title: Consequences of hypertension and chronic obstructive pulmonary disease, healthcare-seeking behaviors of patients, and responses of the health system: a population-based cross-sectional study in Bangladesh.
abstract: BACKGROUND
  Non-communicable diseases are a threat to human health and economic development of low-income countries. Hypertension (HT) and chronic obstructive pulmonary disease (COPD) are two major causes of deaths, worldwide. This study assesses the health status, health-care seeking, and health provider responses among patients with these conditions.
  
  
  METHODS
  The study carried out population-based cross-sectional survey in a rural and an urban surveillance area in Bangladesh. It interviewed all patients identified with HT and COPD at home using a structured questionnaire on the health consequences, healthcare-seeking behaviours, and coping strategies. Qualitative techniques identified key factors relating to the behaviours of patients and providers.
  
  
  RESULTS
  COPD and HT correlate with lower activities of daily living (ADL) scores. The odds ratio (OR) for ADL scores in the combied conditions are high (OR: 3.04, p < 0.05) as compared to hypertension. Financial crises occur significantly more frequently among COPD patients in the urban site as compared to those in rural ares (12.5% vs. 2.4%, p < 0.01). Self-treatment at the onset is common. Seeking care from trained providers is higher in urban settings and is higher for HT. Referral for both COPD and hypertension was inadequate until the disease severity increased.
  
  
  CONCLUSIONS
  COPD and HT significantly are associated with lower ADL scores and financial problems. Public-sector primary healthcare facilities should be better organised to address both conditions with the aim to reduce household poverty.
authors.affiliation: International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh. jasim@icddrb.org.
authors.forename: Md Jasim
authors.initials: MJ
authors.lastname: Uddin
authors.forename: Nurul
authors.initials: N
authors.lastname: Alam
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Koehlmoos
authors.forename: Haribondhu
authors.initials: H
authors.lastname: Sarma
authors.forename: Muhammad Ashique Haider
authors.initials: MA
authors.lastname: Chowdhury
authors.forename: Dewan S
authors.initials: DS
authors.lastname: Alam
authors.forename: Louis
authors.initials: L
authors.lastname: Niessen
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011204:Poverty Areas; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy; D012424:Rural Population; D011795:Surveys and Questionnaires