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Open Access Research article

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

Md Jasim Uddin1*, Nurul Alam1, Haribondhu Sarma1, Muhammad Ashique Haider Chowdhury1, Dewan S Alam1 and Louis Niessen2

Author Affiliations

1 International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh

2 Centre for Applied Health Research and Delivery, Suite 1966–206, Liverpool School of Tropical Medicine/Medical School, University of Warwick Pembroke Place, Liverpool L3 5QA, UK

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BMC Public Health 2014, 14:547  doi:10.1186/1471-2458-14-547

Published: 3 June 2014

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.

Keywords:
Non-communicable diseases; Hypertension; Chronic obstructive; Pulmonary disease; Comorbidity; Health-care behaviour; Health system; Bangladesh