Browsing by Subject "Non-communicable diseases"

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Open Access
Barriers and Facilitators for Including Village Health Workers (VHW) in Non-communicable Diseases (NCDs) Prevention and Control in Chi Linh District, Hai Duong Province, Vietnam
(2017) Long, Hongfei
The burden of non-communicable diseases (NCDs) continues to grow in Vietnam. Recently, Vietnam government initiated a new national plan with a strong focus on NCD prevention and control in the community. This study is intended to investigate the current role of Vietnamese village health workers (VHWs) in preventive and NCD-related care, and to explore the barriers and facilitators to expand the role by including routine community-based NCD prevention and control services. From June to July 2016, four focus group discussions with VHWs (n=24) and thirteen in-depth interviews (n=13) with public health administrators (n=13) were conducted in Chi Lin District, Hai Duong Province, Vietnam. A thematic analysis was conducted to identify themes in the data. The participants identified health education, program outreach, and case management as the current responsibilities of VHW. In NCD programs, VHWs provide these services mostly to hypertension and diabetes patients. Majority of the participants endorsed the idea of incorporating NCD early detection and risk reduction into VHW role and thought their close connection with community justified their strength in conducting these services. Currently perceived barriers included aging VHW, insufficient NCD-related knowledge, poor training quality, imbalanced workload and remuneration, lack of resource, and policy-driven guideline. While, participants believed that upon empowering through training, guidance, and proper incentive, VHWs would serve as effective NCD risk detector and healthy behavior promoter in their communities. The study indicates that, with interpersonal, organizational and policy support, VHWs may have the potential to conduct routine community-based NCD early detection and risk reduction activities in Vietnam.
Open Access
Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study.
(BMJ Open, 2017-11-09) Galson, Sophie W; Staton, Catherine A; Karia, Francis; Kilonzo, Kajiru; Lunyera, Joseph; Patel, Uptal D; Hertz, Julian T; Stanifer, John W
INTRODUCTION: Sub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood. Therefore, we undertook a community-based mixed-methods study in Tanzania to investigate the epidemiology of hypertension and barriers to care. METHODS: In Northern Tanzania, between December 2013 and June 2015, we conducted a mixed-methods study, including a cross-sectional household epidemiological survey and qualitative sessions of focus groups and in-depth interviews. For the survey, we assessed for hypertension, defined as a single blood pressure ≥160/100 mm Hg, a two-time average of ≥140/90 mm Hg or current use of antihypertensive medications. To investigate relationships with potential risk factors, we used adjusted generalised linear models. Uncontrolled hypertension was defined as a two-time average measurement of ≥160/100 mm Hg irrespective of treatment status. Hypertension awareness was defined as a self-reported disease history in a participant with confirmed hypertension. To explore barriers to care, we identified emerging themes using an inductive approach within the framework method. RESULTS: We enrolled 481 adults (median age 45 years) from 346 households, including 123 men (25.6%) and 358 women (74.4%). Overall, the prevalence of hypertension was 28.0% (95% CI 19.4% to 38.7%), which was independently associated with age >60 years (prevalence risk ratio (PRR) 4.68; 95% CI 2.25 to 9.74) and alcohol use (PRR 1.72; 95% CI 1.15 to 2.58). Traditional medicine use was inversely associated with hypertension (PRR 0.37; 95% CI 0.26 to 0.54). Nearly half (48.3%) of the participants were aware of their disease, but almost all (95.3%) had uncontrolled hypertension. In the qualitative sessions, we identified barriers to optimal care, including poor point-of-care communication, poor understanding of hypertension and structural barriers such as long wait times and undertrained providers. CONCLUSIONS: In Northern Tanzania, the burden of hypertensive disease is substantial, and optimal hypertension control is rare. Transdisciplinary strategies sensitive to local practices should be explored to facilitate early diagnosis and sustained care delivery.
Open Access
The Burden of Hypertension in the Emergency Department and Linkage to Care in Moshi, Tanzania; a Prospective Cohort Study
(2018) Galson, Sophie
Background: Globally, hypertension affects one billion people and disproportionately impacts the developing world. Sub-Saharan Africa has a high prevalence of hypertension with a low rate of awareness and compliance with treatment. The current model of community-based screening does not always ensure follow-up for treatment initiation. In high-income countries, emergency department (ED)-based screening has been successful at capturing undiagnosed/uncontrolled hypertension cases.
Methods: Between July 2017 and March 2018 we conducted a prospective cohort study of hypertensive patients in the emergency department of Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Adults patients with a triage blood pressure > 140/90 were recruited, completed a demographic and knowledge, attitudes and practices (KAP) survey and were followed for one month. Hypertension was defined as a single blood pressure ≥ 160/100 mmHg or a three-time average of ≥ 140/90 mmHg. Successful follow-up was defined as seeing a medical doctor within one month of the ED visit. Basic demographics were performed and to investigate relationships with potential risk factors and failure to follow-up, generalized linear models were used.
Results: We enrolled 595 adults (mean age 59.6) including 175 men (39.2%) and 271 women (60.7%). Of the 600 patients enrolled, 590 (99%) meet our definition for hypertension. Overall, the prevalence of hypertension was 10.3 % (95% CI 9.5,11.0) and 303 (56.2%) of participants failed to follow-up with a primary care physician within 1 month of the ED visit. Successful follow-up was independently associated with understanding that hypertension requires lifelong treatment (RR 1.11; 95% CI 1.03,1.21) and inversely associated with being worried about a future with hypertension (RR 0.80; 95% CI .64,1.00). The majority (78.6%) of the participants were aware of their disease, but many 223 (37.2%) had uncontrolled hypertension and 265 (44%) had evidence of end-organ damage.
Conclusion: The emergency department in Moshi Tanzania experiences a high burden of hypertensive patients, the majority of which fail to follow-up within one month of the ED visit. Multi-disciplinary strategies should be employed to improve linkage to care for high-risk patients from the emergency department.