Evaluating the cascade of care for hypertension in Sierra Leone

Abstract

Objective To assess the care for hypertension in Sierra Leone, by the use of a cascade‐of‐care approach, to identify where the need for healthcare system interventions is greatest. Methods Using data from a nationwide household survey on surgical conditions undertaken in 1956 participants ≥18 years from October 2019 to March 2020, a cascade of care for hypertension consisting of four categories – hypertensive population, those diagnosed, those treated and those controlled – was constructed. Hypertension was defined as having a blood pressure ≥140/90 mmHg, or self‐reported use of antihypertensive medication. Logistic regression analysis was used to investigate factors associated with undiagnosed hypertension. Results The prevalence of hypertension was 22%. Among those with hypertension, 23% were diagnosed, 11% were treated and 5% had controlled blood pressure. The largest loss to care (77%) was between being hypertensive and receiving a diagnosis. Male sex, age and living in a rural location, were significantly associated with the odds of undiagnosed hypertension. There was no significant difference between men and women in the number of patients with controlled blood pressure. Adults aged 40 or older were observed to be better retained in care compared with those younger than 40 years of age. Conclusion There is a significant loss to care in the care cascade for hypertension in Sierra Leone. Our results suggest that increasing awareness of cardiovascular risk and risk factor screening for early diagnosis might have a large impact on hypertension care.

Prevalence and determinants of unmet needs for hypertension care among the older population in Selangor: cross-sectional study

“…A study of only low-and middleincome countries found that loss to care was highest at the diagnosis and control stages, with 61% loss and 66% loss, respectively [25]. Studies from Nigeria [26], Sierra Leone [27] and South Africa [11] also show that the greatest loss to care happens at the screening and diagnosis stages, and although the loss to care at the control stage was also high, it did not reach the level observed in the present study. Thus, the high level of loss to care at the control stage is a relatively unique characteristic of this study.…”

Burden of cardiometabolic risk factors and preclinical target organ damage among adults in Freetown, Sierra Leone: a community-based health-screening survey

“…The study design and age population of 25-65 years used in the STEPs survey make it difficult to compare with our study. In Sierra Leone, a much higher prevalence of hypertension (49.6%) was recently reported in a provincial district by Odland et al, while a lower rate of hypertension (22%) was reported by Geraedts et al when compared to this study [24,26]. The disparity may be attributed to the age differences of the studied cohorts (20 years and above in our study, unlike 40 years and above in the reported study by Orland et al [24]).…”

“…Additional information on the sensitivity and specificity of parameters related to target organ damage is shown in Supplementary Table 1. [22,24,26]. Therefore, our study has contributed critical evidence on the burden and distribution of CMRFs among adults living in an urban setting in SSA.…”

“…The study was designed to provide results that truly represent the adult population in Sierra Leone. A month before the awareness and screening campaign for non-communicable diseases, citizens within the Freetown municipality were informed about these activities by repeated mass This was followed by subdividing each constituent region into subzones using the 2015 census data [25], and subsequently, one of the sub-zonal communities was selected by simple random The sample size was calculated using the clinical estimated prevalence of 22% for hypertension in Sierra Leone [26]. The minimum sample size was assessed using the Leisle Kish formula [27]:…”

“…The copyright holder for this preprint this version posted February 23, 2023 [22,24,26]. Therefore, our study has contributed critical evidence on the burden and distribution of CMRFs among adults living in an urban setting in SSA.…”