What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension and diabetes (n=2146). Intervention: Risk factors and care access. Primary outcome: Prevalence of hypertension (95% CI 30.6-36.5).

September 4, 2020Open Access

Hypertension and diabetes in Zanzibar – prevalence and access to care

Resultado clave

The prevalence of hypertension in Zanzibar was 33.5%, with only 10.9% of the hypertensive population achieving adequate blood pressure control.

Diseño del estudio

Tipo

Cross-Sectional (n=2,146)

PICO estructurado

Población

2,146 adults aged 25-64 years in Zanzibar participated in a nationally representative cross-sectional survey assessing the prevalence and care cascades of hypertension and diabetes.

Resultado

Prevalence of hypertension (systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or self-reported diagnosis) and diabetes (fasting blood glucose ≥6.1 mmol/L or self-reported diagnosis), and progression through care cascades (tested, diagnosed, treated, and achieving control).

There is a high prevalence of hypertension and a large unmet need for both hypertension and diabetes care in Zanzibar, with only ~11% of affected individuals achieving disease control.

Limitaciones

Small sample size
Cross-sectional design limits causal inference
Diagnosis based on a single occasion of raised blood pressure or fasting blood glucose
Missingness in responses to household income questions meant income was not included as a covariate

Resumen

BACKGROUND: Cardiovascular diseases are among the most common causes of hospital admissions and deaths in Zanzibar. This study assessed prevalence of, and antecedent factors and care access for the two common cardiovascular risk factors, hypertension and diabetes, to support health system improvements. METHODS: Data was from a population based nationally representative survey. Prevalence of hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or a self-reported diagnosis of hypertension; diabetes was defined as a fasting blood glucose ≥6.1 mmol/L or a self-reported diagnosis of diabetes. Care-cascades for hypertension and diabetes were created with four stages: being tested, diagnosed, treated, and achieving control. Multivariable logistic regression models were constructed to evaluate individual-level factors - including symptoms of mental illness - associated with having hypertension or diabetes, and with progressing through the hypertension care cascade. Whether people at overt increased risk of hypertension or diabetes (defined as > 50 years old, BMI > 30 kg/m2, or currently smoking) were more likely to be tested was assessed using chi squared. RESULTS: Prevalence of hypertension was 33.5% (CI 30.6-36.5). Older age (OR 7.7, CI 4.93-12.02), some education (OR 0.6, CI 0.44-0.89), obesity (OR 3.1, CI 2.12-4.44), and raised fasting blood glucose (OR 2.4, CI 2.38) were significantly independently associated with hypertension. Only 10.9% (CI 8.6-13.8) of the entire hypertensive population achieved blood pressure control, associated factors were being female (OR 4.8, CI 2.33-9.88), formally employed (OR 3.0, CI 1.26-7.17), and overweight (OR 2.5, CI 1.29-4.76). The prevalence of diabetes was 4.4% (CI 3.4-5.5), and associated with old age (OR 14.1, CI 6.05-32.65) and almost significantly with obesity (OR 2.1, CI 1.00-4.37). Only 11.9% (CI 6.6-20.6) of the diabetic population had achieved control. Individuals at overt increased risk were more likely to have been tested for hypertension (chi2 19.4) or diabetes (chi2 33.2) compared to the rest of the population. Symptoms of mental illness were not associated with prevalence of disease or progress through the cascade. CONCLUSION: High prevalence of hypertension and suboptimal management along the care cascades indicates a large unmet need for hypertension and diabetes care in Zanzibar.

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