Hypertension Control In Ghana Research Articles

Impact of COVID-19 on the management of hypertension: a perspective on disease severity, service use patterns and expenditures from Ghana's health insurance claims data.

Hypertension is a leading cause of morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in health service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests including t-tests, z-tests, and exact Poisson tests to estimate and compare hypertension episode intensity and related claim expenditures before and during the pandemic using medical claims data from Ghana's National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019-February 2020) relative to the target/pandemic period (March 2020-February 2021). We observed that although there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant. There was also an 18.64% or $22.88 (95% CI: $21-$25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.

Abstract 15333: The Addressing Hypertension Care in Africa (ADHINCRA) Study: A Multi-Level Nurse-Led, Mobile-Health Enhanced Intervention to Improve Hypertension Control in Ghana

Background: Ghana, is experiencing silent epidemics of hypertension (HTN) and cardiovascular disease (CVD). There is a dire need to implement multilevel strategies to improve HTN control in Ghana. The Addressing Hypertension Care in Africa (ADHINCRA) Study sought to test the feasibility of a multilevel, nurse-led, mobile-health enhanced intervention to improve HTN control in Ghana. Methods: Using a cluster-randomized controlled pilot trial design, we enrolled 4 hospitals in Kumasi, Ghana and recruited 240 patients with uncontrolled HTN, defined as systolic blood pressure (BP) ≥140 mm Hg. Two hospitals were randomized to the intervention and 2 to the enhanced usual care (UC) arm. Patients in the intervention arm received nurse-led task-shifting, a mobile health application and home BP monitoring. The intervention was administered for six months, after which it was withdrawn and patients were followed for 6 more months. The enhanced UC arm received usual care, plus short text messages on health. The primary outcome was change in BP control status at 6 and 12 months. We used general linear models to examine the probability of BP control, accounting for clustering within hospitals. Results: The mean age was 53 ± 9.7 years, 51% were women. After 6 months, BP control improved in the intervention arm (57.0%, 95% CI 56.8% to 57.1%) versus 18.1%, 95% CI 16.9% to 19.3%, for the UC arm), with a between-group difference of 38.9% (95% CI 37.7% to 40.1%; p<0.001). After 12 months, BP control improved in the intervention arm (80.5%, 95% CI 65.5% to 95.4%) versus 24.2%, 95% CI 10% to 38.5%, for the UC arm), with a between-group difference of 56.2% (95% CI 35.6% to 76.8%; p<0.001). ( Figure) Conclusion: A multi-level intervention nurse-led, mobile-health enhanced intervention was associated with greater BP control than enhanced UC among patients with HTN in Ghana. A larger scale study is warranted to support future scale-up of the ADHINCRA Study.

Addressing Hypertension Care in Africa (ADHINCRA): Study protocol for a cluster-randomized controlled pilot trial

BackgroundUncontrolled hypertension is a major risk factor for cardiovascular disease. Evidence-based interventions to improve hypertension control in high-income countries have not been translated equally in sub-Saharan Africa (SSA). The objective of the Addressing Hypertension Care in Africa (ADHINCRA) Study was to test the feasibility and signal of efficacy of a multilevel, nurse-led, mobile health enhanced intervention in improving hypertension control in Ghana. MethodsUsing a cluster randomized controlled pilot trial design, four hospitals in Kumasi, Ghana, were randomized to the intervention arm (2 hospitals) and enhanced usual care arm (2 hospitals). A total of 240 patients with uncontrolled hypertension defined as systolic blood pressure (BP) ≥140 mmHg on their most recent visit were included (60 patients per hospital). Patients in the intervention arm received an intervention that consisted of nurse-led task-shifting and a mobile health application (Medtronic® Labs' Empower Health), and home BP monitoring. The enhanced usual care arm received usual care as determined by their providers, plus short text messages on health. The intervention was administered for six months, after which it was withdrawn, and patients were followed for six more months to assess outcomes. Feasibility measures included recruitment and dropout rates of study participants, protocol adherence in both arms. Clinical outcomes included changes in BP control status and systolic BP levels from baseline. Secondary outcomes included change in glycemic control, rates of hypertensive urgencies/emergencies, cardiovascular disease events, and medication adherence. DiscussionFindings from this study will provide critical pilot data to inform the conduct of a larger scale trial and the development of scalable health system and policy interventions to improve hypertension control in low-resource settings.Trial registrationNCT04010344. Registered on July 8, 2019 at ClinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT04010344

Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial

BackgroundPhysician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana.MethodsGuided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana.DiscussionUptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the “how to do it” empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries.Trial registrationClinicalTrials.gov, NCT03490695. Registered on 6 April 2018.Protocol version and dateVersion 1, date: 21 August, 2019.

Adopting Task-Shifting Strategies for Hypertension Control in Ghana: Insights From a Realist Synthesis of Stakeholder Perceptions

BackgroundThe adoption, intention, initial decision or action to implement evidence-based strategies for hypertension control in real-world settings is a challenge in low- and middle-income countries. Although stakeholders are essential for the adoption of evidence-based interventions, data on how to engage them to improve uptake of these strategies is lacking. Using a realist synthesis of stakeholder perspectives, the authors describe a process for engaging stakeholders to identify facilitators and barriers to the adoption of an evidence-based task-strengthening strategy for hypertension control in Ghana. ObjectivesTo identify stakeholder perceptions of the factors influencing the adoption of evidence-based task-shifting strategies for hypertension control in Ghana. MethodsA realist evaluation of interviews, focus groups, and brainstorming activities was conducted to evaluate stakeholder perceptions of an evidence-based strategy designed to identify, counsel, and refer patients with hypertension for care in community health centers. Stakeholders included community health officers, administrators, and policymakers from the Ghana Health Service, researchers, and community health officers in community-based health planning services in the Kintampo region of Ghana. The study used a realist synthesis approach to thematically analyze the qualitative data generated. ResultsSixty-two stakeholders participated in the study. They identified inner contextual characteristics such as the provision of resources, training, supervision, and monitoring as well as community outreach as important for the adoption of an evidence-based strategy in Ghana. The findings highlight how stakeholders are faced with multiple and often competing system strains when contemplating uptake of evidence-based strategies for hypertension control. ConclusionsThrough the application of a realist synthesis of stakeholder perceptions, the study identified factors likely to enhance the adoption of an evidence-based strategy for hypertension control in Ghana. The lessons learned will help shape the translation of evidence in real-world settings, and could be valuable in future planning to enhance the adoption of evidence-based strategies for hypertension control in LMICs.

Capacity and Readiness for Implementing Evidence-Based Task-Strengthening Strategies for Hypertension Control in Ghana: A Cross-Sectional Study

BackgroundAssessing the practice capacity for hypertension management and control within community-based health planning and services system is an important step toward implementing evidence-based interventions to reduce uncontrolled hypertension at the community level. ObjectivesTo assess the capacity and readiness of community health workers to implement a task-strengthening strategy for hypertension control (TASSH) at the community level. MethodsThis was a cross-sectional study guided by the Consolidated Framework for Implementation Research conducted among community health workers in 6 contiguous districts within the Brong-Ahafo Region of Ghana. Study variables were described using frequency tables. ResultsA total of 179 community health officers (CHOs) were interviewed. The majority of respondents knew lifestyle-related messages to be provided to their clients such as heart-healthy diets (91.6%, n = 164), physical activity (90.5%, n = 162), and low sodium intake (88.3%, n = 158), but not about other lifestyle-modifying messages such as caffeine reduction (46.4%, n = 83). The majority (79%) of the respondents did not know the names of the first-line hypertension medications. Fifty-one percent of respondents did not know about the blood pressure threshold for initiation of blood pressure management. About 90% of respondents had not been trained on hypertension management. More than 80% are however motivated to implement the TASSH intervention. ConclusionsThe majority of CHOs in this study were aware of lifestyle modifications such as diet modifications and increase in physical activity. However, their knowledge was limited in the blood pressure threshold for initiating treatment and in the knowledge of first-line hypertension medication, irrespective of the number of years practiced. Training on hypertension is also low. However, CHOs are motivated to control hypertension at the community level. Community-level interventions such as TASSH can leverage on their motivation to demonstrate an impact on hypertension control.

Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study

ObjectivesTo evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control.SettingLower Manya Krobo, Eastern Region, Ghana.ParticipantsAll adult hypertensive community members, except pregnant women, were eligible for...

Exploring stakeholders\u2019 perceptions of a task-shifting strategy for hypertension control in Ghana: a qualitative study

BackgroundThe purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana.MethodsUsing focus group discussions and in-depth interviews, qualitative data were obtained from 81 key stakeholders including patients, nurses, and site directors of participating community health centers involved in the TASSH trial. Qualitative data were analyzed using open and axial coding techniques.ResultsAnalysis of the qualitative data revealed three themes that illustrate stakeholders' perceptions of the ongoing task-shifting strategy for blood pressure control in Ghana and they include: 1) awareness and understanding of the TASSH program; 2) reasons for participation and non-participation in TASSH; and 3) the benefit and drawbacks to the TASSH program.ConclusionThe findings support evidence that successful implementation of any task-shifting strategy must focus not only on individual patient characteristics, but also consider the role contextual factors such as organizational and leadership factors play. The findings also demonstrate the importance of understanding stakeholder's perceptions of evidence-based task-shifting interventions for hypertension control as it may ultimately influence the sustainable uptake of these interventions into "real world" settings.

Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study

BackgroundNurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses’ knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH).MethodsA pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses’ satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management.ResultsA total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses’ knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention.ConclusionsFindings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana.Trial registrationTrial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.