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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2024:10.1038/s41371-024-00913-6. [PMID: 38698111 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Wattanapisit A, Lapmanee S, Chaovalit S, Lektip C, Chotsiri P. Prevalence of physical activity counseling in primary care: A systematic review and meta-analysis. Health Promot Perspect 2023; 13:254-266. [PMID: 38235006 PMCID: PMC10790122 DOI: 10.34172/hpp.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/20/2023] [Indexed: 01/19/2024] Open
Abstract
Background This systematic review aimed to summarize and evaluate the prevalence of physical activity (PA) counseling in primary care. Methods Five databases (CINAHL Complete, Embase, Medline, PsycInfo, and Web of Science) were searched. Primary epidemiological studies on PA counseling in primary care were included. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to assess the quality of studies. The review protocol was registered with PROSPERO (CRD42021284570). Results After duplicate removal, 4990 articles were screened, and 120 full-text articles were then assessed. Forty studies were included, with quality assessment scores ranging from 5/9 to 9/9. The pooled prevalence of PA counseling based on 35 studies (199830 participants) was 37.9% (95% CI 31.2 to 44.6). The subgroup analyses showed that the prevalence of PA counseling was 33.1% (95% CI: 22.6 to 43.7) in females (10 studies), 32.1% (95% CI: 22.6 to 41.7) in males (10 studies), 65.5% (95% CI: 5.70 to 74.1) in people with diabetes mellitus (6 studies), 41.6% (95% CI: 34.9 to 48.3) in people with hypertension (5 studies), and 56.8% (95% CI: 31.7 to 82.0) in people with overweight or obesity (5 studies). All meta-analyses showed high levels of heterogeneity (I2=93% to 100%). Conclusion The overall prevalence of PA counseling in primary care was low. The high levels of heterogeneity suggest variability in the perspectives and practices of PA counseling in primary care. PA counseling should be standardized to ensure its optimum effectiveness in primary care.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Sarawut Lapmanee
- Department of Basic Medical Sciences, Faculty of Medicine, Siam University, Bangkok, Thailand
| | - Sirawee Chaovalit
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Charupa Lektip
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Palang Chotsiri
- Department of Clinical Pharmacology, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Ishigami J, Charleston J, Miller ER, Matsushita K, Appel LJ, Brady TM. Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med 2023; 183:1061-1068. [PMID: 37548984 PMCID: PMC10407761 DOI: 10.1001/jamainternmed.2023.3264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/07/2023] [Indexed: 08/08/2023]
Abstract
Importance Clinical practice guidelines recommend selecting an appropriately sized cuff based on mid-arm circumference prior to measuring blood pressure (BP). To our knowledge, the effect of miscuffing on BP measurement when using an automated BP device has not been quantified. Objective To determine the effect of using a regular BP cuff vs an appropriately sized BP cuff on automated BP readings. Design, Setting, and Participants This randomized crossover trial of community-dwelling adults with a wide range of mid-arm circumferences took place between March 16 and October 25, 2021, in Baltimore, Maryland. Participants were recruited via BP screening events at a public food market and a senior housing facility, targeted mailings to prior research participants, placement of study brochures in hypertension clinics at Johns Hopkins University, and referrals from physicians providing hypertension care to adults. Interventions Participants underwent 4 sets of triplicate BP measurements, with the initial 3 sets using an appropriate, too-small, or too-large BP cuff in random order; the fourth set of triplicate measurements was always completed with an appropriate BP cuff. Main Outcomes and Measures The primary outcome was the difference in mean BP when measured with a regular BP cuff compared with an appropriate BP cuff. The secondary outcome was the difference in BP when using too-small or too-large BP cuffs vs an appropriate BP cuff across all cuff sizes. Results were also stratified by systolic BP (≥130 mm Hg vs <130 mm Hg) and body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30 vs <30). Results A total of 195 adults (mean [SD] age, 54 [16] years; 67 [34%] male; 132 [68%] Black; 100 [51%] with hypertension) were randomized for inclusion. Among individuals requiring a small BP cuff, use of a regular BP cuff resulted in a statistically significant lower BP reading (mean systolic BP difference, -3.6 [95% CI, -5.6 to -1.7] mm Hg). In contrast, among individuals requiring a large or extra-large BP cuff, use of a regular BP cuff resulted in a statistically significant higher BP reading (mean systolic BP difference, 4.8 [95% CI, 3.0-6.6] mm Hg and 19.5 [95% CI, 16.1-22.9] mm Hg, respectively). For the secondary outcome, BP differences with overcuffing and undercuffing by 1 and 2 cuff sizes were greater among those requiring larger BP cuffs. The results were consistent in stratified analyses by systolic BP and body mass index. Conclusions and Relevance In this randomized crossover trial, miscuffing resulted in strikingly inaccurate BP measurements. This is particularly concerning for settings where 1 regular BP cuff size is routinely used in all individuals, regardless of arm size. A renewed emphasis on individualized BP cuff selection is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT04610775.
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Affiliation(s)
- Junichi Ishigami
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne Charleston
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Edgar R. Miller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J. Appel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tammy M. Brady
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Edward A, Kalyesubula R, Pariyo G, Kyazze AP, Hu X, Appel LJ, Matsushita K. Self-paced online learning to improve knowledge competencies for hypertension among medical students in Uganda: A pre-post study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001609. [PMID: 37459296 PMCID: PMC10351720 DOI: 10.1371/journal.pgph.0001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
The growing burden of hypertension (HT) is projected to reach 1.56 billion globally by 2025 and is an increasing public health concern, even for low- and middle-income countries (LMIC) like Uganda, where the prevalence of HT is 31.5%. The objective of this study was to test the effectiveness of a freely available HT online course on knowledge competencies for medical students in Uganda. The online course was developed by a multidisciplinary team at Johns Hopkins University to address HT control in resource-constrained healthcare settings. Students in the 3rd, 4th, and 5th years of medical school were randomly selected to participate in the online course. Pre and post knowledge tests were administered using an online survey system. Of the 201 invited students, 121 (60.2%) completed the study. Significant improvements in mean knowledge scores were evident following the online course completion for Module 1, Fundamentals of HT (21.9±2.5 to 23.7±2.5, p<0.001), and Module 2, Basics of HT Management (14.9±3.3 to 18.5±4.3, p<0.001). No statistically significant differences were evident by gender or school year. Students who took a shorter duration to complete the course had significantly higher mean score improvement between pre- and post-test (mean score improvement 7.0 if <4 weeks, 3.6 if 4-8 weeks, and 3.7 if >8 weeks, p<0.003). Students recognized information on blood pressure measurement (32.2%) and HT management (22.3%) as the most important concept addressed in the course. A self-paced online course, complementing medical school training, improved knowledge on HT burden and management in Uganda.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Robert Kalyesubula
- Departments of Medicine and Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew Peter Kyazze
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Xiao Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lawrence J. Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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5
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Galson SW, Pesambili M, Vissoci JRN, Manavalan P, Hertz JT, Temu G, Staton CA, Stanifer JW. Hypertension in an Emergency Department Population in Moshi, Tanzania; A Qualitative Study of Barriers to Hypertension Control. PLoS One 2023; 18:e0279377. [PMID: 36608026 PMCID: PMC9821488 DOI: 10.1371/journal.pone.0279377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa has a high prevalence of hypertension with a low rate of awareness, treatment adherence, and control. The emergency department (ED) may represent a unique opportunity to improve hypertension screening, awareness, and linkage to care. We conducted a qualitative study among hypertensive patients presenting to the ED and their healthcare providers to determine barriers to hypertension care and control. METHODS In northern Tanzania, between November and December 2017, we conducted three focus group discussions among patients with hypertension presenting to the emergency department and three in-depth interviews among emergency department physicians. In our study, hypertension was defined as a single blood pressure of ≥160/100 mm Hg or a two-time average of ≥140/90 mm Hg. Barriers to care were identified by thematic analysis applying an inductive approach within the framework method. RESULTS We enrolled 24 total patients into three focus groups and performed three in-depth interviews with individual providers. Thematic analysis identified two major domains: 1) patient knowledge, attitudes, and practices, and 2) structural barriers to hypertension care. Four major themes emerged within the knowledge, attitudes, and practices domain, including disease chronicity, provider communication, family support, and fear-based attitudes. Within the structural domain, several themes emerged that identified barriers that impeded hypertension follow-up care and self-management, including cost, access to care, and transportation and wait time. CONCLUSION Patients and physicians identified multiple barriers and facilitators to hypertension care. These perspectives may be helpful to design emergency department-based interventions that target blood pressure control and linkage to outpatient care.
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Affiliation(s)
- Sophie W. Galson
- Duke Emergency Medicine, Duke Global Health Institute, Durham, NC, United States of America
- * E-mail:
| | | | | | - Preeti Manavalan
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Julian T. Hertz
- Duke Emergency Medicine, Duke Global Health Institute, Durham, NC, United States of America
| | - Gloria Temu
- Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania
| | - Catherine A. Staton
- Duke University Medical Center, Duke Global Health Institute, Durham, NC, United States of America
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Umamah F, Santoso B, Yunitasari E, Nisa F, Wulandari Y. The effectiveness of psycho-educational counseling in pregnant women with preeclampsia: A systematic review. J Public Health Res 2022; 11:22799036221104161. [PMID: 35911429 PMCID: PMC9335477 DOI: 10.1177/22799036221104161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/20/2022] [Indexed: 11/15/2022] Open
Abstract
Pre-eclampsia is one of the main causes of maternal mortality, premature birth and low birth weight in developing countries. In addition, this condition can lead to chronic diseases (including cardiovascular and renal diseases) in postpartum mothers. The purpose of this study was to review the effectiveness of psycho-educational counseling in pregnant women with preeclampsia. The methods of this study were using PRISMA guidelines, databases from Scopus, PubMed and ScienceDirect, were published 2016 until 2020, yielded 65 articles. The keywords were retrieved from Medical Subject Heading (Mesh). The results showed interventions were given during the treatment period ranges from cognitive-behavioral counseling group that received four 1.5-h counseling sessions and the solution-focused counseling that received three 1.5-h counseling sessions, which were held weekly. This systematic review concludes that improving prenatal empowerment and self-care enable mothers to experience fewer complications in this period of their life. Thus, psycho-educational provides an excellent opportunity for educating and counseling pregnant women to promote maternal and neonatal health and psychological well-being.
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Affiliation(s)
- Faridah Umamah
- Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia.,Faculty of Nursing and Midwifery Universitas NU Surabaya, Surabaya, East Java, Indonesia
| | - Budi Santoso
- Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Esti Yunitasari
- Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Fauziyatun Nisa
- Faculty of Nursing and Midwifery Universitas NU Surabaya, Surabaya, East Java, Indonesia
| | - Yuanita Wulandari
- Faculty of Health Science, Muhammadiyah University of Surabaya, Surabaya, East Java, Indonesia
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Edward A, Kagaruki GB, Manase F, Appel LJ, Matsushita K. Effectiveness of instructional videos for enhancing healthcare provider competencies for hypertension management - a pre-post study in primary healthcare settings, Tanzania. BMC Health Serv Res 2022; 22:721. [PMID: 35641952 PMCID: PMC9153873 DOI: 10.1186/s12913-022-08064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Inadequate adherence to hypertension (HT) clinical standards by healthcare providers is one of the major barriers for HT management. We examined the effectiveness of four short instructional training videos on HT management. Methods Eighteen primary health care facilities were randomly selected using systematic sampling from five districts in the Dar es Salaam region, Tanzania. Pre-post provider knowledge assessments were conducted six months after training and provider performance was measured using patient observations on 8-10 consecutive adult patients per facility. A Screening Quality Index (SQI), comprised of ten HT screening standards, was used to measure adherence. Results Pre-post knowledge scores improved significantly, for, time between blood pressure (BP) readings (28.1% to 72.7%, p=0.01), BP threshold for patients with complications (21.2% to 97.0%, p<0.001), and lifestyle/dietary counseling (from 36.4% to 97.0%, p<0.001). SQI was significantly higher following the training for all provider groups; Nurses (3.0±3.5 to 8.4±1.0, p<0.001), Assistant Medical Officers and Medical Officers (3.5±4.1 to 7.6±2.4, p<0.001), and Assistant Clinical Officers and Clinical Officers (5.4±3.8 to 8.4±2.0, p<0.001). After training, significantly higher adherence was evident for key aspects of managing patients with HT: e.g., counseling on medication (62.1% to 92.7%, p=0.002), side effects (41.4% to 56.1%, p=0.009), reducing caloric intake (69.0 % to 95.1%, p=0.003), reducing cooking salt (65.5% to 97.6%, p<0.01), increasing physical activity (55.2% to 92.7% p<0.001), stopping/reducing cigarette smoking (24.1% to 63.4%, p=0.001), and reducing alcohol consumption (24.1% to 68.3%, p<0.001). SQI was significantly associated with number of years of provider experience (more than 2 years), type of primary healthcare facility (public facility), and exposure to the training intervention. Conclusion Training with short instructional videos can improve provider competency and clinical performance for HT management. The strategy has the potential to enhance effective implementation of HT control strategies in primary care clinics in Tanzania and elsewhere.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, USA.
| | - Gibson B Kagaruki
- National Institute for Medical Research, Tukuyu Medical Research Centre, Moshi, Tanzania.,Department of Epidemiology & Biostatistics, Institute of Public Health, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Afrique One ASPIRE via Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Moshi, Tanzania
| | - Frank Manase
- Community Center for Preventive Medicine, Dar es Salaam, Tanzania
| | - Lawrence J Appel
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Johns Hopkins School of Medicine, Baltimore, USA.,Johns Hopkins School of Nursing, Baltimore, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Stieglitz LM, Bärnighausen T, Leyna GH, Kazonda P, Killewo J, Rohr JK, Kohler S. Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221076254. [PMID: 35586032 PMCID: PMC9106316 DOI: 10.1177/26335565221076254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/04/2021] [Indexed: 12/11/2022]
Abstract
Background Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania. Methods We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional survey that was conducted within the Dar es Salaam Urban Cohort Study (DUCS) from June 2017 to July 2018. Diagnoses of chronic conditions were based on body measurements, weight, blood testing, screening instruments, and self-report. Results The five most prevalent chronic conditions and most common comorbidities were hypertension (49.8%, 95% CI 47.2 to 52.3), obesity (39.9%, 95% CI 37.3 to 42.4), anemia (36.9%, 95% CI 33.3 to 40.5), signs of depression (32.5%, 95% CI 30.2 to 34.9), and diabetes (30.9%, 95% CI 27.6 to 34.2). The estimated prevalence of multimorbidity (2+ chronic conditions) was 73.8% (95% CI 71.2 to 76.3). Women aged 70 years or older were 4.1 (95% CI 1.5 to 10.9) times mores likely to be affected by multimorbidity and had 0.7 (95% CI 0.3 to 1.2) more chronic conditions than women aged 40 to 44 years. Worse childhood health, being widowed, not working, and higher food insecurity in the household were also associated with a higher multimorbidity risk and level. Conclusion A high prevalence of multimorbidity in the general population of middle-aged and elderly women suggests substantial need for multimorbidity care in Tanzania. Comorbidity patterns can guide multimorbidity screening and help identify health care and prevention needs.
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Affiliation(s)
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Germana H. Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia K. Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Miselli MA, Cavallin F, Marwa S, Ndunguru B, Itambu RJ, Mutalemwa K, Rizzi M, Ciccarelli G, Conte S, Taddei S, Azzimonti G, Putoto G, Torelli GF. An Integrated Management System for Noncommunicable Diseases Program Implementation in a Sub-Saharan Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11619. [PMID: 34770132 PMCID: PMC8583607 DOI: 10.3390/ijerph182111619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022]
Abstract
Morbidity and mortality due to noncommunicable diseases (NCDs) are growing exponentially across Tanzania. The limited availability of dedicated services and the disparity between rural and urban areas represent key factors for the increased burden of NCDs in the country. From March 2019, an integrated management system was started in the Iringa District Council. The system implements an integrated management of hypertension and diabetes between the hospital and the peripheral health centers and introduces the use of paper-based treatment cards. The aim of the study was to present the results of the first 6 months' roll-out of the system, which included 542 patients. Data showed that 46.1% of patients returned for the reassessment visit (±1 month), more than 98.4% of patients had blood pressure measured and were checked for complication, more than 88.6% of patients had blood sugar tested during follow-up visit, and blood pressure was at target in 42.8% of patients with hypertension and blood sugar in 37.3% of diabetic patients. Most patients who were lost to follow-up or did not reach the targets were those without medical insurance or living in remote peripheries. Our findings suggest that integrated management systems connecting primary health facilities and referral hospitals may be useful in care and follow-up of patients with hypertension and diabetes.
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Affiliation(s)
- Maria Agata Miselli
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | | | - Samwel Marwa
- District Medical Office, Iringa District Council, Iringa P.O. Box 162, Tanzania; (S.M.); (B.N.)
| | - Bruno Ndunguru
- District Medical Office, Iringa District Council, Iringa P.O. Box 162, Tanzania; (S.M.); (B.N.)
| | - Rehema John Itambu
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Katunzi Mutalemwa
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Monica Rizzi
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Giulia Ciccarelli
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Simone Conte
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Stefano Taddei
- Department of Internal Medicine, University of Pisa, 56122 Pisa, Italy;
| | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | | | - Giovanni Fernando Torelli
- Doctors with Africa CUAMM, Dar es Salaam P.O. Box 23447, Tanzania
- Department of Hematology, Oncology and Dermatology, Policlinico Umberto 1, 00161 Rome, Italy
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10
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Brady TM, Charleston J, Ishigami J, Miller ER, Matsushita K, Appel LJ. Effects of Different Rest Period Durations Prior to Blood Pressure Measurement: The Best Rest Trial. Hypertension 2021; 78:1511-1519. [PMID: 34601959 DOI: 10.1161/hypertensionaha.121.17496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.)
| | - Jeanne Charleston
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Junichi Ishigami
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Edgar R Miller
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.).,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Kunihiro Matsushita
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.).,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Lawrence J Appel
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.).,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
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11
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Edward A, Campbell B, Manase F, Appel LJ. Patient and healthcare provider perspectives on adherence with antihypertensive medications: an exploratory qualitative study in Tanzania. BMC Health Serv Res 2021; 21:834. [PMID: 34407820 PMCID: PMC8371775 DOI: 10.1186/s12913-021-06858-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023] Open
Abstract
Background Poor medication adherence is an extraordinarily common problem worldwide that contributes to inadequate control of many chronic diseases, including Hypertension (HT). Globally, less than 14% of the estimated 1.4 billion patients with HT achieve optimal control. A myriad of barriers, across patient, healthcare provider, and system levels, contributes to poor medication adherence. Few studies have explored the reasons for poor medication adherence in Tanzania and other African countries. Methods A qualitative study applying grounded theory principles was conducted in the catchment area of two semi-urban clinics in Dar es Salaam, Tanzania, to determine the perceived barriers to HT medication adherence. Ten key informant interviews were conducted with healthcare providers who manage HT patients. Patients diagnosed with HT (SBP ≥ 140 and DBP ≥ 90), were randomly selected from patient registers, and nine focus group discussions were conducted with a total 34 patients. Inductive codes were developed separately for the two groups, prior to analyzing key thematic ideas with smaller sub-categories. Results Affordability of antihypertensive medication and access to care emerged as the most important barriers. Fee subsidies for treatment and medication, along with health insurance, were mentioned as potential solutions to enhance access and adherence. Patient education and quality of physician counseling were mentioned by both providers and patients as major barriers to medication adherence, as most patients were unaware of their HT and often took medications only when symptomatic. Use of local herbal medicines was mentioned as an alternative to medications, as they were inexpensive, available, and culturally acceptable. Patient recommendations for improving adherence included community-based distribution of refills, SMS text reminders, and family support. Reliance on religious leaders over healthcare providers emerged as a potential means to promote adherence in some discussions. Conclusions Effective management of hypertensive patients for medication adherence will require several context-specific measures. These include policy measures addressing financial access, with medication subsidies for the poor and accessible distribution systems for medication refill; physician measures to improve health provider counseling for patient centric care; and patient-level strategies with reminders for medication adherence in low resource settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06858-7.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins University, Baltimore, USA.
| | - Brady Campbell
- University of Iowa Carver College of Medicine, Iowa City, USA
| | - Frank Manase
- Community Center for Preventive Medicine, Dar es Salaam, Tanzania
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.,Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, MD, USA
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