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.”

Health baseline information in impact assessment

The paucity of reliable health baseline information to carry out HIA in developing countries context has always been a key issue within the HIA discussion. There are arguments in favor of collecting and generating new data, but there are also arguments against this approach. The arguments against mainly center around: costs of data collection and ethical issues about invasive data collection mechanisms. The arguments in favor point to the lack of dependable data needed not only to assess the impacts, but also to monitor the recommendations measures and for the early identification of intended impacts.

Malaria offers a very goo example of the difficulties and challenges of using already existing data to estimate burden of disease in a given context.

The Institute for Health Metrics and Evaluation published an article on the Lancet last Friday suggesting that 1.24 million people died from the mosquito-borne disease in 2010. This is twice what estimated by WHO and partners for the same year. The research used new data and new computer modeling to build a historical database for malaria between 1980 and 2010. WHO has just issued a communication welcoming the research and the effort, but basically WHO re-confirms the precedent estimate of 655 000 deaths attributable to malaria.

While everybody agrees that the burden is extremely high for both estimates, the difference between the 2 numbers is anyway of concern. The research involved trying to judge the impact of the misclassification of deaths in the affected regions. This readjustment alone generated a rise of 21% in the number of malaria deaths. Beside the effects that the mathematical model chosen has on the final data, the issue of the quality of initial data is essential. In the majority of settings where malaria is a feared killer, diagnosis is done clinically without any form of diagnostic devise. Fever is a symptom of malaria, but it is not necessarily malaria. In such settings the collection of baseline information on the health status and determinants of the population residing in the project foot print is therefore very important and the gathering methods should be designed to satisfy project information requirement and ethical aspects.

This discussion is an ongoing one within the HIA community and for those interested there is a session “Health baseline data within different impact assessments” at the next IAIA conference.

Supercourse: epidemiology, the internet and global health

Supercourse is a repository of lectures on global health and prevention designed to improve the teaching of prevention. Supercourse has a network of over 56000 scientists in 174 countries who are sharing for free a library of 4875 lectures in 31 languages. The Supercourse has been produced at the WHO Collaborating Center University of Pittsburgh.

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