Hypertension

Adherence to treatment in rural Bangladesh - findings from a population-based study

Masuma Akter Khanam, Wietze Lindeboom, Tracey Lynn Perez Koehlmoos, Dewan Shamsul Alam, Louis Niessen, Abul Hasnat Milton

Research output: Contribution to journalArticle

Abstract

Background: Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh. Objective: This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh. Design: The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center forDiarrhealDiseaseResearch, Bangladesh (icddr, b):Matlab, Abhoynagar, and Mirsarai. Datawas collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment. Results: The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48-2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31-1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0.79, CI 0.64-0.97). Conclusions: Although village doctors diagnose 40% of hypertension, their treatments are associated with a higher rate of non-adherence to medication. The hypertension care practices of the village doctors should be explored by additional research. More emphasis should be placed on men, young people, and people with low education. Health programs focused on education regarding the importance of taking continuous antihypertensive medication is now of utmost importance.

Original languageEnglish (US)
Article number25028
JournalGlobal Health Action
Volume7
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Bangladesh
Hypertension
Antihypertensive Agents
Population
Medication Adherence
Odds Ratio
Confidence Intervals
Therapeutics
Education
Allied Health Personnel
Sex Education
Health
Comorbidity
Nurses
Demography
Interviews
Research

Keywords

  • Adherence to treatment
  • Bangladesh
  • Hypertension
  • Low-income country
  • Village doctors

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Medicine(all)

Cite this

Hypertension : Adherence to treatment in rural Bangladesh - findings from a population-based study. / Khanam, Masuma Akter; Lindeboom, Wietze; Koehlmoos, Tracey Lynn Perez; Alam, Dewan Shamsul; Niessen, Louis; Milton, Abul Hasnat.

In: Global Health Action, Vol. 7, No. 1, 25028, 2014.

Research output: Contribution to journalArticle

Khanam, Masuma Akter ; Lindeboom, Wietze ; Koehlmoos, Tracey Lynn Perez ; Alam, Dewan Shamsul ; Niessen, Louis ; Milton, Abul Hasnat. / Hypertension : Adherence to treatment in rural Bangladesh - findings from a population-based study. In: Global Health Action. 2014 ; Vol. 7, No. 1.
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AU - Alam, Dewan Shamsul

AU - Niessen, Louis

AU - Milton, Abul Hasnat

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N2 - Background: Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh. Objective: This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh. Design: The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center forDiarrhealDiseaseResearch, Bangladesh (icddr, b):Matlab, Abhoynagar, and Mirsarai. Datawas collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment. Results: The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48-2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31-1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0.79, CI 0.64-0.97). Conclusions: Although village doctors diagnose 40% of hypertension, their treatments are associated with a higher rate of non-adherence to medication. The hypertension care practices of the village doctors should be explored by additional research. More emphasis should be placed on men, young people, and people with low education. Health programs focused on education regarding the importance of taking continuous antihypertensive medication is now of utmost importance.

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