Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial.

BACKGROUND: Despite convincing evidence that lowering blood pressure decreases cardiovascular morbidity and mortality, the hypertension burden remains high and control rates are poor in developing countries. OBJECTIVE: To assess the effectiveness of 2 community-based interventions on blood pressure in hypertensive adults. DESIGN: Cluster randomized, 2 x 2 factorial, controlled trial. (ClinicalTrials.gov registration number: NCT00327574) SETTING: 12 randomly selected communities in Karachi, Pakistan. PATIENTS: 1341 patients 40 years or older with hypertension (systolic blood pressure >or=140 mm Hg, diastolic blood pressure >or=90 mm Hg, or already receiving treatment). MEASUREMENTS: Reduction in systolic blood pressure from baseline to end of follow-up at 2 years. INTERVENTION: Family-based home health education (HHE) from lay health workers every 3 months and annual training of general practitioners (GPs) in hypertension management. RESULTS: The age, sex, and baseline blood pressure-adjusted decrease in systolic blood pressure was significantly greater in the HHE and GP group (10.8 mm Hg [95% CI, 8.9 to 12.8 mm Hg]) than in the GP-only, HHE-only, or no intervention groups (5.8 mm Hg [CI, 3.9 to 7.7 mm Hg] in each; P < 0.001). The interaction between the main effects of GP training and HHE on the primary outcome approached significance (interaction P = 0.004 in intention-to-treat analysis and P = 0.044 in per-protocol analysis). LIMITATIONS: Follow-up blood pressure measurements were missing for 22% of patients. No mechanism was detected by which interventions lowered blood pressure. CONCLUSION: Family-based HHE delivered by trained lay health workers, coupled with educating GPs on hypertension, can lead to significant blood pressure reductions among patients with hypertension in Pakistan. Both strategies in combination may be feasible for upscaling within the existing health care systems of Indo-Asian countries. PRIMARY FUNDING SOURCE: Wellcome Trust.

Food habits and nutrient density of diets of Pakistani children living in different urban and rural settings.

Food habits and nutrient density of diets of six groups of rural and urban school children aged 10-12 years were compared. Data were collected from three-day food records. In the UK, data were collected during October-November 1994 and in Pakistan during April-May 1995. Based on the apparent level of urbanism, the six groups were arbitrarily assigned urbanization rank 1-6. Patterns of their food and intake of nutrients were different from each other in various aspects and were not always associated with the apparent level of urbanism of the group. With urbanization, the intake of fat and sugar increased steadily. The intake of carbohydrate, fibre, riboflavin, and vitamin E decreased with urbanization. The intake of vitamin C, vitamin B12, and folates was higher among group 4, 5, and 6 than other groups. Due to various factors, in terms of micronutrient density, diets of various urban groups could have more differences than similarities. While these differences point toward the need for comprehensive nutrition education and community nutrition surveys, they also indicate the possibility of having healthy diets in urban settings.