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Early detection, care and control of hypertension and diabetes in South Africa: A community-based approach.

ABSTRACT: BACKGROUND:Non-communicable diseases (NCDs) are a major public health concern with raised blood pressure and glucose emerging as leading causes of death and disability. AIM:This community-based demonstration project using community caregivers (CCGs) trained in screening for hypertension and diabetes aimed at improving early detection and linkage to care and management. SETTING:The project was conducted in KwaZulu-Natal province. METHODS:The CCGs were trained in NCD-related health education, promotion and screening for hypertension and diabetes using an accredited programme. The CCGs screened community members for hypertension and diabetes using three screening methods: door-to-door visits, community campaigns and workplaces. RESULTS:Twenty-five CCGs received the accredited NCD training. A total of 10 832 community members were screened for hypertension and 6481 had their blood glucose measured. Of those screened, 29.7% and 4.4%, respectively, had raised blood pressure (? 140/90 mmHg) and blood glucose (? 11.0 mmol/L) who required referral to a primary healthcare facility. More than one in five (21.0%, n = 1448), of those with no previous hypertension diagnosis, were found to have raised blood pressure at screening, representing newly detected cases. Less than a third (28.5%) of patients referred to the facilities for raised blood pressure actually presented themselves for a facility assessment, of which 71.8% had their hypertension diagnosis confirmed and were advised to continue, adjust or initiate treatment. Similarly, 29.1% of patients referred to the facilities for raised blood glucose presented themselves at the facility, of which 71.4% received a confirmatory diabetes diagnosis. CONCLUSION:Community caregivers played an important role in early detection of raised blood pressure and raised blood glucose, and in referring patients to primary care.

SUBMITTER: Madela S

PROVIDER: S-EPMC7061221 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Early detection, care and control of hypertension and diabetes in South Africa: A community-based approach.

Madela Sanele S James Shamagonam S Sewpaul Ronel R Madela Siyathokoza S Reddy Priscilla P

African journal of primary health care & family medicine 20200220 1

<h4>Background</h4>Non-communicable diseases (NCDs) are a major public health concern with raised blood pressure and glucose emerging as leading causes of death and disability.<h4>Aim</h4>This community-based demonstration project using community caregivers (CCGs) trained in screening for hypertension and diabetes aimed at improving early detection and linkage to care and management.<h4>Setting</h4>The project was conducted in KwaZulu-Natal province.<h4>Methods</h4>The CCGs were trained in NCD-r ...[more]

PMID: 32129650

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Project description:IntroductionParticipation in antiretroviral therapy (ART) programmes has been associated with greater utilization of care for hypertension and diabetes in rural South Africa. The objective of this study was to assess whether people living with HIV on ART with comorbid hypertension or diabetes also have improved chronic disease management indicators.MethodsThe Health and Aging in Africa: a longitudinal study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5059 adults >40 years old. Enrollment took place between November 2014 and November 2015. The study collected population-based data on demographics, healthcare utilization, height, weight, blood pressure (BP) and blood glucose as well as HIV infection, HIV-1 RNA viral load (VL) and ART exposure. We used regression models to determine whether HIV care cascade stage (HIV-negative, HIV+ /No ART, ART/Detected HIV VL, and ART/Undetectable VL) was associated with diagnosis or treatment of hypertension or diabetes, and systolic blood pressure and glucose among those with diagnosed hypertension or diabetes. ART use was measured from drug level testing on dried blood spots.Results and discussionCompared to people without HIV, ART/Undetectable VL was associated with greater awareness of hypertension diagnosis (adjusted risk ratio (aRR) 1.18, 95% CI: 1.09 to 1.28) and treatment of hypertension (aRR 1.24, 95% CI: 1.10 to 1.41) among those who met hypertension diagnostic criteria. HIV care cascade stage was not significantly associated with awareness of diagnosis or treatment of diabetes. Among those with diagnosed hypertension or diabetes, ART/Undetectable VL was associated with lower mean systolic blood pressure (5.98 mm Hg, 95% CI: 9.65 to 2.32) and lower mean glucose (3.77 mmol/L, 95% CI: 6.85 to 0.69), compared to being HIV-negative.ConclusionsParticipants on ART with an undetectable VL had lower systolic blood pressure and blood glucose than the HIV-negative participants. HIV treatment programmes may provide a platform for health systems strengthening for cardiometabolic disease.

Project description:BackgroundTreatment 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.MethodsThis 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.ResultsEighty-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.ConclusionsThe 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.

Project description:OBJECTIVE:To develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries. DESIGN:We determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility. SETTING:South Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision. PRIMARY AND SECONDARY OUTCOMES:Our primary outcome was the completion of a tool and user manual. RESULTS:The tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool. CONCLUSIONS:We have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.

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Early detection, care and control of hypertension and diabetes in South Africa: A community-based approach.

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Early detection, care and control of hypertension and diabetes in South Africa: A community-based approach.

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