Chikafu Herbert, Chimbari Moses
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
PeerJ. 2021 Nov 11;9:e12372. doi: 10.7717/peerj.12372. eCollection 2021.
Treatment and control of hypertension are associated with a substantial reduction in adverse cardiovascular disease outcomes. Although South Africa aims to reduce the burden of cardiovascular diseases, there is limited evidence on the hypertension care cascade (HCC) performance in rural areas where stroke and hypertension are high. This study estimated HCC performance and identified predictors of hypertension screening among adults in the Ingwavuma community of KwaZulu-Natal, South Africa.
This was a cross-sectional study. Data were collected using the WHO STEPwise approach to surveillance (STEPS) questionnaire from 400 adult participants, excluding pregnant women and those with physical or cognitive impairments. Three hundred and ninety-three participants had complete data, and 131 had high blood pressure. We calculated progression rates for screening, diagnosis, treatment and control of hypertension from the sub-sample of participants with high blood pressure and assessed the bivariate association between HCC stages and participant characteristics and their effect sizes. We used binary and multivariable logistic regression to identify predictors of hypertension screening.
Eighty-eight per cent of participants reported prior screening for hypertension. However, only 53.5% of patients under pharmacological treatment for hypertension had controlled blood pressure. In bivariate regression, employed participants were 80.3% (COR = 0.197, 95% CI [0.042-0.921]) more likely to be screened. In multivariable regression, the likelihood of hypertension screening was 82.4% (AOR = 0.176, 95% CI [0.047-0.655]) lower among participants in a cohabiting union than single participants. Similarly, employed participants were 87.4% (AOR = 0.129, 95% CI [0.017-0.952]) less likely to be screened than their unemployed counterparts.
The considerable attrition from the HCC across socio-demographic categories indicates a need for community-wide interventions. Empowering health care workers for community-based health promotion and hypertension management through point-of-care diagnostic tools could improve HCC performance. Efforts to improve the HCC should also focus on social determinants of health, notably gender and formal educational attainment.
高血压的治疗与控制可大幅降低不良心血管疾病的发生风险。尽管南非致力于减轻心血管疾病负担，但在中风和高血压高发的农村地区，关于高血压照护流程（HCC）绩效的证据有限。本研究评估了南非夸祖鲁 - 纳塔尔省英瓜武马社区成年人的HCC绩效，并确定了高血压筛查的预测因素。
这是一项横断面研究。采用世界卫生组织的逐步监测方法（STEPS）问卷，从400名成年参与者中收集数据，排除孕妇以及有身体或认知障碍者。393名参与者有完整数据，其中131人患有高血压。我们从高血压患者子样本中计算高血压筛查、诊断、治疗和控制的进展率，并评估HCC各阶段与参与者特征之间的双变量关联及其效应大小。我们使用二元和多变量逻辑回归来确定高血压筛查的预测因素。
88%的参与者报告曾接受过高血压筛查。然而，接受高血压药物治疗的患者中，只有53.5%的血压得到控制。在双变量回归中，就业参与者接受筛查的可能性高出80.3%（校正比值比[COR]=0.197，95%置信区间[0.042 - 0.921]）。在多变量回归中，与单身参与者相比，同居的参与者接受高血压筛查的可能性低82.4%（调整后比值比[AOR]=0.176，95%置信区间[0.047 - 0.655]）。同样，与未就业的参与者相比，就业参与者接受筛查的可能性低87.4%（AOR = 0.129，95%置信区间[0.017 - 0.952]）。
社会人口学类别中HCC的显著流失表明需要进行全社区干预。通过即时诊断工具增强医护人员进行社区健康促进和高血压管理的能力，可能会改善HCC绩效。改善HCC的努力还应关注健康的社会决定因素，尤其是性别和正规教育程度。
