Byiringiro Samuel, Ogungbe Oluwabunmi, Commodore-Mensah Yvonne, Adeleye Khadijat, Sarfo Fred Stephen, Himmelfarb Cheryl R
Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America.
Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLOS Glob Public Health. 2023 Jun 8;3(6):e0001794. doi: 10.1371/journal.pgph.0001794. eCollection 2023.
Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores the health system interventions on hypertension management and associated outcomes in SSA. The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and October 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for the risk of bias using the tools from the Joanna Briggs Institute. Twelve studies clustered in 8 SSA countries met the inclusion criteria. Two thirds (8/12) of the included studies had low risk of bias. Most interventions focused on health workforce factors such as providers' knowledge and task shifting of hypertension care to unconventional health professionals (n = 10). Other health systems interventions addressed the supply and availability of medical products and technology (n = 5) and health information systems (n = 5); while fewer interventions sought to improve financing (n = 3), service delivery (n = 1), and leadership and governance (n = 1) aspects of the health systems. Health systems interventions showed varied effects on blood pressure outcomes but interventions targeting multiple aspects of health systems were likely associated with improved blood pressure outcomes. The general limitations of the overall body of literature was that studies were likely small, with short duration, and underpowered. In conclusion, the literature on health systems internventions addressing hypertension care are limited in quantity and quality. Future studies that are adequately powered should test the effect of multi-faceted health system interventions on hypertension outcomes with a special focus on financing, leadership and governance, and service delivery interventions since these aspects were least explored.
高血压是一个重大的全球健康问题，在撒哈拉以南非洲地区（SSA）尤为突出。尽管药物治疗和生活方式干预在降低血压方面有效，但卫生系统存在的不足继续阻碍着实现最佳高血压控制率的进程。本综述探讨了撒哈拉以南非洲地区高血压管理的卫生系统干预措施及相关结果。世界卫生组织的卫生系统框架指导了文献检索和研究结果的讨论。我们在PubMed、CINAHL和Embase数据库中检索了2010年1月至2022年10月发表的研究，并遵循系统评价和Meta分析的首选报告项目指南。我们使用乔安娜·布里格斯研究所的工具评估研究的偏倚风险。在8个撒哈拉以南非洲国家进行的12项研究符合纳入标准。纳入研究中有三分之二（8/12）的偏倚风险较低。大多数干预措施集中在卫生人力因素上，如提供者的知识以及将高血压护理任务转移给非传统卫生专业人员（n = 10）。其他卫生系统干预措施涉及医疗产品和技术的供应与可及性（n = 5）以及卫生信息系统（n = 5）；而较少的干预措施试图改善卫生系统的筹资（n = 3）、服务提供（n = 1）以及领导与治理（n = 1）方面。卫生系统干预措施对血压结果显示出不同的影响，但针对卫生系统多个方面的干预措施可能与血压结果改善相关。整个文献总体的普遍局限性在于研究可能规模较小、持续时间短且效能不足。总之，关于卫生系统干预高血压护理的文献在数量和质量上都很有限。未来有足够效能的研究应测试多方面卫生系统干预措施对高血压结果的影响，特别关注筹资、领导与治理以及服务提供干预措施，因为这些方面研究最少。
