Key result
A voluntary health insurance program in rural Nigeria was associated with an 11.43 mm Hg greater reduction in systolic BP among adults with stage 2 hypertension (95% CI 1.62 to 21.23).
Why the study?
Does a voluntary health insurance program and facility quality improvement reduce blood pressure in hypertensive adults in rural Nigeria?
Observational (n=332)
Does a voluntary health insurance program and facility quality improvement reduce blood pressure in hypertensive adults in rural Nigeria?
Mean Difference: 4.97 (95% CI -0.76–10.71)
Access to health insurance and healthcare quality improvement in rural settings is associated with significant long-term reductions in systolic blood pressure among adults with moderate to severe hypertension.
Hypothesis-generating for insurance programs in low-resource hypertension care; leaves open causal effects and generalizability.
BACKGROUND: Hypertension is a leading risk factor for death in sub-Saharan Africa. Quality treatment is often not available nor affordable. We assessed the effect of a voluntary health insurance program, including quality improvement of healthcare facilities, on blood pressure (BP) in hypertensive adults in rural Nigeria. METHODS: We compared changes in outcomes from baseline (2009) to midline (2011) and endline (2013) between non-pregnant hypertensive adults in the insurance program area (PA) and a control area (CA), through household surveys. The primary outcome was the difference between the PA and CA in change in BP, using difference-in-differences analysis. RESULTS: Of 1500 eligible households, 1450 (96.7%) participated, including 559 (20.8%) hypertensive individuals, of which 332 (59.4%) had follow-up data. Insurance coverage increased from 0% at baseline to 41.8% at endline in the PA and remained under 1% in the CA. The PA showed a 4.97 mm Hg (95% CI: -0.76 to +10.71 mm Hg) greater decrease in systolic BP and a 1.81 mm Hg (-1.06 to +4.68 mm Hg) greater decrease in diastolic BP from baseline to endline compared to the CA. Respondents with stage 2 hypertension showed an 11.43 mm Hg (95% CI: 1.62 to 21.23 mm Hg) greater reduction in systolic BP and 3.15 mm Hg (-1.22 to +7.53 mm Hg) greater reduction in diastolic BP in the PA compared to the CA. Attrition did not affect the results. CONCLUSION: Access to improved quality healthcare through an insurance program in rural Nigeria was associated with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertension.
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Hendriks et al. (2015) conducted an observational in Hypertension (n=332). Voluntary health insurance program and facility quality improvement vs. Control area without the insurance program was evaluated on Difference in change in blood pressure from baseline to endline (MD 4.97 mm Hg, 95% CI -0.76 to 10.71). A voluntary health insurance program in rural Nigeria was associated with an 11.43 mm Hg greater reduction in systolic BP among adults with stage 2 hypertension (95% CI 1.62 to 21.23).
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