Abstract
BackgroundThe burdens of hypertension and diabetes are increasing in low- and middle-income countries (LMICs). It is important to identify patients with these conditions early in the disease process. The goal of this study, therefore, is to compare community- versus home-based screening for hypertension and diabetes in Kenya.MethodsThis was a feasibility study conducted by the Academic Model Providing Access to Healthcare (AMPATH) program in Webuye, a town in western Kenya. Home-based (door-to-door) screening occurred in March 2010 and community-based screening in November 2011. HIV counselors were trained to screen for diabetes and hypertension in the home-based screening with local district hospital based staff conducting the community-based screening. Participants >18 years old qualified for screening in both groups. Counselors referred all participants with a systolic blood pressure (SBP) ≥160 mmHg and/or a random blood glucose ≥7 mmol/L (126 mg/dL) to a local clinic for follow-up. Differences in likelihood of screening positive between the two strategies were compared using Fischer’s Exact Test. Logistic regression models were used to identify factors associated with the likelihood of following-up after a positive screening.ResultsThere were 236 participants in home-based screening: 13 (6%) had a SBP ≥160 mmHg, and 54 (23%) had a random glucose ≥ 7 mmol/L. There were 346 participants in community-based screening: 35 (10%) had a SBP ≥160 mmHg, and 27 (8%) had a random glucose ≥ 7 mmol/L. Participants in community-based screening were twice as likely to screen positive for hypertension compared to home-based screening (OR=1.93, P=0.06). In contrast, participants were 3.5 times more likely to screen positive for a random blood glucose ≥7 mmol/L with home-based screening (OR=3.51, P<0.01). Rates for following-up at the clinic after a positive screen were low for both groups with 31% of patients with an elevated SBP returning for confirmation in both the community-based and home-based group (P=1.0). Follow-up after a random glucose was also low with 23% returning in the home-based group and 22% in the community-based group (P=1.0).ConclusionCommunity- or home-based screening for diabetes and hypertension in LMICs is feasible. Due to low rates of follow-up, screening efforts in rural settings should focus on linking cases to care.
Highlights
The burdens of hypertension and diabetes are increasing in low- and middle-income countries (LMICs)
We hope to use these comparative assessments to inform local public health policy and health system planning for future screening activities. Study setting This pilot study is an initiative of the Academic Model Providing Access to Healthcare (AMPATH) program located in western Kenya, which is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of North American universities led by the Indiana University School of Medicine
In the community-based screening, 11 (31%) of the 35 participants identified with an systolic blood pressure (SBP) ≥ 160 mmHg returned for confirmation and all of these participants were confirmed to have a SBP ≥ 140 mmHg
Summary
The burdens of hypertension and diabetes are increasing in low- and middle-income countries (LMICs). In Kenya, hypertension and diabetes mellitus are considered widespread problems but there are few studies reporting the prevalence of these diseases or replicable screening strategies. An analysis of worldwide data in 2005 showed that 639 million (625–654 million) patients with hypertension live in low and middle income countries (LMICs) [1,2]. In Kenya, the available data on the burden of hypertension or diabetes suggests prevalence rates of 12% and 6.6%, respectively [7]. While worldwide rates of diabetes and hypertension appear to be increasing, the paucity of locally relevant data can hinder planning and developing preventative and clinical care strategies to manage these diseases. Strategies to improve the availability and accuracy of local prevalence data are needed
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