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Evaluating the cascade of care for hypertension in Sierra Leone
Author(s) -
Geraedts Tessa J. M.,
Boateng Daniel,
Lindenbergh Karel C.,
Delft Diede,
Mathéron Hanna M.,
Mönnink Gulia L. E.,
Martens Janine P. J.,
Leerdam Daniel,
Vas Nunes Jonathan,
BuBuakei Jabbi SonniaMagba,
Kpaka Mohamed S.,
Westendorp Josien,
Duinen Alex J.,
Sankoh Osman,
Grobusch Martin P.,
Bolkan Håkon A.,
KlipsteinGrobusch Kerstin
Publication year - 2021
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13664
Subject(s) - medicine , blood pressure , sierra leone , logistic regression , psychological intervention , odds ratio , population , risk factor , pediatrics , emergency medicine , environmental health , nursing , development economics , economics
Objective To assess the care for hypertension in Sierra Leone, by the use of a cascade‐of‐care approach, to identify where the need for healthcare system interventions is greatest. Methods Using data from a nationwide household survey on surgical conditions undertaken in 1956 participants ≥18 years from October 2019 to March 2020, a cascade of care for hypertension consisting of four categories – hypertensive population, those diagnosed, those treated and those controlled – was constructed. Hypertension was defined as having a blood pressure ≥140/90 mmHg, or self‐reported use of antihypertensive medication. Logistic regression analysis was used to investigate factors associated with undiagnosed hypertension. Results The prevalence of hypertension was 22%. Among those with hypertension, 23% were diagnosed, 11% were treated and 5% had controlled blood pressure. The largest loss to care (77%) was between being hypertensive and receiving a diagnosis. Male sex, age and living in a rural location, were significantly associated with the odds of undiagnosed hypertension. There was no significant difference between men and women in the number of patients with controlled blood pressure. Adults aged 40 or older were observed to be better retained in care compared with those younger than 40 years of age. Conclusion There is a significant loss to care in the care cascade for hypertension in Sierra Leone. Our results suggest that increasing awareness of cardiovascular risk and risk factor screening for early diagnosis might have a large impact on hypertension care.