You are here

Article Text

Article menu

Download PDFPDF

XML
Global health
Research
Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study
  1. Sophie W Galson1,2,
  2. Catherine A Staton1,2,3,
  3. Francis Karia4,
  4. Kajiru Kilonzo5,
  5. Joseph Lunyera6,
  6. Uptal D Patel7,
  7. Julian T Hertz1,2,
  8. John W Stanifer2,8
  1. 1Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA
  2. 2Duke Global Health Institute, Durham, North Carolina, USA
  3. 3Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Global Health Institute, Durham, North Carolina, USA
  4. 4Kilimanjaro Christian Medical University College, Moshi, Tanzania
  5. 5Department of Medicine, Kilimanjaro Christian Medical Center, Moshi, Tanzania
  6. 6Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
  7. 7Department of Medicine, Duke Clinical Research Institute , Duke University, Durham, North Carolina, USA
  8. 8Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Sophie W Galson; sophie.galson{at}duke.edu

Abstract

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.

  • Hypertension
  • Qualitative research
  • Health Disparities
  • Non-communicable diseases

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-018829

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors JS and UDP developed the concept of the project. JS and FK conducted the data collection. SWG and JS contributed to the writing of the manuscript. JS and JL were responsible for the analysis plan and data analysis. All authors were responsible for the final editing and approved the final manuscript.

    • Funding This study was supported by an NIH Research Training Grant (no R25 TW009337) funded by the Fogarty International Center and the National Institute of Mental Health and a Research and Prevention Grant funded by the International Society of Nephrology Global Outreach Committee. CS would like to acknowledge salary support funding from the Fogarty International Center (K01 TW010000-01A1).

    • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

    • Ethics approval The study protocol was approved by the Duke University Institutional Review Board (no Pro00040784), the Kilimanjaro Christian Medical College (KCMC) Ethics Committee (EC no 502) and the National Institute for Medical Research (NIMR) in Tanzania.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We have concerns about the ethics of openly releasing the entire dataset to the public as the structure of the dataset would result in loss of participant anonymity. However, we will ensure that the dataset is openly available to researchers who contact us and meet confidentiality requirements (documentation of ethics training in conduct of human-subject research). They may contact Dr John W Stanifer, DCRI 2400 Pratt St, Durham NC 27710 or john.stanifer@duke.edu