Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
PLoS One. 2022 Sep 9;17(9):e0274242. doi: 10.1371/journal.pone.0274242. eCollection 2022.
Access to care for cardiovascular disease risk factors (CVDRFs) in low- and middle-income countries is limited. We aimed to describe the need and access to care for people with CVDRF and the preparedness of the health system to treat these in Bo, Sierra Leone.
Data from a 2018 household survey conducted in Bo, Sierra Leone, was analysed. Demographic, anthropometric and clinical data on CVDRF (hypertension, diabetes mellitus or dyslipidaemia) from randomly sampled individuals 40 years of age and above were collected. Future risk of CVD was calculated using the World Health Organisation-International Society of Hypertension (WHO-ISH) calculator with high risk defined as >20% risk over 10 years. Requirement for treatment was based on WHO package of essential non-communicable (PEN) disease guidelines (which use a risk-based approach) or requiring treatment for individual CVDRF; whether participants were on treatment was used to determine whether care needs were met. Multivariable regression was used to test associations between individual characteristics and outcomes. Data from the most recent WHO Service Availability and Readiness Assessment (SARA) were used to create a score reflecting health system preparedness to treat CVDRF, and compared to that for HIV.
2071 individual participants were included. Most participants (n = 1715 [94.0%]) had low CVD risk; 423 (20.6%) and 431 (52.3%) required treatment based upon WHO PEN guidelines or individual CVDRF, respectively. Sixty-eight (15.8%) had met-need for treatment determined by WHO guidelines, whilst 84 (19.3%) for individual CVDRF. Living in urban areas, having education, being older, single/widowed/divorced, or wealthy were independently associated with met need. Overall facility readiness scores for CVD/CVDRF care for all facilities in Bo district was 16.8%, compared to 41% for HIV.
The number of people who require treatment for CVDRF in Sierra Leone is substantially lower based on WHO guidelines compared to CVDRF. CVDRF care needs are not met equitably, and facility readiness to provide care is low.
在中低收入国家，心血管疾病风险因素（CVDRFs）的医疗服务可及性有限。本研究旨在描述塞拉利昂博城 CVDRF 患者的医疗服务需求和可及性，以及该地区卫生系统治疗这些疾病的准备情况。
对 2018 年在塞拉利昂博城进行的一项家庭调查的数据进行了分析。从 40 岁及以上的随机抽样个体中收集了 CVDRF（高血压、糖尿病或血脂异常）的人口统计学、人体测量学和临床数据。使用世界卫生组织-国际高血压学会（WHO-ISH）计算器计算未来 CVD 风险，高风险定义为 10 年内风险>20%。根据世界卫生组织基本非传染性疾病（PEN）疾病指南（采用风险为基础的方法）或需要针对个体 CVDRF 进行治疗的要求来确定治疗需求；参与者是否接受治疗用于确定是否满足医疗需求。采用多变量回归检验个体特征与结局之间的关联。使用最近的世界卫生组织服务可用性和准备情况评估（SARA）数据创建一个反映卫生系统治疗 CVDRF 准备情况的评分，并与 HIV 进行比较。
共纳入 2071 名个体参与者。大多数参与者（n=1715 [94.0%]）的 CVD 风险较低；根据世界卫生组织 PEN 指南或个体 CVDRF，分别有 423（20.6%）和 431（52.3%）人需要治疗。根据世界卫生组织指南，有 68（15.8%）人达到了治疗需求，而根据个体 CVDRF，有 84（19.3%）人达到了治疗需求。居住在城市地区、接受教育、年龄较大、单身/丧偶/离异或富裕与满足需求独立相关。博城所有医疗设施的 CVD/CVDRF 治疗总设施准备评分仅为 16.8%，而 HIV 为 41%。
根据世界卫生组织的指南，塞拉利昂需要治疗 CVDRF 的人数大大低于 CVDRF。CVDRF 医疗服务需求未得到公平满足，且医疗设施提供治疗的准备情况较差。
