Bintabara Deogratius, Mpondo Bonaventura C T
Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania.
Department of Internal Medicine, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania.
PLoS One. 2018 Feb 15;13(2):e0192942. doi: 10.1371/journal.pone.0192942. eCollection 2018.
Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania.
This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level.
Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension.
The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes.
撒哈拉以南非洲地区城乡的非传染性疾病负担正在迅速上升。关于卫生系统应对高血压和其他非传染性疾病的准备情况的数据仍然很少。本研究旨在评估坦桑尼亚基层卫生设施对高血压门诊初级护理的准备情况。
本研究使用了2014 - 2015年坦桑尼亚服务提供评估调查的数据。如果设施报告至少有世界卫生组织服务可用性和准备情况评估手册确定的三个领域（人员培训和指南、基本诊断设备以及基本药物）中每个领域列出项目的一半（≥50%），则认为该设施为高血压门诊初级护理做好了准备。使用Stata 14对数据进行分析。使用未调整的逻辑回归模型评估结果与解释变量之间的关联。所有P值<0.2的变量均以5%的显著性水平纳入多元逻辑回归模型。
在本研究涉及的725个卫生设施中，约68%为公共设施，73%位于农村地区。只有28%的评估设施被认为为高血压门诊初级护理做好了准备。分别约9%和42%的评估设施报告至少有一名经过培训的工作人员和高血压指南。在多变量分析中，私立设施[AOR = 2.7，95% CI；1.2 - 6.1]、城市地区[AOR = 2.2，95% CI；1.2 - 4.2]、卫生中心[AOR = 5.2，95% CI；3.1 - 8.7]以及定期管理会议的开展情况[AOR = 2.6，95% CI；1.1 - 5.9]与高血压门诊初级护理的准备情况显著相关。
坦桑尼亚的初级卫生保健系统没有充分配备应对日益增加的高血压和其他非传染性疾病负担的能力。农村地区、公有制以及缺乏定期管理会议与未做好准备相关。有必要加强坦桑尼亚的初级卫生保健系统，以便更好地管理慢性病并遏制其对健康结果日益增加的影响。
