title: Informal allopathic provider knowledge and practice regarding hypertension in urban and rural Bangladesh.
abstract: OBJECTIVE
  Describe informal allopathic practitioner (IAP) knowledge and practice about management of hypertension and identify gaps in IAP knowledge and practice amenable to interventions.
  
  
  METHODS
  A cross sectional descriptive survey of 642 IAPs in Kamalapur (urban) and Mirsarai (rural) Bangladesh was conducted from March to April, 2011. Using a structured, pre-tested questionnaire sociodemographic, training, knowledge and practice data about management of hypertension was collected. Comparative statistics were preformed to show differences between urban and rural practitioners using SAS 8.0.
  
  
  RESULTS
  99.4% of IAPs were male, mean age was 37.5 (12.5 SD) years. Greater than 65% correctly identified the upper limit of normal blood pressure. 50.2% underestimated lower limit of systolic hypertension. 79.8% allowed age to affect their treatment approach. As blood pressure increased, willingness to treat with medication decreased and tendency to refer increased. Sedative/sleeping pills, antidepressants, and beta blockers were the most commonly prescribed medications for prehypertension (58.7%, 50.3% and 53.7% respectively), stage I hypertension (55.0%, 38.6%, 49.8% respectively) and stage II hypertension (42.4%, 23.7%, and 28.8% respectively). Rural IAPs were more likely than urban IAPs to treat (84.7% vs 77.7%), order tests (27.1% vs 6.0%) and write prescriptions (60.4% vs 18.7%).
  
  
  CONCLUSIONS
  While IAPs are crucial to Bangladesh's pluralistic healthcare system, gaps in knowledge and practice could cause unnecessary harm. To include IAPs in the public sector's fight against the chronic disease epidemic, interventions aimed at standardizing IAPs knowledge and practice will be essential. Successfully utilizing IAPs will have beneficial implications not only for Bangladesh, but for all developing countries.
authors.affiliation: International Center for Diarrheal Disease Research, Bangladesh, Health Systems and Infectious Disease Division, Mohakali, Dhaka, Bangladesh. jparr@ccfamilymed.com
authors.forename: John
authors.initials: J
authors.lastname: Parr
authors.forename: Wietze
authors.initials: W
authors.lastname: Lindeboom
authors.forename: Masuma
authors.initials: M
authors.lastname: Khanam
authors.forename: James
authors.initials: J
authors.lastname: Sanders
authors.forename: Tracey Pérez
authors.initials: TP
authors.lastname: Koehlmoos
mesh_terms: D000328:Adult; D000368:Aged; D001459:Bangladesh; D002309:Cardiology; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006282:Health Personnel; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy*; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D000078329:Workforce