Hypertension and Obesity Load in Urban Bangladesh: How Large is the Iceberg?

( A cross-sectional study in selected areas of four city corporations in Bangladesh)

Background: To address the unmet need for public health initiatives in urban areas, the 'Strengthening Urban Public Health System project' is being implemented by Save the Children in 12 City Corporations (CC). Under this project, a study was conducted on hypertension and obesity load in selected areas of Cumilla, Mymensingh, Narayanganj, and Rangpur city corporations with the support of health teams and under the guidance of respective Mayors.

Objectives: To determine the prevalence of Hypertension and Obesity and their associated risk factors in urban areas of Bangladesh.

Methodology: During the study, a total of 48,644 people were selected by convenient sampling and were screened to measure blood pressure and obesity status using the BMI scale. Data regarding the socioeconomic information and associated risk factors like family history of hypertension, smoking and food habits, physical activity, etc. were also collected through a semi-structured questionnaire with informed consent of the respondents. Following the American Medical Association (AMA) definition of hypertension participants were classified into three categories e.g. normal, pre-hypertensive, and hypertensive whereas using the WHO's anthropometric guideline, they were grouped into four categories based on the BMI value- underweight, normal, overweight, and obese. Another subset of 1040 participants (also selected following convenient sampling) were interviewed regarding the knowledge and practice related to hypertension, obesity and risk factors, etc.

Results: Nearly 23% of the participants were identified as hypertensive, while about 14% of them were pre-hypertensive. Prevalence was slightly higher among men (24%) than women (22%) and those aged 61 years or older (29%). Approximately 8% of the participants were found to be obese, and another 28% were overweight. The prevalence of obesity and overweight was higher among women (10% obese and 29% overweight) than among men (7% Obese and 27% overweight). Prevalence of hypertension was found to be highest (34%) in Rangpur City Corporation and lowest (16%) in Cumilla City Corporation whereas obesity was higher (10%) in Rangpur City Corporation and lower (6.5%) in Mymensingh City Corporation.

The association between BMI status and hypertension was found to be statistically significant, and the odds ratio progressively rose as the BMI value increased. Obese participants had odds that were 2.05 [COR: 95%] times greater than those in the normal BMI group. During the pre-screening knowledge check survey, about 78% of the participants answered correctly about the high blood pressure range between 100-160. In the post-screening survey conducted after about two weeks, this proportion increased to 95%. only 73% of the participants knew about the complications of hypertension and obesity in the pre-screening but in the post-screening survey, this proportion increased to 96%.

Conclusion: Since the prevalence of hypertension and pre-hypertension varies between different geographical locations and socio-demographic characteristics, different types and levels of intervention need to be planned for the different locations and groups. Community-based screening should be carried out for early detection of hypertension and obesity status in adults and it should be scaled up in other city corporations as well as in rural areas.

Keywords: Body Mass Index, Prevalence, Hypertension, Overweight/Obesity, Public Health Programs.

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