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Mweemba C, Mutale W, Masiye F, Hangoma P. Why is there a gap in self-rated health among people with hypertension in Zambia? A decomposition of determinants and rural‒urban differences. BMC Public Health 2024; 24:1025. [PMID: 38609942 PMCID: PMC11015612 DOI: 10.1186/s12889-024-18429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Hypertension affects over one billion people globally and is one of the leading causes of premature death. Low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from more affluent and urban populations towards poorer and rural communities. Our study examined inequalities in self-rated health (SRH) among people with hypertension and whether there is a rural‒urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa. METHODS We utilized the Zambia Household Health Expenditure and Utilization Survey for data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) survey. We applied the Linear Probability Model to assess the association between self-rated health and independent variables as a preliminary step. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups. RESULTS Advanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (73.6%), district HIV prevalence (30.8%) and household expenditure (4.8%) being the most important determinants that explain the health gap. CONCLUSIONS Urban hypertension patients have better SRH than rural patients in Zambia. Education, district HIV prevalence and household expenditure were the most important determinants of the health gap between rural and urban hypertension patients. Policies aimed at promoting educational interventions, improving access to financial resources and strengthening hypertension health services, especially in rural areas, can significantly improve the health of rural patients, and potentially reduce health inequalities between the two regions.
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Affiliation(s)
- Chris Mweemba
- Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, P.O. Box 50110, Zambia.
| | - Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, P.O. Box 50110, Zambia
| | - Felix Masiye
- Department of Economics, School of Humanities and Social Science, Great East Road Campus, Lusaka, P.O Box 32379, Zambia
| | - Peter Hangoma
- Department of Health Policy and Management, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, P.O. Box 50110, Zambia
- Chr. Michelson Institute (CMI), Bergen, Norway
- Bergen Center for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
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Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S. Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nat Med 2024; 30:414-423. [PMID: 38278990 DOI: 10.1038/s41591-023-02769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
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Affiliation(s)
- Dorit Talia Stein
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa B Reitsma
- Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kokou Agoudavi
- Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Deborah Carvalho Malta
- Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Soares Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Kibachio Joseph Mwangi
- World Health Organization, Pretoria, South Africa
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Maja E Marcus
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Jobe M, Mactaggart I, Bell S, Kim MJ, Hydara A, Bascaran C, Njai M, Badjie O, Perel P, Prentice AM, Burton MJ. Prevalence of hypertension, diabetes, obesity, multimorbidity, and related risk factors among adult Gambians: a cross-sectional nationwide study. Lancet Glob Health 2024; 12:e55-e65. [PMID: 38097298 DOI: 10.1016/s2214-109x(23)00508-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND As countries progress through economic and demographic transition, chronic non-communicable diseases (NCDs) overtake a previous burden of infectious diseases. We investigated the prevalence of hypertension, diabetes, obesity, and multimorbidity in older adults in The Gambia. METHODS We embedded a survey on NCDs into the nationally representative 2019 Gambia National Eye Health Survey of adults aged 35 years or older. We measured anthropometrics, capillary blood glucose, and blood pressure together with sociodemographic information, personal and family health history, and information on smoking and alcohol consumption. Hypertension was defined as systolic blood pressure of 140 mmHg or more, diastolic blood pressure of 90 mmHg or more, or receiving treatment for hypertension. Diabetes was defined as fasting capillary blood glucose of 7 mmol/L or more, random blood glucose of 11·1mmol/L or more, or previous diagnosis or treatment for diabetes. Overweight was defined as BMI of 25-29·9 kg/m2 and obesity as 30 kg/m2 or more. Multimorbidity was defined as the coexistence of two or more conditions. We calculated weighted crude and adjusted estimates for each outcome by sex, residence, and selected sociodemographic factors. FINDINGS We analysed data from 9188 participants (5039 [54·8%] from urban areas, 6478 [70·5%] women). The prevalence of hypertension was 47·0%; 2259 (49·3%) women, 2052 (44·7%) men. The prevalence increased with age, increasing from 30% in those aged 35-45 years to over 75% in those aged 75 years and older. Overweight and obesity increased the odds of hypertension, and underweight reduced the odds. The prevalence of diabetes was 6·3% (322 [7·0%] women, 255 [5·6%] men), increasing from 3·8% in those aged 35-44 years to 9·1% in those aged 65-75 years, and then declining. Diabetes was much more common among urban residents, especially in women (peaking at 13% by age 65 years). Diabetes was strongly associated with BMI and wealth index. The prevalence of obesity was 12·0% and was notably higher in women than men (880 [20·2%] vs 170 [3·9%]). Multimorbidity was present in 932 (10·7%), and was more common in women than men (694 [15·9] vs 238 [5·5]). The prevalence of smoking was 9·7%; 5 (0·1%) women, 889 (19·3%) men. Alcohol consumption in the past year was negligible. INTERPRETATION We have documented high levels of NCDs and associated risk factors in Gambian adults. This presents a major stress on the country's fragile health system that requires an urgent, concerted, and targeted mutisectoral strategy. FUNDING The Queen Elizabeth Diamond Jubilee Trust and Wellcome Trust.
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Affiliation(s)
- Modou Jobe
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Banjul, The Gambia.
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Min J Kim
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Banjul, The Gambia
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Modou Njai
- Directorate of Health Promotion & Education, Ministry of Health, Banjul, The Gambia
| | - Omar Badjie
- Directorate of Health Promotion & Education, Ministry of Health, Banjul, The Gambia
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Banjul, The Gambia
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Ali N, Aftab U, Soomar SM, Tareen H, Khan UR, Khan BA, Razzak JA. Clinical utility of routine investigations and risk factors of end-organ damage in asymptomatic severe hypertension. Intern Emerg Med 2023; 18:2037-2043. [PMID: 37668749 DOI: 10.1007/s11739-023-03403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
Asymptomatic severe hypertension is defined as systolic blood pressure of ≥ 180 mmHg or diastolic blood pressure of ≥ 120 mmHg without signs and symptoms of end-organ damage or dysfunction. Literature shows that around 5% of the patients with severe asymptomatic hypertension had acute hypertension-related end-organ damage. This study aimed to determine the clinical utility of routine investigations and risk factors of end-organ damage in patients presented to the emergency department with asymptomatic severe hypertension. This single-center, cross-sectional study was conducted at the emergency department of the Aga Khan University Hospital, Karachi, Pakistan, from January 2018 to December 2020. All adult patients (age ≥ 18 years) presented to the emergency department with a systolic blood pressure of ≥ 180 or diastolic blood pressure of ≥ 120 mmHg without any signs and symptoms of end-organ damage (e.g., chest pain, unilateral limb or facial weakness, or hemiplegia, altered mental status, shortness of breath, decreased urine output, and sudden-onset of severe headache) were included. Routine investigations were analyzed to detect end-organ damage, including complete blood count, basic metabolic panel, urine detailed report, electrocardiogram, and troponin-I. Multivariable binary logistic regression was applied to identify the risk factors of end-organ damage considering the significant p value of ≤ 0.05. A total of 180 patients were presented to the emergency department with asymptomatic severe hypertension during the study period. Among the total patients, 60 patients (33.3%) had abnormal investigation findings; out of them, new-onset end-organ damage was diagnosed in 15 patients (8.3%). The most common end-organ damage was the kidney (73.3%) followed by the heart (26.6%). The multivariable binary logistic regression showed that age of more than 60 years, past medical history of diabetes, ischemic heart disease, and cerebrovascular accident were significantly associated with a higher risk of end-organ damage (p < 0.05). The study identified a higher prevalence of abnormal routine investigations and acute end-organ damage in emergency department patients with asymptomatic severe hypertension compared to high-income countries and suggested a lower threshold for end-organ damage screening in these patients. The current recommendations of foregoing further workup in patients with asymptomatic severe hypertension may need modification for emergency departments in low-middle-income countries if similar associations are replicated in other settings.
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Affiliation(s)
- Noman Ali
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan.
| | - Umaira Aftab
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Salman Muhammad Soomar
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Hafsa Tareen
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Badar Afzal Khan
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
- Weill Cornell Medicine,, New York, USA
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Mweemba C, Mutale W, Masiye F, Hangoma P. Why is there a gap in self-rated health among people with hypertension? A decomposition of determinants and rural-urban differences. RESEARCH SQUARE 2023:rs.3.rs-3111338. [PMID: 37461663 PMCID: PMC10350196 DOI: 10.21203/rs.3.rs-3111338/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background Hypertension affects over one billion people globally and is one of the leading causes of premature death. The low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from the more affluent and urban population towards the poorer and rural communities. Our study examined inequalities in self-rated health among people with hypertension and whether there is a rural-urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa. Methods We utilized the Zambia Household Health Expenditure and Utilization Survey for the data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from a previous study. The linear probability model provided a preliminary assessment of the association between self-rated health and independent variables. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups. Results Advanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (62%), district HIV prevalence (26%) and household expenditure (12%) being the most important determinants that explain the health gap. Conclusions Urban hypertension patients have better SRH than rural patients in Zambia. Educational interventions, financial protection schemes and strengthening hypertension health services in rural areas can significantly reduce the health gap between the two regions.
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Affiliation(s)
- Chris Mweemba
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Felix Masiye
- Department of Economics, School of Humanities and Social Science, P.O Box 32379, Great East Road Campus, University of Zambia, Lusaka, Zambia
| | - Peter Hangoma
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
- Chr. Michelson Institute (CMI), Bergen, Norway
- Bergen Center for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
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Son M, Heo YJ, Hyun HJ, Kwak HJ. Effects of Marital Status and Income on Hypertension: The Korean Genome and Epidemiology Study (KoGES). J Prev Med Public Health 2022; 55:506-519. [PMID: 36475316 DOI: 10.3961/jpmph.22.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to analyze the associations of income, marital status, and health behaviors with hypertension in male and female over 40 years of age in the Korea. METHODS The data were derived from the Korean Genome and Epidemiology Study (KoGES; 4851-302) which included 211 576 participants. To analyze the relationships of income, marital status, and health behaviors with hypertension in male and female over 40 years of age, multiple logistic regression was conducted with adjustments for these variables. RESULTS The prevalence of hypertension increased linearly as income decreased. The odds ratio for developing hypertension in people with an income of <0.5 million Korean won (KRW) compared to ≥6.0 million KRW was 1.55 (95% confidence interval [CI], 1.25 to 1.93) in the total population, 1.58 (95% CI, 1.27 to 1.98) in male, and 1.07 (95% CI, 0.35 to 3.28) in female. The combined effect of income level and marital status on hypertension was significant. According to income level and marital status, in male, low income and divorce were most associated with hypertension (1.76 times; 95% CI, 1.01 to 3.08). However, in female, the low-income, married group was most associated with hypertension (1.83 times; 95% CI, 1.71 to 1.97). CONCLUSIONS The results of this study show that it is necessary to approach male and female marital status separately according to income in health policies to address inequalities in the prevalence of hypertension.
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Affiliation(s)
- Mia Son
- Department of Preventive Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yeon Jeong Heo
- Department of Nursing, Kangwon National University, Chuncheon, Korea
| | - Hye-Jin Hyun
- Department of Nursing, Kangwon National University, Chuncheon, Korea
| | - Ho Jong Kwak
- Department of Nursing, Kangwon National University, Chuncheon, Korea
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Dong Y, Chen M, Sun B, Li Y, Gao D, Wen B, Song Y, Ma J. Trends in associations between socioeconomic development and urban-rural disparity with high blood pressure in Chinese children and adolescents over two decades. J Hum Hypertens 2022; 36:866-874. [PMID: 34354252 DOI: 10.1038/s41371-021-00592-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022]
Abstract
This study aimed to assess the association between the trend of urban-rural disparity in high blood pressure (HBP) in Chinese children and adolescents and socioeconomic development. Data on 1,054,602 students aged 7-18 years were obtained from five successive national surveys administered in 29 Chinese provinces in 1995, 2000, 2005, 2010, and 2014. HBP was defined as average measured systolic BP and/or diastolic BP equal to or more than 95th percentile. The socioeconomic indicators at the provincial-level included gross domestic product (GDP) per capita, the Engel coefficient, and urbanization rates. From 1995 to 2014, HBP prevalence in Chinese children and adolescents fluctuated between 6.9% and 9.2%. Rural areas had a higher prevalence of HBP than urban areas, with a diminishing trend in urban-rural disparity from 1995 to 2010 with a reduced OR from 1.45 (95% CI: 1.40-150) in 1995 to 1.09 (1.05-1.12) in 2010, whereas a widening gap in 2014 with OR of 1.23 (1.19-1.26)). A positive association existed between the improvement of socioeconomic indicators and the increase in HBP, which was demonstrated obviously by the Engel coefficient strata. The increases in the urbanization rates were accompanied by a greater increase of HBP in urban than in rural areas. The large urban-rural disparity suggests a priority of HBP control in rural children due to their current and future HBP and cardiovascular disease risks. Socioeconomic development could affect the urban-rural disparity in HBP risk, reflecting the importance of effective policy responses for preventing HBP by avoiding unhealthy lifestyles brought about by rapid economic development.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Binbin Sun
- Institute of Population Research, Peking University/KU-APEC Health Science Academy, Beijing, China
| | - Yanhui Li
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Bo Wen
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China.
| | - Jun Ma
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China.
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Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study. J Hypertens 2022; 40:1411-1420. [PMID: 35762480 DOI: 10.1097/hjh.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. METHODS We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. RESULTS The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. CONCLUSION In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.
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Hansson T, Andersson ME, Ahlström G, Hansson SR. Women´s experiences of preeclampsia as a condition of uncertainty: a qualitative study. BMC Pregnancy Childbirth 2022; 22:521. [PMID: 35765045 PMCID: PMC9241256 DOI: 10.1186/s12884-022-04826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/06/2022] [Indexed: 12/01/2022] Open
Abstract
Background Preeclampsia is a severe condition that annually affects about 3–8% of pregnancies worldwide. Preeclampsia is thereby one of the most common pregnancy complications for both mother and child. Despite that, there is limited research exploring the women´s perspective of experiencing preeclampsia. Aim The aim of this study was to describe women´s experiences of preeclampsia to improve the support and care given during and after pregnancy. Methods A qualitative descriptive interview study was undertaken. Nine women, diagnosed with preeclampsia, were recruited from a maternity unit in southern Sweden. The descriptive phenomenological method according to Amadeo Giorgi was used to analyse the data. Results The women´s experiences of PE were expressed as A condition of uncertainty, meaning that it was an unexpected and unknown situation. This main result consisted of 1) incomprehensible diagnosis message, 2) ambivalent feeling when the unexpected happens, 3) confusing contradictory messages, 4) appreciated support from the midwife, 5) need for continuous information. The nature of preeclampsia can sometimes deteriorate rapidly both for the mother and/or the child, often resulting in conversion from a planned vaginal spontaneous delivery to an emergency Caesarean section. The women narrated diffuse symptoms, and they experienced that they got contradictory information from different health care professionals regarding the severity of their disease. Detailed and continuous information is requested throughout the course of the disease, and the postpartum period. Conclusion This qualitative study reveal a need for improved clinical management. Health care professionals must be aware that women and their partners need detailed, consistent and repeated information about severity and prognosis to diminish the condition of uncertainty, confusion and fearful experience. The clinical implication would be a standardized preeclampsia education for pregnant women early on in the pregnancy, to raise awareness of preeclamptic symptoms. Furthermore, there is a need for harmonized guidelines and individualized support to the woman and her partner both at the antenatal care and the maternity ward and inpatient care at the hospital.
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Affiliation(s)
- Therése Hansson
- Institution of Clinical Sciences Lund, Lund University, Lund, Sweden. .,Ystad Hospital, Ystad, Sweden.
| | - Maria E Andersson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Skane University Hospital (SUS), Malmö/Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stefan R Hansson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Skane University Hospital (SUS), Malmö/Lund, Sweden
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10
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Lassale C, Gaye B, Diop IB, Mipinda JB, Kramoh KE, Kouam Kouam C, Ikama MS, Takombe JL, Damorou JM, Toure IA, Balde DM, Dzudie A, Houenassi M, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Ferreira B, Nhavoto C, Sidy Ali A, Azizi M, N'Guetta R, Antignac M, Jouven X. Use of traditional medicine and control of hypertension in 12 African countries. BMJ Glob Health 2022; 7:bmjgh-2021-008138. [PMID: 35654446 PMCID: PMC9163537 DOI: 10.1136/bmjgh-2021-008138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Use of traditional medicine (TM) is widespread in sub-Saharan Africa as a treatment option for a wide range of disease. We aimed to describe main characteristics of TM users and estimate the association of TM use with control of hypertension. Methods We used data on 2128 hypertensive patients of a cross-sectional study (convenience sampling), who attended cardiology departments of 12 sub-Saharan African countries (Benin, Cameroon, Congo, Democratic Republic of the Congo, Gabon, Guinea, Côte d’Ivoire, Mauritania, Mozambique, Niger, Senegal, Togo). To model association of TM use with odds of uncontrolled, severe and complicated hypertension, we used multivariable mixed logistic regressions, and to model the association with blood pressure (systolic (SBP) and diastolic (DBP)) we used mixed linear models. All models were adjusted for age, sex, wealth, adherence to hypertension conventional treatment and country (random effect). Results A total of 512 (24%) participants reported using TM, varying across countries from 10% in the Congo to 48% in Guinea. TM users were more likely to be men, living in rural area, poorly adhere to prescribed medication (frequently due to its cost). Use of TM was associated with a 3.87 (95% CI 1.52 to 6.22)/1.75 (0.34 to 3.16) mm Hg higher SBP/DBP compared with no use; and with greater odds of severe hypertension (OR=1.34; 95% CI 1.04 to 1.74) and of any hypertension complication (OR=1.27; 95% CI 1.01 to 1.60), mainly driven by renal complication (OR=1.57; 95% CI 1.07 to 2.29) after adjustment for measured confounders. Conclusions The use of TM was associated with higher blood pressure, more severe hypertension and more complications in Sub-Saharan African countries. The widespread use of TM needs to be acknowledged and worked out to integrate TM safely within the conventional healthcare.
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Affiliation(s)
- Camille Lassale
- Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute IMIM, Barcelona, Spain
- CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Bamba Gaye
- Paris Cardiovascular Research Centre, INSERM U970, Université de Paris, Paris, France
- Cardiology department, University Hospital of Fann, Dakar, Senegal
- African Research Network, Dakar, Senegal
- Laboratoire de Physiologie et Explorations Fonctionnelles, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Jean Bruno Mipinda
- Cardiology department, Libreville University Hospital Center, Libreville, Komo-Mondah, Gabon
| | | | | | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien NGouabi University, Brazzaville, Congo
| | - Jean Laurent Takombe
- Department of Internal Medicine of la Gombe, Ngaliema Hospital, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamorde Niamey University, Niamey, Niger
| | - Dadhi M Balde
- Department of Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Car & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | | | - Abdoul Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | - Suzy Gisèle Kimbally-Kaki
- Cardiology Department, National University Hospital of Brazzaville, Marien NGouabi University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe, Ngaliema Hospital, Kinshasa, Congo (the Democratic Republic of the)
- Cardiology Department, University of Kinshasa Faculty of Medicine, Kinshasa, Congo (the Democratic Republic of the)
| | - Liliane Mfeukeu Kuate
- Internal Medecine Department, Regional Hospital, Bafoussam, Cameroon
- Cardiology Department, Central Hospital of Yaounde, Yaounde, Cameroon
| | | | | | | | - Michel Azizi
- Hypertension unit, Georges Pompidou European Hospital, AP-HP Centre, Paris, France
- INSERM, Centre d'Investigation Clinique 1418, Paris, France
- Cardiovascular Epidemiology Department, Université de Paris, Paris, France
| | | | - Marie Antignac
- Paris Cardiovascular Research Centre, INSERM U970, Université de Paris, Paris, France
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre, INSERM U970, Université de Paris, Paris, France
- Cardiovascular Epidemiology Department, Université de Paris, Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France
- Paris-Sudden Death Expertise Center, Paris, France
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11
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The association between socioeconomic status and prevalence, awareness, treatment and control of hypertension in different ethnic groups. J Hypertens 2022; 40:897-907. [DOI: 10.1097/hjh.0000000000003092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Mustapha A, Ssekasanvu J, Chen I, Grabowski MK, Ssekubugu R, Kigozi G, Reynolds SJ, Gray RH, Wawer MJ, Kagaayi J, Chang LW, Post WS. Hypertension and Socioeconomic Status in South Central Uganda: A Population-Based Cohort Study. Glob Heart 2022; 17:3. [PMID: 35174044 PMCID: PMC8757381 DOI: 10.5334/gh.1088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background Limited studies exploring the impact of socioeconomic status (SES) on hypertension in Africa suggest a positive association between higher SES and hypertension. The economic development in sub-Saharan African countries has led to changes in SES and associated changes in lifestyle, diet, and physical activity, which may affect the relationship between hypertension and SES differently compared with higher income countries. This cross-sectional study from a large population-based cohort, the Rakai Community Cohort Study (RCCS), examines SES, hypertension prevalence, and associated risk factors in the rural Rakai Region in south-central Uganda. Methods Adults aged 30-49 years residing in 41 RCCS fishing, trading, and agrarian communities, were surveyed with biometric data obtained between 2016 and 2018. The primary outcome was hypertension (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg). Modified Poisson regression assessed the adjusted prevalence ratios (PR) of hypertension associated with SES; body mass index (BMI) was explored as a potential mediator. Results Among 9,654 adults, 20.8% had hypertension (males 21.2%; females 20.4 %). Participants with hypertension were older (39.0 ± 6.0 vs. 37.8 ± 5.0; p < 0.001). Higher SES was associated with overweight or obese BMI categories (p < 0.001). In the multivariable model, hypertension was associated with the highest SES category (aPR 1.23; confidence interval 1.09-1.38; p = 0.001), older age, male sex, alcohol use, and living in fishing communities and inversely associated with smoking and positive HIV serostatus. When BMI was included in the model, there was no association between SES and hypertension (aPR 1.02; CI 0.90-1.15, p = 0.76). Conclusion Hypertension is common in rural Uganda among individuals with higher SES and appears to be mediated by BMI. Targeted interventions could focus on lifestyle modification among highest-risk groups to optimize public health impact. Key Messages What is already known about this subject? Hypertension is an important modifiable risk factor for cardiovascular disease.There are few large epidemiological studies that investigate the relationship between hypertension and socioeconomic status in low-income countries. What are the new findings? Hypertension is common among adults in rural South-Central Uganda, particularly among those with higher socioeconomic status.BMI is a mediator of the relationship between hypertension and socioeconomic status. How might it impact on clinical practice in the foreseeable future? These findings suggest that public health interventions and community efforts to prevent chronic cardiovascular disease and hypertension should focus on lifestyle modification by elucidating obesity risk perception and health risk awareness, particularly among those of higher socioeconomic status.
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Affiliation(s)
- Aishat Mustapha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ivy Chen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Steven J. Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ronald H. Gray
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria J. Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Larry W. Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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13
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Majumdar U, Nanyonga Clarke R, Moran AE, Doupe P, Gadikota-Klumpers DD, Gidio A, Ssentamu D, Heller DJ. Hypertension screening, prevalence, treatment, and control at a large private hospital in Kampala, Uganda: A retrospective analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000386. [PMID: 36962239 PMCID: PMC10021338 DOI: 10.1371/journal.pgph.0000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
Adult hypertension prevalence in Uganda is 27%, but only 8% are aware of their diagnosis, accordingly treatment and control levels are limited. The private sector provides at least half of care nationwide, but little is known about its effectiveness in hypertension control. We analyzed clinical data from 39 235 outpatient visits among 17 777 adult patients from July 2017 to August 2018 at Uganda's largest private hospital. We calculated blood pressure screening rate at every visit, and hypertension prevalence, medication treatment, and control rates among the 5 090 patients with two or more blood pressure checks who received any medications from the hospital's pharmacy. We defined hypertension in this group as 1) an average of two blood pressure measurements at separate consecutive visits, higher than 140 mm Hg systolic or 90 mm Hg diastolic, 2) receipt of any antihypertensive medication, or 3) the use of a hypertension electronic medical record code. We deemed hypertension control as normotensive at the most recent check. 12 821 (72.1%) of patients received at least 1 blood pressure check. Among the 5 090 patients above, 2 121 (41.6%) had hypertension (33.4% age-standardized to a world population standard): 1 915 (37.6%) with elevated blood pressure, and 170 (3.3%) were normotensive but receiving medication. 838 (39.4%) of patients with hypertension received medication at least once. Overall, 18.3% of patients achieved control (27% of treated patients, and 15% of untreated patients). Hypertension is common and incompletely controlled in this Ugandan private-sector population, suggesting several avenues for novel interventions.
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Affiliation(s)
- Usnish Majumdar
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - Andrew E Moran
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | | | - Darinka D Gadikota-Klumpers
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Agaba Gidio
- Clarke International University, Kampala, Uganda
| | | | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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14
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Kabakambira JD, Shumbusho P, Mujawamariya G, Rutagengwa W, Twagirumukiza M. The Role of the Integrated District Hospital Based Non Communicable Diseases' Clinics in Cardiovascular Disease Control: Preliminary Data from Rwanda. Diabetes Metab Syndr Obes 2022; 15:2107-2115. [PMID: 35898444 PMCID: PMC9309289 DOI: 10.2147/dmso.s348031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Noncommunicable diseases (NCDs), remain the leading cause of death worldwide and represent an emerging global health threat. In Rwanda and elsewhere, the prevalence of cardiovascular diseases is increasing. To address this global health threat, Rwanda launched integrated nurse-led NCD clinics in all the forty-five District Hospitals across the country in 2006, but no evaluation study has been conducted so far for the added value of this program. The main goal of this study was to assess the impact of NCD clinics on disease control in Rwanda. METHODS This was a retrospective ambulatory patient chart review at a rural district hospital and an urban teaching hospital; which enrolled patients with diabetes and/or hypertension who consulted in a period of 1 month with retrospective data of one year. RESULTS A total of 199 patients' electronic health records were reviewed from the University Teaching Hospital of Kigali (CHUK) (53%) and Nyamata District Hospital (47%). Among them, 31% had diabetes, 38% had hypertension and 31% had both diseases. The mean age for the total cohort was 60 years and was predominantly female at 70%. Throughout the year, about 59% patients with hypertension had blood pressure control at the district hospital as opposed to 38% at the referral hospital. The rate of diabetes control was 20% at the referral hospital, but no comparison could be established between the two health facilities as the follow up laboratory markers were not available at the district hospital. CONCLUSION There was a consistent blood pressure control at the district hospital. Diabetes control was not optimal at the referral hospital despite the presence of human resources and logistics required for diabetes care. The situation was even worse at the district hospital where the follow up markers were rarely available.
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Affiliation(s)
- Jean Damascene Kabakambira
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Correspondence: Jean Damascene Kabakambira, Department of Internal Medicine, University Teaching Hospital of Kigali, KN 4th Avenue, P.O Box 655, Kigali, Rwanda, Tel +250 788800966, Email
| | - Patrick Shumbusho
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gisele Mujawamariya
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - William Rutagengwa
- Department of Internal Medicine, Nyamata District Hospital, Bugesera, Rwanda
| | - Marc Twagirumukiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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15
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Cavagna P, Takombe JL, Damorou JM, Kouam Kouam C, Diop IB, Ikama SM, Kramoh KE, Ali Toure I, Balde D, Dzudie A, Ferreira B, Houenassi M, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'Guetta R, Nhavoto C, Sidy Ali A, Gaye B, Tajeu GS, Macquart De Terline D, Perier MC, Azizi M, Jouven X, Antignac M. Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study. BMJ Open 2021; 11:e049632. [PMID: 34857562 PMCID: PMC8640662 DOI: 10.1136/bmjopen-2021-049632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries. SETTING Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015. PARTICIPANTS Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments MAIN OUTCOME MEASURE: We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control. RESULTS Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin-angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01). CONCLUSION Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.
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Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Jean Laurent Takombe
- Department of Internal Medicine, General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Stephane Méo Ikama
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Kouadio Euloge Kramoh
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | - Ibrahim Ali Toure
- Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niamey, Niger
| | - Dadhi Balde
- Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Care & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | | | - Martin Houenassi
- National University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | - Adama Kane
- Cardiology, St Louis Hospital, Dakar, Senegal
| | - Suzy Gisele Kimbally-Kaki
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Limbole
- Cardiology, University of Medicine of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | | | - Roland N'Guetta
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | | | | | - Bamba Gaye
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Gabriel S Tajeu
- Department of Health Services Administration Cardiology Clinics and Policy, Temple University, Philadelphia, Pennsylvania, USA
| | - Diane Macquart De Terline
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | | | - Michel Azizi
- Hypertension Unit, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
- INSERM, Centre d'Investigation Clinique 1418, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
- Cardiology, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
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16
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Ajayi A, Ajayi O. Pathophysiologically based antihypertensive pharmacotherapeutics rationality, efficacy and safety in Sub Saharan African Nations – A review. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2021; 11:200111. [PMID: 34825245 PMCID: PMC8605193 DOI: 10.1016/j.ijcrp.2021.200111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022]
Abstract
Background Hypertension (HT) prevalence, Uncontrolled Blood Pressure (UBP), morbidity and mortality are highest in Sub-Saharan Africa (SSA). Correlating pathophysiology of HT to pharmaco-therapy with antihypertensive drugs (AHD) may bring amelioration. Aims:To review peculiarities of HT in SSA, UBP causes, diagnostic modalities, AHD use, rationality and efficacy. Methods and results 14 published therapeutic audits in 4 SSA nations on Google Scholar or PUBMED, (total n = 6496 patients) were evaluated. Calcium Channel blockers (CCB) amlodipine, and thiazide diuretics (TD), hydrochlorothiazide (HCTZ) were the commonest AHD. Thiazide Like Diuretics (TLD) were underutilized. The % of patients on AHD were: 1 drug 5.4–55%; 2 drugs 37–82%; >/ = 3 drugs 6–50.3%. 2-drug combinations were: ACEI/ARB + TD (42%); CCB + TD (36.8%); ACEI + CCB (15.8%) of studies. Triple/quadruple therapy included Methyldopa (MTD) with ACEI + CCB or TD. The (%) attaining BP < 140/< 90 mmHg, ranged from 29 to 53.6%, median, 44%. The co-morbidities, range and median were: Diabetes Mellitus (DM): 9.8–64%, 19.2%; Chronic Kidney Disease (CKD): 5.7–7.5%, 6.9%, and Coronary artery Disease (CAD): 0.9–2.6%, 2.3%. ACEI + CCB ± TD were the preferred AHD for comorbidities. Conclusions Therapeutic inertia; Non-compliance; co-morbidities; refractory HT; ignorance; substandard AHD; contribute to UBP. Studies relating 24 hour ABPM to complications and mortality in SSA hypertensives; and impact of different AHD classes on ABPM, are needed. Study of ACEI + alpha-1 blockers + TLD on 24 hour ABPM and personalized care, are required.
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17
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Houehanou C, Codjo L, Adjagba P, Sonou A, Dohou H, Hounkponou M, Kpolédji G, Saka D, Assogba G, Assani S, Beaney T, Day E, Poulter NR, Houenassi MD. May Measurement Month 2019: an analysis of blood pressure screening results from Benin–Sub-Saharan Africa. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Hypertension constitutes a major health concern worldwide and particularly in Sub-Saharan Africa. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension for raising awareness of high blood pressure (BP). This work aims to determine the prevalence, awareness and levels of treatment and control of hypertension among adults participating in the MMM Campaign in Benin in 2019 (MMM19). A cross-sectional survey including volunteers aged ≥18 years was carried out in June 2019 in 13 rural and urban areas in Benin. BP measurement followed the MMM19 protocol. Hypertension was defined as a systolic BP ≥140 mmHg, or a diastolic BP ≥90 mmHg (based on the mean of the second and third readings) or taking antihypertensive medication. A total of 3637 people were screened with a female predominance (61.4%) and a mean age of 44.4 ± 16.1 years. A total of 1363 (37.5%) participants had hypertension. Of 1363 participants with hypertension: 64.5% were aware of their status and 43.9% were taking antihypertensive medication. Among 598 participants taking anti-hypertensive medication, 34.9% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). The results suggest a high prevalence of hypertension in Benin and that intensifying actions for its primary prevention, early detection and effective management should be encouraged.
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Affiliation(s)
- Corine Houehanou
- National School of Training of Senior Technicians in Public Health and Epidemiological Surveillance, University of Parakou, postal code 123 Parakou, Benin
| | - Léopold Codjo
- Cardiology Unit, University Hospital CHUD-Borgou, postal code 02 Parakou, Benin
| | - Philippe Adjagba
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
| | - Arnaud Sonou
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
| | - Hugues Dohou
- Cardiology Unit, University Hospital CHUD-Borgou, postal code 02 Parakou, Benin
| | - Murielle Hounkponou
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
| | - Gwladys Kpolédji
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
| | - Dominique Saka
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
| | - Gildas Assogba
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
| | - Salimatou Assani
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
- Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W6 8RP, UK
| | - Emily Day
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Martin D Houenassi
- University Clinic of Cardiology, University Hospital CNHU-HKM, Cotonou, Benin
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18
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Abstract
OBJECTIVE Sub-Saharan Africa faces twin epidemics of HIV and noncommunicable diseases including hypertension. Integrating hypertension care into chronic HIV care is a global priority, but cost estimates are lacking. In the SEARCH Study, we performed population-level HIV/hypertension testing, and offered integrated streamlined chronic care. Here, we estimate costs for integrated hypertension/HIV care for HIV-positive individuals, and costs for hypertension care for HIV-negative individuals in the same clinics. DESIGN Microcosting analysis of healthcare expenditures within Ugandan HIV clinics. METHODS SEARCH (NCT: 01864603) conducted community health campaigns for diagnosis and linkage to care for both HIV and hypertension. HIV-positive patients received hypertension/HIV care jointly including blood pressure monitoring and medications; HIV-negative patients received hypertension care at the same clinics. Within 10 Ugandan study communities during 2015-2016, we estimated incremental annual per-patient hypertension care costs using micro-costing techniques, time-and-motion personnel studies, and administrative/clinical records review. RESULTS Overall, 70 HIV-positive and 2355 HIV-negative participants received hypertension care. For HIV-positive participants, average incremental cost of hypertension care was $6.29 per person per year, a 2.1% marginal increase over prior estimates for HIV care alone. For HIV-negative participants, hypertension care cost $11.39 per person per year, a 3.8% marginal increase over HIV care costs. Key costs for HIV-positive patients included hypertension medications ($6.19 per patient per year; 98% of total) and laboratory testing ($0.10 per patient per year; 2%). Key costs for HIV-negative patients included medications ($5.09 per patient per year; 45%) and clinic staff salaries ($3.66 per patient per year; 32%). CONCLUSION For only 2-4% estimated additional costs, hypertension care was added to HIV care, and also expanded to all HIV-negative patients in prototypic Ugandan clinics, demonstrating substantial synergy. Our results should encourage accelerated scale-up of hypertension care into existing clinics.
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Cavagna P, Kramoh KE, Sidy Ali A, Balde DM, Traore AK, Khoury S, Jouven X, Antignac M. The importance of considering cultural and environmental elements in an interventional model of care to fight hypertension in Africa. J Clin Hypertens (Greenwich) 2021; 23:1269-1270. [PMID: 33830601 PMCID: PMC8678716 DOI: 10.1111/jch.14252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France.,INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France
| | | | - Abdallahi Sidy Ali
- Centre National de Cardiologie, Cabinet de Cardiologie, Nouakchott, Mauritania
| | - Dahdi M Balde
- Cardiology Department, University Hospital of Conakry, Conakry, Guinea
| | | | - Stephanie Khoury
- INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France
| | - Xavier Jouven
- INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France.,Cardiovascular Epidemiology Department, Université de Paris, Paris, France.,Cardiology Department, AP-HP Centre, European Georges Pompidou Hospital, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France.,INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France
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Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T, Fatemi B. Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P's (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review. BMC Cardiovasc Disord 2021; 21:123. [PMID: 33663387 PMCID: PMC7971125 DOI: 10.1186/s12872-021-01934-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
AIM Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps' (patient, professional, primary healthcare system, and public health policy) factors. METHODS PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar. RESULTS Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control. CONCLUSION In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, Arba Minch University College of Medicine and Health Sciences, P.O. Box 21, Arba Minch, Ethiopia
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tamiru Shibru
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Behzad Fatemi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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21
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Otieno HA, Miezah C, Yonga G, Kueffer F, Guy M, Lang'At C, Hettrick DA, Schmieder R. Improved blood pressure control via a novel chronic disease management model of care in sub‐Saharan Africa: Real‐world program implementation results. J Clin Hypertens (Greenwich) 2021; 23:785-792. [PMID: 33471442 PMCID: PMC8678676 DOI: 10.1111/jch.14174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 12/21/2022]
Abstract
A chronic disease management model of care (Empower Health) was launched in rural and urban areas of Ghana and Kenya in 2018. The goal was to improve disease awareness, reduce the burden of disease, and improve the clinical effectiveness and efficiency of managing hypertension. Leveraging the model, clinicians provide patients with tailored management plans. Patients accessed regular blood pressure checks at home, at the clinic, or at community‐partner locations where they received real‐time feedback. On the mobile application, clinicians viewed patient data, provided direct patient feedback, and wrote electronic prescriptions accessible through participating pharmacies. To date, 1266 patients had been enrolled in the “real‐world” implementation cohort and followed for an average of 351 ± 133 days across 5 facilities. Average baseline systolic blood pressure (SBP) was 145 ± 21 mmHg in the overall cohort and 159 ± 16 mmHg in the subgroup with uncontrolled hypertension (n = 743) as defined by baseline SBP ≥ 140 mmHg. SBP decreased significantly through 12 months in both the overall cohort (−9.4 mmHg, p < .001) and in the uncontrolled subgroup (−17.6 mmHg, p < .001). The proportion patients with controlled pressure increased from 46% at baseline to 77% at 12 months (p < .001). In summary, a new chronic disease management model of care improved and sustained blood pressure control to 12 months, especially in those with elevated blood pressure at enrollment.
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Affiliation(s)
| | | | - Gerald Yonga
- School of Medicine University of Nairobi Nairobi Kenya
| | | | | | | | | | - Roland Schmieder
- Department of Nephrology and Hypertension University Hospital of the Friedrich‐Alexander University Erlangen‐Nürnberg Erlangen Germany
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22
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Kachimanga C, Dibba Y, Patiño M, Gassimu JS, Lavallie D, Sesay S, Lado M, Kulinkina AV. Implementation of a non-communicable disease clinic in rural Sierra Leone: early experiences and lessons learned. J Public Health Policy 2021; 42:422-438. [PMID: 34497378 PMCID: PMC8452567 DOI: 10.1057/s41271-021-00304-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 02/04/2023]
Abstract
This study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted. Of the LTFU patients, 47% only came for the initial enrollment visit and never returned. Treatment outcomes of three patient groups [HTN only (n = 720), DM only (n = 51), and HTN/DM (n = 96)] were analyzed through a retrospective chart review. On average, all groups experienced reductions in blood pressure and/or blood glucose of approximately 10% and 20%, respectively. The proportions of patients with their condition controlled also increased. As NCDs remain underfunded and under-prioritized in low-income countries, the integrated program in Kono demonstrates the possibility of improving outpatient NCD care in Sierra Leone and similar settings.
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Affiliation(s)
| | - Yusupha Dibba
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone ,grid.38142.3c000000041936754XHarvard Medical School, 25 Shattuck Street, Boston, MA USA
| | - Marta Patiño
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone
| | - Joseph S. Gassimu
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone
| | - Daniel Lavallie
- grid.463455.5Ministry of Health and Sanitation, Wilkinson Road, Freetown, Sierra Leone
| | - Santigie Sesay
- grid.463455.5Ministry of Health and Sanitation, Wilkinson Road, Freetown, Sierra Leone
| | - Marta Lado
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone
| | - Alexandra V. Kulinkina
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone ,grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Petersplatz 1, Basel, Switzerland
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23
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Dieteren CM, O'Donnell O, Bonfrer I. Prevalence and inequality in persistent undiagnosed, untreated, and uncontrolled hypertension: Evidence from a cohort of older Mexicans. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000114. [PMID: 36962148 PMCID: PMC10021230 DOI: 10.1371/journal.pgph.0000114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/18/2021] [Indexed: 12/21/2022]
Abstract
Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and substantial gaps in diagnosis, treatment and control signal failure to avert premature deaths. Our aim was to estimate the prevalence and assess the socioeconomic distribution of hypertension that remained undiagnosed, untreated, and uncontrolled for at least five years among older Mexicans and to estimate rates of transition from those states to diagnosis, treatment and control. We used data from a cohort of Mexicans aged 50+ in two waves of the WHO Study on Global AGEing and adult health (SAGE) collected in 2009 and 2014. Blood pressure was measured, hypertension diagnosis and treatment self-reported. We estimated prevalence and transition rates over five years and calculated concentration indices to identify socioeconomic inequalities using a wealth index. Using probit models, we identify characteristics of those facing the greatest barriers in receiving hypertension care. More than 60 percent of individuals with full item response (N = 945) were classified as hypertensive. Over one third of those undiagnosed continued to be in that state five years later. More than two fifths of those initially untreated remained so, and over three fifths of those initially uncontrolled failed to achieve continued blood pressure control. While being classified as hypertensive was more concentrated among the rich, missing diagnosis, treatment and control were more prevalent among the poor. Men, singles, rural dwellers, uninsured, and those with overweight were more likely to have persistent undiagnosed, untreated, and uncontrolled hypertension. There is room for improvement in both hypertension diagnosis and treatment in Mexico. Clinical and public health attention is required, even for those who initially had their hypertension controlled. To ensure more equitable hypertension care and effectively prevent premature deaths, increased diagnosis and long-term treatment efforts should especially be directed towards men, singles, uninsured, and those with overweight.
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Affiliation(s)
- C M Dieteren
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - O O'Donnell
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
| | - I Bonfrer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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24
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Ellenga Mbolla BF, Kouala Landa CM, Bakekolo PR, Makani Bassakouahou JK, Bouithy SN, Eyeni-Sinomono T, Bianza JR, Ossou-Nguiet PM, Bani AM, Kimpamboudi A, Beaney T, Ster AC, Poulter NR, Xia X, Kimbally Kaky SG. May Measurement Month 2018: an analysis of blood pressure screening results from Republic of the Congo. Eur Heart J Suppl 2020; 22:H47-H49. [PMID: 32884468 PMCID: PMC7455256 DOI: 10.1093/eurheartj/suaa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To determine the proportion with hypertension among opportunistic screenees in the Republic of the Congo. This cross-sectional study was conducted in Republic of the Congo in May 2018. This screening was done in urban and rural areas that included Brazzaville, Pointe-Noire, District of Ngoyo, and District of Nkayi. The study protocol was provided by the International Society of Hypertension, and local ethical clearance was obtained. The data were processed by the May Measurement Month global project team. In total, 6169 people were screened, 2418 of which were female (39.2%). Most of the people screened were from 18 to 29 years old (n = 4184, 67.8%). The proportion of hypertension found was 22.2% (n = 1371). Among the hypertensive patients, 40.2% were aware of their hypertension, but only 493 (36.0%) were on antihypertensive treatment, and only 16.0% were controlled. The frequency of diabetes was 2.2% (n = 135), 2.3% (n = 139) had a previous stroke, and overweight and obesity were present in 15.4% (n = 952) and 7.3% (n = 449), respectively. Hypertension is frequent in the Republic of the Congo, and levels of awareness, treatment and control are low. Actions are needed to increase access of all to a correct diagnosis and treatment of hypertension to achieve universal health coverage.
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Affiliation(s)
- Bertrand F Ellenga Mbolla
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
| | - Christian M Kouala Landa
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
| | - Paterne R Bakekolo
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
| | - Jospin K Makani Bassakouahou
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
| | - Sabrina N Bouithy
- Reference Hospital of Talangai, n°35 Avenue des 3 martyrs, Talangaï District, Brazzaville, Republic of the Congo
| | - Tony Eyeni-Sinomono
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
| | - Jean-R Bianza
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
| | - Paul-M Ossou-Nguiet
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
| | - Aloise M Bani
- General Hospital of Loandjili, Route n°1, BP 8122, Pointe-Noire, Republic of the Congo
| | - Aubierge Kimpamboudi
- Head of Social and Health District from Pointe-Noire, Pointe-Noire, Republic of the Congo
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
- Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W6 8RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Suzy-G Kimbally Kaky
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, n°1 Avenue des 1er Jeux Africains, Brazzaville, Republic of the Congo
- University Teaching Hospital of Brazzaville, n°13 bd Auxence Ikonga, BP 32, Brazzaville, Republic of the Congo
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Llop-Girones A, Jones S. Beyond access to basic services: perspectives on social health determinants of Mozambique. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1769838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alba Llop-Girones
- Health Inequalities Research Group, University Pompeu Fabra, Barcelona, Spain
| | - Sam Jones
- Department of Economics, Kobenhavns Universitet, Kobenhavn, Denmark
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Muddu M, Tusubira AK, Sharma SK, Akiteng AR, Ssinabulya I, Schwartz JI. Integrated Hypertension and HIV Care Cascades in an HIV Treatment Program in Eastern Uganda: A Retrospective Cohort Study. J Acquir Immune Defic Syndr 2020; 81:552-561. [PMID: 31045649 DOI: 10.1097/qai.0000000000002067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Persons living with HIV (PLHIV) are at increased risk of cardiovascular disease. Integration of services for hypertension (HTN), the primary cardiovascular disease risk factor, into HIV care programs is recommended in Uganda, though, uptake has been limited. We sought to compare the care cascades for HTN and HIV within an HIV program in Eastern Uganda. METHODS We conducted a retrospective cohort study of all PLHIV enrolled in 3 HIV clinics between 2014 and 2017. We determined the proportion of patients in the following cascade steps over 12 months: Screened, Diagnosed, Initiated on treatment, Retained, Monitored, and Controlled. Cascades were analyzed using descriptive statistics and compared using χ and t tests. RESULTS Of 1649 enrolled patients, 98.5% were initiated on HIV treatment, of whom 70.7% were retained in care, 100% had viral load monitoring, and 90.3% achieved control (viral suppression). Four hundred fifty-six (27.7%) participants were screened for HTN, of whom 46.9% were diagnosed, 88.1% were initiated on treatment, 57.3% were retained in care, 82.7% were monitored, and 24.3% achieved blood pressure control. There were no differences in any HIV cascade step between participants with HIV alone and those with both conditions. CONCLUSIONS The HIV care cascade approached global targets, whereas the parallel HTN care cascade demonstrated notable quality gaps. Management of HTN within this cohort did not negatively impact HIV care. Our findings suggest that models of integration should focus on screening PLHIV for HTN and retention and control of those diagnosed to fully leverage the successes of HIV programs.
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Affiliation(s)
- Martin Muddu
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Andrew K Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | | | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda.,Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda.,Section of General Internal Medicine, Yale School of Medicine, CT
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Wangdi K, Jamtsho T. Prevalence and predisposing factors for self-reported hypertension in Bhutanese adults. Nepal J Epidemiol 2020; 10:830-840. [PMID: 32257513 PMCID: PMC7112958 DOI: 10.3126/nje.v10i1.25466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/10/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Bhutan underwent a nutrition transition in the last two decades. Diet has changed from high-fibre, high carbohydrate and low-fat diets to food with high sugar, fat, salt and processed foods. This is further compounded by a sedentary lifestyle. This paper aims to determine the national prevalence of hypertension and study the associated correlates in Bhutanese adults. Materials and Methods: This study used secondary data from the Bhutan National Health Survey 2012 (NHS, 2012) which was a nationwide survey covering all 20 districts in Bhutan. The dependent variable was self-reported hypertension under medication. Multivariable logistic regression was undertaken to identify independent correlates of hypertension. Results: The national prevalence of hypertension was 17.4% (5,408). Risk factors for hypertension were female sex, increasing age, occupation of armed forces, manager, technician, service and sales worker, machine operator and monks, diabetes, and feeling worried. Being single was negatively correlated with hypertension. In addition, hypertension is negatively associated with the poverty of the district. Conclusion: Hypertension was associated with age, being women, occupation with less physical activity, being worried and having diabetes. The preventive measures both at community and healthcare facility-based through cost-effective strategies should target these covariates.
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Affiliation(s)
- Kinley Wangdi
- Research Fellow, Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia.,Medical Officer, Phuentsholing General Hospital, Phuentsholing, Chukha Bhutan
| | - Tshering Jamtsho
- PhD Student, School of Demography, ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australia
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28
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Dominiczak AF, Meyer TJ. Hypertension: Update 2020. Hypertension 2019; 75:3-4. [PMID: 31786975 DOI: 10.1161/hypertensionaha.119.14352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rohacek M, Burkard T. [Heart Failure in Africa]. PRAXIS 2019; 108:983-990. [PMID: 31771489 DOI: 10.1024/1661-8157/a003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Heart Failure in Africa Abstract. In Africa, mortality due to heart failure is twice as high as in other low- to middle-income countries and five times as high as in high-income countries. Arterial hypertension is by far the most common cause of heart failure, followed by cardiomyopathies and rheumatic heart diseases. At diagnosis, most patients suffer already from an advanced disease stage. Only a few patients are aware of arterial hypertension, and few are treated and have their hypertension well controlled. Only a minority of patients have a well-controlled hypertension. The neglect of chronic non-communicable diseases on the health agenda leads to poor awareness, poor diagnostic resources, preventions strategies and treatment options. International guidelines cannot be properly followed in these circumstances. Information at community level and in healthcare facilities is urgently needed as well as training of healthcare staff, implementation of improved diagnostics and treatment of arterial hypertension and heart failure.
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Affiliation(s)
- Martin Rohacek
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Schweizerisches Tropen- und Public Health-Institut (Swiss TPH)
- Universität Basel, Basel
| | - Thilo Burkard
- Universität Basel, Basel
- Kardiologie, Universitätsspital, Basel
- Medical Outpatient Department and Hypertension Clinic, Universitätsspital, Basel
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The trend in blood pressure and hypertension prevalence in the general population of South Kivu between 2012 and 2016: Results from two representative cross-sectional surveys-The Bukavu observational study. PLoS One 2019; 14:e0219377. [PMID: 31393877 PMCID: PMC6687092 DOI: 10.1371/journal.pone.0219377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/21/2019] [Indexed: 02/01/2023] Open
Abstract
Objective Data on blood pressure trends are scarce or unavailable in Sub-Saharan Africa in general and especially in the Democratic Republic of the Congo. This work addresses this gap by analyzing the dynamics in the prevalence and control of hypertension in a cohort of Congolese adults in South Kivu. Methods Two phases of data collection were conducted including a baseline at the beginning in 2012 and a follow up in 2016. The subjects were ≥ 18 years old living in urban (n = 4413) or rural areas (n = 6453). Hypertension was defined as a blood pressure ≥ 140/90 mmHg and/or taking antihypertensive medications. The crude prevalence of hypertension was age-adjusted to the WHO population. Results Between 2012 and 2016, there was a significant increase in blood pressure (+2.5/+1.4 mmHg; p = 0.001), age standardized prevalence of hypertension [19.0% vs. 18.0%; OR = 1.05 (1.02–1.08); p<0.0001], and obesity (7.9% to 9.8%; p<0.0001) as well as the proportion of subjects > 60 years old (8.8% to 11.3%; p<0.0001) and those with tachycardia (10.5% to 14.4%; p<0.0001). The number of subjects under treatment of hypertension were statistically non-significant [16.1% vs. 14.3%; p = 0.29), but the level of control of hypertension was significantly reduced by 32.4% in 2016 compared in 2012 (43.5% vs. 64.4%; p = 0.0008). Conclusion There was an increase in the prevalence of hypertension as well as cardiovascular-associated risk factors in the population. However, this trend did not increase for treated subjects with no improvements in the level of AHT control. Therefore, improved strategies for the prevention and management of non-communicable diseases are very important in Sub-Saharan Africa.
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Macquart de Terline D, Kane A, Kramoh KE, Ali Toure I, Mipinda JB, Diop IB, Nhavoto C, Balde DM, Ferreira B, Dèdonougbo Houenassi M, Ikama MS, Kingue S, Kouam Kouam C, Takombe JL, Limbole E, Mfeukeu Kuate L, N’guetta R, Damorou JM, Sesso Z, Sidy Ali A, Perier MC, Azizi M, Empana JP, Jouven X, Antignac M. Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries. PLoS One 2019; 14:e0219266. [PMID: 31291293 PMCID: PMC6619761 DOI: 10.1371/journal.pone.0219266] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. Aims We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. Method We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. Results There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79–2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35–2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11–1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001). Conclusion This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.
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Affiliation(s)
- Diane Macquart de Terline
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- * E-mail:
| | - Adama Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamorde, Niamey, Niger
| | | | | | | | - Dadhi M. Balde
- Department of Cardiology, University Hospital of Conakry, Conakry, Guinea
| | | | | | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa; Democratic Republic of the Congo
| | | | | | | | | | | | - Marie-Cécile Perier
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Michel Azizi
- Paris Descartes University, Paris, France
- Hypertension Unit, Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique, Paris, France
| | - Jean Philippe Empana
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Marie Antignac
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
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Kwarisiima D, Atukunda M, Owaraganise A, Chamie G, Clark T, Kabami J, Jain V, Byonanebye D, Mwangwa F, Balzer LB, Charlebois E, Kamya MR, Petersen M, Havlir DV, Brown LB. Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study. BMC Public Health 2019; 19:511. [PMID: 31060545 PMCID: PMC6501396 DOI: 10.1186/s12889-019-6838-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/15/2019] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND There is an increasing burden of hypertension (HTN) across sub-Saharan Africa where HIV prevalence is the highest in the world, but current care models are inadequate to address the dual epidemics. HIV treatment infrastructure could be leveraged for the care of other chronic diseases, including HTN. However, little data exist on the effectiveness of integrated HIV and chronic disease care delivery systems on blood pressure control over time. METHODS Population screening for HIV and HTN, among other diseases, was conducted in ten communities in rural Uganda as part of the SEARCH study (NCT01864603). Individuals with either HIV, HTN, or both were referred to an integrated chronic disease clinic. Based on Uganda treatment guidelines, follow-up visits were scheduled every 4 weeks when blood pressure was uncontrolled, and either every 3 months, or in the case of drug stock-outs more frequently, when blood pressure was controlled. We describe demographic and clinical variables among all patients and used multilevel mixed-effects logistic regression to evaluate predictors of HTN control. RESULTS Following population screening (2013-2014) of 34,704 adults age ≥ 18 years, 4554 individuals with HTN alone or both HIV and HTN were referred to an integrated chronic disease clinic. Within 1 year 2038 participants with HTN linked to care and contributed 15,653 follow-up visits over 3 years. HTN was controlled at 15% of baseline visits and at 46% (95% CI: 44-48%) of post-baseline follow-up visits. Scheduled visit interval more frequent than clinical indication among patients with controlled HTN was associated with lower HTN control at the subsequent visit (aOR = 0.89; 95% CI 0.79-0.99). Hypertension control at follow-up visits was higher among HIV-infected patients than uninfected patients to have controlled blood pressure at follow-up visits (48% vs 46%; aOR 1.28; 95% CI 0.95-1.71). CONCLUSIONS Improved HTN control was achieved in an integrated HIV and chronic care model. Similar to HIV care, visit frequency determined by drug supply chain rather than clinical indication is associated with worse HTN control. TRIAL REGISTRATION The SEARCH Trial was prospectively registered with ClinicalTrials.gov : NCT01864603.
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Affiliation(s)
| | | | | | - Gabriel Chamie
- University of California San Francisco, San Francisco, CA USA
| | - Tamara Clark
- University of California San Francisco, San Francisco, CA USA
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Vivek Jain
- University of California San Francisco, San Francisco, CA USA
| | | | | | | | | | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Diane V. Havlir
- University of California San Francisco, San Francisco, CA USA
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Qualitative Study of Barriers to Adherence to Antihypertensive Medication among Rural Women in India. Int J Hypertens 2019; 2019:5749648. [PMID: 30809390 PMCID: PMC6364129 DOI: 10.1155/2019/5749648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/21/2018] [Accepted: 12/30/2018] [Indexed: 01/20/2023] Open
Abstract
Objective There is poor adherence to antihypertensive therapies among women in India. To determine its socioeconomic barriers we performed a qualitative study on Indian rural women with hypertension. Methods In-depth interviews with women having hypertension and presenting to outpatient department at a teaching hospital were performed in 30 women aged 35-65 years, using a questionnaire focused on reasons for nonadherence and poor lifestyle modification. Low to medium adherence was observed in two-thirds of women. Results Majority of women were from low socioeconomic status and were illiterate. Awareness of hypertension and its complications was poor. Knowledge and practices of cessation of smoking and tobacco use and salt restriction in hypertension were low. Efforts to increase physical activity and decrease dietary fat and sugar intake were largely absent. Local follow-up at rural community health centres was not practiced due to physician nonavailability and about half used alternative systems of medicine. None had health insurance or access to free medicines. All the women had to pay out-of-pocket for medicines and were concerned with cost of therapy as well as pill burden. Half of the women borrowed money from relatives or friends to reach the hospital and pay for medicines. Conclusions Socioeconomic barriers for low adherence to antihypertensive medication in women in India are low awareness of hypertension and complications, poor access to care, out-of-pocket payments, borrowing money, lack of insurance, and cost of medicines.
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Raphael DM, Roos L, Myovela V, Mchomvu E, Namamba J, Kilindimo S, Gingo W, Hatz C, Paris DH, Weisser M, Kobza R, Rohacek M. Heart diseases and echocardiography in rural Tanzania: Occurrence, characteristics, and etiologies of underappreciated cardiac pathologies. PLoS One 2018; 13:e0208931. [PMID: 30586432 PMCID: PMC6306243 DOI: 10.1371/journal.pone.0208931] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little is known about heart diseases and their treatment in rural sub-Saharan Africa. This study aimed to describe the occurrence, characteristics, and etiologies of heart diseases, and the medication taken before and prescribed after echocardiography in a rural referral Hospital in Tanzania. METHODS This prospective descriptive cohort study included all adults and children referred for echocardiography. Clinical and echocardiographic data were collated for analysis. RESULTS From December 2015 to October 2017, a total of 1'243 echocardiograms were performed. A total of 815 adults and 59 children ≤15 years had abnormal echocardiographic findings; in adults 537/815 (66%) had hypertension, with 230/537(43%) on antihypertensive drugs, and 506/815 (62%) were not on regular cardiac medication; 346/815 (42%) had severe eccentric or concentric left ventricular hypertrophy, and 182/815 (22%) had severe systolic heart failure. Only 44% demonstrated normal left ventricular systolic function. The most frequent heart diseases were hypertensive heart disease (41%), valvular heart disease (18%), coronary heart disease (18%), peripartum cardiomyopathy (7%), and other non-hypertensive dilated cardiomyopathies (6%) in adults, and congenital heart disease (34%) in children. Following echocardiography, 802/815 (98%) adults and 40/59 (68%) children had an indication for cardiac medication, 70/815 (9%) and 2/59 (3%) for oral anticoagulation, and 35/815 (4%) and 23/59 (39%) for cardiac surgery, respectively. CONCLUSION Hypertension is the leading etiology of heart diseases in rural Tanzania. Most patients present with advanced stages of heart disease, and the majority are not treated before echocardiography. There is an urgent need for increased awareness, expertise and infrastructure to detect and treat hypertension and heart failure in rural Africa.
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Affiliation(s)
| | | | - Victor Myovela
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Elisante Mchomvu
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Jabir Namamba
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Said Kilindimo
- Emergency Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Winfrid Gingo
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Christoph Hatz
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Daniel H. Paris
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Maja Weisser
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Richard Kobza
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Martin Rohacek
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- * E-mail:
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Jafar TH, Gandhi M, Jehan I, Naheed A, de Silva HA, Shahab H, Alam D, Luke N, Wee Lim C. Determinants of Uncontrolled Hypertension in Rural Communities in South Asia-Bangladesh, Pakistan, and Sri Lanka. Am J Hypertens 2018; 31:1205-1214. [PMID: 29701801 PMCID: PMC6188532 DOI: 10.1093/ajh/hpy071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/13/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP) is a leading risk factor for death and disability in South Asia. We aimed to determine the cross-country variation, and the factors associated with uncontrolled BP among adults treated for hypertension in rural South Asia. METHODS We enrolled 1,718 individuals aged ≥40 years treated for hypertension in a cross-sectional study from rural communities in Bangladesh, Pakistan, and Sri Lanka. Multivariable logistic regression model was used to determine the factors associated with uncontrolled BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg). RESULTS Among hypertensive individuals, 58.0% (95% confidence interval (CI) 55.7, 60.4) had uncontrolled BP: 52.8% (49.0, 56.6) in Bangladesh, 70.6% (65.7, 75.1) in Pakistan, and 56.5% (52.7, 60.1) in Sri Lanka. The odds (odds ratio (95% CI)) of uncontrolled BP were significantly higher in individuals with lower wealth index (1.17 (1.02, 1.35)); single vs. married (1.46 (1.10, 1.93)); higher log urine albumin-to-creatinine ratio (1.41 (1.24, 1.60)); lower estimated glomerular filtration rate (1.23 (1.01, 1.49)); low vs. high adherence to antihypertensive medication (1.50 (1.16, 1.94)); and Pakistan (2.91 (1.60, 5.28)) vs. Sri Lanka. However, the odds were lower in those with vs. without self-reported kidney disease (0.51 (0.28, 0.91)); and receiving vs. not receiving statins (0.62 (0.44, 0.87)). CONCLUSIONS The majority of individuals with treated hypertension have uncontrolled BP in rural Bangladesh, Pakistan, and Sri Lanka with significant disparities among and within countries. Urgent public health efforts are needed to improve access and adherence to antihypertensive medications in disadvantaged populations in rural South Asia.
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Affiliation(s)
- Tazeen H Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Imtiaz Jehan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Aliya Naheed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Hunaina Shahab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Dewan Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Nathasha Luke
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ching Wee Lim
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore
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