Galson, Sophie, Staton, Catherine, Karia, Frank, Kilonzo, Kajiru, Lunyera, Joseph, Patel, Uptal, Hertz, Julian, Stanifer, John
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Introduction: Sub-Saharan Africa (SSA) 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 January 2014 and June 2015, we conducted a mixed-method study, including a cross-sectional household epidemiological survey and qualitative sessions of focus groups and indepth interviews. For the survey, we assessed for hypertension, defined as a single blood pressure ≥ 160/100 mmHg or a two-time average of ≥ 140/90 mmHg or current use of anti-hypertensive medications. To investigate relationships with potential risk factors, we used adjusted generalized linear models. Uncontrolled hypertension was defined as a two-time average measurement of ≥ 160/100 mmHg irrespective of treatment status. Hypertension awareness was defined a self-reported disease history in a patient 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) from 346 households, including 123 men (25.6%) and 358 women (74.4%). Overall, the prevalence of hypertension was 28.0% (95% CI 19.4-38.7), which was independently associated with age >60 years (RR 4.68; 95% CI 2.25-9.74) and alcohol use (RR 1.76; 95% CI 1.20- 2.59). 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 waittimes and under-trained providers.

Conclusions: In northern Tanzania, the burden of hypertensive disease is substantial and optimal hypertension control is rare. Trans-disciplinary strategies sensitive to local practices should be explored to facilitate early diagnosis and sustained care delivery.