The Burden of Non-Communicable Disease in Transition Communities in an Asian Megacity: Baseline Findings from a Cohort Study in Karachi, Pakistan

Abstract

BackgroundThe demographic transition in South Asia coupled with unplanned urbanization and lifestyle changes are increasing the burden of non-communicable disease (NCD) where infectious diseases are still highly prevalent. The true magnitude and impact of this double burden of disease, although predicted to be immense, is largely unknown due to the absence of recent, population-based longitudinal data. The present study was designed as a unique ‘Framingham-like’ Pakistan cohort with the objective of measuring the prevalence and risk factors for hypertension, obesity, diabetes, coronary artery disease and hepatitis B and C infection in a multi-ethnic, middle to low income population of Karachi, Pakistan.MethodsWe selected two administrative areas from a private charitable hospital’s catchment population for enrolment of a random selection of cohort households in Karachi, Pakistan. A baseline survey measured the prevalence and risk factors for hypertension, obesity, diabetes, coronary artery disease and hepatitis B and C infection.ResultsSix hundred and sixty-seven households were enrolled between March 2010 and August 2011. A majority of households lived in permanent structures (85%) with access to basic utilities (77%) and sanitation facilities (98%) but limited access to clean drinking water (68%). Households had high ownership of communication technologies in the form of cable television (69%) and mobile phones (83%). Risk factors for NCD, such as tobacco use (45%), overweight (20%), abdominal obesity (53%), hypertension (18%), diabetes (8%) and pre-diabetes (40%) were high. At the same time, infectious diseases such as hepatitis B (24%) and hepatitis C (8%) were prevalent in this population.ConclusionOur findings highlight the need to monitor risk factors and disease trends through longitudinal research in high-burden transition communities in the context of rapid urbanization and changing lifestyles. They also demonstrate the urgency of public health intervention programs tailored for these transition communities.

Prevalence and Sociodemographic Factors of Overweight and Obesity among Pakistani Adults

“…2,3 During the last two decades, Asian developing countries have become more vulnerable to this serious public health threat. Although there has been a need for updated population-based data on the prevalence of obesity among adults in Pakistan, few regional studies [13][14][15][16][17] with adults have identified the escalating rates of overweight and obesity. We therefore established such a kind of study.…”

Association of major dietary patterns and blood pressure longitudinal change in Bangladesh

“…Low income countries currently account for 80% of all non-communicable disease including high BP or CVD. The change in diet behavior could partly account for the rise in high BP or CVD [30]. The findings of the study suggest the effects of diet patterns on longitudinal BP change even in a low-income and lean population.…”

The relationship between exposure to hepatitis B virus and increased atherosclerosis-associated morbidity — a meta-analysis

“…The authors then read the full text of all 29 articles, and excluded studies that were not suitable for this meta-analysis. Eleven articles were excluded because they were the incorrect type of articles, such as reviews and workshop summaries; five articles had the wrong methodology (three included patients who had concurrent infection with other pathogens); one article was a cross-sectional study and did not study the relationship between exposure to HBV and atherosclerosis [15]; one article that considered cerebrovascular disease as an outcome included both ischaemic and haemorrhagic cerebrovascular disease [7]; seven articles had the wrong outcomes (they studied the parameters related to atherosclerosis but did not set a threshold to define atherosclerosis) [4][5][6][16][17][18][19]; and one article was a cohort study, but there was no other cohort study to perform the meta-analysis [11]. Finally, we included five eligible studies for the meta-analysis [8-10, 12, 13].…”