Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa

Background Treatment 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 a...

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Autores principales:	Herbert Chikafu, Moses Chimbari
Formato:	article
Lenguaje:	EN
Publicado:	PeerJ Inc. 2021
Materias:	Chronic disease management Health promotion Hypertension care cascade Primary health Social determinants Rural KwaZulu-Natal Medicine R
Acceso en línea:	https://doaj.org/article/ce7dadff50364b5b8c7971852ba33234
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spelling	oai:doaj.org-article:ce7dadff50364b5b8c7971852ba332342021-11-13T15:05:09ZHypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa10.7717/peerj.123722167-8359https://doaj.org/article/ce7dadff50364b5b8c7971852ba332342021-11-01T00:00:00Zhttps://peerj.com/articles/12372.pdfhttps://peerj.com/articles/12372/https://doaj.org/toc/2167-8359Background Treatment 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. Methods This 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. Results Eighty-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. Conclusions The 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.Herbert ChikafuMoses ChimbariPeerJ Inc.articleChronic disease managementHealth promotionHypertension care cascadePrimary healthSocial determinantsRural KwaZulu-NatalMedicineRENPeerJ, Vol 9, p e12372 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Chronic disease management Health promotion Hypertension care cascade Primary health Social determinants Rural KwaZulu-Natal Medicine R
spellingShingle	Chronic disease management Health promotion Hypertension care cascade Primary health Social determinants Rural KwaZulu-Natal Medicine R Herbert Chikafu Moses Chimbari Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa
description	Background Treatment 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. Methods This 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. Results Eighty-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. Conclusions The 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.
format	article
author	Herbert Chikafu Moses Chimbari
author_facet	Herbert Chikafu Moses Chimbari
author_sort	Herbert Chikafu
title	Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa
title_short	Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa
title_full	Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa
title_fullStr	Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa
title_full_unstemmed	Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa
title_sort	hypertension care cascade in the ingwavuma rural community, umkhanyakude district, kwazulu-natal province of south africa
publisher	PeerJ Inc.
publishDate	2021
url	https://doaj.org/article/ce7dadff50364b5b8c7971852ba33234
work_keys_str_mv	AT herbertchikafu hypertensioncarecascadeintheingwavumaruralcommunityumkhanyakudedistrictkwazulunatalprovinceofsouthafrica AT moseschimbari hypertensioncarecascadeintheingwavumaruralcommunityumkhanyakudedistrictkwazulunatalprovinceofsouthafrica
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Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa

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