Orji Ikechukwu A, Baldridge Abigail S, Omitiran Kasarachi, Guo Mainzhao, Ajisegiri Whenayon Simeon, Ojo Tunde M, Shedul Gabriel, Kandula Namratha R, Hirschhorn Lisa R, Huffman Mark D, Ojji Dike B
Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
BMC Health Serv Res. 2021 Apr 9;21(1):322. doi: 10.1186/s12913-021-06320-8.
Nigeria faces an increase in the burden of non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), leading to an estimated 29% of all deaths in the country. Nigeria has an estimated hypertension prevalence ranging from 25 to 40% of her adult population. Despite this high burden, awareness (14-30%), treatment (< 20%), and control (9%) rates of hypertension are low in Nigeria. Against this backdrop, we sought to perform capacity and readiness assessments of public Primary Healthcare Centers (PHCs) to inform Nigeria's system-level hypertension control program's implementation and adaptation strategies.
The study employed a multi-stage sampling to select 60 from the 243 PHCs in the Federal Capital Territory (FCT) of Nigeria. The World Health Organization (WHO) Service Availability and Readiness Assessment was adapted to focus on hypertension diagnosis and treatment and was administered to PHC staff from May 2019 - October 2019. Indicator scores for general and cardiovascular service readiness were calculated based on the proportion of sites with available amenities, equipment, diagnostic tests, and medications.
Median (interquartile range [IQR]) number of full-time staff was 5 (3-8), and were predominantly community health extension workers (median = 3 [IQR 2-5]). Few sites (n = 8; 15%) received cardiovascular disease diagnosis and management training within the previous 2 years, though most had sufficient capacity for screening (n = 58; 97%), diagnosis (n = 56; 93%), and confirmation (n = 50; 83%) of hypertension. Few PHCs had guidelines (n = 7; 13%), treatment algorithms (n = 3; 5%), or information materials (n = 1; 2%) for hypertension. Most sites (n = 55; 92%) had one or more functional blood pressure apparatus. All sites relied on paper records, and few had a functional computer (n = 10; 17%) or access to internet (n = 5; 8%). Despite inclusion on Nigeria's essential medicines list, 35 (59%) PHCs had zero 30-day treatment regimens of any blood pressure-lowering medications in stock.
This first systematic assessment of capacity and readiness for a system-level hypertension control program within the FCT of Nigeria demonstrated implementation feasibility based on the workforce, equipment, and paper-based information systems, but a critical need for essential medicine supply strengthening, health-worker training, and protocols for hypertension treatment and control in Nigeria.
尼日利亚面临包括心血管疾病（CVD）在内的非传染性疾病（NCD）负担增加的问题，据估计该国所有死亡病例中有29% 归因于此。据估计，尼日利亚成年人高血压患病率在25% 至40% 之间。尽管负担沉重，但尼日利亚高血压的知晓率（14% - 30%）、治疗率（<20%）和控制率（9%）较低。在此背景下，我们试图对公立基层医疗中心（PHC）进行能力和准备情况评估，以为尼日利亚系统层面的高血压控制项目的实施和调整策略提供依据。
该研究采用多阶段抽样方法，从尼日利亚联邦首都地区（FCT）的243个基层医疗中心中选取了60个。对世界卫生组织（WHO）的服务可用性和准备情况评估进行了调整，以聚焦于高血压的诊断和治疗，并于2019年5月至2019年10月对基层医疗中心的工作人员进行了调查。根据具备可用设施、设备、诊断测试和药物的机构比例，计算了一般和心血管服务准备情况的指标得分。
全职工作人员的中位数（四分位间距[IQR]）为5（3 - 8），主要是社区卫生推广工作者（中位数 = 3 [IQR 2 - 5]）。在过去2年内，很少有机构（n = 8；15%）接受过心血管疾病诊断和管理培训，不过大多数机构有足够能力进行高血压筛查（n = 58；97%）、诊断（n = 56；93%）和确诊（n = 50；83%）。很少有基层医疗中心有高血压指南（n = 7；13%）、治疗算法（n = 3；5%）或信息材料（n = 1；2%）。大多数机构（n = 55；92%）有一台或多台可用的血压测量设备。所有机构都依赖纸质记录，很少有机构有可用的计算机（n = 10；17%）或网络接入（n = 5；8%）。尽管列入了尼日利亚基本药物清单，但35个（59%）基层医疗中心没有任何降压药物的30天治疗方案库存。
尼日利亚联邦首都地区对系统层面高血压控制项目的能力和准备情况进行的首次系统评估表明，基于劳动力、设备和纸质信息系统，实施具有可行性，但迫切需要加强基本药物供应、对卫生工作者进行培训，并制定尼日利亚高血压治疗和控制的方案。
