Exploring knowledge and attitudes toward non-communicable diseases among village health teams in Eastern Uganda: a cross-sectional study

A Review on Case Burden of Diabetes Mellitus Before and After the Implementation of National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke

This article focuses on the role of the National Health Program called National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS) in the screening and reduction of the case burden of Diabetes mellitus. The article first discusses the case burden of Diabetes before the implementation of NPCDCS and then the burden of the disease after the implementation of the program by mainly reviewing the cross-sectional studies done in four districts, Jaipur district, Gandhinagar district, Belagavi taluka district, and Udupi district. The studies were conducted at least four years after the program's implementation. The reason for preparing this review article is to assess the efficacy of NPCDCS in controlling the most dreaded chronic disease, which has its highest prevalence in India. Over the past century, there has been a consistent rise in the prevalence of Diabetes.  In all departments of medicine, Diabetes has been a common predisposing factor in several adversities such as blindness, limb amputation, cerebrovascular stroke, diabetic nephropathy, and other microvascular and macrovascular diseases. The studies include field-level cross-checking and on-ground cross-sectional studies, which were done in 2019 in Jaipur, standard cross-sectional studies from the primary data collected from the primary health care center in the Belagavi taluka district, a national-level cross-sectional study conducted by the National NCD Monitoring survey, and cross-sectional studies in Udupi district in Karnataka, which was the first district to be included by NPCDCS in its second phase.

An Evaluation of Community Health Workers' Knowledge, Attitude and Personal Lifestyle Behaviour in Non-Communicable Disease Health Promotion and Their Association with Self-Efficacy and NCD-Risk Perception

Community health workers, also known as health extension workers (HEWs), play an important role in health promotion. This study evaluates HEWs' knowledge, attitude, and self-efficacy for non-communicable diseases (NCD) health promotion. HEWs (n = 203) completed a structured questionnaire on knowledge, attitude, behaviour, self-efficacy and NCD risk perception. Regression analysis was used to determine the association between self-efficacy and NCD risk perception with knowledge (high, medium, low), attitude (favourable/unfavourable) and physical activity (sufficient/insufficient). HEWs with higher self-efficacy were more likely to have high NCD knowledge (AOR: 2.21; 95% CI: 1.21. 4.07), favourable attitude towards NCD health promotion (AOR: 6.27; 95% CI: 3.11. 12.61) and were more physically active (AOR: 2.27; 95% CI: 1.08. 4.74) than those with lower self-efficacy. HEWs with higher NCD susceptibility (AOR: 1.89; 95% CI: 1.04. 3.47) and perceived severity (AOR: 2.69; 95% CI: 1.46, 4.93) had higher odds of NCD knowledge than their counterparts. Moreover, sufficient physical activity was influenced by HEWs' perceived NCD susceptibility and perceived benefits of lifestyle change. Therefore, HEWs need to adopt healthy lifestyle choices to become effective role models for the community. Our findings highlight the need to include a healthy lifestyle when training HEWs, which might increase self-efficacy for NCD health promotion.

Comparison of Body Mass Index and Behavior of CERDIK of Individuals as Risk Factors of Suffering from Non-Communicable Diseases

Non-communicable diseases (NCDs) occur in individuals of the productive age and its risk can be diminished if such individuals possess healthy behaviors. BMI is a calculation which is frequently administered to express individuals at risk of suffering from NCDs. Predicting the risk of an individual from suffering from non-communicable diseases is possible by employing CERDIK behavioral (knowledge, attitude, and actions) questionnaires, but it does not yet elaborate the role of body mass index (BMI). The objective of this study is to compare the body mass index and behavior with individuals’ risk factors suffering from non-communicable diseases. The study administered a cross-sectional design. The sample amounted to 200 individuals in the productive age who generally fast-food establishments in Blitar from April to June of 2022. Sample was selected by administering the simple random sampling method. The results demonstrated that merely few individuals experienced a high risk of contracting non-communicable diseases. Behavioral factors are no longer used to determine an individual's risk of developing non-communicable diseases when body mass index is taken into account as a contributing factor. Therefore, body mass index is not a risk factor. According to research, adopting healthy lifestyle habits can lower the risk of developing non-communicable diseases.

Promoting the adoption of local governmental policy on the reimbursement of chronic disease medicines (PAPMed): study protocol of a field-based cluster randomized trial in rural Nantong, China

Background

Among rural Chinese patients with non-communicable diseases (NCDs), low socioeconomic status increases the risk of developing NCDs and associated financial burdens in paying for medicines and treatments. Despite the chronic disease medicine reimbursement policy of the local government in Nantong City, China, various barriers prevent patients from registering for and benefitting from the policy. This study aims to develop a behavior science-based intervention program for promoting the adoption of the policy and to evaluate the effectiveness of the program compared with usual practices.

Methods

Barriers and opportunities affecting stakeholders in adopting the policy were identified through contextual research and summarized through behavior mapping. The intervention is designed to target these barriers and opportunities through behavior science theories and will be evaluated through a 6-month cluster randomized controlled trial in Tongzhou District, Nantong, China. A total of 30 villages from two townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual practices). Village doctors in the intervention arm (1) receive systematic training on policy details, registration procedures, and intervention protocol, (2) promote the policy and encourage registration, (3) follow up with patients in the first, third, and sixth months after the intervention, and (4) receive financial incentives based on performance. The primary outcome is policy registration rate and the secondary outcomes include the number of patients registering for the policy, medical costs saved, frequency of village doctor visits, and health measures such as blood pressure and glucose levels.

Discussion

This study is one of very few that aims to promote adoption of NCDs outpatient medication reimbursement policies, and the first study to evaluate the impact of these policies on patients’ financial and physical wellbeing in China. The simple, feasible, and scalable intervention is designed based on the theories of behavior science and is applicable to similar low-income regions nationwide where outpatient medical costs remain a financial burden for patients.

Trial registration

ClinicalTrials.govNCT04731194, registered on 29 January 2021; Chinese Clinical Trial Registry ChiCTR2100042152, registered on 14 January 14 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06710-1.

Awareness of non-communicable diseases in women: a cross-sectional study

Chronic non-communicable diseases (NCD) are the major reason for death, morbidity, loss of independency and public health cost. NCD prevalence could be significantly reduced by adopting a healthy lifestyle. This cross-sectional cohort study (online survey) in 221 women aimed to assess NCD awareness, knowledge about NCD prevention and willingness to adopt a healthier lifestyle in women. Overall, NCD awareness level was quite high with, however, information mainly originating from lay media, probably being one reason for false estimations of age groups mainly affected by NCD, impact of NCD on quality of life, NCD mortalities, and the extent of NCD prevention by lifestyle interventions, respectively. Furthermore, also due to mainly lay media, half of women knew online NCD risk calculators, most of them would like to know their NCD risk, but only few had been offered NCD risk calculation by their physician. The mean threshold for willing to adopt a healthier lifestyle was a roughly calculated 37% 5-10 years risk to develop a certain NCD. Acceptance of non-pharmacological interventions for NCD prevention was high, however, major barriers for not implementing a healthier lifestyle were lack of expert information and lack of time. In conclusion, future public health strategies should focus on distributing better understandable and correct information about NCD as well as meeting the individuals' request for personalized NCD risk calculation. Furthermore, physicians should be better trained for personalized NCD prevention counseling.

Knowledge and attitude of peripheral health workers regarding Non-Communicable diseases in a Rural area of Rajasthan

Background: Mortality due to Non communicable disease (NCD) has increased from 50% to 60% in India from 2004 to 2014. Increasing mortality due to NCD has compelled Government of India to launch a national program (NPCDCS). This program has involved peripheral health workers hence this study was conducted to assess level of knowledge and attitude of peripheral health workers working in rural area of CHC Naila regarding NCDs. Methods: Present study was conducted at CHC Naila, Rajasthan, during June to Dec 2019. All (38) peripheral health staff working under CHC Naila were assessed and categorised regarding NCD and NPCDCS program. Results: Majority (77%) peripheral health workers had more than ten years of field experience. All have heard about NPCDCS program and type of NCDs covered under it. they were aware of sign & symptoms of common NCDs, however 18.42% of these were not aware of their role of community awareness about risk factors of NCDs and conducting regular screening. Conclusion: Though the level of awareness of health workers regarding type of NCDs, its consequences and risk factors was good however skill development training is needed so that they can screen people effectively and motivate them for healthy life style for optimum result.

Barriers to the provision of non-communicable disease care in Zimbabwe: a qualitative study of primary health care nurses

Background

Non-communicable diseases (NCDs) contribute significantly to the global disease burden, with low-and middle-income (LMICs) countries disproportionately affected. A significant knowledge gap in NCDs exacerbates the high burden, worsened by perennial health system challenges, including human and financial resources constraints. Primary health care workers play a crucial role in offering health care to most people in LMICs, and their views on the barriers to the provision of quality care for NCDs are critical. This study explored perceived barriers to providing NCDs care in primary health care facilities in Zimbabwe.

Methods

In-depth, individual semi-structured interviews were conducted with general nurses in primary care facilities until data saturation was reached. We focused on diabetes, hypertension, and depression, the three most common conditions in primary care in Zimbabwe. We used thematic content analysis based on an interview guide developed following a situational analysis of NCDs care in Zimbabwe and views from patients with lived experiences.

Results

Saturation was reached after interviewing 10 participants from five busy urban clinics. For all three NCDs, we identified four cross-cutting barriers, a) poor access to medication and functional equipment such as blood pressure machines, urinalysis strips; b) high cost of private care; c)poor working conditions; and d) poor awareness from both patients and the community which often resulted in the use of alternative potentially harmful remedies. Participants indicated that empowering communities could be an effective and low-cost approach to positive lifestyle changes and health-seeking behaviours. Participants indicated that the Friendship bench, a task-shifting programme working with trained community grandmothers, could provide a platform to introduce NCDs care at the community level. Also, creating community awareness and initiating screening at a community level through community health workers (CHWs) could reduce the workload on the clinic nursing staff.

Conclusion

Our findings reflect those from other LMICs, with poor work conditions and resources shortages being salient barriers to optimal NCDs care at the facility level. Zimbabwe's primary health care system faces several challenges that call for exploring ways to alleviate worker fatigue through strengthened community-led care for NCDs. Empowering communities could improve awareness and positive lifestyle changes, thus optimising NCD care. Further, there is a need to optimise NCD care in urban Zimbabwe through a holistic and multisectoral approach to improve working conditions, basic clinical supplies and essential drugs, which are the significant challenges facing the country's health care sector. The Friendship Bench could be an ideal entry point for providing an integrated NCD care package for diabetes, hypertension and depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00841-1.

Mental contrasting and implementation of physical activity intentions in Ugandan primary care patients with mental health problems: A real-world intervention involving support partners

This study explored the efficacy of lay health worker (LHW)-led physical activity (PA) counselling for primary care patients with mental health problems (PCMH) and their support partners. Forty-nine (41♀, median age=47, interquartile range=22) PCMH and 49 support partners [9♀, 31(9)years] participated in once weekly counselling based on the mental contrasting and implementation of intentions framework for 8 weeks. All participants completed the Simple Physical Activity Questionnaire (SIMPAQ) and World Health Organization Disability Assessment Schedule 2 (WHODAS 2), while PCMH completed the Multidimensional Scale for Perceived Social Support (MSPSS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Alcohol Use Disorders Identification Test (AUDIT) pre- and immediately post-intervention. In PCMH significant (P<0.001) increases in walking, exercising and incidental PA (SIMPAQ) levels, reductions in depressive (PHQ-9) and anxiety (GAD-7) symptoms and improvements in mobility and participation (WHODAS 2) were observed. Perceived support from significant others (MSPSS) significantly increased. In support partners, a significant reduction in time spent sedentary, increase in incidental PA (SIMPAQ) and improvement in the perception of getting alone with others (WHODAS 2) was seen. Our study demonstrates that LHW-led PA counselling is beneficial for PCMH and their support partners. Randomized controlled trials are warranted to confirm these positive findings.

Hypertension care cascade at a large urban HIV clinic in Uganda: a mixed methods study using the Capability, Opportunity, Motivation for Behavior change (COM-B) model

BACKGROUND

Persons living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and increased risk of mortality from cardiovascular diseases. HTN and HIV care integration is recommended in Uganda, though its implementation has lagged. In this study, we sought to analyze the HTN and HIV care cascades and explore barriers and facilitators of HTN/HIV integration within a large HIV clinic in urban Uganda.

METHODS

We conducted an explanatory sequential mixed methods study at Mulago ISS clinic in Kampala, Uganda. We determined proportions of patients in HTN and HIV care cascade steps of screened, diagnosed, initiated on treatment, retained, and controlled. Guided by the Capability, Opportunity, Motivation and Behavior (COM-B) model, we then conducted semi-structured interviews and focus group discussions with healthcare providers (n = 13) and hypertensive PLHIV (n = 32). We coded the qualitative data deductively and analyzed the data thematically categorizing them as themes that influenced HTN care positively or negatively. These denoted barriers and facilitators, respectively.

RESULTS

Of 15,953 adult PLHIV, 99.1% were initiated on ART, 89.5% were retained in care, and 98.0% achieved control (viral suppression) at 1 year. All 15,953 (100%) participants were screened for HTN, of whom 24.3% had HTN. HTN treatment initiation, 1-year retention, and control were low at 1.0%, 15.4%, and 5.0%, respectively. Barriers and facilitators of HTN/HIV integration appeared in all three COM-B domains. Barriers included low patient knowledge of HTN complications, less priority by patients for HTN treatment compared to ART, sub-optimal provider knowledge of HTN treatment, lack of HTN treatment protocols, inadequate supply of anti-hypertensive medicines, and lack of HTN care performance targets. Facilitators included patients' and providers' interest in HTN/HIV integration, patients' interest in PLHIV peer support, providers' knowledge and skills for HTN screening, optimal ART adherence counseling, and availability of automated BP machines.

CONCLUSION

The prevalence of HTN among PLHIV is high, but the HTN care cascade is sub-optimal in this successful HIV clinic. To close these gaps, models of integrated HTN/HIV care are urgently needed. These findings provide a basis for designing contextually appropriate interventions for HTN/HIV integration in Uganda and other low- and middle-income countries.

Facilitators and barriers in prevention of cardiovascular disease in Limpopo, South Africa: a qualitative study conducted with primary health care managers

Background

In the Southern African countries, cardiovascular disease burden is increasing and the second most prevalent cause of death after infectious diseases. The sustainable primary prevention of cardiovascular disease is associated with the engagement of facilitators that support it and hindered by barriers that undermine the support of a healthy lifestyle at the community level. The purpose of the study was to investigate facilitators and barriers at the level of primary health care facilities, on prevention of cardiovascular disease in Limpopo Province of South Africa.

Methods

This study is an exploratory and descriptive qualitative design, where open-ended key informant interviews were conducted among 20 primary health care managers conveniently sampled in their respective health care facilities. Coding and analysis were done using the thematic analysis method with the assistance of Atlas ti qualitative software.

Results

Various facilitators for the prevention of CVD were identified in this study. One of such facilitators is the availability and adherence to CVD treatment guidelines in the district. Other facilitators included top-down health education programme; collaboration with schools, traditional and religious leaders; the use of modern technology; and a structured healthcare system. Barriers were also identified as poor infrastructural development; shortage of medical supplies and equipment; lack of health promotion activities; shortage of nurses and other health care personnel; and poor accessibility to primary health care services.

Conclusion

This study has identified barriers and facilitators that may be harnessed to improve cardiovascular disease prevention, care, and management in a rural setting in South Africa. The facilitators should be strengthened, and barriers identified redressed.

Trial registration number: REC-0310111-031.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02290-1.

Uganda Mountain Community Health System-Perspectives and Capacities towards Emerging Infectious Disease Surveillance

In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs' perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts.

The efficacy of a lay health workers – led physical activity counselling program in patients with HIV and mental health problems: a real-world intervention from Uganda

ABSTRACTThis study explored the efficacy of a lay health worker (LHW)-led physical activity (PA) counselling program for inactive patients with HIV/AIDS and mental health problems living in a Ugandan farming community. In total 49 (35 women) community patients (40.0 ± 11.2 years) followed an 8-week once weekly LHW-led PA counselling program based on a self-determination theory and motivational interviewing framework. Participants completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, HIV/AIDS Stress Scale and World Health Organization Disability Assessment Schedule 2 (WHODAS 2) pre- and immediately post-intervention. Small, significant (P < 0.05) effect sizes were found for reductions in HIV/AIDS-related stress (Cohen's d = 0.26) and in global disability (Cohen's d = 0.46). Large effect sizes were observed for reductions in time spent sedentary (Cohen's d = 1.97) and reductions in depressive (Cohen's d = 2.04) and anxiety (Cohen's d = 1.47) symptoms and increases in time spent active (Cohen's d = 1.98). Greater decrease in sedentary time was associated with greater anxiety symptoms reduction (r = 0.32, P = 0.021). In physically inactive patients with HIV/AIDS and mental health problems, an LHW-led PA counselling program reduced stress, anxiety, depression and disability. Randomized controlled trials are needed to confirm these preliminary positive findings.

Community health workers' involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda

Background

Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions.

Methods

A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data.

Results

The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases.

Conclusions

Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-020-00653-5.

Knowledge, attitude, practices, and behavior regarding COVID-19 among serving personnel of a large military garrison: a quick online cross-sectional survey

BACKGROUND

There is a deluge of information available and circulated about COVID-19, during the ongoing course of the pandemic. This study was conducted to assess knowledge, attitudes, practices, and behavior regarding COVID-19 among serving soldiers.

METHODS

A quick cross-sectional online survey was conducted using a web portal and social media platform, wherein a pretested questionnaire was uploaded. Responses were collected for 3 days. Data were analyzed using Epi Info software.

RESULTS

A total of 1231 serving personnel participated in the survey, 133 (10.80%) officers, 144 (11.69%) Junior Commissioned Officers, and 954 (77.49%) Other Ranks. The prevalence of correct knowledge was more than 80% (range 81.47-88.13) except 29.97% regarding transmission by food and water. A statistically significant association (all P values < 0.05) was found with increasing age and education. Social distancing was an effective method as per 93.54%, and 81.38% thought that the response measures were adequate. Handwashing was the only practice which demonstrated a statistically significant association across change in all 3, i.e. age (P = 0.001), education (P = 0.005) and rank (P = 0.022). In the affective domain, increased perception of anxiousness, worriedness, and not feeling relaxed was found in the responses.

CONCLUSION

Levels of knowledge, positive attitude, and practice are high among serving soldiers, however feeling of anxiousness and worry prevail. Aggressive, continuous, relevant target population-oriented Information Education and Communication is the need of the hour, with structured and programmed interventions for positive mental health during course of the pandemic and this has been implemented in our area.

Integrated Hypertension and HIV Care Cascades in an HIV Treatment Program in Eastern Uganda: A Retrospective Cohort Study

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.

Association between tooth loss and hypertension: A cross-sectional study

CONTEXT

Cardiovascular diseases (CVD) are one of the leading causes of premature deaths among noncommunicable disease. Hypertension increases the risk of cardiovascular events. In addition to well-known risk factors for hypertension like obesity, lack of physical activity, studies have shown independent association between tooth loss and increased blood pressure and stroke. However, the relevant literature is not conclusive.

AIMS

Aim of our study was to investigate the association between tooth loss and increased blood pressure among adult patients.

METHODS AND MATERIAL

A cross-sectional study among 270 adults aged 20-59 years was conducted. The dependent variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). The main exploratory variable was the number of self-reported natural teeth for each dental arch. They were recorded as 10 or more natural teeth, less than 10 natural teeth, and no natural teeth. Data were analyzed using descriptive statistics, independent t-test, ANOVA, and multiple linear regression analysis.

RESULTS

Mean SBP was 125.3 mmHg and DBP was 78.9 mmHg. Moreover, 29.3% of participants had hypertension, 8.9% were edentulous, 22.8% had lost more than 10 teeth, and 68.3% had lost less than 10 teeth. Increased SBP was seen with increased tooth loss among participants. After adjusting for all covariates, no significant association between tooth loss and SBP and DBP was seen.

CONCLUSIONS

The mean SBP was higher among the participants who were edentulous than partially edentulous. However, there was no significant association between tooth loss and SBP and DBP after adjusting for confounding factors.

Community awareness of diet needs associated with hypertension and type 2 diabetes mellitus in Hatcliffe, Zimbabwe

BACKGROUND

Diet is an important modifiable risk factor for non-communicable diseases (NCDs) like hypertension (HTN) and type 2 diabetes mellitus (T2DM). A NCD is a disease that cannot be transmitted from person to person. Dietary risk factors account for 5.8% of all-cause mortality in Sub-Saharan Africa (SSA). There has been an increase in the consumption of 'westernized 'diets in SSA. The westernized diets consumed in low-income countries are usually high in salt content, fatty, processed and fast foods; and hence accelerate the development of HTN and T2DM. Previous studies carried out in Zimbabwe showed low levels of knowledge and awareness of HTN and T2DM; and the dietary needs for patients with those conditions. The aim of this study was to explore the dietary habits and awareness of HTN and T2DM of both males and females in a high-density area (HDA) of Zimbabwe.

METHODS

We conducted household-based cross-sectional study in a high density area of Hatcliffe, which has a population of close to 50,000 residents. Face to face interviews were conducted using hand-held mobile devices loaded with KoBo Toolbox. We selected two consenting adults, a male and female, from every fourth household in selected areas of Hatcliffe.

RESULTS

In this study all the 492 participants that were interviewed responded. Eighty eight point 6% (88.6%) of the participants in the study did not know if they were hypertensive or not. In addition, 91.7% of the participants had never voluntarily checked for hypertension. Similarly, 97.6% of the participants did not know if they had T2DM or not. Ninety eight percent (98%) of the participants had not voluntarily checked their blood glucose level.

CONCLUSIONS

The majority of the participants in the study were not aware if they had HTN or T2DM. The participants in the study perceived that the salt they consume is the right quantity. There is a high consumption of vegetable oil in most meals prepared.

Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals

BACKGROUND

The prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda.

METHODS

We conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach.

RESULTS

The results replicated several findings from other settings, and identified some previously undocumented challenges including patients' knowledge gaps regarding the preventable aspects of HTN and DM, patients' mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management.

CONCLUSIONS

In order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.