Expanding access to healthcare in South Asia

Zaidi, Shehla; Saligram, Prasanna; Ahmed, Syed Masud; Sonderp, Egbert; Sheikh, Kabir

doi:10.1136/bmj.j1645

Cited by 36 publications

(41 citation statements)

References 20 publications

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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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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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“…Although there are opposing views on the optimal role of the private healthcare sector, it is clear that global constraints on government investment in public services are resulting in private healthcare providers (HCPs) playing a greater role in health service delivery to rich and poor populations 1–4. Private HCPs are used substantially more than public HCPs in many low-income and middle-income countries (LMIC).…”

Section: Introductionmentioning

confidence: 99%

Invisible medicine sellers and their use of antibiotics: a qualitative study in Cambodia

et al. 2019

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BackgroundGlobal attention to antimicrobial resistance has increased interest in tackling the widespread inappropriate dispensing of antibiotics by informal, for-profit healthcare providers (HCPs). We provide new evidence on an understudied group of informal HCPs: invisible medicine sellers (IMS) who operate without any marked facility. We investigated factors that influence community decisions on which HCPs to purchase medicines from, focusing on reasons for using IMS, and compared different HCPs’ knowledge of antibiotic use.MethodsWe conducted community focus group discussions (FGDs) in seven purposively selected villages representing high and low informal HCPs use in two peri-urban districts in Phnom Penh, Cambodia. Using information from the FGDs to identify HCPs that sell medicines, we interviewed 35 participants: 21 HCPs (including five IMS) and 14 key informants, including government HCPs and village leaders. We adopted an interpretative approach and conducted a thematic analysis.ResultsCommunity members typically knew of several formal and informal HCPs selling medicines nearby, and IMS were common, as were doctors that sell medicines covertly. Two factors were most salient in influencing the choice of HCP for medicine purchasing. The first was trust in the effectiveness of medicines provided, judged by the speed of symptomatic relief. This pushed HCPs to provide several medicines, including antibiotics, at the first consultation. The second was the convenience offered by IMS and other informal HCPs: supplying medicines when other facilities are closed, accepting delayed payments, providing incomplete courses of medication and selling human antibiotics for animal use.ConclusionThis first study focusing on IMS indicates that it is important, but challenging, for public health agencies to engage with them to reduce inappropriate use of antibiotics. Although public health facilities must fill some gaps that informal HCPs are currently addressing, such as access to medicines at night, reducing demand for unnecessary antibiotics is also critical.

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“…In view of this, attempts are being made to strengthen public funding for health in this region. In 2018, India started an ambitious National Health Protection scheme for the poor to bridge the inequalities in accessing health care …”

Section: Demography Of the Countries In South Asiamentioning

confidence: 99%

“…In 2018, India started an ambitious National Health Protection scheme for the poor to bridge the inequalities in accessing health care. 16,17 Most drugs needed to treat rheumatic diseases, like methotrexate, leflunomide and biologicals are readily available. The generic synthetic DMARDs (disease modifying anti-rheumatic drugs) are cheap and easily affordable in countries like India and Bangladesh.…”

mentioning

confidence: 99%

Rheumatology workforce issues in South Asia: Challenges and solutions

Aggarwal

Haq

2020

Int J of Rheum Dis

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Expanding access to healthcare in South Asia

Abstract: Policy initiatives aiming to improve access to healthcare in South Asia have proliferated in recent years, but are they enough to address widespread health inequity in the region, ask Shehla Zaidi and colleagues?

Cited by 36 publications

References 20 publications

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

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

Invisible medicine sellers and their use of antibiotics: a qualitative study in Cambodia

Rheumatology workforce issues in South Asia: Challenges and solutions

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