Assessment of hypertension management in primary health care settings in Kinshasa, Democratic Republic of Congo

Abstract

BackgroundHypertension-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).MethodsA 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.ResultsFrom 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.ConclusionsThis 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 materialThe online version of this article (doi:10.1186/s12913-015-1236-y) contains supplementary material, which is available to authorized users.

Estratos de risco e qualidade do cuidado à pessoa idosa na Atenção Primária à Saúde

“…Even with different methods, which limit the comparison between the data obtained, other national and international studies also emphasized the incipience of the use of the clinical protocol of DM and hypertension recommended for the improvement of the assistance by physicians and nurses working in PHC 10 - 11 , 22 - 23 .…”

“…However, although there is a high degree of agreement on the best practices of prevention, diagnosis and treatment of DM and hypertension, as described in several clinical guidelines and protocols, the use of these practices is still incipient, especially when it refers to the implementation of actions according to risk stratification of the population addressed. This becomes a barrier to achieve better care results based on current scientific knowledge 8 - 11 .…”

Assessment of Follow-Up Care Received by Patients with Hypertension at Primary Health Care Facilities in Tshwane District of Gauteng Province, South Africa

“…There should be a remediation programme for professional nurses who have been trained but are found to be non-adherent to the guidelines. In a study conducted in Kinshasa, Congo, in which knowledge of consulting nurse's was assessed, 84% of the nurses reported to have received training [19]. The results suggest that training alone may not be enough, but continuous support and remedial actions may be necessary [19].…”

“…In a study conducted in Kinshasa, Congo, in which knowledge of consulting nurse's was assessed, 84% of the nurses reported to have received training [19]. The results suggest that training alone may not be enough, but continuous support and remedial actions may be necessary [19].…”

Assessment of Care Provision for Hypertension at Emergency Department of an Urban Hospital in Mozambique

“…Health System related factors impact on the capacity to control blood pressure control [20][21][22] In African countries Health Systems are primarily oriented to managing infectious diseases, and therefore health professionals are unprepared to deal with NCD, given the scarcity of resources in health facilities [23].. The strategy of task-shifting -defined as the rational distribution of health care duties from physicians to non-physicians health care providers -is one of the effective approaches that has been used to address lack of human resources in Africa [24], including for management of HTN [25,26]..…”