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Rao Guthi V, Sujith Kumar D, Kumar S, Kondagunta N, Raj S, Goel S, Ojah P. Hypertension treatment cascade among men and women of reproductive age group in India: analysis of National Family Health Survey-5 (2019-2021). THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100271. [PMID: 38404520 PMCID: PMC10884964 DOI: 10.1016/j.lansea.2023.100271] [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: 01/16/2023] [Revised: 05/12/2023] [Accepted: 08/18/2023] [Indexed: 02/27/2024]
Abstract
Background Only a proportion of adults with hypertension are diagnosed and receive recommended prescriptions despite the availability of inexpensive and efficacious treatment. We aimed to estimate the prevalence of different stages of hypertension treatment cascade among the reproductive age groups in India at the national and state levels. We also identified the predictors of different stages of the hypertension treatment cascade. Methods We used the nationally representative data from National Family Health Survey (NFHS)-5. We included all the males (15-54 years) and females aged 15-49. Socio-demographic factors, anthropometric measurements, habits, comorbid conditions, and healthcare access stratified the stages of the hypertension treatment cascade among hypertensives. We used multinomial logistic regression to identify the determinants of the treatment cascade levels. Findings We had data from 1,267,786 individuals. The national prevalence of hypertension was 18.3% (95% CI: 18.1%-18.4%). Men (21.6%, 95% CI: 21.5%-21.7%) were found to have a higher prevalence as compared to women (14.8%, 95% CI: 14.7%-14.9%). Among hypertensive individuals, 70.5% (95% CI: 70.3%-70.7%) had ever received a BP measurement ("screened"), 34.3% (95% CI: 34.1%-34.5%) had been diagnosed prior to the survey ("aware"), 13.7% (95% CI: 13.5%-13.8%) reported taking a prescribed anti-hypertensive drug ("under treatment"), and 7.8% (95% CI: 7.7%-7.9%) had their BP under control ("controlled"). Males, illiterates, poor, never married, residents of rural areas, smokers/tobacco users, and alcoholic users were less likely to be in any of the treatment cascades. Interpretation The prevalence of hypertension in India is high. The "Rule of half" of hypertension does not apply to India as the proportion of people screened, aware of their hypertension status, treated, and controlled are lower than 50% at each stage. Program managers must improve access to hypertension diagnosis and treatment, especially among men in rural areas and populations with lower household wealth. Funding None.
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Affiliation(s)
- Visweswara Rao Guthi
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - D.S. Sujith Kumar
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, AIIMS, Bhopal, India
| | - Nagaraj Kondagunta
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - Sonika Raj
- Public Health Masters Program, School of Medicine, University of Limerick, Ireland
| | - Sonu Goel
- Public Health Masters Program, School of Medicine, University of Limerick, Ireland
| | - Pratyashee Ojah
- Biostatistics and Demography, International Institute for Population Sciences, Mumbai, India
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Gooden TE, Wang J, Carvalho Goulart A, Varella AC, Tai M, Sheron VA, Wang H, Zhang H, Zhong J, Kumarendran B, Nirantharakumar K, Surenthirakumaran R, Bensenor IM, Guo Y, Lip GYH, Thomas GN, Manaseki-Holland S. Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation. Glob Health Action 2023; 16:2231763. [PMID: 37466418 PMCID: PMC10360996 DOI: 10.1080/16549716.2023.2231763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking. OBJECTIVE To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka. METHODS Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country. RESULTS The required sample size was met in Brazil (n = 267) and China (n = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample (n = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka. CONCLUSIONS Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.
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Affiliation(s)
- Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alessandra Carvalho Goulart
- Faculdade de Medicina, Universidade, Sao Paulo, São Paulo, Brazil
- Center for Clinical and Epidemiologic Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Ana C Varella
- Faculdade de Medicina, Universidade, Sao Paulo, São Paulo, Brazil
| | - Meihui Tai
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Vethanayagan Antony Sheron
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Hao Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hui Zhang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jiaoyue Zhong
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Balachandran Kumarendran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | | | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Isabela M Bensenor
- Faculdade de Medicina, Universidade, Sao Paulo, São Paulo, Brazil
- Center for Clinical and Epidemiologic Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Babagoli MA, Chen YH, Chakma N, Islam MS, Naheed A, Boettiger DC. Association of socio-demographic characteristics with hypertension awareness, treatment, and control in Bangladesh. J Hum Hypertens 2023; 37:993-999. [PMID: 36882527 DOI: 10.1038/s41371-023-00815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/30/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
Hypertension has been rapidly growing in Bangladesh. However, there has been limited analysis of differences in the hypertension cascade across socio-demographic groups. This study was a secondary analysis of the 2017-18 Bangladesh Demographic and Health Survey. Four dichotomous outcome variables - hypertension prevalence, awareness among those with hypertension, treatment among those aware, and control among those treated - were analyzed. The variation of each outcome was assessed across socio-demographic factors. The association between socio-demographic characteristics and outcomes was analyzed using logistic regression. Less than half of the hypertensive individuals were aware of their hypertension (42.5%), and awareness was higher among those who were older, female, of higher household wealth, and living in urban areas. Among those aware, most were receiving treatment (87.4%), and this proportion was higher in older individuals (89.2% among 65 + , 70.4% among 18-24; p < 0.001). One-third of those treated (33.8%) had their blood pressure controlled, and this was higher among younger and more educated individuals. In multivariable models stratified by rural/urban community, most of the aforementioned trends remained with additional differences between communities. Notably, the association of higher education level with treatment odds differed in rural and urban communities (OR 0.34 [95%CI 0.16, 0.75] in rural; OR 2.83 [95%CI 1.04, 7.73] in urban). Efforts to improve hypertension awareness among individuals who are younger, male, of lower household wealth, and in rural areas are required to address disparities in care. Socio-demographic variations in hypertension awareness, treatment, and control must be considered to design targeted interventions for each step of the cascade.
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Affiliation(s)
- Masih A Babagoli
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Yea-Hung Chen
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nantu Chakma
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Md Saimul Islam
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Aliya Naheed
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - David C Boettiger
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Abu Hamad BA, Jamaluddine Z, Safadi G, Ragi ME, Ahmad RES, Vamos EP, Basu S, Yudkin JS, Jawad M, Millett C, Ghattas H. The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip. J Hum Hypertens 2023; 37:957-968. [PMID: 36509988 PMCID: PMC9744039 DOI: 10.1038/s41371-022-00783-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
Although hypertension constitutes a substantial burden in conflict-affected areas, little is known about its prevalence, control, and management in Gaza. This study aims to estimate the prevalence and correlates of hypertension, its diagnosis and control among adults in Gaza. We conducted a representative, cross-sectional, anonymous, household survey of 4576 persons older than 40 years in Gaza in mid-2020. Data were collected through face-to-face interviews, anthropometric, and blood pressure measurements. Hypertension was defined in anyone with an average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg from two consecutive readings or a hypertension diagnosis. The mean age of participants was 56.9 ± 10.5 years, 54.0% were female and 68.5% were Palestinian refugees. The prevalence of hypertension was 56.5%, of whom 71.5% had been diagnosed. Hypertension was significantly higher among older participants, refugees, ex-smokers, those who were overweight or obese, and had other co-morbidities including mental illnesses. Two-thirds (68.3%) of those with hypertension were on treatment with one in three (35.6%) having their hypertension controlled. Having controlled hypertension was significantly higher in females, those receiving all medications for high blood pressure and those who never or rarely added salt to food. Investing in comprehensive but cost-effective initiatives that strengthen the prevention, early detection and timely treatment of hypertension in conflict settings is critical. It is essential to better understand the underlying barriers behind the lack of control and develop multi-sectoral programs to address these barriers.
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Affiliation(s)
| | - Zeina Jamaluddine
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gloria Safadi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Marie-Elizabeth Ragi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Raeda El Sayed Ahmad
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Sanjay Basu
- Research and Development, Waymark, San Francisco, CA, USA
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Comprehensive Health Research Centre and Public Health Research Centre, National School of Public Health, NOVA University, Lisbon, Portugal
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
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Manla Y, Almahmeed W. The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:543-557. [PMID: 37615785 PMCID: PMC10471667 DOI: 10.1007/s11883-023-01126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW Coronary heart disease (CHD) is the leading cause of morbidity, mortality, and disability in the Middle East and North Africa (MENA). While the prevention, diagnosis, and management of CHD have been detailed in international guidelines, we aimed in this review to quantify the pandemic of CHD in the MENA region and highlight regional patient characteristics, clinical challenges, and future directions to optimize CHD care in the region. RECENT FINDINGS Patients with CHD in the MENA feature younger age at presentation and worse prognosis in women. Despite the high burden of CHD risk factors, many of these factors remain underrecognized, undertreated, and uncontrolled. Additionally, CHD care is hampered by poor patient awareness, inefficient preventive strategies, and limited access to guideline-recommended therapeutics. All stakeholders involved in healthcare should work together to develop and execute strategies aimed at tackling the burden of CHD in the MENA.
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Affiliation(s)
- Yosef Manla
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Amir A, Alasnag M, Al-Raddadi R, Al-Bassam T, Saeed K, Yazıcıoğlu M, Shabana A. Patient journey for hypertension and dyslipidemia in Saudi Arabia: highlighting the evidence gaps. Arch Public Health 2023; 81:122. [PMID: 37400868 DOI: 10.1186/s13690-023-01121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/30/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND In recent years, Saudi Arabia has witnessed staggering rates of hypertension and dyslipidemia-related cardiovascular (CV) deaths, overburdening the healthcare ecosystem of the country. Appropriate public health interventions can be devised through quantitative mapping of evidence. Identification of potential data gaps can prioritize future research needs and develop a 'best-fit' framework for patient-centric management of hypertension and dyslipidemia. METHODS This review quantified data gaps in the prevalence and key epidemiological touchpoints of the patient journey including awareness, screening, diagnosis, treatment, adherence, and control in patients with hypertension and dyslipidemia in Saudi Arabia. Studies published in English between January 2010 and December 2021 were identified through a structured search on MEDLINE, Embase, BIOSIS, and PubMed databases. An unstructured search on public and government websites, including Saudi Ministry of Health, without date limits was carried out to fill data gaps. After exclusion of studies based on predefined criteria, a total of 14 studies on hypertension and 12 studies and one anecdotal evidence for dyslipidemia were included in the final analyses. RESULTS The prevalence of hypertension was reported to be 14.0%-41.8% while that for dyslipidemia was 12.5%-62.0%. The screening rate for hypertension was 100.0% as revealed by the nationwide surveys. Among hypertensive patients, only 27.6%-61.1% patients were aware of their condition, 42.2% patients underwent diagnosis, 27.9%-78.9% patients received antihypertensive treatment, 22.5% patients adhered to treatment medication, while blood pressure (BP) control was achieved in 27.0%-45.0% patients. Likewise, among patients with dyslipidemia, 10.5%-47.3% patients were aware of their condition, 34.6% patients were screened, and 17.8% underwent diagnosis. Although high treatment rates ranging from 40.0%-94.0% were reported, medication adherence recorded was 45.0%-77.4% among the treated patients. The overall low control rates ranged from 28.0%-41.5%. CONCLUSIONS The study findings highlight evidence gaps along key touchpoints of patient journey. Reinforcing the efforts for high-quality evidence-based research at a national level may pave a path for better resource utilization and provide guidance to practice and amend health policies for patients, healthcare practitioners (HCPs), and healthcare policy makers for better patient outcomes in Saudi Arabia.
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Affiliation(s)
- Ashraf Amir
- Family Medicine Department, International Medical Center, Jeddah, Saudi Arabia
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital-Jeddah-Saudi Arabia, PO Box 9862, Jeddah, 21159, Saudi Arabia.
| | - Rajaa Al-Raddadi
- Faculty of Medicine, Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tawfik Al-Bassam
- Department of Internal Medicine, Medical Reference Center, Jeddah, Saudi Arabia
| | - Kanwal Saeed
- Research, Development and Medical, Pfizer Upjohn, Dubai, UAE
| | - Mehmet Yazıcıoğlu
- Emerging Markets Medical Portfolio Implementation Lead, Viatris, Istanbul, Turkey
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Madhi ZS, Hasan MA, Almusawi AAH. Prevalence of hypertension links with body mass index by academic population in Babylon city. J Adv Pharm Technol Res 2023; 14:133-136. [PMID: 37255879 PMCID: PMC10226711 DOI: 10.4103/japtr.japtr_106_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/01/2023] Open
Abstract
Many risk factors have been listed that predispose to the occurrence of high blood pressure (BP). Although high body mass index (BMI) is a recognized risk factor for hypertension, the cutoff value for the high BMI was not taken into consideration as a predictor risk. There is no clear data on the occurrence of hypertension in Iraq in the highly educated population. Moreover, studies on hypertension in Iraq have been limited to a few studies. To assess and study the prevalence of BP in the academic population of Babylon city, a prospective study of 100 people was conducted. In the course of 3 months, during their work at the university in the morning, the questionnaire was filled out along with the body weight measurement. The receiver operating characteristic curve was used to measure the maximum area under the curve for the BMI score. Outcomes demonstrated that despite the high level of education, the prevalence of hypertension remains unacceptable. Awareness raising about the risk factors should be addressed through ongoing health education in health sectors and media. BMI of more than 25 could be considered a predictable risk value.
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Affiliation(s)
- Zaid Saad Madhi
- Department of Radiological Techniques, Al-Mustaqbal University College, Hillah, Iraq
| | - Mohannad Ali Hasan
- Department of Surgery, Babylon Medical College, University of Babylon, Hillah, Iraq
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Alhawari H, AlShelleh S, Alhawari H, AlRyalat SA, Khanfar AN, Alzoubi O. Prevalence of Undiagnosed Hypertension and Its Predictors in Jordan: A Cross-Sectional Study. Int J Gen Med 2022; 15:7919-7928. [PMID: 36317098 PMCID: PMC9617551 DOI: 10.2147/ijgm.s388121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/18/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Hypertension is an important cause of morbidity and mortality worldwide. Undiagnosed hypertension is a serious issue that leads to increased morbidity and mortality. In this study, we aim to identify the prevalence of undiagnosed hypertension in the healthy Jordanian population, as well as identify predictors of high blood pressure readings in presumably healthy Jordanians. Materials and Methods We recruited healthy visitors accompanying patients at our Jordan University Hospital Clinics ranging from 18 to 80 years of age. We measured each participant's systolic and diastolic blood pressure at our outpatient clinics on two different days, one week apart. We also obtained demographic data, weight, height, smoking status, and family history of hypertension and cardiovascular diseases. Results A total of 896 participants were included in this study with a mean age of 48 years. The median of systolic blood pressure readings was 125 mmHg, and the median of diastolic blood pressure readings was 83 mmHg. 38.5% had undiagnosed stage 1 hypertension and 30.5% had undiagnosed stage 2 hypertension according to the American College of Cardiology/American Heart Association guidelines. On the other hand, 25.4% had undiagnosed grade 1 hypertension and 5.1% had undiagnosed grade 2 hypertension according to the European Society of Hypertension guidelines. Conclusion According to the ACC/AHA guidelines, 68.5% of previously healthy Jordanians met the criteria to be diagnosed with hypertension. Predictors of high systolic blood pressure were age, BMI and family history of CAD, while female gender is associated with a lower systolic blood pressure. For diastolic blood pressure, only BMI and family history of CAD were associated with significantly higher diastolic blood pressure, while female gender and exercise were significantly associated with lower diastolic blood pressure.
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Affiliation(s)
- Hussein Alhawari
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan,Correspondence: Hussein Alhawari, Division of Nephrology, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan, Email
| | - Sameeha AlShelleh
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
| | - Hussam Alhawari
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
| | - Saif Aldeen AlRyalat
- Department of Special Surgery, School of Medicine, the University of Jordan, Amman, Jordan
| | - Asim N Khanfar
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
| | - Osama Alzoubi
- Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan
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Influence of “Hospital-Community-Family” Integrated Management on Blood Pressure, Quality of Life, Anxiety and Depression in Hypertensive Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1962475. [PMID: 36238498 PMCID: PMC9553346 DOI: 10.1155/2022/1962475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Abstract
Objective To explore the Influence of “hospital-community-family” integrated management on blood pressure, quality of life, anxiety and depression in hypertensive patients. Methods A total of 60 patients with hypertension were treated in our hospital from July 2019 to July 2021. The patients were randomly divided into control group (n =30) and study group (n =30). The former accepts routine management, while the latter accepts “hospital-community-family” integrated management. Nursing satisfaction, blood pressure, disease awareness rate, anxiety and depression scores, disease control ability and quality of life scores were compared. Results First of all, we compared the nursing satisfaction: the study group was very satisfied in 25 cases, satisfactory in 4 cases, general in 1 case, the satisfaction rate was 100.00%, while in the control group, 10 cases were very satisfied, 8 cases were satisfied, 7 cases were general, and 5 cases were dissatisfied, the satisfaction rate was 83.33%; The nursing satisfaction of the study group was higher than that of the control group (P <0.05). Secondly, we compared the level of blood pressure. There was no significant difference before management (P >0.05) but the blood pressure decreased after treatment. In the control group, the level of blood pressure in the study group was lower than that in the control group (P <0.05). In terms of disease awareness rate the scores of hypertension related knowledge hypertension harmfulness community management methods regular reexamination and blood pressure monitoring in the study group were significantly higher than those in the control group (P <0.05). There was no significant difference in anxiety and depression scores before treatment (P >0.05), but decreased after treatment. Compared with the control group, the anxiety and depression scores of the study group were lower (P <0.05). In terms of disease control ability, the total scores of diet management, medication management, behavior management and information management in the study group were higher compared to the control group (P <0.05). Finally, we compared the scores of qualities of life. Before management, there exhibited no significant difference (P >0.05). After management, the scores of quality of life decreased. Compared to the control group, the scores of physiological function, psychological function, social function and health self-cognition in the study group were lower than those in control group (P <0.05). Conclusion The application of integrated “hospital, community and family” management can vertically integrate medical resources and establish a truly effective hierarchical treatment model. Integrated “hospital-community-family” management can improve patient compliance with treatment, enhance patients' self-management ability and confidence, and improve the management efficiency of medical staff.
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Tavolinejad H, Roshani S, Rezaei N, Ghasemi E, Yoosefi M, Rezaei N, Ghamari A, Shahin S, Azadnajafabad S, Malekpour MR, Rashidi MM, Farzadfar F. A machine learning approach to evaluate the state of hypertension care coverage: From 2016 STEPs survey in Iran. PLoS One 2022; 17:e0273560. [PMID: 36129936 PMCID: PMC9491523 DOI: 10.1371/journal.pone.0273560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The increasing burden of hypertension in low- to middle-income countries necessitates the assessment of care coverage to monitor progress and guide future policies. This study uses an ensemble learning approach to evaluate hypertension care coverage in a nationally representative Iranian survey.
Methods
The data source was the cross-sectional 2016 Iranian STEPwise approach to risk factor surveillance (STEPs). Hypertension was based on blood pressure ≥140/90 mmHg, reported use of anti-hypertensive medications, or a previous hypertension diagnosis. The four steps of care were screening (irrespective of blood pressure value), diagnosis, treatment, and control. The proportion of patients reaching each step was calculated, and a random forest model was used to identify features associated with progression to each step. After model optimization, the six most important variables at each step were considered to demonstrate population-based marginal effects.
Results
The total number of participants was 30541 (52.3% female, median age: 42 years). Overall, 9420 (30.8%) had hypertension, among which 89.7% had screening, 62.3% received diagnosis, 49.3% were treated, and 7.9% achieved control. The random forest model indicated that younger age, male sex, lower wealth, and being unmarried/divorced were consistently associated with a lower probability of receiving care in different levels. Dyslipidemia was associated with reaching diagnosis and treatment steps; however, patients with other cardiovascular comorbidities were not likely to receive more intensive blood pressure management.
Conclusion
Hypertension care was mostly missing the treatment and control stages. The random forest model identified features associated with receiving care, indicating opportunities to improve effective coverage.
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Affiliation(s)
- Hamed Tavolinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Shahin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail: f–
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11
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Kumar Datta B, Ansa BE, Jami Husain M. An analytical model of population level uncontrolled hypertension management: a care cascade approach. J Hum Hypertens 2022; 36:726-731. [PMID: 34226635 PMCID: PMC9950962 DOI: 10.1038/s41371-021-00572-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
Effective control of hypertension at the population level is a global public health challenge. This study shows how improving population coverages at different hypertension care cascade levels could impact population-level hypertension management. We developed an analytical framework and a companion Excel model of multi-level hypertension care cascade entailing awareness, treatment, and control. The model estimates the prevalence of uncontrolled hypertension for different level of population coverages at certain cascade levels. We applied the model to data from Bangladesh and reported prevalence estimates associated with coverage interventions at different cascade levels. The model estimated that if 50% of the unaware hypertensive patients became aware of their hypertensive condition, the prevalence of uncontrolled hypertension would decrease by 1.8 and 1.3 percentage points (8.2% and 5.8% relative reduction), respectively, for constant and variable rates in the status quo setting. When 50% of the aware, but untreated individuals received treatment, the prevalence would decrease by around 0.7 percentage points (3.3% relative reduction). A 50% decrease in the share of treated individuals who did not have hypertension under control, would result in decreasing the prevalence by 2.8 percentage points (12.7% relative reduction). By providing an analytical tool that demonstrates the probable impact of population coverage interventions at certain hypertension care cascade levels, our study endows public health practitioners with vital information to identify gaps and design effective policies for hypertension management.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA.,Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Correspondence and requests for materials should be addressed to B.K.D.
| | - Benjamin E. Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Muhammad Jami Husain
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Peters MA, Noonan CM, Rao KD, Edward A, Alonge OO. Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review. BMC Health Serv Res 2022; 22:827. [PMID: 35761254 PMCID: PMC9235242 DOI: 10.1186/s12913-022-08190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance. Methods A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management in LMICs. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage. Results The review identified 18 relevant studies, including 6 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment. Conclusion There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08190-0.
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Affiliation(s)
- Michael A Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Caitlin M Noonan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Krishna D Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Olakunle O Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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13
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Spotlight on hypertension in the Middle-East. J Hum Hypertens 2022; 36:425-427. [PMID: 35264736 DOI: 10.1038/s41371-022-00668-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 11/08/2022]
Abstract
The Middle-East is a diverse region with many countries of differing socio-economic status. While some countries are facing war and famine, others have a booming economy. This is reflected in the health care in these countries. Hypertension is a problem of all these countries. In this spotlight, we wish to draw attention to the barriers faced by the different countries in the region in their fight to bring blood pressure under control.
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14
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Metz M, Pierre JL, Yan LD, Rouzier V, St‐Preux S, Exantus S, Preval F, Roberts N, Tymejczyk O, Malebranche R, Deschamps MM, Pape JW, McNairy ML. Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population-based cohort in Haiti. J Clin Hypertens (Greenwich) 2022; 24:246-254. [PMID: 35199944 PMCID: PMC8925011 DOI: 10.1111/jch.14399] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 01/13/2023]
Abstract
Cardiovascular disease (CVD) is the number one cause of death in low-income countries including Haiti, with hypertension (HTN) being the leading risk factor. This study aims to identify gaps in the HTN continuum of screening, diagnosis, treatment, and blood pressure (BP) control. Sociodemographic and clinical data were collected from a population-based sample of adults ≥18 years in Port-au-Prince (PAP) from March 2019 to April 2021. HTN was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medication. Screening was defined as ever having had a BP measurement; diagnosis as previously being informed of a HTN diagnosis; treatment as having taken antihypertensives in the past 2 weeks; and controlled as taking antihypertensives and having BP < 140/90 mmHg. Factors associated with attaining each step in the continuum were assessed using Poisson multivariable regressions. Among 2737 participants, 810 (29% age-standardized) had HTN, of whom 97% had been screened, 72% diagnosed, 45% treated, and 13% controlled. There were no significant differences across age groups or sex. Obesity (BMI ≥ 30) was a significant factor associated with receiving treatment compared to normal weight (BMI < 25), with a prevalence ratio (PR) of 1.5 (95% CI 1.1-2.0). Having secondary or higher education was associated with higher likelihood of controlled BP (PR 1.9 [95% CI 1.1-3.3]). In this urban Haitian population, the greatest gaps in HTN care are treatment and control. Targeted interventions are needed to improve these steps, including broader access to affordable treatment, timely distribution of medications, and patient adherence to HTN medication.
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Affiliation(s)
- Miranda Metz
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jean Lookens Pierre
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Lily Du Yan
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Vanessa Rouzier
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Stephano St‐Preux
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Serfine Exantus
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Fabyola Preval
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Nicholas Roberts
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Olga Tymejczyk
- City University of New York Institute for Implementation Science in Population HealthNew YorkNew YorkUSA
| | | | - Marie Marcelle Deschamps
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Jean W. Pape
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Margaret L. McNairy
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
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15
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Prevalence, Awareness, Treatment, and Control of Hypertension in the United Arab Emirates: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312693. [PMID: 34886421 PMCID: PMC8657061 DOI: 10.3390/ijerph182312693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Background: Evidence for the prevalence, awareness, treatment, and control of hypertension in the United Arab Emirates (UAE) is limited. A systematic review and meta-analysis were conducted to summarize the existing knowledge regarding the prevalence, awareness, treatment, and control of hypertension in the UAE. Methods: We searched PubMed/MEDLINE, Embase, Scopus, and Google Scholar using prespecified medical subject handling (MeSH) terms and text words to identify the relevant published articles from 1 January 1995 to 31 August 2021. Population-based prospective observational studies conducted among healthy adult subjects living in the UAE and that defined hypertension using the guidelines-recommended blood pressure (BP) cut-offs ≥ 130/80 mmHg or ≥ 140/90 mmHg were considered. Results: Of 1038 studies, fifteen cross-sectional studies were included for data extraction involving 139,907 adults with a sample size ranging from 74 to 50,138 and with cases defined as blood pressure ≥ 140/90 mmHg. The pooled prevalence of hypertension was 31% (95% confidence interval (CI): 27–36), and a higher prevalence was observed in Dubai (37%, 95% CI: 28–45) than in the Abu Dhabi region (29%, 95% CI: 24–35) and in multicenter studies (24%, 95% CI: 14–33). The level of awareness was only 29% (95% CI: 17–42), 31% (95% CI: 18–44) for treatment, and 38% (95% CI: 19–57) had controlled BP (< 140/90 mmHg). Conclusion: This study revealed a high prevalence of hypertension with low awareness and suboptimal control of hypertension. Multifaceted approaches that include the systematic measurement of BP, raising awareness, and improving hypertension diagnoses and treatments are needed.
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Aljadeeah S, Nagel E, Wirtz VJ. Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis. BMC Health Serv Res 2021; 21:1088. [PMID: 34645430 PMCID: PMC8515648 DOI: 10.1186/s12913-021-07124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07124-6.
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Affiliation(s)
- Saleh Aljadeeah
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany.
| | - Eckhard Nagel
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA, 02118, USA
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Achieving Global Targets to Reduce Hypertension: The Importance of Hypertension Self-care Measurement. J Cardiovasc Nurs 2021; 36:409-410. [PMID: 34398572 DOI: 10.1097/jcn.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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