Hypertension: widely present in developing countries

Hypertension is still the leading risk factor for cardiovascular disease and mortality and worldwide, more than 7 million deaths can be attributed directly or indirectly to the effects of hypertension. This major cause of morbidity and mortality affects between 20% and 50% of adults. The Lancet has dedicated a Series of three papers about hypertension

Hypertension is also very common in developing countries as around three quarters of people affected by hypertensions live in a developing region. Despite this high burden, the rates of awareness, treatment, and control are low and this situation might be attributed to several factors .

From  Ibrahim and  Damasceno article: “Several hypertension risk factors seem to be more common in developing countries than in developed regions. Findings from serial surveys show an increasing prevalence of hypertension in developing countries, possibly caused by urbanisation, ageing of population, changes to dietary habits, and social stress. High illiteracy rates, poor access to health facilities, bad dietary habits, poverty, and high costs of drugs contribute to poor blood pressure control. The health system in many developing countries is inadequate because of low funds, poor infrastructure, and inexperience.”

Epidemiological transition in a rural community of northern India

A single paper does not prove a theory but I've strongly believed for a while that there are more similarities than differences in the health, wellbeing and disease profile of high, middle and low income countries and communities. This trend particularly so in the latter half of the 20th Century.

The paper below shows that chronic non-communicable diseases are the single biggest category of deaths in a rural community in India.

But, there's at least one counterargument to my theory. Given diarrhoeal diseases have declined, it could certainly be the case that long term communicable disease interventions have significantly reduced the impact of communicable diseases in that part of rural India (e.g. clean water, sanitation, improved rural incomes, access to primary health care, etc.).

From a HIA perspective, it does strengthen the argument that it is important to consider both non-communicable as well as communicable disease outcomes/impacts in low and middle income countries.

Abstract
Background Information on causes of death is vital for planning of health services. However, vital events registration systems are weak in developing countries. Therefore, verbal autopsy (VA) tools were incorporated in a community-based surveillance system to track causes of death.


Method and Findings: Trained fieldworker identified all deaths and interviewed a living relative of those who had died during 1992–2009, using VA, in eight villages of Haryana (11 864 populations). These field reports detailing events preceding death were reviewed by two trained physicians, who independently assigned an International Classification of Disease-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. Non-communicable conditions were the leading causes of death (47.6%) followed by communicable diseases including maternal, perinatal and nutritional conditions (34.0%), and injuries (11.4%). Cause of death could not be determined in 6.9% cases. Deaths due to cardiovascular diseases showed a significant rise, whereas deaths due to diarrhoeal diseases have declined (p<0.01). Majority (90.0%) of the deceased had contacted a healthcare provider during illness but only 11.5% were admitted in hospital before death.

Conclusion Rising trend of cardiovascular diseases observed in a rural community of Haryana in India calls for reorientation of rural healthcare delivery system for prevention and control of chronic diseases.

Source:

Epidemiological transition in a rural community of northern India: 18-year mortality surveillance using verbal autopsy . Rajesh Kumar, Dinesh Kumar, J Jagnoor, Arun K Aggarwal, P V M Lakshmi
J Epidemiol Community Health published 2 November 2011, 10.1136/jech-2011-200336

Article behind a paywall, click here to go to the abstract.