Risk Factors For Non-communicable Diseases Research Articles

Trends and determinants of clustering for non-communicable disease risk factors in women of reproductive age in Nepal.

Understanding the clustering of two or more risk factors of non-communicable disease, such as smoking, overweight/obesity, and hypertension, among women of reproductive age could facilitate the design and implementation of strategies for prevention and control measures. This study examined the factors associated with smoking, overweight/obesity, and hypertension among Nepalese women of reproductive age (15-49 years). This study used the Nepal Demographic and Health Surveys (NDHS) 2016 (6,079 women for smoking and overweight/obesity, 6076 for hypertension) and 2022 (6,957 women for overweight/obesity and smoking status and 3,749 women for hypertension) for comparison of trends of NCD risk factors among women aged 15-49 years. Additionally, for each participant, risk factors score (range of 0 to 3) was created by summing individual risk factors. We assessed the determinants of risk factor clustering using multivariable Poisson regression models with robust sandwich variance estimator to calculate adjusted prevalence ratios using NDHS 2022. The national prevalence of overweight/obesity increased from 22.2% in 2016 to 29.2% in 2022 among women of reproductive age. In 2022, the prevalence for smoking, overweight/obesity, and hypertension were 3.8%, 29.2%, and 9.6%, respectively. More than one in four women (28.7%) had one NCD risk factor, while 6.5% had two such risk factors. Higher aged women (40-49 years) were more likely to have multiple NCD risk factors than those aged 15-29 years (APR: 3.19; 95% CI: 2.68-3.80). Those in the richest wealth quintile (APR: 1.52; 95% CI: 1.24-1.85), as well as married (APR: 3.02; 95% CI: 2.43-3.76) and widowed/divorced (APR: 2.85; 95% CI: 2.14-3.80) were more likely to have multiple NCD risk factors. Women from Koshi province (APR: 1.74; 95% CI: 1.41-2.15) had more NCD risk factors than those from the Sudurpaschim province. Working women also had a higher prevalence of NCD risk factors compared to non-working women (APR: 1.23; 95% CI: 1.06-1.43). Additionally, Hill Janajatis (APR: 1.44; 95% CI: 1.21-1.72) and Dalits (APR: 1.42; 95% CI: 1.15-1.75) women were more likely to have NCD risk factors compared to women of Brahmin hill origin. Clustering of two or more NCD risk factors was higher among women aged ≥30 years, those who are currently married or widowed/divorced/separated, working women, and individuals from the wealthiest socioeconomic groups. A higher burden of risk factors underscores the importance of targeted public health interventions, particularly among women from advantaged socio-economic groups, those of affluent regions, and in the workplace.

DRADTiP: Drug repurposing for aging disease through drug-target interaction prediction

MotivationThe greatest risk factor for many non-communicable diseases is aging. Studies on model organisms have demonstrated that genetic and chemical perturbation alterations can lengthen longevity and overall health. However, finding longevity-enhancing medications and their related targets is difficult. MethodIn this work, we designed a novel drug repurposing model by identifying the interaction between aging-related genes or targets and drugs similar to aging disease. Each disease is associated with certain specific genetic factors for the occurrence of that disease. The factors include gene expression, pathway, miRNA, and degree of genes in the protein-protein interaction network. In this paper, we aim to find the drugs that prolong the life span of humans with their aging-related targets using the above-mentioned factors. In addition, the contribution or importance of each factor may vary among drugs and targets. Therefore, we designed a novel multi-layer random walk-based network representation learning model including node and edge weight to learn the features of drugs and targets respectively. ResultThe performance of the proposed model is demonstrated using k-fold cross-validation (k = 5). This model achieved better performance with scores of 0.93 and 0.91 for precision and recall respectively. The drugs identified by the system are evaluated to be potential candidates for aging since the degree of interaction between the potential drugs and their gene sets are high. In addition, the genes that are interacting with drugs produce the same biological functions. Hence the life span of the human will be increased or prolonged.

Prevalence and determinants of non-communicable disease risk factors among adult population in rural Manipur: a cross-sectional study

Prevalence and determinants of non-communicable disease risk factors among adult population in rural Manipur: a cross-sectional study

Prevalence of Hypertension and Its Associated Factors in a Rural Population of Southeastern Bangladesh

Background: More than 75% of the population live in rural area in Bangladesh and morbidity and mortality due to Non-Communicable Diseases (NCDs) has increased over the last few decades in this country. Hypertension is a significant risk factor for NCDs, specifically cardiovascular disease. This study aimed to determine hypertension prevalence and associated factors among Bangladeshi adults in rural areas. Materials and methods: This cross-sectional study was conducted in selected rural areas in the Chattogram district of Bangladesh from January 2014 to December 2014. A total of 2500 individuals aged 18 years and above were determined by a multistage sampling method. Self-reported sociodemographic and hypertension-related data were collected using a structured case record form, and blood pressure was measured. Results: The overall prevalence of hypertension was 32.5% (812/2500) [95% confidence interval (CI), 30.7-34.3] (Men: 34.4%, Women: 30.9%). The prevalence of hypertension was 21.1% and 43.6% in the £40 and >40 years age group, respectively (p<0.001). Hypertension had no association with the gender, educational level and monthly income of the respondents. Overall, 1268 (50.7%, 95% CI 48.8-52.7%) of the study participants had ever had their blood pressure measured. Among the 812 people with hypertension, 478 (58.9%, CI 55.5-62.2%) were aware of the disease. Of those familiar with the disease, 404 (84.5% CI 81.0-87.5%) were on treatment, and 285 (70.5%, CI 64.2-74.9%) had achieved disease control. Only 315 (38.8%, CI 35.542.2) were controlled among all people with hypertension. Conclusion: Hypertension is highly prevalent (One in three) in Bangladeshi rural adults, while awareness, treatment, and control are low. The integrated context specific program must be designed and implemented at scale through a primary healthcare approach. IAHS Medical Journal Volume 6(2) December 2023; 78-82

Prevalence of newly diagnosed hypertension and its associated factors in an opportunistic screening program in Addis Ababa, Ethiopia: an institution-based cross-sectional study

BackgroundHypertension is a recognized risk factor that underlies the epidemic of cardiovascular diseases. Guidelines, including those from the European Society of Hypertension, recommend opportunistic screening for hypertension in all adults. However, there have been no institution-based studies on the prevalence of hypertension and its associated factors with an opportunistic screening program in Ethiopia. Hence, this study aimed to assess the prevalence of newly diagnosed hypertension and its associated factors in an opportunistic screening program in Ethiopia.MethodsThis was an institution-based cross-sectional study conducted on adult participants in an opportunistic hypertension screening program at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from November 1, 2023, to February 1, 2024. Data were collected using a structured questionnaire, constructed as per the WHO STEPwise approach to non-communicable disease risk factor surveillance (STEPS). The data was analyzed using Statistical Package for Social Sciences (SPSS), version 26. Descriptive analysis was used to compile the sociodemographic and clinical characteristics of the participants, and logistic regression analyses were performed to determine the factors associated with hypertension.ResultsA total of 301 adult participants were included in this study. The mean age of the participants was 47.6 years (standard deviation: 13.5), and 62.5% were males. The prevalence of newly diagnosed hypertension was 36.2% (95% confidence interval [CI]: 5.6, 66.8). Male sex (adjusted odds ratio (AOR) = 2.06, 95% (CI): 1.05, 4.04), being married (AOR = 4.8, 95% CI: 1.84, 2.77) or widowed (AOR = 5.14, 95% CI: 1.23, 1.46), less frequent intake of vegetables and/or fruits [< 3 days per week (AOR = 2.88, 95% CI: 1.12, 7.39), and 3 to 5 days per week (AOR = 2.22, 95% CI: 1.02, 4.86)], physical inactivity (AOR = 2.26, 95% CI: 1.21, 4.22), and body mass index (AOR = 1.17, 95% CI: 1.09, 1.26), had significant associations with hypertension.ConclusionThis study demonstrated a high prevalence of newly diagnosed hypertension in an opportunistic screening program in Addis Ababa, Ethiopia. It also revealed that most of the factors significantly associated with hypertension were modifiable, underscoring the importance of promoting lifestyle changes. Most importantly, expanding institution-based opportunistic screening programs could be an effective approach to maximize the detection of hypertension and improve access to its treatment.

Prevalence of undiagnosed hypertension and associated factors in Ndera sector, Gasabo district of Rwanda: a cross-sectional study

BackgroundHypertension remains a major global health challenge, including in low- and middle-income countries. In Rwanda, a lack of adequate information and healthcare services impacts healthcare-seeking behaviors, contributing to undiagnosed hypertension in rural areas. Therefore, the need to determine its prevalence and associated factors.MethodsA cross-sectional study was conducted with 393 adults in the Ndera Sector, of Rwanda’s Gasabo District, through a multistage sampling technique. Data was gathered using the WHO STEP-wise approach to non-communicable disease risk factor surveillance (STEPS) questionnaire; physical examination was done to determine blood pressure and body-mass index (BMI), after which the data collected was analyzed using SPSS. Newly diagnosed hypertension was determined when on two different intervals, systolic blood pressure readings was > 140 mmHg, and/or the diastolic blood pressure readings was > 90 mmHg, in the absence of previous hypertension diagnosis.ResultsThe overall prevalence of hypertension among patients at Ndera sector was 15%, all of which were newly diagnosed. The mean (SD) age of the participants was 37 (13.7) years and half (53%) were women. The mean systolic blood pressure for men was 124.3 mmHg compared to 120.9 mmHg for women (p = 0.043, 95%CI: 0.12–6.74). Women had a significantly higher mean BMI (26.0) compared to men (22.8) (p < 0.001, 95%CI: -4.18 - -2.31). Age (χ² = 37.400, p < 0.001), residence (χ² = 10.200, p < 0.001), BMI (χ² = 22.1, p < 0.001), and lack of knowledge about hypertension (χ² = 25.1, p < 0.001) were the factors with significantly undiagnosed hypertension.ConclusionsThe high prevalence of undiagnosed hypertension in Ndera Sector is linked to gender, older age, higher BMI, location, and lack of hypertension knowledge. These findings call for multifaceted approaches, combining educational initiatives, geographical targeting, lifestyle modifications, and policy implementations, all aimed at mitigating the burden of undiagnosed hypertension and enhancing community health within the Ndera Sector.

Prevalence of risk factors for non-communicable disease: a university-based cross-sectional study after the COVID-19 pandemic in Bangladesh

BackgroundNon-communicable diseases (NCDs) account for major health complications globally as well as in Bangladesh. The current study aimed to evaluate the prevalence of risk factors for NCD among students and faculty/staff of the University of Dhaka after the COVID-19 pandemic.MethodsA cross-sectional study (June 2022-July 2023) was conducted collecting information of sociodemographic factors, sleeping and food habits, family history, smoking, usage of electronic devices, refractive errors, and physical measurements, all of which were linked to risk factors. Subsequent analyses, such as bivariate, univariate, and logistic regression, were conducted on the population to evaluate associations between NCD status and the respective risk factors.ResultsThe overall mean age, blood sugar, body mass index (BMI), and systolic and diastolic blood pressure were 22.34 years, 5.88 mmol/L, 23.27 kg/m2, 118.47 mm Hg, and 75.69 mm Hg, respectively. The most significant NCD risk factors were obesity (50.37%), followed by high sugar level (hyperglycemic) (13.45%), and hypertension (11.98%).ConclusionsThis study showed a significant number of NCD risk factors among University of Dhaka students and staff following COVID-19, underlining the urgent need for focused health interventions, particularly those addressing food and sleep. Addressing these hazards is critical to avoiding growing NCD incidence to ensure an effective healthcare system in Bangladesh.

Risk factor profile for non-communicable diseases: findings of a STEPS survey among the support staff at the University of Pretoria, South Africa

Background: Non-communicable diseases (NCDs) are an important problem in South Africa; they account for 60% of all deaths. Early screening could help lower NCD incidences and long-term consequences. Objective: The study aimed to profile NCD risk factors among insourced support staff at the University of Pretoria in 2018. Design: A cross-sectional, descriptive study was conducted at the University of Pretoria, Hatfield Campus. The World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS) questionnaire was administered to collect data in three steps. The participants’ behavioural risk profiles were gathered using the face-to-face interview technique (STEP I), followed by their physical risk profile using anthropometric and blood pressure measurements (STEP II). Last was the biochemical risk profile, including finger-prick blood glucose and cholesterol measurement (STEP III). Data were analysed using Epi-Info, version 3.54. Subjects: A convenient sample of participants aged 18–64 years from the Departments of Industrial Hygiene and Building Services, Landscape Services, Sports Fields Management, and Security Services (n = 146, 60% were females) took part in the study. Results: Most participants (97.8%) had low daily fruit and vegetable intake. Some 80% of the study population always or often added salt to their food when cooking. Daily alcohol consumption was reported by a quarter of the sample. More than two-thirds of all the participants were overweight or obese and 61% had central obesity. Conclusion: The study identified a high prevalence of several NCD risk factors. Tailored nutrition education and monitoring are needed to lower the elevated risk.

Burden of disease in Germany attributed to ambient particulate matter pollution : Findings from the Global Burden of Disease Study 2019.

Ambient fine particulate matter pollution with adiameter less than 2.5micrometers (PM2.5) is asignificant risk factor for chronic noncommunicable diseases (NCDs), leading to asubstantial disease burden, decreased quality of life, and deaths globally. This study aimed to investigate the disease and mortality burdens attributed to PM2.5 in Germany in 2019. Data from the Global Burden of Disease (GBD) Study 2019 were used to investigate disability-adjusted life-years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to ambient PM2.5 pollution in Germany. In 2019, ambient PM2.5 pollution in Germany was associated with significant health impacts, contributing to 27,040 deaths (2.82% of total deaths), 568,784 DALYs (2.09% of total DALYs), 135,725 YLDs (1.09% of total YLDs), and 433,058 YLLs (2.92% of total YLLs). The analysis further revealed that cardiometabolic and respiratory conditions, such as ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and diabetes mellitus, were the leading causes of mortality and disease burden associated with ambient PM2.5 pollution in Germany from 1990-2019. Comparative assessments between 1990 and 2019 underscored ambient PM2.5 as aconsistent prominent risk factor, ranking closely with traditional factors like smoking, arterial hypertension, and alcohol use contributing to deaths, DALYs, YLDs, and YLLs. Ambient PM2.5 pollution is one of the major health risk factors contributing significantly to the burden of disease and mortality in Germany, emphasizing the urgent need for targeted interventions to address its substantial contribution to chronic NCDs.

Empowering communities to use healthy lifestyle centres: an implementation research from Sri Lanka

ObjectiveHealthy lifestyle centres (HLCs), a state service that screens for major non-communicable disease (NCD) risk factors and promotes lifestyle modifications in Sri Lanka, report underutilisation. The study aimed to assess...

Examining the onset and cessation patterns of active smoking among college students: an interpretative analysis

Smoking is a prevalent global issue, with a significant risk factor for various non-communicable diseases necessitating prolonged, costly, and potentially devastating medical treatments. In addition, infectious diseases such as tuberculosis, COVID-19, and pneumonia in toddlers are often associated with active and passive smoking habits. The correlation is evident across diverse demographics, encompassing individuals of varying ages, professions, and genders. Therefore, this research aimed to explore and describe behavior of active smokers among campus members at various universities, focusing on the initiation, cessation, and influencing factors associated with smoking.A qualitative research design was used with a hermeneutic phenomenological approach, where information was provided by five active smoker informants.These individuals started smoking as teenagers, and the fluctuating patterns were influenced by health concerns or a perceived lack of significance attributed to smoking. However, the periods of abstinence were only temporary due to the pervasive influence of social and environmental factors. The initiation of smoking commonly started from the influence of close acquaintances, such as family members. Meanwhile, the process of quitting encountered numerous obstacles, primarily from potent social factors outweighing personal intentions.The implementation of smoking cessation strategies posed challenges due to the profound impacts of addiction, requiring unwavering determination, comprehensive plans, and diligent efforts.

Identification of Symbols in Indonesian Traditional Fairy Tales as a Health Promotion for the Prevention of Non-Communicable Diseases Diabetes Mellitus and Hypertension

Background: Non-communicable diseases are one of the groups of diseases with the highest causes of death in the world. This was shown by data from WHO that in 2023, around 74 percent of the causes of death in the world are non-communicable diseases that kill 41 million people per year. This is due to the lack of public understanding of the influence of risk factors for non-communicable diseases on the incidence of non-communicable diseases and complications that can be caused by non-communicable diseases. Therefore, the use of traditional Indonesian fairy tale symbols in health promotion media to prevent non-communicable diseases can be used as an alternative solution to overcoming this challenge. Aims: This study aims to identify, examine, and synthesize symbols in traditional Indonesian fairy tales that have the potential to they can be developed to improve health messages to prevent noncommunicable diseases, especially diabetes mellitus and hypertension. Method: The method used in this study was a Literature Review with a narrative review study design. The steps taken are to gather all the fairy tales with inclusion criteria are fairy tales that have symbols about non-communicable diseases and exclusion criteria are incomplete fairy tales, and then do the screening, identifying symbols, analyzing symbols, and selecting potential symbols. Results: Of the 21 relevant titles of Indonesian traditional fairy tales and legends, 85 symbols were identified. From the analysis of the meaning of each symbol, 16 symbols were found that have the potential to be used as promotions for the prevention of non-communicable diseases, diabetes mellitus, and hypertension, with 10 different symbol categories spread across 7 provinces in Indonesia. Conclusion: There are many symbols from traditional Indonesian fairy tales that have the potential to they can be used to increase the effectiveness of delivering health messages as an effort to promote the prevention of non-communicable diseases diabetes mellitus and hypertension. These symbols can be made into health messages nationally and can be flexibly used to create health messages in each region.

Together we win! Narratives of couples pursuing a healthy diet and physical activity: A qualitative study.

Metabolic syndrome (MetS) is a major risk factor for non-communicable diseases, including type 2 diabetes mellitus, cardiovascular disease, and cancer. The risk of MetS can be transmitted via epigenetic processes from both the mother and the father. Therefore, it is essential that both members of a couple are targeted in pre-conception nutrition and physical activity-based lifestyle programs. However, lifestyle interventions targeting both members of a couple are scarce in the literature. This study, therefore, aimed to explore the barriers and facilitators of a couples-based lifestyle intervention. Nulliparous couples who had an interest in having children in the future were recruited to the study and each member interviewed separately to gain insight into to gain insight into designing future couples-based lifestyle interventions. Interviews were conducted between June and October 2021. Reflexive thematic analysis (RTA) was applied to conduct and analyse semi-structured, in-depth interviews with nulliparous couples who had an interest in having children in the future. Four major themes were identified in nine couples aged 25-34 years (here referred to as "millennials"): Millennials are committed to preparation for their future offspring; millennials know features of a good program likely to have high adherence and long-term behavior change; millennials acknowledge the importance of couples-based programs; and millennials appreciate that future global emergencies may require lifestyle modifications. This study found that millennial couples showed a strong intention to create optimal emotional, financial, and health conditions for their children. They supported couples-based approach (CBA) lifestyle interventions to mitigate potential epigenetic risks. Couples believed that participating together in these programs would enhance adherence to healthy habits, promoting long-term well-being. The findings advocate for exploring and testing CBA interventions that target both partners, as joint participation not only aids in healthy conception and reduces metabolic syndrome risks but also establishes a foundation for family health. These insights highlight the potential of CBA interventions to positively impact future generations.

P039 INTEGRATED SCREENING FOR HYPERTENSION AND DIABETES MELLITUS IN ROUTINE TUBERCULOSIS CARE IN DELHI, INDIA

Background: Evidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs) like hypertension and diabetes mellitus (DM). Bi-directional screening for TB and DM is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme. Objective: To assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017. Methods: It was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). Results: Amongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p&lt;0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening. Conclusion: Integrating screening for hypertension and DM and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.

Prevalence of inadequate fruit and vegetable consumption and associated food choice motives among adults in an urban population in Kerala

ABSTRACT Background: Existing literature does not account for food choice motives associated with the non-communicable disease risk factor of an unhealthy diet, primarily characterised by inadequate fruit and vegetable consumption, among adults residing in Kochi Municipal Corporation. Our study aims to measure the prevalence of inadequate fruit and vegetable consumption in this urban population and to identify priority food choice motives among individuals at risk. Methods: A community-based cross-sectional study was conducted among 300 adults (mean age 46 years, men 50%) selected by cluster sampling. Information on socio-demographic variables, diet, and food choice motives was collected through a pre-tested structured interview schedule. Binary logistic regression analysis was done to identify factors associated with inadequate fruit and vegetable consumption. Results: In our study, 86% (95% CI: 82.07-89.93) of participants reported inadequate fruit and vegetable consumption. The food choice motives of “price” [aOR 2.99, 95% CI: 1.32–6.78], “health” [aOR 2.56, 95% CI: 1.08–6.24], and “sensory appeal” [aOR 2.20, 95% CI: 1.06–4.56] were found to be significantly associated with inadequate fruit and vegetable consumption per day (P &lt; 0.05). Conclusion: The high prevalence of inadequate fruit and vegetable consumption in this urban community necessitates targeted and comprehensive educational campaigns that highlight the health benefits and sensory appeal of fruits and vegetables, as well as the affordability of seasonal produce, to ensure adequate intake of these foods.

Prevalence, Awareness, and Factors Associated with Hypertension Among People Living with HIV in Eastern Uganda. A Multicentre Cross-Sectional Study.

Despite advancements in Antiretroviral Therapy (ART), people living with HIV (PLHIV) face increasing risks of HTN, leading to significant morbidity and premature mortality, undermining the hard-earned gains of fighting HIV. The prevalence of hypertension among HIV patients and associated risk factors has not been extensively studied in the rural parts of Uganda. We assessed the prevalence, awareness, and factors associated with hypertension among PLHIV at two health facilities in Eastern Uganda. A cross-sectional study was conducted at Mbale Regional Referral Hospital and Bugobero Health Center IV HIV clinics from May to July 2023. We recruited patients with HIV above the age of 18 years and willing to consent. Participants were interviewed using a structured questionnaire adapted from the WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) and the AIDS Clinical Trials Group. Anthropometric measurements and blood pressure were taken. Bivariate and multivariable logistic regression were performed. A P value <0.2 in the bivariate analysis was transferred to the multivariable logistic regression model. A P value < 0.05 was statistically significant. The study surveyed 400 PLHIV with a mean age of 46.5 (SD: 12.4) years; most were female (n=261, 65.3%). Hypertension prevalence was at 37.5%, with 20.5% in stage 2 and 68% ((n=102) of hypertensive participants were unaware. Hypertension was associated with age ≥50 years (aOR: 2.11, 95% CI: 1.33-3.37, p = 0.002), a suppressed viral load (aOR: 3.71, 95% CI: 1.02-5.13, p = 0.046) and BMI ≥25 Kg/m2 (aOR: 1.64, 95% CI: 1.01-2.66, p = 0.044). Hypertension is a significant burden among PLHIV in Eastern Uganda, influenced by HIV and lifestyle-related risk factors. Improved screening and diagnosis are needed with close monitoring for patients with viral load suppression due to the possible negative effects of ART on blood pressure.

P204 BANGLADESH HEARTS: LESSONS LEARNED FROM A NATIONAL HYPERTENSION CONTROL PROGRAM, 2018-2024

Background and Objective: In Bangladesh, 21% of all adults aged &gt;=18 years have hypertension but among hypertensives, only 14.1% have blood pressure (BP) controlled (&lt;140/90 mmHg) .1 To improve hypertension control and prevent cardiovascular disease, the Non-Communicable Disease Control Program under the Ministry of Health &amp; Family Welfare launched the Bangladesh Hypertension Control Initiative (BHCI) with technical support from the National Heart Foundation of Bangladesh and Resolve to Save Lives. Method: The BHCI gradually implemented the World Health Organization (WHO) HEARTS standardized hypertension control package in 172 sub-district facilities (35% of all sub-district facilities) &amp; 10 district-level facilities in 23 districts from 2018 to 2024. BHCI facilities implemented a simple, evidence-based, step-by-step, and drug &amp; dose-specific hypertension treatment protocol, a reliable supply of protocol medicines free of charge to patients, team-based care including non-physician members, and the Simple digital hypertension management app to collect real-time data and facilitate patient and program monitoring over time. A continuous quality improvement initiated in 2020 focused on lowering missed visit rate and raising blood pressure control. Missed visit rate was the proportion of all enrolled patients failing to attend a scheduled clinic visit in the prior three months; BP control was proportion with BP &lt;140/90 mmHg at their last visit in the prior three months. Results: From March 2019 to February 2024, the BHCI had enrolled 364,038 hypertensive patients in treatment (Figure). Facility-based BP control increased from 37% in July 2020 when the quality improvement program started to 57% by April 2024. Missed visits decreased from 53% in July 2020 to 29% by April 2024. Conclusion: BHCI is on track for national scale-up in Bangladesh and can serve as a model for WHO-HEARTS hypertension control programs in other LMIC countries. Reference: 1. World Health Organization. National STEPS survey for non-communicable diseases risk factors in Bangladesh 2018. Panel A: number of hypertension patients enrolled in treatment. Panel B: rates of missed hypertension management visits and blood pressure controlled &lt;140/90

Changes in nutritional status, risk factors and food intake in stroke subjects: cohort study analysis of non-communicable disease risk factors

Background: Stroke is a major cause of death and disability worldwide, affecting 15 million people annually. In Indonesia, the prevalence is 10.9%. Major risk factors include high blood pressure, obesity, inactivity, poor diet, and smoking. Objective: This study aims to analyze long-term trends in risk factors, nutritional status, and food intake among stroke patients from 2011-2021, assessing their impact on stroke incidence. Methods: Data from a longitudinal cohort study of 5,329 subjects, including 215 stroke patients, were analyzed using Microsoft Excel 2019 and SAS software. ANOVA was used to assess annual changes in risk factors, nutritional status, and food intake. Survival analysis was conducted with SAS PROC LIFETEST and PROC LIFEREG. Results: The cohort was primarily female (62.8%), aged 60 or older (57.2%), senior high school education (25.6%), civil servants (30.7%), and low income (57.2%). Significant changes were noted in BMI (p=0.037), fasting blood glucose (FBG) (p=0.001), HDL (p=0.049), abdominal circumference, smoking habits, physical activity (p&lt;0.001), protein intake (p=0.026), and intake of energy, fat, carbohydrates, and sodium (p&lt;0.001). Factors significantly associated with stroke included age, FBG, postprandial glucose, smoking (p&lt;0.0001), LDL (p=0.0380), HDL (p=0.0126), physical activity (p=0.0455), energy intake (p=0.0002), fat intake (p=0.0007), and sodium intake (p=0.0012). Conclusions: The study highlights significant changes in nutritional status, glucose levels, HDL cholesterol, physical activity, and smoking habits. These factors, along with age, cholesterol levels, and dietary intake, impact stroke incidence, underscoring the need for comprehensive stroke prevention strategies.

Lifestyle Differences in the Metabolic Comorbidity Score of Adult Population From South Asian Countries: A Cross-Sectional Study

BackgroundMetabolic comorbidities are involved in the development and progression of non-communicable diseases (NCDs). There is convincing evidence that lifestyles are important contributors to metabolic comorbidities. This study measured the metabolic comorbidity score of South Asian adults, and identified its relationship with lifestyles. MethodsWe studied five South Asian countries including Afghanistan, Bangladesh, Bhutan, Nepal, and Sri Lanka, using WHO's Stepwise approach to NCD risk factor surveillance data between 2014 and 2019. This was a nationally representative and cross-sectional survey on participants aged 15-69 years old. The sample size was 27,616. The outcome was metabolic comorbidity score, calculated based on total cholesterol, fasting plasma glucose, blood pressure, and abdominal obesity. Total metabolic comorbidity score of each participant varied between 0-8. It was then divided into three ranges – the lowest range (total metabolic comorbidity score <3), medium range (total metabolic comorbidity score ≥3 & ≤5), and the highest range (total metabolic comorbidity score ≥6). Based on the outcome of non-parametric receiver operating characteristics analysis, the medium and the highest range together was considered as higher metabolic comorbidity score. The lowest range was considered as lower metabolic comorbidity score. The higher metabolic comorbidity score was coded as “1”and the lower metabolic comorbidity score was coded as “0”. Thus, the outcome variable, metabolic comorbidity score, became a binary variable. Exposures included physical inactivity (<150 minutes of MVPS /week), high daily sedentary time (≥ 9 hours/day), use of tobacco (present or past smoking or daily use of smokeless tobacco products), and consumption of alcohol (at least once/month in the last one year). Binomial logistic regression model produced the odds ratios (OR) with corresponding 95% confidence intervals (CI). ResultsThe prevalence of higher metabolic comorbidity score was 34% among South Asian adults, 25% among the male respondents and 41% among the female respondents. Participants who were physically inactive (OR, 1.26; 95% CI, 1.17-1.36), had high sedentary time (OR, 1.24; 95% CI, 1.11-1.33), and consumed alcohol (OR, 1.40; 95% CI, 1.23-1.53) showed higher metabolic comorbidity score compared with the participants who were physically active, had low sedentary time and did not consume alcohol respectively. However, we found an inverse association (OR, 0.75; 95% CI, 0.71-0.81) between the use of tobacco and metabolic comorbidity score. ConclusionsOne third of South Asian adults had higher metabolic comorbidity score. Physical inactivity, daily sedentary hours and minimal alcohol consumption was associated with higher metabolic comorbidity score.

Predicting high blood pressure using machine learning models in low- and middle-income countries

Responding to the rising global prevalence of noncommunicable diseases (NCDs) requires improvements in the management of high blood pressure. Therefore, this study aims to develop an explainable machine learning model for predicting high blood pressure, a key NCD risk factor, using data from the STEPwise approach to NCD risk factor surveillance (STEPS) surveys. Nationally representative samples of adults aged 18-69 years were acquired from 57 countries spanning six World Health Organization (WHO) regions. Data harmonization and processing were performed to standardize the selected predictors and synchronize features across countries, yielding 41 variables, including demographic, behavioural, physical, and biochemical factors. Five machine learning models - logistic regression, k-nearest neighbours, random forest, XGBoost, and a fully connected neural network - were trained and evaluated at global, regional, and country-specific levels using an 80/20 train-test split. The models’ performance was assessed using accuracy, precision, recall, and F1 score. Feature importance analysis identified age, weight, heart rate, waist circumference, and height as key predictors of blood pressure. Across the 57 countries studied, model performances varied considerably, with accuracy ranging from as low as 58.96% in some models for specific countries to as high as 81.41% in others, underscoring the need for region and country-specific adaptations in modelling approaches. The explainable model offers an opportunity for population-level screening and continuous risk assessment in resource-limited settings.