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Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study.

Publication ,  Journal Article
Galson, SW; Staton, CA; Karia, F; Kilonzo, K; Lunyera, J; Patel, UD; Hertz, JT; Stanifer, JW
Published in: BMJ Open
November 9, 2017

INTRODUCTION: Sub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood. Therefore, we undertook a community-based mixed-methods study in Tanzania to investigate the epidemiology of hypertension and barriers to care. METHODS: In Northern Tanzania, between December 2013 and June 2015, we conducted a mixed-methods study, including a cross-sectional household epidemiological survey and qualitative sessions of focus groups and in-depth interviews. For the survey, we assessed for hypertension, defined as a single blood pressure ≥160/100 mm Hg, a two-time average of ≥140/90 mm Hg or current use of antihypertensive medications. To investigate relationships with potential risk factors, we used adjusted generalised linear models. Uncontrolled hypertension was defined as a two-time average measurement of ≥160/100 mm Hg irrespective of treatment status. Hypertension awareness was defined as a self-reported disease history in a participant with confirmed hypertension. To explore barriers to care, we identified emerging themes using an inductive approach within the framework method. RESULTS: We enrolled 481 adults (median age 45 years) from 346 households, including 123 men (25.6%) and 358 women (74.4%). Overall, the prevalence of hypertension was 28.0% (95% CI 19.4% to 38.7%), which was independently associated with age >60 years (prevalence risk ratio (PRR) 4.68; 95% CI 2.25 to 9.74) and alcohol use (PRR 1.72; 95% CI 1.15 to 2.58). Traditional medicine use was inversely associated with hypertension (PRR 0.37; 95% CI 0.26 to 0.54). Nearly half (48.3%) of the participants were aware of their disease, but almost all (95.3%) had uncontrolled hypertension. In the qualitative sessions, we identified barriers to optimal care, including poor point-of-care communication, poor understanding of hypertension and structural barriers such as long wait times and undertrained providers. CONCLUSIONS: In Northern Tanzania, the burden of hypertensive disease is substantial, and optimal hypertension control is rare. Transdisciplinary strategies sensitive to local practices should be explored to facilitate early diagnosis and sustained care delivery.

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Published In

BMJ Open

DOI

EISSN

2044-6055

Publication Date

November 9, 2017

Volume

7

Issue

11

Start / End Page

e018829

Location

England

Related Subject Headings

  • Tanzania
  • Surveys and Questionnaires
  • Risk Factors
  • Prevalence
  • Middle Aged
  • Medicine, Traditional
  • Male
  • Hypertension
  • Humans
  • Female
 

Citation

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Galson, S. W., Staton, C. A., Karia, F., Kilonzo, K., Lunyera, J., Patel, U. D., … Stanifer, J. W. (2017). Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study. BMJ Open, 7(11), e018829. https://doi.org/10.1136/bmjopen-2017-018829
Galson, Sophie W., Catherine A. Staton, Francis Karia, Kajiru Kilonzo, Joseph Lunyera, Uptal D. Patel, Julian T. Hertz, and John W. Stanifer. “Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study.BMJ Open 7, no. 11 (November 9, 2017): e018829. https://doi.org/10.1136/bmjopen-2017-018829.
Galson SW, Staton CA, Karia F, Kilonzo K, Lunyera J, Patel UD, et al. Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study. BMJ Open. 2017 Nov 9;7(11):e018829.
Galson, Sophie W., et al. “Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study.BMJ Open, vol. 7, no. 11, Nov. 2017, p. e018829. Pubmed, doi:10.1136/bmjopen-2017-018829.
Galson SW, Staton CA, Karia F, Kilonzo K, Lunyera J, Patel UD, Hertz JT, Stanifer JW. Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study. BMJ Open. 2017 Nov 9;7(11):e018829.

Published In

BMJ Open

DOI

EISSN

2044-6055

Publication Date

November 9, 2017

Volume

7

Issue

11

Start / End Page

e018829

Location

England

Related Subject Headings

  • Tanzania
  • Surveys and Questionnaires
  • Risk Factors
  • Prevalence
  • Middle Aged
  • Medicine, Traditional
  • Male
  • Hypertension
  • Humans
  • Female