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Saric J, Aerts A, Anne M, Barboza J, Boch J, Dashdorj N, McGhie DV, Santana A, Shellaby JT, Rollemberg SMS, Silveira M, Steinmann P, Cobos D. Assessing the contributions of an urban population health initiative to shift political priority towards cardiovascular health: three case studies from Brazil, Mongolia and Senegal. BMC Health Serv Res 2024; 24:16. [PMID: 38178108 PMCID: PMC10768224 DOI: 10.1186/s12913-023-10432-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The urban population health initiative was designed as a multidisciplinary, multisector programme to address cardiovascular (CV) disease, specifically hypertension and its underlying causes in the cities of Ulaanbaatar, Mongolia; Dakar, Senegal; and São Paulo, Brazil. This article aims to provide an overview of the history and dynamics of CV disease policy making in the three countries, to present the policy reform contributions of the initiative and its role in the policy agenda-setting framework/process in each country and to identify the enablers and challenges to the initiative for doing so. METHODS A qualitative case study was conducted for each setting from November 2020 to January 2021, comprised of a document review, semi-structured in-depth interviews and unstructured interviews with stakeholders involved in the initiative. The literature review included documents from the initiative and the peer-reviewed and grey literature with a total of 188 documents screened. Interviews were conducted with 21 stakeholders. Data collection and thematic analysis was guided by (i) the Kingdon multiple streams conceptual framework with the main themes being CV disease problems, policy, politics and the role of policy entrepreneurs; and (ii) the study question inquiring on the role of the urban population health initiative at the CV disease policy level and enabling and challenging factors to advancing CV disease policy. Data were thematically analysed using the Framework Method. RESULTS Each setting was characterized by a high hypertension and CV disease burden combined with an aware and proactive political environment. Policy outcomes attributed to the initiative were updating the guidelines and/or algorithms of care for hypertension and including revised physical and nutritional education in school curricula, in each city. Overall, the urban health initiative's effects in the policy arena, were most prominent in Mongolia and Senegal, where the team effectively acted as policy entrepreneur, promoting the solutions/policies in alignment with the most pressing local problems and in strong involvement with the political actors. The initiative was also involved in improving access to CV disease drugs at primary health levels. Its success was influenced by the local governance structures, the proximity of the initiative to the policy makers and the local needs. In Brazil, needs were expressed predominantly in the clinical practice. CONCLUSIONS This multi-country experience shows that, although the policy and political environment plays its role in shaping initiatives, often the local priority needs are the driving force behind wider change.
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Affiliation(s)
- Jasmina Saric
- Swiss Tropical and Public Health Institute, 4123, Allschwil, Switzerland.
- University of Basel, 4003, Basel, Switzerland.
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Malick Anne
- Division de la Lutte contre les Maladies non transmissible Ministère de la Santé et de l'Action Sociale, Dakar, Sénégal
| | | | | | | | | | | | | | | | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, 4123, Allschwil, Switzerland
- University of Basel, 4003, Basel, Switzerland
| | - Daniel Cobos
- Swiss Tropical and Public Health Institute, 4123, Allschwil, Switzerland
- University of Basel, 4003, Basel, Switzerland
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Shim SY, Lee H. Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e44569. [PMID: 38039072 PMCID: PMC10724809 DOI: 10.2196/44569] [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: 11/24/2022] [Revised: 08/11/2023] [Accepted: 10/03/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults. OBJECTIVE We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults. METHODS The final sample included data on 5691 participants (male: n=2521. 44.3% and female: n=3170, 55.7%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life's Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable. RESULTS Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95% CI 0.98-4.18; P=.06). CONCLUSIONS Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance.
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Affiliation(s)
- Sun Young Shim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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Lamloum D, Fassio F, Osetinsky B, Tediosi F. Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1606428. [PMID: 37901590 PMCID: PMC10600349 DOI: 10.3389/ijph.2023.1606428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objective: High blood pressure is the leading risk factor for cardiovascular disease. The hypertension care cascade (HCC) is increasingly being used to evaluate the effectiveness of interventions. This systematic review aims to examine HCC in low-income settings. Methods: The search strategy included articles published between January 2010 and April 2023. We excluded studies with incomplete HCC, on fragile patients or aged <18 years, reviews. We used the MOOSE guideline. Five researchers retrieved data on the survey year, country, population, HCC and diagnostic methods for hypertension. We used JBI Critical Appraisal Tools for quality assessment. Results: Ninety-five articles were analyzed. Average hypertension prevalence was 33% (95% CI: 31%-34%), lower in LICs than in LMICs (25% vs. 34%). The overall mean awareness of hypertension was 48% (95% CI: 45%-51%), its treatment was 35% (95% IC: 32%-38%) and its control 16% (95% CI: 14%-18%). In almost all steps, percentages were lower in LICs and in Sub-Saharan Africa. Conclusion: Trends in HCC vary between countries, with poorer performance in LICs. This review highlights the need for interventions tailored to low-income settings in order to improve hypertension care.
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Affiliation(s)
- Demetrio Lamloum
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Myagmar-Ochir E, Haruyama Y, Takaoka N, Takahashi K, Dashdorj N, Dashtseren M, Kobashi G. Comparison of Three Diagnostic Definitions of Metabolic Syndrome and Estimation of Its Prevalence in Mongolia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4956. [PMID: 36981866 PMCID: PMC10048927 DOI: 10.3390/ijerph20064956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
We sought to estimate the prevalence of metabolic syndrome (MS) in the urban population of Mongolia and suggest a preferred definition. This cross-sectional study comprised 2076 representative samples, which were randomly selected to provide blood samples. MS was defined by the National Cholesterol Education Program's Adults Treatment Panel III (NCEP ATP III), the International Diabetes Federation (IDF), and the Joint Interim Statement (JIS). The Cohen's kappa coefficient (κ) was analyzed to determine the agreement between the individual MS components using the three definitions. The prevalence of MS in the 2076 samples was 19.4% by NCEP ATP III, 23.6% by IDF, and 25.4% by JIS criteria. For men, moderate agreement was found between the NCEP ATP III and waist circumference (WC) (κ = 0.42), and between the JIS and fasting blood glucose (FBG) (κ = 0.44) and triglycerides (TG) (κ = 0.46). For women, moderate agreement was found between the NCEP ATP III and high-density lipoprotein cholesterol (HDL-C) (κ = 0.43), and between the JIS and HDL-C (κ = 0.43). MS is highly prevalent in the Mongolian urban population. The JIS definition is recommended as the provisional definition.
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Affiliation(s)
- Enkhtuguldur Myagmar-Ochir
- Department of Public Health, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.T.); (K.T.); (G.K.)
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan;
| | - Nobuko Takaoka
- Department of Public Health, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.T.); (K.T.); (G.K.)
- Integrated Research Faculty for Advanced Medical Sciences, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan;
| | - Kyo Takahashi
- Department of Public Health, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.T.); (K.T.); (G.K.)
| | - Naranjargal Dashdorj
- Onom Foundation, Onom Foundation Central Office, 3 Bogd Javzandamba 15 Khoroo, Ulaanbaatar 17011, Mongolia;
| | - Myagmartseren Dashtseren
- Department of Family Medicine, School of Medicine, Mongolian National University of Medical Sciences, Jamyan Street 3, Ulaanbaatar 14210, Mongolia;
| | - Gen Kobashi
- Department of Public Health, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.T.); (K.T.); (G.K.)
- Integrated Research Faculty for Advanced Medical Sciences, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan;
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Boch J, Venkitachalam L, Santana A, Jones O, Reiker T, Rosiers SD, Shellaby JT, Saric J, Steinmann P, Ferrer JME, Morgan L, Barshilia A, Albuquerque EPR, Avezum A, Barboza J, Baxter YC, Bortolotto L, Byambasuren E, Cerqueira M, Dashdorj N, Dib KM, Guèye B, Seck K, Silveira M, Rollemberg SMS, de Oliveira RW, Luvsansambuu T, Aerts A. Implementing a multisector public-private partnership to improve urban hypertension management in low-and middle- income countries. BMC Public Health 2022; 22:2379. [PMID: 36536360 PMCID: PMC9761621 DOI: 10.1186/s12889-022-14833-y] [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] [Received: 09/01/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiovascular disease presents an increasing health burden to low- and middle-income countries. Although ample therapeutic options and care improvement frameworks exist to address its prime risk factor, hypertension, blood pressure control rates remain poor. We describe the results of an effectiveness study of a multisector urban population health initiative that targets hypertension in a real-world implementation setting in cities across three continents. The initiative followed the "CARDIO4Cities" approach (quality of Care, early Access, policy Reform, Data and digital technology, Intersectoral collaboration, and local Ownership). METHOD The approach was applied in Ulaanbaatar in Mongolia, Dakar in Senegal, and São Paulo in Brazil. In each city, a portfolio of evidence-based practices was implemented, tailored to local priorities and available data. Outcomes were measured by extracting hypertension diagnosis, treatment and control rates from primary health records. Data from 18,997 patients with hypertension in primary health facilities were analyzed. RESULTS Over one to two years of implementation, blood pressure control rates among enrolled patients receiving medication tripled in São Paulo (from 12·3% to 31·2%) and Dakar (from 6·7% to 19·4%) and increased six-fold in Ulaanbaatar (from 3·1% to 19·7%). CONCLUSIONS This study provides first evidence that a multisectoral population health approach to implement known best-practices, supported by data and digital technologies, and relying on local buy-in and ownership, can improve hypertension control in high-burden urban primary care settings in low-and middle-income countries.
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Affiliation(s)
- Johannes Boch
- grid.453815.e0000 0001 1941 4033Novartis Foundation, Basel, Switzerland
| | | | - Adela Santana
- grid.427645.60000 0004 0393 8328American Heart Association, Dallas, Texas USA
| | - Olivia Jones
- grid.427645.60000 0004 0393 8328American Heart Association, Dallas, Texas USA
| | - Theresa Reiker
- grid.453815.e0000 0001 1941 4033Novartis Foundation, Basel, Switzerland
| | - Sarah Des Rosiers
- grid.453815.e0000 0001 1941 4033Novartis Foundation, Basel, Switzerland
| | - Jason T. Shellaby
- grid.453815.e0000 0001 1941 4033Novartis Foundation, Basel, Switzerland
| | - Jasmina Saric
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Peter Steinmann
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Jose M. E. Ferrer
- grid.427645.60000 0004 0393 8328American Heart Association, Dallas, Texas USA
| | - Louise Morgan
- grid.427645.60000 0004 0393 8328American Heart Association, Dallas, Texas USA
| | - Asha Barshilia
- grid.427645.60000 0004 0393 8328American Heart Association, Dallas, Texas USA
| | | | - Alvaro Avezum
- grid.414358.f0000 0004 0386 8219Sociedade de Cardiologia do Estado de São Paulo & Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | | | | | - Márcia Cerqueira
- grid.419738.00000 0004 0525 5782Secretaria Municipal da Saúde, São Paulo, Brazil
| | | | - Karina Mauro Dib
- grid.419738.00000 0004 0525 5782Secretaria Municipal da Saúde, São Paulo, Brazil
| | - Babacar Guèye
- Ministère de la Santé et de l’Action Sociale, Dakar, Senegal
| | - Karim Seck
- grid.453815.e0000 0001 1941 4033Novartis Foundation, Basel, Switzerland
| | | | | | | | | | - Ann Aerts
- grid.453815.e0000 0001 1941 4033Novartis Foundation, Basel, Switzerland
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Enkhmaa D, Ganmaa D, Tanz LJ, Rich-Edwards JW, Stuart JJ, Enkhtur S, Gantsetseg G, Batkhishig B, Fitzmaurice G, Bayalag M, Nasantogtokh E, Bairey Merz CN, Shufelt CL. Changes in Vascular Function from Preconception to Postpartum Among Mongolian Women. J Womens Health (Larchmt) 2022; 31:1655-1663. [PMID: 35904927 PMCID: PMC9700357 DOI: 10.1089/jwh.2021.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pregnancy is associated with physiological changes to meet the metabolic demands of the growing fetus. To understand adverse pregnancy outcomes it is important to establish vascular changes throughout pregnancy. We examined longitudinal changes in vascular measurements from prepregnancy through postpartum. Materials and Methods: Seventy women planning to conceive in Ulaanbaatar, Mongolia enrolled in this prospective study. Within 6 months, 44 (63%) had conceived; of which 36 (82%) delivered. Ten (28%) developed complex pregnancies and were analyzed separately. Vascular measures included central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), augmentation index corrected for heart rate of 75 beats/minute (AIx-75), and pulse wave velocity (PWV). Measurements were performed at prepregnancy, second trimester (22-24 weeks), third trimester (34-36 weeks), and 2 months postpartum. Missing values (n = 0-6 per time period) were replaced by multiple imputation. A repeated measures analysis of variance analyzed changes within individual women over the four time points adjusted for age, parity, and body mass index. Results: We observed significant reductions from prepregnancy to second trimester for mean Alx-75 (17.1%-12.6%; p = 0.006) and cSBP (91.7-86.8 mmHg; p = 0.03) but not for cDBP or PWV. Both mean AIx-75 and cSBP increased in third trimester. In the postpartum, cSBP returned to prepregnancy levels, whereas AIx-75 exceeded prepregnancy levels, although this fell short of significance (p = 0.09). Similar vascular patterns were observed in women with complex pregnancies for AIx-75; however, PWV increased from the second trimester and remained higher through postpartum, although not significant. Conclusion: In Mongolian women, we observed a decrease in AIx-75 and cSBP from prepregnancy through second trimester, which resolved postpartum. These results provide an understanding of changes across pregnancies in an Asian country. Future studies should assess vascular changes across pregnancies to determine if it can predict conditions such as pre-eclampsia.
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Affiliation(s)
- Davaasambuu Enkhmaa
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Davaasambuu Ganmaa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lauren J. Tanz
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Janet W. Rich-Edwards
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer J. Stuart
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shonkhuuz Enkhtur
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Garmaa Gantsetseg
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Bandi Batkhishig
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Garrett Fitzmaurice
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Munkhuu Bayalag
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Erdenebileg Nasantogtokh
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - C. Noel Bairey Merz
- Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Chrisandra L. Shufelt
- Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Los Angeles, California, USA
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Pengpid S, Peltzer K. National trends in prevalence, awareness, treatment, and control of hypertension among adults in Mongolia from 4 cross-sectional surveys in 2005, 2009, 2013, and 2019. Medicine (Baltimore) 2022; 101:e30140. [PMID: 35984124 PMCID: PMC9388008 DOI: 10.1097/md.0000000000030140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to analyze trends in the prevalence, awareness, treatment, and control of hypertension and associated factors in persons 15 years and older from 2005 to 2019 in Mongolia. National data were analyzed from 21,342 people (≥15 years) who participated in 4 cross-sectional STEPwise Approach to NCD Risk Factor Surveillance surveys in Mongolia (2005, 2009, 2013, or 2019) and had complete blood pressure measurements. The prevalence, awareness, treatment, and control of hypertension were calculated using sociodemographic factors within each study year. Logistic regression was employed to assess the associations between sociodemographic and health factors and status of hypertension, awareness, treatment, and control by study year and pooled sample. Trend analyzes showed that the prevalence of hypertension decreased significantly from 28.4% in 2005 to 23.2% in 2019 (P < .001). The prevalence of awareness among hypertensives remained unchanged, the treatment among aware decreased, and the control rate increased. In adjusted logistic regression analysis with the pooled sample, male sex (adjusted odds ratio [AOR]: 1.49, 95% confidence intervals [CI]: 1.32-1.68), older age (≥45 years) (AOR: 5.90, 95% CI: 4.90-7.10), obesity (AOR: 4.29, 95% CI: 3.77-4.88), more frequent alcohol use (≥1-2 days/week) (AOR: 1.69, 95% CI: 1.39-2.05) were positively, and higher educational level (≥12 years) (AOR: 0.77, 95% CI: 0.68-0.87) and urban residence (AOR: 0.84, 95% CI: 0.74-0.97) were negatively associated with hypertension prevalence. The prevalence of hypertension among Mongolian adults has decreased in recent years. Levels of hypertension awareness were unchanged, treatment decreased, and control increased. Increased health promotion, detection, and treatment of hypertension in Mongolia are indicated.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Karl Peltzer
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- *Correspondence: Karl Peltzer, Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan (e-mail: )
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Bechstein M, Gansukh A, Regzengombo B, Byambajav O, Meyer L, Schönfeld M, Kniep H, Hanning U, Broocks G, Gansukh T, Fiehler J. Risk Factors for Cerebral Aneurysm Rupture in Mongolia. Clin Neuroradiol 2021; 32:499-506. [PMID: 34191041 PMCID: PMC9187534 DOI: 10.1007/s00062-021-01051-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/31/2021] [Indexed: 12/05/2022]
Abstract
Purpose Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. Results The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Conclusion Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.
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Affiliation(s)
- Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Amarjargal Gansukh
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Mongolian Academy of Sciences, Oyun Onosh Medical Center, Ulaanbaatar, Mongolia
| | - Boldbat Regzengombo
- Mongolian Academy of Sciences, Oyun Onosh Medical Center, Ulaanbaatar, Mongolia
- Shastin Central Hospital, Ulaanbaatar, Mongolia
| | - Oyun Byambajav
- Mongolian Academy of Sciences, Oyun Onosh Medical Center, Ulaanbaatar, Mongolia
- Shastin Central Hospital, Ulaanbaatar, Mongolia
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Michael Schönfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tserenchunt Gansukh
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Mongolian Academy of Sciences, Oyun Onosh Medical Center, Ulaanbaatar, Mongolia
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Myanganbayar M, Boldbaatar K, Tuvdendarjaa K, Beaney T, Partington G, Baatarsuren U, Bayarsaikhan NE, Davaadamdin O, Bungert A, Campbell NRC, Poulter NR, Dashdorj N. May Measurement Month 2019: an analysis of blood pressure screening results from Ulaanbaatar, Mongolia. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Mortality from haemorrhagic stroke and ischaemic heart disease per 10 000 people in Mongolia ranks among the highest in the world. The main risk factor being hypertension. We aimed to screen hypertension for the working people in their workplace who rarely visit primary clinics. Two hundred health care volunteers were trained for blood pressure (BP) measuring technique and providing healthy lifestyle advice. Screening was performed at 80 sites, the majority were workplaces, over a period of 60 days when the May Measurement Month (MMM) campaign launched in May 2019. Hypertension was defined by the standard MMM guidance, as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg (based on the mean of the second and third measurement), or taking anti-hypertensive medication. Blood pressure measuring digital devices (Omron-M3, Microlife A6 PC) were all clinically verified and approved for clinical use. A total of 6522 individuals (majority 67.8% male and mean age 37.0 ± 10.4) were screened. The proportion of hypertensive adults was 32.5%, of whom, 62.2% were aware of their hypertension, and 50.1% were on medication. The control rate for those on treatment was 27.1%. Non-communicable disease risk factors were 51.2% (3342) overweight/obese (19.5% obese), 38.7% (2523) smoking, 64.4% (4200) alcohol consumption, 4.5% (294) previously diagnosed with diabetes, and 1.3% and 1.1% with a heart attack or stroke, respectively. We conclude that hypertension management needs to be prioritized and increased awareness is required in the population.
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Affiliation(s)
- Maral Myanganbayar
- Onom Foundation, 3 Governance Academy Street, 15 Khoroo, Khan-Uul District, Ulaanbaatar, Mongolia
| | - Khatantuul Boldbaatar
- Onom Foundation, 3 Governance Academy Street, 15 Khoroo, Khan-Uul District, Ulaanbaatar, Mongolia
| | - Khulan Tuvdendarjaa
- Onom Foundation, 3 Governance Academy Street, 15 Khoroo, Khan-Uul District, Ulaanbaatar, Mongolia
- Asian Development Bank, Ulaanbaatar, Mongolia
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
- Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W6 8RP, UK
| | - Giles Partington
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Uurtsaikh Baatarsuren
- Onom Foundation, 3 Governance Academy Street, 15 Khoroo, Khan-Uul District, Ulaanbaatar, Mongolia
| | | | | | - Andreas Bungert
- Onom Foundation, 3 Governance Academy Street, 15 Khoroo, Khan-Uul District, Ulaanbaatar, Mongolia
| | - Norm R C Campbell
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- O’Brien Institute for Public Health, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Naranjargal Dashdorj
- Onom Foundation, 3 Governance Academy Street, 15 Khoroo, Khan-Uul District, Ulaanbaatar, Mongolia
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