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Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017
Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health syste...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484448/ https://www.ncbi.nlm.nih.gov/pubmed/37676845 http://dx.doi.org/10.1371/journal.pgph.0002055 |
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author | Benade, Mariet Mchiza, Zandile Raquib, Rafeya V. Prasad, Sridevi K. Yan, Lily D. Brennan, Alana T. Davies, Justine Sudharsanan, Nikkil Manne-Goehler, Jennifer Fox, Matthew P. Bor, Jacob Rosen, Sydney B. Stokes, Andrew C. |
author_facet | Benade, Mariet Mchiza, Zandile Raquib, Rafeya V. Prasad, Sridevi K. Yan, Lily D. Brennan, Alana T. Davies, Justine Sudharsanan, Nikkil Manne-Goehler, Jennifer Fox, Matthew P. Bor, Jacob Rosen, Sydney B. Stokes, Andrew C. |
author_sort | Benade, Mariet |
collection | PubMed |
description | Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system’s ability to manage hypertension between 2011 and 2017. We used data from Waves 1–5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure. |
format | Online Article Text |
id | pubmed-10484448 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-104844482023-09-08 Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017 Benade, Mariet Mchiza, Zandile Raquib, Rafeya V. Prasad, Sridevi K. Yan, Lily D. Brennan, Alana T. Davies, Justine Sudharsanan, Nikkil Manne-Goehler, Jennifer Fox, Matthew P. Bor, Jacob Rosen, Sydney B. Stokes, Andrew C. PLOS Glob Public Health Research Article Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system’s ability to manage hypertension between 2011 and 2017. We used data from Waves 1–5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure. Public Library of Science 2023-09-07 /pmc/articles/PMC10484448/ /pubmed/37676845 http://dx.doi.org/10.1371/journal.pgph.0002055 Text en © 2023 Benade et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Benade, Mariet Mchiza, Zandile Raquib, Rafeya V. Prasad, Sridevi K. Yan, Lily D. Brennan, Alana T. Davies, Justine Sudharsanan, Nikkil Manne-Goehler, Jennifer Fox, Matthew P. Bor, Jacob Rosen, Sydney B. Stokes, Andrew C. Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017 |
title | Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017 |
title_full | Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017 |
title_fullStr | Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017 |
title_full_unstemmed | Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017 |
title_short | Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017 |
title_sort | health systems performance for hypertension control using a cascade of care approach in south africa, 2011–2017 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484448/ https://www.ncbi.nlm.nih.gov/pubmed/37676845 http://dx.doi.org/10.1371/journal.pgph.0002055 |
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