Hypertension and Diabetes in Dhaka North City Corporation: Evidence on Prevalence, Risk Factors, and Intervention Strategies

Hypertension and Diabetes in Dhaka North City Corporation: Evidence on Prevalence, Risk Factors, and Intervention Strategies | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hypertension and Diabetes in Dhaka North City Corporation: Evidence on Prevalence, Risk Factors, and Intervention Strategies Syed Mahmood Shahidul Islam This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8580203/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Hypertension and diabetes are major contributors to the growing burden of non-communicable diseases in rapidly urbanizing low- and middle-income countries [ 1 – 4 , 6 , 8 ]. Urban environments such as Dhaka North City Corporation (DNCC) promote sedentary lifestyles, unhealthy dietary patterns, chronic stress, and delayed access to healthcare [ 14 – 17 , 26 – 29 , 36 – 38 ], all of which increase the risk of these conditions and their complications. This cross-sectional study assessed the prevalence of hypertension and diabetes among 473 adult patients attending health facilities in DNCC and examined associated demographic and lifestyle risk factors. Hypertension was identified in 68% of participants, diabetes in 61%, and co-existing disease in 47%. Obesity, physical inactivity, high consumption of processed foods, chronic stress, and delayed diagnosis were significantly prevalent risk factors. The most common complications observed were cardiovascular disease (29%), chronic kidney disease (18%), and retinopathy (12%). These findings highlight the urgent need for integrated urban health interventions focusing on early disease screening, lifestyle modification, and strengthening of primary healthcare services. Policy-driven urban health reforms aligned with the WHO HEARTS framework are essential for sustainable disease control [ 9 , 34 , 41 , 42 ]. Objective: This study aimed to assess the prevalence of hypertension and diabetes among 473 adult patients in Dhaka North City Corporation and to identify major demographic and lifestyle-related risk factors to inform appropriate prevention and management strategies. Methods: This cross-sectional study was carried out in a selected sample of public and private health facilities in Dhaka North City Corporation. Clinical assessments and structured questionnaires covering demographic characteristics, lifestyle behaviors, dietary patterns, and access to healthcare services were the main sources of data collection. The associations between certain risk factors and the prevalence of hypertension and diabetes were the subject of statistical analyses. Results: Among the participants, 68% were suffering from hypertension while 61% had diabetes as the disease of the study population. The two conditions were simultaneous in 47% of the participants. Out of the total sample size of 100%, 55% were men, and the maximum prevalence was in the age group of 45–60 years. Among the populous, the main contributors were overweight (42%), sedentary lifestyle (38%), and diet rich in processed foods (55%). Moreover, chronic stress and late diagnosis were also quite frequently seen. The major complications that arose were among the cardiovascular disease (29%), chronic kidney disease (18%), and retinopathy (12%) patients. Conclusion: Hypertension and diabetes represent a substantial public health burden in Dhaka North City Corporation, driven by urban-specific factors such as sedentary lifestyles, unhealthy dietary practices, chronic stress, and delayed diagnosis. The findings underscore the need for routine screening programs, public health education, improved access to affordable healthcare, and policy-driven urban health interventions to reduce the long-term burden of these conditions. Hypertension Diabetes Urban Health Dhaka North City Corporation Non-Communicable Diseases Public Health Strategies Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction 1.1 Background Hypertension and diabetes are among the leading contributors to the global burden of non-communicable diseases, accounting for substantial morbidity, mortality, and healthcare costs worldwide. The burden of these conditions is overly higher in low and middle income countries, where rapid urbanization, population aging, and lifestyle transitions have accelerated the rise of cardiometabolic risk factors. Urban populations are increasingly exposed to sedentary behavior, unhealthy dietary patterns, psychosocial stress, and limited opportunities for preventive healthcare, all of which contribute to the growing prevalence of hypertension and diabetes and their associated complications. South Asian countries, including Bangladesh, are experiencing a particularly rapid epidemiological transition. Urban centers are witnessing marked increases in obesity, physical inactivity, and consumption of energy-dense processed foods, accompanied by delayed diagnosis and suboptimal disease management. These trends have resulted in a dual burden of communicable and non-communicable diseases, placing significant pressure on already constrained health systems. 1.2 Rationale Despite increasing recognition of non-communicable diseases as a major public health challenge in Bangladesh, evidence specific to urban populations remains limited. Dhaka North City Corporation, one of the most densely populated urban areas in the country, presents a unique context characterized by rapid urban growth, traffic congestion, environmental stressors, and changing lifestyle behaviors. These factors may interact to increase the risk of hypertension and diabetes while simultaneously limiting timely access to preventive and curative healthcare services. Understanding the prevalence and determinants of hypertension and diabetes within this urban setting is essential for informing targeted interventions and policy responses. This study was therefore conducted to assess the burden of hypertension and diabetes among adults in Dhaka North City Corporation and to identify key demographic and lifestyle-related risk factors that can guide urban-specific prevention and management strategies. 1.3 Objectives Assess the prevalence of hypertension and diabetes in DNCC. Identify demographic and lifestyle-related risk factors. Propose actionable strategies for prevention and management. 2. Methods 2.1 Study Design A cross-sectional study was conducted across multiple health facilities in DNCC. 2.2 Sampling and Participants A systematic sampling approach was used to recruit adult patients (≥ 18 years) attending selected public and private health facilities within Dhaka North City Corporation. Every third eligible patient presenting to outpatient services during the study period was invited to participate until the required sample size of 473 was achieved. Patients with acute medical emergencies, pregnancy, or severe cognitive impairment were excluded. The sampling strategy ensured representation across age, gender, and socioeconomic groups within the DNCC population. 2.3 Data Collection Clinical Assessments: Included blood pressure, fasting blood glucose, and BMI measurements [ 5 , 9 , 20 , 21 ]. Questionnaires: Captured data on demographics, lifestyle habits, dietary patterns, and access to healthcare services. 2.4 Ethical Considerations Institutional ethical clearance was obtained, and informed consent was secured from all participants. 2.5 Statistical Analysis Descriptive statistics were used to summarize participant characteristics and disease prevalence. Variables included in the multivariable logistic regression model were selected based on prior literature and results of bivariate analyses. Statistical analyses were conducted using SPSS Statistics (Version 26.0; IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. Complete-case analysis was applied for handling missing data. 3. Results 3.1 Prevalence of Hypertension and Diabetes Hypertension: 68% Diabetes: 61% Co-occurrence: 47% 3.2 Demographics Gender: Male (55%), Female (45%). Age Group: Highest prevalence among individuals aged 45–60 years (62%). Socioeconomic Status: Predominantly middle-income households. 3.3 Key Risk Factors Obesity: 42% of patients exhibited high BMI. Physical Inactivity: 38% reported insufficient physical activity. Dietary Patterns: 55% had diets high in processed and fast foods. Stress: Chronic stress was reported by 48% of participants. Delayed Diagnoses: Median delay of 9 months from symptom onset to diagnosis. 3.4 Complications Cardiovascular Disease: 29% Chronic Kidney Disease: 18% Retinopathy: 12% 3.5 Factors Associated with Hypertension and Diabetes Multivariable logistic regression analysis was conducted to examine the association between selected risk factors and the presence of hypertension and/or diabetes. After adjustment for age and sex, obesity, physical inactivity, high consumption of processed foods, and chronic stress were independently associated with increased odds of having hypertension and diabetes. Table 1 Multivariable Logistic Regression Analysis of Factors Associated with Hypertension and/or Diabetes (n = 473) Risk Factor Adjusted Odds Ratio (AOR) 95% Confidence Interval p -value Obesity (BMI ≥ 25 kg/m²) 2.34 1.52–3.61 < 0.001 Physical inactivity 1.89 1.21–2.95 0.004 High processed food intake 2.11 1.36–3.27 0.001 Chronic stress 1.67 1.09–2.56 0.018 Age ≥ 45 years 2.78 1.80–4.29 < 0.001 Male sex 1.21 0.82–1.78 0.34 Note : Model adjusted for age and sex. Statistical significance set at p < 0.05. 4. Discussion 4.1 Comparison with Regional Data Similar patterns of hypertension and diabetes prevalence have been reported in other urban settings within low- and middle-income countries [ 22 – 25 ]. 4.2 Analysis of Risk Factors The observed associations with obesity, physical inactivity, and processed food consumption are consistent with global evidence [ 14 – 17 , 26 – 29 , 32 ]. 4.3 Implications for Public Health The high prevalence of complications highlights the urgent need for early diagnosis, integrated care, and targeted interventions to mitigate disease progression. The urban context of Dhaka North City Corporation presents unique challenges that intensify the risk of hypertension and diabetes. Prolonged commuting times, heavy traffic congestion, limited walkable spaces, and high density of fast-food outlets contribute to physical inactivity and unhealthy dietary practices [ 36 – 39 ]. Additionally, work-related stress and limited emphasis on preventive health screening further delay diagnosis and management. These DNCC-specific factors highlight the need for urban-tailored interventions rather than generic non-communicable disease strategies. 5. Recommendations 5.1 Short-Term Interventions Community-based screening programs should be implemented through ward-level primary healthcare centers and mobile health camps under the coordination of the City Corporation and Directorate General of Health Services. Annual screening coverage of adults aged ≥ 40 years should be used as a key performance indicator. Targeted health education campaigns focusing on diet, physical activity, and early symptom recognition should be delivered through workplaces, community centers, and digital platforms. Stress management initiatives, including brief counseling and workplace wellness sessions, should be integrated into primary care services [ 9 , 34 , 41 ]. 5.2 Long-Term Strategies Urban health policies should prioritize subsidized access to essential diagnostic services and long-term management of hypertension and diabetes, particularly for low- and middle-income populations. Development of safe walking paths, community exercise spaces, and workplace physical activity programs should be incorporated into urban planning initiatives. Integration of the WHO HEARTS framework into primary healthcare facilities within DNCC should be institutionalized, with routine monitoring of blood pressure control rates, treatment adherence, and complication reduction as measurable outcomes [ 9 , 34 , 41 , 42 ]. 6. Strengths and Limitations This study provides recent evidence on the burden of hypertension and diabetes in an urban population of Bangladesh using a systematic sampling approach and multivariable analysis to identify key risk factors. Inclusion of participants from both public and private healthcare facilities enhances the representativeness of the findings within Dhaka North City Corporation. However, the cross-sectional design limits causal inference, and the facility-based sampling approach may underestimate prevalence among individuals with limited access to healthcare. Additionally, reliance on self-reported lifestyle information may introduce recall bias. Despite these limitations, the study offers important insights to inform urban health policy, targeted non-communicable disease interventions, and the design of context-specific prevention strategies in rapidly urbanizing settings. Conclusion Hypertension and diabetes represent a substantial public health burden in Dhaka North City Corporation, driven by sedentary lifestyles, unhealthy dietary practices, chronic stress, and delayed diagnosis. The findings underscore the need for coordinated public health action, including routine community-based screening, health education, promotion of physical activity, and improved access to affordable healthcare. Integration of global best practices such as the WHO HEARTS framework is essential for sustainable reductions in disease burden [ 9 , 34 , 41 ]. Declarations Author Contribution S.M.S.I. conceptualized the study, designed the methodology, supervised data collection, and performed the statistical analysis. S.M.S.I. drafted the original manuscript, interpreted the findings, and led the discussion and conclusions. All authors contributed to data acquisition, critically reviewed the manuscript for important intellectual content, and approved the final version for submission. Acknowledgement The authors would like to thank the healthcare staff and field personnel who supported participant recruitment and data collection in Dhaka North City Corporation. We also acknowledge the cooperation of all study participants for their time and valuable contributions. No professional writing or editorial services were used in the preparation of this manuscript. Data Availability Yes. This study involved the collection, analysis, and interpretation of primary research data obtained from adult participants residing in Dhaka North City Corporation. Data were generated through structured data collection tools and analysed using appropriate statistical methods. References International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation. 2021. 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WHO HEARTS technical package for cardiovascular disease management in primary health care. Geneva: WHO; 2022. Bangladesh Bureau of Statistics. Urban health survey 2022. Dhaka: BBS; 2022. Diabetic Association of Bangladesh. Diabetes situation in Bangladesh. Dhaka: DAB; 2021. Ahmed SM, Hossain MA. Urban health inequities in Bangladesh. Health Policy Plan. 2019;34(2):90–9. Islam MS, Purnat TD, Phuong NTA, et al. Non-communicable diseases in low- and middle-income countries. Lancet Glob Health. 2014;2(7):e405–6. Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249–57. Misra A, Khurana L. Obesity and the metabolic syndrome in South Asians. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S9–30. Popkin BM. Nutrition transition and the global diabetes epidemic. Nutr Rev. 2017;75(1):73–82. Goryakin Y, Suhrcke M. Economic development and non-communicable diseases. Health Econ. 2014;23(2):176–94. World Bank. Non-communicable diseases in South Asia. Washington DC: World Bank; 2020. Asian Development Bank. Health and urbanization in Dhaka: addressing non-communicable diseases. Manila: ADB; 2020. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311(5):507–20. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA. 2003;289(19):2560–72. Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control. Circulation. 2016;134(6):441–50. Zhou B, Bentham J, Di Cesare M, et al. Worldwide trends in diabetes since 1980. Lancet. 2016;387(10027):1513–30. Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes. Lancet. 2011;378(9785):31–40. Gupta R, Xavier D. Hypertension in developing countries. Indian Heart J. 2018;70(1):2–5. Willett WC, Stampfer MJ. Diet and cardiovascular disease. Am J Clin Nutr. 2013;98(4):699–705. Mozaffarian D. Dietary and policy priorities for cardiovascular disease. Circulation. 2016;133(2):187–225. Malik VS, Willett WC, Hu FB. Sugar-sweetened beverages and cardiometabolic health. Circulation. 2009;119(20):2673–84. Katz DL, Meller S. Can we say what diet is best for health? Annu Rev Public Health. 2014;35:83–103. World Economic Forum. The global economic burden of non-communicable diseases. Geneva: World Economic Forum; 2019. Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India. Circulation. 2016;133(16):1605–20. Popkin BM, Reardon T. Obesity and the food system transformation. Obes Rev. 2018;19(8):1028–64. Public Health England. Health matters: combating high blood pressure. London: Public Health England; 2019. World Health Organization Regional Office for South-East Asia. Regional framework for prevention and control of noncommunicable diseases. New Delhi: WHO SEARO; 2022. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104. Diez Roux AV. Investigating neighborhood and area effects on health. J Urban Health. 2001;78(4):536–41. Sallis JF, Cerin E, Conway TL, et al. Physical activity in relation to urban environments. Lancet. 2016;387(10034):2207–17. Frank LD, Engelke PO. The built environment and human activity patterns. Am J Prev Med. 2001;21(2):117–23. Kearns A, Whitley E, Tannahill C, et al. Living environment and mental health. Soc Sci Med. 2015;138:10–9. Stuckler D, Basu S. The political economy of chronic disease. Int J Health Serv. 2013;43(3):1–22. Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable disease crisis. Lancet. 2011;377(9775):1438–47. Nugent R. Chronic diseases in low- and middle-income countries. Ann N Y Acad Sci. 2008;1136:70–9. 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Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Background\u003c/h2\u003e \u003cp\u003eHypertension and diabetes are among the leading contributors to the global burden of non-communicable diseases, accounting for substantial morbidity, mortality, and healthcare costs worldwide. The burden of these conditions is overly higher in low and middle income countries, where rapid urbanization, population aging, and lifestyle transitions have accelerated the rise of cardiometabolic risk factors. Urban populations are increasingly exposed to sedentary behavior, unhealthy dietary patterns, psychosocial stress, and limited opportunities for preventive healthcare, all of which contribute to the growing prevalence of hypertension and diabetes and their associated complications.\u003c/p\u003e \u003cp\u003eSouth Asian countries, including Bangladesh, are experiencing a particularly rapid epidemiological transition. Urban centers are witnessing marked increases in obesity, physical inactivity, and consumption of energy-dense processed foods, accompanied by delayed diagnosis and suboptimal disease management. These trends have resulted in a dual burden of communicable and non-communicable diseases, placing significant pressure on already constrained health systems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Rationale\u003c/h2\u003e \u003cp\u003eDespite increasing recognition of non-communicable diseases as a major public health challenge in Bangladesh, evidence specific to urban populations remains limited. Dhaka North City Corporation, one of the most densely populated urban areas in the country, presents a unique context characterized by rapid urban growth, traffic congestion, environmental stressors, and changing lifestyle behaviors. These factors may interact to increase the risk of hypertension and diabetes while simultaneously limiting timely access to preventive and curative healthcare services.\u003c/p\u003e \u003cp\u003eUnderstanding the prevalence and determinants of hypertension and diabetes within this urban setting is essential for informing targeted interventions and policy responses. This study was therefore conducted to assess the burden of hypertension and diabetes among adults in Dhaka North City Corporation and to identify key demographic and lifestyle-related risk factors that can guide urban-specific prevention and management strategies.\u003c/p\u003e \u003cp\u003e \u003cb\u003e1.3 Objectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAssess the prevalence of hypertension and diabetes in DNCC.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentify demographic and lifestyle-related risk factors.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePropose actionable strategies for prevention and management.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003ch2\u003e2.1 Study Design\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted across multiple health facilities in DNCC.\u003c/p\u003e\u003ch2\u003e2.2 Sampling and Participants\u003c/h2\u003e\u003cp\u003eA systematic sampling approach was used to recruit adult patients (≥ 18 years) attending selected public and private health facilities within Dhaka North City Corporation. Every third eligible patient presenting to outpatient services during the study period was invited to participate until the required sample size of 473 was achieved. Patients with acute medical emergencies, pregnancy, or severe cognitive impairment were excluded. The sampling strategy ensured representation across age, gender, and socioeconomic groups within the DNCC population.\u003c/p\u003e\u003cp\u003e \u003cb\u003e2.3 Data Collection\u003c/b\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eClinical Assessments: Included blood pressure, fasting blood glucose, and BMI measurements [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQuestionnaires: Captured data on demographics, lifestyle habits, dietary patterns, and access to healthcare services.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003ch2\u003e2.4 Ethical Considerations\u003c/h2\u003e\u003cp\u003e Institutional ethical clearance was obtained, and informed consent was secured from all participants.\u003c/p\u003e\u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics were used to summarize participant characteristics and disease prevalence. Variables included in the multivariable logistic regression model were selected based on prior literature and results of bivariate analyses. Statistical analyses were conducted using SPSS Statistics (Version 26.0; IBM Corp., Armonk, NY, USA), with statistical significance set at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05. Complete-case analysis was applied for handling missing data.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e \u003cb\u003e3.1 Prevalence of Hypertension and Diabetes\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHypertension: 68%\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDiabetes: 61%\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCo-occurrence: 47%\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Demographics\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eGender: Male (55%), Female (45%).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAge Group: Highest prevalence among individuals aged 45\u0026ndash;60 years (62%).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSocioeconomic Status: Predominantly middle-income households.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3 Key Risk Factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eObesity: 42% of patients exhibited high BMI.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePhysical Inactivity: 38% reported insufficient physical activity.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDietary Patterns: 55% had diets high in processed and fast foods.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStress: Chronic stress was reported by 48% of participants.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDelayed Diagnoses: Median delay of 9 months from symptom onset to diagnosis.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.4 Complications\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCardiovascular Disease: 29%\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eChronic Kidney Disease: 18%\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRetinopathy: 12%\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Factors Associated with Hypertension and Diabetes\u003c/h2\u003e \u003cp\u003eMultivariable logistic regression analysis was conducted to examine the association between selected risk factors and the presence of hypertension and/or diabetes. After adjustment for age and sex, obesity, physical inactivity, high consumption of processed foods, and chronic stress were independently associated with increased odds of having hypertension and diabetes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable Logistic Regression Analysis of Factors Associated with Hypertension and/or Diabetes (n\u0026thinsp;=\u0026thinsp;473)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted Odds Ratio (AOR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.52\u0026ndash;3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical inactivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026ndash;2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh processed food intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.36\u0026ndash;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.09\u0026ndash;2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.80\u0026ndash;4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82\u0026ndash;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eNote\u003c/b\u003e: Model adjusted for age and sex. Statistical significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Comparison with Regional Data\u003c/h2\u003e \u003cp\u003eSimilar patterns of hypertension and diabetes prevalence have been reported in other urban settings within low- and middle-income countries [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Analysis of Risk Factors\u003c/h2\u003e \u003cp\u003eThe observed associations with obesity, physical inactivity, and processed food consumption are consistent with global evidence [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Implications for Public Health\u003c/h2\u003e \u003cp\u003eThe high prevalence of complications highlights the urgent need for early diagnosis, integrated care, and targeted interventions to mitigate disease progression. The urban context of Dhaka North City Corporation presents unique challenges that intensify the risk of hypertension and diabetes. Prolonged commuting times, heavy traffic congestion, limited walkable spaces, and high density of fast-food outlets contribute to physical inactivity and unhealthy dietary practices [\u003cspan additionalcitationids=\"CR37 CR38\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Additionally, work-related stress and limited emphasis on preventive health screening further delay diagnosis and management. These DNCC-specific factors highlight the need for urban-tailored interventions rather than generic non-communicable disease strategies.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Recommendations","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Short-Term Interventions\u003c/h2\u003e \u003cp\u003eCommunity-based screening programs should be implemented through ward-level primary healthcare centers and mobile health camps under the coordination of the City Corporation and Directorate General of Health Services. Annual screening coverage of adults aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years should be used as a key performance indicator. Targeted health education campaigns focusing on diet, physical activity, and early symptom recognition should be delivered through workplaces, community centers, and digital platforms. Stress management initiatives, including brief counseling and workplace wellness sessions, should be integrated into primary care services [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e5.2 Long-Term Strategies\u003c/h2\u003e \u003cp\u003eUrban health policies should prioritize subsidized access to essential diagnostic services and long-term management of hypertension and diabetes, particularly for low- and middle-income populations. Development of safe walking paths, community exercise spaces, and workplace physical activity programs should be incorporated into urban planning initiatives. Integration of the WHO HEARTS framework into primary healthcare facilities within DNCC should be institutionalized, with routine monitoring of blood pressure control rates, treatment adherence, and complication reduction as measurable outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"6. Strengths and Limitations","content":"\u003cp\u003eThis study provides recent evidence on the burden of hypertension and diabetes in an urban population of Bangladesh using a systematic sampling approach and multivariable analysis to identify key risk factors. Inclusion of participants from both public and private healthcare facilities enhances the representativeness of the findings within Dhaka North City Corporation. However, the cross-sectional design limits causal inference, and the facility-based sampling approach may underestimate prevalence among individuals with limited access to healthcare. Additionally, reliance on self-reported lifestyle information may introduce recall bias. Despite these limitations, the study offers important insights to inform urban health policy, targeted non-communicable disease interventions, and the design of context-specific prevention strategies in rapidly urbanizing settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHypertension and diabetes represent a substantial public health burden in Dhaka North City Corporation, driven by sedentary lifestyles, unhealthy dietary practices, chronic stress, and delayed diagnosis. The findings underscore the need for coordinated public health action, including routine community-based screening, health education, promotion of physical activity, and improved access to affordable healthcare. Integration of global best practices such as the WHO HEARTS framework is essential for sustainable reductions in disease burden [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.M.S.I. conceptualized the study, designed the methodology, supervised data collection, and performed the statistical analysis. S.M.S.I. drafted the original manuscript, interpreted the findings, and led the discussion and conclusions. All authors contributed to data acquisition, critically reviewed the manuscript for important intellectual content, and approved the final version for submission.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the healthcare staff and field personnel who supported participant recruitment and data collection in Dhaka North City Corporation. We also acknowledge the cooperation of all study participants for their time and valuable contributions. No professional writing or editorial services were used in the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eYes. This study involved the collection, analysis, and interpretation of primary research data obtained from adult participants residing in Dhaka North City Corporation. Data were generated through structured data collection tools and analysed using appropriate statistical methods.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInternational Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation. 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.idf.org\u003c/span\u003e\u003cspan address=\"https://www.idf.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Hypertension: key facts. Geneva: World Health Organization. 2023. 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Ann N Y Acad Sci. 2008;1136:70\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Diabetes, Urban Health, Dhaka North City Corporation, Non-Communicable Diseases, Public Health Strategies","lastPublishedDoi":"10.21203/rs.3.rs-8580203/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8580203/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHypertension and diabetes are major contributors to the growing burden of non-communicable diseases in rapidly urbanizing low- and middle-income countries [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Urban environments such as Dhaka North City Corporation (DNCC) promote sedentary lifestyles, unhealthy dietary patterns, chronic stress, and delayed access to healthcare [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], all of which increase the risk of these conditions and their complications. This cross-sectional study assessed the prevalence of hypertension and diabetes among 473 adult patients attending health facilities in DNCC and examined associated demographic and lifestyle risk factors. Hypertension was identified in 68% of participants, diabetes in 61%, and co-existing disease in 47%. Obesity, physical inactivity, high consumption of processed foods, chronic stress, and delayed diagnosis were significantly prevalent risk factors. The most common complications observed were cardiovascular disease (29%), chronic kidney disease (18%), and retinopathy (12%). These findings highlight the urgent need for integrated urban health interventions focusing on early disease screening, lifestyle modification, and strengthening of primary healthcare services. Policy-driven urban health reforms aligned with the WHO HEARTS framework are essential for sustainable disease control [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObjective:\u003c/p\u003e \u003cp\u003eThis study aimed to assess the prevalence of hypertension and diabetes among 473 adult patients in Dhaka North City Corporation and to identify major demographic and lifestyle-related risk factors to inform appropriate prevention and management strategies.\u003c/p\u003e \u003cp\u003eMethods:\u003c/p\u003e \u003cp\u003eThis cross-sectional study was carried out in a selected sample of public and private health facilities in Dhaka North City Corporation. Clinical assessments and structured questionnaires covering demographic characteristics, lifestyle behaviors, dietary patterns, and access to healthcare services were the main sources of data collection. The associations between certain risk factors and the prevalence of hypertension and diabetes were the subject of statistical analyses.\u003c/p\u003e \u003cp\u003eResults:\u003c/p\u003e \u003cp\u003eAmong the participants, 68% were suffering from hypertension while 61% had diabetes as the disease of the study population. The two conditions were simultaneous in 47% of the participants. Out of the total sample size of 100%, 55% were men, and the maximum prevalence was in the age group of 45\u0026ndash;60 years. Among the populous, the main contributors were overweight (42%), sedentary lifestyle (38%), and diet rich in processed foods (55%). Moreover, chronic stress and late diagnosis were also quite frequently seen. The major complications that arose were among the cardiovascular disease (29%), chronic kidney disease (18%), and retinopathy (12%) patients.\u003c/p\u003e \u003cp\u003eConclusion:\u003c/p\u003e \u003cp\u003eHypertension and diabetes represent a substantial public health burden in Dhaka North City Corporation, driven by urban-specific factors such as sedentary lifestyles, unhealthy dietary practices, chronic stress, and delayed diagnosis. The findings underscore the need for routine screening programs, public health education, improved access to affordable healthcare, and policy-driven urban health interventions to reduce the long-term burden of these conditions.\u003c/p\u003e","manuscriptTitle":"Hypertension and Diabetes in Dhaka North City Corporation: Evidence on Prevalence, Risk Factors, and Intervention Strategies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 10:32:18","doi":"10.21203/rs.3.rs-8580203/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"70423976-9d16-4bda-99bf-efc1aa17d701","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T11:55:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 10:32:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8580203","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8580203","identity":"rs-8580203","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}