Primary Health Care for Hypertension by Nurses in Rural and Urban Sub‐Saharan Africa

Abstract

To implement a nurse-led protocol for the care of hypertension, 5 clinics were established in Yaounde (urban) and Bafut (rural) in Cameroon. International guidelines were adapted and 10 nurses were trained. The initial cohort of patients was referred from a field survey. The program proceeded for 26 months and 454 patients (45% urban) were registered in the clinics. Relative to urban participants, rural participants were more often women (59% vs 45%, P=.002) and less likely to have diabetes (7.2% vs 41.2%, P<.001). Between baseline and final visits, systolic and diastolic blood pressures dropped by 11.7 mm Hg (95% confidence interval, 8.9-14.4) and 7.8 (95% confidence interval, 5.9-9.6), respectively (P<.001). These changes were consistent in subgroups and after adjustment. Most dropouts occurred around the initial visit and among urban participants and nondiabetics. Nurse-led clinics are effective for improving hypertension care in these settings and require implementation and validation through controlled trials. J Clin Hypertens (Greenwich). 2009;11:564-572. 1 In the year 2000, 12.8% of the total global deaths and 4.4% of the total global disability-adjusted lifeyears were attributable to systolic BP (SBP) levels >115 mm Hg.2 The global population of individuals with hypertension was 972 millions in 2000, and is expected to increase to 60% by 2025.3 By then, 71.2 to 76.0 million men and 75.0 to 79.1 million women with hypertension will be found in sub-Saharan Africa (SSA). This will represent a nearly 50% increase relative to recent estimates. The prevalence of hypertension among adults in SSA varies consistently and has increased significantly over the past 2 to 3 decades. 4 Literature survey indicates that related complications and in particular stroke and heart failure are also becoming increasingly more common in this region.5-7 Decades of research into prevention and control have convincingly demonstrated that sustained BP lowering significantly reduces the risk of BP-related complications.8 Guidelines have been developed and are regularly updated to assist the translation of the scientific evidence into actions that will ultimately reduce the burden of hypertension. The uptake of these

Cardiovascular risk factors among the inhabitants of an urban Congolese community: results of the VITARAA Study

“…Traditionally, favorable lipid profiles are reported in populations of African descent which, together with less exposure to smoking, explain lower risk of coronary artery disease in comparison to Caucasians [31]. Unhealthy diet and changes in culinary usages in the urban environment tend to alter the lipid profile towards less safer patterns.…”

“…Nonetheless, our findings highlight the staggering elevated prevalence of cardiovascular risk factors and underscore the pressing need for preventive measures in sub-Saharan Africa, where cardiovascular complications due to limited curative resources run at a high death rate. For management of risk factors in the low resources African context, contribution of nurses [31] and or non-physician clinicians [32] should be highly encouraged. In line with the EUROASPIRE findings [33] prevention by informing the population about a healthy lifestyle, at this stage, is the mostly feasible way forward, because information and health education can be provided at little cost.…”

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

“…However, while linkage to care is known to be a challenge, both in Kenya 9 and elsewhere in sub-Saharan Africa, [10][11][12] specific factors influencing linkage to hypertension care have not been identified in this population.…”

Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria

“…In SSA, nurse-led care programs have been successfully implemented for chronic infectious diseases [18], and chronic non-infectious conditions such as epilepsy, asthma, diabetes, and HTN in primary care settings [19,20]. However, in spite of the huge burden of stroke in SSA, nurse-led clinics have not been tested for impact through controlled trials [21].…”