Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals

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Abstract

Background

The prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda.

Methods

We conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach.

Results

The results replicated several findings from other settings, and identified some previously undocumented challenges including patients’ knowledge gaps regarding the preventable aspects of HTN and DM, patients’ mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management.

Conclusions

In order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.

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Most cited references 15

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Global burden of hypertension: analysis of worldwide data

P. Kearney, M Whelton, K. Reynolds … (2005)

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Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis.

Feven Ataklte, Sebhat Erqou, Stephen Kaptoge … (2015)

The burden of hypertension in Sub-Saharan Africa has been increasing over the past few decades. However, a large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular disease in the region. We conducted a systematic review and meta-analysis to assess the recent burden of hypertension in Sub-Saharan Africa, based on studies published between 2000 and 2013. We pooled data from 33 surveys involving over 110 414 participants of mean age 40 years. Hypertension prevalence varied widely across the studies (range 15%-70%), partly because of differences in participant mean ages (31-76 years). The predicted prevalence of hypertension at mean participant ages of 30, 40, 50, and 60 years were 16%, 26%, 35%, and 44%, respectively, with a pooled prevalence of 30% (95% confidence interval, 27%-34%). Of those with hypertension, only between 7% and 56% (pooled prevalence: 27%; 95% confidence interval, 23%-31%) were aware of their hypertensive status before the surveys. Overall, 18% (95% confidence interval, 14%-22%) of individuals with hypertension were receiving treatment across the studies, and only 7% (95% confidence interval, 5%-8%) had controlled blood pressure. This review found a high prevalence of hypertension, as well as low percentage of hypertension awareness, treatment, and control in Sub-Saharan Africa, highlighting the need for implementation of timely and appropriate strategies for diagnosis, control, and prevention. © 2014 American Heart Association, Inc.

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Is Open Access

The Epidemiology of Hypertension in Uganda: Findings from the National Non-Communicable Diseases Risk Factor Survey

David Guwatudde, Gerald Mutungi, Ronald Wesonga … (2015)

Background Hypertension is an important contributor to global burden of disease and mortality, and is a growing public health problem in sub-Saharan Africa. However, most sub-Saharan African countries lack detailed countrywide data on hypertension and other non-communicable diseases (NCD) risk factors that would provide benchmark information for design of appropriate interventions. We analyzed blood pressure data from Uganda’s nationwide NCD risk factor survey conducted in 2014, to describe the prevalence and distribution of hypertension in the Ugandan population, and to identify the associated factors. Methods The NCD risk factor survey drew a countrywide sample stratified by the four regions of the country, and with separate estimates for rural and urban areas. The World Health Organization’s STEPs tool was used to collect data on demographic and behavioral characteristics, and physical and biochemical measurements. Prevalence rate ratios (PRR) using modified Poison regression modelling was used to identify factors associated with hypertension. Results Of the 3906 participants, 1033 were classified as hypertensive, giving an overall prevalence of 26.4%. Prevalence was highest in the central region at 28.5%, followed by the eastern region at 26.4%, western region at 26.3%, and northern region at 23.3%. Prevalence in urban areas was 28.9%, and 25.8% in rural areas. The differences between regions, and between rural-urban areas were not statistically significant. Only 7.7% of participants with hypertension were aware of their high blood pressure. The prevalence of pre-hypertension was also high at 36.9%. The only modifiable factor found to be associated with hypertension was higher body mass index (BMI). Compared to participants with BMI less than 25 kg/m2, prevalence was significantly higher among participants with BMI between 25 to 29.9 kg/m2 with an adjusted PRR = 1.46 [95% CI = 1.25–1.71], and even higher among obese participants (BMI ≥ 30 kg/m2) with an adjusted PRR = 1.60 [95% CI = 1.29–1.99]. The un-modifiable factor found to be associated with hypertension was older age with an adjusted PRR of 1.02 [95% CI = 1.02–1.03] per yearly increase in age. Conclusions The prevalence of hypertension in Uganda is high, with no significant differences in distribution by geographical location. Only 7.7% of persons with hypertension were aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure. Thus a big percentage of persons with hypertension are at high risk of hypertension-related cardiovascular NCDs.

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Author and article information

Contributors

Haeyoon Chang: haeyoon.chang@yale.edu

Nicola L. Hawley: nicola.hawley@yale.edu

Robert Kalyesubula: rkalyesubula@gmail.com

Trishul Siddharthan: tsiddha1@jhmi.edu

William Checkley: wcheck1@jhmi.edu

Felix Knauf: felix.knauf@yale.edu

Tracy L. Rabin:

ORCID: http://orcid.org/0000-0002-4829-9051

203-785-2905 , tracy.rabin@yale.edu

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-9276

Publication date (Electronic): 28 February 2019

Publication date PMC-release: 28 February 2019

Publication date Collection: 2019

Volume: 18

Electronic Location Identifier: 38

Affiliations

[1 ]ISNI 0000000419368710, GRID grid.47100.32, Department of Epidemiology (Chronic Disease), , Yale University School of Public Health, ; New Haven, CT USA

[2 ]African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda

[3 ]ISNI 0000 0004 0620 0548, GRID grid.11194.3c, Department of Physiology, , Makerere University College of Health Sciences, ; Kampala, Uganda

[4 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Division of Pulmonary and Critical Care, School of Medicine, , Johns Hopkins University, ; Baltimore, MD USA

[5 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Center for Global Noncommunicable Disease Training and Research, , Johns Hopkins University, ; Baltimore, MD USA

[6 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Department of Nephrology and Medical Intensive Care, , Charité – Universitätsmedizin Berlin, ; Berlin, Germany

[7 ]ISNI 0000000419368710, GRID grid.47100.32, Department of Internal Medicine, , Yale University School of Medicine, ; New Haven, CT USA

[8 ]Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda

Author information

Tracy L. Rabin http://orcid.org/0000-0002-4829-9051

Article

Publisher ID: 934

DOI: 10.1186/s12939-019-0934-1

PMC ID: 6394065

PubMed ID: 30819193

SO-VID: 3632754d-5dca-4db8-a3db-1a7b4b775978

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 27 November 2018

Date accepted : 28 January 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003042, Else Kröner-Fresenius-Stiftung;

Award ID: 2016_HA44

Award Recipient : Felix Knauf

Funded by: FundRef http://dx.doi.org/10.13039/100005326, Yale University;

Award ID: Maureen and Antoine Chiquet Fund for Global Health Fellowship

Award ID: Coca-Cola World Fund at Yale

Award ID: Yale Global Health Leadership Institute Hecht-Albert Global Health Pilot Innovation Award for Junior Faculty

Award Recipient : Haeyoon Chang

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ScienceOpen disciplines: Health & Social care

Keywords: hypertension,diabetes,uganda,rural health,chronic diseases,qualitative,village health team

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ScienceOpen disciplines: Health & Social care

Keywords: hypertension, diabetes, uganda, rural health, chronic diseases, qualitative, village health team

Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals

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Most cited references 15

Global burden of hypertension: analysis of worldwide data

Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis.

The Epidemiology of Hypertension in Uganda: Findings from the National Non-Communicable Diseases Risk Factor Survey

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