Prevalence of Hypertension in the Middle Belt of Ghana: A Community-Based Screening Study

Undiagnosed and uncontrolled hypertension in rural African adults: a scoping review protocol of primary health care interventions

INTRODUCTION

Non-communicable diseases cause 74% of global deaths, with cardiovascular diseases as the major contributor. Hypertension, a primary risk factor for cardiovascular disease, is highly prevalent in Africa. Diagnosis, treatment and control rates are notably limited in rural areas. This limitation results in increased risks of premature mortality and complications such as stroke due to socioeconomic, cultural and geographical challenges. Progress in African countries enhancing hypertension services through primary health care interventions exists. However, a comprehensive review of all primary health care interventions addressing undiagnosed and uncontrolled hypertension in rural African settings is lacking. This scoping review aims to categorise primary health care interventions targeting undiagnosed and uncontrolled hypertension in rural African adults. Intervention components will be mapped to the four stages outlined in the hypertension care cascade to develop a pilot intervention logic model for rural African adults with hypertension.

METHOD AND ANALYSIS

The scoping review protocol will adhere to the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Studies considered for inclusion will include any intervention delivered by any healthcare provider in a rural African primary care setting targeting any stage of hypertension care. Eight databases will be searched without date restrictions, supplemented by grey literature and reference list searches. A two-stage screening process (title/abstract and full text) will determine evidence source eligibility. All eligible sources of evidence will be extracted, charted and evaluated using the Template for Intervention Description and Replication checklist. A pilot logic model categorising and mapping interventions to the four stages of the hypertension care cascade will be visually presented and analysed using narrative synthesis.

ETHICS AND DISSEMINATION

No primary data will be collected; therefore, ethics approval is not required. Findings will be disseminated to local health authorities in Ghana and other African Regions and through national and international conferences and publications in peer-reviewed journals.

Estimating the Lifetime Cost of Managing Hypertension in Ghana: A Modelling Study

Introduction

Over the last decade, hypertension (HPT) is among the leading causes of death and morbidity in Ghana. In recent past, most health policy research in Ghana and Africa focussed on communicable diseases. In recent times, Ghana and other developing nations have shifted their attention to non-communicable diseases because most of these countries are going through an epidemiologic transition where there is a surge in the prevalence of HPT. This paper was therefore set out to estimate the cost of treating HPT in Ghana from the patients' and health system's perspectives.

Method

We used a cost of illness framework to simulate the cost of HPT management in Ghana taking into account 4 of the common target organ complications with the most mortality implication. A decision analytic model (DAM) was developed in Microsoft® Excel to simulate the progression of HPT patients and the Markov model was employed in simulating the lifetime cost of illness.

Results

The results show that by 10 years from diagnosis, the probability of death from any of the 4 complications (ie, stroke, myocardial infarction, heart failure, and chronic kidney disease) is roughly 41.03%. By 20 years (or 243 months) from diagnosis, the probability of death is estimated to be 69.61%. However, by the 30th anniversary, the probability of death among the cohort is 82.3%. Also, the lifetime discounted cost of treating HPT is about GHS 869 106 which could range between GHS 570 239 and GHS 1.202 million if wide uncertainty is taken into account. This is equivalent to USD 119 056 (range: USD 78 115-164 723).

Conclusion

By highlighting the lifetime cost of treating HPT in Ghana, policies can be formulated regarding the cost of treating HPT by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health.

Prevalence and risk factors of hypertension among public servants in Ejisu-Juaben municipality, Ghana

OBJECTIVES

We determined the prevalence and risk factors of hypertension among public servants of Ejisu Juaben municipality.

RESULTS

The overall prevalence of hypertension was 29.3% (95%CI:22.5-36.1%) and only 8.6% of the participants were aware of their hypertensive status. Respondents who were > 40 years were twice as likely to develop hypertension compared to those who were ≤ 40 years [adjusted odds ratio (AOR) = 2.37, 95% confidence interval (CI) 1.05-5.32]. Those who were married were 2.54 times more likely to be hypertensive compared with those unmarried [AOR = 2.54, 95%CI: 1.06-6.08]. Compared to health workers, Judicial and Security service workers were almost five times more likely to be hypertensive [AOR = 4.77, 95%CI: 1.20-18.96]. Being overweight [AOR = 2.25, 95%CI: 1.06-6.41] and obese [AOR = 4.80, 95%CI: 1.82-12.91] was associated with increased odds of hypertension. The prevalence of hypertension among the participants in this study is high. Employee wellness programs are needed at workplaces and the Ghana Health Service must adopt targeted intervention programs such as regular screening for non-communicable diseases and promotion of physical activities at the workplace.

Joint modelling of systolic and diastolic blood pressure and its associated factors among women in Ghana: Multivariate response multilevel modelling methods

Elevated blood pressure is the leading cause of cardiovascular diseases related mortality and a major contributor to non-communicable diseases globally, especially in sub-Saharan Africa where about 74.7 million people live with hypertension. In Ghana, hypertension is epidemic with prevalence of over 30% and experiencing continuing burden with its associated morbidity and mortality. Using the 2014 Ghana Demographic and Health Survey, we analyzed data on 4744 women aged 15-49 years residing in 3722 households. We employed univariate and multivariate response multilevel linear regression models to analyze predictors of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Geospatial maps were produced to show the regional distribution of hypertension prevalence in Ghana. Stata version 17 and R version 4.2.1 were used to analyze the data. Of the 4744 woman, 337 (7.1%) and 484 (10.2%) were found to be hypertensive on SBP and DBP, respectively. A combined prevalence of 12.3% was found. Older ages 25-34 (OR 2.45, 95%CI: 1.27, 3.63), 35-44 (OR 8.72, 95%CI: 7.43, 10.01), 45-49 (OR 15.85, 95%CI: 14.07, 17.64), being obese (OR 5.10, 95%CI: 3.62, 6.58), and having no education (OR -2.05, 95%CI: -3.40, -0.71) were associated with SBP. For DBP, we found the associated factors to be older ages 25-34 (OR 3.29, 95%CI: 2.50, 4.08), 35-44 (OR 6.78, 95%CI: 5.91, 7.64), 45-49 (OR 10.05, 95%CI: 8.85, 11.25), being obese (OR 4.20, 95%CI: 3.21, 5.19), and having no education (OR -1.23, 95%CI: -2.14, -0.33). Substantial residual household level differences in SBP (15%) and DBP (14%) were observed. We found strong residual correlation of SBP and DBP on individual women (r = 0.73) and household-level (r = 0.81). The geospatial maps showed substantial regional differences in the observed and reported hypertension prevalence. Interventions should be targeted at the identified high-risk groups like older age groups and those who are obese, and the high-risk regions.

Predictors of Nonadherence to Medications among Hypertensive Patients in Ghana: An Application of the Health Belief Model

Introduction. Hypertension (HPT) is recognized as a significant public health problem worldwide from a health and economic perspective. This study determined predictors of nonadherence to HPT medications in Ghana using the health belief model. Methods. A cross-sectional descriptive survey employing a quantitative approach was conducted among HPT patients who routinely attend clinics at selected hospitals in the Brong Ahafo region of Ghana. Respondents (n = 399) were recruited using a multistage sampling technique. Results. The prevalence of nonadherence was 63.7% (n = 254). Nonadherence to hypertension medication was associated with lower education status ( $p=0.009$ ). In logistic regression analysis, patients with high “perceived susceptibility” and “perceived severity” were more likely to forfeit their HPT medication schedules, while patients with high “perceived barriers” and “cues to action” were less likely to skip their medication. Conclusion. The present study suggests a plausible path to improving medication adherence in this population. Given the high prevalence of nonadherence, policymakers need to urgently design tailor-made health promotion interventions to ensure optimal health outcomes.

Prevalence and Associated Factors of Hypertension among Women in Southern Ghana: Evidence from 2014 GDHS

Background

Hypertension, coupled with prehypertension and other hazards such as high blood pressure, is responsible for 8·5 million deaths from stroke, ischaemic heart disease, other vascular diseases, and renal disease worldwide. Hypertension is the fifth commonest cause of outpatient morbidity in Ghana. Some evidence have illustrated geographical variation in hypertension and it seems to have a heavy toll on women in southern Ghana compared to the north. This study seeks to determine the prevalence and associatedfactors of hypertension among women in southern Ghana using the most recent demographic and health survey (DHS) data set.

Materials and Methods

This study used data of 5,662 women from the current DHS data from Ghana that was conducted in 2014. Data were extracted from the women's file of the 2014 Ghana DHS. The outcome variable of this current study was hypertension and it was measured by blood pressure, according to guidelines of the Joint National Committee Seven (JNC7). Multivariable binary logistic regression analyses were performed to establish the factors associated with hypertension at the individual and community levels.

Results

Prevalence of hypertension among women in southern Ghana was 16%. Women aged 40–44 years (aOR = 8.04, CI = 4.88–13.25) and 45–49 years (aOR = 13.20, CI = 7.96–21.89] had the highest odds of hypertension relative to women aged 15–19 years. Women with two births (aOR = 1.45, CI = 1.01–2.07) and those with three births (aOR = 1.47, CI = 1.01–2.15) had a higher likelihood of being hypertensive. Greater Accra women had higher odds (aOR = 1.35, CI = 1.02–1.79) of being hypertensive relative to the reference category, women from the Western region. Women of Guan ethnicity had a lesser likelihood (aOR = 0.54, CI = 0.29–0.98) of being hypertensive. Women who engaged in agriculture had the least likelihood (aOR = 0.72, CI = 0.52–0.99) of being classified hypertensive compared to unemployed women.

Conclusion

This study has revealed the prevalence of hypertension among women in southern Ghana. The associated factors include age, parity, region, and occupation. As a result, existing interventions need to be appraised in the light of these factors. Of essence is the need for Ghana Health Service to implement wide-embracing health promotion initiatives that accommodate the nutritional, exercise, and lifestyle needs of women in southern Ghana. Having more children is associated with higher propensity of hypertension and consequently, women need to limit childbearing to reduce their chances of being hypertensive. It will also be advisable for women in the Greater Accra region to have frequent hypertension screening, as women in the region exhibited higher hypertension prospects.

Screening of hypertension, risks, knowledge/awareness in second-cycle schools in Ghana. A national cross-sectional study among students aged 12-22

In Ghana, the management of hypertension in primary health care is a cost-effective way of addressing premature deaths from vascular disorders that include hypertension. There is little or no evidence of large-scale studies on the prevalence, risk, and knowledge/awareness of hypertension in students aged 12-22 years in Ghana. In a cross-sectional study, blood pressure, anthropometric indices, and knowledge/awareness assessment of students at second-cycle schools were recorded from 2018 to 2020 in three regions of Ghana. Multistage cluster sampling was used in selecting regions and the schools. Prevalence of prehypertension and hypertension was categorized by the Joint National Committee 7, where appropriate, chi-square, scatter plots, and correlations were used in showing associations. A total of 3165 students comprising 1776 (56.1%) females and 1389 (43.9%) males participated in this study within three regions of Ghana. The minimum age was 12 years and the maximum age was 22 years. The mean age was 17.21 with standard deviation (SD: 1.59) years. A 95% confidence interval was set for estimations and a P value < 0.05 was set as significant. The prevalence rate of overall hypertension was 19.91% and elevated (prehypertension) was 26.07%. Risk indicators such as weight, BMI, waist circumference, physical activity, and form of the diet were positively correlated with hypertension. Among Ghanaian students currently in second-cycle educational institutions, 19.91% were hypertensive and 26.07% were prehypertensive. This may indicate a probable high prevalence of hypertension in the future adult population if measures are not taken to curb the associated risks.

Prevalence of Hypertension in Ghana: Analysis of an Awareness and Screening Campaign in 2019

Introduction:

Hypertension is an important public health menace globally and in sub-Saharan Africa. The prevalence of hypertension is on the rise in low- and lower-middle-income countries (LMIC) such as Ghana. This rise led to the adoption of the May Measurement Month (MMM) initiative, a global blood pressure screening campaign. We aimed to create awareness and present the findings of the 2019 MMM screening campaign in the Ashanti region of Ghana.

Methods:

Ghana was 1 of 92 countries that participated in this global community-based cross-sectional study in May 2019. Participants (⩾18 years) were recruited by opportunistic sampling. The blood pressures of participants were measured 3 times and the mean of the last 2 was used for the analysis. Summary statistics were used to describe the data. Simple and multiple logistic regression models were used to determine the predictors of hypertension.

Results:

We screened 3080 participants with a mean age of 39.8 ± 16.8 years. The prevalence of hypertension was 27.3% among participants. Two-thirds of the hypertensives were unaware of their condition and only 49.5% of participants with a history of hypertension on medication were controlled. Predictors of hypertension in a multiple logistic regression were increasing age (OR = 1.05 (CI 1.04-1.06), P < .001) and high body mass index (OR = 1.06 (1.02-1.10), P = .005).

Conclusion:

The MMM initiative is highly commendable and of huge public health importance in LMICs like Ghana. Population-based health programs such as the MMM initiative is encouraged to shape appropriate public health policies to reduce the prevalence of hypertension.

Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data

BACKGROUND

Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana.

METHODS AND FINDINGS

We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated.

CONCLUSIONS

We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra.

Prevalence of hypertension in Ghanaian society: a systematic review, meta-analysis, and GRADE assessment

BACKGROUND

Hypertension has become an important public health concern in the developing world owing to rising prevalence and its adverse impact on ailing health systems. Despite being a modifiable risk factor for cardiovascular disease, hypertension has not received the needed attention in Ghana as a result of various competing interests for scarce health resources. This systematic review and meta-analysis provides a comprehensive and updated summary of the literature on the prevalence of hypertension in Ghana.

METHODS

Major databases such as MEDLINE, EMBASE, and Google Scholar and local thesis repositories were accessed to identify population-based studies on hypertension among Ghanaians. Data extracted from retrieved reports were screened independently by two reviewers. The quality of eligible studies was evaluated and reported. A reliable pooled estimate of hypertension prevalence was calculated utilizing a random-effects model and reported according to the GRADE framework. Additionally, a meta-regression analysis was performed to analyze the contribution of study-level variables to variance in hypertension prevalence.

RESULTS

In general, a total of 45,470 subjects (n = 22,866 males and 22,604 females) were enrolled from urban (n = 12), rural (n = 8), and mixed populations (n = 7). Blood pressure (BP) was measured across studies according to a validated and clinically approved protocol by trained field workers or healthcare workers including nurses and physicians. A combined total of 30,033 participants across twenty studies reporting on the population prevalence of hypertension were pooled with 10,625 (35.4%) identified to satisfy study criteria for elevated BP. The pooled prevalence across 24 studies was 30.3% (95% CI 26.1-34.8%) after fitting a random effects model. Prevalence of hypertension was 30.1% (95% CI 25.6-36.0%) among females and 34.0% (95% CI 28.5-40.0%) among males. Significant differences in pooled estimates across regions emerged from subgroup comparisons of regional estimates with an increasing trend in the north-to-south direction and with increasing age. Compared to rural settings, the burden of hypertension in urban populations was significantly higher. Age structure and population type accounted for 65.0% of the observed heterogeneity in hypertension estimates.

CONCLUSIONS

The prevalence of hypertension in Ghana is still high. The gap in hypertension prevalence between rural and urban populations is closing especially in elderly populations. These findings must claim the attention of public health authorities in Ghana to explore opportunities to reduce rural hypertension.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this review has been published previously with PROSPERO ( CRD42020215829 ).

Blood Pressure Control, Accessibility, and Adherence to Antihypertensive Medications: Patients Seeking Care in Two Hospitals in the Ashanti Region of Ghana

Hypertension is the second leading cause of death in Ghana, partly accounting for two-thirds of all medical admissions and more than 50% of deaths. This study aimed to comparatively evaluate adherence and accessibility to antihypertensive medications at two different levels of healthcare facilities in Kumasi, Ghana, and determine factors associated with medicine accessibility and adherence. A cross-sectional study involving outpatient department (OPD) hypertensive patients, 143 at KNUST Hospital (UHS) and 342 at Komfo Anokye Teaching Hospital (KATH), was conducted using a semistructured questionnaire. Correlations were drawn to evaluate the effect of accessibility and adherence on blood pressure control. A face-to-face interview was also conducted with relevant stakeholders involved in procurement of medicines. Blood pressure was uncontrolled in 50.4% (n = 72) of participants at UHS and 52.9% (n = 181) at KATH. With respect to medicine accessibility, 98.8% (n = 338) and 42.9% (n = 61) received at least one medication from the hospital pharmacy of KATH and UHS, respectively. Using MARS-10, 49.2% (n = 70) and 52.9% (n = 181) were nonadherent in UHS and KATH, respectively. There was a significant association between adherence and BP control at both UHS (p=0.038) and KATH (p=0.043). At UHS, there was a significant association between accessibility to medicines at the hospital and BP control (p=0.031), whilst at KATH, no significant association was observed (p=0.198). Supply chain practices and delays in payment by the NHIA affected accessibility to antihypertensive medications. Blood pressure control was inadequate among participants in both facilities. Accessibility to medicines was better at the tertiary facility compared to the secondary facility. Increased accessibility and adherence to antihypertensives were related to blood pressure control in both facilities. Good supply chain practices and prompt payment by the National Health Insurance Authority would enhance accessibility to antihypertensive medications.

Epidemiology of hypertension in selected towns of Wollega zones, Western Ethiopia, 2019: A community-based cross-sectional study

Introduction:

Hypertension remains an emerging public health problem globally, particularly in developing countries. Age, income level, obesity, alcohol consumption, smoking, vegetables and fruit consumption, physical activity and chat chewing were some risk factors of hypertension. However, there are limited data on the epidemiology of hypertension in Ethiopia. This study aimed to assess Epidemiology of Hypertension among the community of selected towns of Wollega zones.

Methods:

A community-based cross-sectional study was conducted from 1 to 30 June 2019 in selected towns of Wollega zones. A multistage sampling technique was used to select 840 study participants. Data were collected using the WHO STEP wise approach. The data were coded and entered into EpiData 3, and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regression analyses were conducted. Statistical significance was declared at p-value < 0.05.

Results:

The study included a total of 838 respondents with a response rate of 99.7%. The prevalence of hypertension was found to be 189 (22.6%) (95% confidence interval = 19.9%–25.2%). Of this, 108 (12.9%) and 81 (9.7%) of female and male were hypertensive, respectively. Age groups of 30–44 years (adjusted odds ratio = 2.65 (1.43, 4.89)), 45–59 years (adjusted odds ratio = 3.55 (1.79, 7.04)), above 60 years (adjusted odds ratio = 2.97 (1.43, 6.18)), having history of alcohol consumption (adjusted odds ratio = 4.29 (2.4, 7.66)), involving in vigorous physical activity (adjusted odds ratio = 0.096 (0.028, 0.33)), not walking to and from the work (adjusted odds ratio = 13.12 (8.34, 20.67)), being overweight (adjusted odds ratio = 1.98 (1.21, 3.25)), inadequate fruits serving per day (adjusted odds ratio = 2.93 (1.75, 4.88)) were significantly associated with hypertension.

Conclusion:

The prevalence of hypertension was found to be high in the study area. Older age, alcohol consumption, not engaging in vigorous activity, physical inactivity, being overweight and inadequate intake of fruits were found to be risk factors for hypertension. Therefore, health care providers should provide extensive health education and promotion on recommended lifestyle modification to tackle the burden of hypertension.

Challenges experienced by patients with hypertension in Ghana: A qualitative inquiry

BACKGROUND

Hypertension (HPT) is an essential public health problem affecting both lower and middle-income countries disproportionately. Evidence suggests that HPT is the leading risk factor for cardiovascular diseases and chronic kidney disease. Yet, challenges faced by patients with HPT in Ghana are not sufficiently explored. This study, documents the challenges patients with HPT face in Ghana.

METHODS

We used an explorative descriptive qualitative design. Face-to-face in-depth interviews were conducted with 15 patients with HPT. Interviews were recorded and transcribed verbatim. A thematic content analysis procedure was followed to analyse the data.

RESULTS

Four main themes emerged from interviews; three of which pertained to dimensions of challenges and a fourth which pertained to coping strategies. These include: [1] impairment in physical activities and mobility constraints [2]. Psychological challenges such as suicidal ideations, sadness, fear, anxiety, and reduced sexual affection [3]. Socio-economic challenges identified include loss of friends and social network, difficulty in job demands, and financial burden, and [4] coping strategies such as health system support, social support, and religiosity were identified.

CONCLUSION

Patients with HPT experience an array of challenges. We suggest that health care facilities incorporate post HPT diagnosis counseling sessions for HPT patients in the study area. Also, the National Health Insurance Authority (NHIA) should re-examine their scope of services; thus, drugs, laboratory services, and electrocardiogram services to avoid the issue of co-payment. Collaboration between healthcare professionals and family relations of patients with HPT ought to also be strengthened to ensure optimal care.

Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis

BACKGROUND

Hypertension is a major health problem in Ghana, being a leading cause of admissions and deaths in the country. In the context of a changing food and health policy environment, we undertook a systematic review (PROSPERO registration number: CRD42020177174) and a meta-analysis of the prevalence of adult hypertension, and its awareness and control in Ghana.

METHODS

We searched major databases including PubMed, Embase as well as Google Scholar and online digital collections of public universities of Ghana to locate relevant published and unpublished community-based articles up till April 2020.

FINDINGS

Eighty-five articles involving 82,045 apparently-healthy subjects aged 15-100 years were analyzed. In individual studies, the prevalence of hypertension, defined in most cases as blood pressure ≥ 140/90 mmHg, ranged from 2.8% to 67.5%. The pooled prevalence from the meta-analysis was 27.0% (95% CI 24.0%-30.0%), being twice as high in the coastal (28%, 95% CI: 24.0%-31.0%) and middle geo-ecological belts (29%, 95% CI: 25.0%-33.0%) as in the northern belt (13%, 95% CI: 7.0%-21.0%). The prevalence was similar by sex, urban-rural residence or peer-review status of the included studies. It did not appear to vary over the study year period 1976-2019. Of the subjects with hypertension, only 35% (95% CI: 29.0%-41.0%) were aware of it, 22% (95% CI: 16.0%-29.0%) were on treatment and 6.0% (95% CI: 3.0%-10.0%) had their blood pressure controlled. Sensitivity analyses corroborated the robust estimates. There was, however, high heterogeneity (I2 = 98.7%) across the studies which was partly explained by prevalent obesity in the subjects.

CONCLUSION

More than one in four adults in Ghana have hypertension. This high prevalence has persisted for decades and is similar in rural and urban populations. With the low awareness and poor control of hypertension, greater investments in cardiovascular health are required if Ghana is to meet the global target for hypertension.

Alcohol consumption and fruits and vegetable intake among older adults in Ghana: a cross-sectional survey based on WHO-SAGE Wave 2 data

BACKGROUND

Alcohol consumption and inadequate fruits and vegetable (FnV) intake are major reasons for the shift from communicable to non-communicable diseases (NCDs) over the years. The older Ghanaian adult is at high risk of NCD and data on alcohol and FnV consumption are required to guide policy to mitigate its effect. This analysis aimed to determine the factors associated with alcohol consumption and assess the relationship between alcohol consumption and FnV intake among Ghanaians aged 50 years and older.

METHODS

This analysis used WHO Study on Global Ageing and Adult Health (SAGE) Wave 2, Ghana data set conducted between 2014 and 2015. Data on demographic characteristics, FnV intake, and alcohol consumption were collated and analysed. Multivariable Poisson, logistic and probit regression analyses were performed to assess the associations between alcohol consumption and inadequate FnV intake.

RESULTS

A total of 3533 Ghanaians aged 50 years and older, 41.0% men and 59.0% women, were included in this study. The prevalence of lifetime alcohol consumption was 22.8% (95% CI 20.7% to 25.1%). Alcohol consumption was significantly associated with sex, age group, marital status, religion, place of residence and history of smoking. The prevalence of adequate FnV intake was 52.6% with a mean daily intake of 6.45 servings: 2.98 for fruits and 3.47 for vegetables. There was a significant positive correlation between inadequate FnV intake and alcohol consumption. Inadequate FnV consumption was significantly higher among lifetime alcohol consumers compared with non-alcohol consumers. (Poisson estimate; adjusted Prevalence Ratio (aPR) (95% CI)=1.35 (1.12 to 1.63), logistic estimate; adjusted Old Ratio (aOR) (95% CI)=1.13 (1.05 to 1.21) and probit estimate; adjusted normalized coefficient (aβ) (95% CI)=0.19 (0.07 to 0.31)).

CONCLUSION

About a quarter and nearly half of older Ghanaian adults consume alcohol and inadequate FnV, respectively. Alcohol consumption is significantly associated with inadequate FnV intake. Interventions to address inadequate FnV intake among older adults in Ghana should also include policies that regulate the use of alcohol in this population.

Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial

BACKGROUND

Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana.

METHODS

Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana.

DISCUSSION

Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the "how to do it" empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03490695 . Registered on 6 April 2018.

PROTOCOL VERSION AND DATE

Version 1, date: 21 August, 2019.