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Tusubira AK, Ssinabulya I, Kalyesubula R, Nalwadda CK, Akiteng AR, Ngaruiya C, Rabin TL, Katahoire A, Armstrong-Hough M, Hsieh E, Hawley NL, Schwartz JI. Self-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001777. [PMID: 38079386 PMCID: PMC10712841 DOI: 10.1371/journal.pgph.0001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Implementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda. METHODS Between April and August 2019, we executed a cross-sectional investigation involving 385 adult patients diagnosed with HTN and/or DM. These participants were systematically randomly selected from three outpatient NCD clinics in the Nakaseke district. Data collection was facilitated using a structured survey that inquired about participants' healthcare-seeking patterns, access to self-care services, education on self-care, medication compliance, and overall health-related quality of life. We utilized Chi-square tests and logistic regression analyses to discern disparities in self-care practices, education, and healthcare-seeking actions based on the patient's conditions. RESULTS Of the 385 participants, 39.2% had only DM, 36.9% had only HTN, and 23.9% had both conditions (HTN/DM). Participants with DM or both conditions reported more clinic visits in the past year than those with only HTN (P = 0.005). Similarly, most DM-only and HTN/DM participants monitored their weight monthly, unlike those with only HTN (P<0.0001). Participants with DM or HTN/DM were more frequently educated about their health condition(s), dietary habits, and weight management than those with only HTN. Specifically, education about their conditions yielded adjusted odds ratios (aOR) of 5.57 for DM-only and 4.12 for HTN/DM. Similarly, for diet, aORs were 2.77 (DM-only) and 4.21 (HTN/DM), and for weight management, aORs were 3.62 (DM-only) and 4.02 (HTN/DM). Medication adherence was notably higher in DM-only participants (aOR = 2.19). Challenges in self-care were significantly more reported by women (aOR = 2.07) and those above 65 years (aOR = 5.91), regardless of their specific condition(s). CONCLUSION Compared to rural Ugandans with HTN-only, participants with DM had greater utilization of healthcare services, exposure to self-care education, and adherence to medicine and self-monitoring behaviors. These findings should inform ongoing efforts to improve and integrate NCD service delivery in rural SSA.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Kalyesubula
- Departments of Physiology and Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Christine Ngaruiya
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Emergency Medicine, Stanford School of Medicine, Palo Alto, California, United States of America
| | - Tracy L. Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Mari Armstrong-Hough
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, United States of America
- Department of Epidemiology, School of Global Public Health, New York University, New York, United States of America
| | - Evelyn Hsieh
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nicola L. Hawley
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Assefa B, Zeleke H, Sergo T, Misganaw M, Mekonnen N. Self-care practice and associated factors among hypertensive follow-up patients at East Gojam zone public hospitals, North West Ethiopia, 2021. J Hum Hypertens 2023; 37:854-861. [PMID: 36402827 DOI: 10.1038/s41371-022-00775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/18/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022]
Abstract
Uncontrolled hypertension leads to cardiovascular complications and organ damage. Self-care practice is crucial for the prevention and management of hypertension by improving quality of life, preventing complications and decreasing health care expenditure. The study aimed to assess self-care practice and its associated factors among hypertensive follow up patients at East Gojjam Zone public hospitals; in Northwest Ethiopia. Quantitative cross-sectional study design and qualitative phenomenological approach were applied. The quantitative result was supported by in-depth interview. Out of 480 patients included in the study, 49% have good self-care practices. Out of the total participants 44.6% have poor in antihypertensive medication adherence, 92.5% have low in diet management, 82.8% were poorly practiced physical activity and 62.5% poor practice to weight management. Participants who cannot read and write (AOR = 3.1, 95% CI: 1.6-5.9), and have no comorbidity (AOR = 0.4, 95% CI: 0.2-0.6), uncontrolled blood pressure status (AOR = 2.1, 95% CI: 1.2-3.6), poor social support status (AOR = 2.5, 95% CI: 1.5-4.3) and unfavorable attitude (AOR = 3.1, 95% CI: 1.9-5.2) are the factors for poor self-care practice. During interview; family meal preparation habits, inadequate information about self-care practice during follow-up time, inconvenient working environment, pressure during social events to share food, negligence, and poor self-efficacy were highly described as challenges for practicing and sustaining self- care. The level of hypertension self-care practices was found to be low. Therefore, hypertension self-care practices should be strengthened throughout their follow-up time, and creating awareness in the community is highly encouraged.
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Affiliation(s)
- Birtukan Assefa
- Department of Pediatric Nursing, College of Health Sciences, Debre-Markos University, Debre-Markos, Ethiopia
| | - Haymanot Zeleke
- Department of Nursing, College of Health Sciences, Debre-Markos University, Debre-Markos, Ethiopia.
| | | | - Mekdes Misganaw
- Department of Nursing, College of Health Sciences, Bahir Dar university, Bahir Dar, Ethiopia
| | - Nakachew Mekonnen
- Department of Public Health, College of Health Sciences, Debre-Markos University, Debre Markos, Ethiopia
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Adherence to Self-Care among Patients with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis. Int J Hypertens 2022; 2022:5962571. [PMID: 35879985 PMCID: PMC9308551 DOI: 10.1155/2022/5962571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/01/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Self-care adherence for hypertensive patients is a cornerstone for the control of it and prevention of its complications. However, there are inconsistent findings for self-care adherence of hypertensive patients in Ethiopia. Thus, this systematic review and meta-analysis was done to determine the pooled estimate self-care adherence. Methods This systematic review and meta-analysis was reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. An intensive search of online databases such as PubMed (MEDLINE), CINHAL, Google Scholar, and advanced Google search was made to access both published and unpublished articles that report self-care adherence among hypertensive patients in Ethiopia. The pooled estimate was done with STATA version 11 metan commands in a 95% confidence interval. The presence of heterogeneity and publication bias were detected by I2 and Egger's test, respectively. A random-effect model was obtained, and subgroup analysis was done for the management of heterogeneity. Result A total of 24 articles with a total of 7224 participants were included in the final systematic review and meta-analysis. The pooled estimate of overall self-care adherence among hypertensive patients was 36.98% (95% CI: 27.13–46.83). In subgroup analysis, the highest overall self-care adherence was observed in the Amhara region at 53% (95% CI: 46.54, 59.47). The pooled estimate of self-care dimensions such as medication adherence, low-salt diet, physical activity, smoking abstinence, alcohol abstinence, and weight management was 62.71%, 65.96%, 47.28%, 92.53%, 67.59%, and 52.54%, respectively. Conclusion The pooled estimate of good self-care adherence among hypertensive patients was low. From the dimensions of self-care, the lowest level was in physical activity and the highest level was in smoking abstinence. Comparing all regions, the lowest level of overall self-care adherence was observed in Addis Ababa, Tigray region, and South Nations and Nationalities of Ethiopia. Screening of adherence to self-care and health education should be provided to every patient during every visit.
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Melaku T, Bayisa B, Fekeremaryam H, Feyissa A, Gutasa A. Self-care practice among adult hypertensive patients at ambulatory clinic of tertiary teaching Hospital in Ethiopia: a cross-sectional study. J Pharm Policy Pract 2022; 15:23. [PMID: 35317847 PMCID: PMC8939157 DOI: 10.1186/s40545-022-00421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, hypertension is a major public health problem and a strong predictor of cardiovascular disease complications. To reduce and prevent complications from hypertension, it is important to adapt self-care behaviors. This study aimed to assess the self-care practices of adult hypertensive patients at a tertiary teaching hospital in Ethiopia. METHODS A health facility-based prospective cross-sectional study was conducted at Jimma Medical Center in Ethiopia between February 2021 and July 2021. Binary and logistic regression was performed to assess the strength of associations between independent and dependent variables. Data entry and analysis were done using Statistical Package for social science (SPSS) software version 22.0. A p-value < 0.05 was considered to declare statistical significance. RESULTS From a total of 422 respondents included to the study, male accounted 55.7% and the mean ± SD age of the respondents was 58.7 ± 9.75 years. About 53.1% of patients had poor self-care practices toward hypertension. Not attending formal education [AOR = 2.15; 95% CI (1.74, 6.39); p ≤ 0.001], uncontrolled blood pressure [AOR = 2.14 95% CI (1.27, 3.61); p = 0.003], chronic disease co-morbidity [AOR = 1.48; 95% CI (0.25, 7.73); p ≤ 0.001], unfavorable attitude toward hypertension[AOR = 3.13; 95% CI (1.95, 7.52); p ≤ 0.001], and poor social support [AOR = 2.75; 95% CI (1.45, 6.43); p ≤ 0.001] were independent predictors of poor self-care practice. CONCLUSION The level of self-care practices for hypertension in the study area was low. In particular, the level of adherence to the DASH diet, exercise, and weight control was very low. Patient-specific targeted interventions are required to improve self-care practices for hypertension.
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Affiliation(s)
- Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Bodena Bayisa
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Helen Fekeremaryam
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Alemayehu Feyissa
- Center for Disease Control and Prevention, Oromia Regional Health Bureau, Finfinnee, Ethiopia
| | - Alemayehu Gutasa
- Department of Pharmacy, Black Lion Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
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