Tackling the primary care access challenge in South Asia

Sengupta, Amit; Zaidi, Shehla; Sundararaman, T; Onta, Sharad; Weerasinghe, Manuj C.

doi:10.1136/bmj.k4878

Cited by 25 publications

(15 citation statements)

References 16 publications

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“…Previous studies found that awareness about high blood pressure and use of antihypertensive medication is low in this region [24, 25, 32]. Also, the health systems are not well-prepared to manage the large burden of NDCs [33, 34]. Therefore, the policy makers should focus mainly on reduction of BMI at population level as one of the most important primary prevention strategies.…”

Section: Discussionmentioning

confidence: 99%

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

et al. 2019

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BackgroundAlthough there has been a well-established association between overweight-obesity and hypertension, whether such associations are heterogeneous for South Asian populations, or for different socioeconomic groups is not well-known. We explored the associations of overweight and obesity using South Asian cut-offs with hypertension, and also examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups.MethodsWe analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal, with a total of 821,040 men and women. Hypertension was defined by 2017 ACC/AHA cut-offs and by Joint National Committee 7 (JNC7) cut-offs for measured blood pressure and overweight and obesity were defined by measured height and weight. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI.ResultsThe prevalence of hypertension using JNC7 cut-offs among participants increased by age in all three countries. The prevalence ranged from 17.4% in 35–44 years to 34.9% in ≥55 years in Bangladesh, from 4.6% in 18–24 years to 28.6% in 45–54 years in India, and from 3.8% in 18–24 years to 39.2% in ≥55 years in Nepal. Men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity using both WHO and South Asian cut-offs were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65–1.93), 1.59 (95% CI: 1.58–1.61), and 2.03 (95% CI: 1.90–2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household’s wealth index.ConclusionsOur study shows that the association of BMI with hypertension is stronger for South Asian populations at even lower cut-offs points for overweight and obesity. Therefore, public health measures to reduce population-level reduction in BMI in all population groups would also help in lowering the burden of hypertension.

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Section: Discussionmentioning

confidence: 99%

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

et al. 2019

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“…22,23,30 Also, the health systems are not well-prepared to manage the large burden of NDCs. 31,32 Therefore, the policy makers should focus mainly on reduction of BMI at population level as one of the most important primary prevention strategies.…”

Section: Discussionmentioning

confidence: 99%

Association between body mass index (BMI) and hypertension in South Asian population: Evidence from Demographic and Health Survey

Hossain

Shawon

Adhikary

et al. 2019

Preprint

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1Although there has been a well-established association between adiposity and 2 hypertension, whether such associations are heterogeneous for South Asian 3 populations or for different socioeconomic groups is not well-known. We analysed 4 the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and 5Nepal to estimate the age-specific prevalence of hypertension and the association of 6 body mass index (BMI) with hypertension. We used multiple logistic regressions to 7 estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension 8 for overweight and obesity as well as for each 5-unit increase in BMI. The overall 9 prevalence for hypertension among participants aged 35-44 years were 17.4%, 20%, 10 and 22.5% for Bangladesh, India, and Nepal, respectively. For all age groups, men 11 were more likely to be hypertensive than women in India and Nepal, but not in 12Bangladesh. Overweight and obesity were associated with higher odds of 13 hypertension in all countries. For each 5 kg/m 2 increase in BMI, the ORs for 14 hypertension were 1.79 (95% CI: 1.65-1.93), 1.59 (95% CI: 1.58-1.61), and 2.03 15 (95% CI: 1.90-2.16) in Bangladesh, India, and Nepal, respectively. The associations 16 between BMI and hypertension were consistent across various subgroups defined by 17 sex, age, urbanicity, educational attainment and household's wealth index. Our study 18shows that the association of BMI with hypertension is stronger for South Asian 19 populations, and public health measures to reduce population-level reduction in BMI 20 would also help in lowering the burden of hypertension. population level. [9][10][11] In addition, looking at the association in subgroups defined by 15 sex, age, urbanicity, and socioeconomic status is crucial to understand how 16 consistent the association between BMI and hypertension is across different groups. 17There is no study, to the best of our knowledge, which looked at the association of 18 BMI with hypertension across different groups in nationally-representative samples 19from South Asian countries. 20In this study, we aim to examine the age-specific prevalence of hypertension in three 21 South Asian countries, namely Bangladesh, India, and Nepal. We also systematically 22 assess the association between overweight-obesity and hypertension using different 23 cut-offs, and how the association between BMI and hypertension varies across a 24wide variety of subgroups of population. 25 METHODS 1 Study design and data sources 2This study is based on three South Asian countries, namely Bangladesh, India, and 3Nepal. Recent Demographic and Health Survey (DHS) data for these countries had 4 information on both blood pressure and anthropometry for adult population. 5 DHS are periodical nationally-representative household surveys which provide data 6 for a wide range of variables on population, health, and nutrition. These surveys 7 usually are conducted by a national implementing agency with technical assistances 8 provided by the DHS program. Surveys are based on tw...

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“…The health system especially at the primary level in the region has inadequate public investment with scarce health care workforce and excessive out of pocket expenditure. 7 Over the past decade, the health system has shifted more towards medical-centric based care on the insurance mode for service provision from private sector. 8 The ignorance to public health is a major cause for high burden of morbidity and mortality, especially due to communicable diseases.…”

Section: Introductionmentioning

confidence: 99%

Public health preparedness and responses to the coronavirus disease 2019 (COVID-19) pandemic in South Asia: a situation and policy analysis

Sarkar

Liu

Jin

et al. 2020

Global Health Journal

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Tackling the primary care access challenge in South Asia

Abstract: Increased public financing for primary care and medical education as well as regulation of private services are vital to tackle the primary care crisis in South Asia, argue Amit Sengupta and colleagues

Cited by 25 publications

References 16 publications

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

Association between body mass index (BMI) and hypertension in South Asian population: Evidence from Demographic and Health Survey

Public health preparedness and responses to the coronavirus disease 2019 (COVID-19) pandemic in South Asia: a situation and policy analysis

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