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Sall F, Meneas GC, Siransy BAE, N'cho Mottoh MP, Kpi YH, N'guessan I, Assi VM, Diby F, Adoubi A. Predicting factors of blood pressure normalization in hypertensive patients after short-term follow-up. Front Cardiovasc Med 2024; 11:1403214. [PMID: 39257849 PMCID: PMC11384987 DOI: 10.3389/fcvm.2024.1403214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/30/2024] [Indexed: 09/12/2024] Open
Abstract
Introduction Normalization of blood pressure in hypertensive patients is a major challenge for practitioners. Knowledge of the factors associated with normalization of blood pressure could help optimize management of these hypertensive patients. In this study, we analysed the factors predictive of this in a population of hypertensive patients followed as outpatients in a specialised department. Patients and methods Retrospective and analytic study (January 2021-May 2022) of adult hypertensive patients over 40 years old who had been receiving antihypertensive treatment as outpatients in the Cardiology Department of the Bouake Teaching Hospital for at least 6 months. We studied the epidemiological and clinical parameters as well as the factors involved in the normalization of blood pressure in this population. Statistical analysis was performed using SPPS version 26 software (SPSS Inc., Chicago, IL, USA). Results We collected 194 patients records (57.7% women). The mean age was 59.13 years [extremes: 40-89 years]. One hundred and nine (56.2%) patients had a low socioeconomic status and 151 (77.83%) had at least 2 cardiovascular risk factors. The mean systolic blood pressure on admission was 171.12 ± 22.38 mmHg [extremes: 140-259 mmHg] and the mean diastolic blood pressure was 97.98 ± 17.83 mmHg [extremes: 60-168 mmHg]. First-line treatment consisted of dual anti-hypertensive therapy (n = 133; 68.55%) and fixed combination (n = 152; 78.35%). Only 25.25% (n = 49) of patients achieved normalization of blood pressure with therapeutic adherence estimated at 37.62% (n = 73). In multivariate analysis adjusted for anti-hypertensive treatment adherence, age (OR = 1.03; 95% CI = 1.002-1.059; p = 0.039), absence of alcoholism (OR = 9.48; 95% CI = 2.13-42.11; p = 0.003), number of cardiovascular risk factors <2 (OR = 1.52; 95% CI = 1.06-2.16; p = 0.021), normalization of uricemia (OR = 1.05; 95% CI = 1.00-1.11; p = 0.039) and natraemia (OR = 1.01; 95% CI = 1.00-1.03; p = 0.021), dual therapy (OR = 0.40; 95% CI = 0.18-0.90; p = 0.027), change in treatment for optimization (OR = 4.22; 95% CI = 1.71-10.37; p = 0.002), intellectual education (OR = 10.40; 95% CI = 4.31-25.10; p < 0.001) and health insurance (OR = 0.09; 95% CI = 0.04-0.21; p < 0.001) were the main factors predicting normalization of blood pressure. Conclusion Control of cardiovascular risk factors and compliance with treatment are the main factors in normalizing blood pressure.
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Affiliation(s)
- Fatouma Sall
- Cardiology Department, Bouake Teaching Hospital, Alassane Ouattara University, Bouake, Cote d'Ivoire
| | - Gueu Christophe Meneas
- Cardiology Department, Bouake Teaching Hospital, Alassane Ouattara University, Bouake, Cote d'Ivoire
| | - Balayssac Ahou Edwige Siransy
- Cardiology Department, Institute of Cardiology of Abidjan, Felix Houphouet-Boigny University, Abidjan, Cote d'Ivoire
| | - Marie-Paule N'cho Mottoh
- Cardiology Department, Institute of Cardiology of Abidjan, Felix Houphouet-Boigny University, Abidjan, Cote d'Ivoire
| | - Yannik-Hermann Kpi
- Cardiology Department, Bouake Teaching Hospital, Alassane Ouattara University, Bouake, Cote d'Ivoire
| | - Ismael N'guessan
- Cardiology Department, Bouake Teaching Hospital, Alassane Ouattara University, Bouake, Cote d'Ivoire
| | - Vierge Marie Assi
- Cardiology Department, Bouake Teaching Hospital, Alassane Ouattara University, Bouake, Cote d'Ivoire
| | - Florent Diby
- Cardiology Department, Bouake Teaching Hospital, Alassane Ouattara University, Bouake, Cote d'Ivoire
| | - Anicet Adoubi
- Cardiology Department, Bouake Teaching Hospital, Alassane Ouattara University, Bouake, Cote d'Ivoire
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Sambou ML, Bafei SEC, Bass P. Factors associated with knowledge of hypertension risk factors and symptoms among Gambian women: A cross-sectional study based on the Gambia Demographic and Health Survey. Prev Med Rep 2024; 42:102754. [PMID: 38764757 PMCID: PMC11101705 DOI: 10.1016/j.pmedr.2024.102754] [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: 12/19/2023] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024] Open
Abstract
Background We examined the factors associated with knowledge of hypertension risk factors and symptoms among Gambian women. Methods This cross-section study was based on 11, 865 female participants (aged 15-49 years) of The Gambia Demographic and Health Survey 2019-2020. We performed descriptive statistics, and multivariate-adjusted logistic regression models. Results Only 34.89 % and 36.82 % of the participants knew at least one risk factor and symptom of hypertension, respectively. Women who had never measured their blood pressure had a reduced odds of knowing a hypertension risk factor (OR = 0.68; 95 %CI: 0.60---0.77; P < 0.01) and symptom (OR = 0.56; 95 %CI: 0.49---0.64; P < 0.01). Compared to women with higher education, those with no education had a lower odds of knowing a hypertension risk factor (OR = 0.18; 95 %CI: 0.12---0.27; P < 0.01) and symptom (OR = 0.32; 95 %CI: 0.23---0.45; P < 0.01). Similarly, women who never used the internet had reduced odds of mentioning a hypertension risk factor (OR = 0.55; 95 %CI: 0.48---0.61; P < 0.01) and symptom (OR = 0.61; 95 %CI: 0.54---0.69; P < 0.01). Those who never watched television had decreased odds of knowing a hypertension risk factor (OR = 0.74; 95 %CI: 0.63--0.86; P < 0.01) and symptoms (OR = 0.68; 95 %CI: 0.58---0.80; P < 0.01). Conclusion: Fewer women could mention at least one hypertension risk factor and symptom. We also found that knowledge of hypertension risk factors and symptoms was associated with education level and socio-economic status.
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Affiliation(s)
- Muhammed Lamin Sambou
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, The University of the Gambia, Brikama Campus, Gambia
| | | | - Paul Bass
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, The University of the Gambia, Brikama Campus, Gambia
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Kamath S, Singhal N, J J, Brand H, Kamath R. Out-of-Pocket Expenditure for Selected Surgeries in the Cardiology Department for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Private Health Insurance, and Uninsured Patients in a Tertiary Care Teaching Hospital in Karnataka, India. Cureus 2024; 16:e62444. [PMID: 39015849 PMCID: PMC11250400 DOI: 10.7759/cureus.62444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Cardiovascular diseases are a major public health issue and the leading cause of mortality globally. The global economic burden of out-of-pocket expenditure (OOPE) for cardiovascular surgeries and procedures is substantial, with average costs being significantly higher than other treatments. This imposes a heavy economic burden. Government insurance schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to enhance affordability and access to cardiac care. METHODOLOGY This retrospective study analyzed OOPE incurred for top cardiac surgeries under AB-PMJAY, private insurance, and uninsured patients at a tertiary care teaching hospital in Karnataka. Data of 1021 patients undergoing common cardiac procedures from January to July 2023 were analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for normality. The study aims to evaluate financial risk protection offered by AB-PMJAY compared to private plans and inform effective policy-making in reducing the OOPE burden for surgeries in India. RESULTS The study analyzed OOPE across 1021 patients undergoing any of four surgeries at a tertiary care teaching hospital in Karnataka. AB-PMJAY patients incurred zero OOPE across all surgeries. Uninsured patients faced the highest median OOPE, ranging from ₹1,15,292 (1390.57 USD) to ₹1,72,490 (2080.45 USD) depending on surgery type. Despite the presence of private insurance, the median out-of-pocket expenditure ranged from ₹1,689 (20.38 USD) to ₹68,788 (829.67 USD). Significant variations in OOPE were observed within different payment groups. Private insurance in comparison with AB-PMJAY had limitations like co-payments, deductibles, and limited coverage resulting in higher OOPE for patients. DISCUSSION The results illustrate the efficacy of AB-PMJAY in reducing the financial burden and improving the affordability of cardiac procedures compared to private insurance. This emphasizes the significance of programmmes funded by the government in reducing the OOPE burden and ensuring equitable healthcare access. The comprehensive and particular estimates of OOPE for different surgical procedures, categorized by payment methods provide valuable information to guide the development of policies that aim to reduce OOPE and progress toward universal health coverage in India.
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Affiliation(s)
| | - Neha Singhal
- Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IND
| | - Jeffin J
- Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IND
| | - Helmut Brand
- Public Health, Maastricht University, Maastricht, NLD
| | - Rajesh Kamath
- Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IND
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Alamri A, Alshahrani ASN, Alshabab SQA, Alshehri SM, Alasiri RYS, Alshehri SZA, Faya HK, Almousa MSM, Ogran MAH, Asiri BMM, Hammour AA, Alharthi WS. A systematic literature review for evaluation of knowledge, attitude, and self-care practice regarding common eye diseases in the healthy general population. J Family Med Prim Care 2024; 13:417-424. [PMID: 38605788 PMCID: PMC11006079 DOI: 10.4103/jfmpc.jfmpc_1295_23] [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: 08/07/2023] [Revised: 10/19/2023] [Accepted: 11/28/2023] [Indexed: 04/13/2024] Open
Abstract
Background and purpose Increasing people's knowledge and then changing their attitude and practice with the aim of taking care of their eye health are very important. Considering the importance of the mentioned topic, the main goal of this study was to evaluate the knowledge, attitude, and practice about eye diseases in the general population of the world in the form of a systematic literature review. Materials and Methods This study was a systematic literature review study, and to do it, a systematic search was conducted in internationally available databases including Web of Science, ScienceDirect, Scopus, PubMed, and Google Scholar in the time range of 1998 to 2023. Finally, considering the inclusion and exclusion criteria of the study, the results of 18 articles were extracted. Results The findings showed that in general, people's level of knowledge about glaucoma was lower compared to other eye diseases, and the level of knowledge of men and women about eye diseases was different. In addition, the results showed that there was significant relationship between age and knowledge of various eye diseases. The results of all evaluated studies showed that people with higher education have more knowledge about eye diseases. Conclusion Based on this, it can be concluded that as glaucoma is one of the most important causes of blindness worldwide, it is necessary to plan to increase the level of public knowledge to recognize the symptoms and complications of this disease. In addition to that, it is necessary to increase people's advertisement by ophthalmology centers and eye specialists about the use of glasses and also to encourage people to visit the eye physician regularly.
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Affiliation(s)
| | | | | | | | | | | | - Hamad Khalid Faya
- Department of Ophthalmology, King Khalid University, Abha, Saudi Arabia
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Zaman SB, Evans RG, Chow CK, Joshi R, Thankappan KR, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Riddell MA, Suresh O, Thomas N, Mini GK, Maulik PK, Srikanth VK, Thrift AG. Morbidity and utilisation of healthcare services among people with cardiometabolic disease in three diverse regions of rural India. Chronic Illn 2023; 19:873-888. [PMID: 36744377 PMCID: PMC10655594 DOI: 10.1177/17423953231153550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the prevalence and determinants of cardiometabolic disease (CMD), and the factors associated with healthcare utilisation, among people with CMD. METHODS Using a cross-sectional design, 11,657 participants were recruited from randomly selected villages in 3 regions located in Kerala and Andhra Pradesh from 2014 to 2016. Multivariable logistic regression was used to identify factors independently associated with CMD and healthcare utilisation (public or private). RESULTS Thirty-four per cent (n = 3629) of participants reported having ≥1 CMD, including hypertension (21.6%), diabetes (11.6%), heart disease (5.0%) or chronic kidney disease (CKD) (1.6%). The prevalence of CMD was progressively greater in regions of greater socio-economic position (SEP), ranging from 19.1% to 40.9%. Among those with CMD 41% had sought any medical advice in the last month, with only 19% utilising public health facilities. Among people with CMD, those with health insurance utilised more healthcare (age-gender adjusted odds ratio (AOR) (95% confidence interval (CI)): 1.31 (1.13, 1.51)) as did those who reported accessing private rather than public health services (1.43 (1.23, 1.66)). DISCUSSION The prevalence of CMD is high in these regions of rural India and is positively associated with indices of SEP. The utilisation of outpatient health services, particularly public services, among those with CMD is low.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Clara K Chow
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Rohina Joshi
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- George Institute for Global Health, New Delhi, India
| | | | - Brian Oldenburg
- Non-Communicable Diseases and Implementation Science, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ajay S Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Rishi Valley Rural Health Centre, Chittoor District, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Gomathyamma K Mini
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Pallab K Maulik
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, New Delhi, India
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Elahi A, Ali AA, Khan AH, Samad Z, Shahab H, Aziz N, Almas A. Challenges of managing hypertension in Pakistan - a review. Clin Hypertens 2023; 29:17. [PMID: 37316940 DOI: 10.1186/s40885-023-00245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND This review aims to describe existing evidence on the state of hypertension in Pakistan, including the prevalence, associated risk factors, preventive strategies, and challenges in the management of hypertension. METHODS A comprehensive literature search was conducted electronically using PubMed and Google Scholar. Using specific screening methodology, 55 articles were selected to be included. RESULTS We found from this extensive review that several small studies report high prevalence of hypertension but there is a lack of population based prevalence of hypertension in Pakistan. Lifestyle risk factors such as obesity, unhealthy diet, decreased physical activity, low socioeconomic status, and lack of access to care were the main associated factors with hypertension. Lack of blood pressure monitoring practices and medication non-adherence were also linked to uncontrolled hypertension in Pakistan and were more evident in primary care setups. The evidence presented is essential for delineating the burden of the disease, hence allowing for better management of this underserved population. CONCLUSION There is a need for updated surveys to depict the true prevalence and management of hypertension in Pakistan. Cost-effective implementation strategies and policies at the national level are needed for both prevention and control of hypertension.
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Affiliation(s)
| | | | - Aamir Hameed Khan
- Section of Cardiology, Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Zainab Samad
- Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Hunaina Shahab
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Namra Aziz
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Aysha Almas
- Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Brindley C, Van Ourti T, Capuno J, Kraft A, Kudymowa J, O'Donnell O. Risk factor contributions to socioeconomic inequality in cardiovascular risk in the Philippines: a cross-sectional study of nationally representative survey data. BMC Public Health 2023; 23:689. [PMID: 37046247 PMCID: PMC10092926 DOI: 10.1186/s12889-023-15517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Primary prevention of cardiovascular diseases (CVD) increasingly relies on monitoring global CVD risk scores. Lack of evidence on socioeconomic inequality in these scores and the contributions that specific risk factors make to this inequality impedes effective targeting of CVD prevention. We aimed to address this evidence gap by measuring and decomposing socioeconomic inequality in CVD risk in the Philippines. METHODS We used data on 8462 individuals aged 40-74 years from the Philippines National Nutrition Survey and the laboratory-based Globorisk equation to predict 10-year risk of a CVD event from sex, age, systolic blood pressure, total cholesterol, high blood glucose, and smoking. We used a household wealth index to proxy socioeconomic status and measured socioeconomic inequality with a concentration index that we decomposed into contributions of the risk factors used to predict CVD risk. We measured socioeconomic inequalities in these risk factors and decomposed them into contributions of more distal risk factors: body mass index, fat share of energy intake, low physical activity, and drinking alcohol. We stratified by sex. RESULTS Wealthier individuals, particularly males, had greater exposure to all risk factors, with the exception of smoking, and had higher CVD risks. Total cholesterol and high blood glucose accounted for 58% and 34%, respectively, of the socioeconomic inequality in CVD risk among males. For females, the respective estimates were 63% and 69%. Systolic blood pressure accounted for 26% of the higher CVD risk of wealthier males but did not contribute to inequality among females. If smoking prevalence had not been higher among poorer individuals, then the inequality in CVD risk would have been 35% higher for males and 75% higher for females. Among distal risk factors, body mass index and fat intake contributed most to inequalities in total cholesterol, high blood sugar, and, for males, systolic blood pressure. CONCLUSIONS Wealthier Filipinos have higher predicted CVD risks and greater exposure to all risk factors, except smoking. There is need for a nuanced approach to CVD prevention that targets anti-smoking programmes on the poorer population while targeting diet and exercise interventions on the wealthier.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands.
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Tom Van Ourti
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
| | - Joseph Capuno
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Aleli Kraft
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Jenny Kudymowa
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Rethink Priorities, Frankfurt, Germany
| | - Owen O'Donnell
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
- Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
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Development of cake by using persimmon fruit (Diospyros kaki) as a fat replacer and its chemical and structural profile analysis. Lebensm Wiss Technol 2023. [DOI: 10.1016/j.lwt.2023.114601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Sanuade OA, Kushitor MK, Awuah RB, Asante PY, Agyemang C, de-Graft Aikins A. Lay knowledge of cardiovascular disease and risk factors in three communities in Accra, Ghana: a cross-sectional survey. BMJ Open 2021; 11:e049451. [PMID: 34907046 PMCID: PMC8671941 DOI: 10.1136/bmjopen-2021-049451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 11/05/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Cardiovascular disease is a major cause of morbidity and mortality in Ghana, and urban poor communities are disproportionately affected. Research has shown that knowledge of cardiovascular disease (CVD) is the first step to risk reduction. This study examines knowledge of CVD and risk factors and determinants of CVD knowledge in three urban poor communities in Accra, Ghana. METHODS Using the Cardiovascular Disease Risk Factors Knowledge Level Scale, which has been validated in Ghana, we conducted a cross-sectional survey with 775 respondents aged 15-59 years. CVD knowledge was computed as a continuous variable based on correct answers to 27 questions, and each correct response was assigned one point. Linear regression was used to determine the factors associated with CVD knowledge. RESULTS The mean age of the participants was 30.3±10.8 years and the mean knowledge score was 19.3±4.8. About one-fifth of participants were living with chronic diseases. Overall, 71.1% had good CVD knowledge, and 28.9% had moderate or poor CVD knowledge. CVD knowledge was low in the symptoms and risk factor domains. A larger proportion received CVD knowledge from radio and television. The determinants of CVD knowledge included ethnicity, alcohol consumption, self-reported health and sources of CVD knowledge. CVD knowledge was highest among a minority Akan ethnic group, those who were current alcohol consumers and those who rated their health as very good/excellent, compared with their respective counterparts. CVD knowledge was significantly lower among those who received information from health workers and multiple sources. CONCLUSION This study underscores the need for health education programmes to promote practical knowledge on CVD symptoms, risks and treatment. We outline health systems and community-level barriers to good CVD knowledge and discuss the implications for developing context-specific and culturally congruent CVD primary prevention interventions.
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Affiliation(s)
- Olutobi Adekunle Sanuade
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | - Charles Agyemang
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Wang Y, Wang J. Modelling and prediction of global non-communicable diseases. BMC Public Health 2020; 20:822. [PMID: 32487173 PMCID: PMC7268487 DOI: 10.1186/s12889-020-08890-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the main health and development challenge facing humankind all over the world. They are inextricably linked to socio-economic development. Deaths caused by NCDs should be different in different socio-economic development stages. The stratified heterogeneity of NCD deaths is currently not fully explored. Methods Countries were classified according to their socio-economic types and development stages, which were illustrated as a tree-like structure called Geotree. NCD deaths were linked to the countries and so were attached to the Geotree, which was modelled by a multilevel model (MLM) approach. Accordingly, the levels of NCD death indexes were predicted for 2030. Results Through the Geotree structure constructed in the study, it can be seen that the NCD death index has obvious stratified heterogeneity; that is, the NCD death index shows different trends in different country types and socio-economic development stages. In the first-level branches (country type), as national income increases, NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In the secondary-level trunks (socio-economic development stage), as a country’s development stage rises, the NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In addition, combined with the hierarchical nature of the evolution tree model, the MLM was used to predict the global NCD death index for 2030. The result was that by 2030, the global average age-standardized NCD mortality rate would be 510.54 (per 100,000 population) and the global average mortality for NCD deaths of the total number of deaths would be 75.26%. Conclusions This study found that there is a significant association between socio-economic factors and NCD death indicators in the tree-like structure. In the Geotree, countries on the same branch or trunk can learn from countries with higher development stages to formulate more effective NCD response policies and find the right prevention and treatment path.
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Affiliation(s)
- Yang Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China.
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Little M, Humphries S, Dodd W, Patel K, Dewey C. Socio-demographic patterning of the individual-level double burden of malnutrition in a rural population in South India: a cross-sectional study. BMC Public Health 2020; 20:675. [PMID: 32404080 PMCID: PMC7218837 DOI: 10.1186/s12889-020-08679-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The double burden of malnutrition is the co-occurrence of undernutrition (e.g. underweight, stunting, and micronutrient deficiencies) and over-nutrition (e.g. obesity, type 2 diabetes, and cardiovascular disease) at the population, household, or individual level. The objectives of this study were to determine the extent and determinants of individual-level co-morbid anemia and overweight and co-morbid anemia and diabetes in a population in rural Tamil Nadu, South India. METHODS We undertook a cross-sectional study of adults (n = 753) in a rural region of Tamil Nadu, South India. A survey assessed socio-demographic factors, physical activity levels, and dietary intake. Clinical measurements included body-mass index, an oral glucose tolerance test, and blood hemoglobin assessments. Multivariable logistic regression analyses were used to determine associations between risk factors and two co-morbid double burden pairings: (1) anemia and overweight, and (2) anemia and diabetes. RESULTS Prevalence of co-morbid anemia and overweight was 23.1% among women and 13.1% among men. Prevalence of co-morbid anemia and diabetes was 6.2% among women and 6.3% among men. The following variables were associated with co-morbid anemia and overweight in multivariable models [odds ratio (95% confidence interval)]: female sex [2.3 (1.4, 3.85)], high caste [3.2 (1.34, 7.49)], wealth index [1.1 (1.00, 1.12)], rurality (0.7 [0.56, 0.85]), tobacco consumption [0.6 (0.32, 0.96)], livestock ownership [0.5 (0.29, 0.89)], and energy-adjusted meat intake [1.8 (0.61, 0.94)]. The following variables were associated with co-morbid anemia and diabetes in multivariable models: age [1.1 (1.05, 1.11)], rurality [0.8 (0.57, 0.98)], and family history of diabetes [4.9 (1.86, 12.70). CONCLUSION This study determined the prevalence and factors associated with individual-level double burden of malnutrition. Women in rural regions of India may be particularly vulnerable to individual-level double burden of malnutrition and should be a target population for any nutrition interventions to address simultaneous over- and undernutrition.
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Affiliation(s)
- Matthew Little
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada.
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
| | - Sally Humphries
- Department of Sociology and Anthropology, University of Guelph, Guelph, ON, Canada
| | - Warren Dodd
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kirit Patel
- Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB, Canada
| | - Cate Dewey
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
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12
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Thrift AG, Ragavan RS, Riddell MA, Joshi R, Thankappan KR, Chow C, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Mini GK, Ismail J, Gamage DG, Hasan A, Srikanth VK, Thomas N, Maulik PK, Guggilla RK, Evans RG. Hypertension in Rural India: The Contribution of Socioeconomic Position. J Am Heart Assoc 2020; 9:e014486. [PMID: 32223389 PMCID: PMC7428634 DOI: 10.1161/jaha.119.014486] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Various indicators of socioeconomic position (SEP) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross‐sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP, including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP, had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high‐income countries. Why this effect is absent in rural India merits investigation.
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Affiliation(s)
- Amanda G Thrift
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Michaela A Riddell
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Rohina Joshi
- The George Institute for Global Health University of New South Wales Australia
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India
| | - Clara Chow
- The George Institute for Global Health University of New South Wales Australia.,Department of Cardiology Westmead Hospital Sydney Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Ajay S Mahal
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.,Nossal Institute for Global Health Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Oduru Suresh
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia.,Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - G K Mini
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India.,Global Institute of Public Health Ananthapuri Hospitals and Research Institute Trivandrum Kerala India
| | - Jordan Ismail
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Aniqa Hasan
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Velandai K Srikanth
- Peninsula Clinical School Central Clinical School Monash University Frankston Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India
| | - Pallab K Maulik
- George Institute for Global Health New Delhi India.,George Institute for Global Health-Oxford University Oxford United Kingdom
| | - Rama K Guggilla
- Department of Population Medicine and Civilization Diseases Prevention Faculty of Medicine With the Division of Dentistry and Division of Medical Education in English Medical University of Bialystok Bialystok Poland
| | - Roger G Evans
- Cardiovascular Disease Program Biomedicine Discovery Institute, and Department of Physiology Monash University Melbourne Australia
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13
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Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading causes of death among women globally. Cardiovascular disease-related events are more common in older women compared with men and are more likely to result in death. Although research in high-income countries suggests that women have unique sociobiological CVD risk factors, only a few study authors have examined risk factor knowledge among women from low- and middle-income countries. OBJECTIVE The aim of this study was to assess CVD risk factor knowledge among low-income urban Indian women. METHODS A cross-sectional study was conducted among a nonprobability sample of 607 slum-dwelling women, 40 to 64 years old, living in Mysore, India, between October 2017 and May 2018. Participants underwent an interviewer-administered questionnaire measuring demographics, CVD risk factor knowledge, and medical history. RESULTS Cardiovascular disease risk factor knowledge was low in this population and was associated with age, education, income, and caste. Approximately half of the participants (47%) answered less than 50% of the questions correctly, and a third had knowledge scores greater than 70%, which we defined as "good knowledge." Only 4 of 7 traditional CVD risk factors (ie, physical activity, smoking, overweight, and high cholesterol) were recognized by greater than half of the participants. The lowest knowledge levels were among older single women with no education and monthly household incomes less than Rs 3000 (approximately US $42). CONCLUSIONS Previous research among slum dwellers in India reported a high prevalence of modifiable CVD risk factors compared with more affluent urban peers. Interventions aimed at CVD risk factor knowledge may be an important first step in controlling heart disease in this vulnerable population.
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14
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Park E, Kim YS. Gender Differences in Harmful Use of Alcohol Among Korean Adults. Osong Public Health Res Perspect 2019; 10:205-214. [PMID: 31497491 PMCID: PMC6711715 DOI: 10.24171/j.phrp.2019.10.4.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives Harmful alcohol consumption is associated with considerable social and economic damage to individuals and society. Because gender and ethnic background influence alcohol intake differently, examining gender specific factors influencing harmful drinking is necessary. This study investigated gender differences in alcohol consumption, harmful drinking, and the associated factors among Korean adults. Methods We analyzed the data from the 2012–2015 Korean National Health and Nutrition Examination Survey. Data from survey participants aged 20–64 years (N = 18,581) were included. The Alcohol Use Disorders Identification Test was used for alcohol dependence, and pooled weights were used. Chi-squared tests and multiple logistic regression analyses were conducted. Results The prevalence of harmful alcohol use (Alcohol Use Disorders Identification Test score ≥ 16) was 10.7% in the total sample; 18.4% in men and 3.4% in women, which constituted a significant difference. Education, marital status, smoking, perceived stress, and depressive feeling were associated with harmful drinking in both genders. However, household income, occupation, and perceived health status were associated with harmful drinking only in men. Conclusion Since there are gender differences in harmful drinking and alcohol dependence, gender tailored prevention and intervention strategies for alcohol dependence are necessary including consideration of smoking, stress, and depressive feeling.
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Affiliation(s)
- Eunok Park
- College of Nursing, Jeju National University, Jeju, Korea
| | - Yeon Sook Kim
- Department of Nursing, California State University San Bernardino, San Bernardino, CA, USA
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15
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Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Nepalese adults: findings from a nationwide cross-sectional survey. J Biosoc Sci 2019; 52:412-438. [PMID: 31466532 DOI: 10.1017/s0021932019000531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of this cross-sectional study was to determine the gender differences in hypertension awareness, antihypertensive use and blood pressure (BP) control among the adult Nepalese population (≥18 years) using data from the nationally representative Nepal Demographic and Health Survey 2016. A weighted sample of 13,393 adults (5620 males and 7773 females) was included in the final analysis. After conducting descriptive analyses with the selective explanatory variable, multivariable logistic regression analysis was performed to assess the association between the outcome variable and the explanatory variables. The strength of the association was expressed in adjusted odds with 95% confidence intervals. A higher proportion of women had their BP checked (87.7% females vs 73.0% males, p<0.001) and were aware of their raised BP (43.9% females vs 37.1% males, p<0.001) compared with men. Although female hypertensive individuals had a higher prevalence of antihypertensive medication use than their male counterparts (50.1% females vs 47.5% males), a higher proportion of male hypertensive participants had their BP controlled (49.2% females vs 53.5% males). Women with the poorest wealth index had a lower prevalence of antihypertensive use than their male counterparts. The odds of having their own BP measured increased with age among men but decreased with age among women. The household wealth index was positively associated with the odds of BP measurement, awareness of own BP and antihypertensive use. This study revealed that although women had a higher prevalence of hypertension awareness and antihypertensive medication use, the practice did not translate into better BP control. Inequality in antihypertensive medication use was observed among the poorest wealth quintiles. Public health programmes in Nepal should focus on reducing these inequalities. Further research is needed to learn why females have poorer control of BP, despite having higher antihypertensive medication use.
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16
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Uddin MN, Bhar S, Islam FMA. An assessment of awareness of mental health conditions and its association with socio-demographic characteristics: a cross-sectional study in a rural district in Bangladesh. BMC Health Serv Res 2019; 19:562. [PMID: 31409332 PMCID: PMC6692949 DOI: 10.1186/s12913-019-4385-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the level of awareness, knowledge and help-seeking attitudes and behaviours in relation to mental health conditions (MHCs) and associations with socio-demographic characteristics of a rural district of Bangladesh. METHODS We recruited 2425 adult samples (18-90 years) from a Cross-sectional study in Narial district of Bangladesh. Data on awareness, knowledge, help-seeking attitudes and practice in relation to six MHCs were collected. The MHCs were classified as common (depression, anxiety and drug addiction), and severe (psychosis, dementia and bipolar disorder). Associations of MHCs with socio-demographic characteristics were assessed using Chi-square tests. Rasch analysis was performed to transform the latent attribute (awareness) of MHCs from ordinal to interval scale. Multiple regression analysis was performed to determine how the socio-demographic characteristics contribute to the combined awareness score of MHCs. RESULTS Of 2425 participants, 17 (0.7%) were cognizant of all the awareness construct of MHCs, and 1365 (56.28%) were not aware of any of MHCs. The prevalence of awareness of MHCs such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low. Awareness was significantly lower in older adults, and in women. Higher levels of education (β 1.77, 95% confidence interval (CI): 1.58-1.97) associated with common MHCs and (β 0.81, 95% CI: 0.67-0.95) those associated with severe MHCs contributed significantly to increased awareness as opposed to having no or primary level of education. Availability of sufficient funds when applied to common MHCs (β 0.43, 95% CI: 0.26-0.61) and severe MHCs (β 0.25, 95% CI: 0.13-0.38) appeared to be more effective in boosting awareness compared to unstable financial situations. Almost 100% of the participants who were aware of the MHCs demonstrated positive attitudes towards seeking medical or psychological counselling. CONCLUSIONS Awareness of MHCs appeared to be very limited. However, knowledgeable participants were found to be very receptive to medical or psychological counselling. For improving awareness of MHCs need to conduct various intervention programs in particular those campaigns that focus on women, older adults, low SES and people up to the primary levels of education.
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Affiliation(s)
- Mohammed Nazim Uddin
- Department of Statistics, Data Science and Epidemiology; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122 Australia
| | - Sunil Bhar
- Department of Psychological Sciences; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122 Australia
| | - Fakir M Amirul Islam
- Department of Statistics, Data Science and Epidemiology; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122 Australia
- Organisation for Rural Community Development (ORCD), Dariapur, Narail, Bangladesh
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17
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Agarwal A, Jindal D, Ajay VS, Kondal D, Mandal S, Ghosh S, Ali M, Singh K, Huffman MD, Tandon N, Prabhakaran D. Association between socioeconomic position and cardiovascular disease risk factors in rural north India: The Solan Surveillance Study. PLoS One 2019; 14:e0217834. [PMID: 31283784 PMCID: PMC6613705 DOI: 10.1371/journal.pone.0217834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Although most Indians live in rural settings, data on cardiovascular disease risk factors in these groups are limited. We describe the association between socioeconomic position and cardiovascular disease risk factors in a large rural population in north India. Methods We performed representative, community-based sampling from 2013 to 2014 of Solan district in Himachal Pradesh. We used education, occupation, household income, and household assets as indicators of socioeconomic position. We used tobacco use, alcohol use, low physical activity, obesity, hypertension, and diabetes as risk factors for cardiovascular disease. We performed hierarchical multivariable logistic regression, adjusting for age, sex and clustering of the health sub-centers, to evaluate the cross-sectional association of socioeconomic position indicators and cardiovascular disease risk factors. Results Among 38,457 participants, mean (SD) age was 42.7 (15.9) years, and 57% were women. The odds of tobacco use was lowest in participants with graduate school and above education (adjusted OR 0.11, 95% CI 0.09, 0.13), household income >15,000 INR (adjusted OR 0.35, 95% CI 0.29, 0.43), and highest quartile of assets (adjusted OR 0.28, 95% CI 0.24, 0.34) compared with other groups but not occupation (skilled worker adjusted OR 0.93, 95% CI 0.74, 1.16). Alcohol use was lower among individuals in the higher quartile of income (adjusted OR 0.75, 95% CI 0.64, 0.88) and assets (adjusted OR 0.70, 95% CI 0.59, 0.82). The odds of obesity was highest in participants with graduate school and above education (adjusted OR 2.33, 95% CI 1.85, 2.94), household income > 15,000 Indian rupees (adjusted OR 1.89, 95% CI 1.63, 2.19), and highest quartile of household assets (adjusted OR 2.87, 95% CI 2.39, 3.45). The odds of prevalent hypertension and diabetes were also generally higher among individuals with higher socioeconomic position. Conclusions Individuals with lower socioeconomic position in Himachal Pradesh were more likely to have abnormal behavioral risk factors, and individuals with higher socioeconomic position were more likely to have abnormal clinical risk factors.
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Affiliation(s)
- Anubha Agarwal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Devraj Jindal
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Vamadevan S. Ajay
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Siddhartha Mandal
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Shreeparna Ghosh
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Mumtaj Ali
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Mark D. Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- The George Institute for Global Health, Sydney, Australia
| | - Nikhil Tandon
- Public Health Foundation of India, Gurugram, Haryana, India
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Public Health Foundation of India, Gurugram, Haryana, India
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18
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Zhao M, Gillani AH, Amirul Islam FM, Ji W, Hayat K, Li Z, Akbar J, Ahmed AB, Azam A, Masood I, Fang Y. Factors Associated with Knowledge, Attitude and Practices of Common Eye Diseases in General Population: A Multicenter Cross-Sectional Study from Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091568. [PMID: 31060273 PMCID: PMC6539305 DOI: 10.3390/ijerph16091568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/16/2022]
Abstract
High prevalence of blindness coupled with low public awareness of eye diseases is a severe problem in Pakistan. The objective of this study was to evaluate the awareness, attitude and practices related to common ocular problems and eye care use among general population of Punjab, Pakistan. Data were collected cross-sectionally, using random selection of participants from five districts of Punjab, Pakistan. A pre-tested questionnaire was used to collect the data from January to March 2017. The ordinal data were converted to interval--based data by Rasch analysis, which is termed as "knowledge score" and ranges from -3 to +3. Descriptive statistics, linear regression, binary logistic regression and chi square analysis were performed to evaluate the data. Of the 2073 people contacted, 96.4% (2019) responded the interviewer. The mean (SD) age was 39.9 (11.4) years, majority were males (64.8%) and only 3.1% were illiterate. The majority (68.1%) of respondents were aware that blindness can be prevented and are least aware of age-related macular degradation (31.4%). Multivariate analysis to knowledge scores demonstrated that male gender (β = 0.53 95%CI = 0.39, 0.66, p < 0.001), higher education (β = 0.31 95%CI = 0.25, 0.37, p < 0.001) were significantly associated with knowledge score. Eighty-two percent of our respondents had a positive attitude towards health-seeking behavior and those who had adequate income on most of occasions were 1.82 (AOR = 1.82 95%CI = 1.26, 2.62 p = 0.001) times more prone towards health-seeking behavior than those who had insufficient income. Out of all respondents, 21.5% had an eye examination at least once a year and this frequency was significantly higher in lower age, females, high education and high Socio Economic Status level (p < 0.05). Among the general population of Pakistan, awareness about prevention of blindness and refractive error was optimum, while awareness of blindness causing eye conditions, like age-related macular degradation was low. Intensive improvements in the health literacy and public interventions-specifically in old age people, males and respondents with lower education-are urgently needed.
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Affiliation(s)
- Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Fakir Mohammad Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn VIC 3122, Australia.
- Organization for Rural Community Development, Dariapur, Narail 7500, Bangladesh.
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| | - Zongjie Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Jamshaid Akbar
- Department of pharmaceutical Sciences, The Superior College, Lahore, Punjab 54000, Pakistan.
| | - Abu Bakar Ahmed
- Department of Pharmacy, Islamia University of Bahawalpur 63100, Pakistan.
| | - Ans Azam
- Department of Pharmacy, Islamia University of Bahawalpur 63100, Pakistan.
| | - Imran Masood
- Department of Pharmacy, Islamia University of Bahawalpur 63100, Pakistan.
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
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19
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Busingye D, Arabshahi S, Evans RG, Riddell MA, Srikanth VK, Kartik K, Kalyanram K, Zhu X, Suresh O, Howard G, Thrift AG. Knowledge of risk factors for hypertension in a rural Indian population. HEART ASIA 2019; 11:e011136. [PMID: 31031832 DOI: 10.1136/heartasia-2018-011136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/22/2019] [Accepted: 02/04/2019] [Indexed: 11/04/2022]
Abstract
Objective To study knowledge of risk factors and consequences of hypertension in a rural population in South India. Methods This is a community-based study conducted among adults of a rural population in the Rishi Valley, India. Residents of randomised rural villages were invited to participate in a study of hypertension. We obtained measures of blood pressure, height, weight, waist and hip circumferences and questionnaire-based information on knowledge about hypertension, sociodemographic characteristics and health behaviours. Multivariable logistic regression analyses were conducted to determine the factors associated with knowledge of risk factors for hypertension (knowledge of ≥2 risk factors). Results The study comprised 641 adults; 132 aware and 218 unaware of their hypertension, and 291 with normal blood pressure. Only 31% of participants knew that hypertension adversely affects an individual's health and 7% knew the benefits of treating hypertension. Almost a third (30%) of those aware of their hypertensive status, and 48% overall, did not know any of the risk factors for hypertension. Being aware of one's hypertensive status (OR 2.51, 95% CI 1.44 to 4.39), being treated for hypertension, male sex, younger age, having some schooling, abdominal obesity and physical inactivity were associated with better knowledge of risk factors for hypertension. Conclusion Knowledge of risk factors and consequences of hypertension in this disadvantaged population was poor. There was better knowledge of risk factors in some, but not all, people who were aware of having hypertension. Screening and targeted educational programmes are warranted in this population to improve health behaviours and reduce the consequences of hypertension.
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Affiliation(s)
| | | | - Roger G Evans
- Physiology, Monash University, Clayton, Victoria, Australia
| | | | | | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Madanapalle, Andhra Pradesh, India
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Madanapalle, Andhra Pradesh, India
| | - Xuan Zhu
- School of Earth, Atmosphere and Environment, Monash University, Clayton, Victoria, Australia
| | - Oduru Suresh
- Rishi Valley Rural Health Centre, Madanapalle, Andhra Pradesh, India
| | - George Howard
- Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Williams J, Allen L, Wickramasinghe K, Mikkelsen B, Roberts N, Townsend N. A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries. J Glob Health 2018; 8:020409. [PMID: 30140435 PMCID: PMC6076564 DOI: 10.7189/jogh.08.020409] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death globally. Eighty-two percent of premature NCD deaths occur within low- and lower middle-income countries (LLMICs). Research to date, largely drawn from high-income countries, suggests that disadvantaged and marginalized groups have a higher NCD burden, but there has been a dearth of research studying this relationship within LLMICs. The purpose of this systematic review is to map the literature on evidence from LLMICs on the socio-economic status (SES) gradient of four particular NCDs: cardiovascular disease, cancer, diabetes, and chronic respiratory diseases. Methods We conducted a comprehensive literature search for primary research published between 1 January 1990 and 27 April 2015 using six bibliographic databases and web resources. We included studies that reported SES and morbidity or mortality from cardiovascular disease, cancer, diabetes and chronic respiratory diseases within LLMICs. Results Fifty-seven studies from 17 LLMICs met our inclusion criteria. Fourteen of the 18 papers that reported significant associations between cancer and SES suggested that low SES groups had the highest cancer risk. Eleven of 15 papers reporting significant relationships between CVD and SES suggested that low SES groups have higher risk. In contrast, seven of 12 papers reporting significant findings related to diabetes found that higher SES groups had higher diabetes risk. We identified just three studies on the relationship between chronic respiratory diseases and SES; none of them reported significant findings. Conclusions Only 17 of the 84 LLMICs were represented, highlighting the need for more research on NCDs within these countries. The majority of studies were medium to high quality cross-sectional studies. When we restricted our analyses to high quality studies only, for both cancer and cardiovascular disease more than half of studies found a significantly higher risk for those of lower SES. The opposite was true for diabetes, whilst there was a paucity of high quality research on chronic respiratory disease. Development programmes must consider health alongside other aims and NCD prevention interventions must target all members of the population. Systematic review registration number Prospero: CRD42015020169.
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Affiliation(s)
- Julianne Williams
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Luke Allen
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Wickramasinghe
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bente Mikkelsen
- Secretariat of the WHO Global Coordination Mechanisms on the Prevention and Control of Non-communicable diseases, World Health Organization, Geneva, Switzerland
| | - Nia Roberts
- Health Care Libraries, Bodleian Libraries, University of Oxford, Oxford, UK
| | - Nick Townsend
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Gillani AH, Amirul Islam FM, Hayat K, Atif N, Yang C, Chang J, Qu Z, Fang Y. Knowledge, Attitudes and Practices Regarding Diabetes in the General Population: A Cross-Sectional Study from Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091906. [PMID: 30200534 PMCID: PMC6164838 DOI: 10.3390/ijerph15091906] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/16/2022]
Abstract
Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18⁻90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0⁻9; a score ≥6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents' mean age was 32.92 ± 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored ≥6 (adequate awareness). Being female (β = 0.37, 95% confidence interval [CI]: 0.16, 0.05; p = 0.001), socioeconomic status (β = 0.24, 95% CI: 0.12, 0.36; p < 0.001), being diabetic (β = 0.82, 95% CI: 0.53, 1.10; p < 0.001), and higher education (β = 0.25, 95% CI: 0.17, 0.33; p < 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan's general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.
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Affiliation(s)
- Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of pharmacy Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Fakir Mohammad Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne VIC 3122, Australia.
- Organization for Rural Community Development, Dariapur, Narail 7500, Bangladesh.
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of pharmacy Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| | - Naveel Atif
- Department of Pharmacy Administration and Clinical Pharmacy, School of pharmacy Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of pharmacy Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of pharmacy Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
| | - Zhan Qu
- School of Nursing, Health Science center, College of Medicine, Xian Jiaotong University, Xi'an 710061, China.
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of pharmacy Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an 710061, China.
- Shaanxi Centre for Health Reform and Development Research, Xi'an 710061, China.
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Allen L, Townsend N, Williams J, Mikkelsen B, Roberts N, Wickramasinghe K. Socioeconomic status and alcohol use in low- and lower-middle income countries: A systematic review. Alcohol 2018; 70:23-31. [PMID: 29723827 DOI: 10.1016/j.alcohol.2017.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Harmful use of alcohol is a major cause of global morbidity and mortality. The role of alcohol as a driver of the unfolding non-communicable disease crisis has led to high-profile calls for better epidemiological data. Despite causing a disproportionate amount of harm in low-income groups, there is a critical dearth of evidence on the intra-national socioeconomic patterning of alcohol use in low- and lower-middle income countries (LLMICs). This review aims to fill the gap, providing evidence on the association between socioeconomic status (SES) and alcohol use in these low-income settings. METHODS We conducted a comprehensive literature search for primary research published between January 1, 1990 and June 30, 2015 using 13 electronic databases, including Embase and Medline. We also hand-searched references and reviewed 'gray literature' - studies that have not been published in peer-reviewed journals. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and alcohol use. No age or language restrictions were applied. Due to high heterogeneity, we used a narrative approach for data synthesis. FINDINGS After reviewing 4242 records and 247 full-text articles, 23 studies met our inclusion criteria, reporting data on 861,295 individuals aged >10 years from 10 countries. Alcohol use was found to be more prevalent in lower socioeconomic groups in the majority of Southeast Asian studies. The association was mixed for African studies, although these tended to have smaller sample sizes and weaker methods. Studies that measured multiple domains of SES found good agreement between different indicators. Definitions of alcohol use and abuse varied widely between studies, as did socioeconomic groupings. CONCLUSIONS The lack of consistency between studies and the abject lack of data from the majority of LLMICs present a major barrier to policymakers tasked with reducing alcohol-related harm in these settings. Adherence to standardized definitions, the publication of WHO survey data on alcohol and SES, and enhanced surveillance is needed to build an accurate picture of the socioeconomic patterning of alcohol use in developing countries.
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Alter JS, Sharma C. Nature cure treatment in the context of India's epidemiological transition. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 14:245-54. [PMID: 27417171 DOI: 10.1016/s2095-4964(16)60265-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Scholars have argued that theoretical insights of critical medical anthropology should be applied to the analysis of complementary and alternative medicine in order to develop more critically engaged integrative medicine. In this essay we focus on nature cure in the context of India's contemporary epidemiological transition as an example of why engaged integrative medicine is important for public health, and how the institutionalization of nature cure treatment in India provides a critical framework for the development of programs focused on holistic treatment and prevention. After providing an overview of the epidemiological transition in contemporary India, we develop this argument through an examination of illustrative cases in a clinic that operates within the structure of India's Central Council for Research on Yoga and Naturopathy. Based on a review of recent history and contemporary practice we describe how a system of medicine that makes use exclusively of air, earth, sunlight, water and food has been institutionalized and professionalized in India. Whereas biomedical treatment for chronic non-communicable diseases is focused on the problem of curing individual diseases, nature cure establishes a regimen of personalized public healthcare for the integrated management of symptoms. We argue that nature cure is based on an ecological understanding of health, thus providing treatment that reflects a broad appreciation for the risk factors that characterize India's current crises of public health.
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Dhungana RR, Thapa P, Devkota S, Banik PC, Gurung Y, Mumu SJ, Shayami A, Ali L. Prevalence of cardiovascular disease risk factors: A community-based cross-sectional study in a peri-urban community of Kathmandu, Nepal. Indian Heart J 2018; 70 Suppl 3:S20-S27. [PMID: 30595258 PMCID: PMC6309148 DOI: 10.1016/j.ihj.2018.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/21/2018] [Accepted: 03/09/2018] [Indexed: 12/26/2022] Open
Abstract
Background As a low-income country, Nepal is experiencing cardiovascular diseases as an emerging health problem. However, studies are lacking on the risk factors of cardiovascular diseases in peri-urban communities; where the socio-demographical transition is in progress. Therefore, this study aimed to identify the prevalence and socio-demographic distribution of cardiovascular disease risk factors in one of the peri-urban communities in Kathmandu, Nepal. Methods We conducted a cross-sectional study in Sitapaila Village Development Committee, Kathmandu from February 2014 to February 2015. Altogether, 347 adults from 18 to 70 years of age were selected randomly. Data were collected through modified WHO STEPS questionnaire for non-communicable disease (NCD) risk factors survey and analyzed in SPSS V.16.0 software. Results Mean age of the participant was 42.5 ± 13.2 years. Majority of them were female (n = 206; 59.4%), one-third (34%) represented Brahman and Chetri, and over a quarter (29.1%) did not attend school. Cardiovascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%), and high triglyceride levels (10.8%). They were significantly associated with different socio-demographic characteristics: smoking with gender, age groups and education level; alcohol consumption was with gender, age groups, ethnicity and occupation; insufficient physical activity with gender, age groups and occupation; hypertension with gender, age groups, ethnicity, education level and occupation. Conclusion A high prevalence of cardiovascular disease risk factors and their disproportional distribution among the study population indicated an inevitable risk of cardiovascular events in near future.
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Affiliation(s)
- Raja Ram Dhungana
- Nepal Family Development Foundation, Kathmandu, Nepal; Department of Epidemiology and Biostatistics, Bangladesh Institute of Health Sciences, Dhaka University, Dhaka, Bangladesh.
| | | | - Surya Devkota
- Manmohan Cardiothoracic, Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Yadav Gurung
- Nepal Family Development Foundation, Kathmandu, Nepal
| | | | - Arun Shayami
- Manmohan Cardiothoracic, Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Liaquat Ali
- Bangladesh University of Health Sciences, Dhaka, Bangladesh
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Gabert R, Ng M, Sogarwal R, Bryant M, Deepu RV, McNellan CR, Mehra S, Phillips B, Reitsma M, Thomson B, Wilson S, Wollum A, Gakidou E, Duber HC. Identifying gaps in the continuum of care for hypertension and diabetes in two Indian communities. BMC Health Serv Res 2017; 17:846. [PMID: 29282052 PMCID: PMC5746011 DOI: 10.1186/s12913-017-2796-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 12/13/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) represent the largest, and fastest growing, burden of disease in India. This study aimed to quantify levels of diagnosis, treatment, and control among hypertensive and diabetic patients, and to describe demand- and supply-side barriers to hypertension and diabetes diagnosis and care in two Indian districts, Shimla and Udaipur. METHODS We conducted household and health facility surveys, as well as qualitative focus group discussions and interviews. The household survey randomly sampled individuals aged 15 and above in rural and urban areas in both districts. The survey included questions on NCD knowledge, history, and risk factors. Blood pressure, weight, height, and blood glucose measurements were obtained. The health facility survey was administered in 48 health care facilities, focusing on NCD diagnosis and treatment capacity, including staffing, equipment, and pharmaceuticals. Qualitative data was collected through semi-structured key informant interviews with health professionals and public health officials, as well as focus groups with patients and community members. RESULTS Among 7181 individuals, 32% either reported a history of hypertension or were found to have a systolic blood pressure ≥ 140 mmHg and/or diastolic ≥90 mmHg. Only 26% of those found to have elevated blood pressure reported a prior diagnosis, and just 42% of individuals with a prior diagnosis of hypertension were found to be normotensive. A history of diabetes or an elevated blood sugar (Random blood glucose (RBG) ≥200 mg/dl or fasting blood glucose (FBG) ≥126 mg/dl) was noted in 7% of the population. Among those with an elevated RBG/FBG, 59% had previously received a diagnosis of diabetes. Only 60% of diabetics on treatment were measured with a RBG <200 mg/dl. Lower-level health facilities were noted to have limited capacity to measure blood glucose as well as significant gaps in the availability of first-line pharmaceuticals for both hypertension and diabetes. CONCLUSIONS We found high rates of uncontrolled diabetes and undiagnosed and uncontrolled hypertension. Lower level health facilities were constrained by capacity to test, monitor and treat diabetes and hypertension. Interventions aimed at improving patient outcomes will need to focus on the expanding access to quality care in order to accommodate the growing demand for NCD services.
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Affiliation(s)
- Rose Gabert
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Ruchi Sogarwal
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Miranda Bryant
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - R V Deepu
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Sunil Mehra
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Bryan Phillips
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Marissa Reitsma
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Blake Thomson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Shelley Wilson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Alexandra Wollum
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Herbert C Duber
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
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Ahmed KR, Jebunessa F, Hossain S, Chowdhury HA. Ocular knowledge and practice among type 2 diabetic patients in a tertiary care hospital in Bangladesh. BMC Ophthalmol 2017; 17:171. [PMID: 28927398 PMCID: PMC5605995 DOI: 10.1186/s12886-017-0560-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/29/2017] [Indexed: 11/28/2022] Open
Abstract
Background and aims Diabetes mellitus is likely to have a major effect on vision, and adequate knowledge of its ocular manifestations is of substantial importance to diabetic patients. The study aimed to assess the ocular knowledge and practices among Type 2 diabetic patients of Bangladesh. Methods This cross-sectional study included 122 diabetic patients from the outpatient department (OPD) of the apex diabetic healthcare hospital of the country under the sponsorship of the Diabetic Association of Bangladesh (BIRDEM). A questionnaire was used for collecting data on knowledge on and practices relating to diabetes mellitus with particular emphasis on ocular issues. A predefined score was used for categorizing levels of knowledge and practices as poor, average, and good. Results Of the 122 respondents, 63%, 55%, 40%, 44%, and 30% reported, blindness, retinopathy, cataracts, glaucoma, and double vision respectively, as complications of diabetes mellitus. About 50% were aware of the need for eye screening for people with the complications. Only 8% monitored their blood glucose levels daily, 15% monitored weekly, and 10% reported checking their blood pressure daily and 43% took their medications as prescribed. The level of diabetic knowledge was poor, moderate and good, respectively, among 24%, 56%, and 20% of the respondents, whereas the practice standards showed that 47%, 31%, and 22% had poor, average, and good levels respectively. The knowledge score was significantly associated with the practice score (r = 0.460, p = 0.001). Conclusion The results indicate that the ocular knowledge and practices among diabetic patients attending a tertiary-care hospital in Bangladesh is average. Health and eye-care practitioners need to expand diabetic health education and promotion among diabetic patients.
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Affiliation(s)
- Kazi Rumana Ahmed
- Department of Health Promotion and Health Education, Bangladesh University of Health Sciences, 125/1, Darus Salam, Mirpur-1, Dhaka, Bangladesh. .,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Fatema Jebunessa
- Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, 125/1, Darus Salam, Mirpur-1, Dhaka, Bangladesh
| | - Sharmin Hossain
- Department of Health Promotion and Health Education, Bangladesh University of Health Sciences, 125/1, Darus Salam, Mirpur-1, Dhaka, Bangladesh
| | - Hasina Akhter Chowdhury
- Department of Biostatistics, Bangladesh University of Health Sciences, 125/1, Darus Salam, Mirpur-1, Dhaka, Bangladesh
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Uddin MN, Bhar S, Al Mahmud A, Islam FMA. Psychological distress and quality of life: rationale and protocol of a prospective cohort study in a rural district in Bangaladesh. BMJ Open 2017; 7:e016745. [PMID: 28864700 PMCID: PMC5588978 DOI: 10.1136/bmjopen-2017-016745] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/26/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A significant proportion of the global burden of disease has been attributed to mental and behavioural disorders. People with mental disorders (MDs) have lower levels of health-related quality of life than those without MDs. Several studies have shown that in low-resource countries, a range of social determinants including poor health literacy is critical in the epidemiological transition of disease outcome. There is a lack of evidence of MDs literacy, the prevalence and risk factors of common mental health conditions, or any validated instruments to measure psychological distress or evaluate the quality of life in rural areas of Bangladesh. AIMS The aims of this study are: (1) report the awareness, knowledge, attitudes and practice (KAP) of MDs; (2) estimate the prevalence of and risk factors for psychological distress; (3) measure association of psychological distress and other socio-demographic factors with quality of life and (4) test the feasibility to use Kessler 10-item (K10) and WHO Quality Of Life-BREF (WHOQOL-BREF) questionnaires in rural Bangladesh for measuring psychological distress and quality of life. METHODS AND ANALYSIS A sample of 1500 adults aged 18-59 years and 1200 older adults aged 60-90 years will be interviewed from a multistage cluster random sample. Each participant will go through a face-to-face interview to assess their awareness and KAP of MDs. Information about the participant's sociodemographic and socioeconomic status will be collected along with the psychological distress (K10) and quality of life (WHOQOL-BREF) questionnaires. Internal consistency, validity, reliability and item discrimination of K10 and WHOQOL-BREF instruments will be determined by using Rasch analysis and regression techniques. ETHICS AND DISSEMINATION Human Ethics Approval was received from the Swinburne University of Technology Human Ethics Committee. Results of this research will be disseminated via scientific forums including peer-reviewed publications and presentations at national and international conferences.
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Affiliation(s)
- Mohammed Nazim Uddin
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Abdullah Al Mahmud
- Centre for Design Innovation (CDI), School of Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Fakir M Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Organisation for Rural Community Development (ORCD), Narail, Bangladesh
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Fatema K, Hossain S, Natasha K, Chowdhury HA, Akter J, Khan T, Ali L. Knowledge attitude and practice regarding diabetes mellitus among Nondiabetic and diabetic study participants in Bangladesh. BMC Public Health 2017; 17:364. [PMID: 28446194 PMCID: PMC5406895 DOI: 10.1186/s12889-017-4285-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 04/22/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Increased awareness amongst large population groups is a major determinant for the prevention of diabetes and its complications as well as related metabolic disorders. Knowledge and attitude are the principal markers of awareness that need to be studied in various population groups in specific racial and cultural contexts. The present study was undertaken to explore knowledge, attitude and practice (KAP) regarding -diabetes mellitus (DM) among nondiabetic (nonDM) and type 2 diabetes mellitus (T2DM) patients in Bangladesh. METHODS A cross-sectional study was conducted among 18,697 adults (aged 18 years and above; 7796 male and 10,901 female; 6780 nonDM and 11,917 T2DM) selected purposively from the OPD of 19 healthcare centres in and around Dhaka and in northern parts of Bangladesh. KAP were assessed by a pre-structured, interviewer-administered questionnaire and categorised using predefined scores of poor (mean + 1 SD). Univariate and bivariate statistical analysis were done as appropriate. Multivariate linear regression was done to examine the association between diabetes related KAP and other covariates. RESULTS The mean (±SD) age (years) of all the study participants was 46 ± 14, mean BMI 24.4 ± 4.1 and mean waist-hip ratio (WHR) was 0.93 ± 0.07. The proportion of poor, average and good knowledge scores among T2DM subjects were 17%, 68% and 15% respectively. The corresponding values for attitude score were 23%, 67% and 10% respectively. The KAP regarding diabetes was found to be better among people who were living with diabetes compared to their counterparts. DM males showed better knowledge and practice regarding diabetes, compared to nonDM counterparts (M ± SD; 44.18 ± 16.13 vs 40.88 ± 15.62, p = <0.001; 66.00 ± 29.68 vs 64.21 ± 31.79, p < 0.001, respectively). Females showed better attitude score compared to males. Overall KAP were found to be significantly higher (p < 0.001) in middle aged (31-50 years) participants in each group. Participants from urban residents, higher educational background and upper socio-economic class demonstrated significantly greater score in terms of KAP in both nonDM and T2DM groups (p < 0.001). On linear regression analysis, knowledge scores correlated strongly with education, income, residence, diabetic state, BMI and attitude. CONCLUSIONS The overall level of knowledge and practice concerning diabetes among Bangladeshi population is average, but the overall level of attitude is good both in nonDM and T2DM subjects. To prevent diabetes and its complications there is an urgent need for coordinated educational campaigns with a prioritized focus on poorer, rural and less educated groups.
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Affiliation(s)
- Kaniz Fatema
- Department of Epidemiology, Bangladesh University of Health Sciences (BUHS), 125/1 Darus Salam, Mirpur, Dhaka, 1216 Bangladesh
- Present address: Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Sharmin Hossain
- Department of Health Promotion and Health Education, BUHS, 125/1 Darus Salam, Mirpur, Dhaka, 1216 Bangladesh
| | - Khurshid Natasha
- Department of Health Promotion and Health Education, BUHS, 125/1 Darus Salam, Mirpur, Dhaka, 1216 Bangladesh
| | | | - Jesmin Akter
- Department of Reproductive and Child Health, BUHS, 125/1 Darus Salam, Mirpur, Dhaka, 1216 Bangladesh
| | - Tahmina Khan
- Department of Health Promotion and Health Education, BUHS, 125/1 Darus Salam, Mirpur, Dhaka, 1216 Bangladesh
| | - Liaquat Ali
- Department of Biochemistry and Cell Biology, BUHS, 125/1 Darus Salam, Mirpur, Dhaka, 1216 Bangladesh
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Age and Socioeconomic Gradients of Health of Indian Adults: An Assessment of Self-Reported and Biological Measures of Health. J Cross Cult Gerontol 2017; 31:193-211. [PMID: 26895999 DOI: 10.1007/s10823-016-9283-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This paper describes overall socioeconomic gradients and the age patterns of socioeconomic gradients of health of Indian adults for multiple health indicators encompassing the multiple aspects of health. Cross-sectional data on 11,230 Indians aged 18 years and older from the WHO-SAGE India Wave 1, 2007 were analyzed. Multivariate logit models were estimated to examine effects of socioeconomic status (education and household wealth) and age on four health domains: self-rated health, self-reported functioning, chronic diseases, and biological health measures. Results show that socioeconomic status (SES) was negatively associated with prevalence of each health measure but with considerable heterogeneity across age groups. Results for hypertension and COPD were inconclusive. SES effects are significant while adjusting for background characteristics and health risk factors. The age patterns of SES gradient of health depict divergence with age, however, no conclusive age pattern emerged for biological markers. Overall, results in this paper dispelled the conclusion of negative SES-health association found in some previous Indian studies and reinforced the hypothesis of positive association of SES with health for Indian adults. Higher prevalence of negative health outcomes and SES disparities of health outcomes among older age-groups highlight need for inclusive and focused health care interventions for older adults across socioeconomic spectrum.
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Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, Wickramasinghe K. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 2017; 5:e277-e289. [PMID: 28193397 PMCID: PMC5673683 DOI: 10.1016/s2214-109x(17)30058-x] [Citation(s) in RCA: 358] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/24/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. METHODS We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. FINDINGS After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings. INTERPRETATION Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4-reducing premature non-communicable disease mortality by a third by 2030-should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases. FUNDING WHO.
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Affiliation(s)
- Luke Allen
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julianne Williams
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Townsend
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Bente Mikkelsen
- WHO Global Coordination Mechanisms on the Prevention and Control of Non-communicable diseases, WHO, Geneva, Switzerland
| | - Nia Roberts
- Health Care Libraries, Bodleian Libraries, University of Oxford, Oxford, UK
| | - Charlie Foster
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Wickramasinghe
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Biswas T, Islam MS, Linton N, Rawal LB. Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh. PLoS One 2016; 11:e0167140. [PMID: 27902760 PMCID: PMC5130253 DOI: 10.1371/journal.pone.0167140] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/09/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas. Materials and Method Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations. Results Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p<0.001), and overweight/obesity (CI = 0.45, p<0.001). In contrast to the high prevalence of the chronic health conditions among the urban richest, a significant difference in CI was observed for pre-hypertension (CI = -0.20, p = 0.001), hypertension (CI = -0.20, p = 0.005), pre-diabetes (CI = -0.15, p = 0.005), diabetes (CI = -0.26, p = 0.004) and overweight/obesity (CI = 0.25, p = 0.004) were observed more among the low wealth quintiles of rural population. In the same vein, the poorest rural households had more co-morbidities compared to the richest rural households (p = 0.003), and prevalence of co-morbidities was much higher for the richest urban households compared to the poorest urban households. On the other hand in rural the “disachievement” of health indicators is more noticeable than the urban ones. Conclusion The findings indicate the high burden of selected NCDs among the low wealth quintile populations in rural areas and wealthy populations in urban areas. Particular attentions may be necessary to address the problem of NCDs among these groups.
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Affiliation(s)
- Tuhin Biswas
- Health Systems and Populations Studies Division, icddr,b, Mohakhali, Bangladesh
- * E-mail:
| | - Md. Saimul Islam
- Health Systems and Populations Studies Division, icddr,b, Mohakhali, Bangladesh
| | - Natalie Linton
- Oregon State University, Corvallis, Oregon, United States of America
| | - Lal B. Rawal
- Health Systems and Populations Studies Division, icddr,b, Mohakhali, Bangladesh
- James P Grant Schools of Public Health, BRAC University, Dhaka, Bangladesh
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Thakkar J, Karthikeyan G, Purohit G, Thakkar S, Sharma J, Verma S, Parakh N, Seth S, Mishra S, Yadav R, Singh S, Joshi R, Thiagalingam A, Chow CK, Redfern J. Development of macaronic Hindi-English 'Hinglish' text message content for a coronary heart disease secondary prevention programme. HEART ASIA 2016; 8:32-38. [PMID: 27752288 DOI: 10.1136/heartasia-2016-010789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/04/2016] [Accepted: 09/05/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is a leading cause of morbidity and mortality in India. Text message based prevention programs have demonstrated reduction in cardiovascular risk factors among patients with CHD in selected populations. Customisation is important as behaviour change is influenced by culture and linguistic context. OBJECTIVES To customise a mobile phone text message program supporting behaviour and treatment adherence in CHD for delivery in North India. METHODS We used an iterative process with mixed methods involving three phases: (1) Initial translation, (2) Review and incorporation of feedback including review by cardiologists in India to assess alignment with local guidelines and by consumers on perceived utility and clarity and (3) Pilot testing of message management software. RESULTS Messages were translated in three ways: symmetrical translation, asymmetrical translation and substitution. Feedback from cardiologists and 25 patients was incorporated to develop the final bank. Patients reported Hinglish messages were easy to understand (93%) and useful (78%). The software located in Australia successfully delivered messages to participants based in Delhi-surrounds (India). CONCLUSIONS Our process for customisation of a text message program considered cultural, linguistic and the medical context of potential participants. This is important in optimising intervention fidelity across populations enabling examination of the generalisability of text message programs across populations. We also demonstrated the customised program was acceptable to patients in India and that a centralised cross-country delivery model was feasible. This process could be used as a guide for other groups seeking to customise their programs. TRIAL REGISTRATION NUMBER TEXTMEDS Australia (Parent study)-ACTRN 12613000793718.
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Affiliation(s)
- Jay Thakkar
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia
| | | | - Gaurav Purohit
- All India Institute of Medical Sciences , New Delhi , India
| | | | | | | | - Neeraj Parakh
- All India Institute of Medical Sciences , New Delhi , India
| | - Sandeep Seth
- All India Institute of Medical Sciences , New Delhi , India
| | - Sundeep Mishra
- All India Institute of Medical Sciences , New Delhi , India
| | - Rakesh Yadav
- All India Institute of Medical Sciences , New Delhi , India
| | - Sandeep Singh
- All India Institute of Medical Sciences , New Delhi , India
| | - Rohina Joshi
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Aravinda Thiagalingam
- Sydney Medical School, The University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia
| | - Clara K Chow
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia
| | - Julie Redfern
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
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Shridhar K, Millett C, Laverty AA, Alam D, Dias A, Williams J, Dhillon PK. Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia-A multi-centre study. BMC Public Health 2016; 16:690. [PMID: 27485010 PMCID: PMC4970267 DOI: 10.1186/s12889-016-3353-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/22/2016] [Indexed: 01/27/2023] Open
Abstract
Background We report the prevalence of recommended physical activity levels (RPALs) and examine the correlates of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes. Methods This analysis on rural South Asian children aged 5–14 years (n = 564) is a part of the Chronic Disease Risk Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores). Results The majority of children (71.8 %) belonged to households where a parent had at least a secondary education. Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had ≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10–14 years, OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3; 95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5–9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education (OR = 2.1; 95 % CI: 1.1, 4.1). In multivariate analyses, sedentary activity ≤ 2 h/day was associated with lower BMI-z-scores (β = −0.3; 95 % CI: −0.5, −0.08) and lower waist-z-scores (β = −1.1; 95 % CI: −2.2, −0.07). Conclusion Only one quarter of children in these rural areas achieved RPAL in active travel, leisure and sedentary activity. Improved understanding of RPAL in rural South Asian children is important due to rapid socio-economic transition.
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Affiliation(s)
- Krithiga Shridhar
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 4th Floor, Plot.No.47, Sector 44, Gurgaon, 122002, Haryana, India.
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College, Reynolds Building, Charing Cross Campus, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College, Reynolds Building, Charing Cross Campus, London, UK
| | - Dewan Alam
- Centre for Global Health Research, Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Amit Dias
- Goa Medical College, Sangath, Bardez, Goa, India
| | | | - Preet K Dhillon
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 4th Floor, Plot.No.47, Sector 44, Gurgaon, 122002, Haryana, India
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The 2013 cholesterol guideline controversy: Would better evidence prevent pharmaceuticalization? Health Policy 2016; 120:797-808. [PMID: 27256859 DOI: 10.1016/j.healthpol.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 01/08/2023]
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Time for a pan-India prevention plan for cardiovascular diseases. Indian Heart J 2016; 68:252-5. [PMID: 27316472 DOI: 10.1016/j.ihj.2015.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/07/2015] [Accepted: 11/09/2015] [Indexed: 11/21/2022] Open
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Li G, Wang H, Wang K, Wang W, Dong F, Qian Y, Gong H, Xu G, Li Y, Pan L, Wang B, Zhu G, Shan G. Prevalence, awareness, treatment, control and risk factors related to hypertension among urban adults in Inner Mongolia 2014: differences between Mongolian and Han populations. BMC Public Health 2016; 16:294. [PMID: 27036609 PMCID: PMC4818445 DOI: 10.1186/s12889-016-2965-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/15/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Han and Mongolian populations constitute approximately 96% of the population of Inner Mongolia Autonomous Region, and the two ethnic groups have different genetic backgrounds and lifestyle. We aim to assess the prevalence, awareness, treatment, control, and related risk factors of hypertension among urban adults in Inner Mongolia, with the comparison of the differences between Mongolian and Han populations in this respect. METHODS Three thousand two hundred fifty-one individuals aged 20-80 years (2326 Han and 925 Mongolian) were selected using a multistage cluster sampling method from Inner Mongolia in 2014. The adjusted prevalence, awareness, treatment and control of hypertension were evaluated by the Logistic regression. In addition, possible interactions were also tested. When interactions were found significant, strata-specific analysis were performed. Multivariate logistic regression was used for estimating independent associations between risk factors and hypertension. RESULTS The prevalence of hypertension was 27.47% for Han population, 31.46% for Mongolian population. The adjusted prevalence, awareness, treatment and control of hypertension were 26.45, 65.43, 78.24 and 48.28% in Han, and 31.30, 68.22, 85.57 and 50.55% in Mongolian, respectively. There was no significant difference in the adjusted awareness, treatment and control of hypertension among Mongolian and Han adult residents (all P >0.05). Lower prevalence of hypertension was associated with younger age and healthy weight in both Mongolian and Han adults. Within Han adults, high education, moderate physical activity and non-alcohol drinkers were additionally associated with lower prevalence of hypertension, whereas within Mongolian adults, lower prevalence was associated with being female. Among residents with medium education level, nondrinkers had 0.60 times lower odds of having hypertension than current drinkers (OR = 0.60, 95% CI: 0.44-0.82); among residents with high education level, nondrinkers has 0.65 times lower odds of having hypertension than current drinkers (OR = 0.65, 95% CI: 0.43-0.97). CONCLUSIONS Mongolian population had a higher prevalence of hypertension than Han population. There were no significant difference between Mongolian and Han population in awareness, treatment and control of hypertension, which suggested that there was no difference between the two ethnicities in the distribution of health resources.
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Affiliation(s)
- Guoju Li
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Hailing Wang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, Inner Mongolia Autonomous Region, 010110, China
| | - Ke Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Wenrui Wang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, Inner Mongolia Autonomous Region, 010110, China
| | - Fen Dong
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Yonggang Qian
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, Inner Mongolia Autonomous Region, 010110, China
| | - Haiying Gong
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Guodong Xu
- Department of Epidemiology and Health Statistics, College of Public Health, Jilin University, Changchun, 130021, China
| | - Yanlong Li
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Bin Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Guangjin Zhu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
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Ali MK, Bhaskarapillai B, Shivashankar R, Mohan D, Fatmi ZA, Pradeepa R, Masood Kadir M, Mohan V, Tandon N, Narayan KMV, Prabhakaran D. Socioeconomic status and cardiovascular risk in urban South Asia: The CARRS Study. Eur J Prev Cardiol 2016; 23:408-19. [PMID: 25917221 PMCID: PMC5560768 DOI: 10.1177/2047487315580891] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/18/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although South Asians experience cardiovascular disease (CVD) and risk factors at an early age, the distribution of CVD risks across the socioeconomic spectrum remains unclear. METHODS We analysed the 2011 Centre for Cardiometabolic Risk Reduction in South Asia survey data including 16,288 non-pregnant adults (≥20 years) that are representative of Chennai and Delhi, India, and Karachi, Pakistan. Socioeconomic status (SES) was defined by highest education (primary schooling, high/secondary schooling, college graduate or greater); wealth tertiles (low, middle, high household assets) and occupation (not working outside home, semi/unskilled, skilled, white-collar work). We estimated age and sex-standardized prevalence of behavioural (daily fruit/vegetables; tobacco use), weight (body mass index; waist-to-height ratio) and metabolic risk factors (diabetes, hypertension, hypercholesterolaemia; hypo-HDL; and hypertriglyceridaemia) by each SES category. RESULTS Across cities, 61.2% and 16.1% completed secondary and college educations, respectively; 52.8% reported not working, 22.9% were unskilled; 21.3% were skilled and 3.1% were white-collar workers. For behavioural risk factors, low fruit/vegetable intake, smoked and smokeless tobacco use were more prevalent in lowest education, wealthy and occupation (for men only) groups compared to higher SES counterparts, while weight-related risks (body mass index 25.0-29.9 and ≥30 kg/m(2); waist-to-height ratio ≥0.5) were more common in higher educated and wealthy groups, and technical/professional men. For metabolic risks, a higher prevalence of diabetes, hypertension and dyslipidaemias was observed in more educated and affluent groups, with unclear patterns across occupation groups. CONCLUSIONS SES-CVD patterns are heterogeneous, suggesting customized interventions for different SES groups may be warranted. Different behavioural, weight, and metabolic risk factor prevalence patterns across SES indicators may signal on-going epidemiological transition in South Asia.
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Islam FMA, Chakrabarti R, Islam MT, Wahab M, Lamoureux E, Finger RP, Shaw JE. Prediabetes, diagnosed and undiagnosed diabetes, their risk factors and association with knowledge of diabetes in rural Bangladesh: The Bangladesh Population-based Diabetes and Eye Study. J Diabetes 2016; 8:260-8. [PMID: 25851830 DOI: 10.1111/1753-0407.12294] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/12/2015] [Accepted: 03/22/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine the prevalence and risk factors of prediabetes and diagnosed and undiagnosed diabetes mellitus (DM) in rural Bangladesh. METHODS Using a population-based cluster random sampling strategy, 3104 adults aged ≥30 years were recruited. Fasting capillary blood glucose, blood pressure, height, weight, waist circumference, and knowledge, attitudes, and practice related to diabetes were recorded. Diabetes was defined as fasting glucose (FG) ≥7.0 mmol/L or a self-reported diagnosis of diabetes; impaired FG (IFG) was defined as FG ≥ 6.1 and <7.0 mmol/L. RESULTS The overall crude prevalence of DM was 7.2% (95% confidence interval [CI] 6.3%-8.1%; n = 222), of which 55% (n = 123) was previously undiagnosed (UDM). The prevalence of IFG was 5.3% (95% CI 4.5%-6.1%; n = 163). The age-standardized prevalence of DM and IFG was 6.6% and 5.0%, respectively. The prevalence of UDM was higher in people of lower socioeconomic status (59% vs. 31%; P < 0.001). Of those with known DM, 56% had poor glycemic control (FG ≥ 7.0 mmol/L) and 37% were not on medication. Overall knowledge of DM was poor; only 16.3%, 17.8%, and 13.4% of those with UDM, IFG, and normal FG knew that diabetes causes eye disease, compared with 55.6% of those with known DM (Ptrend < 0.001). CONCLUSIONS In this rural Bangladeshi community, UDM was high. Lower socioeconomic status was associated with a higher risk of UDM. Overall knowledge of DM was poor. Public health programmes should target those of low socioeconomic status and aim to increase knowledge of DM in rural Bangladesh.
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Affiliation(s)
- Fakir M Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - Rahul Chakrabarti
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - M Tauhidul Islam
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - Mohammad Wahab
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - Ecosse Lamoureux
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Duke-National University of Singapore, Graduate Medical School
- Singapore Eye Research Institute, Singapore
| | - Robert P Finger
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Little M, Humphries S, Patel K, Dewey C. Factors associated with BMI, underweight, overweight, and obesity among adults in a population of rural south India: a cross-sectional study. BMC OBESITY 2016; 3:12. [PMID: 26904203 PMCID: PMC4761187 DOI: 10.1186/s40608-016-0091-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/08/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Overweight, obesity, and related chronic diseases are becoming serious public health concerns in rural areas of India. Compounded with the existing issue of underweight, such concerns expose the double burden of disease and may put stress on rural healthcare. The purpose of this article was to present the prevalence and factors associated with underweight, overweight, and obesity in an area of rural south India. METHODS During 2013 and 2014, a random sample of adults aged 20-80 years were selected for participation in a cross-sectional study that collected information on diet (using a food frequency questionnaire), physical activity (using the Global Physical Activity Questionnaire), socioeconomic position (using a wealth index), rurality (using the MSU rurality index), education, and a variety of descriptive factors. BMI was measured using standard techniques. Using a multivariate linear regression analysis and multivariate logistic regression analyses, we examined associations between BMI, overweight, obesity, and underweight, and all potential risk factors included in the survey. RESULTS Age and sex-adjusted prevalence of overweight, obesity class I, and obesity class II were 14.9, 16.1, and 3.3 % respectively. Prevalence of underweight was 22.7 %. The following variables were associated with higher BMI and/or increased odds of overweight, obesity class I, and/or obesity class II: Low physical activity, high wealth index, no livestock, low animal fat consumption, high n-6 polyunsaturated fat consumption, television ownership, time spent watching television, low rurality index, and high caste. The following variables were associated with increased odds of underweight: low wealth index, high rurality index, and low intake of n-6 PUFAs. CONCLUSION Underweight, overweight, and obesity are prevalent in rural regions of southern India, indicating a village-level dual burden. A variety of variables are associated with these conditions, including physical activity, socioeconomic position, rurality, television use, and diet. To address the both underweight and obesity, policymakers must simultaneously focus on encouraging positive behaviour through education and addressing society-level risk factors that inhibit individuals from achieving optimal health.
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Affiliation(s)
- Matthew Little
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
| | - Sally Humphries
- />Department of Sociology and Anthropology, University of Guelph, Guelph, ON Canada
| | - Kirit Patel
- />Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB Canada
| | - Cate Dewey
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
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Bonotto GM, Mendoza-Sassi RA, Susin LRO. Conhecimento dos fatores de risco modificáveis para doença cardiovascular entre mulheres e seus fatores associados: um estudo de base populacional. CIENCIA & SAUDE COLETIVA 2016; 21:293-302. [DOI: 10.1590/1413-81232015211.07232015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/08/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste estudo foi avaliar o conhecimento dos fatores de risco modificáveis para a doença cardiovascular e sua distribuição em termos demográficos, socioeconômicos, comportamentais e biológicos entre mulheres residentes em Rio Grande, Rio Grande do Sul, Brasil. Foi um estudo transversal de base populacional, com a inclusão de mulheres com idade igual ou superior a 18 anos. Foram realizadas análise descritiva, bivariada e multivariável pela Regressão de Poisson. O desfecho foi definido como conhecer três ou mais dos sete fatores de risco pesquisados (percentil 75). De 1.593 entrevistadas, 33,0% conheciam três ou mais fatores. Foram associados de forma independente com maior probabilidade de conhecimento: a faixa etária de 25 a 44 anos, cor da pele não branca, ensino médio completo, maior renda e ser portadora da doença cardiovascular. Mulheres sedentárias apresentaram menor probabilidade de conhecimento. Os achados indicam a necessidade de ações educativas para melhorar a compreensão e o conhecimento dos fatores associados à doença cardiovascular, particularmente entre as mulheres mais pobres e menos escolarizadas.
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Islam FMA, Chakrabarti R, Islam SZ, Finger RP, Critchley C. Factors Associated with Awareness, Attitudes and Practices Regarding Common Eye Diseases in the General Population in a Rural District in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES). PLoS One 2015. [PMID: 26200458 PMCID: PMC4511641 DOI: 10.1371/journal.pone.0133043] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Methods Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Results Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (p<0.001). Overall 51% of people had heard of at least six (67%) out of nine items relating to awareness of common eye diseases. This included 41% of participants aged 65 years or older compared to 61% of those aged 30–35 years (p<0.001). Only 4% had an eye check at least once a year and higher education and better SES were associated with higher frequency of eye checks. Conclusions In rural Bangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps.
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Affiliation(s)
- Fakir M. Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Australia
- Organisation for Rural Community Development, Dariapur, Narail, Bangladesh
- * E-mail:
| | - Rahul Chakrabarti
- Organisation for Rural Community Development, Dariapur, Narail, Bangladesh
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Silvia Z. Islam
- Organisation for Rural Community Development, Dariapur, Narail, Bangladesh
- School of Economics, Finance and Marketing, RMIT University of Technology, Melbourne, Australia
| | - Robert P. Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Christine Critchley
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Australia
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Gautam A, Bhatta DN, Aryal UR. Diabetes related health knowledge, attitude and practice among diabetic patients in Nepal. BMC Endocr Disord 2015; 15:25. [PMID: 26045031 PMCID: PMC4456997 DOI: 10.1186/s12902-015-0021-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/22/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Globally, diabetes is the top priority chronic disease. Health literary would be cost effective for prevention and control of diabetes and its consequences. This study was conducted to determine the level of diabetes related health knowledge, attitude and practice (KAP) among diabetic patient and factors associated with KAP. METHODS An institutional based cross-sectional study was conducted using a non-probability sampling technique to select the diabetic patients. A total of 244 diabetic patients were interviewed from July to November 2014. Data was collected by face to face interview using structured interviewer rater questionnaires. Relative risk ratio (RRR) and 95% confidence interval (CI) of associated factors were estimated by a stepwise likelihood ratio method with multinomial logistic regression. RESULTS More than half (52.5%) of all patients were female, 18% were illiterate, and 24.6% were from rural residence. The diabetes related risk factors were common among diabetic patients; 9.8% smoker, 16% alcohol drinking, and 17.6% reported low or no physical activity. Median score for knowledge, attitude, and practice were 81, 40 and 14 respectively. Among all patients, 12.3%, 12.7% and 16% had highly satisfactory knowledge, attitude and practice respectively. Using highly insufficient knowledge as the baseline, the likelihood of having a level of highly sufficient knowledge was 17 times higher among patients who have graduated and above level of education compared to those who were illiterate. Albeit this value was comparatively lower than insufficient level of knowledge. The probability of having a sufficient level of practice among diabetic patient with a history of smoking was 0.10 times lower than in patient with no history of smoking. CONCLUSIONS Our study reveals a variation between diabetes related health knowledge, attitude and practice in Nepal among those who are affected by diabetes. Our results show the potential diabetes health literacy needs to be improved or developed for better health promotion.
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Affiliation(s)
- Anju Gautam
- Department of Public Health, Pokhara University, Nobel College, Sinamangal, Kathmandu, Nepal.
| | - Dharma Nand Bhatta
- Department of Public Health, Pokhara University, Nobel College, Sinamangal, Kathmandu, Nepal.
- Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand.
| | - Umesh Raj Aryal
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
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Hussain MA, Noorani S, Khan A, Asad H, Rehan A, Kazi A, Baig MZ, Noor A, Aqil A, Bham NS, Khan MA, Hassan IN, Kadir MM. The Role of Neighborhood Environment in Promoting Risk Factors of Cardiovascular Disease among Young Adults: Data from Middle to High Income Population in an Asian Megacity. PLoS One 2015; 10:e0124827. [PMID: 25946006 PMCID: PMC4422655 DOI: 10.1371/journal.pone.0124827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 03/18/2015] [Indexed: 11/20/2022] Open
Abstract
Background Modifiable risk factors of cardiovascular diseases (CVD) have their triggers in the neighborhood environments of communities. Studying the environmental triggers for CVD risk factors is important to understand the situation in a broader perspective. Young adults are influenced the most by the environment profile around them hence it is important to study this subset of the population. Methods This was a descriptive study conducted using the EPOCH research tool designed by the authors of the PURE study. The study population consisted of young adults aged 18-25 in two areas of Karachi. The study setting was busy shopping malls frequented by young adults in the particular community being studied. Results Our total sample size was 120 individuals, who consented to be interviewed by our interviewers. Less than 50% of the population recognized some form of restriction regarding smoking in their communities. The largest contributor to tobacco advertising was actors smoking in movies and TV shows with 89% responses from both communities. Only 11.9% of the individuals disapproved of smoking cigarettes among men with wide acceptance of ‘sheesha’ across all age groups. Advertising for smoking and junk food was more frequent as compared to smoking cessation, healthy diet and exercise in both the areas. Unhealthy food items were more easily available in contrast to healthier options. The cost of healthy snack food options including vegetables and fruits was higher than sugary drinks and foods. Conclusion This assessment showed that both communities were exposed to environments that promote risk factors for cardiovascular diseases.
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Affiliation(s)
- Mohammad Ahraz Hussain
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
- * E-mail:
| | - Sandal Noorani
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Amna Khan
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Hafsa Asad
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Anam Rehan
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Aamir Kazi
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Mirza Zain Baig
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Arish Noor
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Amash Aqil
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Nida Shahab Bham
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Mohammad Ali Khan
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Irfan Nazir Hassan
- Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - M. Masood Kadir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
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Gupta V, Millett C, Walia GK, Kinra S, Aggarwal A, Prabhakaran P, Bhogadi S, Kumar A, Gupta R, Prabhakaran D, Reddy KS, Smith GD, Ben-Shlomo Y, Krishna KVR, Ebrahim S. Socio-economic patterning of cardiometabolic risk factors in rural and peri-urban India: Andhra Pradesh children and parents study (APCAPS). JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2015; 23:129-136. [PMID: 26000232 PMCID: PMC4434856 DOI: 10.1007/s10389-015-0662-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 02/24/2015] [Indexed: 12/30/2022]
Abstract
Aim To assess the prevalence of cardiometabolic risk factors by socio-economic position (SEP) in rural and peri-urban Indian population. Subjects and methods Cross-sectional survey of 3,948 adults (1,154 households) from Telangana (2010–2012) was conducted to collect questionnaire-based data, physical measurements and fasting blood samples. We compared the prevalence of risk factors and their clustering by SEP adjusting for age using the Mantel Hansel test. Results Men and women with no education had higher prevalence of increased waist circumference (men: 8 vs. 6.4 %, P < 0.001; women: 20.9 vs. 12.0 %, P = 0.01), waist-hip ratio (men: 46.5 vs. 25.8 %, P = 0.003; women: 58.8 vs. 29.2 %, P = 0.04) and regular alcohol intake (61.7 vs. 32.5 %, P < 0.001; women: 25.7 vs. 3.8 %, P < 0.001) than educated participants. Unskilled participants had higher prevalence of regular alcohol intake (men: 57.7 vs. 38.7 %, P = 0.001; women: 28.3 vs. 7.3 %, P < 0.001). In contrast, participants with a higher standard of living index had higher prevalence of diabetes (top third vs. bottom third: men 5.2 vs. 3.5 %, P = 0.004; women 5.5 vs. 2.4 %, P = 0.003), hyperinsulinemia (men 29.5 vs. 16.3 %, P = 0.002; women 31.1 vs. 14.3 %, P < 0.001), obesity (men 23.3 vs. 10.6 %, P < 0.001; women 25.9 vs. 12.8 %, P < 0.001), and raised LDL (men 16.8 vs. 11.4 %, P = 0.001; women 21.3 vs. 14.0 %, P < 0.001). Conclusions Cardiometabolic risk factors are common in rural India but do not show a consistent association with SEP except for higher prevalence of smoking and regular alcohol intake in lower SEP group. Strategies to address the growing burden of cardiometabolic diseases in urbanizing rural India should be assessed for their potential impact on social inequalities in health.
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Affiliation(s)
- Vipin Gupta
- Department of Anthropology, University of Delhi, New Delhi, 110007 India
| | - Christopher Millett
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK ; Public Health Foundation of India, Delhi NCR, India
| | | | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Aniket Kumar
- Public Health Foundation of India, Delhi NCR, India
| | - Ruby Gupta
- Public Health Foundation of India, Delhi NCR, India
| | - D Prabhakaran
- Public Health Foundation of India, Delhi NCR, India ; Centre for Chronic Disease Control, New Delhi, India
| | | | | | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - K V Radha Krishna
- Indian Council for Medical Research, National Institute of Nutrition, Hyderabad, India
| | - Shah Ebrahim
- Public Health Foundation of India, Delhi NCR, India ; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Vellakkal S, Millett C, Basu S, Khan Z, Aitsi-Selmi A, Stuckler D, Ebrahim S. Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey. J Epidemiol Community Health 2015; 69:218-25. [PMID: 25550454 PMCID: PMC4345525 DOI: 10.1136/jech-2014-204621] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The use of self-reported measures of chronic disease may substantially underestimate prevalence in low-income and middle-income country settings, especially in groups with lower socioeconomic status (SES). We sought to determine whether socioeconomic inequalities in the prevalence of non-communicable chronic diseases (NCDs) differ if estimated by using symptom-based or criterion-based measures compared with self-reported physician diagnoses. METHODS Using population-representative data sets of the WHO Study of Global Ageing and Adult Health (SAGE), 2007-2010 (n=42 464), we calculated wealth-related and education-related concentration indices of self-reported diagnoses and symptom-based measures of angina, hypertension, asthma/chronic lung disease, visual impairment and depression in three 'low-income and lower middle-income countries'-China, Ghana and India-and three 'upper-middle-income countries'-Mexico, Russia and South Africa. RESULTS SES gradients in NCD prevalence tended to be positive for self-reported diagnoses compared with symptom-based/criterion-based measures. In China, Ghana and India, SES gradients were positive for hypertension, angina, visual impairment and depression when using self-reported diagnoses, but were attenuated or became negative when using symptom-based/criterion-based measures. In Mexico, Russia and South Africa, this distinction was not observed consistently. For example, concentration index of self-reported versus symptom-based angina were: in China: 0.07 vs. -0.11, Ghana: 0.04 vs. -0.21, India: 0.02 vs. -0.16, Mexico: 0.19 vs. -0.22, Russia: -0.01 vs. -0.02 and South Africa: 0.37 vs. 0.02. CONCLUSIONS Socioeconomic inequalities in NCD prevalence tend to be artefactually positive when using self-report compared with symptom-based or criterion-based diagnostic criteria, with greater bias occurring in low-income countries. Using standardised, symptom-based measures would provide more valid estimates of NCD inequalities.
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Affiliation(s)
- Sukumar Vellakkal
- Public Health Foundation of India, New Delhi, India
- Department of Sociology, Oxford University, Oxford, UK
| | - Christopher Millett
- Public Health Foundation of India, New Delhi, India
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sanjay Basu
- Prevention Research Center, Stanford University, Stanford, Palo Alto, California, USA
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Zaky Khan
- Public Health Foundation of India, New Delhi, India
| | - Amina Aitsi-Selmi
- Department of Epidemiology & Public Health, University College London, UK
| | - David Stuckler
- Department of Sociology, Oxford University, Oxford, UK
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Shah Ebrahim
- Public Health Foundation of India, New Delhi, India
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens 2015; 32:1170-7. [PMID: 24621804 PMCID: PMC4011565 DOI: 10.1097/hjh.0000000000000146] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: A region-specific (urban and rural parts of north, east, west, and south India) systematic review and meta-analysis of the prevalence, awareness, and control of hypertension among Indian patients have not been done before. Methods: Medline, Web of Science, and Scopus databases from 1950 to 30 April 2013 were searched for ‘prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (≥140 SBP and or ≥90 DBP) among Indian adults’ (≥18 years). Of the total 3047 articles, 142 were included. Results: Overall prevalence for hypertension in India was 29.8% (95% confidence interval: 26.7–33.0). Significant differences in hypertension prevalence were noted between rural and urban parts [27.6% (23.2–32.0) and 33.8% (29.7–37.8); P = 0.05]. Regional estimates for the prevalence of hypertension were as follows: 14.5% (13.3–15.7), 31.7% (30.2–33.3), 18.1% (16.9–19.2), and 21.1% (20.1–22.0) for rural north, east, west, and south India; and 28.8% (26.9–30.8), 34.5% (32.6–36.5), 35.8% (35.2–36.5), and 31.8% (30.4–33.1) for urban north, east, west, and south India, respectively. Overall estimates for the prevalence of awareness, treatment, and control of BP were 25.3% (21.4–29.3), 25.1% (17.0–33.1), and 10.7% (6.5–15.0) for rural Indians; and 42.0% (35.2–48.9), 37.6% (24.0–51.2), and 20.2% (11.6–28.7) for urban Indians. Conclusion: About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.
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The association between a vegetarian diet and cardiovascular disease (CVD) risk factors in India: the Indian Migration Study. PLoS One 2014; 9:e110586. [PMID: 25343719 PMCID: PMC4208768 DOI: 10.1371/journal.pone.0110586] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/23/2014] [Indexed: 11/21/2022] Open
Abstract
Background Studies in the West have shown lower cardiovascular disease (CVD) risk among people taking a vegetarian diet, but these findings may be confounded and only a minority selects these diets. We evaluated the association between vegetarian diets (chosen by 35%) and CVD risk factors across four regions of India. Methods Study participants included urban migrants, their rural siblings and urban residents, of the Indian Migration Study from Lucknow, Nagpur, Hyderabad and Bangalore (n = 6555, mean age-40.9 yrs). Information on diet (validated interviewer-administered semi-quantitative food frequency questionnaire), tobacco, alcohol, physical history, medical history, as well as blood pressure, fasting blood and anthropometric measurements were collected. Vegetarians ate no eggs, fish, poultry or meat. Using robust standard error multivariate linear regression models, we investigated the association of vegetarian diets with blood cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides, fasting blood glucose (FBG), systolic (SBP) and diastolic blood pressure (DBP). Results Vegetarians (32.8% of the study population) did not differ from non-vegetarians with respect to age, use of smokeless tobacco, body mass index, and prevalence of diabetes or hypertension. Vegetarians had a higher standard of living and were less likely to smoke, drink alcohol (p<0.0001) and were less physically active (p = 0.04). In multivariate analysis, vegetarians had lower levels of total cholesterol (β = −0.1 mmol/L (95% CI: −0.03 to −0.2), p = 0.006), triglycerides (β = −0.05 mmol/L (95% CI: −0.007 to −0.01), p = 0.02), LDL (β = −0.06 mmol/L (95% CI: −0.005 to −0.1), p = 0.03) and lower DBP (β = −0.7 mmHg (95% CI: −1.2 to −0.07), p = 0.02). Vegetarians also had decreases in SBP (β = −0.9 mmHg (95% CI: −1.9 to 0.08), p = 0.07) and FBG level (β = −0.07 mmol/L (95% CI: −0.2 to 0.01), p = 0.09) when compared to non-vegetarians. Conclusion We found beneficial association of vegetarian diet with cardiovascular risk factors compared to non-vegetarian diet.
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Islam FMA, Chakrabarti R, Dirani M, Islam MT, Ormsby G, Wahab M, Critchley C, Finger RP. Knowledge, attitudes and practice of diabetes in rural Bangladesh: the Bangladesh Population based Diabetes and Eye Study (BPDES). PLoS One 2014; 9:e110368. [PMID: 25313643 PMCID: PMC4196995 DOI: 10.1371/journal.pone.0110368] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background To assess the Knowledge, Attitudes and Practice (KAP) amongst the general community regarding type 2 diabetes mellitus (DM) in rural Bangladesh. Methods Data was collected using cluster random sampling from 3104 adults residing in a rural district in Bangladesh. Participants underwent a KAP questionnaire survey regarding assessing diabetes, socio-demographic and medical history. Descriptive, Chi-square and regression analyses were performed. Results Participants were aged between 30 and 89 years (M = 51, SD = 11.8) and 65.5% were female. The prevalence of diabetes was found to be 8.3%. The majority (93%) reported to have heard of diabetes, yet only 4% knew what a glucose tolerance test was. Only 50% reported that they knew physical inactivity was a risk factor. Age, gender, level of education and socio-economic status (SES) were significantly associated with KAP. A lower proportion (41%) of older participants (aged ≥65 years) reported that they knew that dietary modifications assist in diabetes control compared to those aged less than 35 years (69%), p<0.001. Males (β = 0.393, 95% CI = 0.142–0.643), and any level of education compared to no schooling (β = 0.726, 95% CI = 0.596, 0.857) reported significantly more knowledge, after multivariate adjustments for covariates. Participants aged under 35 years, (odds ratio (OR) = 1.73, 95% CI = 1.22–2.43) had significantly higher positive attitudes towards treatments of diabetes compared to those aged ≥65 years. Of the 99 people with known diabetes, more than 50% (n = 52) never had their blood sugar levels checked since diagnosis. Conclusions Knowledge of diabetes and its risk factors is very limited in rural Bangladesh, even in persons diagnosed with type 2 DM. The development of public health programmes to increase knowledge of diabetes and its complications is required to assist people living in rural Bangladesh to control and management of diabetes.
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Affiliation(s)
- Fakir M. Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
- Organisation for Rural Community Development, Dariapur, Narail, Bangladesh
- * E-mail:
| | - Rahul Chakrabarti
- Organisation for Rural Community Development, Dariapur, Narail, Bangladesh
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - M. Tauhidul Islam
- Organisation for Rural Community Development, Dariapur, Narail, Bangladesh
- Department of Physics, University of Melbourne, Melbourne, Australia
| | - Gail Ormsby
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
- Avondale College of Higher Education, Cooranbong, Sydney, Australia
| | - Mohamed Wahab
- Organisation for Rural Community Development, Dariapur, Narail, Bangladesh
- Narail Diabetes Hospital and Narail Diabetes Shamity, Narail, Bangladesh
| | - Christine Critchley
- Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Robert P. Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
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Justin Zaman M. Commentary: no smoke without fire-the continuing menace of the betel nut in the world's most vulnerable populations. Int J Epidemiol 2014; 43:1183-6. [PMID: 24691956 PMCID: PMC4258776 DOI: 10.1093/ije/dyu069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Justin Zaman
- Department of Cardiology, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea NR31 6LA, UK.
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Dhungana RR, Devkota S, Khanal MK, Gurung Y, Giri RK, Parajuli RK, Adhikari A, Joshi S, Hada B, Shayami A. Prevalence of cardiovascular health risk behaviors in a remote rural community of Sindhuli district, Nepal. BMC Cardiovasc Disord 2014; 14:92. [PMID: 25066117 PMCID: PMC4115072 DOI: 10.1186/1471-2261-14-92] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/21/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is emerging as a public health menace among low and middle income countries. It has particularly affected the poorest. However, there is paucity of information about CVD risk factors profile among Nepalese rural communities where the majority of people live in poverty. Therefore, this study aimed to identify the prevalence of cardiovascular health risk behaviors in an outback community of Nepal. METHODS We conducted a descriptive cross-sectional study in Tinkanya Village Development Committee (VDC), Sindhuli between January and March, 2014. Total 406 participants of age 20 to 50 years were selected randomly. Data were collected using WHO-NCD STEPwise approach questionnaires and analyzed with SPSS V.16.0 and R i386 2.15.3 software. RESULT The mean age of participants was 36.2 ± 9 years. Majority of participants (76.3%) were from lower socio-economic class, Adibasi/Janajati (63.1%), and without formal schooling (46.3%). Smoking was present in 28.6%, alcohol consumption in 47.8%, insufficient fruits and vegetables intake in 96.6%, insufficient physical activity in 48.8%; 25.6% had high waist circumference, 37.4% had overweight and obesity. Average daily salt intake per capita was 14.4 grams ±4.89 grams. Hypertension was detected in 12.3%. It had an inverse relationship with education and socio-economic status. In binary logistic regression analysis, age, smoking, body mass index (BMI) and daily salt intake were identified as significant predictors of hypertension. CONCLUSION Present study showed high prevalence of smoking, alcohol consumption, insufficient fruit and vegetable intake, daily salt intake, overweight and obesity and hypertension among remote rural population suggesting higher risk for developing CVD in future. Nepalese rural communities, therefore, are in need of population-wide comprehensive intervention approaches for reducing CVD health risk behaviors.
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Affiliation(s)
| | - Surya Devkota
- Manmohan Cardiothoracic, Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Yadav Gurung
- Auckland University of Technology, Auckland, New Zealand
| | | | | | - Anup Adhikari
- Youth Vision Central office Bhanimandal, Lalitpur, Nepal
| | | | - Barsha Hada
- Nature Care Hospital, Baneshwor, Kathmandu, Nepal
| | - Arun Shayami
- Manmohan Cardiothoracic, Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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