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St Sauveur R, Sufra R, Jean Pierre MC, Rouzier V, Preval F, Exantus S, Jean M, Jean J, Forestal GPL, Fleurijean O, Mourra N, Ogyu A, Malebranche R, Brisma JP, Deschamps MM, Pape JW, Sundararajan R, McNairy ML, Yan LD. Effectiveness of community-based hypertension management on hypertension in the urban slums of Haiti: A mixed methods study. J Clin Hypertens (Greenwich) 2024. [PMID: 39150035 DOI: 10.1111/jch.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024]
Abstract
Hypertension is a leading contributor to mortality in low-middle income countries including Haiti, yet only 13% achieve blood pressure (BP) control. We evaluated the effectiveness of a community-based hypertension management program delivered by community health workers (CHWs) and physicians among 100 adults with uncontrolled hypertension from the Haiti Cardiovascular Disease Cohort. The 12-month intervention included: community follow-up visits with CHWs (1 month if BP uncontrolled ≥140/90, 3 months otherwise) for BP measurement, lifestyle counseling, medication delivery, and dose adjustments. Primary outcome was mean change in systolic BP from enrollment to 12 months. Secondary outcomes were mean change in diastolic BP, BP control, acceptability, feasibility, and adverse events. We compared outcomes to 100 age, sex, and baseline BP matched controls with standard of care: clinic follow-up visits with physicians every 3 months. We also conducted qualitative interviews with participants and providers. Among 200 adults, median age was 59 years, 59% were female. Baseline mean BP was 154/89 mmHg intervention versus 153/88 mmHg control. At 12 months, the difference in SBP change between groups was -12.8 mmHg (95%CI -6.9, -18.7) and for DBP -7.1 mmHg (95%CI -3.3, -11.0). BP control increased from 0% to 58.1% in intervention, and 28.4% in control group. Four participants reported mild adverse events. In mixed methods analysis, we found community-based delivery addressed multiple participant barriers to care, and task-shifting with strong teamwork enhanced medication adherence. Community-based hypertension management using task-shifting with CHWs and community-based care was acceptable, and effective in reducing SBP, DBP, and increasing BP control.
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Affiliation(s)
- Reichling St Sauveur
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Marie Christine Jean Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Fabiola Preval
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Serfine Exantus
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Mirline Jean
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Josette Jean
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | | | - Obed Fleurijean
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Nour Mourra
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Anju Ogyu
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Rodolphe Malebranche
- Collège Haïtien de Cardiologie, Port-au-Prince, Ouest, Haiti
- Medicine and Pharmacology, Université d'État d'Haïti, Port-au-Prince, Ouest, Haiti
| | | | - Marie M Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
| | - Jean W Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Ouest, Haiti
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Margaret L McNairy
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lily D Yan
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA
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Chaturvedi A, Zhu A, Gadela NV, Prabhakaran D, Jafar TH. Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases. Hypertension 2024; 81:387-399. [PMID: 38152897 PMCID: PMC10863660 DOI: 10.1161/hypertensionaha.123.21354] [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] [Indexed: 12/29/2023]
Abstract
High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual's birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD morbidity from a socioecological and life course perspective. We present evidence-based strategies, emphasizing interventions tailored to specific community needs and cross-sector collaboration to address health inequalities rooted in social factors, which are key elements toward achieving the United Nations' Sustainable Development Goal 3.4 for reducing premature CVD mortality by 30% by 2030.
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Affiliation(s)
- Abhishek Chaturvedi
- Georgetown University, MedStar Washington Hospital Center, Washington, DC (A.C.)
| | - Anqi Zhu
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India (D.P.)
- Public Health Foundation of India, Gurugram, India (D.P.)
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
- Aga Khan University, Karachi, Pakistan (T.H.J.)
- Duke Global Health Institute, Durham, NC (T.H.J.)
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Russell JBW, Koroma TR, Sesay S, Samura SK, Lakoh S, Bockarie A, Abir OT, Kanu JS, Coker J, Jalloh A, Conteh V, Conteh S, Smith M, Mahdi OZ, Lisk DR. Burden of cardiometabolic risk factors and preclinical target organ damage among adults in Freetown, Sierra Leone: a community-based health-screening survey. BMJ Open 2023; 13:e067643. [PMID: 37192807 DOI: 10.1136/bmjopen-2022-067643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage (TOD) and its associated factors among adults in Freetown, Sierra Leone. DESIGN This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants. SETTING The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Sierra Leone. PARTICIPANTS A total of 2394 adult Sierra Leoneans aged 20 years or older were enrolled. OUTCOME MEASURE Anthropometric data, fasting lipid profiles, fasting plasma glucose, TOD, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to TOD. RESULTS The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidaemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by ECG, 14.2% had LVH by two-dimensional echo and 11.4% had chronic kidney disease (CKD). The odds of developing ECG-LVH were higher with diabetes (OR=1.255, 95% CI (0.822 to 1.916) and dyslipidaemia (OR=1.449, 95% CI (0.834 to 2.518). Associated factors for higher odds of Left Ventricular Mass Index by echo were dyslipidaemia (OR=1.844, 95% CI (1.006 to 3.380)) and diabetes mellitus (OR=1.176, 95% CI (0.759 to 1.823)). The odds of having CKD were associated with diabetes mellitus (OR=1.212, 95% CI (0.741 to 1.983)) and hypertension (OR=1.163, 95% CI (0.887 to 1.525)). A low optimal cut-off point for ECG-LVH (male 24.5 mm vs female 27.5 mm) was required to maximise sensitivity and specificity by a receiver operating characteristics curve since the odds for LVH by ECG were low. CONCLUSIONS This study provides novel data-driven information on the burden of CMRF and its association with preclinical TOD in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management in Sierra Leonean.
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Affiliation(s)
- James Baligeh Walter Russell
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Theresa Ruba Koroma
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Santigie Sesay
- Directorate of Non-Communicable Diseases and Mental Health, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Sallieu Kabay Samura
- Department of Mathematics and Statistics, Fourah Bay College, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ansumana Bockarie
- School of Medical Sciences, Department of Internal Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Onome Thomas Abir
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- Department of Community Health, Faculty of Clinical Sciences, College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joshua Coker
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdul Jalloh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Victor Conteh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sorie Conteh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Smith
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Othman Z Mahdi
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - Durodami R Lisk
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Preparedness of primary health care facilities on implementation of essential non-communicable disease interventions in osun state south-west Nigeria: a rural-urban comparative study. BMC Health Serv Res 2023; 23:154. [PMID: 36788557 PMCID: PMC9930353 DOI: 10.1186/s12913-023-09138-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Global response to the growing burden of non-communicable diseases (NCDs) in developing countries includes the development of WHO Package of Essential Non-communicable Disease Interventions (WHO PEN) for Primary Health Care (PHC). The study assessed the level of preparedness of PHC facilities on implementation of essential NCD interventions in rural and urban Local Government Areas (LGAs) of Osun State, Nigeria. METHODS The study was a comparative cross-sectional survey. Information was collected from heads of 33 rural and 33 urban PHC facilities and through direct observation on the domains of staff training, basic equipment, diagnostics and essential medicines for cardiovascular diseases, diabetes and chronic respiratory diseases (CRDs) using a semi-structured interviewer administered questionnaire. RESULTS Manual sphygmomanometer was found in similar proportions (84.8%) of PHC facilities in rural and urban LGAs. Glucometer was available in 45.5% of the PHC facilities in urban and 33.3% of the PHC facilities in the rural LGAs, the difference was not statistically significant (χ2 = 1.015; p = 0.314). Basic equipment for CRDs were not available in majority of PHC facilities in both locations. Moduretic tablets were the most reported essential NCD medicines, available in 15% of PHC facilities in rural LGAs and none in urban LGAs. The anti-diabetic medicines were not available in any of the PHC facilities in both locations. More than 90% (≥ 30) of the PHC facilities in both locations were not prepared to implement essential interventions for each NCD across domains of staff training and essential medicines. Overall, 97.0% of the PHC facilities in the rural LGAs and all the PHC facilities in urban LGAs were not prepared on implementation of essential interventions for the three NCDs. CONCLUSION The level of preparedness of the PHC facilities on implementation of essential NCD interventions in the rural and urban LGAs of Osun State is very low. Government needs to strengthen the PHC system by providing needed essential medicines, basic diagnostics, equipment, and training of clinical health care workers for implementation of essential NCD interventions in the state.
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Ammoun R, Wami WM, Otieno P, Schultsz C, Kyobutungi C, Asiki G. Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey. BMC Health Serv Res 2022; 22:985. [PMID: 35918710 PMCID: PMC9344761 DOI: 10.1186/s12913-022-08364-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya. METHODS A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as "ready" to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. RESULTS Of the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67-74) and CVD (69%; 95% CI: 66-72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45-50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be "ready" to offer NCDs services than public facilities. Similarly, hospitals were more likely "ready" to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide. CONCLUSIONS Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs.
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Affiliation(s)
- Rita Ammoun
- Faculty of Médicine, Limoges Université, 2 Rue du Docteur Marcland, 87025, LIMOGES CEDEX, France
| | - Welcome Mkhululi Wami
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands.
| | - Peter Otieno
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya
| | - Constance Schultsz
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Catherine Kyobutungi
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya
- Department of Women's and Children's Health (KBH), Karolinka Institutet, Tomtebodavägen 18A, 171 77, Solna, Sweden
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Gyamfi J, Vieira D, Iwelunmor J, Watkins BX, Williams O, Peprah E, Ogedegbe G, Allegrante JP. Assessing descriptions of scalability for hypertension control interventions implemented in low-and middle-income countries: A systematic review. PLoS One 2022; 17:e0272071. [PMID: 35901114 PMCID: PMC9333290 DOI: 10.1371/journal.pone.0272071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of hypertension continues to rise in low- and middle-income- countries (LMICs) where scalable, evidence-based interventions (EBIs) that are designed to reduce morbidity and mortality attributed to hypertension have yet to be fully adopted or disseminated. We sought to evaluate evidence from published randomized controlled trials using EBIs for hypertension control implemented in LMICs, and identify the WHO/ExpandNet scale-up components that are relevant for consideration during “scale-up” implementation planning. Methods Systematic review of RCTs reporting EBIs for hypertension control implemented in LMICs that stated “scale-up” or a variation of scale-up; using the following data sources PubMed/Medline, Web of Science Biosis Citation Index (BCI), CINAHL, EMBASE, Global Health, Google Scholar, PsycINFO; the grey literature and clinicaltrials.gov from inception through June 2021 without any restrictions on publication date. Two reviewers independently assessed studies for inclusion, conducted data extraction using the WHO/ExpandNet Scale-up components as a guide and assessed the risk of bias using the Cochrane risk-of-bias tool. We provide intervention characteristics for each EBI, BP results, and other relevant scale-up descriptions. Main results Thirty-one RCTs were identified and reviewed. Studies reported clinically significant differences in BP, with 23 studies reporting statistically significant mean differences in BP (p < .05) following implementation. Only six studies provided descriptions that captured all of the nine WHO/ExpandNet components. Multi-component interventions, including drug therapy and health education, provided the most benefit to participants. The studies were yet to be scaled and we observed limited reporting on translation of the interventions into existing institutional policy (n = 11), cost-effectiveness analyses (n = 2), and sustainability measurements (n = 3). Conclusion This study highlights the limited data on intervention scalability for hypertension control in LMICs and demonstrates the need for better scale-up metrics and processes for this setting. Trial registration Registration PROSPERO (CRD42019117750).
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Affiliation(s)
- Joyce Gyamfi
- Teachers College, Columbia University, New York, NY, United States of America
- NYU School of Global Public Health, New York, NY, United States of America
- * E-mail:
| | - Dorice Vieira
- NYU School of Global Public Health, New York, NY, United States of America
- NYU Health Sciences Library, New York, NY, United States of America
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States of America
| | | | - Olajide Williams
- Columbia University Medical Center, New York, NY, United States of America
| | - Emmanuel Peprah
- NYU School of Global Public Health, New York, NY, United States of America
| | - Gbenga Ogedegbe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - John P. Allegrante
- Teachers College, Columbia University, New York, NY, United States of America
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Srinivasan K, Heylen E, Johnson Pradeep R, Mony PK, Ekstrand ML. Collaborative care compared to enhanced standard treatment of depression with co-morbid medical conditions among patients from rural South India: a cluster randomized controlled trial (HOPE Study). BMC Psychiatry 2022; 22:394. [PMID: 35698087 PMCID: PMC9195442 DOI: 10.1186/s12888-022-04000-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression is common among primary care patients in LMIC but treatments are largely ineffective. In this cluster-randomized controlled trial, we tested whether depression outcomes are different among recipients of a collaborative care model compared to enhanced standard treatment in patients with co-morbid chronic medical conditions. METHODS We conducted a cluster randomized controlled trial among participants 30 years or older seeking care at 49 primary health centers (PHCs) in rural Karnataka, diagnosed with major depressive disorder, dysthymia, generalized anxiety disorder, or panic disorder on the MINI-International Neuropsychiatric Interview plus either hypertension, diabetes, or ischemic heart disease. From a list of all PHCs in the district, 24 PHCs were randomized a priori to deliver collaborative care and 25 PHCs enhanced standard treatment. The collaborative care model consisted of a clinic-based and a community-based component. Study assessment staff was blinded to treatment arm allocation. The primary outcome was the individual-level PHQ-9 score over time. RESULTS Between May 2015 and Nov 2018, 2486 participants were enrolled, 1264 in the control arm, and 1222 in the intervention arm. They were assessed at baseline, 3, 6 and 12 months. The mean PHQ-9 depression score was around 8.5 at baseline. At each follow-up PHQ-9 scores were significantly lower in the intervention (5.24, 4.81 and 4.22 at respective follow-ups) than in the control group (6.69, 6.13, 5.23, respectively). A significant time-by-treatment interaction (p < 0.001) in a multi-level model over all waves, nested within individuals who were nested within PHCs, confirmed that the decrease in depression score from baseline was larger for collaborative care than enhanced standard care throughout follow-up. CONCLUSIONS The collaborative care intervention resulted in significantly lower depression scores compared to enhanced standard care among participants with co-morbid physical conditions. The findings have potential implications for integrating mental health and chronic disease treatment in resource constrained settings. TRIAL REGISTRATION ClinicalTrials.gov NCT02310932 , registered on December 8, 2014, and Clinical Trials Registry India CTRI/2018/04/013001 , registered on April 4, 2018. Retrospectively registered.
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Affiliation(s)
- Krishnamachari Srinivasan
- grid.418280.70000 0004 1794 3160Division of Mental Health & Neurosciences, St John’s Research Institute, Bangalore, India ,grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Bangalore, India
| | - Elsa Heylen
- grid.266102.10000 0001 2297 6811Division of Prevention Sciences, University of California, San Francisco, USA
| | - R. Johnson Pradeep
- grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Bangalore, India
| | - Prem K. Mony
- grid.416432.60000 0004 1770 8558Division of Epidemiology and Community Health, St John’s Medical College & Research Institute, Bangalore, India
| | - Maria L. Ekstrand
- grid.418280.70000 0004 1794 3160Division of Mental Health & Neurosciences, St John’s Research Institute, Bangalore, India ,grid.266102.10000 0001 2297 6811Division of Prevention Sciences, University of California, San Francisco, USA
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9
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Akinwumi AF, Esimai OA, Fajobi O, Idowu A, Esan OT, Ojo TO. Knowledge of primary healthcare workers regarding the prevention and control of non-communicable diseases in Osun State, Nigeria: A rural-urban comparison. Afr J Prim Health Care Fam Med 2021; 13:e1-e8. [PMID: 34212741 PMCID: PMC8252157 DOI: 10.4102/phcfm.v13i1.2873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/11/2021] [Accepted: 04/17/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is a rising burden of non-communicable diseases (NCDs) in the sub-Saharan Africa, and calls for integration of management of selected NCDs with primary healthcare (PHC) have been unrelenting. Cost-effective interventions for the prevention and control of NCDs can be delivered at PHC facilities in low-resource settings by clinical healthcare workers (HCWs). AIM This study compared the knowledge of HCWs in PHC facilities regarding the prevention and control of NCDs in rural and urban local government areas (LGAs) of Osun State. SETTING A comparative cross-sectional study was conducted amongst 400 eligible HCWs recruited using a multistage sampling technique in PHC facilities of six rural and six urban LGAs. METHODS A pretested self-administered case-scenarios questionnaire was used to assess the knowledge of HCWs regarding the prevention and control of three selected NCDs (diabetes, hypertension and chronic respiratory diseases). Both descriptive and inferential statistics were conducted. RESULTS The mean knowledge scores of HCWs regarding the prevention and control of the three NCDs were 17.76 ± 4.41 in rural and 17.62 ± 4.02 in urban LGAs out of 30 maximum scores. The proportion of HCWs with adequate knowledge in the rural LGAs (31.0%) was slightly higher than the urban LGAs (23.0%); however, it was not statistically significant (χ2 = 3.247; p = 0.072). The major determinants of adequate knowledge include cadre of HCWs, location, years in practice with professional certificate, NCD training course attendance and reported experience managing diabetic patients. CONCLUSION The HCWs in PHC facilities in rural and urban LGAs of Osun State, Nigeria, had a poor knowledge regarding the prevention and control of NCDs. Training and re-training of less-skilled HCWs in the PHC facilities using relevant WHO NCD protocols and guidelines are imperatives to improve their knowledge about the prevention and control of NCDs.
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Affiliation(s)
- Adebowale F Akinwumi
- Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria; and, Department of Community Medicine, Faculty of Clinical Sciences, Ekiti State University, Ado Ekiti.
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10
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Muthee TB, Kimathi D, Richards GC, Etyang A, Nunan D, Williams V, Heneghan C. Factors influencing the implementation of cardiovascular risk scoring in primary care: a mixed-method systematic review. Implement Sci 2020; 15:57. [PMID: 32690051 PMCID: PMC7370418 DOI: 10.1186/s13012-020-01022-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/08/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) such as ischemic heart disease and stroke is the leading causes of death and disability globally with a growing burden in low and middle-income countries. A credible way of managing the incidence and prevalence of cardiovascular diseases is by reducing risk factors. This understanding has led to the development and recommendation for the clinical use of cardiovascular risk stratification tools. These tools enhance clinical decision-making. However, there is a lag in the implementation of these tools in most countries. This systematic review seeks to synthesise the current knowledge of the factors influencing the implementation of cardiovascular risk scoring in primary care settings. METHODS We searched bibliographic databases and grey literature for studies of any design relating to the topic. Titles, abstracts and full texts were independently assessed for eligibility by two reviewers. This was followed by quality assessment and data extraction. We analysed data using an integrated and best fit framework synthesis approach to identify these factors. Quantitative and qualitative forms of data were combined into a single mixed-methods synthesis. The Consolidated Framework for Implementation Research was used as the guiding tool and template for this analysis. RESULTS Twenty-five studies (cross-sectional n = 12, qualitative n = 9 and mixed-methods n = 4) were included in this review. Twenty (80%) of these were conducted in high-income countries. Only four studies (16%) included patients as participants. This review reports on a total of eleven cardiovascular risk stratification tools. The factors influencing the implementation of cardiovascular risk scoring are related to clinical setting and healthcare system (resources, priorities, practice culture and organisation), users (attributes and interactions between users) and the specific cardiovascular risk tool (characteristics, perceived role and effectiveness). CONCLUSIONS While these findings bolster the understanding of implementation complexity, there exists limited research in the context of low and middle-income countries. Notwithstanding the need to direct resources in bridging this gap, it is also crucial that these efforts are in concert with providing high-quality evidence on the clinical effectiveness of using cardiovascular risk scoring to improve cardiovascular disease outcomes of mortality and morbidity. TRIAL REGISTRATION PROSPERO registration number: CRD42018092679.
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Affiliation(s)
- Tonny B. Muthee
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Derick Kimathi
- KEMRI-Wellcome Trust Research Programme, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgia C. Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Anthony Etyang
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - David Nunan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Veronika Williams
- Faculty of Education and Professional Studies, School of Nursing, Nipissing University, North Bay, Canada
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
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11
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Mercer T, Nulu S, Vedanthan R. Innovative Implementation Strategies for Hypertension Control in Low- and Middle-Income Countries: a Narrative Review. Curr Hypertens Rep 2020; 22:39. [PMID: 32405820 DOI: 10.1007/s11906-020-01045-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the most recent and innovative implementation strategies for hypertension control in low- and middle-income countries (LMICs). RECENT FINDINGS Implementation strategies from Latin America, Africa, and Asia were organized across three levels: community, health system, and policy/population. Multicomponent interventions involving task-shifting strategies, with or without mobile health tools, had the most supporting evidence, with policy or population-level interventions having the least, focused only on salt reduction with mixed results. More research is needed to better understand how context affects intervention implementation. There is an emerging evidence base for implementation strategies for hypertension control and CVD risk reduction in LMICs at the community and health system levels, but further research is needed to determine the most effective policy and population-level strategies. How to best account for local context in adapting and implementing these evidence-based interventions in LMICs still remains largely unknown. Accelerating the translation of this implementation research into policy and practice is imperative to improve health and save lives globally.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, Division of Global Health, The University of Texas at Austin Dell Medical School, 1601 Trinity St., Bldg. B, Austin, TX, 78712, USA.
| | - Shanti Nulu
- Department of Internal Medicine, Division of Cardiology, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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12
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Gyamfi J, Allegrante JP, Iwelunmor J, Williams O, Plange-Rhule J, Blackstone S, Ntim M, Apusiga K, Peprah E, Ogedegbe G. Application of the Consolidated Framework for Implementation Research to examine nurses' perception of the task shifting strategy for hypertension control trial in Ghana. BMC Health Serv Res 2020; 20:65. [PMID: 31996195 PMCID: PMC6990487 DOI: 10.1186/s12913-020-4912-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.
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Affiliation(s)
- Joyce Gyamfi
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - John P. Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, Salus Center, Saint Louis University, 3545 Lafayette Ave., Saint Louis, MO 63103 USA
| | - Olajide Williams
- Columbia University Medical Center, 710 West 168th Street, New York, NY 10032 USA
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Sarah Blackstone
- Health and Behavioral Studies Building, James Madison University, MSC 4301,235 Martin Luther King Jr Way, Harrisonburg, VA 22807 USA
| | - Michael Ntim
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Kingsley Apusiga
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Emmanuel Peprah
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Gbenga Ogedegbe
- Department of Population Health/ Section for Global Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
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Hertz JT, Sakita FM, Manavalan P, Madut DB, Thielman NM, Mmbaga BT, Staton CA, Galson SW. The Burden of Hypertension and Diabetes in an Emergency Department in Northern Tanzania. Ethn Dis 2019; 29:559-566. [PMID: 31641323 DOI: 10.18865/ed.29.4.559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Little is known about the burden of hypertension and diabetes on emergency department (ED) utilization and hospitalizations in sub-Saharan Africa. Methods A retrospective review of adult ED patients in northern Tanzania was performed from September 2017 through March 2018. Hypertension was defined as documented diagnosis of hypertension or blood pressure ≥ 140/90 mm Hg. Diabetes was defined as documented diagnosis of diabetes mellitus or random glucose ≥ 200 mg/dL. Results Of 3961 adult ED patients, 1359 (34.3%) had hypertension, 518 (13.1%) had diabetes, and 273 (6.9%) had both. Both hypertension (OR 1.42, 95% CI 1.23-1.63, P<.001) and diabetes (OR 2.05, 95% CI 1.66-2.54, P<.001) were associated with increased odds of admission. Of 2418 hospital admissions, 694 (28.7%) were for complications of hypertension or diabetes. Of 499 patients admitted for hypertensive complications, the most common admission diagnoses were: heart failure (163 patients, 32.7%); stroke (147 patients, 29.5%); and severe hypertension (139 patients, 27.9%). Of 278 patients admitted for diabetic complications, the most common admission diagnoses were: hyperglycemia (158 patients, 56.9%); infection (60 patients, 21.6%); and stroke (28 patients, 10.1%). Conclusions The burden of hypertension and diabetes in a Tanzanian ED is high, and the ED may serve as an opportune location for case identification and linkage-to-care interventions. Given the large proportion of Africans with undiagnosed hypertension and diabetes, an ED-based screening program would likely identify many new cases of these diseases. The high burden of hypertension- and diabetes-related hospitalizations highlights the urgent need for improvements in primary preventative care in Tanzania.
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Affiliation(s)
- Julian T Hertz
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC.,Duke Global Health Institute, Duke University, Durham, NC
| | - Francis M Sakita
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Deng B Madut
- Department of Medicine, Duke University, Durham, NC
| | | | - Blandina T Mmbaga
- Kilimanjaro Christian Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Catherine A Staton
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC.,Duke Global Health Institute, Duke University, Durham, NC
| | - Sophie W Galson
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC
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Rawal LB, Kanda K, Biswas T, Tanim MI, Poudel P, Renzaho AMN, Abdullah AS, Shariful Islam SM, Ahmed SM. Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: a qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level. BMJ Open 2019; 9:e029562. [PMID: 31594874 PMCID: PMC6797278 DOI: 10.1136/bmjopen-2019-029562] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore healthcare providers' perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level. DESIGN We used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners' service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted. SETTING Twelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions. PARTICIPANTS Participants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters. RESULTS Participants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments' initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems. CONCLUSION The initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country.
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Affiliation(s)
- Lal B Rawal
- School of Health Medical and Allied Sciences, CQUniversity Sydney, Sydney, New South Wales, Australia
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Kie Kanda
- Health Section, Japanese International Cooperation Agency (JICA), Accra, Ghana
| | - Tuhin Biswas
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Institute for Social Science Research, University of Queensland, Long Pocket Precinct, Indooroopilly Queensland, Brisbane, Queensland, Australia
| | - Md Imtiaz Tanim
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- mPower Social Enterprises Ltd, Dhaka, Bangladesh
| | - Prakash Poudel
- Collaboration for Oral Health Outcomes, Research, Translation and Evaluation (COHORTE) Research Group, Western Sydney University, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu, Kunsan, China
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Syed Masud Ahmed
- Centre of Excellence for Universal Health Coverage (CoE-UHC), James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Mbouemboue OP, Ngoufack TJO. High Blood Pressure Prevalence, Awareness, Control, and Associated Factors in a Low-Resource African Setting. Front Cardiovasc Med 2019; 6:119. [PMID: 31544107 PMCID: PMC6728810 DOI: 10.3389/fcvm.2019.00119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/05/2019] [Indexed: 01/13/2023] Open
Abstract
Background and Objectives: Recent and contextualized data are needed to improve hypertension management known as a major cardiovascular disease risk factor regardless of the geographical area. This study aimed at assessing the prevalence of hypertension, awareness of hypertensive status, treatment, and control of hypertension as well as assessing the factors associated with risk of hypertension and awareness of hypertensive status in the population of Ngaoundere. Methods: This was a community based cross sectional study carried out from February to December 2016. A three-stage sampling method was used for recruitment of participants. Demographic, clinical, and biological data were collected and analyzed using Statistical Package for Social Sciences version 20.0. Statistical significance was set at P < 0.05. Results: In total, 948 participants were included in the study. The overall prevalence of hypertension was 46.94% (n = 445). Fraction of hypertensive participants who were aware of their status was 36.85% (n = 164). Among them, 39 (23.78%) were getting treatment and the control rate of treated hypertensives was 30.56%. Age, marital status, family history of hypertension, overweight, and high serum triglyceride level were identified as independent predicting factors of hypertension, whereas female gender, age, personal history of stroke or diabetes, family history of hypertension or heart failure, overweight, and abdominal obesity were those of hypertension awareness. Conclusion: The present study revealed high prevalence, extremely low awareness, treatment, and control rates of hypertension in Ngaoundere community setting.
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Affiliation(s)
- Olivier Pancha Mbouemboue
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Ngaoundere, Cameroon
- General Medicine Service, Ngaoundere Regional Hospital, Ngaoundere, Cameroon
| | - Tsougmo Jacques Olivier Ngoufack
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Ngaoundere, Cameroon
- Hypertension and Diabetes Unit, Ngaoundere Regional Hospital, Ngaoundere, Cameroon
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Biswas T, Haider MM, Das Gupta R, Uddin J. Assessing the readiness of health facilities for diabetes and cardiovascular services in Bangladesh: a cross-sectional survey. BMJ Open 2018; 8:e022817. [PMID: 30385441 PMCID: PMC6252707 DOI: 10.1136/bmjopen-2018-022817] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the readiness of health facilities for diabetes and cardiovascular services in Bangladesh. DESIGN This study was a cross-sectional survey. SETTING This study used data from a nationwide Bangladesh Health Facility Survey conducted by the Ministry of Health and Social Welfare in 2014. PARTICIPANTS A total of 319 health facilities delivering services focused on diabetes and cardiovascular diseases (CVD) were included in the survey. Some of these facilities were run by the public sector while others were managed by the private sector and non-governmental organisations. It was a mix of primary and secondary care facilities. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was readiness of health facilities for diabetes and cardiovascular services. We analysed relevant data following the Service Availability and Readiness Assessment manual of the WHO to assess the readiness of selected health facilities towards services for diabetes and CVD. RESULTS 58% and 24.1% of the facilities had diagnosis and treatment services for diabetes and CVD, respectively. Shortage of trained staff (18.8% and 14.7%) and lack of adequate medicine supply (23.5% and 43.9%) were identified to be factors responsible for inadequate services for diabetes and CVD. Among the facilities that offer services for diabetes and CVD, only 0.4% and 0.9% had all the four service readiness factors (guideline, trained staff, equipment and medicine). CONCLUSIONS The study suggests that health facilities suffered from numerous drawbacks, such as shortage of trained staff and required medicine. Most importantly, they lack effective guidelines on the diagnosis and treatment for diabetes and CVD. It is, therefore, essential now to ensure that there are trained staff, adequate medicine supply, and appropriate guidelines on the diagnosis and treatment for diabetes and CVD in Bangladesh.
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Affiliation(s)
- Tuhin Biswas
- Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Moinuddin Haider
- Initiative for Climate Change and Health, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rajat Das Gupta
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Centre for Science of Implementation and Scale-Up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Jasim Uddin
- Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Srinivasan K, Mazur A, Mony PK, Whooley M, Ekstrand ML. Improving mental health through integration with primary care in rural Karnataka: study protocol of a cluster randomized control trial. BMC FAMILY PRACTICE 2018; 19:158. [PMID: 30205830 PMCID: PMC6134696 DOI: 10.1186/s12875-018-0845-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/31/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND People who are diagnosed with both mental and chronic medical illness present unique challenges for the health care system. In resource-limited settings, such as rural India, people with depression and anxiety are often under-served, due to both stigma and lack of trained providers and resources. These challenges can lead to complications in the management of chronic disease as well as increased suffering for patients, families and communities. In this study, we evaluate the effects of integrating mental health and chronic disease treatment of patients in primary health care (PHC) settings using a collaborative care model to improve the screening, diagnosis and treatment of depression in rural India. METHODS This study is a multi-level randomized controlled trial among patients with depression or anxiety and co-morbid diabetes, or cardiovascular disease. Aim 1 examines whether patients screened at community health-fairs are more likely to be diagnosed and treated for these co-morbid conditions than patients screened after presenting at PHCs. Aim 2 evaluates the impact of collaborative care compared to usual care in a cluster RCT, randomizing at the level of the PHCs. Intervention arm PHC staff are trained in mental health diagnoses, treatment, and the collaborative care model. The intervention also involves community-based "Healthy Living groups" co-led by Ashas, using cognitive-behavioral strategies to promote healthy behaviors. The primary outcome is severity of common mental disorders, with secondary outcomes being diabetes and cardiovascular risk, staff knowledge and patient perceptions. DISCUSSION If effective, our results will contribute to the field in five ways: 1) expand on implementation research in low resource settings by examining how multiple chronic diseases can be treated using integrated low-cost, evidence-based strategies, 2) build the capacity of PHC staff to diagnose and treat mental illness within their existing clinic structure and strengthen referral linkages; 3) link community members to primary care through community-based health fairs and healthy living groups; 4) increase mental health awareness in the community and reduce mental health stigma; 5) demonstrate the potential for intervention scale-up and sustainability. TRIAL REGISTRATION http://Clinicaltrials.gov : NCT02310932 registered December 8, 2014 URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932 ; Clinical Trials Registry India: CTRI/2018/04/013001 retrospectively registered on April 4, 2018.
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Affiliation(s)
- Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, Karnataka India
- Department of Psychiatry, St John’s Medical College Hospital, Bangalore, Karnataka India
| | - Amanda Mazur
- Division of Prevention Sciences, University of California, San Francisco, USA
| | - Prem K. Mony
- Division of Epidemiology and Community Health, St. John’s Medical College and Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Mary Whooley
- Division of Cardiology, University of California, San Francisco, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
| | - Maria L. Ekstrand
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, Karnataka India
- Division of Prevention Sciences, University of California, San Francisco, USA
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Validation of the Omron HEM-7320-LA, upper arm blood pressure monitor with Intelli Wrap Technology Cuff HEM-FL1 for self-measurement and clinic use according to the European Society of Hypertension International Protocol revision 2010 in the Mexican population. Blood Press Monit 2018; 22:375-378. [PMID: 28945665 PMCID: PMC5680989 DOI: 10.1097/mbp.0000000000000290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective The aim of this study was to determine the accuracy of the Omron HEM-7320-LA with Intelli Wrap technology cuff HEM-FL1 for self-measurement and clinic blood pressure (BP) measurement according to the European Society of Hypertension International Protocol revision 2010. Participants and methods The evaluation was performed in 39 individuals. The mean age of the participants was 47.9±14 years; systolic BP was 145.2±24.3 mmHg (range: 97–190), diastolic BP was 90.9±12.9 mmHg (range: 68–120), and arm circumference was 30.8±4 cm (range: 25–38.5). Results The device successfully fulfilled the established criteria of the validation protocol. The device overestimated systolic BP by 0.6±5.7 mmHg and diastolic BP by 2.2±5.1 mmHg. The specially designed cuff HEM-FL1 to cover a broad range of arm circumferences and self-placement fulfilled the requirements of the International Protocol.
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Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, Iwelunmor J, Awudzi KY, Quakyi KN, Mogaverro J, Khurshid K, Tayo B, Cooper R. Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: A pragmatic cluster randomized trial in Ghana. PLoS Med 2018; 15:e1002561. [PMID: 29715303 PMCID: PMC5929500 DOI: 10.1371/journal.pmed.1002561] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/26/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Poor access to care and physician shortage are major barriers to hypertension control in sub-Saharan Africa. Implementation of evidence-based systems-level strategies targeted at these barriers are lacking. We conducted a study to evaluate the comparative effectiveness of provision of health insurance coverage (HIC) alone versus a nurse-led task shifting strategy for hypertension control (TASSH) plus HIC on systolic blood pressure (SBP) reduction among patients with uncontrolled hypertension in Ghana. METHODS AND FINDINGS Using a pragmatic cluster randomized trial, 32 community health centers within Ghana's public healthcare system were randomly assigned to either HIC alone or TASSH + HIC. A total of 757 patients with uncontrolled hypertension were recruited between November 28, 2012, and June 11, 2014, and followed up to October 7, 2016. Both intervention groups received health insurance coverage plus scheduled nurse visits, while TASSH + HIC comprised cardiovascular risk assessment, lifestyle counseling, and initiation/titration of antihypertensive medications for 12 months, delivered by trained nurses within the healthcare system. The primary outcome was change in SBP from baseline to 12 months. Secondary outcomes included lifestyle behaviors and blood pressure control at 12 months and sustainability of SBP reduction at 24 months. Of the 757 patients (389 in the HIC group and 368 in the TASSH + HIC group), 85% had 12-month data available (60% women, mean BP 155.9/89.6 mm Hg). In intention-to-treat analyses adjusted for clustering, the TASSH + HIC group had a greater SBP reduction (-20.4 mm Hg; 95% CI -25.2 to -15.6) than the HIC group (-16.8 mm Hg; 95% CI -19.2 to -15.6), with a statistically significant between-group difference of -3.6 mm Hg (95% CI -6.1 to -0.5; p = 0.021). Blood pressure control improved significantly in both groups (55.2%, 95% CI 50.0% to 60.3%, for the TASSH + HIC group versus 49.9%, 95% CI 44.9% to 54.9%, for the HIC group), with a non-significant between-group difference of 5.2% (95% CI -1.8% to 12.4%; p = 0.29). Lifestyle behaviors did not change appreciably in either group. Twenty-one adverse events were reported (9 and 12 in the TASSH + HIC and HIC groups, respectively). The main study limitation is the lack of cost-effectiveness analysis to determine the additional costs and benefits, if any, of the TASSH + HIC group. CONCLUSIONS Provision of health insurance coverage plus a nurse-led task shifting strategy was associated with a greater reduction in SBP than provision of health insurance coverage alone, among patients with uncontrolled hypertension in Ghana. Future scale-up of these systems-level strategies for hypertension control in sub-Saharan Africa requires a cost-benefit analysis. TRIAL REGISTRATION ClinicalTrials.gov NCT01802372.
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Affiliation(s)
- Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Jacob Plange-Rhule
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joyce Gyamfi
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
| | - William Chaplin
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Michael Ntim
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Apusiga
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, United States of America
| | | | - Kofi Nana Quakyi
- College of Global Public Health, New York Unversity, New York, New York, United States of America
| | - Jazmin Mogaverro
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Kiran Khurshid
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Bamidele Tayo
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Richard Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
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Bintabara D, Mpondo BCT. Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey. PLoS One 2018; 13:e0192942. [PMID: 29447231 PMCID: PMC5814020 DOI: 10.1371/journal.pone.0192942] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 01/20/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania. METHODS This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level. RESULTS Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension. CONCLUSION The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes.
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Affiliation(s)
- Deogratius Bintabara
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Bonaventura C. T. Mpondo
- Department of Internal Medicine, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
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Gyamfi J, Plange-Rhule J, Iwelunmor J, Lee D, Blackstone SR, Mitchell A, Ntim M, Apusiga K, Tayo B, Yeboah-Awudzi K, Cooper R, Ogedegbe G. Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study. BMC Health Serv Res 2017; 17:104. [PMID: 28148255 PMCID: PMC5288999 DOI: 10.1186/s12913-017-2026-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/17/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses' knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH). METHODS A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses' satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management. RESULTS A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses' knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention. CONCLUSIONS Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana. TRIAL REGISTRATION Trial registration for parent TASSH study: NCT01802372 . Registered February 27, 2013.
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Affiliation(s)
- Joyce Gyamfi
- New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA
| | - Jacob Plange-Rhule
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Juliet Iwelunmor
- University of Illinois at Urbana-Champaign, Urbana, IL 61801 USA
| | - Debbie Lee
- Stony Brook University School of Medicine, Stony Brook, NY 11797 USA
| | | | - Alicia Mitchell
- New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA
| | - Michael Ntim
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Apusiga
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bamidele Tayo
- Stritch School of Medicine, Loyola Chicago Medical Center, Maywood, IL 60153 USA
| | | | - Richard Cooper
- Stritch School of Medicine, Loyola Chicago Medical Center, Maywood, IL 60153 USA
| | - Gbenga Ogedegbe
- New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA
- NYU College of Global Public Health, New York University, New York, NY 10003 USA
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Barasa FA, Vedanthan R, Pastakia SD, Crowe SJ, Aruasa W, Sugut WK, White R, Ogola ES, Bloomfield GS, Velazquez EJ. Approaches to Sustainable Capacity Building for Cardiovascular Disease Care in Kenya. Cardiol Clin 2016; 35:145-152. [PMID: 27886785 DOI: 10.1016/j.ccl.2016.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial.
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Affiliation(s)
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Susie J Crowe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
| | | | | | - Russ White
- Tenwek Mission Hospital, Bomet, Kenya; Alpert School of Medicine, Brown University, 2 Dudley Street, PO Box 39, Providence, RI 02905, USA
| | - Elijah S Ogola
- Department of Clinical Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Gerald S Bloomfield
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eric J Velazquez
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
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Krishnadath ISK, Jaddoe VWV, Nahar-van Venrooij LM, Toelsie JR. Ethnic differences in prevalence and risk factors for hypertension in the Suriname Health Study: a cross sectional population study. Popul Health Metr 2016; 14:33. [PMID: 27660556 PMCID: PMC5026769 DOI: 10.1186/s12963-016-0102-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/09/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Limited information is available about the prevalence, ethnic disparities, and risk factors of hypertension within developing countries. We used data from a nationwide study on non-communicable disease (NCD) risk factors to estimate, explore, and compare the prevalence of hypertension overall and in subgroups of risk factors among different ethnic groups in Suriname. METHOD The Suriname Health Study used the World Health Organization Steps design to select respondents with a stratified multistage cluster sample of households. The overall and ethnic specific prevalences of hypertension were calculated in general and in subgroups of sex, age, marital status, educational level, income status, employment, smoking status, residence, physical activity, body mass index (BMI), and waist circumference (WC). Differences in the prevalence between ethnic subgroups were assessed using the Chi-square test. We used several adjustment models to explore whether the observed ethnic differences were explained by biological, demographic, lifestyle, or anthropometric risk factors. RESULTS The prevalence of hypertension was 26.2 % (95 % confidence interval 25.1 %-27.4 %). Men had higher mean values for systolic and diastolic blood pressure compared to women. Blood pressure increased with age. The prevalence was highest for Creole, Hindustani, and Javanese and lowest for Amerindians, Mixed, and Maroons. Differences between ethnic groups were measured in the prevalence of hypertension in subcategories of sex, marital status, education, income, smoking, physical activity, and BMI. The major difference in association of ethnic groups with hypertension was between Hindustani and Amerindians. CONCLUSION The prevalence of hypertension in Suriname was in the range of developing countries. The highest prevalence was found in Creoles, Hindustani, and Javanese. Differences in the prevalence of hypertension were observed between ethnic subgroups with biological, demographic, lifestyle, and anthropometric risk factors. These findings emphasize the need for ethnic-specific research and prevention and intervention programs.
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Affiliation(s)
- Ingrid S. K. Krishnadath
- Department of Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Vincent W. V. Jaddoe
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Lenny M. Nahar-van Venrooij
- Department of Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Jerry R. Toelsie
- Department of Physiology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
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Odusola AO, Stronks K, Hendriks ME, Schultsz C, Akande T, Osibogun A, van Weert H, Haafkens JA. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers. Glob Health Action 2016; 9:29041. [PMID: 26880152 PMCID: PMC4754020 DOI: 10.3402/gha.v9.29041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/18/2015] [Accepted: 01/12/2016] [Indexed: 11/14/2022] Open
Abstract
Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Results Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.
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Affiliation(s)
- Aina O Odusola
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ; ;
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen E Hendriks
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Tanimola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Akin Osibogun
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Henk van Weert
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joke A Haafkens
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Lulebo AM, Mapatano MA, Kayembe PK, Mafuta EM, Mutombo PB, Coppieters Y. Assessment of hypertension management in primary health care settings in Kinshasa, Democratic Republic of Congo. BMC Health Serv Res 2015; 15:573. [PMID: 26704087 PMCID: PMC4690396 DOI: 10.1186/s12913-015-1236-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/11/2015] [Indexed: 12/03/2022] Open
Abstract
Background Hypertension-related complications have become more diagnosed at secondary and tertiary care levels, in the Democratic Republic of the Congo (DRC), probably indicative of poor management of hypertensive patients at primary health care level. This study aimed to assess the management of hypertension in primary health care settings by using guidelines of the International Forum for Prevention and Control of HTN in Africa (IFHA). Methods A multi-center cross-sectional study was carried out in primary health care settings. A total of 102 nurses were surveyed using a structured interview. Mean and proportion comparisons were performed using the t Student test and the Chi-square test respectively. The Kinshasa Primary Health Care network facilities were compared with non-Kinshasa Primary Health Care network facilities. Results From the 102 nurses surveyed; 52.9 % were female with a mean age of 41.1, (SD = 10) years, merely 9.5 % benefited from in-job training on cardiovascular diseases or their risk factors, and 51.7 % had guidelines on the management of hypertension. Less than a quarter of the nurses knew the cut-off values of hypertension, diabetes and obesity. Merely 14.7 % knew the therapeutic goals for uncomplicated hypertension. Several of the indicators for immediate referral recommended by IFHA were unmentioned. The content of patient education was lacking, avoiding stress being the best advice provided to hypertensive patients. The antihypertensive most used were unlikely to be recommended by the IFHA. Conclusions This study showed a considerable gap of knowledge and practices in the management of hypertensive patients at primary health care facilities in Kinshasa pertaining to the IFHA guidelines. We think that task-shifting for management of hypertension is feasible if appropriate guidelines are provided and nurses trained. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1236-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aimée M Lulebo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo. .,Department of Epidemiology and Bio-statistics, Kinshasa School of Public Health, University of Kinshasa, P.O. Box 11850, Kinshasa, Democratic Republic of Congo.
| | - Mala A Mapatano
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Patrick K Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Eric M Mafuta
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Paulin B Mutombo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Yves Coppieters
- School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Peck R, Mghamba J, Vanobberghen F, Kavishe B, Rugarabamu V, Smeeth L, Hayes R, Grosskurth H, Kapiga S. Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey. LANCET GLOBAL HEALTH 2015; 2:e285-92. [PMID: 24818084 PMCID: PMC4013553 DOI: 10.1016/s2214-109x(14)70033-6] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Historically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, non-communicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs. Methods Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for-profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources. Findings Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and first-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hyptertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than five patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV. Interpretation Most outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identified crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements. Funding UK Medical Research Council.
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Iwelunmor J, Plange-Rhule J, Airhihenbuwa CO, Ezepue C, Ogedegbe O. A Narrative Synthesis of the Health Systems Factors Influencing Optimal Hypertension Control in Sub-Saharan Africa. PLoS One 2015; 10:e0130193. [PMID: 26176223 PMCID: PMC4503432 DOI: 10.1371/journal.pone.0130193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/17/2015] [Indexed: 01/13/2023] Open
Abstract
Introduction In sub-Saharan Africa (SSA), an estimated 74.7 million individuals are hypertensive. Reducing the growing burden of hypertension in sub-Saharan Africa will require a variety of strategies one of which is identifying the extent to which actions originating at the health systems level improves optimal management and control. Methods and Results We conducted a narrative synthesis of available papers examining health systems factors influencing optimal hypertension in SSA. Eligible studies included those that analyzed the impact of health systems on hypertension awareness, treatment, control and medication adherence. Twenty-five articles met the inclusion criteria and the narrative synthesis identified the following themes: 1) how physical resources influence mechanisms supportive of optimal hypertension control; 2) the role of human resources with enabling and/or inhibiting hypertension control goals; 3) the availability and/or use of intellectual resources; 4) how health systems financing facilitate and/or compromise access to products necessary for optimal hypertension control. Conclusion The findings highlight the need for further research on the health systems factors that influence management and control of hypertension in the region.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, United States of America
- * E-mail:
| | - Jacob Plange-Rhule
- School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins O. Airhihenbuwa
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States of America
| | - Chizoba Ezepue
- Department of Neurology, Georgia Regents University, Augusta, GA, United States of America
| | - Olugbenga Ogedegbe
- Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University Langone Medical Center, New York, New York, United States of America
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Feasibility and quality of cardiovascular disease prevention within a community-based health insurance program in rural Nigeria. J Hypertens 2015; 33:366-75. [DOI: 10.1097/hjh.0000000000000401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ovbiagele B. Phone-based intervention under nurse guidance after stroke: concept for lowering blood pressure after stroke in Sub-Saharan Africa. J Stroke Cerebrovasc Dis 2015; 24:1-9. [PMID: 25440360 PMCID: PMC4277714 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/09/2014] [Indexed: 12/31/2022] Open
Abstract
Over the last 4 decades, rates of stroke occurrence in low- and middle-income countries (LMIC) have roughly doubled, whereas they have substantively decreased in high-income countries. Most of these LMIC are in Sub-Saharan Africa (SSA) where the burden of stroke will probably continue to rise over the next few decades because of an ongoing epidemiologic transition. Moreover, SSA is circumstantially distinct: socioeconomic obstacles, cultural barriers, underdiagnosis, uncoordinated care, and shortage of physicians impede the ability of SSA countries to implement cardiovascular disease prevention among people with diabetes mellitus in a timely and sustainable manner. Reducing the burden of stroke in SSA may necessitate an initial emphasis on high-risk individuals motivated to improve their health, multidisciplinary care coordination initiatives with clinical decision support, evidence-based interventions tailored for cultural relevance, task shifting from physicians to nurses and other health providers, use of novel patient-accessible tools, and a multilevel approach that incorporates individual- and system-level components. This article proposes a theory-based integrated blood pressure (BP) self-management intervention called Phone-based Intervention under Nurse Guidance after Stroke (PINGS) that could be tested among hospitalized stroke patients with poorly controlled hypertension encountered in SSA. PINGS would comprise the implementation of nurse-run BP control clinics and administration of health technology (personalized phone text messaging and home telemonitoring), aimed at boosting patient self-efficacy and intrinsic motivation for sustained adherence to antihypertensive medications.
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Affiliation(s)
- Bruce Ovbiagele
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
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Odusola AO, Nelissen H, Hendriks M, Schultsz C, Wit F, Bolarinwa OA, Akande T, Agyemang C, Ogedegbe G, Agbede K, Adenusi P, Osibogun A, Stronks K, Haafkens J. How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjcd.2015.57021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Estudio EPRAS: estudio poblacional del riesgo cardiovascular de una población colombiana. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/j.rccar.2014.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Ngalesoni F, Ruhago G, Norheim OF, Robberstad B. Economic cost of primary prevention of cardiovascular diseases in Tanzania. Health Policy Plan 2014; 30:875-84. [PMID: 25113027 PMCID: PMC4524339 DOI: 10.1093/heapol/czu088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important.
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Affiliation(s)
- Frida Ngalesoni
- Ministry of Health and Social Welfare, PO Box 9083 Dar es Salaam, Tanzania, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway,
| | - George Ruhago
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway, School of Public Health and Social Sciences, Muhimbili University, PO Box 65015 Dar es Salaam, Tanzania and
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway
| | - Bjarne Robberstad
- Center of International Health, University of Bergen, PO Box 7804, N-5020, Bergen, Norway
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Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, Khurshid K, Cooper R. A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol. Implement Sci 2014; 9:73. [PMID: 24923300 PMCID: PMC4063247 DOI: 10.1186/1748-5908-9-73] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Countries in sub-Saharan Africa (SSA) are experiencing an epidemic of cardiovascular disease (CVD) propelled by rapidly increasing rates of hypertension. Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs. Although SSA bears 24% of the global disease burden, it has only 3% of the global health workforce. Given such limited resources, cost-effective strategies, such as task shifting, are needed to mitigate the rising CVD epidemic in SSA. Ghana, a country in SSA with an established community health worker program integrated within a national health insurance scheme provides an ideal platform to evaluate implementation of the World Health Organization (WHO) task-shifting strategy. This study will evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment versus provision of health insurance coverage, on blood pressure (BP) reduction. METHODS Using a cluster randomized design, 32 community health centers (CHCs) and district hospitals in Ghana will be randomized to either the intervention group (16 CHCs) or the control group (16 CHCs). A total of 640 patients with uncomplicated hypertension (BP 140-179/90-99 mm Hg and absence of target organ damage) will be enrolled in this study (20 patients per CHC). The intervention consists of WHO Package of CV risk assessment, patient education, initiation and titration of antihypertensive medications, behavioral counseling on lifestyle behaviors, and medication adherence every three months for 12 months. The primary outcome is the mean change in systolic BP from baseline to 12 months. The secondary outcomes are rates of BP control at 12 months; levels of physical activity, percent change in weight, and dietary intake of fruits and vegetables at 12 months; and sustainability of intervention effects at 24 months. All outcomes will be assessed at baseline, six months and 12 months. Trained community health nurses will deliver the intervention as part of Ghana's community-based health planning and services (CHPS) program. DISCUSSION Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy with respect to comprehensive CV risk reduction and hypertension control in resource-poor settings. TRIAL REGISTRATION NCT01802372.
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Affiliation(s)
- Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
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Iwelunmor J, Airhihenbuwa CO, Cooper R, Tayo B, Plange-Rhule J, Adanu R, Ogedegbe G. Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa. Global Health 2014; 10:42. [PMID: 24886649 PMCID: PMC4046625 DOI: 10.1186/1744-8603-10-42] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 05/01/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In West Africa, hypertension, once rare, has now emerged as a critical health concern and the trajectory is upward and factors are complex. The true magnitude of hypertension in some West African countries, including in-depth knowledge of underlying risk factors is not completely understood. There is also a paucity of research on adequate systems-level approaches designed to mitigate the growing burden of hypertension in the region. AIMS In this review, we thematically synthesize available literature pertaining to the prevalence of hypertension in West Africa and discuss factors that influence its diagnosis, treatment and control. We aimed to address the social and structural determinants influencing hypertension in the sub-region including the effects of urbanization, health infrastructure and healthcare workforce. FINDINGS The prevalence of hypertension in West Africa has increased over the past decade and is rising rapidly with an urban-rural gradient that places higher hypertension prevalence on urban settings compared to rural settings. Overall levels of awareness of one's hypertension status remain consistently low in West African. Structural and economic determinants related to conditions of poverty such as insufficient finances have a direct impact on adherence to prescribed antihypertensive medications. Urbanization contributes to the increasing incidence of hypertension in the sub-region and available evidence indicates that inadequate health infrastructure may act as a barrier to optimal hypertension control in West Africa. CONCLUSION Given that optimal hypertension control in West Africa depends on multiple factors that go beyond simply modifying the behaviors of the individuals alone, we conclude by discussing the potential role systems-thinking approaches can play to achieve optimal control in the sub-region. In the context of recent advances in hypertension management including new therapeutic options and innovative solutions to expand health workforce so as to meet the high demand for healthcare, the success of these strategies will rely on a new understanding of the complexity of human behaviors and interactions most aptly framed from a systems-thinking perspective.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, 123 Huff Hall, 1206 S. Fourth St, Champaign, IL 61820, USA
| | - Collins O Airhihenbuwa
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802, USA
| | - Richard Cooper
- Department of Public Health Sciences, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL 60153, USA
| | - Bamidele Tayo
- Department of Public Health Sciences, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL 60153, USA
| | - Jacob Plange-Rhule
- School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Adanu
- School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, USA
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Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One 2014; 9:e84238. [PMID: 24454721 PMCID: PMC3893097 DOI: 10.1371/journal.pone.0084238] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/12/2013] [Indexed: 01/13/2023] Open
Abstract
Background Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.
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Doulougou B, Kouanda S, Ouédraogo GH, Meda BI, Bado A, Zunzunegui MV. Awareness, treatment, control of hypertension and utilization of health care services following screening in the North-central region of Burkina Faso. Pan Afr Med J 2014; 19:259. [PMID: 25852802 PMCID: PMC4382071 DOI: 10.11604/pamj.2014.19.259.4707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/27/2014] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION In Africa, a non-urban area is affected by hypertension. But in Burkina Faso, no study on factors associated with awareness, treatment and control of hypertension has not yet been published. The objectives of this report are to: (i) identify the factors associated with awareness, treatment, and control of hypertension in the adult population of Kaya health and demographic surveillance system (Kaya HDSS) and (ii) estimate health care services utilization by participant newly screened as hypertensive. METHODS A screening survey for hypertension was conducted on 1481 adults in Kaya HDSS in late 2012. Hypertensive individuals provided information relating to "awareness", "treatment" and "control" of their hypertension. After approximately two months, unaware hypertensive individuals were interviewed to know whether they had sought treatment. RESULTS During the screening survey, 123 individuals (9.4%) were identified as having hypertension. Among them, 33 (26.8%, 95% CI: 18.9-34.8) were aware of their condition, 25 (75.8%, 95% CI: 60.3-91.2) of them were receiving medication. Among those receiving treatment, 15 (60.0%, 95% CI: 39.4-80.6) had their blood pressure controlled. Semi-urban residence, presence of chronic diseases and physical inactivity were significantly associated with awareness of hypertension. Seventy two of the 90 participants who were classified as unaware were interviewed two months later. Out of them, 37 individuals had consulted a health worker and 28 received a diagnosis of hypertension. CONCLUSION Awareness was low but treatment and control of those who knew they were hypertensive were relatively high. These results could be used to improve management of hypertension in Burkina Faso.
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Affiliation(s)
- Boukaré Doulougou
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192 Ouagadougou 03, Burkina Faso ; Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada
| | - Séni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192 Ouagadougou 03, Burkina Faso
| | - Gautier Henri Ouédraogo
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192 Ouagadougou 03, Burkina Faso
| | | | - Aristide Bado
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192 Ouagadougou 03, Burkina Faso
| | - Maria Victoria Zunzunegui
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada ; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, QC, Canada ; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
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Wee LE, Wong J, Chin RT, Lin ZY, Goh DEQ, Vijakumar K, Vong KY, Tay WL, Lim HT, Koh GCH. Hypertension Management and Lifestyle Changes Following Screening for Hypertension in an Asian Low Socioeconomic Status Community: A Prospective Study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n9p451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: This study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined. Materials and Methods: The study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up. Results: The follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99). Conclusion: An access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.
Key words: Cardiovascular screening, Control, Treatment
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Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Jolene Wong
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Run Ting Chin
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Zhi Yong Lin
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Daniel EQ Goh
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kalpana Vijakumar
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kiat Yee Vong
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Wei Ling Tay
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Hui Ting Lim
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Gerald CH Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
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Mayega RW, Guwatudde D, Makumbi F, Nakwagala FN, Peterson S, Tomson G, Ostenson CG. Diabetes and pre-diabetes among persons aged 35 to 60 years in eastern Uganda: prevalence and associated factors. PLoS One 2013; 8:e72554. [PMID: 23967317 PMCID: PMC3743823 DOI: 10.1371/journal.pone.0072554] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 07/11/2013] [Indexed: 11/27/2022] Open
Abstract
Background Our aim was to estimate the prevalence of abnormal glucose regulation (AGR) (i.e. diabetes and pre-diabetes) and its associated factors among people aged 35-60 years so as to clarify the relevance of targeted screening in rural Africa. Methods A population-based survey of 1,497 people (786 women and 711 men) aged 35-60 years was conducted in a predominantly rural Demographic Surveillance Site in eastern Uganda. Participants responded to a lifestyle questionnaire, following which their Body Mass Index (BMI) and Blood Pressure (BP) were measured. Fasting plasma glucose (FPG) was measured from capillary blood using On-Call® Plus (Acon) rapid glucose meters, following overnight fasting. AGR was defined as FPG ≥6.1mmol L-1 (World Health Organization (WHO) criteria or ≥5.6mmol L-1 (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG >6.9mmol L-1, or being on diabetes treatment. Results The mean age of participants was 45 years for men and 44 for women. Prevalence of diabetes was 7.4% (95%CI 6.1-8.8), while prevalence of pre-diabetes was 8.6% (95%CI 7.3-10.2) using WHO criteria and 20.2% (95%CI 17.5-22.9) with ADA criteria. Using WHO cut-offs, the prevalence of AGR was 2 times higher among obese persons compared with normal BMI persons (Adjusted Prevalence Rate Ratio (APRR) 1.9, 95%CI 1.3-2.8). Occupation as a mechanic, achieving the WHO recommended physical activity threshold, and higher dietary diversity were associated with lower likelihood of AGR (APRR 0.6, 95%CI 0.4-0.9; APRR 0.6, 95%CI 0.4-0.8; APRR 0.5, 95%CI 0.3-0.9 respectively). The direct medical cost of detecting one person with AGR was two US dollars with ADA and three point seven dollars with WHO cut-offs. Conclusions There is a high prevalence of AGR among people aged 35-60 years in this setting. Screening for high risk persons and targeted health education to address obesity, insufficient physical activity and non-diverse diets are necessary.
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Affiliation(s)
- Roy William Mayega
- Division of Global Health-IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Data from different national and regional surveys show that hypertension is common in developing countries, particularly in urban areas, and that rates of awareness, treatment, and control are low. Several hypertension risk factors seem to be more common in developing countries than in developed regions. Findings from serial surveys show an increasing prevalence of hypertension in developing countries, possibly caused by urbanisation, ageing of population, changes to dietary habits, and social stress. High illiteracy rates, poor access to health facilities, bad dietary habits, poverty, and high costs of drugs contribute to poor blood pressure control. The health system in many developing countries is inadequate because of low funds, poor infrastructure, and inexperience. Priority is given to acute disorders, child and maternal health care, and control of communicable diseases. Governments, together with medical societies and non-governmental organisations, should support and promote preventive programmes aiming to increase public awareness, educate physicians, and reduce salt intake. Regulations for the food industry and the production and availability of generic drugs should be reinforced.
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Barry AR, Loewen PS, de Lemos J, Lee KG. Reasons for non-use of proven pharmacotherapeutic interventions: systematic review and framework development. J Eval Clin Pract 2012; 18:49-55. [PMID: 20738466 DOI: 10.1111/j.1365-2753.2010.01524.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The quality of patient care and safety is dependent on addressing both errors of commission (e.g. overuse of medications) and errors of omission (e.g. patients receiving too little care). Despite guidelines recommending the use of certain proven pharmacotherapeutic interventions, a large gap exists between the patients that have an indication for, and those that actually receive such interventions. To address how the rate of implementation of proven interventions can be improved is dependent on a comprehensive knowledge of the factors contributing to their underuse. The aim of the review is to create an evidence-based framework of reasons why eligible patients do not receive proven pharmacotherapeutic interventions. METHODS A systemic review of the published reasons for non-use based on the Cochrane methodology. RESULTS The systematic review identified 67 articles meeting the inclusion criteria. The reasons for non-use were extracted from the studies and a framework was created from the results. CONCLUSIONS The factors associated with lack of implementation of proven pharmacotherapeutic interventions are complex and heterogeneous but can be understood from the perspectives of clinicians, patients and health care delivery systems. Efforts to increase the utilization of proven interventions should focus on disease/intervention-specific programmes that take into account the identified modifiable clinician, patient and system factors.
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Affiliation(s)
- Arden R Barry
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Wee LE, Koh GCH, Yeo WX, Chin RT, Wong J, Seow B. Screening for cardiovascular disease risk factors in an urban low-income setting at baseline and post intervention: a prospective intervention study. Eur J Prev Cardiol 2012; 20:176-88. [PMID: 22345673 DOI: 10.1177/2047487311433890] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Not all segments of society might have equal access to screening. We determined predictors for regular cardiovascular health screening at baseline amongst those of low socioeconomic status (SES) and evaluated the effectiveness of a 6-month intervention on screening in this group compared to a high-SES group. METHODS The study population involved all residents aged ≥ 40 years in two housing estates comprising owner-occupied housing (high SES) and rental flats (low SES) in Singapore. From 2009 to 2011, residents not being screened regularly at baseline for hypertension, diabetes, and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose, and lipid testing over 6 months. Chi-squared and multi-level logistic regression identified predictors of regular screening at baseline; likelihood ratio and Cox regression analysis identified predictors of screening participation post intervention. RESULTS Participation was 78.2% (1081/1383). At baseline, in the low-SES group, 41.7% (150/360), 38.8% (177/456), and 30.8% (128/416) had gone for regular hypertension, diabetes, and dyslipidaemia screening, respectively; compared with higher numbers in the high-SES group. Sociodemographic factors predicting regular screening in the low-SES community included being married and not smoking. Post intervention, screening rates rose significantly (p < 0.001) by similar proportions in both communities. Staying in a lower-SES community (adjusted relative risk (aRR) 0.61, 95% CI 0.37-0.99, p = 0.048) and having hypertension (aRR 0.45, 95% CI 0.18-0.98, p = 0.049) was associated with lower take-up; Chinese ethnicity (aRR 1.84, 95% CI 1.00-3.43, p = 0.050) and employment associated with higher take-up (aRR 1.57, 95% CI 1.03-2.60, p = 0.040). CONCLUSION Participation in cardiovascular health screening was poor amongst those of low SES; a 6-month intervention programme improved participation in this population.
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Affiliation(s)
- Liang En Wee
- National University of Singapore, National University Health System, Singapore
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Affiliation(s)
- Karen Sliwa
- Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, 7935 Cape Town, Western Cape, South Africa.
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Lai WT, Park JE, Dongre N, Wang J. Efficacy, safety, and tolerability of valsartan/hydrochlorothiazide in Asian patients with essential hypertension. Adv Ther 2011; 28:427-38. [PMID: 21491172 DOI: 10.1007/s12325-011-0014-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Previous studies have demonstrated that hypertensive patients need concomitant therapy with one or more drugs from different classes of antihypertensive agents to achieve their blood pressure control targets. We performed the first multinational observational study of valsartan/hydrochlorothiazide (HCTZ) single pill combination in Asia to determine the efficacy, safety, and tolerability in hypertensive patients. The objective of this multinational, multicenter, 24-week follow-up observational study is to evaluate the efficacy, safety, and tolerability of valsartan/hydrochlorothiazide single pill combination in the treatment of essential hypertension in the Asia-Pacific region. METHODS A total of 7567 Asian patients who were diagnosed with stage 1 or stage 2 essential hypertension and who took at least one dose of valsartan/hydrochlorothiazide single pill combination were included in the statistical analyses. A total of 59% were taking antihypertensive medication at the time of the study. Eligible patients received valsartan/hydrochlorothiazide single pill combination 80/12.5 mg tablets orally once daily at visit 1. The investigator could decide the subsequent dose of valsartan/hydrochlorothiazide single pill combination for their patients, and efficacy, safety, and tolerability data were collected at week 4, 12, and 24. RESULTS Basal blood pressure was 155.9±13.3 mmHg (systolic) and 96.3±10.1 mmHg (diastolic). Response rates and control rates increased continuously from baseline to the study endpoint at week 24, when they reached 94.6% and 73.2%, respectively. Systolic and diastolic blood pressure reductions were -25.4±15.2 mmHg and -14.9±13.5 mmHg, respectively (P<0.001). Using a four-point global assessment scale, 96.8% of the patients and physicians reported good, very good, or excellent for both their subjective efficacy and tolerability assessments. CONCLUSION In this multicenter, multicountry study including 7567 Asian patients with hypertension, valsartan/hydrochlorothiazide single pill combination was found efficacious, well tolerated, and devoid of any serious adverse effects.
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Affiliation(s)
- Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Parati G, Kilama MO, Faini A, Facelli E, Ochen K, Opira C, Mendis S, Wang J, Atkins N, O'Brien E. A new solar-powered blood pressure measuring device for low-resource settings. Hypertension 2010; 56:1047-53. [PMID: 21059998 DOI: 10.1161/hypertensionaha.110.160408] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of high blood pressure (BP) is particularly inadequate in low-income countries, where the unavailability of a reliable, durable, and affordable BP-measurement device is a major obstacle to accurate diagnosis. Recognizing this, a World Health Organization committee was established to correct this deficiency by influencing manufacturers to produce a device according to predetermined criteria and to demonstrate the suitability of the device for low resource settings. A device, which fulfilled stipulated criteria in being inexpensive, semiautomated, and solar powered, was validated according to the International Protocol of the European Society of Hypertension; it was then subjected to field testing in 716 subjects from 2 centers in Uganda and 1 in Zambia. The Omron HEM-SOLAR having previously fulfilled accuracy criteria of the International Protocol for both systolic blood pressure (SBP) and diastolic blood pressure (DBP), fulfilled criteria for SBP, but not for DBP, when revalidated. In field testing, average SBPs and DBPs were 120.5 ± 21.6/74.6 ± 13.8 mm Hg and 122.3 ± 21.8/71.2 ± 14.0 mm Hg, respectively, with the auscultatory technique and the Omron HEM-SOLAR, respectively. Between-device agreement in defining SBP was 93.7%. The Omron HEM-SOLAR was favored over the mercury sphygmomanometer by both patients and investigators. In summary, considering the accuracy, robustness, relatively low cost, operational simplicity, and advantages such as solar power, the Omron HEM-SOLAR is likely to be a valuable device for improving BP measurement in low-resource settings with nonphysician health workers.
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Affiliation(s)
- Gianfranco Parati
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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Windak A, Gryglewska B, Tomasik T, Narkiewicz K, Yaphe J, Grodzicki T. The competence of primary care doctors in the investigation of patients with elevated blood pressure: results of a cross-sectional study using clinical vignettes. J Eval Clin Pract 2010; 16:784-9. [PMID: 20557416 DOI: 10.1111/j.1365-2753.2009.01194.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Specific laboratory tests are required to ensure adequate management of patients with hypertension, according to internationally accepted guidelines. There is wide variation in doctor test ordering behaviour. Many factors are known to affect this. Little is known about the interaction between doctor, patient and practice characteristics. The current study was designed to explore this. METHODS A series of eight case vignettes was designed to examine test ordering behaviour among primary care doctors in Poland. The cases differed with regard to the level of blood pressure and the presence or absence of other cardiovascular risk factors, including diabetes. Doctors stated their choices of laboratory investigations needed in these cases. Their responses were compared with recommendations in the 2003 European Society of Hypertension/European Society of Cardiology hypertension guidelines. Associations between the correct responses and patient, doctor and practice characteristics were tested. RESULTS One hundred and twenty-five out of 192 invited doctors (65%) participated in the study. They ordered a mean of 4.9 laboratory tests per case. This represents 47.9% of the tests recommended by current guidelines. Older doctors working in smaller practices and private settings ordered fewer laboratory tests. Specialization in family medicine was associated with greater compliance with guidelines. Grade 2 hypertension and the presence of other risk factors of cardiovascular disease were associated with ordering more tests but the presence of diabetes did not improve compliance with guidelines. CONCLUSIONS Further educational efforts are needed to promote rational test ordering for hypertensive patients by Polish primary health care doctors.
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Affiliation(s)
- Adam Windak
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland.
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Van Minh H, Soonthornthada K, Ng N, Juvekar S, Razzaque A, Ashraf A, Ahmed SM, Bich TH, Kanungsukkasem U. Blood pressure in adult rural INDEPTH population in Asia. Glob Health Action 2009; 2. [PMID: 20027254 PMCID: PMC2785103 DOI: 10.3402/gha.v2i0.2010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/25/2009] [Accepted: 07/25/2009] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION High blood pressure (BP) is a well-known major risk factor for cardiovascular diseases and is a leading contributor to cardiovascular mortality and morbidity worldwide. Reliable population-based BP data from low-middle income countries are sparse. OBJECTIVE This paper reports BP distributions among adults in nine rural populations in five Asian countries and examines the association between high BP and associated risk factors, including gender, age, education, and body mass index. METHODS A multi-site cross-sectional study of the major non-communicable disease risk factors (tobacco and alcohol use, fruit and vegetable intake, physical activity patterns) was conducted in 2005 in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries, all part of the INDEPTH Network. In addition to the self-report questions on risk factors, height and weight, and BP were measured during household visits using standard protocols of the WHO STEPwise approach to Surveillance. RESULTS In all the study sites (except among men and women in WATCH and among women in Chililab), the mean levels of systolic BP were greater than the optimal threshold (115 mmHg). A considerable proportion of the study populations - especially those in the HDSS in India, Indonesia, and Thailand - had high BP (systolic BP >/= 140 mmHg or diastolic BP >/= 90 mmHg or on treatment with BP medications). A more conservative definition of high BP (systolic BP >/= 160 mmHg or diastolic BP >/= 100 mmHg) substantially reduced the prevalence rate. The marked differences in the proportion of the populations on high BP medication (range between 0.6 and 10.8%) raised problems in comparing the prevalence of high BP across sites when using the commonly used definition of high BP as in this study. In the four HDSS in Bangladesh, women had a higher prevalence of high BP than men; the reverse was true in the other sites (Chililab, Filabavi in Vietnam; Kanchanaburi, Thailand; and Vadu, India) where men experienced higher prevalence than women. Overweight and obesity were significantly associated with high BP, with odds ratio ranging from two in Chililab to five in Filabavi (both in Vietnam HDSS). CONCLUSION The patterns of BP in these nine cross-sectional surveys were complex, reflecting the fact that the Asian countries are at different stages of the epidemiological transition. Actions to prevent the rise of BP levels are urgently required. An emphasis should be placed on cost-effective interventions to reduce salt consumption in the population as an immediate priority.
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Affiliation(s)
- Hoang Van Minh
- Filabavi Health and Demographic Surveillance System, Vietnam
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Nguyen TT, Adair LS, Suchindran CM, He K, Popkin BM. The association between body mass index and hypertension is different between East and Southeast Asians. Am J Clin Nutr 2009; 89:1905-12. [PMID: 19369374 PMCID: PMC2714374 DOI: 10.3945/ajcn.2008.26809] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have allowed direct comparison of the association between body mass index (BMI; in kg/m2) and hypertension in different Asian ethnicities. OBJECTIVE We compared the association of BMI with hypertension in Chinese, Indonesian, and Vietnamese adults and determined BMI cutoffs that best predicted hypertension in these populations. DESIGN We included 7562 Chinese, 18,502 Indonesian, and 77,758 Vietnamese participants aged 18-65 y. Blood pressure, weight, and height were measured by trained health workers. To define an optimal BMI cutoff, we computed and searched for the shortest distance on receiver operating characteristic curves. RESULTS Despite a low mean BMI, the prevalences of hypertension in Chinese, Indonesian, and Vietnamese men were 22.9%, 24.8%, and 14.4%, respectively, and in women were 16.6%, 26.9%, and 11.7%, respectively. At all BMI levels, the sex-specific prevalence of hypertension was higher in Indonesian adults than in Chinese and Vietnamese adults (P < 0.05 at almost all BMI levels). The overall and stratified analyses suggested optimal BMI cutoffs of 23-24, 21-22.5, and 20.5-21 for Chinese, Indonesian, and Vietnamese adults, respectively. The cutoffs were approximately 0.5-1.0 units higher in women than in men and in the older (41-65 y) than in the younger (18-40 y) participants. CONCLUSIONS The study showed an ethnic difference in the BMI-hypertension association and in optimal BMI cutoffs between Chinese, Indonesian, and Vietnamese adults. Country-specific or even country-, sex-, and age-specific BMI cutoffs might be needed to identify persons at high risk of cardiovascular diseases.
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Affiliation(s)
- Tuan T Nguyen
- Department of Nutrition, University of North Carolina at Chapel Hill, NC 27516-3997, USA
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Pakenham-Walsh N, Bukachi F. Information needs of health care workers in developing countries: a literature review with a focus on Africa. HUMAN RESOURCES FOR HEALTH 2009; 7:30. [PMID: 19356239 PMCID: PMC2680393 DOI: 10.1186/1478-4491-7-30] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 04/08/2009] [Indexed: 05/15/2023]
Abstract
Health care workers in developing countries continue to lack access to basic, practical information to enable them to deliver safe, effective care. This paper provides the first phase of a broader literature review of the information and learning needs of health care providers in developing countries. A Medline search revealed 1762 papers, of which 149 were identified as potentially relevant to the review. Thirty-five of these were found to be highly relevant. Eight of the 35 studies looked at information needs as perceived by health workers, patients and family/community members; 14 studies assessed the knowledge of health workers; and 8 looked at health care practice. The studies suggest a gross lack of knowledge about the basics on how to diagnose and manage common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous health care practices. If this level of knowledge and practice is representative, as it appears to be, it indicates that modern medicine, even at a basic level, has largely failed the majority of the world's population. The information and learning needs of family caregivers and primary and district health workers have been ignored for too long. Improving the availability and use of relevant, reliable health care information has enormous potential to radically improve health care worldwide.
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Affiliation(s)
| | - Frederick Bukachi
- Global Healthcare Information Network, Charlbury, Oxford, UK
- Department of Medical Physiology, University of Nairobi, Nairobi, Kenya
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Bovet P, Gervasoni JP, Mkamba M, Balampama M, Lengeler C, Paccaud F. Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study. BMC Public Health 2008; 8:407. [PMID: 19087300 PMCID: PMC2615777 DOI: 10.1186/1471-2458-8-407] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 12/16/2008] [Indexed: 01/09/2023] Open
Abstract
Background Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management. Methods A population-based survey of 9254 persons aged 25–64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP ≥ 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval. Results Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care. Conclusion Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.
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Affiliation(s)
- Pascal Bovet
- University Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and University of Lausanne, rue du Bugnon 17, 1005 Lausanne, Switzerland.
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