Outcomes of the healthy heart Africa program on management of hypertensive patients in Nairobi county, Kenya.
Abstract
Background: Hypertension is an independent risk factor for developing cardiovascular and renal
diseases worldwide. Hypertensive patients in Sub-Saharan Africa have low hypertension
awareness, treatment levels and control. In response to these problems, AstraZeneca, a British Swedish Pharmaceutical Company, introduced the Healthy Heart Africa program which it
implements in partnership with AMREF Health Africa in Nairobi.
Study objective: To compare the management and treatment outcomes of hypertensive patients
enrolled into the Healthy Heart Africa (HHA) program and their unenrolled counterparts.
Method: The study was carried out at two HHA program implementation sites in Kibera slum i.e.
Kibera Community Health Center and Karen Health Center. The comparison population was
drawn from Dandora Phase 1 and 2 Health Centers. This study was conducted in two phases. The
first phase that was quantitative adopted a retrospective cohort study approach whereby
hypertensive patients who met the eligibility criteria were identified. A designed, pre-tested and
modified Data Collection Form was used for collecting patient information including sociodemographic and clinical characteristics, BP readings and all prescribed medicines and the
respective dosages. The primary outcome was adequacy of controlled blood pressure. The second
phase was a qualitative research design that employed patient interviews that were used in
assessing the level of adherence to treatment among the hypertensive patients. Prescribers and key
informants were also interviewed to elicit information on aspects of management of patients as
well as the challenges experienced in the adoption and implementation of the program.
Quantitative data was analyzed descriptively using measures such as frequencies, percentages,
mean and standard deviation. Two-sample t-test analysis were used to establish whether the mean
and median BP of the patients at the two study groups were significantly different. The strength of
association between adherence score and level of blood pressure was obtained using linear
regression. Multiple logistic regression analysis was used to establish the independent relationship
between adequacy of BP control and selected predictor variables of the study. The level of
significance was set at 0.05. A descriptive thematic approach was used to analyze the qualitative
data, whereby the data was examined; key and meaningful themes/patterns were identified and
interpreted by triangulation of all the provided information. Approval to carry out the study was
granted by Kenyatta National Hospital/University of Nairobi Ethics and Research Committee
(KNH/UoN-ERC).
Results: Of the 265 patients screened over a 6 months’ period, 250 (91%) met the inclusion criteria
and 205 were recruited; 58.5% were female; mean age was 54 years; mean duration of
hypertension management was <2 years. Seventy-eight (72%) patients enrolled in HHA had
adequate BP control compared to forty-two (43%) in the non-HHA sites after 6 months of
treatment. Seventy (34.1%) of the patients were fully adherent to medication. Patients in the HHA
(OR 2.6 95% CI 1.5, 4.6; p <0.001) had their BP better controlled compared to their unenrolled
counterparts. Adherence to medication (OR 0.87 95% CI 0.8, 0.9; p<0.001) significantly
contributed to BP control.
Conclusion: Patients managed at the HHA enrolled facilities had their Blood pressure levels
adequately controlled compared to those in non-HHA health facilities. These patients were also
observed to be highly adherent to their antihypertensive therapy. Adherence to antihypertensive
therapy and patient’s level of education were predictors of adequate BP control. Programs similar
to HHA should be designed and scaled up to cover numerous facilities so that large numbers of
patients benefit. A prospective study on hypertension treatment outcomes and adherence should
also be conducted.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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