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OBJECTIVE: For over a decade, the prevalence of asthma remained unchanged at around 7% in Bangladesh. Although asthma causes significant morbidity among both children and adults, updates on epidemiological data are limited on the prevalence in Bangladesh. This study attempted to determine the prevalence of asthma, and its modifiable and non-modifiable lifestyle predictors in a rural population of Bangladesh. METHOD: This study was part of a cross-sectional study that applied the WHO Package of Essential Noncommunicable Disease Interventions via census in a rural area of Bangladesh, where self-reported data on asthma were recorded. Data on anthropometric measurement, sociodemographic characteristics and behavioural risk factors were collected following the standard protocol described in the WHO STEP-wise approach to surveillance (STEPS) questionnaire. Analysis included descriptive statistics to assess the prevalence of asthma and its risk factors, and binary logistic regression to determine contributing factors. RESULT: The overall prevalence of asthma was 4.2%. Asthma was predominant among people above 60 years (8.4%). Higher asthma was noted among males (4.6%), self-employed (5.1%), with a family history of asthma (9.1%), with comorbidities besides asthma (7.8%) and underweight (6.0%) compared with their counterparts. The OR of having asthma was 1.89, 1.93, 1.32, 1.50, 2.60, 0.67, 0.67 and 0.78 if a respondent was 45 years old or more, married, underweight, ever smoker, with a family history of asthma, housewife, employed and consumed red meat, respectively, while considering all other variables constant, compared with their counterparts. CONCLUSION: The study emphasised asthma to be a public health concern in Bangladesh, although it seems to have decreased over the last decade. Among others, red meat intake and nutritional status were strongly associated with asthma, and the linkage among these is still a grey area that needs further exploration.
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Asma , Magreza , Adulto , Masculino , Criança , Humanos , Pessoa de Meia-Idade , Autorrelato , Estudos Transversais , Magreza/epidemiologia , Fatores Socioeconômicos , Prevalência , Bangladesh/epidemiologia , População Rural , Fatores de Risco , Asma/epidemiologia , Organização Mundial da SaúdeRESUMO
AIMS/INTRODUCTION: Our objective was to estimate the prevalence of hyperglycemia at baseline, and identify its predictors among community clinic (CC) users from a selected rural area of Bangladesh. MATERIALS AND METHODS: This cross-sectional study partly used the baseline data of implementation research in which a total of 11,244 adults visited the CC, and their blood glucose, blood pressure and anthropometry were evaluated according to 'Action 2' of the World Health Organization (WHO) Package of Essential Noncommunicable Disease Interventions (PEN) protocol 1. Of these, 11,144 had complete information on demography, chronic diseases and their risk factors, which were collected during the implementation of 'Action 1' of WHO PEN protocol 1 at the household level. Hyperglycemia, prediabetes (PreD) and type 2 diabetes were diagnosed using the WHO criteria. RESULTS: Using WHO PEN protocol 1, the estimated baseline prevalence was 12.5% for hyperglycemia, 3.4% for PreD and 9.2% for type 2 diabetes, and was more prevalent among men compared with women. PreD and type 2 diabetes had significantly higher odds ratio (OR >1) of having common risk factors as follows: age ≥40 years (PreD, P < 0.001; type 2 diabetes, P < 0.001), generalized obesity (PreD, P < 0.001; type 2 diabetes, P = 0.005) and hypertension (PreD, P < 0.000; type 2 diabetes, P < 0.001). Furthermore, participants with a family history of diabetes appeared to be a significant predictor of type 2 diabetes (P < 0.001), but not for PreD (P = 0.303). CONCLUSIONS: Hyperglycemia, preD and type 2 diabetes showed a comparatively high prevalence among the CC users of the selected rural area. Obesity and hypertension are the key modifiable risk factors that should be reduced using a CC-centered risk reduction strategy.
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Diabetes Mellitus Tipo 2 , Hiperglicemia , Hipertensão , Estado Pré-Diabético , Adulto , Masculino , Humanos , Feminino , Diabetes Mellitus Tipo 2/epidemiologia , Estudos Transversais , Prevalência , Bangladesh/epidemiologia , Hiperglicemia/epidemiologia , Fatores de Risco , Estado Pré-Diabético/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Hipertensão/epidemiologia , População RuralRESUMO
Chronic illness among health professionals (HPs) is rarely reported due to idealistic views of their role in treating and fighting diseases. This creates a gap mainly due to a lack of research on them, resulting in insufficient data at the national level, especially in Bangladesh. In this circumstance, we analyzed the data of senior staff nurses (SSNs) and para-health professionals (PHPs) to assess their healthy bahaviours, treatment, and control status of hypertension (HTN) and diabetes mellitus (DM). It was a cross-sectional study that used the census as a sampling technique. The study site was a medical university in Bangladesh located in the capital city of Dhaka. A total of 1942 government-employed health professionals working at Upazila Health Complexes participated and completed both the questionnaire and physical measurements with a response rate of 100%. Among them, 1912 (SSNs = 938 and PHPs = 974) remained for analysis after data cleaning. The prevalence of self-screening (HTN, 97.4%; DM, 81.5%), diagnosis (HTN, 20.5%; DM,15.3%), treatment (HTN, 88.7%; DM, 83.7%) and control status (HTN, 63.7%; DM, 31%) did not reveal any notable differences between SSNs and PHPs. Most of the HPs with HTN and DM failed to maintain adequate physical activity (87.4%; 86.2%), fruit and/or vegetable intake (60.7%; 59%), and healthy body weight (60.5%; 54%) respectively. Only avoidance of smoking showed a significant association with the professional categories in both hypertensives (AOR, 7.98; p = 0.001) and diabetics (AOR, 14.78; p<0.001). Although working in the field of primary health care and involved in assisting patient management, control of HTN, DM and their risk factors is not satisfactory among the SSNs and PHPs of Bangladesh. Future interventions should focus on smoking, diet, and physical activity to reduce HTN and DM in the HPs of Bangladesh.
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BACKGROUND: We aimed to determine the prevalence of type 2 diabetes (T2D) and pre-diabetes (pre-DM) among patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in Bangladesh. We also examined the association between type of TB and hyperglycaemia as an adjunct to the primary objective. MATERIALS AND METHODS: This cross-sectional analytical study recruited 350 TB patients (175 PTB and 175 EPTB) from two tertiary care hospitals specialized for TB treatment. Oral glucose tolerance tests and fasting plasma glucose measurements were carried out for unknown glycaemic status and those with previously known diabetes, respectively. RESULTS: Overall, the prevalence of T2D and pre-DM was 19.1% (new 85.1%, old 14.9%) and 34.3%, respectively. Although the risk factors were highly prevalent among the patients with EPTB, a higher proportion of T2D (26.3%) and pre-DM (34.3%) was detected among the patients with PTB. The proportion of impaired fasting glucose was low in both groups, but a high trend of impaired glucose tolerance was observed across the groups, with a higher proportion (35.4%) in the PTB group. Both pre-DM and T2D showed significantly higher odds (pre-DM, AOR: 4.488; CI: 2.531-7.958; p < .001 and T2D, AOR: 4.280; CI: 2.305-7.946; p < .001) for having PTB. CONCLUSION: The prevalence of T2D and pre-DM was higher among the patients with PTB, and it (PTB) appeared as a predictor of hyperglycaemia. It indicates the primary intervention should target the patients with PTB to get the maximum benefit of screening to reduce the number of risk factors, disease burden and subsequent complications.
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Diabetes Mellitus Tipo 2 , Hiperglicemia , Estado Pré-Diabético , Tuberculose Pulmonar , Tuberculose , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Estado Pré-Diabético/epidemiologia , Prevalência , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose Pulmonar/epidemiologiaRESUMO
Diabetes and chronic kidney disease (CKD) are a major public health burden in low- and middle-income countries. This study aimed to explore factors associated with CKD in patients with type 2 diabetes (T2D) in Bangladesh. A cross-sectional study was conducted among 315 adults with T2D presenting at the outpatient department of Bangladesh Institute of Health Sciences (BIHS) hospital between July 2013 to December 2013. CKD was diagnosed based on the estimated glomerular filtration rate using the 'Modification of Diet in Renal Disease' equations and the presence of albuminuria estimated by the albumin-to-creatinine ratio. Multivariate logistic regression analysis was used to determine the factors associated with CKD. The overall prevalence of CKD among patients with T2D was 21.3%. In the unadjusted model, factors associated with CKD included age 40-49 years (OR: 5.7, 95% CI: 1.3-25.4), age 50-59 years (7.0, 1.6-39), age ≥60 years (7.6, 1.7-34), being female (2.2, 1.2-3.8), being hypertensive (1.9, 1.1-3.5), and household income between 10,001 and 20,000 Bangladeshi taka, BDT (2.9, 1.0-8.2) compared with income ≤10,000 BDT. However, after adjustment of other covariates, only the duration of hypertension and household income (10,001-20,000 BDT) remained statistically significant. There is a need to implement policies and programs for early detection and management of hypertension and CKD in T2D patients in Bangladesh.
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Diabetes Mellitus Tipo 2 , Hipertensão , Insuficiência Renal Crônica , Adulto , Albuminúria , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/epidemiologia , Fatores de RiscoRESUMO
This cross-sectional study estimated the prevalence of high blood pressure (BP) and examined its predictors at baseline following protocol 1 (actions 1 and 2) of World Health Organization (WHO) Package of Essential Noncommunicable Disease (PEN) Interventions in a selected rural area of Bangladesh. A total of 11 145 adults (both sex and age ≥ 18 years) completed both the questionnaire and clinical measurements at the household and community clinics, respectively. We defined high BP as systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg, prehypertension (pre-HTN) as systolic BP 120-139 mmHg or diastolic BP 80-89 mmHg, and hypertension (HTN) as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg and/or anti-hypertensive drug intake for the raised BP. The prevalence of high BP was 51.2% (pre-HTN, 25.3%; HTN, 25.9%). Among them, the proportion of pre-HTN was higher among men (28.7%) while HTN was higher among women (27.4%). Other than fast food intake (pre-HTN, OR: 1.110, P = .063) and women sex (HTN, OR: 1.236, P < .001), the pre-HTN and HTN had higher odds for having same predictors as follows: age ≥ 40 years, family history of HTN, physical inactivity, central obesity, generalized obesity, and diabetes. In conclusion, the application of WHO PEN protocol 1 detected one-fourth of the rural adult population had pre-HTN and HTN respectively, and the common significant predictors of those were the age, family history of HTN, physical inactivity, generalized obesity, and diabetes.
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Hipertensão , Doenças não Transmissíveis , Adolescente , Adulto , Bangladesh/epidemiologia , Pressão Sanguínea , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Prevalência , Fatores de Risco , Organização Mundial da SaúdeRESUMO
INTRODUCTION: The burden of malnutrition is widely evaluated in Bangladesh in different contexts. However, most of them determine the influence of sociodemographic factors, which have limited scope for modification and design intervention. This study attempted to determine the prevalence of underweight, overweight and obesity and their modifiable lifestyle predictors in a rural population of Bangladesh. METHODS: This study was part of a cross-sectional study that applied the WHO Package of Essential Noncommunicable Disease Interventions in a rural area of Bangladesh to assess the burden of diabetes, hypertension and their associated risk factors. Census was used as the sampling technique. Anthropometric measurement and data on sociodemographic characteristics and behavioural risk factors were collected following the standard protocol described in the WHO STEP-wise approach. Analysis included means of continuous variables and multinomial regression of factors. RESULTS: The mean body mass index of the study population was 21.9 kg/m2. About 20.9% were underweight, 16.4% were overweight and 3.5% were obese. Underweight was most predominant among people above 60 years, while overweight and obesity were predominant among people between 31 and 40 years. Higher overweight and obesity were noted among women. Employment, consumption of added salt and inactivity increased the odds of being underweight by 0.32, 0.33 and 0.14, respectively. On the other hand, the odds of being overweight or obese increased by 0.58, 0.55, 0.78, 0.21 and 0.25 if a respondent was female, literate, married, housewife and consumed red meat, and decreased by 0.38 and 0.18 if a respondent consumed added salt and inadequate amounts of fruits and vegetables, respectively. Consumption of added salt decreases the odds of being overweight or obese by 0.37. CONCLUSION: The study emphasised malnutrition to be a public health concern in spite of the dynamic sociodemographic scenario. Specific health messages for targeted population may help improve the nutritional status. Findings from further explorations may support policies and programmes in the future.
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Desnutrição , Estado Nutricional , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Feminino , Humanos , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , População Rural , Magreza/epidemiologiaRESUMO
OBJECTIVE: To determine the prevalence of non-communicable disease (NCD) risk factors among nurses and para-health professionals (PHPs) working at primary healthcare centres in Bangladesh. In addition to this, we also investigated the association of these risk factors with the categories of health professions. DESIGN: Cross-sectional study and the sampling technique was a census. SETTING: The study site was a medical university of Bangladesh where the study population was recruited by NCD Control Programme of Directorate General of Health Services to participate in a 3-day training session from November 2017 to May 2018. PARTICIPANTS: A total of 1942 government-employed senior staff nurses (SSNs) and PHPs working at Upazila Health Complexes. PRIMARY AND SECONDARY OUTCOME MEASURES: The data were collected using a modified STEPwise approach to NCD risk factors surveillance questionnaire of the World Health Organisation (V.3.2). The prevalence of NCD risk factors was presented descriptively and the χ² test was used to determine the association between NCD risk factors distribution and categories of health professions. RESULTS: The mean age of the participants was 37.6 years (SD 9.5) and most of them (87.6%) had a diploma in their respective fields. Physical inactivity (86.9%), inadequate fruits and/vegetable intake (56.3%) and added salt intake (35.6%) were the most prevalent behavioural risk factors. The prevalence of central obesity, overweight, raised blood glucose and raised BP were 83.5%, 42.6%, 19.2% and 12.8% respectively. Overall, the NCD risk factors prevalence was higher among PHPs compared with SSNs. A highly significant association (p<0.001) was found between risk factors and the categories of health professions for tobacco use, alcohol intake, added salt intake and physical inactivity. CONCLUSION: High NCD risk factors prevalence and its significant association with SSNs and PHPs demand an appropriate risk-reduction strategy to minimise the possibility of chronic illness among them.
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Hipertensão , Doenças não Transmissíveis , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Humanos , Doenças não Transmissíveis/epidemiologia , Prevalência , Atenção Primária à Saúde , Fatores de RiscoRESUMO
AIMS/INTRODUCTION: We aimed to assess the health-related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh. MATERIALS AND METHODS: This nationwide cross-sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade-off value set. The predictors were determined using multinomial logistic regression analysis. RESULTS: The mean EQ-5D-5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as "average" HRQoL. Overall, 64% of respondents had a "problem" at least in one of the dimensions of the EQ-5D-5L, and the burden of reported "problems" was higher among women (70%). Among the five dimensions, the highest reported "problem" was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged <30 years) showed a higher burden of anxiety/depression (95%) compared with the rest of the population. The specific predictors of average/good HRQoL (odds ratio >1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years. CONCLUSIONS: The majority of Bangladesh's type 2 diabetes patients had an "average" HRQoL based on the EQ-5D-5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes.
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Diabetes Mellitus Tipo 2/epidemiologia , Qualidade de Vida , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Primarily, we assessed the distribution of cardiovascular disease (CVD) risk factors among school children living in urban and rural areas of Bangladesh. In addition to this, we sought the association between place of residence and modifiable CVD risk factors among them. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study was conducted among 854 school children (aged 12-18 years) of Bangladesh. Ten public high schools (five from Dhaka and five from Sirajgonj district) were selected randomly and subjects from those were recruited conveniently. To link the family milieu of CVD risk factors, a parent of each children was also interviewed. PRIMARY AND SECONDARY OUTCOME MEASURES: Distribution of CVD risk factors was measured using descriptive statistics as appropriate. Again, a saturated model of binary logistic regression was used to seek the association between place of residence and modifiable CVD risk factors. RESULTS: Mean age of the school children was 14.6±1.1 years and more than half (57.6%) were boys. Overall, 4.4% were currently smoker (urban-3.5%, rural-5.2%) with a strong family history of smoking (42.2%). Similar proportion of school children were identified as overweight (total 9.8%, urban 14.7%, rural 5%) and obese (total 9.8%, urban 16.8%, rural 2.8%) with notable urban-rural difference. More than three-fourth (80%) of them were physically inactive with no urban-rural variation. Only 2.4% consumed recommended fruits and/ or vegetables (urban-3.1%, rural-1.7%). In the adjusted model, place of residence had higher odds for having several modifiable CVD risk factors: current smoking (OR: 1.807, CI 0.872 to 3.744), inadequate fruits and vegetables intake (OR: 1.094, CI 0.631 to 1.895), physical inactivity (OR: 1.082, CI 0.751 to 1.558), overweight (OR: 3.812, CI 2.245 to 6.470) and obesity (OR: 7.449, CI 3.947 to 14.057). CONCLUSIONS: Both urban and rural school children of Bangladesh had poor CVD risk factors profile that demands further nation-wide large scale study to clarify the current findings more precisely.
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Doenças Cardiovasculares , Adolescente , Bangladesh/epidemiologia , Doenças Cardiovasculares/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , População Rural , Instituições Acadêmicas , População UrbanaRESUMO
OBJECTIVE: To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh. PRIMARY AND SECONDARY OUTCOME MEASURES: Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately. RESULTS: Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy. CONCLUSION: A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.
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Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh , Estudos Transversais , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de RiscoRESUMO
Background: Frontline doctors are the most vulnerable and high-risk population to get the novel coronavirus disease 2019 (COVID-19) infection. Hence, we aimed to evaluate the anxiety, depression, sleep disturbance and fear of COVID-19 among frontline doctors of Bangladesh during the pandemic, and the associated factors for these psychological symptoms. Methods: In total, 370 frontline doctors who were involved in the treatment of suspected or confirmed COVID-19 patients during the pandemic took part in an online cross-sectional study. Recruitment was completed using convenience sampling and the data were collected after the start of community transmission of COVID-19 in the country. Anxiety and depression, sleep disturbance, and fear of COVID-19 were assessed by the Patient Health Questionnaire-4, two-item version of the Sleep Condition Indicator, and the Fear of Coronavirus-19 scale, respectively. Socio-demographic information, health service-related information, co-morbidity, and smoking history were collected for evaluating risk factors. The proportion of psychological symptoms were presented using descriptive statistics and the associated factors were identified using multinomial logistic regression analysis. Results: Of the doctors, 36.5% had anxiety, 38.4% had depression, 18.6% had insomnia, and 31.9% had fear of COVID-19. In multinomial logistic regression, inadequate resources in the workplace were found as the single most significant predictor for all psychological outcomes: anxiety and/or depression (severe, OR 3.0, p=0.01; moderate, OR 5.3, p=0.000; mild, OR 2.3, p=0.003), sleep disturbance (moderate, OR 1.9, p=0.02), and fear of COVID-19 (severe, OR 1.9, p=0.03; moderate, OR 1.8, p=0.03). Conclusions: The study demonstrated a high burden of psychological symptoms among frontline doctors of Bangladesh during the COVID-19 pandemic situation. Inadequate resources are contributing to the poor mental health of Bangladeshi doctors. The supply of sufficient resources in workplaces and mental health counseling may help to mitigate the burden of the psychological symptoms identified among the respondents..
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COVID-19/psicologia , Pandemias , Médicos/psicologia , Adulto , Ansiedade/epidemiologia , Bangladesh/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: There is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting. METHODS: This cross-sectional study recruited 265 postmenopausal women aged 40-70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the 'noncommunicable disease risk factors survey Bangladesh 2010'. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis. RESULTS: Overall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (ß = 0.606, p = 0.043), waist-hip ratio (ß = 0.165, p = 0.003), 2-h plasma glucose (ß = 0.118, p = 0.04), total cholesterol (ß = 1.082, p < 0.001), low-density lipoprotein cholesterol (ß = -1.044, p < 0.001), and metabolic equivalent of tasks (ß = -0.171, p = 0.003) showed a significant association with AIP. CONCLUSION: High AIP and its significant association with CVD risk factors demand proper lifestyle intervention for postmenopausal women of Bangladesh.
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Doenças Cardiovasculares/sangue , Pós-Menopausa , Adulto , Idoso , Bangladesh/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Prevention of cardiovascular disease (CVD) among postmenopausal women with limited resource is a great challenge for a country like Bangladesh. OBJECTIVES: This study aimed to evaluate the level of agreement among different risk prediction tools to find out the cost-effective and suitable one that can be applied in a low-resource setting. METHODS: This was a cross-sectional study conducted from February through December 2016 among 265 postmenopausal women of 40-70 years age. Data were collected from the outpatient department of a rural health-care center situated in the village Karamtola of Gazipur district, Bangladesh. The CVD risk was estimated using the World Health Organization/International Society of Hypertension (WHO/ISH) "with" and "without" cholesterol risk charts and the Framingham Risk Score (FRS). Concordance among the tools was evaluated using Cohen's kappa (κ), prevalence-adjusted bias-adjusted kappa (PABAK), and first-order agreement coefficient (AC1). RESULTS: The "without" cholesterol version showed 79% concordance against the "with" cholesterol and 75.4% concordance against the FRS. In between the WHO/ISH risk charts, slight-to-substantial levels of agreement (κ = 0.14, PABAK = 0.58, and AC1 = 0.72; P = 0.023) were observed. With FRS, the "without" cholesterol version showed higher agreement (κ = 0.38, fair; PABAK = 0.50, moderate; and AC1 = 0.60, moderate; P = 0.000) compared to "with" cholesterol version (κ = 0.13, slight; PABAK = 0.30, fair; and AC1 = 0.44, moderate; P = 0.013). Predictability of CVD risk positive (≥10%) cases was similar for both the versions of WHO/ISH risk charts. CONCLUSION: In a low-resource setting, the "without" cholesterol version of WHO/ISH risk chart is a good option to detect and target the population with high CVD risk.
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Hipertensão/etiologia , Adulto , Idoso , Bangladesh/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , População Rural/estatística & dados numéricos , Uso de Tabaco/efeitos adversos , Uso de Tabaco/epidemiologiaRESUMO
Background and objectives: Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. Materials and Methods: This cross-sectional study recruited 265 postmenopausal women of 40-70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP ≥ 140 or DBP ≥ 90 mmHg), and the 2017 ACC/AHA guidelines (SBP ≥ 130 mmHg, or DBP ≥ 80 mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen's Kappa (κ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). Results: The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis & Koch's approach detected highest agreement for ISH (κ = 0.74, substantial; PABAK = 0.76, substantial; AC1 = 0.84, excellent; p < 0.001) and pre-hypertension/elevated blood pressure (κ= 0.12, slight; PABAK = 0.42, moderate; AC1 = 0.83, excellent; p < 0.001). Conclusions: The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely.
Assuntos
Hipertensão/diagnóstico , Pós-Menopausa/fisiologia , Adulto , Idoso , Bangladesh/epidemiologia , Pressão Sanguínea , Determinação da Pressão Arterial/métodos , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricosRESUMO
OBJECTIVES: The role of physical inactivity in relation to cardiovascular disease (CVD) among postmenopausal women is understudied. The main objective of this study was to measure the physical activity levels (PALs) and evaluate its relation to other CVD risk factors among postmenopausal rural women of Bangladesh. METHODS: A cross-sectional study was conducted among 265 postmenopausal women aged 40-70 years who visited the outpatient department of a primary health-care center situated in the village Karamtola of Gazipur district. A pretested modified questionnaire of STEP-wise approach to Surveillance (STEPS) of noncommunicable disease risk factors was used to collect data on sociodemographic and lifestyle factors. PAL was determined by the Estimated Energy Requirement (EER) equation of the Dietary Reference Intakes (DRIs) Committee, and association with CVD risk factors was examined by Spearman's rank correlation. RESULTS: More than half (58.1%) of the postmenopausal women were identified as sedentary with high prevalence of central obesity (73.2%) among them. CVD risk factors including age (r = -0.228, p < 0.01), age at menopause (r = -0.129, p < 0.05), duration of menopause (r = -0.183, p < 0.05), 2-h plasma glucose (r = -0.148, p < 0.05), total cholesterol (r = -0.138, p < 0.05), low-density lipoprotein cholesterol (r = -0.122, p < 0.05), and triglyceride (r = -0.168, p < 0.01) showed a significant as well as inverse association with Metabolic Equivalent of Task (MET) of physical activity. CONCLUSION: Low PAL and significant inverse correlation with various CVD risk factors demand interventions to maintain higher PAL among postmenopausal women of Bangladesh.