Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study.
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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.
Published Version (Please cite this version)10.1136/bmjopen-2017-018829
Publication InfoGalson, SW; Hertz, JT; Karia, Francis; Kilonzo, K; Lunyera, Joseph; Patel, Uptal Dinesh; ... Staton, Catherine Ann (2017). Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study. BMJ Open, 7(11). pp. e018829. 10.1136/bmjopen-2017-018829. Retrieved from http://hdl.handle.net/10161/15851.
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I am an in-training physician-scientist with expertise in clinical epidemiology and health policy. My life-long desire is to advance our understanding of etiologic mechanisms of kidney disease, and to advocate for policies that promote the highest quality care for individuals with kidney disease. Specifically, I am interested in delineating mechanisms by which socio-environmental exposures might increase risk for adverse kidney outcomes such as chronic kidney disease and acute kidney injury
Adjunct Professor in the Department of Medicine
Uptal Patel, MD is an Adjunct Professor interested in population health with a broad range of clinical and research experience. As an adult and pediatric nephrologist with training in health services and epidemiology, his work seeks to improve population health for patients with kidney diseases through improvements in prevention, diagnosis and treatment. Prior efforts focused on four inter-related areas that are essential to improving kidney health: i) reducing the progressi
Adjunct Assistant Professor of Medicine
John W. Stanifer, MD, MSc-GH, is a nephrologist and clinical researcher with a focus on using translational and trans-disciplinary methods to uncover mechanisms of global health disparities in kidney disease. John completed his residency training in internal medicine and global health at Duke, completing the Master of Science in Global Health program in 2014. He also completed his sub-specialty training in nephrology at Duke, and during that time, he also completed a fellowship in c
Assistant Professor of Surgery
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