Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA.
Duke Global Health Institute, Durham, North Carolina, USA.
BMJ Open. 2017 Nov 9;7(11):e018829. doi: 10.1136/bmjopen-2017-018829.
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.
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.
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.
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.
撒哈拉以南非洲特别容易受到全球高血压负担日益加重的影响，但流行病学研究有限，对最佳管理的障碍也了解甚少。因此，我们在坦桑尼亚进行了一项基于社区的混合方法研究，以调查高血压的流行病学和护理障碍。
在坦桑尼亚北部，我们于 2013 年 12 月至 2015 年 6 月进行了一项混合方法研究，包括横断面家庭流行病学调查和焦点小组及深入访谈的定性会议。在调查中，我们评估了高血压，定义为单次血压≥160/100mmHg，两次平均血压≥140/90mmHg 或当前使用抗高血压药物。为了研究与潜在危险因素的关系，我们使用了调整后的广义线性模型。未控制的高血压定义为两次平均测量值≥160/100mmHg，无论治疗状态如何。高血压意识定义为患有高血压的参与者自我报告的疾病史。为了探索护理障碍，我们在框架方法内使用了一种归纳方法来确定新出现的主题。
我们从 346 户家庭中招募了 481 名成年人（中位年龄 45 岁），其中包括 123 名男性（25.6%）和 358 名女性（74.4%）。总体而言，高血压患病率为 28.0%（95%CI 19.4%至 38.7%），与年龄>60 岁（患病率比（PRR）4.68；95%CI 2.25 至 9.74）和饮酒（PRR 1.72；95%CI 1.15 至 2.58）独立相关。传统医学的使用与高血压呈负相关（PRR 0.37；95%CI 0.26 至 0.54）。近一半（48.3%）的参与者意识到自己的疾病，但几乎所有人（95.3%）都患有未控制的高血压。在定性会议中，我们确定了最佳护理的障碍，包括护理点沟通不良、对高血压的理解不足以及长等待时间和训练不足的提供者等结构障碍。
在坦桑尼亚北部，高血压疾病负担沉重，高血压控制情况不佳。应探索对当地实践敏感的跨学科策略，以促进早期诊断和持续护理。
