The burden of non-communicable disease in transition communities in an Asian megacity: baseline findings from a cohort study in Karachi, Pakistan

Nationwide prevalence of type 2 diabetes mellitus and pre-diabetes in Pakistan: A systematic review and meta-analysis

Type 2 diabetes mellitus (T2DM) and pre-diabetes (pre-DM) are significant health concerns in Pakistan. This systematic review and meta-analysis estimate the prevalence of T2DM and pre-DM, assessing regional, gender, and urban-rural differences. We searched PubMed, Scopus, Cochrane, and PakMediNet databases, identifying 3478 articles. After screening, 17 studies from 1995 to 2018 were included. The pooled prevalence of T2DM and pre-DM in Pakistan was found to be 10.0 % and 11.0 %, respectively. This equates to approximately 24 million individuals with T2DM and 26 million with pre-DM, totaling 50 million affected. Rural areas showed higher T2DM prevalence post-2000, with an odds ratio (OR) of 1.25 (95 % CI: 0.73 to 2.14). Gender analysis revealed a slightly higher, though statistically insignificant, prevalence of T2DM in females and a significantly higher prevalence of pre-DM in males (OR: 0.79, 95 % CI: 0.63 to 0.98). Regionally, Punjab had the highest T2DM prevalence (16 %), followed by Baluchistan (15 %), Sindh (14 %), and Khyber Pakhtunkhwa (KPK) (11 %). There is a substantial burden of T2DM and pre-DM in Pakistan, with significant regional and gender differences. Targeted interventions and resource allocation are needed to address the rising prevalence of diabetes, focusing on early detection and lifestyle modifications.

A comparative systematic review of risk factors, prevalence, and challenges contributing to non-communicable diseases in South Asia, Africa, and Caribbeans

BACKGROUND

Non-communicable diseases (NCDs) are a global epidemic challenging global public health authorities while imposing a heavy burden on healthcare systems and economies.

AIM

To explore and compare the prevalence of NCDs in South Asia, the Caribbean, and non-sub-Saharan Africa, aiming to identify both commonalities and differences contributing to the NCD epidemic in these areas while investigating potential recommendations addressing the NCD epidemic.

METHOD

A comprehensive search of relevant literature was carried out to identify and appraise published articles systematically using the Cochrane Library, Ovid, Google Scholar, PubMed, Science Direct, and Web of Science search engines between 2010 and 2023. A total of 50 articles fell within the inclusion criteria.

RESULTS

Numerous geographical variables, such as lifestyle factors, socio-economic issues, social awareness, and the calibre of the local healthcare system, influence both the prevalence and treatment of NCDs. The NCDs contributors in the Caribbean include physical inactivity, poor fruit and vegetable intake, a sedentary lifestyle, and smoking, among others. While for South Asia, these were: insufficient societal awareness of NCDs, poverty, urbanization, industrialization, and inadequate regulation implementation in South Asia. Malnutrition, inactivity, alcohol misuse, lack of medical care, and low budgets are responsible for increasing NCD cases in Africa.

CONCLUSION

Premature mortality from NCDs can be avoided using efficient treatments that reduce risk factor exposure for individuals and populations. Proper planning, implementation, monitoring, training, and research on risk factors and challenges of NCDs would significantly combat the situation in these regions.

Thirty-year trends of triple burden of disease in the adult population of Pakistan

BACKGROUND

The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages.

METHODS

The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio.

RESULTS

A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively.

CONCLUSION

Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.

Evaluating the effect of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan, a facility based retrospective cohort study

Non-communicable diseases (NCDs) claim 74% of global lives, disproportionately affecting lower and middle-income countries like Pakistan. NCDs may increase the risk of preterm birth (PTB), caesarean section (CS), and low birthweight. This study aims to determine whether the high prevalence of NCDs in Pakistan play a role in the high rates of preterm births, and CS. This retrospective cohort study from Aga Khan University Hospital, Pakistan, investigated effects of pre-existing NCDs on pregnancy outcomes of 817 pregnant women. Medical records were used to generate odds ratios for the risk of PTB, labour outcome and birthweight in women with type 1 and type 2 diabetes, hypertension, asthma and thyroid disorders. Multinomial logistic regression and general linear models were used to adjust for confounding variables using IBM SPSS Statistics (v27). Type 2 diabetes significantly increased the risk of PTB and elective CS (both P < 0.05). Elective CS was significantly increased by hypertension and asthma (both, P < 0.05). Surprisingly, asthma halved the risk of PTB (P < 0.05), while type 1 diabetes significantly increased birthweight from 2832 to 3253g (P < 0.001). In conclusion, pre-existing NCDs increase the risk of negative pregnancy outcomes, including PTB, elective CS and birthweight. Asthma, however reduced PTB and justifies further investigation.

Unique Pakistani gut microbiota highlights population-specific microbiota signatures of type 2 diabetes mellitus

Biogeographic variations in the gut microbiota are pivotal to understanding the global pattern of host-microbiota interactions in prevalent lifestyle-related diseases. Pakistani adults, having an exceptionally high prevalence of type 2 diabetes mellitus (T2D), are one of the most understudied populations in microbiota research to date. The aim of the present study is to examine the gut microbiota across individuals from Pakistan and other populations of non-industrialized and industrialized lifestyles with a focus on T2D. The fecal samples from 94 urban-dwelling Pakistani adults with and without T2D were profiled by bacterial 16S ribosomal RNA gene and fungal internal transcribed spacer (ITS) region amplicon sequencing and eubacterial qPCR, and plasma samples quantified for circulating levels of lipopolysaccharide-binding protein (LBP) and the activation ability of Toll-like receptor (TLR)-signaling. Publicly available datasets generated with comparable molecular methods were retrieved for comparative analysis of the bacterial microbiota. Overall, urbanized Pakistanis' gut microbiota was similar to that of transitional or non-industrialized populations, depleted in Akkermansiaceae and enriched in Prevotellaceae (dominated by the non-Westernized clades of Prevotella copri). The relatively high proportion of Atopobiaceae appeared to be a unique characteristic of the Pakistani gut microbiota. The Pakistanis with T2D had elevated levels of LBP and TLR-signaling in circulation as well as gut microbial signatures atypical of other populations, e.g., increased relative abundance of Libanicoccus/Parolsenella, limiting the inter-population extrapolation of gut microbiota-based classifiers for T2D. Taken together, our findings call for a more global representation of understudied populations to extend the applicability of microbiota-based diagnostics and therapeutics.

Prevalence and correlates of multimorbidity among adults in Botswana: A cross-sectional study

BACKGROUND

Botswana is currently undergoing rapid epidemiological transition indicated by a decline in infectious diseases and an increase in chronic non-communicable diseases and their associated risk factors. The main aim of this study was to assess prevalence and correlates of multimorbidity among the adult population in Botswana.

METHODS

A cross-sectional study called Chronic Non-Communicable Diseases Study (NCDs study) was conducted in March, 2016. Using multistage cross sectional sampling design, 1178 male and female respondents aged 15 years and above were interviewed across 3 cities and towns, 15 urban villages and 15 rural villages. Participants were interviewed face-to-face using a structured questionnaire. Adjusted multinomial logistic regression analysis was used to assess covariates of multimorbidity. The statistical significant level was fixed at p <0 .05.

RESULTS

Prevalence of multimorbidity in the sampled population was estimated at 5.4%. Multivariate results indicate that the odds of multimobridty were significantly high among women (AOR = 3.34, 95% C.I. = 1.22-21.3) than men. On the other hand, the odds of multimorbidity were significantly low among young people aged below 24 years (AOR = 0.01, 95% C.I. = 0.00-0.07), currently married people (AOR = 0.24, 95% C.I. = 0.07-0.80) and individuals in the 2nd wealth quintile (AOR = 0.20, 95% C.I. = 0.05-0.75) compared to their counterparts. For behavioural risk factors, alcohol consumption (AOR = 4.80, 95% C.I. = 1.16-19.8) and overweight/obesity (AOR = 1.44, 95% CI = 1.12-2.61) were significantly associated with high multimorbidity prevalence.

CONCLUSION

Multimorbidity was found to be more prevalent among women, alcohol consumers and overweight/obese people. There is need to strengthen interventions encouraging healthy lifestyles such as non-consumption of alcohol, physical activity and healthy diets. Moreover, there is need for a holistic approach of health care services to meet the needs of those suffering from multimorbidity.

Prevalence and Sociodemographic Factors of Overweight and Obesity among Pakistani Adults

Background

Obesity is a serious public health problem that is growing alarmingly worldwide. The main objective of this study is to examine the current prevalence of overweight and obesity among Pakistani adults and to identify the sociodemographic factors that are associated with overweight and obesity.

Methods

Secondary data from a population-based household survey (the Pakistan Panel Household Survey) were used for this study. A total of 10,063 participants (3,916 men and 6,147 women) were included. Overweight and obese individuals were identified using the World Health Organization-recommended cutoffs for body mass index (kg/m²). Along with descriptive statistics, the Pearson chi-square test was used to investigate the association among categorical variables. Odds ratios (ORs) along with 95% confidence intervals (CIs) were estimated using univariate logistic regression analysis to evaluate the most significantly associated risk factors for overweight/obesity.

Results

The mean age and body mass index of the participants were 38.2 years and 22.9 kg/m², respectively. Overall, 22.8% of the participants (23.9% of the women and 21.1% of the men) were overweight, and 5.1% (6.3% of the women and 3.2% of the men) were obese. Sociodemographic factors, such as sex, marital status, and residential area, were significantly associated with body mass index categories. Women (OR, 1.34; 95% CI, 1.23-1.47; P<0.01), ever-married individuals (OR, 1.92; 95% CI, 1.70-2.16; P<0.01), and individuals living in urban areas (OR, 1.23; 95% CI, 1.12-1.35; P<0.01) were more likely to become overweight/obese than their counterparts.

Conclusion

We have found the excess weight problem to be quite high in the Pakistani adult population. The government and other health agencies should take initiatives in launching programs about nutritional awareness for adults to prevent obesity.

Prevalence of prehypertension and hypertension and its risk factors in Iranian school children: a population-based study

OBJECTIVE

Because of the incidence of a childhood obesity epidemic and the widespread changes in people's lifestyle, the prevalence of high blood pressure in children is increasing. This study was conducted to determine the prevalence of prehypertension and hypertension and its risk factors in Iranian children.

METHODS

Using random cluster sampling in urban areas and census in rural areas, a total of 5620 schoolchildren aged 6-12 years living in Shahroud, Northeast of Iran, were studied. The prevalence of hypertension was determined on the basis of the fourth report of the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents by age, sex, and place of residence. The factors influencing blood pressure were studied using multivariate regression.

RESULTS

The prevalence of prehypertension was 7.44% and the prevalence of hypertension was 6.82%. The relative risk ratio (RRR) of prehypertension was 1.17 for BMI, 1.43 for female sex, and 3.71 for residence in rural areas; in addition, the RRR of hypertension was 1.22 for BMI, 6.64 for residence in rural areas, 1.69 for moderate economic status, and 1.89 for low economic status.

CONCLUSION

The prevalence of prehypertension and hypertension is significant in children and alarming in rural areas and requires urgent intervention. As factors such as high BMI, female sex, residence in rural areas, and moderate and low economic status are associated with increased risk of prehypertension and hypertension, it is recommended to conduct routine care programs at regular intervals in schools to prevent hypertension and its related complications.

Automatic localization of anatomical regions in medical ultrasound images of rheumatoid arthritis using deep learning

The pace of population aging is growing faster worldwide. The quality of life of the aging population is mostly affected by rheumatic diseases. With the increasing rate of rheumatoid arthritis in the aging population, technological advances in the field of automatic image processing and analysis have paved way for automatic detection and diagnosis of arthritis based on how the grade of the synovial region is designed. The proposed method is based on spatial analysis using intensity-based approach to segment the skin border, thresholding and connectivity algorithm for bone region segmentation, hit-or-miss transform for bone line segmentation and distance measure with image profile to detect the joint region. After this process of localization, the synovial region is determined using the active contour technique. In arthritis condition, synovitis also occurs which is categorized into four different grades based on the fluid expansion in the synovial region. The different grades are defined and analyzed through deep learning. Convolutional neural network in a deep learning algorithm is used to diagnose the particular grade of synovitis to describe the nature of arthritis. With these results, a module to detect the nature of arthritis automatically is defined.

The Association between Socioeconomic Status, Smoking, and Chronic Disease in Inner Mongolia in Northern China

The interactive associations of socioeconomic status (SES) and smoking with chronic disease were investigated with a view to expanding the evidence to inform tobacco policies and interventions in Northern China. The fifth NHSS (National Health Service Survey) 2013 in Inner Mongolia was a population-based survey of national residents, aged 15 years and older, in which multi-stage stratified cluster sampling methods were used to survey 13,554 residents. The SES was measured by scores derived from levels of education level and household annual income. Multivariate logistic regression models were performed to determine the association between SES, smoking, and chronic disease adjusted by confounders. Three thousand nine hundred and thirty-seven residents (32.29%) were identified as current smokers and 3520 residents (26.01%) had been diagnosed with chronic diseases. In the males, former smoking with low SES had the highest risk of one chronic disease, with an odds ratio (OR) of 2.505 (95% confidence interval [95% CI] (OR = 2.505, 95% CI: 1.635–3.837) or multiple chronic diseases (OR = 2.631, 95% CI: 1.321–5.243). In the females, current smoking with low SES had the highest risk of one chronic disease (OR = 3.044, 95% CI: 2.158–4.292). The conclusion of this study was that residents with combined ever-smoking and low SES deserved more attention in the prevention and control of chronic disease.

Current Trends of Cardiovascular Risk Determinants in Pakistan

We carried out a case control study to determine the prevalence of various cardiovascular risk factors in a Pakistani population. A total of 835 patients (555 males and 280 females) and 794 control subjects (486 males and 308 females) were recruited in this study. Patients with documented history of coronary artery disease (CAD) were included. We assessed major risk factors such as age, body mass index (BMI), hypertension and dyslipidemia, using pre-specified definitions. A comparative analysis of the biochemical and clinical parameters was carried out between controls and patients using student's t test. We observed that the cardiovascular disease (CVD) risk factors were more prominent in the patient group as compared to the controls (P < 0.05). In the whole studied population females had increased levels of total cholesterol (TC) (P = 0.01), triglyceride (TG) (P = 0.02), and very low density lipoprotein cholesterol (vLDL-C) (P = 0.02) as compared to males. Among patients group all the risk factors were significantly higher and more prevalent in females when compared with male patients (P < 0.05). The study population was also analyzed according to the smoking status and BMI to study the effect of these risk factors independently. The smokers and study subjects with raised BMI had significantly raised blood pressure and cholesterol levels. The role of age as a risk factor was also investigated in the current study. The persons with age ≤45 years had the highest levels of lipid profile including TC, TG, low density lipoprotein cholesterol (LDL-C), vLDL-C and high density lipoprotein cholesterol (HDL-C) among the three (≤45, 46-55, ≥56 years) groups (P < 0.05). In conclusion, the present study demonstrates an increased propensity of CVD risk factors at a younger age with female preponderance. Moreover, hypertension and dyslipidemia are the most prominent of the risk factors.

Prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents: the CASPIAN-V Study

Introduction: This study presents the prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents. Methods: This multi-centric study was conducted in 2015 among 4200 students aged 7-18 years. They were selected by multistage cluster sampling from 30 provinces of Iran. Anthropometric indices, biochemical and clinical parameters were measured. Results: The mean of weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose (FBG) was higher in boys than in girls (P < 0.05). The mean of triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) levels were higher in girls than in boys (P < 0.05). The mean of weight, height, WC, SBP, DBP, alanine transaminase (ALT) and body mass index (BMI) was higher in urban than in rural residents (P < 0.05). Overall, 16.1%, 9.4% and 11.4% were underweight, overweight and obese. Abdominal obesity was documented in 21.6% of boys and 20.5% of girls. Low HDL-C was the most prevalent abnormality of lipid profile (29.5%) followed by high serum TGs (27.7%). Low HDL-C was more prevalent in boys than in girls (32.7% vs. 26%, respectively, P < 0.05). Prevalence of obesity and overweight were higher in girls than in boys (P < 0.05). The prevalence of obesity and overweight, abdominal obesity, and low HDL-C were higher in urban than in rural residents (P < 0.05). Conclusion: We found considerably high prevalence of some cardiometabolic risk factors including overweight and obesity, low HDL-C and hypertriglyceridemia in Iranian children and adolescents. The current findings underscore the necessity of intensifying health interventions for primordial and primary prevention of non-communicable diseases from early life.

The burden and high prevalence of hypertension in Pakistani adolescents: a meta-analysis of the published studies

Background

Hypertension has been recognized as a global health concern for developing countries and is scarcely described in many of these countries. In Pakistan, few population-based surveys evaluated the prevalence of hypertension and there is no current nationally representative study (the latest nationwide survey was conducted more than two decades ago). Objective: The goal of the current study was to estimate the pooled prevalence of hypertension in Pakistani population using meta-analysis approach.

Methods

We searched the published literature using PubMed, Google and Scopus supplemented by a manual search of bibliographies of retrieved articles for population studies providing estimates on the prevalence of hypertension between 1990 and 2017. Studies were included if they defined hypertension as ≥140/90 mmHg and conducted in adults (≥15 years). From the extracted results, the heterogeneity index of the studies was determined using Chi-squared I2 tests and on the basis of heterogeneity, a fixed or random effect model was used to estimates the pooled prevalence of hypertension. Meta-regression was performed to determine those factor of generating heterogeneity.

Results

Of a total of 1240 articles, 18 studies comprising 42,618 participants met the eligibility criteria. The overall pooled prevalence of hypertension was 26.34% (25.93%, 26.75%). Subgroup analysis showed higher urban prevalence 26.61% (21.80%, 31.42%) than the rural dwellers 21.03% (10.18%, 31.87%). The prevalence by decade in 1990s was 19.55% (18.07%, 21.05%), in 2000s 23.95% (16.60%, 31.30%) and in 2010s 29.95% (24.13%, 35.77%). Similarly, the pooled prevalence was 24.99% (19.70%, 30.28%) in males and 24.76% (16.76%, 32.76%) in females. We recorded high burden of hypertension among the adult Pakistanis when compared to the data published in local and international journals 23.32% (18.9%, 27.74%) and 27.44% (20.97%, 33.91%). We also found differences in the prevalence of hypertension among small, medium and large studies.

Conclusion

Comparing data from previous studies in Pakistan, we found a higher prevalence in urban areas and among males. The prevalence over time is likely to increase faster, further our results underscore the importance of good quality long-term studies that will help to understand hypertension better and implement effective prevention and management programs.

The epidemiology of hepatitis C virus in Pakistan: systematic review and meta-analyses

To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, we systematically reviewed all available records of HCV incidence and/or prevalence from 1989 to 2016, as informed by the Cochrane Collaboration Handbook. This systematic review was reported following the PRISMA guidelines. Populations were classified into six categories based on the risk of exposure to HCV infection. Meta-analyses were performed using DerSimonian and Laird random-effects models with inverse variance weighting. The search identified one HCV incidence study and 341 prevalence measures/strata. Meta-analyses estimated the pooled mean HCV prevalence at 6.2% among the general population, 34.5% among high-risk clinical populations, 12.8% among populations at intermediate risk, 16.9% among special clinical populations, 55.9% among populations with liver-related conditions and 53.6% among people who inject drugs. Most reported risk factors in analytical epidemiologic studies related to healthcare procedures. Pakistan is enduring an HCV epidemic of historical proportions-one in every 20 Pakistanis is infected. HCV plays a major role in liver disease burden in this country, and HCV prevalence is high in all-risk populations. Most transmission appears to be driven by healthcare procedures. HCV treatment and prevention must become a national priority.

Establishing a cohort in a developing country: Experiences of the diabetes-tuberculosis treatment outcome cohort study

BACKGROUND

Prospective cohort studies are instrumental in generating valid scientific evidence based on identifying temporal associations between cause and effect. Researchers in a developing country like Pakistan seldom undertake cohort studies hence little is known about the challenges encountered while conducting them. We describe the retention rates among tuberculosis patients with and without diabetes, look at factors associated with loss to follow up among the cohort and assess operational factors that contributed to retention of cohort.

METHODS

A prospective cohort study was initiated in October 2013 at the Gulab Devi Chest Hospital, Lahore, Pakistan. We recruited 614 new adult cases of pulmonary tuberculosis, whose diabetic status was ascertained by conducting random and fasting blood glucose tests. The cohort was followed up at the 2nd, 5th and 6th month while on anti-tuberculosis therapy (ATT) and 6months after ATT completion to determine treatment outcomes among the two groups i.e. patients with diabetes and patients without diabetes.

RESULTS

The overall retention rate was 81.9% (n=503), with 82.3% (93/113) among patients with diabetes and 81.8% (410/501) among patients without diabetes (p=0.91). Age (p=0.001), area of residence (p=0.029), marital status (p=0.001), educational qualification (p=<0.001) and smoking (p=0.026) were significantly associated with loss to follow up. Respondents were lost to follow up due to inability of research team to contact them as either contact numbers provided were incorrect or switched off (44/111, 39.6%).

CONCLUSION

We were able to retain 81.9% of PTB patients in the diabetes tuberculosis treatment outcome (DITTO) study for 12months. Retention rates among people with and without diabetes were similar. Older age, rural residence, illiteracy and smoking were associated with loss to follow up. The study employed gender matched data collectors, had a 24-h helpline for patients and sent follow up reminders through telephone calls rather than short messaging service, which might have contributed to retention of cohort.

Association of major dietary patterns and blood pressure longitudinal change in Bangladesh

BACKGROUND

Observational studies and clinical trials have shown associations of diet and high blood pressure (BP). However, prospective studies on the association between dietary patterns and longitudinal BP change are lacking, especially in low-income populations.

METHOD

We evaluated the association of dietary patterns and food groups with longitudinal change of BP in 10 389 participants in the Health Effects of Arsenic Longitudinal Study, with a median of 6.7 years of follow-up. Dietary information was obtained through a previously validated food-frequency questionnaire. BP was measured at baseline and at each biennial follow-up using the same method.

RESULT

Each standard deviation (SD) increase for the 'gourd vegetable' dietary pattern score was related to a slower annual change of 0.08, 0.04, and 0.05 mmHg in SBP, DBP, or pulse pressure, respectively. Each SD increase in the 'balanced' dietary pattern score was related to a decreasing annual change of 0.06 mmHg (P = 0.012) and 0.08 mmHg in SBP and pulse pressure (P < 0.001). On the contrary, one SD increase in 'western' dietary pattern score was related to a greater annual increase of 0.07 (P = 0.005) and 0.05 mmHg in SBP and pulse pressure (P = 0.013). Higher intake of fruits and vegetables was associated with a slower rate of change in annual SBP and pulse pressure, whereas higher meat intake was related to a more rapid increase in annual pulse pressure.

CONCLUSION

The findings suggest that dietary patterns play a significant role in the rate of BP change over time in a low-income population.

Chronic kidney disease in low- and middle-income countries

Most of the global burden of chronic kidney disease (CKD) is occurring in low- and middle-income countries (LMICs). As a result of rapid urbanization in LMICs, a growing number of populations are exposed to numerous environmental toxins, high infectious disease burdens and increasing rates of noncommunicable diseases. For CKD, this portends a high prevalence related to numerous etiologies, and it presents unique challenges. A better understanding of the epidemiology of CKD in LMICs is urgently needed, but this must be coupled with strong public advocacy and broad, collaborative public health efforts that address environmental, communicable, and non-communicable risk factors.

The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey

Background

World Health Organization (WHO) estimates for deaths attributed to Non Communicable Diseases (NCDs) in Nepal have risen from 51% in 2010 to 60% in 2014. This study assessed the distribution and determinants of NCD risk factors among the Nepalese adult population.

Methods and Findings

A nationally representative cross-sectional survey was conducted from Jan to June 2013 on the prevalence of NCD risk factors using the WHO NCD STEPS instrument. A multistage cluster sampling method was used to randomly select the 4,200 respondents. The adjusted prevalence ratio (APR) was used to assess the determinants of NCD risk factors using a Poisson regression model. The prevalence of current smoking (last 30 days) was 19% (95%CI:16.6-20.6), and harmful alcohol consumption (≥60 g of pure alcohol for men and ≥40 g of pure alcohol for women on an average day) was 2% (95%CI:1.4-2.9). Almost all (99%, 95%CI:98.3-99.3) of the respondents consumed less than five servings of fruits and vegetables combined on an average day and 3% (95%CI:2.7-4.3) had low physical activity. Around 21% (95%CI:19.3-23.7) were overweight or obese (BMI≥25). The prevalence of raised blood pressure (SBP≥140 mm of Hg or DBP≥90 mm of Hg) and raised blood glucose (fasting blood glucose ≥126 mg/dl), including those on medication were 26% (95%CI:23.6-28.0) and 4% (95%CI:2.9-4.5) respectively. Almost one quarter of respondents, 23% (95%CI:20.5-24.9), had raised total cholesterol (total cholesterol ≥190 mg/dl or under current medication for raised cholesterol). he study revealed a lower prevalence of smoking among women than men (APR:0.30; 95%CI:0.25-0.36), and in those who had higher education levels compared to those with no formal education (APR:0.39; 95%CI:0.26-0.58). Harmful alcohol use was also lower in women than men (APR:0.26; 95%CI:0.14-0.48), and in Terai residents compared to hill residents (APR:0.16; 95%CI:0.07-0.36). Physical inactivity was lower among women than men (APR:0.55; 95%CI:0.38-0.80), however women were significantly more overweight and obese (APR:1.19; 95%CI:1.02-1.39). Being overweight or obese was significantly less prevalent in mountain residents than in hill residents (APR:0.41; 95%CI:0.21-0.80), and in rural compared to urban residents (APR:1.39; 95%CI:1.15-1.67). Lower prevalence of raised blood pressure was observed among women than men (APR:0.69; 95%CI: 0.60-0.80). Higher prevalence of raised blood glucose was observed among urban residents compared to rural residents (APR:2.05; 95%CI:1.29-3.25). A higher prevalence of raised total cholesterol was observed among the respondents having higher education levels compared to those respondents having no formal education (APR:1.76; 95%CI:1.35-2.28).

Conclusion

The prevalence of low fruit and vegetable consumption, overweight and obesity, raised blood pressure and raised total cholesterol is markedly high among the Nepalese population, with variation by demographic and ecological factors and urbanization. Prevention, treatment and control of NCDs and their risk factors in Nepal is an emerging public health problem in the country, and targeted interventions with a multi-sectoral approach need to be urgently implemented.

Hypertension prevalence, awareness, treatment, and control, in male South Asian immigrants in the United Arab Emirates: a cross-sectional study

Background

South Asian males constitute the largest proportion of the United Arab Emirates (UAE) population. Minimal data is available on the prevalence of hypertension among South Asian immigrants in the UAE. We determined the prevalence, associated factors, awareness, treatment, and control of hypertension among male South Asian immigrants from India, Pakistan and Bangladesh residing in the UAE.

Methods

We recruited a representative sample (n = 1375; 76.4 % participation rate) of South Asian adult (≥18 years) immigrant males, including Indian (n = 433), Pakistani (n = 383) and Bangladeshi (n = 559) nationalities in Al Ain, UAE (January-June 2012). Blood pressure, height, body mass, waist and hip circumference data were obtained using standard protocols. Information related to socio-demographics, lifestyle factors, history of diagnosis and treatment of hypertension was collected through a pilot-tested adapted version of the STEPS instrument, developed by the World Health Organization for the measurement of non-communicable disease risk factors at the country level .

Results

Mean age of participants was 34.0 years (95 % confidence interval (CI): 33.4, 34.5 years) and the overall prevalence of hypertension was 30.5 % (95 % CI 28.0, 32.8). In this study, 62 % of study participants had never had their blood pressure measured. Over three quarters (76 %) of the sample classified as hypertensive were not aware of their condition. Less than half (48.5 %) of the sample that were aware of their hypertension reported using antihypertensive medication and only 8.3 % had their hypertension under control (<140/90 mmHg). Hypertensive participants were more likely to be overweight (adjusted odds ratio (AOR) = 1.43; 95 % CI 1.01, 2.01); obese (AOR = 2.49; 95 % CI: 1.51, 4.10); have central obesity (AOR = 2.01; 95 % CI 1.37, 2.92); have a family history of hypertension (AOR = 1.51; 95 % CI 1.05, 2.17); and were less likely to walk 30 minutes daily (AOR = 1.79; 95 % CI 1.24, 2.60).

Conclusions

The prevalence of hypertension in a representative sample of young male South Asian immigrants living in the UAE was relatively high. However, the awareness, treatment, and control of hypertension within this population were very low. Strategies are urgently needed to improve the awareness and control of hypertension in this large population of migrant workers in the UAE.

The Role of Neighborhood Environment in Promoting Risk Factors of Cardiovascular Disease among Young Adults: Data from Middle to High Income Population in an Asian Megacity

Background

Modifiable risk factors of cardiovascular diseases (CVD) have their triggers in the neighborhood environments of communities. Studying the environmental triggers for CVD risk factors is important to understand the situation in a broader perspective. Young adults are influenced the most by the environment profile around them hence it is important to study this subset of the population.

Methods

This was a descriptive study conducted using the EPOCH research tool designed by the authors of the PURE study. The study population consisted of young adults aged 18-25 in two areas of Karachi. The study setting was busy shopping malls frequented by young adults in the particular community being studied.

Results

Our total sample size was 120 individuals, who consented to be interviewed by our interviewers. Less than 50% of the population recognized some form of restriction regarding smoking in their communities. The largest contributor to tobacco advertising was actors smoking in movies and TV shows with 89% responses from both communities. Only 11.9% of the individuals disapproved of smoking cigarettes among men with wide acceptance of ‘sheesha’ across all age groups. Advertising for smoking and junk food was more frequent as compared to smoking cessation, healthy diet and exercise in both the areas. Unhealthy food items were more easily available in contrast to healthier options. The cost of healthy snack food options including vegetables and fruits was higher than sugary drinks and foods.

Conclusion

This assessment showed that both communities were exposed to environments that promote risk factors for cardiovascular diseases.

Below the poverty line and non-communicable diseases in Kerala: The Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study

INTRODUCTION

India carries the greatest burden of global non-communicable diseases (NCDs). Poverty is strongly associated with NCDs but there are few prevalence studies which have measured poverty in India, particularly in rural settings.

METHODS

In Kerala, India, a population of 113,462 individuals was identified. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists). Standardised questionnaires were used in household interviews of individuals ≥18years during 2012 to gather sociodemographic, lifestyle and medical data for this population. The Government of Kerala definition of "the poverty line" was used. The association between below poverty line (BPL) status, NCDs and risk factors was analysed in multivariable regression models.

RESULTS

84,456 adults were included in the analyses (25.4% below the poverty line). The prevalence of NCDs was relatively common: myocardial infarction (MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. BPL status was not associated with age (p=0.96) or gender (p=0.26). Compared with those above the poverty line (APL), the BPL group was less likely to have diabetes, hypertension or dyslipidaemia (p<0.0001), and more likely to smoke (p<0.0001). Compared with APL, BPL was associated with stroke (OR 1.33, 1.04-1.69; p=0.02) and respiratory disease (OR 1.23, 1.15-1.32; p<0.0001) in multivariable analyses, but not MI or cancer.

CONCLUSIONS

In rural Kerala, BPL status was associated with stroke and respiratory diseases, but not with MI and cancer although it was associated with smoking status, compared with above poverty line status.

Prevalence of obesity and overweight, its clinical markers and associated factors in a high risk South-Asian population

Background

Obesity is a global epidemic, which is a risk factor for cardiovascular diseases and metabolic abnormalities. It is measured by body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body fat (BF) distribution and abdominal fat mass, each having its own merits and limitations. Variability in body composition between ethnic groups in South-Asians is significant and may not be truly reflected by BMI alone, which may result in misclassification. This study therefore, aims to determine the frequency of obesity, body fat composition and distribution, in a high risk population of an urban slum of Karachi, Pakistan. This survey included 451 participants selected by systematic sampling who were administered pre-tested questionnaires on socio-demographics, diet and physical activity. Chi-square was used to determine the association between categorical variables and multiple linear regression was used for quantitative variables. A P value of less than 0.05 was considered significant.

Results

Classified by BMI, 29% study subjects were overweight and 21% obese (58.7% with central obesity). Body fat percent (BF%) classified 81% as overweight. Females were more obese (P 0.03) with higher prevalence of central obesity (P <0.001) and WHR (P 0.003) but with a lower muscle mass (P 0.001). Activity score and muscle mass showed inverse linear association with BF% whereas, WC, weight, BMI and WHR had a positive linear association with BF%. The relationship between BMI and BF% was quadratic with a weaker association at lower BMI. Adjusting for socio-demographic variables, BF%, weight, diastolic blood pressure (DBP), BMI and score on the diet questionnaire had a positive linear association with WC, while WC, WHR and BP had a positive linear association with BF%. BF%, muscle content and WC had a positive linear association with BMI.

Conclusion

Considering lower cut-offs for South-Asians BMI and WC, this study showed a high prevalence of obesity among a sub-urban population of Karachi, which was even higher when BF% was measured. Considering the rising prevalence of non-communicable diseases, BF%, WC, WHR and BMI measurements are convenient and feasible means of identifying population at risk and hence addressing it through public awareness and early detection.

Electronic supplementary material

The online version of this article (doi:10.1186/s40608-015-0044-6) contains supplementary material, which is available to authorized users.

Community-based assessment of surgical symptoms in a low-income urban population

BACKGROUND

The global burden of surgical disease has not been well quantified, but is potentially immense. Given the enormity of the problem and the relative paucity of data, definition and monitoring of surgical burden of disease is an essential step in confronting the problem. This study aimed to estimate the prevalence of non-acute surgical disease symptoms in a low-income population.

METHODS

The survey was conducted as part of the Indus Hospital Community Cohort in Karachi, Pakistan. A systematic random sampling design was used to enroll 667 households from March to August 2011. An unvalidated questionnaire intending to measure prevalence of surgical symptoms was administered to 780 participants.

RESULTS

761 participants completed the screening questionnaire, with 346 (45%) reporting one or more symptoms requiring surgical assessment (excluding those screened positive for symptoms of osteoarthritis), of which only 8.4% followed up on scheduled appointments at the referral hospital. A total of 126 past surgical procedures were recorded in 120 participants.

CONCLUSION

There is a high prevalence of symptoms suggestive of surgical diseases in our urban catchment population with relatively convenient access to health facilities including a tertiary care hospital providing free of cost care. The perceived severity of symptoms, and a complex interaction of other factors, may play an important role in understanding health seeking behavior in our population. Developing a context-specific validated tool to correctly identify surgical symptoms disease in the community with appropriate referral for early management is essential to identify and therefore reduce the burden of surgical diseases within the community. This must happen hand in hand with further studies to understand the barriers to seeking timely health care.

Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN)

BACKGROUND

Although palliative care is an important public healthcare issue worldwide, the current situation in the Asia-Pacific region has not been systematically evaluated.

OBJECTIVES

This survey aimed to clarify the current status of palliative care in the Asia-Pacific region.

METHODS

Questionnaires were sent to a representative physician of each member country/region of the Asia Pacific Hospice Palliative Care Network (APHN). The questionnaire examined palliative care service provision, information regarding physician certification in palliative care, the availability of essential drugs for palliative care listed by the International Association for Hospice and Palliative Care (IAHPC) and the regulation of opioid-prescribing practice.

RESULTS

Of the 14 member countries/regions of the APHN, 12 (86%) responded. Some form of specialist palliative care services had developed in all the responding countries/regions. Eight member countries/regions had physician certifications for palliative care. Most essential drugs for palliative care listed by the IAHPC were available, whereas hydromorphone, oxycodone and transmucosal fentanyl were unavailable in most countries/regions. Six member countries/regions required permission to prescribe and receive opioids.

CONCLUSIONS

The development of palliative care is in different stages across the surveyed countries/regions in the Asia-Pacific region. Data from this survey can be used as baseline data for monitoring the development of palliative care in this region.

Ischemic strokes in Pakistan: observations from the national acute ischemic stroke database

BACKGROUND

The objective of this study was to establish a multicenter ischemic stroke registry, first of its kind in Pakistan, to provide insight into the epidemiology, subtypes, and risk factors of ischemic strokes in this country.

METHODS

Four academic centers (3 urban and 1 rural) participated in this project. The inclusion criteria for subjects included adults (>14 years) with acute neurologic deficit, consistent with clinical diagnosis of ischemic stroke and supported by neuroimaging.

RESULTS

Data were available for 874 subjects. Mean age of the subjects was 59.7 years, 60.5% were males, and 18% were young. Large vessel strokes were the most common subtype found in 31.7% subjects, followed by small vessel disease (25.7%) and cardioembolic strokes (10.4%). Almost 32% subjects had ill-defined etiology for their ischemic stroke. Dyslipidemia was a most common risk factor present in 83% patients. Data related to in-hospital complications were available for 808 subjects, of which 233 complications were recorded. Pneumonia was the most common of these seen in 105 (13%) subjects, followed by urinary tract infection (7.2%). Outcome at discharge was recorded for 697 subjects. Ninety-two had died during their hospital stay (13.2%). Only 36% subjects had a favorable outcome at discharge defined as a modified Rankin Scale (mRS) score of 2 or less. A total of 446 of 697 subjects had poor outcome at discharge (defined as an mRS score≥3).

CONCLUSIONS

Hypertension and dyslipidemia were the most common risk factors and large vessel atherosclerosis was the most common stroke etiology. Elderly patients were significantly more likely to have in-hospital complications, die during their hospital stay, and have a higher mRS score at discharge.

Prevalence and risk factors of kidney disease in urban Karachi: baseline findings from a community cohort study

BACKGROUND

Chronic kidney disease (CKD) is being increasingly recognized as a leading public health problem. However, there are limited data available with respect to prevalence of CKD in Pakistan, a developing South Asian country. The study presents the baseline findings of prevalence and risk factors for adult kidney disease in a Pakistani community cohort.

METHODS

A total of 667 households were enrolled between March 2010 and August 2011 including 461 adults, aged 15 and older. Mild kidney disease was defined as estimated Glomerular Filtration Rate (eGFR) ≥60 ml/min with microalbuminuria ≥ 30 mg/dl and moderate kidney disease was defined as eGFR <60 ml/min (with or without microalbuminuria).

RESULTS

The overall prevalence of kidney disease was 16.6% with 8.6% participants having mild kidney disease and 8% having moderate kidney disease. Age was significantly associated with kidney disease (p < 0.0001). The frequency of diabetes, hypertension and smoking differed significantly among the three groups, i.e., no kidney disease, mild kidney disease and moderate kidney disease.

CONCLUSION

Our study results suggest that the burden of kidney disease in this population is found considerable and comparable to neighboring developing countries. We believe that these results have critical implications on health and economics of these countries and due to the epidemic of diabetes, hypertension, cardiovascular disease, smoking and association with worsening poverty, further rapid growth is expected. There is an urgent need for early recognition and prevention strategies based on risk factors and disease trends determined through longitudinal research.

Prevalence of Prehypertension and Hypertension in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study

BACKGROUND

The global health burden has faced toward non-communicable diseases (NCDs). It is suggested that adulthood blood pressure (BP) is tracked from childhood. This study aims to evaluate the mean BP and the prevalence of prehypertension and hypertension in the Iranian pediatric population.

METHODS

In a national survey as the 4(th) phase of Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable diseases study and through random multistage cluster sampling, a national sample of Iranian school students, aged 6-18 years, were recruited. Data gathered by means of modified World Health Organization Global school-based student health survey questionnaire, a weight disorders determinants questionnaire and anthropometric and BP measurements. Prehypertension (HTN) was defined as BP equal or greater than 90(th) age and sex specific percentile or ≥120/80 mmHg and HTN was defined as BP ≥95(th) percentile.

RESULTS

A total of 13486 students entered the study (49.2% girls, 75.6% urban). Mean age of participants was 11.47 ± 3.36 years. A total rate of 4.17% (3.84-4.52 95% CI) for high systolic BP (SBP), 4.33% (3.99-4.68) for high diastolic BP (DBP) and 6.88% (6.45-7.32) for high SBP and/or DBP was depicted.

CONCLUSIONS

The prevalence rate of high BP (pre-HTN together with HTN) is substantially high in this population. It is needed to study the causative situations and implement relevant interventions.