Abstract
BackgroundThe burden of chronic diseases is increasing in both low- and middle-income countries. However, healthcare systems in low-income countries are inadequately equipped to deal with the growing disease burden, which requires chronic care for patients. The aim of this study was to assess the capacity of health facilities to manage hypertension in two districts in Uganda.MethodsIn a cross-sectional study conducted between June and October 2012, we surveyed 126 health facilities (6 hospitals, 4 Health Center IV (HCIV), 23 Health Center III (HCIII), 41 Health Center II (HCII) and 52 private clinics/dispensaries) in Mukono and Buikwe districts in Uganda. We assessed records, conducted structured interviews with heads of facilities, and administered questionnaires to 271 health workers. The study assessed service provision for hypertension, availability of supplies such as medicines, guidelines and equipment, in-service training for hypertension, knowledge of hypertension management, challenges and recommendations.ResultsOf the 126 health facilities, 92.9% reported managing (diagnosing/treating) patients with hypertension, and most (80.2%) were run by non-medical doctors or non-physician health workers (NPHW). Less than half (46%) of the facilities had guidelines for managing hypertension. A 10th of the facilities lacked functioning blood pressure devices and 28% did not have stethoscopes. No facilities ever calibrated their BP devices except one. About a half of the facilities had anti-hypertensive medicines in stock; mainly thiazide diuretics (46%), beta blockers (56%) and calcium channel blockers (48.4%). Alpha blockers, mixed alpha & beta blockers and angiotensin II receptor antagonists were only stocked by private clinics/dispensaries. Most HCIIs lacked anti-hypertensive medicines, including the first line thiazide diuretics. Significant knowledge gaps in classification of patients as hypertensive were noted among respondents. All health workers (except 5, 1.9%) indicated that they needed additional training in hypertension management. Several provider and patient related challenges were also observed in this study.ConclusionsHealth facilities in this setting are inadequately equipped to provide services for management of hypertension. Diagnostic equipment, anti-hypertensive drugs and personnel present great challenges. To address the increasing burden of hypertension and other chronic diseases, measures are needed to substantially strengthen the healthcare facilities, including training of personnel in management of hypertension and other chronic diseases, and improving diagnostic and treatment supplies.
Highlights
The epidemiological transition in global health from infectious to chronic non-communicable diseases (NCDs), especially, systemic hypertension, cardiovascular disease (CVD) and diabetes poses a significant threat to the health of those affected and the health systems at large[1]
Current literature shows that acute infectious communicable diseases still contribute the major disease burden in sub-Saharan Africa including Uganda with malaria, acute respiratory infections and HIV/AIDS among the top 10 causes of illness and deaths[7]
For least resources settings which are usually staffed by non-medical doctors or non-physicians health workers (NPHW), the WHO recommends a series of services which include BP measurement, history taking to elicit antecedents of heart attack, angina and stroke, counselling on behaviour modification, measurement of body mass index (BMI), administration of 1st line thiazide and prompt referral[14]
Summary
The epidemiological transition in global health from infectious to chronic non-communicable diseases (NCDs), especially, systemic hypertension, cardiovascular disease (CVD) and diabetes poses a significant threat to the health of those affected and the health systems at large[1]. Current literature shows that acute infectious communicable diseases still contribute the major disease burden in sub-Saharan Africa including Uganda with malaria, acute respiratory infections and HIV/AIDS among the top 10 causes of illness and deaths[7]. Managing NCDs including hypertension is a daunting task in many facilities in low and middle income countries[10]. The Uganda clinical guidelines (UCG) stipulate a range of recommendations for classification, diagnosis and management of hypertension. According to these guidelines, patients are classified as hypertensive if they present with a persistently high resting blood pressure (SBP 140 mmHg or DBP 90 mmHg or both).
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