Is rule of halves still an occurrence in South India

Abstract

Background:The objective of the present study was to assess the applicability of the rule of halves in an urban population of Puducherry, South India. We also aimed to find the correlates associated with undiagnosed hypertension to facilitate targeted screening.Methodology:We derive our observation from a community-based cross-sectional study conducted using the World Health Organization STEPwise approach to surveillance in urban slum of Puducherry during 2014–15. Blood pressure (BP) was measured for all the study subjects (n = 2399), and the subjects were classified as hypertensive using Joint National Committee 8 criteria, systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mmHg and/or known hypertensives and/or treatment with antihypertensive drugs. Controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg.Results:Of 2399, 799 (33.3%; 95% confidence interval [CI]: 31.4%–35.2%) adults were found to have raised BP by any means (known and unknown hypertensives). Of the 799, 367 (15.3%; 95%CI: 13.9%–16.8%) of study participants were known hypertensives. Of the known hypertensives, 74.7% (274/367) were put on treatment (drugs and or lifestyle modification), and 80% (218/274) were on regular treatment. Higher proportions of men were found to have undiagnosed hypertension compared to women (26.1 vs. 19.8%, P < 0.001). Similarly, adult from below poverty line (23.8 vs. 20%, P < 0.001), unskilled laborer (26.6 vs. 20%, P < 0.001), and literacy less than middle school (12.3 vs. 23%, P < 0.001) had more undiagnosed hypertension.Conclusion:In the selected urban area of Puducherry around one-third of the adult populations are having hypertension, including the 54% of undiagnosed hypertension. Adults from the vulnerable subgroups such as lower level of literacy, below poverty line, and unskilled work are found to have higher proportions of undiagnosed hypertension.

District-Wise Heterogeneity in Blood Pressure Measurements, Prehypertension, Raised Blood Pressure, and Their Determinants Among Indians: National Family Health Survey-5

“…Education and wealth played important roles, with higher educational attainment associated with a higher likelihood of blood pressure measurement and a lower likelihood of prehypertension. Wealthier individuals had increased odds of blood pressure measurement, prehypertension and raised blood pressure, which is consistent with findings from previous studies [ 14 , 15 , 42 ]. This reflects the influence of economic status on healthcare access and lifestyle factors.…”

Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature

“…Income and wealth21 41 48–50 60 65 67 80 104–108 including financial constraint19 21 38 45 73 76 78 84 86 89 100 102 109–113 featured prominently. Higher education level39 48 55–58 60 61 65–67 69 80–82 106–108 114–116 and higher income21 48–50 55 57 60 65 67 80 104 106–108 117 were associated with more seeking and utilisation of healthcare services. With some exceptions,66 104 previous studies reported that employed slum residents tend to seek and use healthcare services more frequently than unemployed slum residents and housewives 48 50 65 66 69 80 82 83 118.…”

“…Personal and biological factors: The common factors associated with healthcare accessing and utilisation included intrinsic factors such as age,21 39–55 sex18 21 41 45 51 53 55–58 and ethnicity,21 familial factors such as birth order of the sick child,21 46 59–61 as well as personal health and type of illness,45 58 disability47 and morbidity,21 51 62 63 and the specific features of the health condition 52 55 64. Slum residents are more likely to seek healthcare services when sick children are younger,48 49 52 55 but evidence on the association between mother’s age and child’s vaccination was inconsistent 21 39.…”

“…Healthcare seeking and utilisation were different by sex, but the association was context dependent. Several studies reported higher healthcare utilisation among female slum dwellers,18 51 55 57 while other studies showed male children had higher vaccination coverage56 and incurred more medical expenditure 58. Major life events such as recent migration21 49 65–67 and relocation48 into slums tend to be associated with lower healthcare seeking and utilisation.…”

High prevalence of prehypertension and its association with modifiable risk factors: findings of household steps survey from Urban Puducherry, South India

“…Details of the study methods and findings are reported elsewhere. [ 20 ] Based on the assumptions of prevalence of hypertension for Puducherry (p) as 12.2%,[ 21 ] 15% relative precision (d = ~1.83%), 95% CI (Z), and design effect (DEFF) 2, the estimated sample size obtained in Open Epi using the formula n = [DEFF*Np (1-p)]/[(d 2 /Z 2 1- α / 2 *(N-1)+p*(1-p)] was 2096. Bearing in mind the nonresponse rate of 10%, the required sample size was found to be 2305.…”