Prevalence of undiagnosed type 2 diabetes, hyperlipidemia, and hypertension in rural communities in Pakistan

Introduction: According to the International Diabetes Federation, Pakistan (total population 229M) has the highest prevalence of type 2 diabetes in the world – with over 25% (i.e., 1in 4) of the adult population living with diabetes. It is estimated that more than a quarter (26.9%) of adults with diabetes in Pakistan are undiagnosed. We conducted an opportunistic screening of individuals presenting with minor health issues at health clinics in rural settings in the Sindh province to ascertain the prevalence of prediabetes/diabetes, hyperlipidemia and hypertension to inform the development of primary and secondary (including early diagnosis) prevention programs. Methods: All adult (aged 35-65 years) presenting at the rural health clinics, during February 2021 to May 2022, were examined for height/weight, blood pressure, HbA1C, fasting blood glucose, and lipid profile. Informed consent was obtained from all participants. Results: During the 16 months period, a total of 532 individuals (35% males, 65% females) were screened for diabetes. Of these, about 39% had undiagnosed prediabetes and 25% had undiagnosed diabetes. Of the 92 individuals enrolled for hyperlipidemia and hypertension screening, 32% had undiagnosed hyperlipidemia and 27% had undiagnosed hypertension. The prevalence of hypertension was much higher in females compared to males (81% vs. 19%). Conclusion: The prevalence undiagnosed prediabetes/diabetes, hyperlipemia and hypertension is much higher in rural communities in Pakistan compared to similar settings in other low- middle-income countries. There is an immediate need for formulation of public health programs, including early diagnosis and treatment, of these conditions to mitigate the risk of serious and life-threatening complications in these communities.</p

Exceptionally high prevalence of iron deficiency anaemia in children residing in rural areas in Pakistan

Introduction: Despite a reduction in the global prevalence of anaemia over the past three decades (from 28.2% to 24.3%), anaemia in children aged ≤15 years remains a major public health challenge in sub-Saharan Africa and south Asia. In these regions, there is substantial variation in anaemia burden by age, sex, and socioeconomic status – the highest prevalence is observed in children aged ≤5 years and females. The condition is attributed to a complex interplay of several interconnected causes, including nutritional deficiencies (i.e., iron, vitamin B12, folate), poor and/or cultural child feeding practices, parasitic infections, high birth rates, and short birth intervals. We examined children presenting with signs/symptoms of anaemia at SHINE Humanity primary healthcare clinics in rural settings in the Sindh province, Pakistan, to ascertain the prevalence of anaemia in children aged ≤15 years to inform the development of targeted interventions to reduce the associated morbidity – [e.g. impaired development, years lived with disability (YLDs)] and premature mortality.Methods: All children aged ≤15 years, presenting with pallor and complaints from parents of weakness, fatigue, and decreased concentration were subject to laboratory investigation for complete blood count examination. A haemoglobin (Hb) level of ≤11.4 g/dL was considered diagnostic for anaemia. Informed consent was obtained from all parents.Results: During the study period (July-November 2023), a total of 593 children aged ≤15 years (45.9% males, 54.1% females) were examined for anaemia – of these, 74.4% (n=441) were diagnosed with anaemia (mean Hb 10.3 g/dL; standard deviation=1.8; range, 4.7-15.0). The prevalence of anaemia was 73.5% in males and 75.1% in females. With regard to age, the highest prevalence (86.5%, 64/74) was observed in children aged ≤5 years (mean Hb 9.7 g/dL; standard deviation=1.7; range, 6.3-13.6), followed by 75.8% (266/351) in those aged 6-10 years and 66.1% (111/168) in those aged 11-15 years.Conclusion: Compared with the World Health Organisation (WHO) Global Anaemia estimates (2021 Edition) for South-East Asia, this is the highest recorded prevalence of anaemia in children (86.5 % in those aged ≤5 years) in the region. Considering the morbidity (e.g. poor cognitive and motor development) associated with the duration and severity of anaemia and subsequent YLDs, this study informs formulation of targeted multifaceted interventions, including early diagnosis, combating iron and nutrient deficiencies, promoting hygiene, and health education to reduce the burden of anaemia in children residing in rural areas in Pakistan.</p

Exceptionally high prevalence of iron deficiency anaemia in children residing in rural areas in Pakistan

Introduction: Despite a reduction in the global prevalence of anaemia over the past three decades (from 28.2% to 24.3%), anaemia in children aged ≤15 years remains a major public health challenge in sub-Saharan Africa and south Asia. In these regions, there is substantial variation in anaemia burden by age, sex, and socioeconomic status – the highest prevalence is observed in children aged ≤5 years and females. The condition is attributed to a complex interplay of several interconnected causes, including nutritional deficiencies (i.e., iron, vitamin B12, folate), poor and/or cultural child feeding practices, parasitic infections, high birth rates, and short birth intervals. We examined children presenting with signs/symptoms of anaemia at SHINE Humanity primary healthcare clinics in rural settings in the Sindh province, Pakistan, to ascertain the prevalence of anaemia in children aged ≤15 years to inform the development of targeted interventions to reduce the associated morbidity – [e.g. impaired development, years lived with disability (YLDs)] and premature mortality.Methods: All children aged ≤15 years, presenting with pallor and complaints from parents of weakness, fatigue, and decreased concentration were subject to laboratory investigation for complete blood count examination. A haemoglobin (Hb) level of ≤11.4 g/dL was considered diagnostic for anaemia. Informed consent was obtained from all parents.Results: During the study period (July-November 2023), a total of 593 children aged ≤15 years (45.9% males, 54.1% females) were examined for anaemia – of these, 74.4% (n=441) were diagnosed with anaemia (mean Hb 10.3 g/dL; standard deviation=1.8; range, 4.7-15.0). The prevalence of anaemia was 73.5% in males and 75.1% in females. With regard to age, the highest prevalence (86.5%, 64/74) was observed in children aged ≤5 years (mean Hb 9.7 g/dL; standard deviation=1.7; range, 6.3-13.6), followed by 75.8% (266/351) in those aged 6-10 years and 66.1% (111/168) in those aged 11-15 years.Conclusion: Compared with the World Health Organisation (WHO) Global Anaemia estimates (2021 Edition) for South-East Asia, this is the highest recorded prevalence of anaemia in children (86.5 % in those aged ≤5 years) in the region. Considering the morbidity (e.g. poor cognitive and motor development) associated with the duration and severity of anaemia and subsequent YLDs, this study informs formulation of targeted multifaceted interventions, including early diagnosis, combating iron and nutrient deficiencies, promoting hygiene, and health education to reduce the burden of anaemia in children residing in rural areas in Pakistan.</p