Evaluating the cascade of care for hypertension in Sierra Leone
Geraedts, Tessa J M; Boateng, Daniel; Lindenbergh, Karel C; van Delft, Diede; Mathéron, Hanna M; Mönnink, Gulia L E; Martens, Janine P J; van Leerdam, Daniel; Vas Nunes, Jonathan; Bu-Buakei Jabbi, Sonnia-Magba; Kpaka, Mohamed S; Westendorp, Josien; van Duinen, Alex J; Sankoh, Osman; Grobusch, Martin P; Bolkan, Håkon A; Klipstein-Grobusch, Kerstin
(2021) Tropical medicine & international health, volume 26, issue 11, pp. 1470 - 1480
(Article)
Abstract
OBJECTIVE: To assess the care for hypertension in Sierra Leone, by the use of a cascade-of-care approach, to identify where the need for healthcare system interventions is greatest. METHODS: Using data from a nationwide household survey on surgical conditions undertaken in 1956 participants ≥18 years from October 2019 to March
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2020, a cascade of care for hypertension consisting of four categories - hypertensive population, those diagnosed, those treated and those controlled - was constructed. Hypertension was defined as having a blood pressure ≥140/90 mmHg, or self-reported use of antihypertensive medication. Logistic regression analysis was used to investigate factors associated with undiagnosed hypertension. RESULTS: The prevalence of hypertension was 22%. Among those with hypertension, 23% were diagnosed, 11% were treated and 5% had controlled blood pressure. The largest loss to care (77%) was between being hypertensive and receiving a diagnosis. Male sex, age and living in a rural location, were significantly associated with the odds of undiagnosed hypertension. There was no significant difference between men and women in the number of patients with controlled blood pressure. Adults aged 40 or older were observed to be better retained in care compared with those younger than 40 years of age. CONCLUSION: There is a significant loss to care in the care cascade for hypertension in Sierra Leone. Our results suggest that increasing awareness of cardiovascular risk and risk factor screening for early diagnosis might have a large impact on hypertension care.
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Keywords: care cascade, hypertension, low resource setting, Sierra Leone, sub-Saharan Africa, Public Health, Environmental and Occupational Health, Infectious Diseases, Parasitology, Journal Article
ISSN: 1360-2276
Publisher: Wiley-Blackwell
Note: Funding Information: We greatly appreciate the contributions of study participants, research assistants, Statistics Sierra Leone and the PRESSCO 2020 study group, funding from the Norwegian University of Science and Technology (Norway), CapaCare (Norway), the Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Center (the Netherlands), the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (the Netherlands) and the Masanga Research Unit, Masanga Hospital (Sierra Leone). Publisher Copyright: © 2021 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd
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