Screening for diabetes and hypertension in a rural low income setting in western Kenya utilizing home-based and community-based strategies

Pastakia, Sonak D.; Ali, S; Kamano, Jemima H.; Akwanalo, Constantine; Ndege, Samson; Buckwalter, Victor; Vedanthan, Rajesh; Bloomfield, Gerald S.

doi:10.1186/1744-8603-9-21

Cited by 64 publications

(89 citation statements)

References 21 publications

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“…Low numbers of individuals utilizing healthcare providers after community and home-based screening events was also observed in other sub-Saharan African settings [15–18]. Some of the reasons for this low attendance include individual (e.g.…”

Section: Discussionmentioning

confidence: 82%

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Nelissen

Okwor

Khalidson³

et al. 2018

Global Health Action

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Background: In Lagos, Nigeria, approximately 33% of the population suffers from hypertension, yet antihypertensive treatment coverage is low. To improve access to care, a decentralized pharmacy-based hypertension care model was piloted. This study reports on the recruitment strategies used and is part of a larger study to evaluate the feasibility of the care model. Objective: To describe our experience executing three different strategies to recruit hypertensive patients in the program: community hypertension screenings, hospital and pharmacy referral. Methods: Individuals with elevated blood pressure and no history of cardiovascular disease were referred to the program’s recruitment days to see a medical doctor for hypertension diagnosis and enrollment. Individuals were referred from community screenings, tertiary hospital outpatient clinics, and pharmacies participating in the program. For the community screenings, we report the number needed to screen (NNS) to find one individual with elevated blood pressure, the NNS to enroll one individual in the program, and factors associated with enrollment in the program among participants referred. Results: We recruited 226 individuals (69%) in the program via the pharmacies, 97 (30%) via the community screenings, and 2 (<1%) via hospital referral. At the community screenings 3,204 individuals participated, 729 (23%) had elevated blood pressure and 618 (85%) were eligible for referral of whom 142 (23%) visited the recruitment days, and 97 (16%) enrolled. The NNS to find one individual with elevated blood pressure was 5, and the NNS to enroll one individual was 34. Enrollment in the program was associated with advancing age, blood pressure ≥160/100 and currently using antihypertensive medication. Conclusions: Despite the potential attractiveness of community screenings to identify and refer individuals with hypertension, enrollment in the program was low. For future programs we recommend pharmacy referral as individuals seem more inclined to access care through healthcare providers they are familiar with.

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Section: Discussionmentioning

confidence: 82%

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Nelissen

Okwor

Khalidson³

et al. 2018

Global Health Action

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“…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.…”

Section: Introductionmentioning

confidence: 94%

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

et al. 2016

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BACKGROUND: Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low-and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known. OBJECTIVE: To evaluate factors influencing linkage to hypertension care in rural western Kenya. DESIGN: Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior. PARTICIPANTS: Mabaraza (traditional community assembly) participants (n=242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers (n=169). APPROACH: We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics. KEY RESULTS: We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. CONCLUSIONS: Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other lowresource settings worldwide. INTRODUCTIONCardiovascular disease is the leading cause of mortality worldwide, with 80 % of cardiovascular deaths occurring in lowand middle-income countries (LMICs). 1 Hypertension, a major risk factor for cardiovascular disease, 2 is the leading global risk for mortality. 3 Over the next decade, the global cost of suboptimal blood pressure may approach $1 trillion. 4 Unless it is adequately controlled, hypertension will continue to be responsible for significant morbidity and mortality worldwide. 5 In many LMICs, however, the rates of hypertension treatment and control are low. 6 In Kenya, hypertension treatment and control rates have been reported at 9 % and 3 %, respectively. 7 Poor linkage to hypertension care, manifested as delays in seeking care after screening and referral, has been shown to be associated with increased mortality among pre...

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“…21−23 One study in Western Kenya reported a prevalence of 8% in a neighbouring rural population. 24 Dyslipidaemia is an abnormal lipid profile that is evidenced by any or all of the four (elevated levels of total plasma cholesterol, low-density lipoprotein cholesterol, triglycerides and reduced levels of high-density lipoprotein cholesterol). 25−29 Through atherosclerosis, dyslipidaemia is a well-documented risk factor for CVD.…”

Section: Introductionmentioning

confidence: 99%

Multiple cardiovascular disease risk factors in rural Kenya: evidence from a health and demographic surveillance system using the WHO STEP-wise approach to chronic disease risk factor surveillance

Chege

2016

South African Family Practice

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Results:The mean age was 44 years and 57% were female. The distribution of BMI was: mean = 20 kg/m 2 (range 24-36); 18.5-25 kg/m 2 = 57%;< 18.5 kg/m 2 = 35%. Distribution of blood pressure levels: Normal in 40%; pre-hypertensive 40%; hypertension stages 1 and 2 was 13% and 8% respectively. Nearly all affected were unaware of their elevated blood pressure. Impaired fasting glucose was found in 4.5% while 6.5% were diabetic. Fasting serum lipid profile was normal in over 85% of the population. Conclusions: This rural population had low BMI with 92% having a BMI below 25 kg/m 2 and about 20% of them being in hypertension stage 1 and 2 and nearly all unaware of it. Despite the majority having below normal BMI, it was noted that rates of hypertension increased with increasing BMI. There was significant presence of dysglycaemia but not dyslipidaemia.

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Screening for diabetes and hypertension in a rural low income setting in western Kenya utilizing home-based and community-based strategies

Cited by 64 publications

References 21 publications

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

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

Multiple cardiovascular disease risk factors in rural Kenya: evidence from a health and demographic surveillance system using the WHO STEP-wise approach to chronic disease risk factor surveillance

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