Quantifying population level hypertension care cascades in India: a cross-sectional analysis of risk factors and disease linkages.

BACKGROUND: Hypertension is associated with higher morbidity and mortality burden, and is reported to pose severe repercussions on those above the age of 60 years. Despite the growing concern, empirical evidence providing nationally representative estimates of hypertension care cascades for the elderly population are inadequate in India. Therefore, the present study aims to quantify the magnitude of hypertension care cascades, identify the co-morbidities attributed to hypertension and recognize lifestyle modifications to reduce the instances of uncontrolled blood pressure among the elderly population in India. METHOD: This study employed data on 28,109 elderly individuals from the Longitudinal Ageing Study in India, 2017-18. Descriptive and multivariable analyses were performed to identify the burden and correlates of hypertension and uncontrolled blood pressure levels. Population Attributable Risk was computed to identify deteriorating health implications and recognize viable solutions to improve the situation. RESULTS: The findings suggest that elderly experiences loss at all stages of hypertension care, namely, at the level of measured hypertension (72.5%), diagnosis/awareness (57.3%), treatment (50.5%), and control (27.5%). The highest dip was observed at the level of blood pressure control. The findings hint towards the linkages between socio-economic, demographic, and lifestyle factors with hypertension and uncontrolled blood pressure levels. Caste, religion, living arrangement, MPCE quintile, residence, family history of hypertension, working status, and alcohol consumption were the significant predictors of uncontrolled hypertension. The findings quantified the proportion of diseased cases attributed to hypertension, and highlighted essential contributors of overall and uncontrolled hypertension. CONCLUSIONS: There is an urgent need to improve access to cost-effective anti-hypertensive prescriptions to curtail the increasing burden of uncontrolled blood pressure and some other co-morbid diseases. Thus, if apprehended cautiously, findings from this study can serve to design practical approaches aimed at control, prevention, and management of hypertension among the elderly population of India.

The burden of hypertension and unmet need for hypertension care among men aged 15-54 years: a population-based cross-sectional study in India.

Hypertension is one of the primary causes of morbidity and premature mortality among the working-age population in India. This study evaluated the burden of hypertension and unmet need for hypertension care among working-age men aged 15-54 years in India using data from the fourth round of the National Family Health Survey (NFHS-4, 2015-16). An individual was recognized as hypertensive if his blood pressure was over 140/90 mmHg or if he was consuming anti-hypertensive medication to lower his blood pressue. The study design was based on the Rule of Halves framework. Hypertensive cases were segmented into five analytical levels: (1) total, (2) screened, (3) diagnosed, (4) treated and (5) controlled cases. The prevalence of hypertension was 16% (n=16,254) among the men aged 15-54 years. Of the total hypertensive individuals, 63.2% (10,314) were screened, 21.5% (3428) were diagnosed, 12.6% (1862) were treated and only 6.1% (905) had controlled blood pressure. Of the screened individuals, 66.8% (6886) had never been diagnosed, 45.7% (1566) of those diagnosed had not receive treatment and 51.4% (957) of those treated still had uncontrolled blood pressure. The analyses revealed that 36.5% (5940) of hypertensive individuals were lost at the screening stage. The results demonstrate that there is a significant burden of hypertension and unmet need for hypertension care among men aged 15-54 in India. There is an urgent need to develop suitable strategies and programmes to manage this rising burden of hypertension among men, and reduce losses in the hypertension care continuum.

Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study.

BACKGROUND: India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India? METHODS: The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015-16 in India. The analysis was limited to 107,016 women aged 15-49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC. RESULTS: Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion. CONCLUSION: The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child.

Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India.

Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.