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Oshidari Y, Salehi M, Kermani M, Jonidi Jafari A. Associations between long-term exposure to air pollution, diabetes, and hypertension in metropolitan Iran: an ecologic study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2476-2490. [PMID: 37674318 DOI: 10.1080/09603123.2023.2254713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Epidemiological studies on air pollution, diabetes, and hypertension conflict. This study examined air pollution, diabetes, and hypertension in adults in 11 metropolitan areas of Iran (2012-2016). Local environment departments and the Tehran Air Quality Control Company provided air quality data. The VIZIT website and Stepwise Approach to Chronic Disease Risk Factor Surveillance study delivered chronic disease data. Multiple logistic regression and generalized estimating equations evaluated air pollution-related diabetes and hypertension. In Isfahan, Ahvaz, and Tehran, PM2.5 was linked to diabetes. In all cities except Urmia, Yasuj, and Yazd, PM2.5 was statistically related to hypertension. O3 was connected to hypertension in Ahvaz, Tehran, and Shiraz, whereas NO2 was not. BMI and gender predict hypertension and diabetes. Diabetes, SBP, and total cholesterol were correlated. Iran's largest cities' poor air quality may promote diabetes and hypertension. PM2.5 impacts many cities' outcomes. Therefore, politicians and specialists have to control air pollution.
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Affiliation(s)
- Yasaman Oshidari
- Research Center of Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Kermani
- Research Center of Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jonidi Jafari
- Research Center of Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Hu X, Fang X, Wu M. Prevalence, awareness, treatment and control of type 2 diabetes in southeast China: A population-based study. J Diabetes Investig 2024. [PMID: 38741389 DOI: 10.1111/jdi.14213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/16/2024] Open
Abstract
AIMS/INTRODUCTION To estimate the prevalence, awareness, treatment, control rate, and influence factors of type 2 diabetes in Fujian province and provide the scientific basic for prevention. MATERIALS AND METHODS A population-based study with the analysis of binary logistic regression was carried out to estimate the odds ratios of the influencing factor on type 2 diabetes. Data of the Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) in southeast China were used. The study sample originated from 12 counties in Fujian province and included 135,352 permanent residents aged 35-75 years in 2021. RESULTS The prevalence of type 2 diabetes was 18.32% (24,801/135,352). Among them, 13,921 (56.13%) were aware of their condition, 11,894 (47.96%) were receiving treatment, and 4,537 (18.29%) had achieved control of blood glucose. Multivariate logistic regression analysis showed that older age, men, low-family income, low-education level, urban locality, no medical insurance, and histories of myocardial infarction, stroke, dyslipidemia, hypertension, alcohol consumption, and obesity were associated with a higher prevalence of type 2 diabetes. CONCLUSIONS The prevalence of type 2 diabetes among residents aged 35-75 years in southeast China is high, whereas the status of its low awareness, treatment and control is severe, warranting a broad-based global strategy, including greater efforts in earlier screening, and more effective and affordable treatment is essential.
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Affiliation(s)
- Xiangju Hu
- School of Public Health, Fujian Medical University, Fuzhou, China
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Xin Fang
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Minxia Wu
- Public Technology Service Center, Fujian Medical University, Fuzhou, China
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López-Bueno R, Núñez-Cortés R, Calatayud J, Salazar-Méndez J, Petermann-Rocha F, López-Gil JF, Del Pozo Cruz B. Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis. Cardiovasc Res 2024; 120:13-33. [PMID: 38033266 DOI: 10.1093/cvr/cvad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.
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Affiliation(s)
- Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Fanny Petermann-Rocha
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | | | - Borja Del Pozo Cruz
- Faculty of Education, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Nyarko SH, Addo IY, Ayebeng C, Dickson KS, Acquah E. Mediating effects of hypertension in association between household wealth disparities and diabetes among women of reproductive age: analysis of eight countries in sub-Saharan Africa. Int Health 2024:ihae013. [PMID: 38321706 DOI: 10.1093/inthealth/ihae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Diabetes prevalence appears to be increasing in low- and middle-income countries, yet little is known about how hypertension status mediates the association between household wealth and diabetes. This study examined the mediation effects of hypertension in associations between household wealth and diabetes in eight sub-Saharan African (SSA) countries. METHODS This is a cross-sectional study of 71 577 women from recent Demographic and Health Surveys for eight SSA countries. Sample-weighted logistic regression and causal mediation analyses were conducted. RESULTS Of the 71 577 women, 1.1% (782) reported ever being diagnosed with diabetes. Women with diabetes were more likely to have hypertension compared with those without diabetes (54.9% vs 9.9%). The odds of diabetes were significantly higher among women with hypertension (adjusted odds ratio [OR] 5.71 [95% confidence interval {CI} 4.62 to 7.05]) and women from rich households (adjusted OR 1.65 [95% CI 1.23 to 2.22]) compared with their respective counterparts. Hypertension status mediated 27.4% of the association between household wealth and diabetes status. CONCLUSIONS Hypertension status partly contributes to the associations between household wealth disparities and diabetes status among women in the selected countries. Further research and targeted interventions are needed to explore specific mechanisms and confounding factors related to household wealth disparities, hypertension status and diabetes prevalence in this population.
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Affiliation(s)
- Samuel H Nyarko
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Isaac Y Addo
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Research and Advocacy, Challenging Heights, Winneba, Ghana
| | - Kwamena S Dickson
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Ramani S, Bahuguna M, Spencer J, Pathak S, Shende S, Pantvaidya S, D’Souza V, Jayaraman A. Many hops, many stops: care-seeking "loops" for diabetes and hypertension in three urban informal settlements in the Mumbai Metropolitan Region. Front Public Health 2024; 11:1257226. [PMID: 38264249 PMCID: PMC10803512 DOI: 10.3389/fpubh.2023.1257226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
Background The burden of Non-Communicable Diseases (NCDs) in urban informal settlements across Lower and Middle Income Countries is increasing. In recognition, there has been interest in fine-tuning policies on NCDs to meet the unique needs of people living in these settlements. To inform such policy efforts, we studied the care-seeking journeys of people living in urban informal settlements for two NCDs-diabetes and hypertension. The study was done in the Mumbai Metropolitan Region, India. Methods This qualitative study was based on interviews with patients having diabetes and hypertension, supplemented by interactions with the general community, private doctors, and public sector staff. We conducted a total of 47 interviews and 6 Focus Group Discussions. We synthesized data thematically and used the qualitative software NVivo Version 10.3 to aid the process. In this paper, we report on themes that we, as a team, interpreted as striking and policy-relevant features of peoples' journeys. Results People recounted having long and convoluted care-seeking journeys for the two NCDs we studied. There were several delays in diagnosis and treatment initiation. Most people's first point of contact for medical care were local physicians with a non-allopathic degree, who were not always able to diagnose the two NCDs. People reported seeking care from a multitude of healthcare providers (public and private), and repeatedly switched providers. Their stories often comprised multiple points of diagnosis, re-diagnosis, treatment initiation, and treatment adjustments. Advice from neighbors, friends, and family played an essential role in shaping the care-seeking process. Trade-offs between saving costs and obtaining relief from symptoms were made constantly. Conclusion Our paper attempts to bring the voices of people to the forefront of policies on NCDs. People's convoluted journeys with numerous switches between providers indicate the need for trusted "first-contact" points for NCD care. Integrating care across providers-public and private-in urban informal settlements-can go a long way in streamlining the NCD care-seeking process and making care more affordable for people. Educating the community on NCD prevention, screening, and treatment adherence; and establishing local support mechanisms (such as patient groups) may also help optimize people's care-seeking pathways.
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Affiliation(s)
| | | | | | | | | | | | | | - Anuja Jayaraman
- Society for Nutrition, Education and Health Action, Mumbai, India
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Ye J, Wu Y, Yang S, Zhu D, Chen F, Chen J, Ji X, Hou K. The global, regional and national burden of type 2 diabetes mellitus in the past, present and future: a systematic analysis of the Global Burden of Disease Study 2019. Front Endocrinol (Lausanne) 2023; 14:1192629. [PMID: 37522116 PMCID: PMC10376703 DOI: 10.3389/fendo.2023.1192629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Aim To report the global, regional, and national burden of type 2 diabetes mellitus (T2DM) in 2019, assess its trends in the past, and forecast its trends in the future. Methods The main data source was the Global Burden of Disease 2019 database. We assessed the changes in T2DM burden from 1990 to 2019 with joinpoint regression analysis. Age-period-cohort analysis was used to forecast the T2DM incidence and mortality rate from 2020 to 2034. Results The burden of T2DM has increased from 1990 to 2019 generally. The low-middle socio-demographic index (SDI) region had the highest increase in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) due to T2DM. Nationally, the increase in ASIR (r=0.151, p=0.046) and the decrease in ASMR (r=0.355, p<0.001) were positively correlated with SDIs. In 2019, the global ASIR, ASPR, ASMR, ASDR due to T2DM were 259.9 (95% UI 240.3-281.4), 5282.9 (95% UI 4853.6-5752.1), 18.5 (95% UI 17.2-19.7), and 801.5 (95% UI 55477000-79005200) per 100,000 population, respectively. Additionally, the ASIR (r=0.153, p=0.030) and ASPR (r=0.159, p=0.024) of T2DM were positively correlated with SDIs, while ASMR (r=-0.226, p=0.001) and ASDR (r=-0.171, p=0.015) due to T2DM were negatively correlated with SDIs. The ASIR was estimated to increase to 284.42, and ASMR was estimated to increase to 19.1 from 2030 to 2034, per 100,000 population. Conclusion Globally, the burden of T2DM has increased in the past and was forecast to continue increasing. Greater investment in T2DM prevention is needed.
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Affiliation(s)
- Junjun Ye
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yixi Wu
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Shuhui Yang
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Dan Zhu
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Fengwu Chen
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Jingxian Chen
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Endocrine and Metabolic Diseases, Longhu Hospital, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiaoxia Ji
- Department of Endocrine and Metabolic Diseases, Shantou Central Hospital, Shantou, Guangdong, China
| | - Kaijian Hou
- Department of Endocrine and Metabolic Diseases, Longhu Hospital, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- School of Public Health, Shantou University, Shantou, China
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Rakesh PS, Renjini BA, Mohandas S, Menon J, Numpelil M, Sreedevi A, Vasudevan B. Hypertension in urban slums of southern India: Burden, awareness, health seeking, control and risk factor profile. Indian Heart J 2023; 75:258-262. [PMID: 37328137 PMCID: PMC10421987 DOI: 10.1016/j.ihj.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 05/14/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India. METHODS Blood pressure of 5980 adults from 20 randomly selected slums were measured by door to door survey by trained nurses as a part of baseline assessment for a cluster randomised controlled trial. RESULTS Prevalence of hypertension was found to be 34.8% (95% CI 33.5-34.9). Among those with hypertension, 66.9% were aware of their hypertensive status, of which 75.8% were initiated on treatment for hypertension. Proportion of hypertensive in the population who had their blood pressure under control was 24.5%. Among hypertensive, 53% were obese, 25.1% had diabetes mellitus, 14% had history of hospitalisation for high blood pressure. Of them, 60.3% had a per capita salt consumption above 8 g/day and 47.5% of them reported sitting for more than 8 h on a usual day. Mean monthly out of pocket expenditure for treatment of hypertension was $9(Median $8, IQR $16). CONCLUSION One in three adults in urban slums of Kochi had hypertension. High rates of obesity, salt intake, physical inactivity prevails among the people with hypertension. Awareness, treatment initiation and control rate of hypertension are lower in urban slums as compared to non-slum urban areas. Slums require additional attention to ensure equitable and universal access to hypertension control.
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Affiliation(s)
- P S Rakesh
- Centre for Public Health, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India; Bernard Lown Scholar, Department of Global Health & Population, Harvard T H Chan School of Public Health, Boston, USA
| | - B A Renjini
- Amrita Urban Health Center; Executive MPH scholar, Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India.
| | - Sreelakshmi Mohandas
- Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
| | - Jaideep Menon
- Bernard Lown Scholar, Department of Global Health & Population, Harvard T H Chan School of Public Health, Boston, USA; Department of Preventive Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
| | | | - Aswathy Sreedevi
- Bernard Lown Scholar, Department of Global Health & Population, Harvard T H Chan School of Public Health, Boston, USA; Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
| | - Beena Vasudevan
- Centre for Public Health, Amrita Institute of Medical Sciences, Amrita Vishwavidhyapeetham, Kochi, India
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Bentué-Martínez C, Mimbrero MR, Zúñiga-Antón M. Spatial patterns in sociodemographic factors explain to a large extent the prevalence of hypertension and diabetes in Aragon (Spain). Front Med (Lausanne) 2023; 10:1016157. [PMID: 36760398 PMCID: PMC9905822 DOI: 10.3389/fmed.2023.1016157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction The global burden of multi-morbidity has become a major public health challenge due to the multi stakeholder action required to its prevention and control. The Social Determinants of Health approach is the basis for the establishment of health as a cross-cutting element of public policies toward enhanced and more efficient decision making for prevention and management. Objective To identify spatially varying relationships between the multi-morbidity of hypertension and diabetes and the sociodemographic settings (2015-2019) in Aragon (a mediterranean region of Northeastern Spain) from an ecological perspective. Materials and methods First, we compiled data on the prevalence of hypertension, diabetes, and sociodemographic variables to build a spatial geodatabase. Then, a Principal Component Analysis (PCA) was performed to derive regression variables, i.e., aggregating prevalence rates into a multi-morbidity component (stratified by sex) and sociodemographic covariate into a reduced but meaningful number of factors. Finally, we applied Geographically Weighted Regression (GWR) and cartographic design techniques to investigate the spatial variability of the relationships between multi-morbidity and sociodemographic variables. Results The GWR models revealed spatial explicit relationships with large heterogeneity. The sociodemographic environment participates in the explanation of the spatial behavior of multi-morbidity, reaching maximum local explained variance (R2) of 0.76 in men and 0.91 in women. The spatial gradient in the strength of the observed relationships was sharper in models addressing men's prevalence, while women's models attained more consistent and higher explanatory performance. Conclusion Modeling the prevalence of chronic diseases using GWR enables to identify specific areas in which the sociodemographic environment is explicitly manifested as a driving factor of multi-morbidity. This is step forward in supporting decision making as it highlights multi-scale contexts of vulnerability, hence allowing specific action suitable to the setting to be taken.
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Affiliation(s)
- Carmen Bentué-Martínez
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,*Correspondence: Carmen Bentué-Martínez, ✉
| | - Marcos Rodrigues Mimbrero
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain
| | - María Zúñiga-Antón
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain,Health Research Institute of Aragon, Zaragoza, Spain
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Mohamed SF, Macharia T, Asiki G, Gill P. A socio-ecological framework examination of drivers of blood pressure control among patients with comorbidities and on treatment in two Nairobi slums; a qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001625. [PMID: 36963082 PMCID: PMC10021823 DOI: 10.1371/journal.pgph.0001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/31/2023] [Indexed: 03/12/2023]
Abstract
Despite the known and effective treatments to control blood pressure, there is limited information on why there are high uncontrolled hypertension rates in urban slum settings. The aim of this paper is to explore the views of treated people with uncontrolled hypertension and other key stakeholders on the facilitators and barriers to blood pressure control among people with comorbid conditions in two Nairobi slums. The study was conducted in two Nairobi slums namely, Korogocho and Viwandani. This study used a qualitative methodology using interviews and focus group discussions. Barriers and facilitators to blood pressure control were explored using the Social Ecological Model (SEM) framework. A total of 57 participants were interviewed for this study. There were 31 in-depth interviews and two focus group discussions among participants with uncontrolled hypertension and with comorbidities. Additionally, 16 key informant interviews were conducted with healthcare providers and decision/policymakers. All interviews were audio-recorded, transcribed verbatim and analysed thematically. This study identified barriers and facilitators to blood pressure control among patients with uncontrolled hypertension at the patient/individual level, family and community level, health system level and at the policy level. High cost of hypertension medicines, the constant unavailability of medicines at the health facilities, unsupportive family and environment, poor medicines supply chain management, availability and use of guidelines were among the barriers reported. The results show that uncontrolled hypertension is a major public health issue in slums of Nairobi and they highlight barriers to blood pressure control at different levels of the socio-ecological model. These findings can be used to design holistic interventions to improve blood pressure control by addressing factors operating at multiple levels of the socio-ecological framework.
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Affiliation(s)
- Shukri F Mohamed
- Division of Health Sciences and the NIHR Global Health Research Unit on Improving Health in Slums, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Global Health and Population, Lown Scholars Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Paramjit Gill
- Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, United Kingdom
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