ArticleBMJ open2023
Enhancing care quality and accessibility through digital technology-supported decentralisation of hypertension and diabetes management: a proof-of-concept study in rural Bangladesh.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06258473 (Addressing Gaps in the Hypertension and Diabetes Care Continuum in Rural Bangladesh Through mHealth and Decentralized Primary Care), which is not on this map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Addressing Gaps in the Hypertension and Diabetes Care Continuum in Rural Bangladesh Through mHealth and Decentralized Primary Care: The Dinajpur Study
Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Implementation strategies for evidence-based management of type 2 diabetes at primary healthcare facilities in low- and middle-income countries and related barriers and facilitators: a scoping review.Implementation science communications · 2026Pooled it
- Integration of Cardiovascular Disease Services within Primary Health Care Systems: Insights from South Asia.Current atherosclerosis reports · 2026Review
- The readiness of primary healthcare facilities to address non-communicable diseases in rural Bangladesh.BMC health services research · 2026Article
- Cost of diabetes and hypertension care among patients in rural Bangladesh: a cross-sectional study.BMC public health · 2026Article
- Addressing Gaps in the Hypertension and Diabetes Care Continuum in Rural Bangladesh Through Digital Technology Supported Decentralized Primary Care: Study Protocol and Baseline Results for a Hybrid Effectiveness-Implementation Trial.JMIR research protocols · 2026Article
- Article
- Evaluation of a diabetes decentralization program in rural Madagascar using the RE-AIM framework.PLOS global public health · 2026Article
- Transforming hypertension management with digital technology: a retrospective cohort study in four sub-Saharan African countries.BMJ public health · 2026Article
- A realist review to understand the complexity of effective management of type 2 diabetes and hypertension.Public health reviews · 2026Review
- Challenges and strategies for early diagnosis and management of type 2 diabetes mellitus at the primary healthcare level in rural Western Vidarbha, India: a qualitative study.BMJ public health · 2025Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
objectiveThe critical shortage of healthcare workers, particularly in rural areas, is a major barrier to quality care for non-communicable diseases (NCD) in low-income and middle-income countries. In this proof-of-concept study, we aimed to test a decentralised model for integrated diabetes and hypertension management in rural Bangladesh to improve accessibility and quality of care. DESIGN AND
settingThe study is a single-cohort proof-of-concept study. The key interventions comprised shifting screening, routine monitoring and dispensing of medication refills from a doctor-managed subdistrict NCD clinic to non-physician health worker-managed village-level community clinics; a digital care coordination platform was developed for electronic health records, point-of-care support, referral and routine patient follow-up. The study was conducted in the Parbatipur subdistrict, Rangpur Division, Bangladesh.
participantsA total of 624 participants were enrolled in the study (mean (SD) age, 59.5 (12.0); 65.1% female). OUTCOMES: Changes in blood pressure and blood glucose control, patient retention and patient-visit volume at the NCD clinic and community clinics.
resultsThe proportion of patients with uncontrolled blood pressure reduced from 60% at baseline to 26% at the third month of follow-up, a 56% (incidence rate ratio 0.44; 95% CI 0.33 to 0.57) reduction after adjustment for covariates. The proportion of patients with uncontrolled blood glucose decreased from 74% to 43% at the third month of follow-up. Attrition rates immediately after baseline and during the entire study period were 29.1% and 36.2%, respectively.
conclusionThe proof-of-concept study highlights the potential for involving lower-level primary care facilities and non-physician health workers to rapidly expand much-needed services to patients with hypertension and diabetes in Bangladesh and in similar global settings. Further investigations are needed to evaluate the effectiveness of decentralised hypertension and diabetes care.
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