Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study.

Galson, Sophie W

Staton, Catherine A

Karia, Francis

Kilonzo, Kajiru

Lunyera, Joseph

Patel, Uptal D

Hertz, Julian T

Stanifer, John W

England

2017-12-12T16:41:31Z

2017-12-12T16:41:31Z

2017-11-09

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.

https://www.ncbi.nlm.nih.gov/pubmed/29127232

bmjopen-2017-018829

2044-6055

https://hdl.handle.net/10161/15851

eng

BMJ

BMJ Open

10.1136/bmjopen-2017-018829

Health Disparities

Hypertension

Non-communicable diseases

Qualitative research

Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study.

Journal article

Galson, Sophie W|0000-0003-4709-6006

Staton, Catherine A|0000-0001-7061-5762|0000-0002-6468-2894

Lunyera, Joseph|0000-0002-9350-320X

Hertz, Julian T|0000-0002-7396-4789

Stanifer, John W|0000-0001-6379-300X

https://www.ncbi.nlm.nih.gov/pubmed/29127232

e018829

11

Clinical Science Departments

Duke

Medicine

Medicine, Nephrology

School of Medicine

Staff

Surgery

Surgery, Emergency Medicine

Temp group - logins allowed

Published online

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