Key result
Health system determinants like provider knowledge and service access drive hypertension outcomes in Sub-Saharan Africa.
Why the study?
Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates in Sub-Saharan Africa.
Systematic Review
Yes
A combination of multiple health system interventions, rather than solo interventions, may yield significant improvements in blood pressure outcomes in Sub-Saharan Africa.
Answers are grounded in this paper and cite their sources.
Combined interventions targeting provider knowledge and access may improve hypertension control in Sub-Saharan Africa; extends evidence to guide future implementation trials.
Background Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores health system factors contributing to hypertension outcomes in SSA. Methods The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and June 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for risk of bias using the tools from Joanna Briggs Institute. Results Thirty-nine studies clustered in 10 SSA countries met inclusion criteria. Health system determinants included human resource factors such as providers’ knowledge and adherence to hypertension treatment guidelines (n=21) and task sharing and shifting strategies (n=10). The second health system factors explored in service delivery were the health facility type and capacity (n=7) and hypertension service accessibility by cost, place, and time of services (n=15). A quarter of the included studies explored supply chain management for access to essential equipment and medicines. An additional set of studies addressed quality improvement strategies involving cross-integration of services (n=7) and various strategies of gauging the systems for better hypertension outcomes (n=8). Conclusion A combination of multiple rather than solo system interventions may yield significant improvements in blood pressure outcomes. Health information management and leadership involvement were less explored. Additional research on health system determinants of hypertension is needed to drive global improvements in hypertension outcomes. Future research would benefit from more rigorous implementation type interventional studies comprehensively assessing health system factors that contribute to better hypertension outcomes.
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Byiringiro et al. (2022) conducted a systematic review in Hypertension. Health system interventions was evaluated on Hypertension outcomes. Health system determinants like provider knowledge (n=21 studies) and service accessibility (n=15) were identified as key drivers of hypertension outcomes in 10 Sub-Saharan African countries.
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