title: Hypertension: adherence to treatment in rural Bangladesh--findings from a population-based study.
abstract: BACKGROUND
  Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh.
  
  
  OBJECTIVE
  This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh.
  
  
  METHODS
  The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center for Diarrheal Disease Research, Bangladesh (icddr,b): Matlab, Abhoynagar, and Mirsarai. Data was collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment.
  
  
  RESULTS
  The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48-2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31-1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0.79, CI 0.64-0.97).
  
  
  CONCLUSIONS
  Although village doctors diagnose 40% of hypertension, their treatments are associated with a higher rate of non-adherence to medication. The hypertension care practices of the village doctors should be explored by additional research. More emphasis should be placed on men, young people, and people with low education. Health programs focused on education regarding the importance of taking continuous antihypertensive medication is now of utmost importance.
authors.affiliation: Centre for Control of Chronic Diseases in Bangladesh, icddr,b, Mohakali, Bangladesh; Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Masuma Akter
authors.initials: MA
authors.lastname: Khanam
authors.affiliation: Centre for Control of Chronic Diseases in Bangladesh, icddr,b, Mohakali, Bangladesh.
authors.forename: Wietze
authors.initials: W
authors.lastname: Lindeboom
authors.affiliation: Centre for Control of Chronic Diseases in Bangladesh, icddr,b, Mohakali, Bangladesh.
authors.forename: Tracey Lynn Perez
authors.initials: TL
authors.lastname: Koehlmoos
authors.affiliation: Centre for Control of Chronic Diseases in Bangladesh, icddr,b, Mohakali, Bangladesh.
authors.forename: Dewan Shamsul
authors.initials: DS
authors.lastname: Alam
authors.affiliation: Health Economics, Liverpool School of Tropical Medicine, Liverpool, UK; International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Niessen
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia; milton.hasnat@newcastle.edu.au.
authors.forename: Abul Hasnat
authors.initials: AH
authors.lastname: Milton
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors
chemical_list: D000959:Antihypertensive Agents
keywords: Bangladesh; adherence to treatment; hypertension; low-income country; village doctors