Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P’s (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review

  • BMC Cardiovascular Disorders, Volume 21, No. 1, Year 2021

listen audio

Study Justification:
– Hypertension control in Sub-Saharan Africa (SSA) is significantly worse compared to the rest of the world.
– This scoping review aims to identify and describe the possible reasons for poor blood pressure control in Eastern SSA based on four factors: patient, professional, primary healthcare system, and public health policy.
Highlights:
– The mean prevalence of hypertension in Eastern SSA is 20.95%, with only 11.5% of patients having their blood pressure under control.
– Patient adherence to prescribed medicines is at 60%.
– Only three out of ten countries (Kenya, Malawi, and Zambia) have started annual screening of the high-risk population for hypertension.
– Reasons for nonadherence to prescribed medicines include lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws.
– Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, and maternal and child malnutrition contribute to the worst blood pressure control in the region.
Recommendations:
– Improve government commitment to addressing hypertension control.
– Increase patient awareness and access to medicines.
– Design country-specific annual screening programs for high-risk populations.
– Empower clinicians to follow individualized treatment plans.
– Conduct medication adherence research using more robust tools.
Key Role Players:
– Government health departments and policymakers
– Primary healthcare providers and clinicians
– Patient advocacy groups and community health workers
– Researchers and academics in the field of hypertension control
Cost Items for Planning Recommendations:
– Government funding for healthcare infrastructure and services
– Budget for public health campaigns and patient education programs
– Resources for training and capacity building of healthcare professionals
– Research grants for medication adherence studies
– Funding for the implementation of country-specific annual screening programs

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a scoping review that included 68 relevant articles. The study used a systematic search query and included various types of studies related to uncontrolled blood pressure and associated factors. However, the abstract does not provide specific details about the methodology used in the scoping review, such as the search strategy or the criteria for inclusion and exclusion. To improve the strength of the evidence, the abstract could provide more transparency about the methodology and ensure that the inclusion and exclusion criteria are clearly defined. Additionally, the abstract could mention the quality assessment of the included studies and any potential limitations of the scoping review.

Aim: Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps’ (patient, professional, primary healthcare system, and public health policy) factors. Methods: PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar. Results: Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control. Conclusion: In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.

In eastern SSA, there is lack of comprehensive evidence on reasons of poor blood pressure control. Out of 20 Eastern SSA countries, we included ten countries in this review. Countries included were; Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Seychelles, United Republic of Tanzania, Uganda, Zambia, and Zimbabwe [19, 20]. Countries are selected based on the following criteria: availability of recent national STEPS survey report, availability of primary health system capacity survey to provide care for patients with CVDs, availability of national chronic disease management strategies, accessibility of national health policy, and accessibility of health sector improvement strategies, directives, strategies, guidelines, and manuals. We searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google Scholar with a systematic search query (available in Additional file 1). The following national documents are included in addition to systematically searched articles. These include the National health policy of selected countries, national chronic disease prevention, management and control strategies of selected countries, national quality improvement strategies, and national technology integration strategies. Systematic reviews, clinical trials, cohort studies, observational and cross-sectional studies related to uncontrolled blood pressure and associated factors. Systematic reviews, clinical trials, cohort studies, observational and cross-sectional studies related to uncontrolled blood pressure and associated (patient, professional, public policy, and political) factors among adults in Eastern Sub-Saharan Africa are included. Studies conducted before January 2000, short communications, and conference proceedings are excluded. Articles that are not related to uncontrolled blood pressure and associated (patient, professional, public policy and political) factors among adults in Eastern Sub-Saharan Africa are excluded. From a total of 421 articles identified by the literature search, 172 potentially relevant articles were abstracted. After applying the inclusion–exclusion criteria listed above, 68 articles were found to be relevant (Fig. 1). Two investigators independently reviewed each study’s abstract against pre-specified inclusion and exclusion criteria. In case of disagreement on the article’s quality, two authors discussed In front of the table in the third and fourth authors’ presence. Flowchart representing the selection of sources of evidence and the number of articles excluded and eligible for review Two investigators abstracted population CVD risk factors, level of uncontrolled blood pressure, 4Ps (patient, professional, primary healthcare, and public policy related factors) associated with uncontrolled blood pressure data from all included studies. A second investigator checked these data for accuracy. Disagreements among us are managed through discussion in the presence of other authors. Prevalence of blood pressure control, patient-related, professional-related, primary healthcare system-related, and public health policy and politics, determinants of poor blood pressure control are used as data-items. We qualitatively described and summarized the evidence on blood pressure control based on 4P’s (primary care, patient, professional, and public health policy-related factors). We also described the major primary healthcare challenges contributing to the region’s worst BP control and strategies to address them.

Based on the information provided, it appears that the scoping review focused on identifying and describing the possible reasons for poor blood pressure control in Eastern Sub-Saharan Africa. The review highlighted several factors contributing to the low rate of blood pressure treatment, control, and medication adherence in the region. Some potential innovations that could be considered to improve access to maternal health in this context include:

1. Strengthening primary healthcare systems: Enhancing the capacity of primary healthcare facilities to provide comprehensive maternal health services, including blood pressure monitoring and management.

2. Increasing patient awareness: Implementing targeted awareness campaigns to educate pregnant women and their families about the importance of blood pressure control during pregnancy and the potential risks associated with hypertension.

3. Improving access to medicines and health services: Addressing the barriers that limit access to essential medicines and healthcare services, such as geographical distance, cost, and availability.

4. Enhancing healthcare provider training: Providing healthcare professionals with training and resources to effectively manage hypertension in pregnant women, including the use of evidence-based guidelines and individualized treatment approaches.

5. Government commitment and policy support: Encouraging governments to prioritize maternal health and develop policies that support the implementation of effective interventions for blood pressure control during pregnancy.

6. Annual screening programs: Designing and implementing country-specific annual screening programs to identify high-risk pregnant women who may require closer monitoring and intervention for blood pressure control.

7. Research on medication adherence: Conducting research to better understand the factors influencing medication adherence among pregnant women with hypertension and developing interventions to improve adherence rates.

These innovations, if implemented effectively, have the potential to improve access to maternal health services and contribute to better blood pressure control during pregnancy in Eastern Sub-Saharan Africa.
AI Innovations Description
Based on the information provided, the scoping review identified several reasons for poor blood pressure control in Eastern Sub-Saharan Africa (SSA). These reasons include:

1. Patient-related factors: Lack of awareness about hypertension, lack of access to medicines and health services, and non-adherence to prescribed medications.

2. Professional-related factors: Professional inertia to intensify drug treatment, lack of knowledge on evidence-based guidelines, and insufficient government commitment.

3. Primary healthcare system-related factors: Lack of screening for high-risk patients, weak political commitment, and poverty.

4. Public health policy-related factors: Maternal and child malnutrition, specific health behavior-related laws, and insufficient government commitment.

To improve access to maternal health in Eastern SSA, the following recommendations can be developed into innovations:

1. Improve government commitment: Governments should prioritize maternal health by allocating sufficient resources, developing and implementing comprehensive national health policies, and integrating maternal health into existing healthcare systems.

2. Increase patient awareness: Implement community-based education programs to raise awareness about the importance of maternal health, including the prevention and management of hypertension during pregnancy.

3. Enhance access to medicines: Improve the availability and affordability of essential medicines for maternal health, including medications for managing hypertension during pregnancy.

4. Design country-specific annual screening programs: Develop and implement national screening programs to identify high-risk pregnant women for hypertension and other maternal health conditions.

5. Empower clinicians: Provide training and support to healthcare professionals to ensure they have the knowledge and skills to provide individualized treatment for pregnant women with hypertension and other maternal health conditions.

6. Conduct medication adherence research: Use robust tools to study medication adherence among pregnant women with hypertension and develop interventions to improve adherence rates.

By implementing these recommendations, access to maternal health can be improved, leading to better outcomes for pregnant women and their babies in Eastern SSA.
AI Innovations Methodology
Based on the provided information, it appears that the focus is on improving blood pressure control in Eastern Sub-Saharan Africa. However, the request is to consider innovations for potential recommendations to improve access to maternal health. It seems there may be a mismatch in the information provided.

To address the request for innovations to improve access to maternal health, here are a few potential recommendations:

1. Telemedicine: Implementing telemedicine services can improve access to maternal health by allowing pregnant women in remote or underserved areas to consult with healthcare professionals through virtual appointments. This can help overcome geographical barriers and provide timely prenatal care.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information and resources on maternal health can empower women with knowledge and support. These apps can offer guidance on prenatal care, nutrition, breastfeeding, and postpartum care, ensuring that women have access to essential information at their fingertips.

3. Community health workers: Training and deploying community health workers who are specifically focused on maternal health can improve access to care in rural areas. These workers can provide education, prenatal check-ups, and referrals to healthcare facilities, bridging the gap between communities and formal healthcare systems.

4. Maternal health clinics: Establishing dedicated maternal health clinics in underserved areas can ensure that women have access to comprehensive prenatal care, including regular check-ups, screenings, and vaccinations. These clinics can also provide postpartum care and family planning services.

Methodology to simulate the impact of these recommendations on improving access to maternal health:

1. Define the target population: Identify the specific population that will benefit from the recommendations, such as pregnant women in rural areas or low-income communities.

2. Collect baseline data: Gather data on the current state of access to maternal health services in the target population. This can include information on the number of healthcare facilities, distance to the nearest facility, availability of prenatal care, and maternal health outcomes.

3. Develop a simulation model: Create a simulation model that incorporates the recommended innovations and their potential impact on improving access to maternal health. This model should consider factors such as the number of telemedicine consultations, usage of mHealth applications, deployment of community health workers, and establishment of maternal health clinics.

4. Input data and parameters: Input the baseline data and parameters into the simulation model. This can include information on the population size, geographical distribution, healthcare infrastructure, and utilization rates of the recommended innovations.

5. Run simulations: Run multiple simulations using different scenarios to assess the potential impact of the recommendations on improving access to maternal health. This can involve varying parameters such as the number of telemedicine consultations, coverage of mHealth applications, and the number of community health workers deployed.

6. Analyze results: Analyze the simulation results to determine the potential impact of the recommendations on access to maternal health. This can include evaluating changes in the number of women receiving prenatal care, reductions in travel distances, improvements in health outcomes, and cost-effectiveness.

7. Refine and validate the model: Refine the simulation model based on feedback and validation from relevant stakeholders, including healthcare professionals, policymakers, and community members. Incorporate additional data and refine parameters to improve the accuracy of the simulations.

8. Communicate findings: Present the findings of the simulation study to key stakeholders and decision-makers. Highlight the potential benefits of the recommended innovations in improving access to maternal health and advocate for their implementation.

It’s important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data.


Statistics:
Citations: 9
Identifiers:
DOI: 10.1186/s12872-021-01934-6
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Social Determinants, Technology and Innovations
Study Countries:
Ethiopia, Kenya, Malawi, Mozambique, Multi-Countries, Rwanda, Seychelles, Tanzania, Uganda, Zambia, Zimbabwe
Study Design:
Cohort Study, Cross Sectional Study
Study Approach:
Mixed-methods, Quantitative, Systematic Review
Share this:
Facebook
Twitter
LinkedIn
WhatsApp
Email