Institute for Health and Sport, Victoria University, Melbourne, Australia.
Nepal Health Research Council, Kathmandu, Nepal.
Glob Health Action. 2022 Dec 31;15(1):2000092. doi: 10.1080/16549716.2021.2000092.
BACKGROUND: The growing burden of hypertension is emerging as one of the major healthcare challenges in low- and middle-income countries (LMICs), such as Nepal. Given that they are struggling to deliver adequate health services, some LMICs have significant gaps in the cascade of hypertension care (including screening, awareness, treatment, and control). This results in uncontrolled hypertension, placing a high burden on both patients and healthcare providers. OBJECTIVE: The objective of this study was to quantify the gaps in hypertension screening, awareness, treatment, and control in the Nepalese population. METHODS: We used the data from a pooled sample of 9682 participants collected through two consecutive STEPwise approach to Surveillance (STEPS) surveys conducted in Nepal in 2013 and 2019. A multistage cluster sampling method was applied in the surveys, to select nationally representative samples of 15- to 69-year-old Nepalese individuals. Prevalence ratios were calculated using multivariable Poisson regression. RESULTS: Among the hypertensive participants, the prevalence of hypertension screening was 65.9% (95% CI: 62.2, 69.5), the prevalence of hypertension awareness was 20% (95% CI: 18.1, 22.1), the prevalence of hypertension treatment was 10.3% (95% CI: 8.8, 12.0), and the prevalence of hypertension control was 3.8% (95% CI: 2.9, 4.9). The unmet need of hypertension treatment and control was highest amongst the poorest individuals, the participants from Lumbini and Sudurpaschim provinces, those who received treatment in public hospitals, the uninsured, and those under the age of 30 years. CONCLUSIONS: The gaps in the cascade of hypertension care in Nepal are large. These gaps are particularly pronounced among the poor, persons living in Lumbini and Sudurpaschim provinces, those who sought treatment in public hospitals, those who did not have health insurance, and young people. National- and local-level public health interventions are needed to improve hypertension screening, awareness, treatment, and control in Nepal.
背景：高血压负担不断加重，已成为尼泊尔等中低收入国家（LMICs）面临的主要医疗保健挑战之一。由于这些国家难以提供充足的卫生服务，因此在高血压护理的各个环节（包括筛查、知晓、治疗和控制）都存在较大差距。这导致高血压无法得到控制，给患者和医疗服务提供者都带来了沉重的负担。
目的：本研究旨在量化尼泊尔人群中高血压筛查、知晓、治疗和控制方面的差距。
方法：我们使用了 2013 年和 2019 年在尼泊尔连续开展的两项 STEP 式监测（STEPS）调查的汇总样本数据，该样本共纳入了 9682 名参与者。调查采用多阶段聚类抽样方法，从全国范围内抽取了 15-69 岁尼泊尔个体的有代表性样本。采用多变量泊松回归计算患病率比。
结果：在高血压患者中，高血压筛查的患病率为 65.9%（95%CI：62.2，69.5），高血压知晓率为 20%（95%CI：18.1，22.1），高血压治疗率为 10.3%（95%CI：8.8，12.0），高血压控制率为 3.8%（95%CI：2.9，4.9）。最贫困的个体、来自蓝毗尼和苏德哈布地区的参与者、在公立医院接受治疗的个体、未参保的个体以及 30 岁以下的个体，高血压治疗和控制的未满足需求最高。
结论：尼泊尔高血压护理各个环节均存在较大差距。这些差距在贫困人口、蓝毗尼和苏德哈布地区的居民、在公立医院接受治疗的个体、未参保的个体以及年轻人中尤为明显。需要在国家和地方层面开展公共卫生干预措施，以改善尼泊尔的高血压筛查、知晓、治疗和控制。
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