Burden, barriers, and behavioral adaptation: A mixed-method study of hypertension and diabetes management among the geriatric population in the drought-prone barind tract of Bangladesh

Abstract

Background: Intense heat and extended periods of drought is a growing concern for the rural elderly in the north-western Barind tract of Bangladesh, both physiologically and economically. Bangladesh is currently experiencing an epidemiological transition, where geriatric population is suffering from non-communicable diseases such as hypertension and diabetes, and there is a need to understand the impact of environmental precarity on the management of chronic diseases. Objectives: Overall the goal was to determine the burden and climate sensitive management of HTN and DM in the geriatric population in the rural drought-prone Barind tract. Specific objectives were to establish prevalence of these conditions, exposure to predisposing risk factors and coping and challenges faced by the people in extreme climatic conditions. Methods: The study was conducted in Niamatpur Upazila, Naogaon District using mixed method study approach. The secondary data for phase 2 (quantitative) was obtained from a climate-sensitive surveillance database for 225 geriatric subjects (60 years old and above) through the two-stage stratification random sampling technique. Purposive sampling was used to select 12 in-depth interviews (IDIs) with patients and 3 key informant interviews (KIIs) with healthcare providers. Thematic analysis with a hybrid coding structure was used for the qualitative data, and descriptive statistics were used to analyze the quantitative data using Stata. Results: Diagnosed cases of hypertension presented 37.33% and diabetes 10.67%. A critical treatment gap was identified with 47.62% of hypertensive patients reporting not taking treatment medication and 41.67% of diabetic patients reported doing the same. 58.3% among the diabetic individuals and 60.7% among the hypertensive individuals are on low level of physical activity. Qualitative results emphasized a reactive care tendency whereby patients are dependent on physical signs and not routine screening. The significant obstacles to care were high carrying costs of treatment, institutional friction (long queues) and forgetfulness. The seasonal adaptation was to range across dietary behavior change to physical activity moderation to cope with seasonal extremities. Conclusions: The geriatric population in Barind tract is exposed to various risk factors due to aging, chronic metabolic diseases and environmental stress factors. The large treatment gaps stem from the lack of resources and the dysfunction of the primary health care supply chain. Public health implications include the need for climate-resilient health infrastructure, subsidized geriatric medications and seasonally focused health education to offset the cumulative effects of drought and heat on the outcomes of chronic diseases.