Abstract
Good practice on modifiable cardiovascular risk factors is based on good knowledge and a positive attitude. The study aims to assess cardiovascular risk and knowledge, attitudes and practices of hypertensive patients in Kinshasa on modifiable cardiovascular risk factors as well as their associated determinants. We conducted a cross-sectional study with 345 hypertensive patients followed at Monkole Hospital and at Saint-Joseph Hospital in the city of Kinshasa in the Democratic Republic of the Congo from September 2017 to February 2018. The participants were submitted to the WHO-Steps survey. Cardiovascular risk was assessed by the number of deleterious risk factors present in patients. Descriptive and inferential analyzes were performed. The statistical significance threshold was set at p<0.05. The average age of the participants was 62.1±11.2 years with a gender ratio of 1.1 in favor of women. In total, 61%, 56% and 60% of our respondents had, respectively, a low level of knowledge, a bad attitude and an insufficient practice on modifiable cardiovascular risk factors. Good knowledge was statistically significantly linked to education, the medical profession as a source of information, and employment. Only age ≥ 60 years was significantly associated with the right attitude in our patients while good practice was linked to the level of education. The majority of participants (80.3%) had a high cardiovascular risk. Poor knowledge (p: 0.032) and insufficient overall practice (p<0.001) were significantly associated with high cardiovascular risk. The present study showed that hypertension was associated with a high Cardiovascular risk underpinned by a low level of knowledge, a bad attitude and insufficient practice on modifiable cardiovascular risk factors. Therefore, education programs and strategies to positively influence attitudes and practices are essential to reduce the impact of cardiovascular disease and its risk factors in our environment.
Highlights
Cardiovascular diseases top the list of mortality causes worldwide with a high prevalence of modifiable risk factors [1]
[2] that Non-communicable diseases (NCDs) including cardiovascular disease, are the leading cause of death Journal of Family Medicine and Health Care 2021; 7(2): 47-56 worldwide, they are becoming a burden to both individuals and health system. [3, 4]. This rise is becoming more and more evident in Low and Middle income countries (LMICs) for diverse reasons such as poor collaboration and response, challenge in prioritizing allocation of resources between NCDs and pre-existing infectious diseases, [5] poor health delivery standards; [6] bias in health seeking behaviour with the most poor going for affordable, substandard services; [7] poor detection and management in rural areas compared to urban’s, [8] lack of control measures of risk factors in place to control high salt and fat consumption and data showing effect of interventions on them despite of availability of evidence supporting their cost-effectiveness; [9] and lastly, late detection with treatment commonly not aligned to guidelines and medicines not affordable by most patients
[10] LMICs, including sub-Saharan Africa (SSA) including DRC, NCDs present few specific features which explain its negative impact on health systems and even development prospects of these countries: firstly, they appear at a younger age compared to the age of onset in the western’s, complications and even deaths are seen prematurely and they carry a high death toll
Summary
Cardiovascular diseases top the list of mortality causes worldwide with a high prevalence of modifiable risk factors [1]. [3, 4] This rise is becoming more and more evident in Low and Middle income countries (LMICs) for diverse reasons such as poor collaboration and response, challenge in prioritizing allocation of resources between NCDs and pre-existing infectious diseases, [5] poor health delivery standards; [6] bias in health seeking behaviour with the most poor going for affordable, substandard services; [7] poor detection and management in rural areas compared to urban’s, [8] lack of control measures of risk factors in place to control high salt and fat consumption and data showing effect of interventions on them despite of availability of evidence supporting their cost-effectiveness; [9] and lastly, late detection with treatment commonly not aligned to guidelines and medicines not affordable by most patients. Even though studies examining issues of knowledge, attitude and practice regarding hypertension are scarce and they are inexistent in most places in Kinshasa
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