Julian T Hertz1,2, Francis M Sakita3, Preeti Manavalan4, Deng B Madut4, Nathan M Thielman2, Blandina T Mmbaga5, Catherine A Staton1,2, Sophie W Galson1. 1. Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC. 2. Duke Global Health Institute, Duke University, Durham, NC. 3. Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania. 4. Department of Medicine, Duke University, Durham, NC. 5. Kilimanjaro Christian Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Abstract
Introduction: Little is known about the burden of hypertension and diabetes on emergency department (ED) utilization and hospitalizations in sub-Saharan Africa. Methods: A retrospective review of adult ED patients in northern Tanzania was performed from September 2017 through March 2018. Hypertension was defined as documented diagnosis of hypertension or blood pressure ≥ 140/90 mm Hg. Diabetes was defined as documented diagnosis of diabetes mellitus or random glucose ≥ 200 mg/dL. Results: Of 3961 adult ED patients, 1359 (34.3%) had hypertension, 518 (13.1%) had diabetes, and 273 (6.9%) had both. Both hypertension (OR 1.42, 95% CI 1.23-1.63, P<.001) and diabetes (OR 2.05, 95% CI 1.66-2.54, P<.001) were associated with increased odds of admission. Of 2418 hospital admissions, 694 (28.7%) were for complications of hypertension or diabetes. Of 499 patients admitted for hypertensive complications, the most common admission diagnoses were: heart failure (163 patients, 32.7%); stroke (147 patients, 29.5%); and severe hypertension (139 patients, 27.9%). Of 278 patients admitted for diabetic complications, the most common admission diagnoses were: hyperglycemia (158 patients, 56.9%); infection (60 patients, 21.6%); and stroke (28 patients, 10.1%). Conclusions: The burden of hypertension and diabetes in a Tanzanian ED is high, and the ED may serve as an opportune location for case identification and linkage-to-care interventions. Given the large proportion of Africans with undiagnosed hypertension and diabetes, an ED-based screening program would likely identify many new cases of these diseases. The high burden of hypertension- and diabetes-related hospitalizations highlights the urgent need for improvements in primary preventative care in Tanzania.
Introduction: Little is known about the burden of hypertension and diabetes on emergency department (ED) utilization and hospitalizations in sub-Saharan Africa. Methods: A retrospective review of adult ED patients in northern Tanzania was performed from September 2017 through March 2018. Hypertension was defined as documented diagnosis of hypertension or blood pressure ≥ 140/90 mm Hg. Diabetes was defined as documented diagnosis of diabetes mellitus or random glucose ≥ 200 mg/dL. Results: Of 3961 adult ED patients, 1359 (34.3%) had hypertension, 518 (13.1%) had diabetes, and 273 (6.9%) had both. Both hypertension (OR 1.42, 95% CI 1.23-1.63, P<.001) and diabetes (OR 2.05, 95% CI 1.66-2.54, P<.001) were associated with increased odds of admission. Of 2418 hospital admissions, 694 (28.7%) were for complications of hypertension or diabetes. Of 499 patients admitted for hypertensive complications, the most common admission diagnoses were: heart failure (163 patients, 32.7%); stroke (147 patients, 29.5%); and severe hypertension (139 patients, 27.9%). Of 278 patients admitted for diabetic complications, the most common admission diagnoses were: hyperglycemia (158 patients, 56.9%); infection (60 patients, 21.6%); and stroke (28 patients, 10.1%). Conclusions: The burden of hypertension and diabetes in a Tanzanian ED is high, and the ED may serve as an opportune location for case identification and linkage-to-care interventions. Given the large proportion of Africans with undiagnosed hypertension and diabetes, an ED-based screening program would likely identify many new cases of these diseases. The high burden of hypertension- and diabetes-related hospitalizations highlights the urgent need for improvements in primary preventative care in Tanzania.
Authors: Paul A James; Suzanne Oparil; Barry L Carter; William C Cushman; Cheryl Dennison-Himmelfarb; Joel Handler; Daniel T Lackland; Michael L LeFevre; Thomas D MacKenzie; Olugbenga Ogedegbe; Sidney C Smith; Laura P Svetkey; Sandra J Taler; Raymond R Townsend; Jackson T Wright; Andrew S Narva; Eduardo Ortiz Journal: JAMA Date: 2014-02-05 Impact factor: 56.272
Authors: Jean-René M'Buyamba-Kabangu; Rachel T Biswika; Lutgarde Thijs; Gilbert M Tshimanga; Francine M Ngalula; Tumba Disashi; Patrick K Kayembe; Tom Richart; Jean-René M'Buyamba-Kayamba; François B Lepira; Jan A Staessen Journal: Am J Hypertens Date: 2009-03-12 Impact factor: 2.689
Authors: Robert N Peck; Ethan Green; Jacob Mtabaji; Charles Majinge; Luke R Smart; Jennifer A Downs; Daniel W Fitzgerald Journal: J Hypertens Date: 2013-09 Impact factor: 4.844
Authors: Sihyoung Lee; Chang-Youn You; Joonghee Kim; You Hwan Jo; Young Sun Ro; Si-Hyuck Kang; Heeyoung Lee Journal: PLoS One Date: 2018-02-15 Impact factor: 3.240