Non-communicable diseases and injuries in Pakistan: strategic priorities

Jafar, Tazeen H.; Haaland, Benjamin; Rahman, Atıf; Razzak, Junaid Abdul; Bilger, Marcel; Naghavi, Mohsen; Mokdad, Ali H.; Hyder, Adnan A.

doi:10.1016/s0140-6736(13)60646-7

Cited by 105 publications

(86 citation statements)

References 55 publications

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“…Moreover, South Asian countries are undergoing an epidemiological transition with an increase in risk factors of CKD, and consequently posing a burden on health systems [6]. Furthermore, CKD is also known to progress fast in Asians compared to Western counterparts underscoring the need for prevention through early detection and management of risk factors [7].…”

Section: Introductionmentioning

confidence: 99%

Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - a community based cross-sectional study

2014

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BackgroundChronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications.MethodsWe conducted a cross-sectional study on 2873 participants aged ≥40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPI (CKD Epidemiology Collaboration) Pakistan equation (0.686 × CKD-EPI1.059) or urinary albumin to creatinine ratio ≥3 mg/mmol (i.e. KDOQI CKD stage G3, A2 or worse).ResultsThe overall prevalence (95% CI) of CKD was 12.5% (11.4 – 13.8%). The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p < 0.05 for each). About 267 (74.4%, 69.5 – 78.8%) adults with CKD had concomitant hypertension. Of these, 130 (48.7%, 42.6 – 54.9%) were on antihypertensive medications, and less than 20% had their BP controlled to conventional target of ≤140/90 mm Hg, and only 16.9% (12.6 – 21.9%) were on blockers of renin-angiotensin system alone or in combination with other drugs.ConclusionsClinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure in Pakistan, and possibly neighbouring countries.

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Section: Introductionmentioning

confidence: 99%

Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - a community based cross-sectional study

2014

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“…In Pakistan, as in many LMICs, diets are poor in fruit and vegetables (99% have less than one serving per day), and most individuals with hypertension have uncontrolled BP (25). Thus, the scope for improvement from interventions targeting individual and provider behavior is considerable.…”

Section: Discussionmentioning

confidence: 99%

Health Education and General Practitioner Training in Hypertension Management: Long-Term Effects on Kidney Function

Jafar

Allen

Jehan³

et al. 2016

CJASN

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Background and objectives In the Control of Blood Pressure and Risk Attenuation trial, a 232 factorial design study (2004)(2005)(2006)(2007), the combined home health education and trained general practitioner intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. We aimed to assess the effectiveness of the interventions on kidney function.Design, participants, settings, & methods In 2012-2013, we conducted extended follow-up of a total of 1271 individuals aged $40 years with hypertension (systolic BP $140 mmHg, diastolic BP $90 mmHg, or receipt of antihypertensive treatment) and serum creatinine measurements with 2 years in-trial and 5 years of post-trial period in 12 randomly selected low-income communities in Karachi, Pakistan. The change in eGFR from baseline to 7 years was assessed among randomized groups using a generalized estimating equation method with multiple imputation of missing values.Results At 7 years of follow-up, adjusted mean eGFR remained unchanged, with a change of 20.3 (95% confidence interval [95% CI], 23.5 to 2.9) ml/min per 1.73 m 2 among adults randomly assigned to the combined home health education plus trained general practitioner intervention compared with a significant decline of 23.6 (95% CI, 25.7 to 22.0) ml/min per 1.73 m 2 in those assigned to usual care (P=0.01, modified intention-to-treat analysis). The risk for the combined intervention of death from kidney failure or .20% decline in eGFR relative to usual care was significantly reduced (risk ratio, 0.47; 95% CI, 0.25 to 0.89). ConclusionsThe combined home health education plus trained general practitioner intervention is beneficial in preserving kidney function among adults with hypertension in communities in Karachi. These findings highlight the importance of scaling up simple strategies for renal risk reduction in low-and middle-income countries.

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“…Almost everyone paid out of pocket for any kind of health care services. 3 Despite all these challenges, survivors reported better quality of life scores assessed by Stroke Specific Quality of Life Scores (SSQOLS) as compared to reported scores from other developing countries. 4 Qualitative in-depth interviews and focus group discussions exposed the real cost of these scores; they were related to the efforts of stroke caregivers.…”

Section: Dear Editormentioning

confidence: 99%