a year ago

Bangladesh ill-equipped to manage hypertension

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A large number of patients with hypertension are being deprived of proper treatment as the country's community clinics are yet to include necessary drugs in its list.

The country has a total of 14,200 community clinics that must have to store government-enlisted 27 types of drugs, heath sector sources said.

However, drugs to control high blood pressure and diabetes are yet to be included in the government prescribed lists for community clinics.

rural people, enlistment of hypertension drugs could save a vast majority, experts observed.

In 2020, the number of high pressure patients was 30 million in Bangladesh which may go up to 38 million by 2030, according to Bangladesh Demographic and Health Survey (BDHS)-2017-18.

For high blood pressure drugs, the community people have to visit Upazila Health Complex (UHC) to get their medicines.

To avoid such hassle, many of the high blood pressure patients skip routine treatment plan leading to stroke, heart failure, kidney and many other diseases.

Fortyfive-year-old Sufia Khatun, who lives in Choyghoria, a small village in Chandina upazila of Cumilla district, said she visited UHC thrice and was diagnosed with high blood pressure. Doctors prescribed her anti-hypertensive drugs to be taken regularly.

She, however, found it difficult to visit the UHC every month paying transport cost and other related costs for the drugs.

The country is yet to get ready to manage increased number of high blood pressure patients due to not having adequate preparation in peripheral health care centres, experts opined.

Professor Dr Sohel Reza Choudhury, head of the Epidemiology and Research Department, National Heart Foundation of Bangladesh, said the UHCs are supplying antihypertensive drugs to the community clinics from its Non-Communicable Disease (NCD) corners but there is scarcity of drugs against the demand.

The UHCs are experiencing a huge rush of hypertension patients due to an acute rise in the incidence of that NCD, he added.

Rural people find it difficult to visit UHCs every month and take this medicine. Rural people may skip taking the hypertension drugs on a regular basis if those are not easily available which may cause sudden stroke and heart failure, he added.

"As the high blood pressure patients need to take medicines life-long, availability of the drugs at community clinic level is utmost required," he added.

He said they are working so that first line drugs for hypertension and diabetes can be made available from community clinics. It has been found that many of the health care centres do not know how to manage a patient with sudden rise of blood pressure.

They can measure blood pressure which anybody in the recent time can do if they have the reading equipment. Bangladesh Health Facility Survey-2017 said only 17 per cent health care centres have high blood pressure detection and management guidelines.

Also, only 29 per cent of health care centres have trained workers to manage the NCD.

Though it has been claimed that seven out of 10 health care centres are providing high pressure related treatments but management of the diseases is extremely poor.

Dr Masud Reza Kabir, line director of Community Based Health Care of Directorate General of Heath Services (DGHS), said the CBHC has been planning to include anti-hypertensive and anti-diabetic drugs in the lists of the community clinics.

It has a 'Drug Committee' that decides on inclusion of the drugs in the list, he added.

The committee will sit in a meeting soon to review the list, said Mr Kabir who is now on Post Retirement Leave.

Muhammad Ruhul Quddus, country lead of Global Health Advocacy Incubator (GHAI), said NCD burden is high in Bangladesh because of high prevalence of both hypertension and diabetes.

Many people do not know they have hypertension while those who know do not get drugs due to its non-availability, he said.

Advocacy is going on with DGHS and they agreed 'in principle' to include hypertension medicine in the list of community clinics drugs, he said.

After being diagnosed as high pressure patients in three consecutive visits in UHC, a patient should get the high pressure control drugs in community clinics so that they could continue their hypertension management treatment, he said.

He said work on making such drugs available in community clinics is going on.

ABM Zubair, executive director of PROGGA, an advocacy organisation to control NCD, said proper budget allocation to ensure availability of hypertension drugs in community clinic is required.

He said currently hypertension drugs are being provided to some community clinics from the UHCs on pilot basis.

Such drugs should be made available to all of the community clinics across the country considering prevalence of the NCD, he said.

Health experts, however, pointed at some of the initiatives to intensify hypertension control treatment.

The Non-Communicable Disease Control Program (NCDC) under the Directorate General of Health Services (DGHS) of the Ministry of Health and Family Welfare (MOHFW) and the National Heart Foundation of Bangladesh (NHFB) have been jointly implementing a project with support from US based organisation Resolve to Save Lives (RTSL) to control hypertension since 2018, sources said.

They have been working in 54 upazilas of Sylhet, Dhaka, and Mymensingh divisions with the aim to strengthen hypertension screening, treatment, and follow-up services.

Under this programme, anti-hypertensive drugs are being given (prescription refilling) to patients from eight community clinics of four Upazilas (Beanibazar, Bishwanath, Golapganj and Fenchuganj) in Sylhet district on pilot basis. Advocacy organisations said by expanding this programme nationwide, it is possible to prevent hypertension, a major risk factor for heart disease, stroke and heart attack.

This hypertension control programme in Bangladesh has been designed following the best practices in the world.

World Health Organisation (WHO) data said some 1.28 billion of people are suffering from high blood pressure world-wide. Of them, two-thirds live in low and middle income countries.

Every year, some 10 million people die due to high blood pressure related diseases, which is higher than death from any of the communicable diseases. According to Bangladesh NCD Steps Survey, 2018, one in every five adult people or 21 per cent of adults is suffering from high blood pressure.

In Bangladesh, the high blood pressure situation is getting worst. The BNSS-2018, some 24.1 per cent of adult women and 17.9 per cent of men are suffering from high blood pressure. Of them, only 14 per cent (less than one person in each seven) have managed the diseases by taking drugs regularly.

Bangladesh Demographic and Health Survey-2017-18 findings said intensity of high blood pressure increased alarmingly among the people aged 35 and above between 2011 and 2017-18.

Of them, ratio of male patients increased to 34 from 20 per cent while female patients to 45 from 32 per cent. People with obesity have higher chance of high blood pressures---females 49 per cent and males 42 per cent.

Some 51 per cent females and 67 per cent males do not know that they are suffering from high blood pressure.

Some 64 per cent of the high pressure patients do not take drugs regularly. In the eighth five year plan (July 2020-June 2025), the government targets to bring down death rate of heart diseases including NCD to 16.8 per cent from 21.6 per cent by 2025.

Global Burden of Disease Study (GBD) 2019 findings said high blood pressure is among one of the three major reasons of death and disability in Bangladesh.

Some 2,77,000 people die because of cardio vascular diseases in Bangladesh.

A joint study of WHO and Imperial College London said number of high blood pressure patients, aged between 30 to 79, increased to 1.28 billion in the last 30 years (1990-2018) from 650 million.

However, the high blood pressure patients in lower and middle income countries increased fast shifting from high income countries like Canada, Peru and Switzerland.

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