L Mbau1, R Harrison2, W Kizito2, C Timire3, T Namusonge4, S Muhula5, L Nyanjau6, P Owiti3. 1. Kenya Cardiac Society, Nairobi, Kenya. 2. Medecins Sans Frontieres, Brussels, Belgium. 3. International Union Against Tuberculosis and Lung Disease, Paris, France. 4. Canadian Red Cross, Ottawa, ON, Canada. 5. Amref Health Africa in Kenya, Nairobi, Kenya. 6. Ministry of Health, Nairobi, Kenya.
Abstract
BACKGROUND: Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya. DESIGN: This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included. RESULTS: Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control. CONCLUSIONS: The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.
BACKGROUND: Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya. DESIGN: This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included. RESULTS: Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control. CONCLUSIONS: The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.
Authors: Clara K Chow; Koon K Teo; Sumathy Rangarajan; Shofiqul Islam; Rajeev Gupta; Alvaro Avezum; Ahmad Bahonar; Jephat Chifamba; Gilles Dagenais; Rafael Diaz; Khawar Kazmi; Fernando Lanas; Li Wei; Patricio Lopez-Jaramillo; Lu Fanghong; Noor Hassim Ismail; Thandi Puoane; Annika Rosengren; Andrzej Szuba; Ahmet Temizhan; Andy Wielgosz; Rita Yusuf; Afzalhussein Yusufali; Martin McKee; Lisheng Liu; Prem Mony; Salim Yusuf Journal: JAMA Date: 2013-09-04 Impact factor: 56.272
Authors: Dena Ettehad; Connor A Emdin; Amit Kiran; Simon G Anderson; Thomas Callender; Jonathan Emberson; John Chalmers; Anthony Rodgers; Kazem Rahimi Journal: Lancet Date: 2015-12-24 Impact factor: 79.321
Authors: Shukri F Mohamed; Martin K Mutua; Richard Wamai; Frederick Wekesah; Tilahun Haregu; Pamela Juma; Loise Nyanjau; Catherine Kyobutungi; Elijah Ogola Journal: BMC Public Health Date: 2018-11-07 Impact factor: 3.295