Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa

Abstract

BackgroundIn West Africa, hypertension, once rare, has now emerged as a critical health concern and the trajectory is upward and factors are complex. The true magnitude of hypertension in some West African countries, including in-depth knowledge of underlying risk factors is not completely understood. There is also a paucity of research on adequate systems-level approaches designed to mitigate the growing burden of hypertension in the region.AimsIn this review, we thematically synthesize available literature pertaining to the prevalence of hypertension in West Africa and discuss factors that influence its diagnosis, treatment and control. We aimed to address the social and structural determinants influencing hypertension in the sub-region including the effects of urbanization, health infrastructure and healthcare workforce.FindingsThe prevalence of hypertension in West Africa has increased over the past decade and is rising rapidly with an urban-rural gradient that places higher hypertension prevalence on urban settings compared to rural settings. Overall levels of awareness of one’s hypertension status remain consistently low in West African. Structural and economic determinants related to conditions of poverty such as insufficient finances have a direct impact on adherence to prescribed antihypertensive medications. Urbanization contributes to the increasing incidence of hypertension in the sub-region and available evidence indicates that inadequate health infrastructure may act as a barrier to optimal hypertension control in West Africa.ConclusionGiven that optimal hypertension control in West Africa depends on multiple factors that go beyond simply modifying the behaviors of the individuals alone, we conclude by discussing the potential role systems-thinking approaches can play to achieve optimal control in the sub-region. In the context of recent advances in hypertension management including new therapeutic options and innovative solutions to expand health workforce so as to meet the high demand for healthcare, the success of these strategies will rely on a new understanding of the complexity of human behaviors and interactions most aptly framed from a systems-thinking perspective.

Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study

“…Financial constraints are known to discourage initiation of care. [31][32][33] This factor is not limited to LMICs; lack of health insurance, lack of medication coverage, and higher costs are strong predictors of missing appointments among hypertensive patients in the United States. 27,34 In addition, poor adherence to antihypertensive medications has been associated with unaffordable drug prices.…”

Results from implementing updated 2012 World Health Organization Guidance on early-warning indicators of HIV drug resistance in Zimbabwe

“…[21] In Ethiopia community-based organizations have provided the vital link in improving patient retention in care within HIV care settings from 77% in 2004 to 92% in 2012 with minimum resources. [22] This may also assist in improving the performance of this indicator in Zimbabwe. Being part of a support group enables a patient to have a treatment supporting partner who would then help enhance adherence to treatment.…”

Several Conventional Risk Markers Suggesting Presence of Albuminuria Are Weak Among Rural Africans With Hypertension

“…Thus, we speculate whether the rural vs urban difference in living conditions and lifestyle could modify the effect of some of the conventional risk markers for albuminuria in rural SSA. A recent review suggested that living in an urban SSA environment caused more physical and psychic stress in general than living in a rural setting . It is a possibility that ongoing exposure to physical and psychic stress could aggravate the chronic endothelial inflammation usually found in patients with hypertension.…”

“…A recent review suggested that living in an urban SSA environment caused more physical and psychic stress in general than living in a rural setting. 13 It is a possibility that ongoing exposure to physical and psychic stress could aggravate the chronic endothelial inflammation usually found in patients with hypertension. HbA 1c level >53 mmol/mol corresponding to suboptimal or poor glycemic control was strongly associated with albuminuria.…”