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Ramalivhana FW, Veldsman T, Moss SJ. Assessment of non-communicable disease risk factors, functional performance, and health-related quality of life in adults: a comparative analysis in low-resourced urban and rural areas of South Africa. BMC Public Health 2024; 24:1580. [PMID: 38867182 PMCID: PMC11170915 DOI: 10.1186/s12889-024-18964-2] [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: 12/04/2023] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Globally, disparities between non-communicable disease (NCD) risk factors, functional performance, and health-related quality of life (HRQoL) exist in people living in rural and low-resourced urban settings. Evidence of these health differences determined with objective NCD risk factors and functional performance measurements in South Africa, is scarce. Therefore, the study aimed to determine the differences in NCD risk factors, functional performance and HRQoL between rural and low-resourced urban areas. METHODS The study recruited 311 adults (35-80 years) presenting with at least one NCD risk factor from low-resourced urban- (n = 183) and rural (n = 128) communities. Objective measurements of physical activity (PA) by means of combined heart rate and accelerometery, body composition employing skinfolds, peripheral lipid and glucose concentrations, blood pressure, functional performance indicators (handgrip, single leg stand, sit-to-stand, timed-up-and-go speed, predicted peak VO2 max); and HRQoL were measured according to standard procedures. Independent t-tests, Mann-Whitney U, and chi-square tests were performed to determine differences between the variables of low-resourced urban and rural settings. RESULTS The participants from the low-resourced urban setting were significantly older than the rural residents (59.1 ± 10.7 years vs. 52.8 ± 11.3 years; p = 0.001). NCD risk factors were significantly more prevalent in the low-resourced urban participants compared to rural participants, in particular for elevated systolic (85.8% vs. 62.5%; p = 0.001), and diastolic blood pressure (88.5% vs. 65.6%; p = 0.001), physical inactivity (95.9% vs. 87.7%; p = 0.026), increased cholesterol concentrations (22.1% vs. 8.7%; p = 0.002), and increased waist circumference (61.9% vs. 49.2%; p = 0.027). Low-resourced urban residents presented with a higher average body fat percentage (27.69% ± 7.65% vs. 12.23% ± 4.67%; p < 0.001), and lower moderate to vigorous PA levels (37.19 ± 49.55 [95% CI = 29.12-45.27] vs. 62.92 ± 60.43 min/week [95% CI = 47.95-77.90]; p = 0.003) compared to rural residents. Rural residents showed significantly better functional performance, including peak VO2 (23.99 ± 9.89 vs. 16.95 ± 7.64 ml/min/kg; p = 0.001) and single leg stand (right leg: 44.96 ± 18.47 vs. 20.87 ± 19.18 s; p = 0.001) as well as higher HRQoL for the physical (51.06 ± 8.14% vs. 45.62 ± 11.13%; p < 0.001) and mental (54.75 ± 8.24% vs. 48.91 ± 12.27%; p < 0.001) component scores compared to participants from the low-resourced urban areas. CONCLUSION NCD risk factors, functional performance, and HRQoL significantly differ in rural communities compared to low-resourced urban communities in South Africa. Urban areas' most prevalent risk factors were elevated blood pressure, physical inactivity, and increased waist circumference. Participants from rural areas demonstrated significantly better functional performance, such as fitness and balance. HRQoL was better in rural settings than in urban settings. Future intervention programmes should be tailored for specific settings.
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Affiliation(s)
- Fhatuwani W Ramalivhana
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Tamrin Veldsman
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Sarah J Moss
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
- North-West University, Private Bag X6001, Potchefstroom, 2531, South Africa.
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Das P, Saha S, Das T, Das P, Roy TB. Assessing the modifiable and non-modifiable risk factors associated with multimorbidity in reproductive aged women in India. BMC Public Health 2024; 24:676. [PMID: 38439011 PMCID: PMC10910662 DOI: 10.1186/s12889-024-18186-6] [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: 11/21/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Reproductive span is the foundation of every woman's health in later life. India is currently facing a growing burden of multiple morbidities among the women in their reproductive age group which may further increase over the coming decades. The purpose of the present study aimed to identify different modifiable and non-modifiable risk factors affecting multimorbidity among the women in reproductive age group in Indian context. METHODS Secondary data were obtained from the Demography and Health Survey (DHS), conducted in India during 2019-2021. A total of 671,967 women aged 15-49 years were selected for this present study. Descriptive, association studies and multinominal logistic regression analyses were performed to accomplish the objectives. RESULTS Currently, 6.3% of total study participant's reproductive age group women suffered from multimorbidity in India. Never consuming protein, fruits, vegetables and milk increase the chances of developing multimorbidity. Consumption of fried foods, aerated drinks and addiction towards tobacco and alcohol also has a greater influence on the prevalence of multimorbidity. The prevalence of multimorbidity is sharply increased with increasing age and Body Mass Index (BMI). Regionally, the prevalence of multimorbidity was found more among the women hailed from eastern and north-eastern India. CONCLUSION To reduce the risk of developing multimorbidity, targeted interventions are needed in the form of educating every woman concerning the importance of having minimum health-related knowledge, maintaining healthy lifestyle, weight management and having proper and balanced diet.
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Affiliation(s)
- Priya Das
- Department of Geography, University of Gour Banga, 732101, Malda, West Bengal, India
| | - Subhadeep Saha
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India
| | - Tanu Das
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India
| | - Partha Das
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India
| | - Tamal Basu Roy
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India.
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Pengpid S, Peltzer K. Rural-urban health differences among aging adults in India. Heliyon 2024; 10:e23397. [PMID: 38173538 PMCID: PMC10761573 DOI: 10.1016/j.heliyon.2023.e23397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/08/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Background The aim of this study was to determine the rural-urban health differences among aging adults in India. Methods The national cross-sectional data of 67,489 individuals (≥45 years) in 2017-2018 from 35 states and union territories of India (excluding Sikkim) in 2017-2018 were analysed. Various sociodemographic data, well-being indicators, lifestyle factors and physical conditions were assessed by face-to-face interviews and physical measurement. Univariable and multivariable logistic regression was utilized to assess the predictors between residence status (rural dweller, urban migrant, and urban dweller) and various health indicator outcomes. Results Majority (70.4 %) of the participants lived in rural areas, 10.3 % were urban migrants and 19.3 % urban dwellers. In the multivariable logistic regression analysis, urban migrants and urban dwellers had a higher self-rated health status, cognitive functioning, physical inactivity, overweight or obesity and abdominal obesity than rural dwellers, while urban migrants and/or urban dwellers had lower functional disability, insomnia symptoms, current smokeless tobacco use, current smoking, heavy episodic drinking and underweight than rural dwellers. Furthermore, urban migrants and/or urban dwellers had higher odds of diabetes, hypertension, heart disease, cancer, high cholesterol than rural dwellers, while urban migrants and/or urban dwellers had lower odds of persistent headaches, major injury, recurrent fall, physical pain, periodontal disease, vision impairment, and gastrointestinal problems than rural dwellers. Conclusion Among 30 health indicators assessed, 16 had an urban migrant and/or urban dweller advantage, 8 had urban migrant and/or urban dweller penalty, and 6 did not differ between rural-urban groups. Public health promotion and health care should address differing health care needs of rural and urban middle-aged and older adults.
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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
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Zayar NN, Chotipanvithayakul R, Bjertness E, Htet AS, Geater AF, Chongsuvivatwong V. Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar. Int J Gen Med 2023; 16:5909-5920. [PMID: 38106977 PMCID: PMC10725691 DOI: 10.2147/ijgm.s439141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose We investigated the association of TB patients and their household contacts with diabetes mellitus (DM) and hypertension compared to the general population, and the mediating effects of risk behaviors including current smoking, alcohol drinking, and poor diet quality. Patients and Methods A cross-sectional study on screening for DM, hypertension, and risk behaviors among newly diagnosed TB patients (n = 221) and their household contacts (n = 257) aged 25-74 years in Yangon in 2018. Health data of the general population (n = 755) were obtained from an NCD risk factor survey in Yangon. A directed acyclic graph is used to identify possible pathways of association between variables. Associations are presented as adjusted odds ratios (aOR). Results Compared to the general population, both TB patients and their household contacts were associated with current smoking and drinking, and TB patients were more likely to be underweight. Without considering mediating effects, TB patients had higher odds of DM (aOR = 6.3, 95% CI: 3.8-10.6), but both TB patients and household contacts had lower odds of hypertension (aOR = 0.54; 95% CI: 0.33-0.87) and (aOR = 0.68; 95% CI: 0.47-0.98), respectively. The body mass index-mediated pathway reduced the odds of DM and hypertension among TB patients (aOR = 3.4; 95% CI: 2.2-5.3) and (aOR = 0.3; 95% CI: 0.2-0.5), respectively. Conclusion The shared risk behaviors among TB patients and household contacts with high burden of DM in TB patients endorse screening of risk behaviors and strengthening the integration of NCD services among TB patients and household contacts in this dual-burden country.
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Affiliation(s)
- Nyi Nyi Zayar
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Rassamee Chotipanvithayakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aung Soe Htet
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alan Frederick Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Sawane H, Rajpurohit L, Mathur A, Sonawane S, Kharat P. Smokeless Tobacco Use and Its Association with Type 2 Diabetes: A Case Control Study. Asian Pac J Cancer Prev 2023; 24:4209-4217. [PMID: 38156856 PMCID: PMC10909092 DOI: 10.31557/apjcp.2023.24.12.4209] [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: 07/28/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder characterized by hyperglycemia and insulin resistance. Its incidence is increasing globally, with a significant impact on public health. Smokeless tobacco (SLT) is a form of tobacco consumption that has been associated with various health risks, including potential effects on glucose homeostasis. This case-control study aimed to investigate the association between SLT use and T2DM. Additionally, the study aimed to assess the relationship of age, gender, socioeconomic status (SES), body mass index (BMI), family history of diabetes, physical activity, and periodontal status with T2DM participants. METHODS The study was conducted over 24 months and included 82 T2DM cases and 164 non-diabetic controls. Demographic data, tobacco use, medical history, oral hygiene habits, BMI, and periodontal status were collected through a self-administered questionnaire and interviews. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) for Windows 26.0 (SPSS, Inc. Chicago, Illinois). RESULTS The majority of T2DM cases were in the age group of 31-50 years, and there was a significant association between gender and T2DM, with more males being diabetic. There was no significant association between SES and diabetes. Obesity was found to be a significant risk factor for T2DM. Among SLT users, gutkha was the most commonly used product. SLT use was significantly associated with T2DM. Family history of diabetes and physical inactivity were also significantly associated with diabetes. CONCLUSION The study suggests that SLT use is a risk factor for T2DM and may be associated with increased diabetes risk. Further research is warranted to understand the underlying mechanisms and potential interventions to reduce the impact of SLT on diabetes risk.
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Affiliation(s)
| | - Ladusingh Rajpurohit
- Department of Public Health Dentistry, Dr D Y Patil Dental College and Hospital, Pimpri, Pune Maharashtra, Dr D Y Patil Vidyapeeth Pimpri, Pune Maharashtra, India.
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Yizengaw HA, Ayele WM, Yalew AW. The trend and pattern of adult mortality in South-Central Ethiopia: analysis using the 2008-2019 data from Butajira Health and Demographic Surveillance System. Glob Health Action 2022; 15:2118180. [PMID: 36178408 PMCID: PMC9542780 DOI: 10.1080/16549716.2022.2118180] [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] [Indexed: 11/04/2022] Open
Abstract
Background Understanding context-specific temporal trends in mortality is essential for setting health policy priorities. Objective To investigate the trends and distribution of deaths due to communicable and non-communicable diseases and external causes in South-Central Ethiopia. Method All adult deaths captured by the Butajira Health and Demographic Surveillance System between January 2008 and December 2019 were included. A verbal autopsy method of collecting cause of death data was used. Physician review and a computerised algorithm, InterVA, were used to determine the cause of death. Coding was undertaken using the World Health Organization's International Classification of Diseases. Trends in adult mortality rate and proportional mortality were estimated by major cause of death categories. Significant trends were analysed using the Mann–Kendall statistical test with a significance set at P < 0.05. Deaths were also disaggregated by age, sex, and residence. Results There were 1,612 deaths in 279,681 person-years; 811 (50.3%) were females. The median age at death was 65 years. The proportional adult mortality and adult mortality rates (per 1000 person-years) attributed to communicable diseases, non-communicable diseases, and external causes were 31.1%, 58.9%, and 6.0%, and 1.9, 3.4, and 0.4, respectively. Adult mortality due to communicable diseases showed a declining trend (tau, the measure of the strength and direction of association, = −0.52; P < 0.05), whereas the trend increased for non-communicable diseases (tau = 0.67, P < 0.05) and external causes (tau = 0.29, P > 0.05). Moreover, death rates were pronounced in the 65+ age group and rural areas but comparable among males and females. Conclusion The trend in deaths due to communicable diseases declined but increased for non-communicable diseases and external causes with significant public health burdens. These findings will provide essential input in formulating health policy reforms to reduce premature mortality.
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Affiliation(s)
- Hailelule Aleme Yizengaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku Yalew
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kim JM, Bae YJ. Regional Differences in Metabolic Risk in the Elderly in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11675. [PMID: 36141947 PMCID: PMC9517405 DOI: 10.3390/ijerph191811675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Lifestyle and dietary differences in urban and rural environments have different impacts on elderly health. We aimed to evaluate the nutritional intakes and metabolic risks in the urban and rural elderly. We analyzed 3018 elderly individuals (1358 men, 1660 women) who were aged 65 years and older using the Korea National Health and Nutrition Examination Survey data (2013-2016). Anthropometric data, blood pressure, and blood profiles were collected using health examinations. Daily dietary intakes were analyzed by the 24-h dietary recall method. Rural elderly women had significantly higher triglycerides (TG) levels and lower high-density lipoprotein (HDL)-cholesterol levels than urban elderly women (p = 0.014, p = 0.005). The rural elderly had higher carbohydrate intake and percentage of carbohydrate energy intake and lower intakes of fat, vitamin A, vitamin B2, and vitamin C and percentage of fat energy intake than the urban elderly for both men and women (p < 0.05). The odds of high TG and low HDL-cholesterol were 1.66 (95% confidence interval [CI] 1.23-2.23) and 1.33 (95% CI 1.01-1.77), respectively, in elderly women living in rural areas compared to their urban counterparts, after adjusting for confounding factors. Therefore, nutritional intervention might be needed to improve the nutritional status of the elderly in rural areas and to manage low HDL-cholesterol in rural women.
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Affiliation(s)
- Ji-Myung Kim
- Food and Nutrition Major, Division of Food Science & Culinary Arts, Shinhan University, Uijeongbu 11644, Korea
| | - Yun-Jung Bae
- Major in Food and Nutrition, Division of Food Science and Biotechnology, Korea National University of Transportation, Jeungpyeong 27909, Korea
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Urbanization and Unfavorable Changes in Metabolic Profiles: A Prospective Cohort Study of Indonesian Young Adults. Nutrients 2022; 14:nu14163326. [PMID: 36014832 PMCID: PMC9414085 DOI: 10.3390/nu14163326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The substantial increase in the prevalence of non-communicable diseases in Indonesia might be driven by rapid socio-economic development through urbanization. Here, we carried out a longitudinal 1-year follow-up study to evaluate the effect of urbanization, an important determinant of health, on metabolic profiles of young Indonesian adults. University freshmen/women in Jakarta, aged 16−25 years, who either had recently migrated from rural areas or originated from urban settings were studied. Anthropometry, dietary intake, and physical activity, as well as fasting blood glucose and insulin, leptin, and adiponectin were measured at baseline and repeated at one year follow-up. At baseline, 106 urban and 83 rural subjects were recruited, of which 81 urban and 66 rural were followed up. At baseline, rural subjects had better adiposity profiles, whole-body insulin resistance, and adipokine levels compared to their urban counterparts. After 1-year, rural subjects experienced an almost twice higher increase in BMI than urban subjects (estimate (95%CI): 1.23 (0.94; 1.52) and 0.69 (0.43; 0.95) for rural and urban subjects, respectively, Pint < 0.01). Fat intake served as the major dietary component, which partially mediates the differences in BMI between urban and rural group at baseline. It also contributed to the changes in BMI over time for both groups, although it does not explain the enhanced gain of BMI in rural subjects. A significantly higher increase of leptin/adiponectin ratio was also seen in rural subjects after 1-year of living in an urban area. In conclusion, urbanization was associated with less favorable changes in adiposity and adipokine profiles in a population of young Indonesian adults.
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Aung WH, Kitreerawutiwong N, Keeratisiroj O, Jariya W. Health Service Readiness, Availability, and Utilization of Primary Health Care Facilities for Non-Communicable Diseases in Shan State, Myanmar. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1303-1312. [PMID: 36447964 PMCID: PMC9659547 DOI: 10.18502/ijph.v51i6.9675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Non-communicable diseases (NCDs) are increasing in Myanmar. There have been limited studies to assess the health service system for NCDs patients at the primary health care (PHC) level. We aimed to assess and compare the health service readiness, availability, and utilization of PHC facilities for NCDs in districts in Myanmar. METHODS This cross-sectional study collected data by questionnaires from 242 health care providers working at PHC facilities in three districts in Shan State, Myanmar from January 2020 to January 2021. Differences were calculated with the ANOVA test for NCD capacity readiness and NCD service availability and the Kruskal-Wallis test for NCD service utilization. RESULTS PHC facilities had a mean score of greater than 70% for NCD capacity readiness of health workforces, health information systems, and essential medicines and equipment domains, but there were large gaps for improvement in financing and governance of health. Almost all PHC facilities had NCD services available, and the differences were not significant among the three districts. However, the mean scores of NCD services availability for chronic respiratory diseases and cancers were lower in all districts. Regarding NCD service utilization, the screening and new patient rates had significant differences among districts (P-value < 0.05). CONCLUSION We revealed the situation and gaps in managing NCDs in Myanmar's PHC facilities. These findings can inform policymakers at the state and district levels to implement programs for improving health services for NCDs, particularly in rural areas.
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Sasaki Y, Shobugawa Y, Nozaki I, Takagi D, Nagamine Y, Funato M, Chihara Y, Shirakura Y, Lwin KT, Zin PE, Bo TZ, Sone T, Win HH. Association between Happiness and Economic Status among Older Adults in Two Myanmar Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3216. [PMID: 35328904 PMCID: PMC8951419 DOI: 10.3390/ijerph19063216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022]
Abstract
Few studies have examined whether objective or subjective economic status (ES) has a greater association with the happiness of older adults, despite concerns regarding the growing economic cost of morbidity and their functional dependence in developing countries with aging populations. Thus, this study examined whether objective/subjective ES was associated with happiness in older adults in two Myanmar regions. A multistage random sampling procedure and face-to-face interviews were conducted in the urban and rural areas of Myanmar. The happiness of 1200 participants aged >60 years was evaluated using a single happiness score ranging from 0 (very unhappy) to 10 (very happy). The wealth index, used as an objective ES, was calculated from 17 household asset items, such as radio, washing machines, and television. Subjective ES was assessed by asking “Which of the following best describes your current financial situation in light of general economic conditions?” Responses ranged from “very difficult” to “very comfortable”. Both low objective and subjective ES were negatively associated with happiness, after adjusting for confounding variables and stratification by region (urban and rural areas). Although objective and subjective ES had similar associations with happiness in urban areas, subjective ES had a stronger association in rural areas.
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Affiliation(s)
- Yuri Sasaki
- Department of International Health and Collaboration, National Institute of Public Health, Wako City 351-0197, Japan
| | - Yugo Shobugawa
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
| | - Daisuke Takagi
- Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Yuiko Nagamine
- Department of Family Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| | - Masafumi Funato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Yuki Chihara
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Yuki Shirakura
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Kay Thi Lwin
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Poe Ei Zin
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Thae Zarchi Bo
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Tomofumi Sone
- National Institute of Public Health, Wako City 351-0197, Japan;
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
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Association between Dietary Habits and Type 2 Diabetes Mellitus in Yangon, Myanmar: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111056. [PMID: 34769575 PMCID: PMC8582904 DOI: 10.3390/ijerph182111056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
In Myanmar, the escalating prevalence of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance among adults was recently reported, with the highest prevalence in the Yangon Region. The aim of the present study was to identify the risk factors in dietary habits and their relationship with T2DM in urban Myanmar residents. We conducted a case–control study recruiting 300 individuals aged 25–74 years living in the Yangon Region, consisting of 150 newly diagnosed cases attending a diabetes clinic, and 150 controls, who were community residents and free of diabetes. The case group had a significantly higher consumption of noodles, fish, beans, fermented food and pickles, dried food, topping seasonings, and non-dairy milk products than the control group, whereas they had a lower vegetable intake (more than three servings/day) and fruit intake (more than three servings/day) than the control group. Furthermore, the case group exhibited a higher frequency of some dietary behaviors than the control group, such as (1) having meals with family, (2) skipping breakfast, and (3) eating out. The final model showed that topping seasonings (adjusted odds ratio (aOR) 11.23, 95% confidence interval (CI) 3.08–40.90), more than three servings/day of vegetable intake (aOR 0.18, 95% CI 0.05–0.67), and having meals with family (aOR 2.23, 95% CI 1.05–4.71) were associated with diabetes. The study suggests that Myanmar’s characteristic dietary culture of topping their meals with salty seasonings and sauces and eating multiple dishes together as a family are risk factors associated with T2DM. Our findings may contribute recommendations and opportunities for the primary prevention of T2DM in urban Myanmar.
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Warrell CE, Phyo AP, Win MM, McLean ARD, Watthanaworawit W, Swe MMM, Soe K, Lin HN, Aung YY, Ko CK, Waing CZ, Linn KS, Aung YPW, Aung NM, Tun NN, Dance DAB, Smithuis FM, Ashley EA. Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes. Trans R Soc Trop Med Hyg 2021; 115:914-921. [PMID: 33681986 PMCID: PMC8326957 DOI: 10.1093/trstmh/trab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. METHODS A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. RESULTS Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. CONCLUSIONS TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.
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Affiliation(s)
- Clare E Warrell
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | | | - Mo Mo Win
- Department of Medical Research, Myanmar
| | - Alistair R D McLean
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wanitda Watthanaworawit
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Kyaw Soe
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Htet Naing Lin
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | | | | | | | | | | | - Ne Myo Aung
- Department of Medicine, Insein General Hospital, Min Gyi Road, Insein Township, Yangon, Myanmar.,Department of Medicine, University of Medicine 2, Khaymar Thi Road, North Okkalapa Township, Yangon, Myanmar
| | - Ni Ni Tun
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | - David A B Dance
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank M Smithuis
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | - Elizabeth A Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Leach MJ, Gillam M, Gonzalez-Chica DA, Walsh S, Muyambi K, Jones M. Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:905-917. [PMID: 32767700 DOI: 10.1111/hsc.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 05/05/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard-copy. The survey was conducted between April 2017 and March 2018. A multi-modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional-urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW, Australia
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | | | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
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Rural-Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062818. [PMID: 33802054 PMCID: PMC7999321 DOI: 10.3390/ijerph18062818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to investigate rural–urban differences in depressive symptoms in terms of the risk factors among older adults of two regions in Myanmar to provide appropriate intervention for depression depending on local characteristics. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from the two regions, for face-to-face interviews. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS). Depressive symptoms were positively associated with living in rural areas (B = 0.42; 95% confidence interval (CI): 0.12,0.72), female (B = 0.55; 95% CI: 0.31,0.79), illness during the preceding year (B = 0.68; 95% CI: 0.45,0.91) and non-Buddhist religion (B = 0.57; 95% CI: 0.001,1.15) and protectively associated with education to middle school level or higher (B = −0.61; 95% CI: −0.94, −0.28) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.30, −0.10). In women in urban areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.78; 95% CI: 0.36, 1.20) and protectively associated with education to middle school level or higher (B = −0.67; 95% CI: −1.23, −0.11), middle or high wealth index (B = −0.92; 95% CI: −1.59, −0.25) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.38, −0.03). In men in rural areas, illness during the preceding year was positively associated with depressive symptoms (B = 0.87; 95% CI: 0.33, 1.42). In women in rural areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.83; 95% CI: 0.36, 1.30) and protectively associated with primary education (B = −0.62; 95% CI: −1.12, −0.12) and the frequency of visits to religious facilities (B = −0.44; 95% CI: −0.68, −0.21). Religion and wealth could have different levels of association with depression between older adults in the urban and rural areas and men and women. Interventions for depression in older adults should consider regional and gender differences in the roles of religion and wealth in Myanmar.
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Thapa R, Dahl C, Aung WP, Bjertness E. Urban-rural differences in overweight and obesity among 25-64 years old Myanmar residents: a cross-sectional, nationwide survey. BMJ Open 2021; 11:e042561. [PMID: 33653748 PMCID: PMC7929804 DOI: 10.1136/bmjopen-2020-042561] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To investigate whether urban-rural location and socioeconomic factors (income, education and employment) are associated with body mass index (BMI) and waist-hip ratio (W/H-ratio), and to further explore if the associations between urban-rural location and BMI or W/H-ratio could be mediated through variations in socioeconomic factors. DESIGN Cross-sectional, WHO STEPS survey of non-communicable disease risk factors. SETTING Urban and rural areas of Myanmar. PARTICIPANTS A total of 8390 men and women aged 25 to 64 years included during the study period from September to December 2014. Institutionalised people (Buddhist monks and nuns, hospitalised patients) and temporary residents were excluded. RESULTS The prevalence of overweight and obesity was higher in the urban areas and increased with increasing socioeconomic status (SES) score. Mean BMI was higher among urban residents (ß=2.49 kg/m2; 95% CI 2.28 to 2.70; p<0.001), individuals living above poverty line, that is, ≥US$1.9/day (ß=0.74 kg/m2; 95% CI 0.43 to 1.05; p<0.001), and those with high education attainment (ß=1.48 kg/m2; 95% CI 1.13 to 1.82; p<0.001) when adjusting for potential confounders. Similarly, greater W/H-ratio was observed in participants living in an urban area, among those with earnings above poverty line, and among unemployed individuals. The association between urban-rural location and BMI was found to be partially mediated by a composite SES score (9%), income (17%), education (16%) and employment (16%), while the association between urban-rural location and W/H-ratio was found to be partially mediated by income (12%), education (6%) and employment (6%). CONCLUSION Residents living in urban locations had higher BMI and greater W/H-ratio, partially explained by differences in socioeconomic indicators, indicating that socioeconomic factors should be emphasised in the management of overweight and obesity in the Myanmar population. Furthermore, new national or subnational STEPS surveys should be conducted in Myanmar to observe the disparity in trends of the urban-rural differential.
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Affiliation(s)
- Rupa Thapa
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wai Phyo Aung
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Occupational and Environmental Health Division, Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Sasaki Y, Shobugawa Y, Nozaki I, Takagi D, Nagamine Y, Funato M, Chihara Y, Shirakura Y, Lwin KT, Zin PE, Bo TZ, Sone T, Win HH. Association between depressive symptoms and objective/subjective socioeconomic status among older adults of two regions in Myanmar. PLoS One 2021; 16:e0245489. [PMID: 33507963 PMCID: PMC7842968 DOI: 10.1371/journal.pone.0245489] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/03/2021] [Indexed: 12/20/2022] Open
Abstract
Low objective socioeconomic status (SES) has been correlated with poor physical and mental health among older adults. Some studies suggest that subjective SES is also important for ensuring sound physical and mental health among older adults. However, few studies have been conducted on the impact of both objective and subjective SES on mental health among older adults. This study examines whether objective or subjective SES is associated with depressive symptoms in older adults in Myanmar. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from two regions of Myanmar, for face-to-face interviews. The Geriatric Depression Scale (GDS) was used to evaluate the depressive symptoms. Participants were classified as having no depressive symptom (GDS score <5) and having depressive symptoms (GDS score ≥5). Objective and subjective SES were assessed using the wealth index and asking participants a multiple-choice question about their current financial situation, respectively. The relationship between objective/subjective SES and depressive symptoms was examined using a multivariable logistic regression analysis. The mean age of the 1,186 participants aged 60 years and above was 69.7 (SD: 7.3), and 706 (59.5%) were female. Among them, 265 (22.3%) had depressive symptoms. After adjusting for objective SES and other covariates, only low subjective SES was positively associated with depressive symptoms (adjusted odds ratio, AOR: 4.18, 95% confidence interval, CI: 2.98-5.87). This association was stronger among participants in the rural areas (urban areas, AOR: 2.10, 95% CI: 1.08-4.05; rural areas, AOR: 5.65, 95% CI: 3.69-8.64). Subjective SES has a stronger association with depressive symptoms than objective SES, among older adults of the two regions in Myanmar, especially in the rural areas. Interventions for depression in older adults should consider regional differences in the context of subjective SES by reducing socioeconomic disparities among the communities.
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Affiliation(s)
- Yuri Sasaki
- National Institute of Public Health, Wako, Japan
- * E-mail:
| | - Yugo Shobugawa
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ikuma Nozaki
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - Masafumi Funato
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Yuki Chihara
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Shirakura
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Poe Ei Zin
- University of Medicine 1, Yangon, Myanmar
| | | | | | - Hla Hla Win
- University of Medicine 1, Yangon, Myanmar
- University of Public Health, Yangon, Myanmar
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Tiruneh SA, Bukayaw YA, Yigizaw ST, Angaw DA. Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS One 2020; 15:e0244642. [PMID: 33382819 PMCID: PMC7774863 DOI: 10.1371/journal.pone.0244642] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Hypertension is a major public health problem globally and it is a leading cause of death and disability in developing countries. This review aims to estimate the pooled prevalence of hypertension and its determinants in Ethiopia. Methods A systematic literature search was conducted at the electronic databases (PubMed, Hinari, and Google Scholar) to locate potential studies. Heterogeneity between studies checked using Cochrane Q test statistics and I2 test statistics and small study effect were checked using Egger’s statistical test at 5% significance level. Sensitivity analysis was checked. A random-effects model was employed to estimate the pooled prevalence of hypertension and its determinants in Ethiopia. Results In this review, 38 studies that are conducted in Ethiopia and fulfilled the inclusion criteria with a total number of 51,427 study participants were reviewed. The overall pooled prevalence of hypertension in the country was 21.81% (95% CI: 19.20–24.42, I2 = 98.35%). The result of the review also showed that the point of prevalence was higher among males (23.21%) than females (19.62%). When we see the pervasiveness of hypertension from provincial perspective; the highest prevalence of hypertension was observed in Addis Ababa (25.35%) and the lowest was in Tigray region (15.36%). In meta-regression analysis as the mean age increases by one year, the likelihood of developing hypertension increases by a factor of 0.58 times (β = 0.58, 95% CI: 0.31–0.86, R2 = 36.67). Male sex (OR = 1.29, 95% CI: 1.03–1.61, I2 = 81.35%), age > 35 years (OR = 3.59, 95% CI: 2.57–5.02, I2 = 93.48%), overweight and/or obese (OR = 3.34, 95% CI: 2.12–5.26, I2 = 95.41%), khat chewing (OR = 1.42, 95% CI: I2 = 62%), alcohol consumption (OR = 1.50, 95% CI: 1.21–1.85, I2 = 64%), family history of hypertension (OR = 2.56, 95% CI: 1.64–3.99, I2 = 83.28%), and family history of diabetes mellitus (OR = 3.69, 95% CI: 1.85–7.59, I2 = 89.9%) are significantly associated with hypertension. Conclusion Hypertension is becoming a major public health problem in Ethiopia. Nearly two out of ten individuals who are older than 18 years living with hypertension. Sex, age, overweight and/or obese, khat chewing, alcohol consumption, and family history of hypertension and diabetes mellitus are statistically significant determinant factors for hypertension in Ethiopia. Primary attention should be given for behavioral risk factors to tackle the alarming increase of hypertension in Ethiopia.
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Affiliation(s)
- Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Yeaynmarnesh Asmare Bukayaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seblewongel Tigabu Yigizaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Urban-Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis. J Clin Med 2020; 9:jcm9093012. [PMID: 32962006 PMCID: PMC7565280 DOI: 10.3390/jcm9093012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/20/2022] Open
Abstract
Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan.
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19
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Leach MJ, Walsh S, Muyambi K, Gillam M, Jones M. Expressed Demand for Health Care Services in Regional South Australia: A Cross-sectional Study. J Rural Health 2020; 37:645-654. [PMID: 32602978 DOI: 10.1111/jrh.12472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Accessibility and availability of health care services/providers is an increasing concern for many regional communities, particularly regional South Australia. Assessing the level of health service/provider utilization within a region (ie, expressed demand) can be useful in determining health care need and health service/workforce demand. METHODS The regional South Australia health (RESONATE) survey aimed to determine the expressed demand for health care services and the health workforce in a regional South Australian population. The study was open to adults living in regional South Australia and was promoted using a comprehensive multimodal recruitment campaign. Data were collected between April 2017 and March 2018 using the consumer utilization, expectations and experiences of healthcare instrument. FINDINGS A total of 3,926 adults completed the questionnaire. Participants reported using 47 different health care providers in the previous 12 months. Whilst almost all (92.9%) participants had seen a general practitioner in the past 12 months, yoga instructors, chiropractors, pharmacists, and physiotherapists were visited most frequently. Proportionally fewer participants in more remote locations received conventional services/treatments, though a significantly greater proportion of those in more remote locations had received complementary medicine services/treatments (relative to inner regional areas). CONCLUSIONS Findings of the RESONATE survey point to a high level of expressed demand for conventional and complementary health care services among study participants, possibly higher than that reported in the general population. Examining the extent to which the health needs of this and other regional populations are met should be the focus of further research to better inform future health workforce/services planning.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, New South Wales, Australia.,Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
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Grover S, Sinha DN, Gupta S, Gupta PC, Mehrotra R. The changing face of risk factors for non-communicable disease in Myanmar: findings from the 2009 and 2014 WHO STEP Surveys. J Public Health (Oxf) 2020; 41:750-756. [PMID: 30321380 DOI: 10.1093/pubmed/fdy176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Myanmar is burdened with the dual problem of communicable and non-communicable diseases (NCD), and is constantly endeavoring to attain its health objectives with limited resources. This study compares the results for the 2009 and 2014 WHO STEPs surveys (the 'stepwise' approach to adult risk factor surveillance) in Myanmar to determine the change in NCD risk factors over time. METHODOLOGY The proportion of individuals with major NCD risk factors such as current tobacco and alcohol consumption, <5 fruit/vegetable servings, physical activity, raised blood pressure (BP) and overweight and obesity from the year 2009 (n = 6414) and year 2014 (n = 8757) WHO STEP surveys were compared for the age group 25-64 and relative changes (RC) calculated. RESULTS Tobacco and alcohol consumption has increased significantly (25 and 49% RC, respectively) over the years. Individuals with low fruit/vegetable consumption (<5 servings) have declined (4.3% RC) and physical activity has increased significantly (46.5% RC). The prevalence of overweight, obese and hypertensive individuals has reduced significantly during this period with a RC reduction of 18, 28 and 20%, respectively. CONCLUSION Reductions in some NCD risk factors are encouraging but control of tobacco use and alcohol consumption requires more stringent policies in order to prevent NCDs in the future.
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Affiliation(s)
- Shekhar Grover
- National Institute of Cancer Prevention & Research, Noida, UP, India
| | - Dhirendra N Sinha
- National Institute of Cancer Prevention & Research, Noida, UP, India
| | - Sanjay Gupta
- National Institute of Cancer Prevention & Research, Noida, UP, India
| | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention & Research, Noida, UP, India
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Leach MJ. Determinants of Complementary Medicine Service Utilization in a Regional South Australian Population: A Cross-Sectional Study. J Rural Health 2020; 37:69-80. [PMID: 32150311 DOI: 10.1111/jrh.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The dearth of accessible and appropriate conventional health care services in regional areas may drive many people to seek care provided by complementary medicine (CM) practitioners. Understanding the drivers of CM service use in this population may help inform future health services planning. This study set out to examine the determinants of CM service utilization in a regional South Australian population. METHODS Adults residing in regional South Australia between April 2017 and March 2018 were invited to complete the 44-item consumer utilization, expectations, and experiences of health care instrument. The questionnaire was available in print and online, and was promoted using a multimodal recruitment campaign. Independent predictors of CM service use were determined using multivariate logistic regression. FINDINGS Completing the questionnaire were 3,926 adults (56.7% aged 50+ years; 52.5% females). Forty-seven percent of participants reported using a CM service within the last 12 months. Univariate analyses revealed a statistically significant association between 13 factors and CM service use. When these factors were forced into a multivariate logistic regression model, the number of predictors of CM service utilization was reduced to 10, which included 6 predisposing factors, 3 enabling factors, and 1 personal health practice. This model was able to explain 23.1% (Nagelkerke R2 = 0.231) of the variation in CM service use in this sample. CONCLUSIONS A high level of CM service use was reported among participants living in regional South Australia. The findings highlight the degree to which the appropriateness of health services impacts health-seeking behavior in regional communities.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia.,Patarina Institute, Adelaide, South Australia.,National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, New South Wales
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Prevalence and characteristics of risk factors for non-communicable diseases in semi-urban communities. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-03-2019-0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe purpose of this research aimed to identify the risk factors for non-communicable diseases (NCDs) and determine their prevalence and characteristics in a semi-urban community in Thailand.Design/methodology/approachThe survey was designed to determine the type and prevalence of risk factors for NCDs among populations in semi-urban areas in the Takianleurn subdistrict of Nakhonsawan, Thailand. A stratified random sampling design was used to select 352 subjects, aged over 15 years and living in this region. Data were collected by questionnaire and analyzed to show frequency, percentage, mean, standard deviation, chi-squared, prevalence rate and prevalence rate ratio with significance indicated by p-value < 0.05 and confidence interval 95 percent.Research limitations/implicationsThe implications for the future study are as follows: (1) a comparative study between rural and urban or rural and semi-urban or urban and semi-urban should be studied to understand how risk factors cause NCDs and (2) Participatory action research should be introduced to assess the effectiveness of the decrease in NCDs risk factors management in the community.Practical implications(1) To scale up public health interventions measures to promote and prevent NCDs should be focused on behavioral risk factors of NCDs such as eating habits, physical activity, smoking and alcohol consumption. (2) Health promotion and disease prevention for decrease in NCDs should consist of reducing alcohol consumption and enhancing healthy eating habits and (3) To manage unmodified risk factors such as age, gender, educational level, etc. should be focused on surveillance and physical health examination yearly.FindingsThe results revealed a prevalence of NCDs of 14.8 percent. The main unmodifiable risk factors affecting NCD prevalence were gender, age, low level of education and poverty; behavioral risk factors included not eating enough fruit and vegetables, high alcohol consumption, a high-fat fast-food diet and smoking.Originality/valueThe prevention of NCDs requires more focus on changing the eating behavior of high-risk groups and providing easily accessible health care information and services. The entire family should be involved in the process of maintaining good health and disease prevention for all family members.
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Thike TZ, Saw YM, Lin H, Chit K, Tun AB, Htet H, Cho SM, Khine AT, Saw TN, Kariya T, Yamamoto E, Hamajima N. Association between body mass index and ready-to-eat food consumption among sedentary staff in Nay Pyi Taw union territory, Myanmar. BMC Public Health 2020; 20:206. [PMID: 32041555 PMCID: PMC7011543 DOI: 10.1186/s12889-020-8308-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ready-to-eat (RTE) food consumption has become popular in the working community with the increase in full-time jobs and the limited time to prepare food. Although RTE food is essential for this community, its consumption causes obesity. In Myanmar, obesity is a modifiable risk factor for non-communicable diseases, causing increases in morbidity and mortality. This study aimed to identify the association between body mass index (BMI) and RTE food consumption among sedentary staff in Nay Pyi Taw Union Territory, Myanmar. METHODS A cross-sectional study was conducted in 2018, in which 400 respondents participated in face-to-face interviews. The study area was selected using simple random sampling and drawing method. Measuring tape and digital weighing scale were used to measure the height and weight of the respondents. BMI was calculated by dividing the weight by height squared (kg/m2). Overweight and obesity were categorized by World Health Organization cut-off points. The collected data were analyzed using multiple logistic regression to estimate the adjusted odds ratio (AOR), and the 95% confidence interval (CI). RESULTS This study revealed that sedentary staff who consumed RTE food once or more per month were nearly five times more likely to be overweight and obese (AOR = 4.78, 95% CI 1.44-15.85) than those who consumed RTE food less frequently. In addition, five factors namely being older than 32 years (AOR = 3.97, 95% CI 1.82-8.69), preference for RTE food (AOR = 8.93, 95% CI 2.54-31.37), light-intensity of physical exercise (AOR = 3.55, 95% CI 1.63-7.73), sedentary leisure activities (AOR = 3.32, 95% CI 1.22-9.03), and smoking (AOR = 5.62, 95% CI 1.06-29.90) were positively associated with overweight and obesity. CONCLUSION Frequent consumers of RTE food and less physically active sedentary staff were more likely to be overweight and obese. This study highlights the urgent need to raise awareness regarding healthy lifestyle behaviors among the working community to reduce the burden of obesity-related chronic diseases. Moreover, sedentary workers should be aware of the food-based dietary guidelines of the country. Policy makers should strictly enforce nutritional labeling of RTE food, and strictly prohibit over-branding of RTE food.
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Affiliation(s)
- Thin Zar Thike
- Department of Food and Drug Administration, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Htin Lin
- Department of Food and Drug Administration, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Khin Chit
- Department of Food and Drug Administration, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Ba Tun
- Directorate of Medical Service, Nay Pyi Taw, Myanmar
| | - Hein Htet
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Department of Preventative and Social Medicine, University of Medicine, Mandalay, Myanmar
| | - Su Myat Cho
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Aye Thazin Khine
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thu Nandar Saw
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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Gebremedhin G, Enqueselassie F, Deyessa N, Yifter H. Urban-Rural Differences in the Trends of Type 1 and Type 2 Diabetes Among Adults Who Received Medical Treatment from Public Hospitals in Resource-Poor Community Tigray, Ethiopia. Diabetes Metab Syndr Obes 2020; 13:859-868. [PMID: 32273737 PMCID: PMC7106991 DOI: 10.2147/dmso.s238275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study carried out to describe urban-rural differences in the trend of type 1 and type 2 diabetes among adults who have received medical treatment from public hospitals over the last five years. METHODS The trends of adult diabetes assessed from September 1, 2013, to August 31, 2018, using hospital-based retrospective medical records of 299,806 adult patients in the adult medical outpatient and emergency units. Data were collected using a uniform data abstraction format. An extended Mantel-Haenszel chi-square test of the linear trend used to examine the trend over time. RESULTS Of the total 299,806 adult patients, 3056 (1.02% (95% CI: 0.98-1.06)) patients were confirmed diabetes patients. The overall trend in the proportion of diabetes had increased from 6.8 to 14.3 per 1000 adult patients. The trend of type 1 diabetes increased for both urban from 1.0 to 2.2 per 1000 adult urban residents and rural from 1.2 to 2.6 per 1000 adult rural residents, with statistically a significant increase (χ2= 9.1, P=0.002) and (χ2=17.8, P<0.001) for linear trend, respectively. The trend of type 2 diabetes increased for both urban from 6.9 to 14.0 per 1000 adult urban residents and rural from 4.0 to 9.5 per 1000 adult rural residents, with a statistically significant increase (χ2=68.4, P<0.001) and (χ2=74.2, P<0.001) for linear trend, respectively. The higher increase in the proportion of both type 1 and type 2 diabetes observed among women patients. CONCLUSION The trend in the proportion of type 1 and type 2 diabetes increasing for both urban and rural residents, with a higher increase observed among women. These findings highlight health-care professionals and policymakers to design effective public health policies to treat each type of disease.
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Affiliation(s)
- Getachew Gebremedhin
- College of Medicine and Health Sciences, Department of Nursing, Adigrat University, Adigrat, Ethiopia
- College Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Getachew Gebremedhin Email
| | - Fikre Enqueselassie
- College Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- College Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen Yifter
- College Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Trends in Diabetes Prevalence, Awareness, Treatment and Control in Yangon Region, Myanmar, Between 2004 and 2014, Two Cross-Sectional Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183461. [PMID: 31540348 PMCID: PMC6765960 DOI: 10.3390/ijerph16183461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 01/04/2023]
Abstract
Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the prevalence, awareness, treatment and control of DM from 2004 to 2014, among adults aged 25–74 years, in the Yangon region. Two cross-sectional household-based studies, according to World Health Organization STEPwise approach to surveillance (WHO STEPS) methodology, were conducted in 2004 (n = 4448) and 2014 (n = 1372). The overall age-standardized prevalence of DM was 8.3% (95% CI 6.5–10.6) in 2004 and 10.2% (7.6–13.6) in 2014 (p = 0.296). The DM prevalence increased between the study years among elderly participants only, from 14.6% (11.7–18.1) to 31.9% (21.1–45.0) (p = 0.009). Awareness of having DM increased from 44.3% (39.2, 49.6) to 69.4% (62.9–75.2) (p < 0.001). Among participants who were aware of having DM, the proportion under treatment increased from 55.1% (46.8–63.1) to 68.6% (61.5–74.8) (p = 0.015). There was no change in proportion with controlled DM. Adjusted for age, sex and education, mean fasting plasma glucose levels in 2014 were 0.56 mmol/L (0.26–0.84) higher than in 2004. Preventive measures to halt future increases in DM prevalence and to increase the detection of undiagnosed DM cases are needed.
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Thandar MM, Kiriya J, Shibanuma A, Ong KIC, Tin KN, Win HH, Jimba M. Women's knowledge on common non-communicable diseases and nutritional need during pregnancy in three townships of Ayeyarwaddy region, Myanmar: a cross-sectional study. Trop Med Health 2019; 47:12. [PMID: 30723383 PMCID: PMC6352420 DOI: 10.1186/s41182-019-0137-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/14/2019] [Indexed: 12/02/2022] Open
Abstract
Background Health systems in many countries do not adequately address non-communicable diseases (NCDs) during pregnancy, especially in low- and middle-income countries. In Myanmar, most studies on NCDs have investigated risk factors and prevalence of NCDs in the general population. This study aimed to assess the level of knowledge of common NCDs and nutritional need during pregnancy and to identify the factors associated with such knowledge, in three townships of Ayeyarwaddy region in Myanmar. Methods A cross-sectional study was conducted among pregnant women aged between 18 and 49 years. We interviewed 630 pregnant women by using a pretested structured questionnaire. Knowledge questionnaire had five categories: general knowledge in NCDs, hypertension, diabetes, anemia, and nutritional need during pregnancy. Knowledge scores ranged from 0 to 56. We used Bloom’s cut-off point to classify the knowledge into three levels: low level as 59% or below (0–33 scores), moderate level as 60–80% (34–49 scores), and high level as 80–100% (50–56 scores). We conducted multiple linear regression analyses to find the association between different exposure variables (behavioral risk factors, pre-existing NCDs in pregnant women, and family history of NCDs) and knowledge on common NCDs and nutritional need during pregnancy adjusted for socioeconomic factors. Results Among pregnant women, 64.8% had moderate level of knowledge, 22.7% had low level, and only 12.5% had high level. The mean knowledge scores were 39.6 (standard deviation 10.2). Pregnant women with the following factors were more likely to have higher knowledge: their belonging to the second, middle, and fourth quintiles of wealth index and their family members’ status of having some kind of NCDs. Conclusions Majority of pregnant women had low to moderate level of knowledge on common NCDs and nutritional need during pregnancy. Wealth and family history of NCDs were significantly associated with their knowledge. Prevention and promotion of NCDs should be integrated in maternal and child health programs and should emphasize for the pregnant women who are in the poorest or richest wealth quintiles and who do not have family history of NCDs.
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Affiliation(s)
- Moe Moe Thandar
- 1Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Kiriya
- 1Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- 1Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken Ing Cherng Ong
- 1Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Khaing Nwe Tin
- 2Maternal and Reproductive Health Division, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Hla Hla Win
- 3Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar
| | - Masamine Jimba
- 1Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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de Groot R, van den Hurk K, Schoonmade LJ, de Kort WLAM, Brug J, Lakerveld J. Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001017. [PMID: 30740247 PMCID: PMC6347938 DOI: 10.1136/bmjgh-2018-001017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction The built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults. Methods PubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome. Results After screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively). Conclusions Total and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas. Prospero registration number CRD42016043226.
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Affiliation(s)
- Rosa de Groot
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Linda J Schoonmade
- Department of Medical Library, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Wim L A M de Kort
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes Brug
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Abdullah N, Murad NAA, Attia J, Oldmeadow C, Kamaruddin MA, Jalal NA, Ismail N, Jamal R, Scott RJ, Holliday EG. Differing Contributions of Classical Risk Factors to Type 2 Diabetes in Multi-Ethnic Malaysian Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2813. [PMID: 30544761 PMCID: PMC6313591 DOI: 10.3390/ijerph15122813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
Abstract
The prevalence of type 2 diabetes is escalating rapidly in Asian countries, with the rapid increase likely attributable to a combination of genetic and lifestyle factors. Recent research suggests that common genetic risk variants contribute minimally to the rapidly rising prevalence. Rather, recent changes in dietary patterns and physical activity may be more important. This nested case-control study assessed the association and predictive utility of type 2 diabetes lifestyle risk factors in participants from Malaysia, an understudied Asian population with comparatively high disease prevalence. The study sample comprised 4077 participants from The Malaysian Cohort project and included sub-samples from the three major ancestral groups: Malay (n = 1323), Chinese (n = 1344) and Indian (n = 1410). Association of lifestyle factors with type 2 diabetes was assessed within and across ancestral groups using logistic regression. Predictive utility was quantified and compared between groups using the Area Under the Receiver-Operating Characteristic Curve (AUC). In predictive models including age, gender, waist-to-hip ratio, physical activity, location, family history of diabetes and average sleep duration, the AUC ranged from 0.76 to 0.85 across groups and was significantly higher in Chinese than Malays or Indians, likely reflecting anthropometric differences. This study suggests that obesity, advancing age, a family history of diabetes and living in a rural area are important drivers of the escalating prevalence of type 2 diabetes in Malaysia.
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Affiliation(s)
- Noraidatulakma Abdullah
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Nor Azian Abdul Murad
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - John Attia
- Clinical Research Design, IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, 2305, Australia.
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, 2305, Australia.
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
| | - Mohd Arman Kamaruddin
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Nazihah Abd Jalal
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Norliza Ismail
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Rahman Jamal
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Rodney J Scott
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
- Hunter Area Pathology Service, John Hunter Hospital, Newcastle, New South Wales, 2305, Australia.
| | - Elizabeth G Holliday
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
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Fatty Acid Profiles of Various Vegetable Oils and the Association between the Use of Palm Oil vs. Peanut Oil and Risk Factors for Non-Communicable Diseases in Yangon Region, Myanmar. Nutrients 2018; 10:nu10091193. [PMID: 30200403 PMCID: PMC6163161 DOI: 10.3390/nu10091193] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023] Open
Abstract
The majority of vegetable oils used in food preparation in Myanmar are imported and sold non-branded. Little is known about their fatty acid (FA) content. We aimed to investigate the FA composition of commonly used vegetable oils in the Yangon region, and the association between the use of palm oil vs. peanut oil and risk factors for non-communicable disease (NCD). A multistage cluster survey was conducted in 2016, and 128 oil samples from 114 households were collected. Data on NCD risk factors were obtained from a household-based survey in the same region, between 2013 and 2014. The oils most commonly sampled were non-branded peanut oil (43%) and non-branded palm oil (19%). Non-branded palm oil had a significantly higher content of saturated fatty acids (36.1 g/100 g) and a lower content of polyunsaturated fatty acids (9.3 g/100 g) than branded palm oil. No significant differences were observed regarding peanut oil. Among men, palm oil users had significantly lower mean fasting plasma glucose levels and mean BMI than peanut oil users. Among women, palm oil users had significantly higher mean diastolic blood pressure, and higher mean levels of total cholesterol and triglycerides, than peanut oil users. Regulation of the marketing of non-branded oils should be encouraged.
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Aung WP, Htet AS, Bjertness E, Stigum H, Chongsuvivatwong V, Kjøllesdal MKR. Urban-rural differences in the prevalence of diabetes mellitus among 25-74 year-old adults of the Yangon Region, Myanmar: two cross-sectional studies. BMJ Open 2018; 8:e020406. [PMID: 29602856 PMCID: PMC5884374 DOI: 10.1136/bmjopen-2017-020406] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To investigate the association between urban-rural location and the occurrence of diabetes mellitus (DM) in the Yangon Region, and to estimate the proportion of urban and rural participants already diagnosed with DM, and of those, the proportion under treatment and under control. DESIGN Two cross-sectional studies, using the WHO STEPs methodology. SETTING The Yangon Region of Myanmar, urban and rural areas. PARTICIPANTS Men and women, aged 25-74 years, included during the study period from September-November 2013 (urban) and 2014 (rural areas) (n=1372). Institutionalised people, physically and mentally ill person, monks and nuns were excluded. RESULTS The age-standardised prevalence of DM was 12.1% in urban and 7.1% in rural areas (p=0.039). In urban areas, the prevalence of DM was lowest in the highest educational groups (p<0.001). There were no differences in DM prevalence between gender or income levels. In rural areas, those who were physically inactive had a low intake of fruit and vegetable and were overweight/obese had a higher DM prevalence than others. In a logistic regression, the OR for DM in rural compared with urban areas was 0.38 (0.22, 0.65), adjusted for sociodemographic variables and behavioural risk factors. In urban areas, 43.1% of participants had the experience of receiving blood glucose measurements by a doctor or health worker, and 61.5% of all cases of DM were already diagnosed, 78.7% were under treatment and 45.8% were under control. The corresponding proportions in rural areas were 26.4%, 52.4%, 78.1% and 32.0%, respectively. CONCLUSION The prevalence of DM in the Yangon Region was high, and significantly higher in urban than in rural areas. More health services are needed to serve this population with a large proportion of undiagnosed diabetes. Preventive measures to halt and reduce the prevalence of DM are urgently needed.
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Affiliation(s)
- Wai Phyo Aung
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Occupational and Environmental Health Division, Department of Public Health, Ministry of Health and Sports, Yangon, Myanmar
| | - Aung Soe Htet
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- International Relations Division, Ministry of Health and Sports, Yangon, Myanmar
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Bermúdez-Aza EH, Shetty S, Ousley J, Kyaw NTT, Soe TT, Soe K, Mon PE, Tun KT, Ciglenecki I, Cristofani S, Fernandez M. Long-term clinical, immunological and virological outcomes of patients on antiretroviral therapy in southern Myanmar. PLoS One 2018; 13:e0191695. [PMID: 29420652 PMCID: PMC5805251 DOI: 10.1371/journal.pone.0191695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/09/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To study the long-term clinical, immunological and virological outcomes among people living with HIV on antiretroviral therapy (ART) in Myanmar. Methods A retrospective analysis of people on ART for >9 years followed by a cross-sectional survey among the patients in this group who remained on ART at the time of the survey. Routinely collected medical data established the baseline clinical and demographic characteristics for adult patients initiating ART between 2004 and 2006. Patients remaining on ART between March-August 2015 were invited to participate in a survey assessing clinical, virological, immunological, and biochemical characteristics. Results Of 615 patients included in the retrospective analysis, 35 (6%) were lost-to-follow-up, 9 (1%) were transferred, 153 died (25%) and 418 (68%) remained active in care. Among deaths, 48 (31.4%) occurred within 3 months of ART initiation, and 81 (52.9%) within 12 months, 90.1% (n = 73) of which were initially classified as stage 3/4. Of 385 patients included in the survey, 30 (7.7%) were on second-line ART regimen; 373 (96.8%) had suppressed viral load (<250 copies/ml). The mean CD4 count was 548 cells/ mm3 (SD 234.1) after ≥9 years on treatment regardless of the CD4 group at initiation. Tuberculosis while on ART was diagnosed in 187 (48.5%); 29 (7.6%) had evidence of hepatitis B and 53 (13.9%) of hepatitis C infection. Conclusions Appropriate immunological and virological outcomes were seen among patients on ART for ≥9 years. However, for the complete initiating cohort, high mortality was observed, especially in the first year on ART. Concerning co-infections, tuberculosis and viral hepatitis were common among this population. Our results demonstrate that good long-term outcomes are possible even for patients with advanced AIDS at ART initiation.
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Affiliation(s)
| | | | | | | | | | - Kyipyar Soe
- Médecins Sans Frontières (MSF), Yangon, Myanmar
| | - Phyu Ei Mon
- Médecins Sans Frontières (MSF), Yangon, Myanmar
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Htet AS, Kjøllesdal MK, Aung WP, Moe Myint AN, Aye WT, Wai MM, Nu TT, Hla EM, Soe PP, Tun NWY, Angela N, Khaing MM, Htoo AK, Tun S, Thitsar P, Lwin T, Wai SS, Aung TT, Thant KA, Aung Po WW, Gauzam ST, Naing TT, Tun TM, Myint KS, Oo KK, Mang NKM, Naing SM, Zaw KK, Bjertness MB, Sherpa LY, Oo WM, Stigum H, Bjertness E. Lipid profiles and determinants of total cholesterol and hypercholesterolaemia among 25-74 year-old urban and rural citizens of the Yangon Region, Myanmar: a cross-sectional study. BMJ Open 2017; 7:e017465. [PMID: 29146640 PMCID: PMC5695408 DOI: 10.1136/bmjopen-2017-017465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The first is to estimate the prevalence of dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia, high low-density lipoprotein (LDL) level and low high-density lipoprotein (HDL) level), as well as the mean levels of total cholesterol, triglyceride, LDL and HDL, in the urban and rural Yangon Region, Myanmar. The second is to investigate the association between urban-rural location and total cholesterol. DESIGN Two cross-sectional studies using the WHO STEPS methodology. SETTING Both the urban and rural areas of the Yangon Region, Myanmar. PARTICIPANTS A total of 1370 men and women aged 25-74 years participated based on a multistage cluster sampling. Physically and mentally ill people, monks, nuns, soldiers and institutionalised people were excluded. RESULTS Compared with rural counterparts, urban dwellers had a significantly higher age-standardised prevalence of hypercholesterolaemia (50.7% vs 41.6%; p=0.042) and a low HDL level (60.6% vs 44.4%; p=0.001). No urban-rural differences were found in the prevalence of hypertriglyceridaemia and high LDL. Men had a higher age-standardised prevalence of hypertriglyceridaemia than women (25.1% vs 14.8%; p<0.001), while the opposite pattern was found in the prevalence of a high LDL (11.3% vs 16.3%; p=0.018) and low HDL level (35.3% vs 70.1%; p<0.001).Compared with rural inhabitants, urban dwellers had higher age-standardised mean levels of total cholesterol (5.31 mmol/L, SE: 0.044 vs 5.05 mmol/L, 0.068; p=0.009), triglyceride (1.65 mmol/L, 0.049 vs 1.38 mmol/L, 0.078; p=0.017), LDL (3.44 mmol/L, 0.019 vs 3.16 mmol/L, 0.058; p=0.001) and lower age-standardised mean levels of HDL (1.11 mmol/L, 0.010 vs 1.25 mmol/L, 0.012; p<0.001). In linear regression, the total cholesterol was significantly associated with an urban location among men, but not among women. CONCLUSION The mean level of total cholesterol and the prevalence of hypercholesterolaemia were alarmingly high in men and women in both the urban and rural areas of Yangon Region, Myanmar. Preventive measures to reduce cholesterol levels in the population are therefore needed.
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Affiliation(s)
- Aung Soe Htet
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- International Relations Division, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | - Wai Phyo Aung
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aye Nyein Moe Myint
- International Relations Division, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
- Epidemiology Unit, Prince of Songkla University, Songkla, Thailand
| | - Win Thuzar Aye
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Myint Myint Wai
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Ei Mon Hla
- University of Pharmacy, Yangon, Yangon, Myanmar
| | | | | | - Naw Angela
- University of Nursing, Yangon, Yangon, Myanmar
| | | | - Aung Kyaw Htoo
- University of Dental Medicine, Mandalay, Mandalay, Myanmar
| | - Soe Tun
- University of Dental Medicine, Mandalay, Mandalay, Myanmar
| | - Pai Thitsar
- Military Institute of Nursing and Paramedical Sciences, Yangon, Myanmar
| | - Theeoo Lwin
- University of Pharmacy, Mandalay, Mandalay, Myanmar
| | - San San Wai
- University of Pharmacy, Mandalay, Mandalay, Myanmar
| | - Thi Thi Aung
- Health and Disease Control Unit, Directorate of Medical Services, Nay Pyi Taw, Myanmar
| | | | | | | | | | | | | | - Kyi Kyi Oo
- University of Traditional Medicine, Mandalay, Myanmar
| | | | | | - Ko Ko Zaw
- University of Public Health, Yangon, Myanmar
| | | | - Lhamo Yangchen Sherpa
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Win Myint Oo
- Faculty of Medicine, SEGi University, Petaling Jaya, Malaysia
| | - Hein Stigum
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Htet AS, Bjertness MB, Oo WM, Kjøllesdal MK, Sherpa LY, Zaw KK, Ko K, Stigum H, Meyer HE, Bjertness E. Changes in prevalence, awareness, treatment and control of hypertension from 2004 to 2014 among 25-74-year-old citizens in the Yangon Region, Myanmar. BMC Public Health 2017; 17:847. [PMID: 29073891 PMCID: PMC5659019 DOI: 10.1186/s12889-017-4870-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 10/20/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertension is the leading risk factor for cardiovascular diseases, and little is known about trends in prevalence, awareness, treatment and the control of hypertension in Myanmar. This study aims at evaluating changes from 2004 to 2014 in the prevalence, awareness, treatment and control of hypertension in the Yangon Region, Myanmar, and to compare associations between hypertension and selected socio-demographic, behavioural- and metabolic risk factors in 2004 and 2014. METHODS In 2004 and 2014, household-based cross-sectional studies were conducted in urban and rural areas of Yangon Region using the WHO STEPS protocol. Through a multi-stage cluster sampling method, a total of 4448 and 1486 participated in 2004 and 2014, respectively, with the response rates above 89%. RESULTS From 2004 to 2014, there was a significant increase in the age-standardized prevalence of hypertension from 26.7% (95% CI:24.4-29.1) - 34.6% (32.2-37.1), as well as an awareness from 19.4% (17.2-21.9) to 27.8% (24.9-31.0), while treatment and control rates did not change. The age-standardized mean systolic blood pressure increased from 122.8 (SE) ± 0.82 mmHg in 2004 to 128.1 ± 0.53 mmHg in 2014, whereas diastolic blood pressure increased from 76.2 ± 0.35 mmHg to 80.9 ± 0.53 mmHg. In multivariate analyses, hypertension was significantly associated with age, alcohol consumption, overweight and diabetes in both 2004 and 2014, and additionally associated with low physical activity and hypercholesterolemia in 2004. Combining all data, a significant association between study-year and hypertension persisted in different models with an adjustment for socio-demographic variables and behavioural variables, but not when adjusting for a combination of socio-demographic variables, the metabolic variables, BMI and hypercholesterolemia. CONCLUSION The prevalence of hypertension has risen from 2004 to 2014 in both urban and rural areas of the Yangon Region, while, the awareness, treatment and control rate of hypertension remains low in urban and rural areas among both males and females. It is likely that changes in the metabolic variables, BMI and hypercholesterolemia have contributed to an increase in the prevalence of hypertension from 2004 to 2014. Factors associated with hypertension in both study years were age, alcohol consumption, overweight and diabetes. A national hypertension control programme should be implemented in order to reduce premature deaths in Myanmar.
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Affiliation(s)
- Aung Soe Htet
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- International Relations Division, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Marius B. Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Win Myint Oo
- Faculty of Medicine, SEGi University, Petaling Jaya, Malaysia
| | - Marte Karoline Kjøllesdal
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lhamo Y. Sherpa
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ko Ko Zaw
- University of Public Health, Yangon, Myanmar
| | - Ko Ko
- Department of Diabetes and Endocrinology, University of Medicine 2, Yangon, Myanmar
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Haakon E. Meyer
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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