Quite disappointing
India’s first dist-level study on hypertension flags disparities in care
* In Karnataka, four districts — Chikmagalur, Shimoga, Udupi and Chitradurga — have a similar prevalence of hypertension, but the proportion of participants diagnosed and treated in Chikmagalur and Udupi was higher.
* In Meghalaya, the five districts of Garo Hills, the two districts of Jaintia Hills and the three districts of Khasi Hills all have a similar prevalence of hypertension, but the proportion of those diagnosed is much lower in Garo Hills than in Jaintia Hills and Khasi Hills.
These are among the key findings of an exhaustive study that has, for the first time, mapped and assessed the variation in hypertension care at the district level in India, highlighting the urgent need for a more “targeted” approach to fight the medical condition often referred to as the “silent killer”.
According to a recent WHO report, 188.3 million people in India suffer from hypertension but only 37% get diagnosed, only 30% start treatment, and only 15% manage to keep their blood pressure under control. It estimated that at least 4.6 million deaths in India can be prevented by 2040 if half of those with the condition manage to keep their blood pressure under control.
The district-level study, published in JAMA Network, a journal published by the American Medical Association, was conducted by AIIMS Delhi and scientists from Europe and the US who used the hypertension data from NFHS-5, the fifth round report of which was released in May 2022. The researchers have also created a dashboard of district- and state-wise hypertension caseload in India, which they said will help stakeholders identify priorities for reducing burden and tracking progress.
Analysing data of nearly 1.7 million respondents across socio-demographic groups in 707 districts, the study found that one in four adults had hypertension. Of these, only one in three came to know of their condition after being diagnosed with it, less than one in five were treated, and only one in 12 had their blood pressure under control.
More significantly, the study found, there were substantial variations across districts in blood pressure diagnosis (range: 6.3%-77.5%), treatment (range: 8.7%-97.1%) and control (range: 2.7%-76.6%). Raising a red flag, the researchers said that the national mean values of hypertension “hide considerable” variation at the district level and recommended a critical public health strategy to improve care — “targeted, decentralised solutions” at the district level.
According to Dr Ambuj Roy, Professor of Cardiology at AIIMS and one of the investigators of the study, the district-wise level analysis was important as the many state-level analyses done earlier did not highlight “the heterogeneity” within states, even those considered better-performing states. And with the new dashboard, he said, every district can now analyse their data according to gender and socio-demographic disparities.
“The NFHS 5 data is available publicly, but we took the variables relevant to hypertension, such as age, gender, socio-economic status, and it is the first time that data on hypertension was analysed district-wise. We have also opened the dashboard for academicians and administrators to access it. The dashboard was created as a part of the study and has gender-wise, area-wise educational levels data on hypertension,” Dr Roy said.
The findings of the study showed that despite health being a state subject, there was a need for more autonomy at the district level, Dr Roy said: “Chief Medical Officers should know where they are failing in terms of hypertension management and what measures they could take, rather than having a similar approach for all districts in a state. We need to look at the continuum of care within each district and within each state, however good or bad that state or district may be.”
Another key finding of the study was the importance of screening hypertension and diabetes using local healthcare workers, including ASHA workers. Said Dr Roy: “So that you can increase and improve the pick-up rates. Instead of people coming to the hospital, you go to them and do hypertension screening in a door-to-door survey, and even the treatment should be provided through the nearest healthcare facility rather than them coming to the tertiary healthcare facility and district hospitals.”
Ankita Upadhyay – 2023-10-30 04:20