Mnazi Mmoja Referral Hospital, Kaunda Rd, Vuga, Po Box 3793, Zanzibar, Tanzania.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
BMC Public Health. 2020 Sep 4;20(1):1352. doi: 10.1186/s12889-020-09432-8.
Cardiovascular diseases are among the most common causes of hospital admissions and deaths in Zanzibar. This study assessed prevalence of, and antecedent factors and care access for the two common cardiovascular risk factors, hypertension and diabetes, to support health system improvements.
Data was from a population based nationally representative survey. Prevalence of hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or a self-reported diagnosis of hypertension; diabetes was defined as a fasting blood glucose ≥6.1 mmol/L or a self-reported diagnosis of diabetes. Care-cascades for hypertension and diabetes were created with four stages: being tested, diagnosed, treated, and achieving control. Multivariable logistic regression models were constructed to evaluate individual-level factors - including symptoms of mental illness - associated with having hypertension or diabetes, and with progressing through the hypertension care cascade. Whether people at overt increased risk of hypertension or diabetes (defined as > 50 years old, BMI > 30 kg/m2, or currently smoking) were more likely to be tested was assessed using chi squared.
Prevalence of hypertension was 33.5% (CI 30.6-36.5). Older age (OR 7.7, CI 4.93-12.02), some education (OR 0.6, CI 0.44-0.89), obesity (OR 3.1, CI 2.12-4.44), and raised fasting blood glucose (OR 2.4, CI 2.38) were significantly independently associated with hypertension. Only 10.9% (CI 8.6-13.8) of the entire hypertensive population achieved blood pressure control, associated factors were being female (OR 4.8, CI 2.33-9.88), formally employed (OR 3.0, CI 1.26-7.17), and overweight (OR 2.5, CI 1.29-4.76). The prevalence of diabetes was 4.4% (CI 3.4-5.5), and associated with old age (OR 14.1, CI 6.05-32.65) and almost significantly with obesity (OR 2.1, CI 1.00-4.37). Only 11.9% (CI 6.6-20.6) of the diabetic population had achieved control. Individuals at overt increased risk were more likely to have been tested for hypertension (chi2 19.4) or diabetes (chi2 33.2) compared to the rest of the population. Symptoms of mental illness were not associated with prevalence of disease or progress through the cascade.
High prevalence of hypertension and suboptimal management along the care cascades indicates a large unmet need for hypertension and diabetes care in Zanzibar.
心血管疾病是桑给巴尔岛住院和死亡的最常见原因之一。本研究评估了高血压和糖尿病这两种常见心血管危险因素的患病率、相关因素和护理途径，以支持卫生系统的改善。
数据来自基于人群的全国代表性调查。高血压的定义为收缩压≥140mmHg、舒张压≥90mmHg 或自我报告的高血压诊断；糖尿病的定义为空腹血糖≥6.1mmol/L 或自我报告的糖尿病诊断。通过四个阶段创建高血压和糖尿病的护理级联：检测、诊断、治疗和控制。使用多变量逻辑回归模型评估与高血压或糖尿病相关的个体水平因素——包括精神疾病症状——以及与高血压护理级联进展相关的因素。使用卡方检验评估患有高血压或糖尿病（定义为>50 岁、BMI>30kg/m2 或目前吸烟）的高危人群中，是否更有可能接受检测。
高血压患病率为 33.5%（95%CI 30.6-36.5）。年龄较大（OR 7.7，95%CI 4.93-12.02）、受教育程度较高（OR 0.6，95%CI 0.44-0.89）、肥胖（OR 3.1，95%CI 2.12-4.44）和空腹血糖升高（OR 2.4，95%CI 2.38）与高血压显著相关。仅有 10.9%（95%CI 8.6-13.8）的高血压患者血压得到控制，相关因素为女性（OR 4.8，95%CI 2.33-9.88）、有正式工作（OR 3.0，95%CI 1.26-7.17）和超重（OR 2.5，95%CI 1.29-4.76）。糖尿病的患病率为 4.4%（95%CI 3.4-5.5），与年龄较大（OR 14.1，95%CI 6.05-32.65）相关，与肥胖几乎显著相关（OR 2.1，95%CI 1.00-4.37）。仅有 11.9%（95%CI 6.6-20.6）的糖尿病患者达到了控制。与其他人群相比，处于明显增加风险的个体更有可能接受高血压（卡方检验 19.4）或糖尿病（卡方检验 33.2）的检测。精神疾病症状与疾病的患病率或护理级联的进展无关。
高血压的高患病率和护理级联管理不佳表明，桑给巴尔岛对高血压和糖尿病护理的需求未得到满足。
