
- Faculté de médecine de l'Université de Parakou, Parakou, Benin
| | - A F Bouraima
- Faculté de médecine de l'Université de Parakou, Parakou, Benin
| | - H N Amegan
- Faculté des sciences de la Santé de l'Université d'Abomey-Calavi, Cotonou, Benin
| | | | - W Adjibabi
- Faculté des sciences de la Santé de l'Université d'Abomey-Calavi, Cotonou, Benin
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Ware LJ, Charlton K, Kruger R, Breet Y, van Rooyen J, Huisman H, Botha S, Uys AS, Rennie KL, Naidoo N, Kowal P, Schutte AE. Assessing tobacco use in an African population: Serum and urine cotinine cut-offs from South Africa. Drug Alcohol Depend 2019; 195:82-89. [PMID: 30593984 PMCID: PMC6424978 DOI: 10.1016/j.drugalcdep.2018.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cotinine, a nicotine metabolite, is used to measure tobacco use and exposure, but recommended cut-offs to differentiate tobacco users from those exposed through the environment range from 3 to 58 ng/ml in serum, and 2.5 to 550 ng/ml in urine. Cut-offs may differ by ethnicity, sex and age. As data from adults in Africa are scarce, our aim was to evaluate cut-offs for serum and urine cotinine that best predict self-reported tobacco use in South African adults. METHODS Two datasets were explored: African-PREDICT (n = 941 black and white healthy young adults, 20-30 years, serum cotinine); and WHO SAGE Wave 2 (n = 604 adults, 18-102 years, urine cotinine). Population specific cut-offs (ROC analyses) were compared with published cut-offs and self-reported tobacco use. RESULTS Overall, 19% (293 of 1545) reported current tobacco use. The following cotinine cut-offs showed the highest sensitivity and specificity: serum ≥15 ng/ml in black and white men, and white women; serum ≥10 ng/ml in black women; urine ≥300 ng/ml for black, mixed ancestry, and older adults (50-plus years); urine ≥500 ng/ml for younger adults (18-49 years). Specificity was lower for urine than for serum cotinine. CONCLUSION Our study suggests that a serum cotinine level of ≥15 ng/ml and a urine cotinine level of ≥300 ng/ml best distinguish current tobacco users from non-users generally in the South African adult population.
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Affiliation(s)
- Lisa J. Ware
- South African MRC Developmental Pathways for Health
Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University
of the Witwatersrand, Johannesburg, South Africa;
,Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa; ;
; ;
; ;
| | - Karen Charlton
- School of Medicine, University of Wollongong, and Illawarra Health and Medical Research Institute, New South Wales, Australia.
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Johannes van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Hugo Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Shani Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.
| | - Aletta S. Uys
- Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa; ;
; ;
; ;
| | - Kirsten L. Rennie
- Centre for Lifespan and Chronic Illness Research,
University of Hertfordshire, United Kingdom;
| | | | - Paul Kowal
- World Health Organization (WHO), Geneva, Switzerland; University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, Australia.
| | - Aletta E. Schutte
- Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa; ;
; ;
; ;
,MRC Research Unit for Hypertension and Cardiovascular
Disease, North-West University, South Africa
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Hossain MS, Kypri K, Rahman B, Akter S, Milton AH. Health knowledge and smokeless tobacco quit attempts and intentions among married women in rural Bangladesh: Cross-sectional survey. Drug Alcohol Rev 2015; 35:514-22. [PMID: 26530853 DOI: 10.1111/dar.12346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 08/27/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS The aim of this study was to investigate health knowledge, attitudes and smokeless tobacco quit attempts and intentions among married women in rural Bangladesh. DESIGN AND METHODS A cross-sectional survey was conducted using an interviewer administered, pretested, semistructured questionnaire. All 8082 women living in the Jhaudi and Ghotmajhee local government areas, aged ≥18 years with at least one pregnancy in their lifetime, were invited to participate. Questions covered smokeless tobacco consumption (STC), knowledge regarding its health effects, users' quit attempts and intentions and sociodemographic characteristics. RESULTS Eight thousand seventy-four women completed the survey (response rate 99.9%). Almost half (45%) of current consumers thought STC was good for their health and many ascribed medicinal values to it, for example 25% thought STC reduced stomach aches. A quarter had previously tried to quit and 10% intended to quit. After adjusting for potential confounders, inaccurate knowledge of STC health consequences was associated with being older [adjusted odds ratio (aOR) = 2.71, 95% confidence interval (CI) 1.99-3.50], less educated (aOR = 2.18, 95% CI 1.66-2.85), Muslim (aOR = 17.0, 95% CI 12.0-23.9) and unemployed (aOR = 29.7, 95% CI: 25.2-35.1). Having less education (aOR = 2.52, 95% CI 0.98-6.45) and being unemployed (aOR = 1.52, 95% CI 1.03-2.23) were associated with the intention to quit. DISCUSSION AND CONCLUSIONS Large gaps exist in rural Bangladeshi women's understanding of the adverse health effects of STC. Health awareness campaigns should highlight the consequences of STC. Routine screening and cessation advice should be provided in primary healthcare and smokeless tobacco control strategies should be implemented. [Hossain MS, Kypri K, Rahman B, Akter S, Milton AH. Health knowledge and smokeless tobacco quit attempts and intentions among married women in rural Bangladesh: Cross-sectional survey. Drug Alcohol Rev 2016;35:514-522].
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Affiliation(s)
| | - Kypros Kypri
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, the University of New South Wales, Sydney, Australia
| | - Shahnaz Akter
- Directorate General of Health Services, Dhaka, Bangladesh
| | - Abul Hasnat Milton
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Agaku IT, Adisa AO, Omaduvie UT, Vardavas CI. The relationship between proximity of tobacco retail outlets to schools and tobacco use among school personnel in sub-Saharan Africa. Prev Med 2014; 69:21-7. [PMID: 25152505 DOI: 10.1016/j.ypmed.2014.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/08/2014] [Accepted: 08/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND We investigated the impact of proximity of tobacco retail outlets to schools on tobacco-related behavior and attitudes of school personnel in sub-Saharan Africa. METHODS A pooled analysis of the 2006-2011 Global School Personnel Surveys from 19 sub-Saharan African countries was performed (n=12,201). Multivariate logistic regression analyses were applied to measure the relationship between proximity of tobacco outlets to school premises and school personnel's tobacco-related behavior and attitudes (p<0.05). RESULTS Among all school personnel, there was a significant association between the presence of tobacco outlets on school premises and current cigarette smoking (adjusted odds ratio [aOR]=3.89; 95% confidence interval [CI]: 2.17-7.20), current smokeless tobacco use (aOR=2.63; 95%CI: 1.04-6.65), and permissiveness towards tobacco industry sponsorship activities in school (aOR=2.27; 95%CI: 1.37-3.78). Complete smoke-free school policies were associated with lower odds of current cigarette smoking (aOR=0.42; 95%CI: 0.23-0.74), but were not significantly associated with current smokeless tobacco use. Among lifetime any tobacco users, there was a significant association between the presence of tobacco outlets on school premises and use of combustible (aOR=2.03; 95%CI: 1.09-3.75) and smokeless (aOR=3.85; 95%CI: 1.51-9.81) tobacco products on campus within the past year. CONCLUSIONS Policies limiting the distance of tobacco outlets from schools, coupled with complete tobacco-free school policies may reduce tobacco use among school personnel.
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Affiliation(s)
- Israel T Agaku
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, USA.
| | | | | | - Constantine I Vardavas
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, USA
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Agaku IT, Ayo-Yusuf OA, Vardavas CI, Connolly G. Predictors and patterns of cigarette and smokeless tobacco use among adolescents in 32 countries, 2007-2011. J Adolesc Health 2014; 54:47-53. [PMID: 24060573 PMCID: PMC3872244 DOI: 10.1016/j.jadohealth.2013.07.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE This study compared data from 32 countries to assess predictors and patterns of cigarette and smokeless tobacco (SLT) use among students aged 13-15 years old. METHODS Data from the 2007-2008 Global Youth Tobacco Surveys were analyzed for students aged 13-15 years in 31 countries located in all six World Health Organization regions. In addition, the 2011 National Youth Tobacco Survey was analyzed for U.S. students aged 13-15 years. Country-specific prevalence of current smoking, current SLT use, and concurrent use patterns were assessed. RESULTS The national prevalence of current cigarette smoking among students aged 13-15 years ranged from 1.8% (Rwanda) to 32.9% (Latvia), whereas current SLT use ranged from 1.1% (Montenegro) to 14.4% (Lesotho). In the U.S. and most European countries surveyed, current smoking prevalence was significantly higher than SLT prevalence, in contrast to patterns observed in low- and middle-income countries. Also, in most of the surveyed countries outside of Europe and the United States, SLT use among girls was as common as their use of cigarettes, and not significantly different from use by boys. When compared with U.S. adolescents, the odds of SLT use were highest among African adolescents (adjusted odds ratio = 3.98; 95% CI: 2.19-7.24) followed by those in the Southeast Asian region (adjusted odds ratio = 2.76; 95% CI: 1.38-5.53). CONCLUSIONS Region-specific patterns of tobacco use were noticed. Furthermore, it is alarming that in several low- and middle-income countries, the prevalence of SLT use among females did not differ from that among males, suggesting the possibility of a future shared burden of disease between both males and females.
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Affiliation(s)
- Israel T Agaku
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts.
| | - Olalekan A Ayo-Yusuf
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts; Department of Community Dentistry, University of Pretoria, South Africa
| | - Constantine I Vardavas
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts
| | - Gregory Connolly
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts
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Ayo-Yusuf OA, Odukoya OO, Olutola BG. Sociodemographic correlates of exclusive and concurrent use of smokeless and smoked tobacco products among Nigerian men. Nicotine Tob Res 2013; 16:641-6. [PMID: 24323573 DOI: 10.1093/ntr/ntt199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study sought to determine the sociodemographic correlates of exclusive and concurrent use of smokeless tobacco (SLT) and smoking (i.e., dual use) and to explore the association between SLT use and the amount of cigarettes smoked per day. METHODS Data were obtained from a nationally representative sample of Nigerian men aged 15-59 years (N = 15,453) who participated in the 2008 Nigerian Demographic and Health Survey (NDHS). The NDHS used an interviewer-administered questionnaire to collect data on participants' sociodemographic characteristics and tobacco use status. Taking account of the multistage sampling used in the NDHS, data analyses included descriptive statistics, chi-square analysis, and multivariable adjusted multinomial logistic regression analysis. RESULTS Of the respondents, 12.2% (n = 1,842) were tobacco users, out of which 24.5% (n = 477) were exclusive SLT users, 69% (n = 1,236) were exclusive smokers, and 6.5% (n = 129) were dual users. Both SLT use and smoking were most prevalent among the Igbo ethnic group and among the least educated men. SLT use was most prevalent among those in the southeast (9.75%) and north-central (7.71%) regions, where smoking was also common. The number of cigarettes smoked per day was not significantly different among dual users when compared with exclusive smokers (7.3 vs. 5.6; p = .088). Dual users were also more likely to self-identify as traditionalists (RRR = 6.03; 95% CI = 2.96-12.28) compared with self-identifying as practicing Islam or Christianity. CONCLUSIONS There are distinctive ethnic and regional differences in tobacco use patterns among Nigerian men, and SLT use was not associated with reduced smoking intensity among dual users.
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Affiliation(s)
- Olalekan A Ayo-Yusuf
- Department of Community Dentistry, School of Dentistry, University of Pretoria, Pretoria, South Africa
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Rahman MA, Mahmood MA, Spurrier N, Rahman M, Choudhury SR, Leeder S. Why Do Bangladeshi People Use Smokeless Tobacco Products? Asia Pac J Public Health 2012; 27:NP2197-209. [DOI: 10.1177/1010539512446957] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite scientific evidence about the harmful effects of smokeless tobacco (SLT), it is widely used in Bangladesh. This study explored perceptions about health effects of SLT use. Semistructured interviews were conducted with 1812 nonsmoking adults. About 40% of the participants were current SLT users or had used SLT in the past. Family members’ influence was the main factor for initiation. The participants believed that people continued using SLT because of addiction (52%) and as a part of their lifestyle (23%). The majority of participants (77%) did not mention any benefit, but SLT users considered it to be a remedy for toothache ( P < .05). Almost all participants mentioned that SLT was harmful and causes heart disease, cancer, and tuberculosis. Doctors’ advice was the common motivating factor to quit. Health promotion interventions should highlight the adverse effects of SLT use, which outweigh the perceived benefits, and should consider addressing the role of family in SLT initiation and use.
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Affiliation(s)
| | | | | | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- National Heart Foundation Hospital & Research Institute (NHFH&RI), Dhaka, Bangladesh
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