Period Prevalence and Sociodemographic Factors of Hypertension in Rural Maharashtra: A Cross-Sectional Study

Background:

Hypertension is most common cardiovascular disease and it account for large proportion of all cardiovascular deaths and disability worldwide.

Research Questions:

What is the level of prevalence of hypertension in rural area? What are the soociodemographic factors associated with hypertension?

Objectives:

To find out prevalence of hypertension in rural area.

Study Design:

A community-based cross-sectional study setting: Rural Health Training Centre Paithan, field practice area of govt. medical college Aurangabad, Maharashtra.

Participants:

1297 persons aged 19 years and above.

Study Period:

June 2005 to December 2006.

Materials and Methods:

A house-to-house survey was conducted by the author himself, interviewed the participants by systematic random sampling method, using pretested structured standard questionnaire. Two independent blood pressure (BP) readings were taken in sitting position by visiting each participant at their home. Hypertension was defined as systolic BP more than or equal to 140 mm of Hg or diastolic BP more than or equal to 90 mm of Hg or those individuals currently taking antihypertensive treatment.

Statistical Tests:

Percentiles, Chi Square test, Chi-Square for linear trend, multiple logistic regression analysis on SPSS software Version 10.

Results:

Overall prevalence of hypertension in the study subjects was 7.24%. Multiple logistic regression analysis identified various factors significantly associated with hypertension were age, sex, BMI, additional salt intake, smoking, DM, alcohol consumption, and higher socioeconomic status.

Conclusions:

The overall prevalence of hypertension in study subjects was 7.24%.     

Prevalence and Correlates of Metabolic Syndrome in the Adolescents of Rural Wardha

Background and Objective:

Metabolic syndrome is a major concern as a precursor of cardiometabolic diseases. The present study was designed to study the magnitude and correlates of metabolic syndrome among the adolescents of rural Wardha.

Materials and Methods:

A cross-sectional study was carried out among the adolescents (10-19 years) of Anji PHC. A sample of 405 was selected by random sampling from the sampling frame available with department of Community Medicine. We collected data about their sociodemographic variables and other cardiometabolic risk factors. Fasting blood sample was collected to measure lipid profile and blood glucose. Blood pressure and anthropometric measurements (height, weight, and waist circumference) were also taken.

Results:

Prevalence of metabolic syndrome using ATP-III criteria modified for adolescents was found to be 9.9% (95% CI: 7.3-13.1) in the study population and lower level of high-density lipoprotein (HDL) cholesterol was found with a prevalence of 58.3% (95% CI: 53.4-63.0). The prevalence of metabolic syndrome was found to be significantly (P < 0.05) associated with the presence of obesity and hypertension among family members.

Interpretation:

There was a moderately high prevalence of metabolic syndrome among rural adolescents.

Conclusion:

The early identification of cardiometabolic risk factors such as hypertension and obesity can help prevent metabolic syndrome, diabetes, and cardiovascular disease.     

The Senegal urban reproductive health initiative: a longitudinal program impact evaluation

Objectives

This paper presents the impact of key components of the Senegal Urban Reproductive Health Initiative, including radio, television, community-based activities, Muslim religious-leader engagement and service quality improvement on modern contraceptive use by all women and the sub-sample of poor women.

Factors Related to Attempted Suicide in Davanagere

Research Question:

What are the factors responsible for suicidal attempts?

Objectives:

To study the socio-demographic factors, methods and reasons for suicidal attempts.

Type of Study:

Cross-sectional study.

Setting:

Bapuji and C.G. Hospitals attached to J.J.M. Medical College, Davanagere.

Participants:

A total of 540 suicidal attempters admitted to emergency wards.

Methodology:

A pretested proforma was administered to the subjects relating the factors responsible for the attempt. The data thus obtained was compiled and analyzed.

Statistical Analysis:

Proportions, Z-test and Chi-square test.

Results:

In this study, 61.3% were males and 38.7% were females. Peak occurrence of suicidal attempts was found in the second and third decades (15-29 years). Hindus constituted about 94.6% of the total suicidal attempters. Almost half (52.2%) of the subjects had education below or up to matriculation and 83% of them were from the lower (classes IV and V) socio-economic groups. Agriculturists, housewives and unskilled workers represented 75% of the total subjects. Fifty-five percent of the subjects were from nuclear families and most (62.4%) of them were married; frequent mode of attempting suicides was by organo-phosphorus compounds (66.3%) followed by overdosage of tablets (17.8%). Common cause was family problem (27.2%) followed by illness (27%).     

Alcohol Use and STI among Men in India: Evidences from a National Household Survey

Background:

Alcohol use has been found to correlate with risky sexual behavior as well as with sexually transmitted infections (STI) among populations with high-risk behavior in India.

Objective:

To examine the correlates of alcohol use and its association with STI among adult men in India.

Materials and Methods:

Data from a national representative large-scale household sample survey in the country were used. It included information on sociodemographic characteristics and alcohol use as a part of substance use. Clinical as well laboratory testing was done to ascertain the STI.

Results:

The overall STI prevalence among adult males was found to be 2.5% (95% confidence interval (CI): 1.9–3.1). Over 26% adult men were found to have been using alcohol in the study population. It was higher among men who were illiterate and unskilled industrial workers/drivers. The men who consumed alcohol had higher prevalence of STI (3.6%; 95% CI: 2.9–5.1) than those who did not consume alcohol (2.1%; 95% CI: 1.5–2.6). The degree of association between alcoholism and STI was slightly reduced after adjusting for various sociodemographic characteristics (adjusted odds ratio: 1.5; 95% CI: 0.9–2.3; P=0.06).

Conclusions:

The findings of present study suggest integrating alcohol risk reduction into STI/HIV prevention programmes.     

Risk Factors for Community-Based Reports of Gastrointestinal,Respiratory, and Dermal Symptoms: Findings From a Cohort Study in Australia

Background

Although gastrointestinal (GI), respiratory, and dermal symptoms are common, few studies have conducted concurrent and comparative prospective analyses of risk factors for these 3 morbidity outcomes.

Methods

We used data from a community-based randomized controlled trial among 277 South Australian families to analyze GI (diarrhea, vomiting), respiratory (sore throat, runny nose, cough) and dermal (rash, generalized itch, dermal infection) symptoms.

Results

Log-binomial regression analysis revealed similar risks of GI (adjusted risk ratio [RR], 1.65; 95% CI, 1.05–2.58) and respiratory (RR, 1.68; 95% CI, 1.31–2.15) symptoms among childcare/kindergarten attendees. Swimming in public pools/spas in the current or previous week was associated with all 3 symptom complexes, conferring similar risk for each (RR for GI: 1.33; 95% CI, 0.99–1.77; respiratory: 1.20; 95% CI, 1.04–1.38; dermal: 1.41; 95% CI, 1.08–1.85). Pet ownership was not associated with symptoms. Household clustering of GI and respiratory symptoms was common, and clustering of respiratory symptoms correlated with number of individuals per household.

Conclusions

This simultaneous examination of risk factors for 3 health outcomes yielded new comparative data that are useful for developing prevention strategies.Key words: risk factors, respiratory symptoms, gastrointestinal symptoms, dermal symptoms, swimming, swimming pools, household clustering     

Prevalence and Risk Factors of Abuse among Community Dwelling Elderly of Guwahati City,Assam

Background:

In spite of tremendous impact on health, elder abuse is still an underreported and unrecognized issue.

Objectives:

To assess the prevalence of abuse among community dwelling elderly and to identify the various risk factors.

Materials and Methods:

This community-based cross-sectional study was conducted in 10 randomly selected wards of Guwahati city. A total of 331 elderly (60 years and above) were interviewed. Abuse was screened by Hwalek-Sengstock Elder Abuse Screening Test (H-S EAST).

Results:

The study revealed 9.31% prevalence. Neglect was the most common type of abuse reported. Age, sex, socioeconomic status, living status, and functional status were found to be significantly associated with abuse.

Conclusion:

Abuse is prevalent among elderly population.     

Tracking Progress Toward Elimination of Iodine Deficiency Disorders in Jharkhand, India

Research question:

What is the current status of Iodine Deficiency Disorders (IDD) in the state of Jharkhand?

Objectives:

(1) To determine the status of iodine deficiency in the state. (2) To determine the availability and cost of adequately iodized salt at the retail shops. (3) To study the perceptions of the community regarding iodine deficiency, salt and iodized salt.

Design:

A cross-sectional community-based survey.

Study setting:

Thirty clusters selected through the probability proportion to size (PPS) sampling in the state of Jharkhand.

Study participants:

Children aged 6-12 years, households, retail shopkeepers and opinion leaders.

Study tool:

Quantitative and qualitative methodology using a pretested questionnaire and focus group discussion used to carry out the community-based survey.

Results:

Total goiter rate (TGR) was 0.9%. Median urinary iodine level was 173.2 µg/L. The proportion of individuals with urinary iodine levels less than 100 and 50 µg/L were 26.4% and 10%, respectively. Slightly less than two-thirds (64.2%) of the households were found to be consuming adequately iodized salt as measured by titration (greater than 15 ppm). Iodized salt was available across the state and the cost varied between Re. 1 and Rs. 8 per kilogram. A common belief among the community was that iodized salt is equivalent to refined packet salt that is further equivalent to expensive salt.

Conclusion:

The results of the present survey show that the iodine nutrition in the state of Jharkhand is optimal. Considering that the consumption of adequately iodized salt should increase from 64.2% to the goal of more than 90%, sustained efforts are required in this place to consolidate the current coverage of adequately iodized salt and increase it to greater than 90%.     

Prevalence,Awareness, Treatment and Control of Diabetes Among Elderly Persons in an Urban Slum of Delhi

Background:

The increasing proportion of elderly persons is contributing to an increase in the prevalence of diabetes. The residents of urban slums are more vulnerable due to poverty and lack of access to health care.

Objective:

To estimate the prevalence of diabetes in elderly persons in an urban slum and to assess their awareness, treatment and control of this condition.

Materials and Methods:

All persons aged 60 years and above, residing in an urban slum of Delhi, were included in this cross-sectional community- based study. Data were collected on sociodemographic variables. The participants’ awareness and treatment of diabetes was recorded. Their fasting blood sugar was estimated using an automated glucometer. Diabetes was diagnosed if fasting blood glucose was ≥126 mg/dL, or if the participant was taking treatment for diabetes. Impaired fasting blood glucose was diagnosed if fasting blood glucose was 110–125 mg/dL.

Results:

Among the 474 participants studied, the prevalence of diabetes was estimated to be 18.8% (95% CI 15.3–21.5). It decreased with increasing age, and was higher among women. The prevalence of impaired fasting blood glucose was 19.8% (95% CI 16.3–23.7). It was higher among women. One-third of the diabetic participants were aware of their condition; two-thirds of these were on treatment and three-fourths of those on treatment had controlled fasting blood sugar level. The awareness, treatment and control were better among women.

Conclusions:

Diabetes is common among elderly persons in urban slums. Its magnitude and low awareness warrant effective public health interventions for their treatment and control.     

Behavioral and Psychosocial Risk Factors Associated with First and Recurrent Cystitis in Indian Women: A Case-control Study

Background:

The risk factors for urinary tract infections (UTIs) from developed countries are not applicable to women from developing world.

Objective:

To analyze the behavioral practices and psychosocial aspects pertinent to women in our region and assess their association with acute first time or recurrent UTI.

Materials and Methods:

Sexually active premenopausal women with their first (145) and recurrent (77) cystitis with Escherichia coli as cases and women with no prior history of UTI as healthy controls (257) were enrolled at a tertiary care hospital in India, between June 2011 and February 2013. Questionnaire-based data was collected from each participant through a structured face-to-face interview.

Results:

Using univariate and multivariate regression models, independent risk factors for the first episode of cystitis when compared with healthy controls were (presented in odds ratios [ORs] with its 95% confidence interval [CI]): Anal sex (OR = 3.68, 95% CI = 1.59-8.52), time interval between last sexual intercourse and current episode of UTI was <5 days (OR = 2.27, 95% CI = 1.22-4.23), use of cloth during menstrual cycle (OR = 2.36, 95% CI = 1.31-4.26), >250 ml of tea consumption per day (OR = 4.73, 95% CI = 2.67-8.38), presence of vaginal infection (OR = 3.23, 95% CI = 1.85-5.62) and wiping back to front (OR = 2.52, 95% CI = 1.45-4.38). Along with the latter three, history of UTI in a first-degree female relative (OR = 10.88, 95% CI = 2.41-49.07), constipation (OR = 4.85, 95% CI = 1.97-11.92) and stress incontinence (OR = 2.45, 95% CI = 1.18-5.06) were additional independent risk factors for recurrent cystitis in comparison to healthy controls.

Conclusion:

Most of the risk factors for initial infection are potentially modifiable but sufficient to also pose risk for recurrence. Many of the findings reflect the cultural and ethnic practices in our country.     

Association of Poultry Farms with Housefly and Morbidity: A Comparative Study from Raipur Rani, Haryana

Background:

Large poultry belt is located in the residential areas of rural Haryana in North India. Housefly problem has become a big nuisance in this area. Policy makers require evidence of the association of poultry farming with houseflies and its possible impact on the health of the population.

Materials and Methods:

Across-sectional two-group comparison study was conducted. Six villages within 3 km and another six villages beyond 5 km from any poultry farms were selected as the study and the control villages, respectively. We measured indoor and outdoor housefly density and family morbidity in the last 1 month and observed the poultry hygiene and manure management practices.

Findings:

The mean fly density was 1737 (95% CI 697-2778) houseflies in study villages compared to 100 (95% CI 2-197) houseflies in the control area. The mean all-cause morbidity was also significantly higher in study village families compared to control village families. Poultry farm hygiene and use of insecticides and growth regulators were inadequate.

Interpretation:

Poultry farms are associated strongly with high fly density and high infectious morbidity in this area.Monitoring and regulation for poultry manure management practices and insecticide use practices need to be strengthened.     

Evaluation of the Universal Immunization Program and Challenges in Coverage of Migrant Children in Haridwar,Uttarakhand, India

Background:

Studies show that immunization among migrant children is poor. India has a dropout rate of 17.7% between Bacillus Calmette-Guιrin (BCG) and measles (District Level Household Survey (DLHS)-3). Haridwar district had the highest dropout rate of 27.4% from BCG to diphtheria, pertussis, and tetanus (DPT) 3 (DLHS-3) in Uttarakhand. We evaluated the Universal Immunization Programme (UIP) among migrants in Haridwar in two blocks.

Materials and Methods:

We developed input, process, and output indicators on infrastructure, human resources, and service delivery. A facility, session site and cross-sectional survey of 180 children were done and proportions for various indicators were estimated. We determined factors associated with not taking vaccination using multivariate analysis.

Results:

We surveyed 11 cold chain centers, 25 subcenters, 14 sessions, and interviewed 180 mothers. Dropouts were supposed to be tracked using vaccination card counterfoils and tracking registers. The dropout rate from BCG to DPT3 was 30%. Lack of knowledge (adjusted odds ratio (AOR) 6.6,95% confidence interval (CI) 2.6–16.7), mother not being decision maker (AOR 4.0,95%CI 1.7–9.2), lack of contact by Accredited Social Health Activist (ASHA; AOR 3.0,95%CI 1.1–7.7), not being given four post-vaccination messages (AOR 7.7, 95% CI 2.9–20.2), and longer duration of stay in Haridwar (AOR 3.0 95% 1.9–7.6) were risk factors for nonimmunization. The reasons stated by mothers included lack of awareness of session site location (67%) and belief that child should only be vaccinated in their resident district (43%).

Conclusions:

There was low immunization coverage among migrants within adequate supervision, poor cold chain maintenance, and improper tracking of dropouts. Mobile immunization teams, prelisting of migrant children, and change in incentives of ASHAs for child tracking were needed. A monitoring plan for sessions and cold chain needed enforcement.     

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE:

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD:

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson''s Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS:

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION:

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.     

Work-related Neck Pain Among Desk Job Workers of Tertiary Care Hospital in New Delhi,India: Burden and Determinants

Background:

Work-related Neck Pain (WRNP) is a leading cause of disability and absenteeism. There is dearth of information about burden and determinants of WRNP in health facility setting in India.

Materials and Methods:

A cross-sectional study was carried out at tertiary care hospital in New Delhi. All Group C desk job workers involved in the administrative work were included in the study. Participants were screened for WRNP by using pretested semi-structured questionnaire. Detailed information on probable risk factors was collected among patients with WRNP. Neck examination by trained investigator was done. Work place assessment was done by using observation check-list using the recommendations of the ISO Standard (Ergonomic requirements for office work with visual display terminals). Crude and adjusted odds ratio was calculated with 95% confidence interval to understand the determinants of WRNP.

Results:

In total, 441 participants were included in the study. Of them, 58% were males. Majority of participants aged between31-50 years. One-year prevalence of neck pain and WRNP was reported as 43.3%, (95% CI 38.7%-47.9%) and 28.3%, (95% CI 24.3%-32.7%) respectively. On multivariate analysis, female gender (OR-2.0 95% CI) and poor perception of breaks during working hours (OR-2.4 95% CI), along with work place related factors such as posture (OR-5.4 95% CI) and height of the screen (<10 cms) (OR-2.6) were identified as independent determinants of WRNP.

Conclusion:

High one-year prevalence of WRNP was reported among desk job workers. Burden of WRNP was reported more among females as compared to males. Most common factor identified was Computer use for more than 4-6 hours was most important predictor of WRNP followed by work related factors such as height of screen and posture are associated with WRNP.     

Isolated Systolic Hypertension and its Determinants - A Cross-sectional Study in the Adult Population of Lucknow District in North India

Objectives:

1) To determine the prevalence of isolated systolic hypertension (ISH) in the adult population of Lucknow district. 2) To study the determinants of ISH especially the relationship with age.

Materials and Methods:

A community-based cross-sectional study was conducted in four randomly selected areas of Lucknow district. A total of 800 subjects, aged 20 years and above, 400 from urban and 400 from rural area of Lucknow district were included in the study. The statistical tools used for analysis were Pearson''s Chi-square test and multiple logistic regression.

Results:

The prevalence of ISH according to JNC-7 criteria was 4.3%, which was 5.1% in men and 3.6% in women. A significant increase in the prevalence of ISH was seen with an increase in age. Multivariate logistic regression analysis of the determinants showed that age, BMI and smoking were significant independent risk factors of ISH.

Conclusions:

Given the risk of cardiovascular disease associated with ISH, the findings of this study emphasize the need for further research to document the impact of modifiable risk factors of ISH and the effect of hypertension screening and specific health promotion in bringing down the burden of ISH and related cardiovascular morbidity.     

Determinants of Overweight and Obesity in Affluent Adolescent in Surat City, South Gujarat region, India

Background:

Obesity is a major global burden. Low levels of physical activity, TV watching, and dietary pattern are modifiable risk factors for overweight and obesity in adolescent.

Objective:

The objective of this study was to determine risk factors for overweight and obesity among affluent adolescent, in Surat city in south Gujarat.

Design:

Cross sectional from July 2009 to April 2010.

Setting:

Two private schools with tuition fees more than Rs. 2000 per month, were selected randomly using a random table.

Participants:

The participants were adolescents, 12 to 15 years of age.

Data collection:

Pre-designed and pre-tested questionnaire was used to elicit the information about dietary history and physical activity.

Measurement:

Height and weight was measured and BMI was calculated. Overweight and obesity were assessed by BMI for age. Student who had BMI for age <85^th and <95^th percentile of reference population were classified as overweight and BMI for age <95^th percentile of reference population were classified as obese (IAP Growth Monitoring Guidelines for Children from Birth to 18 Year).

Result:

The overall prevalence of obesity and overweight was 6.55% and 13.9% (boys: 6.7% and 15.1%; girls 6.4% and 13.35%). Final model of multiple logistic regression analysis showed that important determinants of overweight and obesity were low levels of physical activity, watching television or playing computer games, and consuming junk foods, snacks and carbonated drinks.

Conclusion:

The magnitude of obesity and overweight among affluent adolescent of Surat city was found to be 6.55% and 13.9%, respectively. Low level of physical activity, watching TV or playing computer games, and dietary pattern predisposed the adolescent to overweight/obesity.     

Family History of Hypertension and the Risk of Overweight in Japanese Children: Results From the Toyama Birth Cohort Study

Background

Family history can be a useful screening tool in the assessment and management of the risk for noncommunicable disease. However, no data have yet been reported on family history of hypertension and its effect on children’s overweight.

Methods

A total of 7249 Japanese children enrolled in the Toyama Birth Cohort Study were followed until 2002 (mean age: 12.3 years). Family history of hypertension was ascertained by asking children’s parents whether children’s biological parents or grandparents had doctor-diagnosed hypertension. Child overweight was defined according to international criteria for age- and sex-specific body mass index.

Results

The prevalence of child overweight at age 12 was 21.7% for males and 15.9% for females. After adjusting for family structure, parental employment status, and lifestyle factors, we found that a maternal family history of hypertension was positively associated with the risk of child overweight at age 12 (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 1.04–1.39). The adjusted OR increased from 1.16 (95% CI 0.99–1.35) to 1.42 (95% CI 1.04–1.92) to 4.75 (95% CI 1.35–16.69) as the number of family members with hypertension increased from 1 to 2 to 3, respectively. There was no significant difference in the prevalence of overweight between children with a paternal family history of hypertension and those without.

Conclusions

A maternal family history of hypertension was positively associated with the risk of overweight in children at age 12.Key words: family history, hypertension, overweight, the Toyama study     

Interaction of Sleep Duration and Sleep Quality on Hypertension Prevalence in Adult Chinese Males

Background

Previous studies demonstrated conflicting results about the association of sleep duration and hypertension. Given the potential relationship between sleep quality and hypertension, this study aimed to investigate the interaction of self-reported sleep duration and sleep quality on hypertension prevalence in adult Chinese males.

Methods

We undertook a cross-sectional analysis of 4144 male subjects. Sleep duration were measured by self-reported average sleep time during the past month. Sleep quality was evaluated using the standard Pittsburgh Sleep Quality Index. Hypertension was defined as blood pressure level ≥140/90 mm Hg or current antihypertensive treatment. The association between hypertension prevalence, sleep duration, and sleep quality was analyzed using logistic regression after adjusting for basic cardiovascular characteristics.

Results

Sleep duration shorter than 8 hours was found to be associated with increased hypertension, with odds ratios and 95% confidence intervals (CIs) of 1.25 (95% CI, 1.03–1.52) for 7 hours, 1.41 (95% CI, 1.14–1.73) for 6 hours, and 2.38 (95% CI, 1.81–3.11) for <6 hours. Using very good sleep quality as the reference, good, poor, and very poor sleep quality were associated with hypertension, with odds ratios of 1.20 (95% CI, 1.01–1.42), 1.67 (95% CI, 1.32–2.11), and 2.32 (95% CI, 1.67–3.21), respectively. More importantly, further investigation of the association of different combinations of sleep duration and quality in relation to hypertension indicated an additive interaction.

Conclusions

There is an additive interaction of poor sleep quality and short sleep duration on hypertension prevalence. More comprehensive measurement of sleep should be performed in future studies.Key words: sleep duration, sleep quality, hypertension     

Health system strengthening and hypertension awareness,treatment and control: data from the China Health and Retirement Longitudinal Study

Objective

To monitor hypertension prevalence, awareness, treatment and control in China two to three years after major reform of the health system.

Methods

Data from a national survey conducted in 2011–2012 among Chinese people aged 45 years or older – which included detailed anthropometric measurements – were used to estimate the prevalence of hypertension and the percentages of hypertensive individuals who were unaware of, receiving no treatment for, and/or not controlling their hypertension well. Modified Poisson regressions were used to estimate relative risks (RRs).

Findings

At the time of the survey, nearly 40% of Chinese people aged 45 years or older had a hypertensive disorder. Of the individuals with hypertension, more than 40% were unaware of their condition, about 50% were receiving no medication for it and about 80% were not controlling it well. Compared with the other hypertensive individuals, those who were members of insurance schemes that covered the costs of outpatient care were more likely to be aware of their hypertension (adjusted RR, aRR: 0.737; 95% confidence interval, CI: 0.619–0.878) to be receiving treatment for it (aRR: 0.795; 95% CI: 0.680–0.929) and to be controlling it effectively (aRR: 0.903; 95% CI: 0.817–0.996).

Conclusion

In China many cases of hypertension are going undetected and untreated, even though the health system appears to deliver effective care to individuals who are aware of their hypertension. A reduction in the costs of outpatient care to patients would probably improve the management of hypertension in China.     

Retrospective comparative evaluation of the lasting impact of a community-based primary health care programme on under-5 mortality in villages around Jamkhed, India

Objective

To conduct the first rigorous evaluation of the long-term effect of the Comprehensive Rural Health Project on childhood mortality in rural Maharashtra.

Methods

Background information and full birth histories were collected by conducting household surveys and interviewing women. Control villages resembling project villages in terms of population size were randomly selected from an area enclosed by two ellipses centred around, but not including, the project area. An equal number of villages and approximately equal numbers of households and women were randomly sampled from both areas. Cox models with robust standard errors were used to compare the hazard of death among children under 5 years of age in project and control villages.

Findings

The hazard of death was reduced by 30% (95% confidence interval, CI: 6% to 48%) after the neonatal period in the project villages compared with control villages after adjustment for caste and religion of subjects and for availability of irrigation in the villages. During the neonatal period there was an increase of 3% in the hazard of death, but it was not statistically significant (95% CI: −18% to 29%).

Conclusion

Our methods provide useful tools for evaluating long-running community-based primary health care programmes. Our findings add to the growing debate on the long-term sustainability of community-based interventions designed to reduce child mortality.