Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study

Abstract

IntroductionSub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood. Therefore, we undertook a community-based mixed-methods study in Tanzania to investigate the epidemiology of hypertension and barriers to care.MethodsIn Northern Tanzania, between December 2013 and June 2015, we conducted a mixed-methods study, including a cross-sectional household epidemiological survey and qualitative sessions of focus groups and in-depth interviews. For the survey, we assessed for hypertension, defined as a single blood pressure ≥160/100 mm Hg, a two-time average of ≥140/90 mm Hg or current use of antihypertensive medications. To investigate relationships with potential risk factors, we used adjusted generalised linear models. Uncontrolled hypertension was defined as a two-time average measurement of ≥160/100 mm Hg irrespective of treatment status. Hypertension awareness was defined as a self-reported disease history in a participant with confirmed hypertension. To explore barriers to care, we identified emerging themes using an inductive approach within the framework method.ResultsWe enrolled 481 adults (median age 45 years) from 346 households, including 123 men (25.6%) and 358 women (74.4%). Overall, the prevalence of hypertension was 28.0% (95% CI 19.4% to 38.7%), which was independently associated with age >60 years (prevalence risk ratio (PRR) 4.68; 95% CI 2.25 to 9.74) and alcohol use (PRR 1.72; 95% CI 1.15 to 2.58). Traditional medicine use was inversely associated with hypertension (PRR 0.37; 95% CI 0.26 to 0.54). Nearly half (48.3%) of the participants were aware of their disease, but almost all (95.3%) had uncontrolled hypertension. In the qualitative sessions, we identified barriers to optimal care, including poor point-of-care communication, poor understanding of hypertension and structural barriers such as long wait times and undertrained providers.ConclusionsIn Northern Tanzania, the burden of hypertensive disease is substantial, and optimal hypertension control is rare. Transdisciplinary strategies sensitive to local practices should be explored to facilitate early diagnosis and sustained care delivery.

Prevalence and associated factors of hypertension among adults in Gadarif in eastern Sudan: a community-based study

“…Interestingly, a much higher prevalence (49.1%) of hypertension was reported among 513 adults in a rural setting in Madagascar [12]. Conversely, a lower rate (28.0%) of hypertension was reported in Tanzania [13] and in a population-based sectional study that enrolled 67,397 participants in Ethiopia (31.9%) [24]. In neighbouring Ethiopia, while a low rate (10.5%) of hypertension was reported in a hospital-based study [8], a prevalence rate of 34.7% for hypertension was reported in the capital, Addis Ababa [10].…”

“…Because of our study design (controlled for age), it might not be valid to compare our results (age and hypertension) with the results of the large study that was recently conducted in four states (Khartoum, Gezira, Blue Nile and Kassala) in Sudan [15]. Several studies have shown that an older age is significantly associated with hypertension in neighbouring countries, including Ethiopia [8,9,11], Tanzania [13] and Madagascar [12]. Similarly, a recent metaanalysis including 43,025 older adults (> 53 years) in 15 African countries showed that an older age is independently associated with hypertension [25].…”

“…The epidemiology of hypertension (prevalence and associated risk factors) has been extensively investigated in many African countries, e.g., Ethiopia [9,10], Tanzania [13], Uganda [14] and Madagascar [12], but little published data exist on the epidemiology of hypertension in Sudan [6,7,15]; in addition, there are no published data on the prevalence of and risk factors for hypertension in Eastern Sudan. The current study was conducted to investigate the prevalence and associated factors of hypertension in Gadarif in Eastern Sudan.…”

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

“…This study was conducted in the ED at Kilimanjaro Christian Medical Center (KCMC), a tertiary care center in Moshi, Tanzania. In 2014, the local prevalence of hypertension and diabetes was estimated to be 28% and 6%, respectively [10,29]. KCMC has multiple electrocardiogram (ECG) machines, and the laboratory can perform laboratory-based assays for troponin I and troponin T. KCMC has capacity for thrombolytic therapy, but does not presently have capacity for cardiac catheterization or stress testing.…”

Epidemiology and comorbidity of arterial hypertension and gallstone disease

“…В Южной Америке в кросс-секционном национальном исследовании в Бразилии (2018) распространенность АГ составила 32,3% (95% ДИ 31,7-33,0) [26]. Распространенность АГ в Африке в Танзании (2017) составляла 28,0% [27]. Распространенность АГ была самой низкой в сельской Индии (3,4% у мужчин и 6,8% у женщин) [28].…”