Three of the world's top 10 most populous countries are located in South Asia. The health-care problems of this region are different from those in the developed world, and the rapidly changing socioeconomic scenario, fast-increasing urbanization and longevity, changes in dietary patterns, and decrease in mortality from infectious diseases has made chronic illnesses of old age, such as coronary artery disease and stroke, an important area of focus. This article reviews stroke epidemiology and management issues in four South Asian countries: India, Pakistan, Sri Lanka and Bangladesh. The available literature is limited and mostly hospital-based, and differing study methodologies make direct comparisons difficult. The high prevalence of traditional risk factors, including hypertension, diabetes, dyslipidaemia and smoking, in these countries is alarming, and several nontraditional risk factors, such as water-pipe use, desi ghee, chewable tobacco, and infectious causes of stroke, are understudied. Access to tertiary stroke care is limited, and the use of tissue plasminogen activator is scarce. In addition, public and caregiver awareness of stroke risk factors and management is disappointing, and the interest of governments and policy makers in stroke is suboptimal. Interventions to reduce stroke burden and stroke-related mortality in South Asia should have a substantial impact at the global level.

Stroke in South Asian countries.

Primary prevention of stroke.

Stroke is the third leading cause of death in Bangladesh. The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world. The reported prevalence of stroke in Bangladesh is 0.3%, although no data on stroke incidence have been recorded. Hospital-based studies conducted in past decades have indicated that hypertension is the main cause of ischaemic and haemorrhagic stroke in Bangladesh. The high number of disability-adjusted life-years lost due to stroke (485 per 10,000 people) show that stroke severely impacts Bangladesh's economy. Although two non-governmental organizations, BRAC and the Centre for the Rehabilitation of the Paralysed, are actively involved in primary stroke prevention strategies, the Bangladeshi government needs to emphasize healthcare development to cope with the increasing population density and to reduce stroke occurrence.

Burden of stroke in Bangladesh.

Background: Factors associated with the development of hypertension can be categorized into modifiable and nonâÂÂÂÂmodifiable risk factors. The modifiable risk factors include obesity, physical inactivity, high salt diet, smoking alcohol consumption and others. Aim: This study was aimed to determine the prevalence of modifiable risk factors of hypertension in a rural community; Oghara and to ascertain if any association exists with these risk factors and socioâÂÂÂÂdemographic variables. Subjects and Methods: Descriptive crossâÂÂÂÂsectional study design was utilized for the study and it was carried out over a period of 6 months (Feburary 2012 to August 2012). Cluster sampling was utilized to select a total of 272 respondents for the study. An interviewer administered questionnaire was used to collect data and data analysis was performed by SPSS version 16.0 (Chicago II, USA). Results: The prevalence of hypertension is 21.0% (57/272), while the prevalence of modifiable risk factors of hypertension such as smoking, alcohol consumption and obesity are 15.8% (43/272), 43.4% (118/272) and 18.8% (51/272) respectively. There is a statistical significant association between hypertension and smoking (P < 0.001), as well as hypertension and alcohol. (P < 0.001), on the other hand socioâÂÂÂÂdemographic variables were significantly associated with smoking (P < 0.001). Conclusion: The study showed high prevalence of modifiable risk factors of hypertension. This underscores the need for preventive efforts to encourage changes in life style pattern in order to reverse the impending epidemic of hypertension and other nonâÂÂÂÂcommunicable diseases.

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Modifiable Risk factors of Hypertension and Socio-demographic Profile in Oghara, Delta State; Prevalence and Correlates

BACKGROUND The mortality and morbidity from the diseases which contribute to the deaths among children can be reduced if early intervention is made in terms of appropriate care and treatment. Thus, utmost care should be taken to prevent diseases, recognize the danger signals, and treat them urgently. Thus, healthcare-seeking behavior is of prime importance and is pivotal in the well-being of the individual as well as the community. The aims of this research were to determine the possible factors that affect the healthcare-seeking behavior of mothers for their children in a tribal community of Narmada district and to determine the reasons for not seeking curative care for children who are perceived to be sick. METHODS A cross-sectional, community-based study of 405 mothers of the Dediyapada Block in Narmada District Gujarat, India, was undertaken, using a two-stage, cluster-sampling technique. The study was conducted from June through August 2011 using the questionnaire method. The chi squared test was used to determine the association between various factors and the healthcare-seeking behaviors of mothers. RESULTS The mothers were in the age range of 17 to 44 years, with the mean (+SD) being 26.2+3.2 years. Ninety-one percent of the children, irrespective of gender, had completed their primary immunization. Regarding curative healthcare-seeking behavior, 16.5% of the males and 42% of the females received no treatment. Joint family structure (P<0.05, df=1, χ(2)=41.39), mass media exposure (P<0.05, df=1, χ(2)=16.42), literacy status (P<0.05, df=1, χ(2)=60.76), socioeconomic status of the mothers (P<0.05, df=1, χ(2)=56.08), and gender differences among children (P<0.05, df=1, χ(2)=21.18) were found to be associated significantly with the healthcare-seeking behavior of the mothers. CONCLUSION Increased maternal education, generation of intensified awareness through the mass media approach, implementing gender-sensitive interventions, and counseling may have positive implications in the future, leading to better health outcomes and favorable health indicators.

Healthcare-Seeking Behaviors of Mothers regarding their Children in a Tribal Community of Gujarat, India.

A hospital based cross sectional study was carried out to analyze prevalence of risk factors for stroke in hospitalized patient in a medical college hospital. 100 patients were chosen using purposive sampling technique. Highest incidence of stroke was between the 6th and 7th decade. Patients came from both urban (54%) and rural (46%) areas and most of them belong to the low-income group (47%). In occupational category; service holder (28%) and retired person (21%) were the highest groups. Most of the study subjects were literate (63%). CT scan study revealed that the incidence of ischaemic stroke was 61% and haemorrhagic stroke 39%. Analysis indicated hypertension as major risk factor for stroke (63%) and major portion of the patients (42.85%) were on irregular or no treatment. Twenty four percent of the patients had heart diseases and out of 24 patients 45.83% were suffering from ischaemic heart disease. The present study detected diabetes in 21% patients. Fifty three percent of the study subjects were smoker, 39% patients had habit of betelnut chewing. Out of 26 female patients, only 23% had history of using oral contraceptives. Majority of the patients were sedentary workers (46%). Thirty seven percent of the stroke patients were obese. Among the stroke patients 9% had previous history of stroke and 3% had TIA respectively. Most of the patients (21%) were awake while they suffered from stroke and the time of occurrence was mostly in the afternoon (46%). This study found that hypertension, cigarette smoking, ischaemic heart disease and diabetes mellitus are the major risk factors prevalent in our community while other risk factors demand further study.

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Analysis of Sociodemographic and Clinical Factors Associated with Hospitalized Stroke Patients of Bangladesh

Knowledge about the existing disease pattern and health seeking behavior is essential to provide need based health care delivery to any population and to make the health care system more pro-poor. A community based cross sectional study was conducted among 493 systematically selected households in the Modhukhali Upazilla of Faridpur District to determine the prevailing disease pattern and health seeking behavior in rural Bangladesh. Data were collected through face-to-face interview of the selected respondents. More than half of the respondents gave history of illness of her or her family members during the preceding 15 days. Fever (33.2%), gastrointestinal diseases (24.9%) and respiratory diseases (17.8%) were the most reported complaints. Overall, there were no discernible differences in the likelihood of seeking traditional or any kind of care considering socio-demographic variables and prevailing disease types. Occupation of household head as day labor or in agriculture and suffering from gastrointestinal diseases positively predicted use of para-professionals. Use of un-qualified allopths was negatively predicted by the male gender or literacy of the household head and presence of gastrointestinal, respiratory and other types of diseases and positively predicted by occupation of the household head in agricultural field or as day labor. Use of qualified allopaths was positively predicted by respiratory, skin/eye/ENT and other types of diseases and also by standard of living and relationship of the respondents with household head and negatively predicted by agricultural or day labor work of the household head. Existence of several distinct therapeutic systems in a single cultural setting was found to be an important feature of health care system in the study area. This study concluded that it is important to develop a need based health care delivery system and actions should be taken to improve the overall scenario of health system of rural Bangladesh.

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Disease Pattern and Health Seeking Behavior in Rural Bangladesh

Hypertension is an important independent predictor of cardiovascular disease, cerebrovascular accidents and death. The prevalence of cardiovascular diseases and hypertension is rapidly increasing in developing countries. A cross sectional study was conducted among 103 hypertensive patients during December 2009 to June 2010 in Goshair Hat Upazilla of Shariatpur District to determine the socio-demographic, clinical characteristics and status of control of hypertension in rural population. Respondents were distributed more or less equally among males and females. The mean + S D and median age of the respondents were calculated as 59.97 + 11 .12 years, with 64% of them were included in the age group of 51 to 70 years. More than half of the respondents were housewives (51.5%), which were followed by businessmen (21.4%). Every three of five patients were over weight, while 22.3% respondents were obese. One third of the respondents were also diabetic (33%). None of the 103 patients had achieved the target for SBP (Systolic blood pressure) control ( 180/110 mm of Hg), all of whom were female. From this study control of hypertension was found poor among rural hypertensive population. For effectively combating the burden of hypertension in this population, education and awareness about hypertension needs to be given priority.

Socio-demographic, Clinical Characteristics and Status of Hypertension Control among Rural Hypertensive Patients

This cross- sectional study was conducted among the truck drivers at Daulatdia Ghat, Goalanda, Rajbari district. The objective of this study was to find out the knowledge and awareness about the risk of HIV/AIDS transmission among the truck drivers .Out of 226 respondents, 37.3% were within the age group 25 to 35 years. Most of the respondents (74%) were married and 44% were educated up to primary level. Half of the respondents (50%) had monthly income from taka 10,000 to taka 15,000 per month. From this study, it was found that 97% respondents had heard the name of HIV/AIDS, 61.8% had known about HIV/AIDS from media and newspaper. In respect of the route of HIV transmission, 39.8% of respondents thought that HIV is transmitted by sexual activities and 58.7% thought the disease is transmitted by syringe, transfusion. About 47.8% respondents thought that HIV can be detected from blood and 76% knew the fate of HIV/AIDS is death. Majority (82.5%) of the respondents obtained correct knowledge about HIV/AIDS transmission and 13.2% of them knew the place where test of HIV can be done.

G Sadhya

Papers

Analysis of Sociodemographic and Clinical Factors Associated with Hospitalized Stroke Patients of Bangladesh

Disease Pattern and Health Seeking Behavior in Rural Bangladesh

Socio-demographic, Clinical Characteristics and Status of Hypertension Control among Rural Hypertensive Patients

Knowledge And Awareness About The Risk Of HIV/AIDS Among Truck Drivers Of A Selected Area

Health service seeking behavior and factors associated with under utilization of public health care facilities in a rural area of Bangladesh