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1.  An Endogenously Produced Fragment of Cardiac Myosin Binding Protein C is Pathogenic and Can Lead to Heart Failure 
Circulation research  2013;113(5):10.1161/CIRCRESAHA.113.301225.
Rationale
A stable 40 kD fragment is produced from cardiac myosin binding protein-C (cMyBP-C) when the heart is stressed, using a stimulus such as ischemia reperfusion injury. Elevated levels of the fragment can be detected in both the diseased mouse and human heart but its ability to interfere with normal cardiac function in the intact animal is unexplored.
Objective
To understand the potential pathogenicity of the 40 kD fragment in vivo and to investigate the molecular pathways that could be targeted for potential therapeutic intervention.
Methods and Results
We generated cardiac myocyte-specific transgenic mice (TG) using a Tet-Off inducible system to permit controlled expression of the 40 kD fragment in cardiomyocytes. When 40 kD protein expression is induced by crossing the responder animals with tetracycline transactivator (tTA) mice under conditions where substantial quantities approximating those observed in disease hearts are reached, the double TG (DTG) mice subsequently develop sarcomere dysgenesis, altered cardiac geometry and the heart fails between 3 to 17 weeks of age. The induced DTG mice developed cardiac hypertrophy with myofibrillar disarray and fibrosis, and activation of pathogenic MEK-ERK pathways. Inhibition of MEK-ERK signaling was achieved by injection of the MAPK/ERK kinase inhibitor U0126. The drug effectively improved cardiac function, decreased fibrosis, normalized heart size and increased probability of survival.
Conclusion
These results suggest that the 40 kD cMyBP-C fragment, which is produced at elevated levels during human cardiac disease, is a pathogenic fragment that is sufficient to cause hypertrophic cardiomyopathy and heart failure.
doi:10.1161/CIRCRESAHA.113.301225
PMCID: PMC3835189  PMID: 23852539
Myosin-binding protein-C; cardiomyopathy; mitogen-activated protein kinase
2.  Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh 
Background
Antenatal Care (ANC) during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples.
Methods
This study was conducted within the Health and Demographic Surveillance System (HDSS) of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA) where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH) program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006) and after (2008–2009) implementation of the MNCH program.
Results
Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR) 1.91; 95% confidence intervals (CI): 1.50, 2.42) among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78) to non-significance (OR 0.81; 95% CI: 0.65, 1.01), when comparing cohorts before and after the MNCH program initiation (Sobel test of mediation P < 0.001).
Conclusions
ANC visits are associated with increased uptake of facility-based delivery and improved perinatal survival in the icddr,b SA. Further testing of the icddr,b approach to simultaneously improving quality of ANC and facility delivery care is needed in the existing health system in Bangladesh and in other low-income countries to maximize health benefits to mothers and newborns.
doi:10.1186/1471-2393-12-111
PMCID: PMC3495045  PMID: 23066832
3.  Ageing and adult health status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration 
Global Health Action  2010;3:10.3402/gha.v3i0.5302.
Background
Globally, ageing impacts all countries, with a majority of older persons residing in lower- and middle-income countries now and into the future. An understanding of the health and well-being of these ageing populations is important for policy and planning; however, research on ageing and adult health that informs policy predominantly comes from higher-income countries. A collaboration between the WHO Study on global AGEing and adult health (SAGE) and International Network for the Demographic Evaluation of Populations and Their Health in developing countries (INDEPTH), with support from the US National Institute on Aging (NIA) and the Swedish Council for Working Life and Social Research (FAS), has resulted in valuable health, disability and well-being information through a first wave of data collection in 2006–2007 from field sites in South Africa, Tanzania, Kenya, Ghana, Viet Nam, Bangladesh, Indonesia and India.
Objective
To provide an overview of the demographic and health characteristics of participating countries, describe the research collaboration and introduce the first dataset and outputs.
Methods
Data from two SAGE survey modules implemented in eight Health and Demographic Surveillance Systems (HDSS) were merged with core HDSS data to produce a summary dataset for the site-specific and cross-site analyses described in this supplement. Each participating HDSS site used standardised training materials and survey instruments. Face-to-face interviews were conducted. Ethical clearance was obtained from WHO and the local ethical authority for each participating HDSS site.
Results
People aged 50 years and over in the eight participating countries represent over 15% of the current global older population, and is projected to reach 23% by 2030. The Asian HDSS sites have a larger proportion of burden of disease from non-communicable diseases and injuries relative to their African counterparts. A pooled sample of over 46,000 persons aged 50 and over from these eight HDSS sites was produced. The SAGE modules resulted in self-reported health, health status, functioning (from the WHO Disability Assessment Scale (WHODAS-II)) and well-being (from the WHO Quality of Life instrument (WHOQoL) variables). The HDSS databases contributed age, sex, marital status, education, socio-economic status and household size variables.
Conclusion
The INDEPTH WHO–SAGE collaboration demonstrates the value and future possibilities for this type of research in informing policy and planning for a number of countries. This INDEPTH WHO–SAGE dataset will be placed in the public domain together with this open-access supplement and will be available through the GHA website (www.globalhealthaction.net) and other repositories. An improved dataset is being developed containing supplementary HDSS variables and vignette-adjusted health variables. This living collaboration is now preparing for a next wave of data collection.
doi:10.3402/gha.v3i0.5302
PMCID: PMC2957285  PMID: 20959878
ageing; survey methods; public health; burden of disease; demographic transition; disability; well-being; health status; INDEPTH WHO-SAGE
4.  Health inequalities among older men and women in Africa and Asia: evidence from eight Health and Demographic Surveillance System sites in the INDEPTH WHO-SAGE Study 
Global Health Action  2010;3:10.3402/gha.v3i0.5420.
Background
Declining rates of fertility and mortality are driving demographic transition in all regions of the world, leading to global population ageing and consequently changing patterns of global morbidity and mortality. Understanding sex-related health differences, recognising groups at risk of poor health and identifying determinants of poor health are therefore very important for both improving health trajectories and planning for the health needs of ageing populations.
Objectives
To determine the extent to which demographic and socio-economic factors impact upon measures of health in older populations in Africa and Asia; to examine sex differences in health and further explain how these differences can be attributed to demographic and socio-economic determinants.
Methods
A total of 46,269 individuals aged 50 years and over in eight Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network were studied during 2006–2007 using an abbreviated version of the WHO Study on global AGEing and adult health (SAGE) Wave I instrument. The survey data were then linked to longitudinal HDSS background information. A health score was calculated based on self-reported health derived from eight health domains. Multivariable regression and post-regression decomposition provide ways of measuring and explaining the health score gap between men and women.
Results
Older men have better self-reported health than older women. Differences in household socio-economic levels, age, education levels, marital status and living arrangements explained from about 82% and 71% of the gaps in health score observed between men and women in South Africa and Kenya, respectively, to almost nothing in Bangladesh. Different health domains contributed differently to the overall health scores for men and women in each country.
Conclusion
This study confirmed the existence of sex differences in self-reported health in low- and middle-income countries even after adjustments for differences in demographic and socio-economic factors. A decomposition analysis suggested that sex differences in health differed across the HDSS sites, with the greatest level of inequality found in Bangladesh. The analysis showed considerable variation in how differences in socio-demographic and economic characteristics explained the gaps in self-reported health observed between older men and women in African and Asian settings. The overall health score was a robust indicator of health, with two domains, pain and sleep/energy, contributing consistently across the HDSS sites. Further studies are warranted to understand other significant individual and contextual determinants to which these sex differences in health can be attributed. This will lay a foundation for a more evidence-based approach to resource allocation, and to developing health promotion programmes for older men and women in these settings.
doi:10.3402/gha.v3i0.5420
PMCID: PMC2958198  PMID: 20967141
ageing; survey methods; public health; burden of disease; demographic transition; disability; well-being; health status; INDEPTH WHO-SAGE
5.  Socio-demographic differentials of adult health indicators in Matlab, Bangladesh: self-rated health, health state, quality of life and disability level 
Global Health Action  2010;3:10.3402/gha.v3i0.4618.
Background
Mortality has been declining in Bangladesh since the mid- twentieth century, while fertility has been declining since the late 1970s, and the country is now passing through the third stage of demographic transition. This type of demographic transition has produced a huge youthful population with a growing number of older people. For assessing health among older people, this study examines self-rated health, health state, quality of life and disability level in persons aged 50 and over.
Data and methods
This is a collaborative study between the World Health Organization Study on global AGEing and adult health and the International Network for the Demographic Evaluation of Populations and Their Health in developing countries which collected data from eight countries. Two sources of data from the Matlab study area were used: health indicator data collected as a part of the study, together with the ongoing Health and Demographic Surveillance System (HDSS) data. For the survey, a total of 4,000 randomly selected people aged 50 and over (HDSS database) were interviewed. The four health indicators derived from these data are self-rated health (five categories), health state (eight domains), quality of life (eight items) and disability level (12 items). Self-rated health was coded as dummy while scores were calculated for the rest of the three health indicators using WHO-tested instruments.
Results
After controlling for all the variables in the regression model, all four indicators of health (self-rated health, health state, quality of life and disability level) documented that health was better for males than females, and health deteriorates with increasing age. Those people who were in current partnerships had generally better health than those who were single, and better health was associated with higher levels of education and asset score.
Conclusions
To improve the health of the population it is important to know health conditions in advance rather than just before death. This study finds that all four health indicators vary by socio-demographic characteristics. Hence, health intervention programmes should be targeted to those who suffer and are in the most need, the aged, female, single, uneducated and poor.
doi:10.3402/gha.v3i0.4618
PMCID: PMC2958199  PMID: 20975960
adult health; self-rated health; health state; quality of life; disability; Matlab; Bangladesh; INDEPTH WHO-SAGE
6.  Patterns of alcohol consumption in diverse rural populations in the Asian region 
Global Health Action  2009;2:10.3402/gha.v2i0.2017.
Background
Alcohol abuse, together with tobacco use, is a major determinant of health and social well-being, and is one of the most important of 26 risk factors comparatively assessed in low and middle income countries, surpassed only by high blood pressure and tobacco.
Objectives
The alcohol consumption patterns and the associations between consumption of alcohol and socio-demographic and cultural factors have been investigated in nine rural Health and Demographic Surveillance System (HDSS) located in five Asian countries.
Methods
The information was collected from multiple study sites, with sample sizes of sufficient size to measure trends in age and sex groups over time. Adopting the WHO STEPwise approach to Surveillance (WHO STEPS), stratified random sampling (in each 10-year interval) from the HDSS sampling frame was undertaken. Information regarding alcohol consumption and demographic indicators were collected using the WHO STEPwise standard surveillance form. The data from the nine HDSS sites were merged and analysed using STATA software version 10.
Results
Alcohol was rarely consumed in five of the HDSS (four in Bangladesh, and one in Indonesia). In the two HDSS in Vietnam (Chililab, Filabavi) and one in Thailand (Kanchanaburi), alcohol consumption was common in men. The mean number of drinks per day during the last seven days, and prevalence of at-risk drinker were found to be highest in Filabavi. The prevalence of female alcohol consumption was much smaller in comparison with men. In Chililab, people who did not go to school or did not complete primary education were more likely to drink in comparison to people who graduated from high school or university.
Conclusions
Although uncommon in some countries because of religious and cultural practices, alcohol consumption patterns in some sites were cause for concern. In addition, qualitative studies may be necessary to understand the factors influencing alcohol consumption levels between the two sites in Vietnam and the site in Thailand in order to design appropriate interventions.
doi:10.3402/gha.v2i0.2017
PMCID: PMC2785538  PMID: 20027253
alcohol consumption; risk factor surveillance; INDEPTH; Asia; WHO STEPS
7.  Clustering of chronic non-communicable disease risk factors among selected Asian populations: levels and determinants 
Global Health Action  2009;2:10.3402/gha.v2i0.1986.
Background
The major chronic non-communicable diseases (NCDs) operate through a cluster of common risk factors, whose presence or absence determines not only the occurrence and severity of the disease, but also informs treatment approaches. Primary prevention based on mitigation of these common risk factors through population-based programmes is the most cost-effective approach to contain the emerging epidemic of chronic NCDs.
Objectives
This study was conducted to explore the extent of risk factors clustering for the major chronic NCDs and its determinants in nine INDEPTH Health and Demographic Surveillance System (HDSS) sites of five Asian countries.
Design
Data originated from a multi-site chronic NCD risk factor prevalence survey conducted in 2005. This cross-sectional survey used a standardised questionnaire developed by the WHO to collect core data on common risk factors such as tobacco use, intake of fruits and vegetables, physical inactivity, blood pressure levels, and body mass index. Respondents included randomly selected sample of adults (25–64 years) living in nine rural HDSS sites in Bangladesh, India, Indonesia, Thailand, and Vietnam.
Results
Findings revealed a substantial proportion (>70%) of these largely rural populations having three or more risk factors for chronic NCDs. Chronic NCD risk factors clustering was associated with increasing age, being male, and higher educational achievements. Differences were noted among the different sites, both between and within country.
Conclusions
Since there is an extensive clustering of risk factors for the chronic NCDs in the populations studied, the interventions also need to be based on a comprehensive approach rather than on a single factor to forestall its cumulative effects which occur over time. This can work best if it is integrated within the primary health care system and the HDSS can be an invaluable epidemiological resource in this endeavor.
doi:10.3402/gha.v2i0.1986
PMCID: PMC2785214  PMID: 20027260
chronic NCDs; risk factors surveillance; clustering; INDEPTH; Asia; WHO STEPS
8.  Fruit and vegetable consumption in rural adults population in INDEPTH HDSS sites in Asia 
Global Health Action  2009;2:10.3402/gha.v2i0.1988.
Background
Low fruit and vegetable consumption is among the top 10 risk factors contributing to mortality worldwide. WHO/FAO recommends intake of a minimum of 400 grams (or five servings) of fruits and vegetables per day for the prevention of chronic diseases such as heart diseases, cancer, diabetes, and obesity.
Objective
This paper examines the fruit and vegetable consumption patterns and the prevalence of inadequate fruit and vegetable consumption (less than five servings a day) among the adult population in rural surveillance sites in five Asian countries.
Data and methods
The analysis is based on data from a 2005 cross-site study on non-communicable disease risk factors which was conducted in nine Asian INDEPTH Health and Demographic Surveillance System (HDSS) sites. Standardised protocols and methods following the WHO STEPwise approach to risk factor surveillance were used. The total sample was 18,429 adults aged 25–64 years. Multivariate logistic regression analysis was performed to assess the association between socio-demographic factors and inadequate fruit and vegetable consumption.
Results
Inadequate fruit and vegetable consumption was common in all study sites. The proportions of inadequate fruit and vegetable consumption ranged from 63.5% in men and 57.5% in women in Chililab HDSS in Vietnam to the whole population in Vadu HDSS in India, and WATCH HDSS in Bangladesh. Multivariate logistic regression analysis in six sites, excluding WATCH and Vadu HDSS, showed that being in oldest age group and having low education were significantly related to inadequate fruit and vegetable consumption, although the pattern was not consistent through all six HDSS.
Conclusions
Since such a large proportion of adults in Asia consume an inadequate amount of fruits and vegetables, despite of the abundant availability, education and behaviour change programmes are needed to promote fruit and vegetable consumption. Accurate and useful information about the health benefits of abundant fruit and vegetable consumption should be widely disseminated.
doi:10.3402/gha.v2i0.1988
PMCID: PMC2785138  PMID: 20027259
fruit; vegetables; inadequate consumption; risk factors surveillance; non-communicable diseases; INDEPTH; WHO STEPS
9.  Self-reported use of tobacco products in nine rural INDEPTH Health and Demographic Surveillance Systems in Asia 
Global Health Action  2009;2:10.3402/gha.v2i0.1997.
Background
Tobacco use is the most preventable cause of premature death and disability. Even though tobacco use is common in many Asian countries, reliable and comparable data on the burden imposed by tobacco use in this region are sparse, and surveillance systems to track trends are in their infancy.
Objective
To assess and compare the prevalence of tobacco use and its associated factors in nine selected rural sites in five Asian countries.
Methods
Tobacco use among 9,208 men and 9,221 women aged 25–64 years in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries of the INDEPTH Network were examined in 2005 as part of a broader survey of the major chronic non-communicable disease risk factors. All sites used a standardised protocol based on the WHO STEPS approach to risk factor surveillance; expanded questions of local relevance, including chewing tobacco, were also included. Multivariable logistic regression was used to assess demographic factors associated with tobacco use.
Results
Tobacco use, whether smoked or chewed, was common across all sites with some notable variations. More than 50% of men smoked daily; this applied to almost all age groups. Few women smoked daily in any of the sites. However, women were more likely to chew tobacco than men in all sites except Vadu in India. Tobacco use in men began in late adolescence in most of the sites and the number of cigarettes smoked daily ranged from three to 15. Use of both forms of tobacco, smoked and chewed, was associated with age, gender and education. Men were more likely to smoke compared to women, smoking increased with age in the four sites in Bangladesh but not in other sites and with low level of education in all the sites.
Conclusion
The prevalence of tobacco use, regardless of the type of tobacco, was high among men in all of these rural populations with tobacco use started during adolescence in all HDSS sites. Innovative communication strategies for behaviour change targeting adolescents in schools and adult men and women at work or at home, may create a mass awareness about adverse health consequences of tobacco smoking or chewing tobacco. Such efforts, to be effective, however, need to be supported by strong legislation and leadership. Only four of the five countries involved in this multi-site study have ratified the Framework Convention on Tobacco Control, and even where it has been ratified, implementation is uneven.
doi:10.3402/gha.v2i0.1997
PMCID: PMC2785137  PMID: 20027256
tobacco smoking; tobacco chewing; cigarette; risk factor surveillance; INDEPTH Network; WHO STEPS
10.  Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries 
Global Health Action  2009;2:10.3402/gha.v2i0.1985.
Background
Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases (NCDs) such as stroke and heart disease. In high income countries, studies have measured the population level of physical activity, but comparable data are lacking from most low and middle-income countries.
Objective
To assess the level of physical inactivity and its associated factors in selected rural sites in five Asian countries.
Methods
The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network in Bangladesh, India, Indonesia, Thailand, and Vietnam. Using the methodology from the WHO STEPwise approach to Surveillance (STEPS), about 2,000 men and women aged 25–64 years were selected randomly from each HDSS sampling frame. Physical activity at work and during leisure time, and on travel to and from places, was measured using the Global Physical Activity Questionnaire version 2 (GPAQ2). The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week, and was used to determine the level of physical activity. Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity.
Results
The prevalence of physical inactivity ranged from 13% in Chililab HDSS in Vietnam to 58% in Filabavi HDSS in Vietnam. The majority of men were physically active, except in the two sites in Vietnam. Most of the respondents walked or cycled for at least 10 minutes to get from place to place, with some exceptions in the HDSSs in Indonesia and Thailand. The majority of respondents, both men and women, were inactive during their leisure time. Women, older age, and high level of education were significantly associated with physical inactivity.
Conclusion
This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive. The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity. Considering the importance of physical activity in improving health and preventing chronic NCDs, efforts need to be made to promote physical activity particularly among women, older people, and high education groups in these settings.
doi:10.3402/gha.v2i0.1985
PMCID: PMC2785136  PMID: 20027261
chronic non-communicable diseases; risk factors surveillance; physical inactivity; low and middle-income countries; Asia; WHO STEPS
11.  Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle-income countries 
Global Health Action  2009;2:10.3402/gha.v2i0.1984.
Background
Chronic non-communicable diseases (NCDs) are the leading cause of morbidity, mortality, and disability worldwide. More than 80% of chronic disease deaths occur in low-income and middle-income countries. Epidemiological data on the burden of chronic NCD and the risk factors which predict them are lacking in most low-income countries. The INDEPTH Network (http://www.indepth-network.org) which includes the Health and Demographic Surveillance System (HDSS) with many surveillance sites in low-middle income countries provided an opportunity to establish surveillance of the major chronic NCD risk factors in 2005 using a standardised approach.
Objective
This paper presents the conceptual framework and research design of the chronic NCD risk factor surveillance within nine rural INDEPTH HDSS settings in Asia.
Methods
This multi-site study was designed as a baseline cross-sectional survey with sufficient sample size to measure trends over time. In each of nine HDSS sites in five Asian countries, a sample of 2,000 men and women aged 25–64 years, using the WHO STEPwise approach to Surveillance (http://who.int/chp/steps), was selected using stratified random sampling (in each 10-year interval) from the HDSS sampling frame.
Results
A total of 18,494 men and women from the nine sites were interviewed with an overall response rate of 98%. The major NCDs risk factors included self-reported information on tobacco and alcohol consumption, fruit and vegetable intake, physical activity patterns, and measured body weight, height, waist circumference, and blood pressure. A series of training sessions were conducted for research scientists, supervisors, and surveyors in each site. Data quality was ensured through spot check, re-check, and data validation procedures, including accuracy and completeness of data obtained. Standardised data entry programme, created using the EPIDATA software, was used to ensure uniform database structure across sites. The data merging and analysis were done using STATA Version 10.
Conclusion
This multi-site study confirmed the feasibility of conducting chronic NCD risk factor surveillance in the low and middle-income settings by integrating the chronic NCDs risk factor surveillance into an existing HDSS data collection and management setting. This collaborative work has provided reliable epidemiological data as a basis for developing chronic NCD prevention and control activities.
doi:10.3402/gha.v2i0.1984
PMCID: PMC2785135  PMID: 20027262
chronic non-communicable diseases; risk factor surveillance; INDEPTH Network; low-middle income countries; WHO STEPS
12.  Blood pressure in adult rural INDEPTH population in Asia 
Global Health Action  2009;2:10.3402/gha.v2i0.2010.
Introduction
High blood pressure (BP) is a well-known major risk factor for cardiovascular diseases and is a leading contributor to cardiovascular mortality and morbidity worldwide. Reliable population-based BP data from low–middle income countries are sparse.
Objective
This paper reports BP distributions among adults in nine rural populations in five Asian countries and examines the association between high BP and associated risk factors, including gender, age, education, and body mass index.
Methods
A multi-site cross-sectional study of the major non-communicable disease risk factors (tobacco and alcohol use, fruit and vegetable intake, physical activity patterns) was conducted in 2005 in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries, all part of the INDEPTH Network. In addition to the self-report questions on risk factors, height and weight, and BP were measured during household visits using standard protocols of the WHO STEPwise approach to Surveillance.
Results
In all the study sites (except among men and women in WATCH and among women in Chililab), the mean levels of systolic BP were greater than the optimal threshold (115 mmHg). A considerable proportion of the study populations – especially those in the HDSS in India, Indonesia, and Thailand – had high BP (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or on treatment with BP medications). A more conservative definition of high BP (systolic BP ≥ 160 mmHg or diastolic BP ≥ 100 mmHg) substantially reduced the prevalence rate. The marked differences in the proportion of the populations on high BP medication (range between 0.6 and 10.8%) raised problems in comparing the prevalence of high BP across sites when using the commonly used definition of high BP as in this study. In the four HDSS in Bangladesh, women had a higher prevalence of high BP than men; the reverse was true in the other sites (Chililab, Filabavi in Vietnam; Kanchanaburi, Thailand; and Vadu, India) where men experienced higher prevalence than women. Overweight and obesity were significantly associated with high BP, with odds ratio ranging from two in Chililab to five in Filabavi (both in Vietnam HDSS).
Conclusion
The patterns of BP in these nine cross-sectional surveys were complex, reflecting the fact that the Asian countries are at different stages of the epidemiological transition. Actions to prevent the rise of BP levels are urgently required. An emphasis should be placed on cost-effective interventions to reduce salt consumption in the population as an immediate priority.
doi:10.3402/gha.v2i0.2010
PMCID: PMC2785103  PMID: 20027254
high blood pressure; hypertension; risk factor surveillance; socioeconomic; INDEPTH; WHO STEPS
13.  Social factors and overweight: evidence from nine Asian INDEPTH Network sites 
Global Health Action  2009;2:10.3402/gha.v2i0.1991.
Background
Overweight/obesity increases the risk of morbidity and mortality from a number of chronic conditions, including heart disease, stroke, diabetes and some cancers. This study examined the distribution of body mass index (BMI) in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries and investigated the association between social factors and overweight.
Data and methods
This cross-sectional study was conducted in nine HDSS sites in Bangladesh, India, Indonesia, Thailand and Vietnam. The methodology of the WHO STEPwise approach to Surveillance with core risk factors (Step 1) and physical measurements for weight, height and waist circumference (Step 2) were included. In each site, about 2,000 men and women aged 25–64 years were selected randomly using the HDSS database. Weight was measured using electronic scales, height was measured by portable stadiometers and waist circumference was measured by measuring tape. Overweight/obesity was assessed by BMI defined as the weight in kilograms divided by the square of the height in metres (kg/m2).
Results
At least 10% people were overweight (BMI ≥ 25) in each site except for the two sites in Vietnam and WATCH HDSS in Bangladesh where few men and women were overweight. After controlling for all the variables in the model, overweight increases with age initially and then declines, with increasing education, and with gender with women being heavier than men. People who eat vegetables and fruits below the recommended level and those who do high level of physical activity are, on the whole, less heavy than those who eat more and do less physical activity.
Conclusions
As the proportion of the population classified as being overweight is likely to increase in most sites and overweight varies by age, sex, and social and behavioural factors, behavioural interventions (physical exercise, healthy diet) should be developed for the whole population together with attention to policy around nutrition and the environment, in order to reduce the adverse effects of overweight on health.
doi:10.3402/gha.v2i0.1991
PMCID: PMC2785100  PMID: 20027257
obesity; overweight; body mass index; risk factor surveillance; WHO STEPS; Asia
14.  Self-Reported Prevalence of Chronic Diseases and Their Relation to Selected Sociodemographic Variables: A Study in INDEPTH Asian Sites, 2005 
Preventing Chronic Disease  2008;5(3):A86.
Introduction
Lack of reliable population-based data, especially morbidity data, is a barrier to preventing and controlling chronic diseases in developing countries. We report the self-reported prevalences of major chronic diseases in Southeast Asia and examine their relation to selected sociodemographic variables in adults.
Methods
Data are from a 2005 cross-site study of 8 sites in 5 Asian countries that surveyed 18,484 people aged 25–64 years. Respondents were asked whether they had been told by a health care worker that they had any of 7 chronic health conditions: joint problems, stroke, heart disease, diabetes, pulmonary disease, hypertension, or cancer. Information about participants' sex, age, and educational level was also obtained.
Results
We found that 22.7% of men and 31.6% of women reported having at least 1 of the chronic health conditions of interest, and 5.1% of men and 9.2% of women reported having 2 or more chronic conditions. Multivariate regression analyses showed that women had more chronic conditions than men, the prevalence of chronic conditions increased with age, and people with the least education were more likely to have chronic conditions.
Conclusion
Chronic conditions are commonly reported among adults in Asian countries. Disparities in the prevalence of chronic conditions by sex and education are evident.
PMCID: PMC2483549  PMID: 18558036
15.  Does health intervention improve socioeconomic inequalities of neonatal, infant and child mortality? Evidence from Matlab, Bangladesh 
Background
Although there are wide variations in mortality between developed and developing countries, socioeconomic inequalities in health exist in both the societies. The study examined socioeconomic inequalities of neonatal, infant and child mortality using data from the Matlab Health and Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).
Methods
Four birth cohorts (1983–85, 1988–90, 1993–95, 1998–00) were followed for five years for death and out-migration in two adjacent areas (ICDDR,B-service and government-service) with similar socioeconomic but differ health services. Based on asset quintiles, inequality was measured through both poor-rich ratio and concentration index.
Results
The study found that the socioeconomic inequalities of neonatal, infant and under-five mortality increased over time in both the ICDDR,B-service and government-service areas but it declined substantially for 1–4 years in the ICDDR,B- service area.
Conclusion
The study concluded that usual health intervention programs (non-targeted) do not reduce poor-rich gap, rather the gap increases initially but might decrease in long run if the program is very intensive.
doi:10.1186/1475-9276-6-4
PMCID: PMC1894794  PMID: 17547776

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