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Hypertension in Vietnam: from community-based studies to a national targeted programme
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In the context of transitional Vietnam, hypertension has been shown to be one of the ten leading causes of morbidity and mortality in hospitals. However, population-based data on hypertension are to a large extent lacking. This thesis aims to characterise the current epidemiology of hypertension in the adult Vietnamese population and provide preliminary evidence for developing effective community-based hypertension management programmes nationwide.

Methods: The study was conducted during 2002-2010. It includes two national surveys of the adult population aged 25 years and older, randomly selected in eight provinces in different regions of Vietnam, as well as a community-based programme on hypertension management in two communes of Bavi district. The survey on hypertension and associated risk factors, which included 9,832 adults, applied the WHO STEP-wise approach. The survey on hypertension-related knowledge and health seeking behaviour included 31,720 adults, using a structured questionnaire. For the community-based study, three-year follow-up data on 860 hypertensives was used to assess the effectiveness of the hypertension control model.

Main findings: Hypertension prevalence was high (overall 25.1%, 28.3% in men and 23.1% in women). The proportions of hypertensives aware, treated and controlled were unacceptably low (48.4%, 29.6% and 10.7% respectively). Most Vietnamese adults (82.4%) had good knowledge about high blood pressure. People received their information on hypertension from mass media (newspapers, radio, and especially television). Most people would choose a commune health station (75%) if seeking health care for hypertension. The programme on hypertension control was able to run independently at the commune health station. Severity of hypertension and effectiveness of treatment were the main factors influencing people’s adherence to the programme. The hypertension control programme successfully reduced blood pressure (systolic blood pressure: -2.2 mmHg in men and -7.8 mmHg in women; diastolic blood pressure: -4.3 mmHg in men and -6.8 mmHg in women), the estimated CVD 10-year risk (-2.5% in women), and increased the proportions of treatment (22% in men and 13.6% in women) and control (11% in men and 17.3% in women) among hypertensive people.

Suggestions for hypertension control: (1) Address the general population by developing community interventions, particularly salt reduction; (2) Provide interventions to individuals at high risk of a CVD event, including multi-drug treatment within patient-centred primary health care. (3) Set up a hypertension care network based in the existing health care system; (4) Improve and strengthen capacity and skills of medical staff in cardiac care, particularly staff at primary care level.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2012. , 81 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1499
Keyword [en]
Hypertension, risk factor, community, programme, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-55175ISBN: 978-91-7459-421-8 (print)OAI: oai:DiVA.org:umu-55175DiVA: diva2:526145
Public defence
2012-06-01, Sal 135, Allmänmedicin, Byggnad 9 A, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2012-05-11 Created: 2012-05-10 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Prevalence, awareness, treatment and control of hypertension in Vietnam: results from a national survey
Open this publication in new window or tab >>Prevalence, awareness, treatment and control of hypertension in Vietnam: results from a national survey
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2012 (English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 26, 268-280 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to estimate mean blood pressure (BP), prevalence of hypertension (defined as BP 140/90 mm Hg) and its awareness, treatment and control in the Vietnamese adult population. This cross-sectional survey took place in eight Vietnamese provinces and cities. Multi-stage stratified sampling was used to select 9832 participants from the general population aged 25 years and over. Trained observers obtained two or three BP measurements from each person, using an automatic sphygmomanometer. Information on socio-geographical factors and anti-hypertensive medications was obtained using a standard questionnaire. The overall prevalence of hypertension was 25.1%, 28.3% in men and 23.1% in women. Among hypertensives, 48.4% were aware of their elevated BP, 29.6% had treatment and 10.7% achieved targeted BP control (<140/90 mm Hg). Among hypertensive aware, 61.1% had treatment, and among hypertensive treated, 36.3% had well control. Hypertension increased with age in both men and women. The hypertension was significantly higher in urban than in rural areas (32.7 vs 17.3%, P<0.001). Hypertension is a major and increasing public health problem in Vietnam. Prevalence among adults is high, whereas the proportions of hypertensives aware, treated and controlled were unacceptably low. These results imply an urgent need to develop national strategies to improve prevention and control of hypertension in Vietnam.

Place, publisher, year, edition, pages
Nature Publishing Group, 2012
Keyword
prevalence, awareness, treatment, control, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-51851 (URN)10.1038/jhh.2011.18 (DOI)21368775 (PubMedID)
Available from: 2012-02-03 Created: 2012-02-03 Last updated: 2017-12-08Bibliographically approved
2. Hypertension-related knowledge and healthcare seeking behaviour based on a national survey of Vietnamese adults
Open this publication in new window or tab >>Hypertension-related knowledge and healthcare seeking behaviour based on a national survey of Vietnamese adults
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(English)In: Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-53582 (URN)
Available from: 2012-04-03 Created: 2012-04-03 Last updated: 2015-04-29Bibliographically approved
3. Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam
Open this publication in new window or tab >>Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam
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2011 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, 325- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Costly efforts have been invested to control and prevent cardiovascular diseases (CVD) and their risk factors but the ideal solutions for low resource settings remain unclear. This paper aims at summarising our approaches to implementing a programme on hypertension management in a rural commune of Vietnam.

METHODS: In a rural commune, a programme has been implemented since 2006 to manage hypertensive people at the commune health station and to deliver health education on CVD risk factors to the entire community. An initial cross-sectional survey was used to screen for hypertensives who might enter the management programme. During 17 months of implementation, other people with hypertension were also followed up and treated. Data were collected from all individual medical records, including demographic factors, behavioural CVD risk factors, blood pressure levels, and number of check-ups. These data were analysed to identify factors relating to adherence to the management programme.

RESULTS: Both top-down and bottom-up approaches were applied to implement a hypertension management programme. The programme was able to run independently at the commune health station after 17 months. During the implementation phase, 497 people were followed up with an overall regular follow-up of 65.6% and a dropout of 14.3%. Severity of hypertension and effectiveness of treatment were the main factors influencing the decision of people to adhere to the management programme, while being female, having several behavioural CVD risk factors or a history of chronic disease were the predictors for deviating from the programme.

CONCLUSION: Our model showed the feasibility, applicability and future potential of a community-based model of comprehensive hypertension care in a low resource context using both top-down and bottom-up approaches to engage all involved partners. This success also highlighted the important roles of both local authorities and a cardiac care network, led by an outstanding cardiac referral centre.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-51833 (URN)10.1186/1471-2458-11-325 (DOI)21586119 (PubMedID)
Available from: 2012-02-03 Created: 2012-02-03 Last updated: 2017-12-08Bibliographically approved
4. Effects of a 3-year community-based hypertension control programme in rural Vietnam
Open this publication in new window or tab >>Effects of a 3-year community-based hypertension control programme in rural Vietnam
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(English)In: Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-53583 (URN)
Available from: 2012-04-03 Created: 2012-04-03 Last updated: 2015-04-29Bibliographically approved

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