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Hypertension: adherence to treatment in rural Bangladesh--findings from a population-based study
Masuma Akter Khanam1, Wietze Lindeboom2, Tracey Lynn Perez Koehlmoos2
1Centre for Control of Chronic Diseases in Bangladesh, icddr,b, Mohakali, Bangladesh; Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
Insights
Poor adherence to hypertension treatment is common in rural Bangladesh, especially when diagnosed by unqualified providers. Health programs must emphasize continuous medication for men, young people, and those with less education.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Health Services Research
Background:
- Poor adherence to antihypertensive treatment is a primary reason for uncontrolled hypertension and a significant, often overlooked, cardiovascular risk factor.
- No prior studies in Bangladesh have investigated adherence to antihypertensive medication or the characteristics of non-adherent patients.
Purpose of the Study:
- To describe the prevalence of hypertension and identify factors influencing treatment adherence among hypertensive individuals in rural Bangladesh.
Main Methods:
- A cross-sectional study was conducted on 29,960 individuals aged 25 and above in three rural demographic surveillance sites in Bangladesh.
- Data collection included information on diagnostic providers, initial treatment, and current treatment status.
- Non-adherence was defined as discontinuation of medication at the time of the interview.
Main Results:
- The prevalence of hypertension was 13.67%. Only 53.5% of hypertension cases were diagnosed by qualified providers.
- 26% of patients who initiated treatment discontinued their medication. Factors associated with non-adherence included younger age, male sex, lower education, lower wealth quintile, and diagnosis by unqualified providers.
- Men (OR 1.74) and patients treated by unqualified providers (OR 1.52) showed higher non-adherence rates, while older age, higher education, greater wealth, and cardiovascular comorbidity were associated with better adherence.
Conclusions:
- Village doctors diagnose a substantial portion of hypertension cases (40%), but their treatments are linked to higher non-adherence rates.
- Further research into the hypertension care practices of village doctors is warranted.
- Interventions should target men, younger individuals, and those with lower educational attainment, emphasizing the critical importance of continuous antihypertensive medication adherence.
Background:
Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh.
Objective:
This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh.
Design:
The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center for Diarrheal Disease Research, Bangladesh (icddr,b): Matlab, Abhoynagar, and Mirsarai. Data was collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment.
Results:
The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48-2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31-1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0.79, CI 0.64-0.97).
Conclusions:
Although village doctors diagnose 40% of hypertension, their treatments are associated with a higher rate of non-adherence to medication. The hypertension care practices of the village doctors should be explored by additional research. More emphasis should be placed on men, young people, and people with low education. Health programs focused on education regarding the importance of taking continuous antihypertensive medication is now of utmost importance.
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