Hypertension, its correlates and differences in access to healthcare services by gender among rural Zambian residents: a cross-sectional study

Abstract

ObjectivesTo examine the prevalence of hypertension and access to related healthcare services among rural residents of Mumbwa district in Zambia.DesignCross-sectional study with probability cluster sampling.SettingRural Zambia.ParticipantsWe recruited 690 residents from Mumbwa district aged 25–64 years who had been living in the study area for ≥6 months and had adopted the lifestyle of the study area. Pregnant women and women who had given birth in the past 6 months were excluded. The data collection—questionnaire survey and anthropometric and biological measurements—was conducted between May and July 2016.ResultsIn the overall sample, 39.7% and 33.5% of the men and women had hypertension (systolic blood pressure (BP)≥140 or diastolic BP ≥90 mm Hg), respectively. Among the participants without a previous diagnosis of hypertension, 30.3% presented with hypertension at the time of measurement. In the multivariable analysis, alcohol intake and urban residence in men, and older age group, higher education and body mass index ≥25 kg/m2 in women were significantly associated with hypertension. Among the 21.8% who never had their BP measured, 83.8% were men; among these men, older age (adjusted OR (AOR), 0.43; 95% CI 0.25 to 0.73) and HIV positive status (AOR, 0.37; 95% CI 0.14 to 0.97) were negatively associated, while current smoker status (AOR, 2.09; 95% CI 1.19 to 3.66) was positively associated with the lack of BP measurements.ConclusionWe found that hypertension is prevalent in the target rural area. However, many were not aware of their hypertension status and many never had their BP measured, indicating a serious gap in cardiovascular disease prevention services in Zambia. There is an urgent need for health promotion and screening for hypertension, especially in the primary health services of rural Zambia. Issues related to healthcare accessibility in men require particular attention.

Awareness, treatment, and control among adults living with arterial hypertension or diabetes mellitus in two rural districts in Lesotho

“…With regards to this, our study found that participants with hypertension who were male, below 30 years, and lived in urban areas had lower odds of taking treatment or being controlled than women, elder age groups or those in rural areas. These ndings are consistent with regards to women and elder groups engaging in care better 37,[44][45][46] , however it is contrary to previous studies which have suggested that awareness and control tend to be higher in urban areas 47,48 .…”

Why is there a gap in self-rated health among people with hypertension? A decomposition of determinants and rural‒urban differences

“…Currently, health service utilization is not only concentrated among urban patients but also more effective in urban areas, thereby partially explaining the existing health gap between the two regions. The access gaps in rural areas may be attributed to weak healthcare systems, distance to facilities, staff shortages, etc., as revealed by other studies in Zambia (21) and in the region (98,99). Reducing health inequalities between urban and rural hypertensives entails addressing these system inadequacies and improving service utilization.…”

“…We then examine whether there is a rural-urban gap in the overall health of people with hypertension and quantify what factors drive this gap. While several studies have looked at inequalities in the burden of hypertension (13,21,22) and access to hypertension treatment (23)(24)(25)(26)(27), there are limited or no studies that have documented inequalities in overall health among individuals with hypertension and what could be driving such inequalitiesof which access to treatment could be one of the factors. Understanding systematic differences in health status among people with hypertension would help to highlight that even within people with the same disease condition, some are left behind and suffer more ill health.…”

“…We then examine whether there is a rural‒urban gap in the overall health of people with hypertension and quantify what factors drive this gap. While several studies have looked at inequalities in the burden of hypertension ( 13 , 21 , 22 ) and access to hypertension treatment ( 23 – 27 ), there are limited or no studies that have documented inequalities in overall health among individuals with hypertension and what could be driving such inequalities – of which access to treatment could be one of the factors.…”

Evaluating a multifaceted implementation strategy and package of evidence-based interventions based on WHO PEN for people living with HIV and cardiometabolic conditions in Lusaka, Zambia: protocol for the TASKPEN hybrid effectiveness-implementation stepped wedge cluster randomized trial

“…While screening, diagnosis, and treatment of cardiometabolic NCDs for PLHIV are recommended by national HIV guidelines, these services are generally unavailable or inconsistent in most ART and DSD clinics leading to low rates of NCD control [ 5 , 38 ]. Equipment for blood pressure measurement is often available in ART and DSD clinics, but hypertension screening is not normalized nor universal in such clinics.…”