ABSTRACT
Background: Hypertension is a chronic non-communicable disease that effects adversely on heart, brain and kidney. Nearly 2/3rd of all hypertensive patients live in low and middle income countries, so the economic burden of hypertension is huge. India is one of those countries which spent more than 1/3rd of all income on CVD and hypertension. This study was conceptualized to study the disease and economic burden of hypertension. Methods: A cross-sectional study was conducted in New Collector Compound (NCC) of Malwani. Five plots of NCC were selected by simple random sampling. A list of hypertensive patients was prepared by house-to-house survey. Fifty per cent patients were selected randomly for studying economic burden. Results: The study covered 447 households and 2360 persons. Eighty participants (3.4%) were found hypertensive. The average annual total cost of hypertension and related disorders was Rs. 7154. It was Rs. 6073 and Rs. 8235 for government and private respectively. Only 7.50% households were not incurring any cost of illness. The average annual out of pocket expenditure (OOPE) was Rs. 4042 and Rs. 7621 for government and private facilities respectively. Fifteen per cent households were incurring catastrophic expenditure at highest threshold of 40%. The catastrophic spending led to impoverishment of 34.2% households. Conclusions: High prevalence of hypertension, high OOPE, high incidence of catastrophic spending and impoverishment among households intensively reflect the need of interventions. Early preventive measures may be a key in controlling economic and disease burden. There is need to provide the financial risk protection against the OOPE for outpatient care.
ABSTRACT
Tribals are the most marginalised social category in the country and there is little and scattered information on the actual burden and pattern of illnesses they suffer from. This study provides information on burden and pattern of diseases among tribals, and whether these can be linked to their nutritional status, especially in particularly vulnerable tribal groups (PVTG) seen at a community health programme being run in the tribal areas of chhattisgarh and Madhya Pradesh States of India. This community based programme, known as Jan Swasthya Sahyog (JSS) has been serving people in over 2500 villages in rural central India. It was found that the tribals had significantly higher proportion of all tuberculosis, sputum positive tuberculosis, severe hypertension, illnesses that require major surgery as a primary therapeutic intervention and cancers than non tribals. The proportions of people with rheumatic heart disease, sickle cell disease and epilepsy were not significantly different between different social groups. Nutritional levels of tribals were poor. Tribals in central India suffer a disproportionate burden of both communicable and non communicable diseases amidst worrisome levels of undernutrition. There is a need for universal health coverage with preferential care for the tribals, especially those belonging to the PVTG. Further, the high level of undernutrition demands a more augmented and universal Public Distribution System.