Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study

Abstract

BackgroundNon-communicable diseases (NCDs), malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors.MethodsA nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15–64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs) and 95 % confidence intervals (CIs) for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs).ResultsThe prevalence of hypertension was 30.1 % (95 % CI: 28.4–31.8) in males and 29.8 % (28.5–31.1) in females. The mean BMI was 21.7 (SD 4.3) kg/m2 for males and 23.0 (5.1) kg/m2 for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1–3.3, females: OR = 2.3; 2.0–2.7) and high waist circumference (males: OR = 3.4; 1.8–6.8, females: OR = 2.7; 2.2–3.3). In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension.ConclusionsThe prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe trends in the risk factors, especially modifiable factors, which will most likely be on rise. Studies on effectiveness on interventions are needed, and policies to reduce the burden of NCD risk factors should be implemented if proven effective in similar settings.

Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25–74 years old citizens in Yangon Region, Myanmar: a cross sectional study

“…As compared with national data from 2009 (30%) [14, 15], the prevalence of hypertension is higher in both urban and rural Yangon. Studies have reported that salt-intake in South-East Asian countries is high [42], and because salt and mono-sodium glutamate (MSG) intake are associated with high blood pressure [43–45], they could be a contributor to high prevalence of hypertension in Myanmar.…”

“…Similar to other figures from the region [34], daily smoking prevalence in males outnumber females, more than ten times in urban area and about three and a half time in rural area. The overall prevalence of smokeless tobacco (28.0% for urban areas and 32.5% for rural areas) is comparative to the 2009 nationwide figure (30.0%) [14, 15]. The results indicate that in both urban and rural areas, tobacco consumption among males stands as a public health problem in Myanmar, although more than 90% of smokers consumed less than ten tobacco units (cigarettes or cheroots) daily Tobacco use is a socio-culture entertaining habit in this society [35].…”

“…The global leading NCD risk factors ranked according to their contribution to global death, are high blood pressure, tobacco use, high blood glucose, low physical activity, overweight and obesity, high blood cholesterol and alcohol use [13]. Based on a national STEPwise approach to NCD risk factor surveillance (STEPs) survey in Myanmar in 2009, the prevalence of daily smokers, current alcohol drinkers, low fruit and vegetable intake, low physical activity, overweight and obesity, and hypertension were 17, 13, 90, 13, 25 and 30%, respectively [14, 15]. …”

Hypertension Trends in Asia

“…[13] In Asia, prevalence of hypertension between the years 2008 and 2015 has been largely similar to the global average. Nationwide surveys have found prevalence to be 48.3% in Brunei, [14] 15.3% in Cambodia, [15] 33.4% in Indonesia, [16] 24.9% among men and 20% among women in Laos, [17] 35.3% in Malaysia, [18] 31% in males and 29% in females in Myanmar, [19] 23.5% in Singapore, [20] 19.1% in Thailand, [21] and 25.1% in Vietnam. [22] Trends in hypertension prevalence have not been consistent across SEA nations.…”

“…Awareness of prior diagnosis of hypertension also varies widely between the Southeast Asian nations. Awareness of hypertension is highest in Singapore at 73.7%, [20] followed by Thailand and Vietnam at 48.4%, [21,22] and lowest in Myanmar at 27.8%, [19] while awareness to hypertension has increased in Asian countries such as Indonesia, Malaysia, Myanmar, and Singapore levels still fall far short of awareness levels in Western nations such as the US (81%), Canada (83%), and England (65%). [28]…”