Determinants of Uncontrolled Hypertension in Rural Communities in South Asia—Bangladesh, Pakistan, and Sri Lanka

Abstract BACKGROUND Uncontrolled blood pressure (BP) is a leading risk factor for death and disability in South Asia. We aimed to determine the cross-country variation, and the factors associated with uncontrolled BP among adults treated for hypertension in rural South Asia. METHODS We enrolled 1,718 individuals aged ≥40 years treated for hypertension in a cross-sectional study from rural communities in Bangladesh, Pakistan, and Sri Lanka. Multivariable logistic regression model was used to determine the factors associated with uncontrolled BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg). RESULTS Among hypertensive individuals, 58.0% (95% confidence interval (CI) 55.7, 60.4) had uncontrolled BP: 52.8% (49.0, 56.6) in Bangladesh, 70.6% (65.7, 75.1) in Pakistan, and 56.5% (52.7, 60.1) in Sri Lanka. The odds (odds ratio (95% CI)) of uncontrolled BP were significantly higher in individuals with lower wealth index (1.17 (1.02, 1.35)); single vs. married (1.46 (1.10, 1.93)); higher log urine albumin-to-creatinine ratio (1.41 (1.24, 1.60)); lower estimated glomerular filtration rate (1.23 (1.01, 1.49)); low vs. high adherence to antihypertensive medication (1.50 (1.16, 1.94)); and Pakistan (2.91 (1.60, 5.28)) vs. Sri Lanka. However, the odds were lower in those with vs. without self-reported kidney disease (0.51 (0.28, 0.91)); and receiving vs. not receiving statins (0.62 (0.44, 0.87)). CONCLUSIONS The majority of individuals with treated hypertension have uncontrolled BP in rural Bangladesh, Pakistan, and Sri Lanka with significant disparities among and within countries. Urgent public health efforts are needed to improve access and adherence to antihypertensive medications in disadvantaged populations in rural South Asia.

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Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia—Bangladesh, Pakistan and Sri Lanka

BMJ Open ◽

10.1136/bmjopen-2019-030584 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030584 ◽

Cited By ~ 2

Author(s):

Liang Feng ◽

Imtiaz Jehan ◽

H Asita de Silva ◽

Aliya Naheed ◽

Hamida Farazdaq ◽

...

Keyword(s):

Rural Communities ◽

Sri Lanka ◽

South Asia ◽

South Asians ◽

Wealth Index ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Rural South ◽

Physically Active

ObjectiveTo determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia.DesignA cross-sectional study.SettingRural communities in Bangladesh, Pakistan and Sri Lanka.ParticipantsA total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial.Main outcome measuresCMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM.ResultsAbout 25.4% (95% CI 23.6% to 27.2%) of the hypertensive individuals had CMM. Factors positively associated with CMM included residing in Bangladesh (OR 3.42, 95% CI 2.52 to 4.65) or Sri Lankan (3.73, 95% CI 2.48 to 5.61) versus in Pakistan, advancing age (2.33, 95% CI 1.59 to 3.40 for 70 years and over vs 40–49 years), higher waist circumference (2.15, 95% CI 1.42 to 3.25) for Q2–Q3 and 2.14, 95% CI 1.50 to 3.06 for Q3 and above), statin use (2.43, 95% CI 1.84 to 3.22), and higher levels of triglyceride (1.01, 95% CI 1.01 to 1.02 per 5 mg/dL increase). A lower odds of CMM was associated with being physically active (0.75, 95% CI 0.57 to 0.97). A weak inverted J-shaped association between International Wealth Index and CMM was found (p for non-linear=0.058), suggesting higher risk in the middle than higher or lower socioeconomic strata.ConclusionsCMM is highly prevalent in rural South Asians affecting one in four individuals with hypertension. There is an urgent need for strategies to concomitantly manage hypertension, cardiometabolic comorbid conditions and associated determinants in South Asia.

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Regional Variation in Comorbid Prediabetes and Diabetes and Associated Factors among Hypertensive Individuals in Rural Bangladesh, Pakistan, and Sri Lanka

Journal of Obesity ◽

10.1155/2019/4914158 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11

Author(s):

Liang Feng ◽

Aliya Naheed ◽

H. Asita de Silva ◽

Imtiaz Jehan ◽

Rubhana Raqib ◽

...

Keyword(s):

Waist Circumference ◽

Rural Communities ◽

Sri Lanka ◽

South Asia ◽

Density Lipoprotein ◽

Wealth Index ◽

Cross Sectional ◽

Rural South ◽

Antidiabetic Treatment ◽

Study Population

We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of prediabetes or diabetes (53.5% (51.5%, 55.5%)) and diabetes (27.7% (25.9%, 29.5%)) was high in the overall hypertensive study population in rural communities in 3 countries. Rural communities in Sri Lanka had the highest crude prevalence of prediabetes or diabetes and diabetes (73.1% and 39.3%) with hypertension, followed by those in Bangladesh (47.4% and 23.1%) and Pakistan (39.2% and 20.5%). The factors independently associated with comorbid diabetes and hypertension were residing in rural communities in Sri Lanka, higher education, international wealth index, waist circumference, pulse pressure, triglyceride, and lower high-density lipoprotein. The association of diabetes with waist circumference was stronger than with BMI in hypertensive individuals. Prediabetes or diabetes are alarmingly common among adults with hypertension and vary among countries in rural South Asia. The high prevalence of comorbid diabetes in Sri Lanka among hypertensives is not fully explained by conventional risk factors and needs further etiological research. Urgent public health efforts are needed to integrate diabetes control within hypertension management programs in rural South Asia, including screening waist circumference.

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Factors associated with social participation amongst elders in rural Sri Lanka: a cross-sectional mixed methods analysis

BMC Public Health ◽

10.1186/s12889-018-5482-x ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Celeste Marsh ◽

Paul A. Agius ◽

Gamini Jayakody ◽

Roshan Shajehan ◽

Chandima Abeywickrema ◽

...

Keyword(s):

Mixed Methods ◽

Sri Lanka ◽

Social Participation ◽

Cross Sectional ◽

Factors Associated

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Risk Factors Associated with Overweight among Adolescents in Serbia/ Dejavniki Tveganja, Povezani S Prekomerno Telesno Težo Pri Mladostnikih V Srbiji

Slovenian Journal of Public Health ◽

10.2478/sjph-2014-0031 ◽

2014 ◽

Vol 53 (4) ◽

pp. 283-293 ◽

Cited By ~ 1

Author(s):

Katarina Boričić ◽

Snežana Simić ◽

Nađa Vasiljević ◽

Jelena Marinković

Keyword(s):

Risk Factors ◽

Wealth Index ◽

Cross Sectional Study ◽

Normal Weight ◽

Multivariate Logistic Regression Model ◽

Preventive Interventions ◽

Multivariate Logistic Regression ◽

Cross Sectional ◽

Factors Associated ◽

Skipping Breakfast

AbstractIntroduction. The pandemic of obesity in adolescents is one of the challenges of public health.Aim. The aim of this study was to examine the association of overweight with demographic, socioeconomic and lifestyle factors among Serbian adolescents.Method. A cross-sectional study of 2139 adolescents aged 10 to 19 years was carried out. Data used in this study were from the 2006 Health Survey. In accordance with the international sex- and age-specific Body Mass Index cut-off points, all participants were classified as being normal weight or overweight, including obese. The association between the risk factors and overweight were examined using a multivariate logistic regression model.Results. The study showed that 28.9% of boys and 17.0% of girls were overweight, while 14.5% of boys and 8.1% of girls were obese. Boys were more likely to be overweight/obese, compared with girls. Being younger (p< 0.01 for 14 to 15 years) and (p< 0.01, for 16 to 19 years), engaging in physical activities that last less than 7 hours a week, in such a manner that they breathe quickly and become sweaty, (p< 0.01) and skipping breakfast (p< 0.05) were risk factors significantly associated with overweight among adolescents. No significant association was found with wealth index.Conclusion. These findings should be an integral part of further preventive interventions, especially oriented towards younger adolescents, who are physically inactive, have a habit of skipping breakfast and are boys.

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Cataract among elderly in Sri Lanka

10.1101/540518 ◽

2019 ◽

Author(s):

A.A. Nilanga Nishad ◽

S.A. Hewage ◽

K. Arulmoly ◽

M.S. Amaratunge ◽

J de Silva ◽

...

Keyword(s):

Sri Lanka ◽

Screening Programme ◽

National Level ◽

Age Groups ◽

Cross Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Future Studies ◽

Factors Associated ◽

Younger Age

AbstractOut of 39 billion people who are blind around the world, 20 billion (51.3%) is due to cataract, which is preventable. This study intended to assess the prevalence and factors associated with cataract among elderly in a divisional secretariat area in Sri Lanka. This community based cross sectional study assessed randomly selected470 adults over 60 years of age. Diagnosis of cataract was made by a slit lamp examination by medical officers, and classified according to Oxford Lens Opacity Classification system (LOCS III). Majority was between 60-69 age groups and 71% was females. The prevalence of cataract was estimated to be 80.6% including operated eye and 73.6% excluding the operated eye, with a female preponderance in lower age categories. Commonest type of cataract was the nuclear type (n=422; 44.9%), with a majority in grade 2 (218; 23.2%). The prevalence of cataract surgery in the diseased population was as low as 7%. Cataract leading to blindness is very prevalent among adults over 60 years of age in the studied area. Females tend to develop the disease at an early age than males. These findings warrant screening programme for elderly at community level, targeting females at a younger age than males. Future studies are recommended to assess the coverage and barriers for cataract surgeries at national level, which would be immensely useful in planning and improving health services.

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Patient perspectives on hypertension management in health system of Sri Lanka: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2019-031773 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031773

Author(s):

Manuja Perera ◽

Chamini Kanatiwela de Silva ◽

Saeideh Tavajoh ◽

Anuradhani Kasturiratne ◽

Nathathasa Vihangi Luke ◽

...

Keyword(s):

Sri Lanka ◽

Health Services ◽

Low Income ◽

Rural Areas ◽

Healthcare Professionals ◽

Public Awareness ◽

Uncontrolled Hypertension ◽

Hypertension Management ◽

Antihypertensive Medications ◽

Patient Pathways

IntroductionUncontrolled hypertension is the leading risk factor for mortality globally, including low-income and middle-income countries (LMICs). However, pathways for seeking hypertension care and patients’ experience with the utilisation of health services for hypertension in LMICs are not well understood.ObjectivesThis study aimed to explore patients’ perspectives on different dimensions of accessibility and availability of healthcare for the management of uncontrolled hypertension in Sri Lanka.SettingPrimary care in rural areas in Sri Lanka.Participants20 patients with hypertension were purposively sampled from an ongoing study of Control of Blood Pressure and Risk Attenuation in rural Bangladesh, Pakistan, Sri Lanka.MethodWe conducted in-depth interviews with patients. Interviews were audio-recorded and transcribed into local language (Sinhala) and translated to English. Thematic analysis was used and patient pathways on their experiences accessing care from government and private clinics are mapped out.ResultsOverall, most patients alluded to the fact that their hypertension was diagnosed accidentally in an unrelated visit to a healthcare provider and revealed lack of adherence and consuming alternatives as barriers to control hypertension. Referring to the theme ‘Accessibility and availability of hypertension care’, patients complained of distance to the hospitals, long waiting time and shortage of medicine supplies at government clinics as the main barriers to accessing health services. They often resorted to private physicians and paid out of pocket when they experienced acute symptoms attributable to hypertension. Considering the theme ‘Approachability and ability to perceive’, the majority of patients mentioned increasing public awareness, training healthcare professionals for effective communication as areas of improvement. Under the theme ‘Appropriateness and ability to engage’, few patients were aware of the names or purpose of their medications and reportedly missed doses frequently. Reminders from family members were considered a major facilitator to adherence to antihypertensive medications. Patients welcomed the idea of outreach services for hypertension and health education closer to home in the theme ‘Things the patients reported to improve the system’.ConclusionPatients identified several barriers to accessing hypertension care in Sri Lanka. Measures recommended improving hypertension management in Sri Lanka including public education on hypertension, better communication between healthcare professionals and patients, and efforts to improve access and understanding of antihypertensive medications.Trial registration numberNCT02657746.

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Susceptibility for varicella and factors associated with immunity among pregnant women in a tertiary care hospital in Sri Lanka- a cross-sectional study

BMC Infectious Diseases ◽

10.1186/s12879-019-3996-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ishara P. Premathilake ◽

Praveena Aluthbaduge ◽

Channa P. Senanayake ◽

Renuka Jayalatharachchi ◽

Sirithilak Gamage ◽

...

Keyword(s):

Sri Lanka ◽

Pregnant Women ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

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Factors associated with inappropriate overdose response among people who use prescription opioids non-medically in rural Appalachia: A cross-sectional study

10.21203/rs.3.rs-676671/v1 ◽

2021 ◽

Author(s):

Alexandria Macmadu ◽

Kelly K. Gurka ◽

Herbert I. Linn ◽

Gordon S. Smith

Keyword(s):

Rural Communities ◽

Total Sample ◽

The United States ◽

Cross Sectional Study ◽

Prescription Opioids ◽

Cross Sectional ◽

Factors Associated ◽

Inappropriate Response ◽

Rural Appalachia ◽

Overdose Deaths

Abstract Background Opioid-related overdose deaths have accelerated in recent years. In response, overdose education and naloxone distribution (OEND) programs have been implemented across the United States, although many rural Appalachians continue to lack access. Despite the growing number of OEND programs, risk factors for inappropriate overdose response among persons who are training-naïve are currently unknown. Methods We used respondent-driven sampling to recruit and enroll 169 adults who use prescription opioids non-medically from three rural counties in West Virginia. Participants were interviewed to ascertain experience with witnessed overdose (lifetime and prior-year), characteristics of the most recent witnessed overdose, responses to the witnessed overdose, and OEND acceptability. Logistic regression was used to assess factors associated with inappropriate response to opioid-related overdose. Results Among the 73 (43% of the total sample) participants who witnessed an opioid-related overdose, the majority (n = 53, 73%) reported any inappropriate response. Participants were significantly more likely to report an inappropriate overdose response when the overdose victim was unresponsive (OR = 3.36; 95% CI = 1.07, 10.58). The most common appropriate responses were staying with the victim until recovery or help arrived (n = 66, 90%) and calling 911 (n = 63, 86%), while the most common inappropriate responses were hitting or slapping the victim (n = 37, 51%) and rubbing the victim with ice or placing them in a cold shower or bath (n = 14, 19%). While most (n = 60, 82%) had never heard of overdose prevention training, the vast majority (n = 69, 95%) were willing to participate in training, particularly those who had responded inappropriately (n = 52, 98%). Conclusions These findings underscore the urgent need for expanded access to OEND programs in at-risk rural communities that lacked coverage. Indeed, information generated by this study informed the development of a statewide naloxone distribution program in WV. These findings also indicate OEND programs are highly acceptable to training-naïve people who use opioids in rural Appalachia. Additional approaches to expand access to harm reduction services in the region, including mobile services and mail-based naloxone distribution should be aggressively pursued.

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G. Rodgen (ed) Population Growth and Poverty in Rural South Asia. New Delhi: Sage Publications. 1989.

The Pakistan Development Review ◽

10.30541/v29i3-4pp.355-357 ◽

1990 ◽

Vol 29 (3-4) ◽

pp. 355-357

Author(s):

Zeba A. Sathar

Keyword(s):

Population Growth ◽

South Asia ◽

New Delhi ◽

Cross Sectional ◽

Rural South ◽

Rural Pakistan ◽

Interesting Contribution ◽

Demographic Patterns ◽

The Relationship ◽

Country Specific

Rapid population growth and high levels of poverty continue to be outstanding features of the South Asian region. It is often acknowledged, both implicitly and explicitly, that these two features have close linkages especially in the case of South Asia. This book addresses this very issue through five case studies of Rural Bihar, Rural Pakistan, India, Rural Bangladesh, and Nepal. The book makes an interesting contribution to the literature on population in South Asia. In particular, it has a strong empirical base. However, most of the enquiries, as is quite understandable, are limited by the type of data typically collected in cross-sectional sample surveys. Their limitations are pointed out by the authors themselves. Each chapter makes a significant contribution in its own area and the country-specific results are interesting. In Chapter 2, Rodgers, Gupta, Sharma and Sharma, examine, as their title says, "Demographic Patterns and Poverty among Households in Rural Bihar". The associations between family planning, fertility, child mortality, and incomerelated measures are studied: the relationship between economic variables and fertility is found to be weak; mortality and poverty are more directly related; and the conclusion, therefore, is that there is no evidence to warrant the conclusion that reducing poverty (even if a desirable objective in itself) would reduce fertility.

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Factors Associated with Minimum Acceptable Diet in 6–11-Month-Old Indonesian Children Using the 2017 IDHS

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7452 ◽

2021 ◽

Vol 9 (E) ◽

pp. 1403-1412

Author(s):

Eurika Zebadia ◽

Trias Mahmudiono ◽

Dominikus Raditya Atmaka ◽

Mira Dewi ◽

Siti Helmyati ◽

...

Keyword(s):

Logistic Regression ◽

Complementary Feeding ◽

Research Question ◽

Secondary Analysis ◽

Significant Risk ◽

Wealth Index ◽

Feeding Practices ◽

Cross Sectional Study ◽

Cross Sectional ◽

Factors Associated

BACKGROUND: Inadequate complementary feeding practices are known to contribute to children’s nutritional status. A minimum acceptable diet (MAD) is one of the simple, valid, and reliable indicators to assess complementary feeding practices in 6–23-month-old children on food diversity and meal frequency. Based on the UNICEF data, the MAD of 6–11 months in Indonesia was 26.3% in 2017 and the lowest compared to other groups. Hence, this study research question is posing toward several factors associated with the low MAD among 6–11 months infant. AIM: This study aimed to determine factors associated with MAD in 6–11-month-old children in Indonesia. METHODS: This study was a secondary analysis using the 2017 Indonesia Demographic and Health Survey. This is a cross-sectional study involving 17,848 children in Indonesia. Final sample to be analyzed were 1,441 children of 6–11-month-old. Logistic regression model was applied to identify the significant risk factors associated with MAD. RESULTS: The result showed that the prevalence of MAD in this study is 29%. From the multivariate logistic regression, wealth index, television ownership, and mother’s occupation were significantly associated with MAD of 6–11-month-old children in Indonesia. CONCLUSION: In conclusion, factors associated with MAD among 6–11-month-old children were wealth index, television ownership, and mother’s occupation.

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