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Hypertension and diabetes in Zanzibar – prevalence and access to care
BACKGROUND: Cardiovascular diseases are among the most common causes of hospital admissions and deaths in Zanzibar. This study assessed prevalence of, and antecedent factors and care access for the two common cardiovascular risk factors, hypertension and diabetes, to support health system improvemen...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472575/ https://www.ncbi.nlm.nih.gov/pubmed/32887593 http://dx.doi.org/10.1186/s12889-020-09432-8 |
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author | Jorgensen, Jutta M. Adelin Hedt, Kaya Helene Omar, Omar Mwalim Davies, Justine I. |
author_facet | Jorgensen, Jutta M. Adelin Hedt, Kaya Helene Omar, Omar Mwalim Davies, Justine I. |
author_sort | Jorgensen, Jutta M. Adelin |
collection | PubMed |
description | BACKGROUND: Cardiovascular diseases are among the most common causes of hospital admissions and deaths in Zanzibar. This study assessed prevalence of, and antecedent factors and care access for the two common cardiovascular risk factors, hypertension and diabetes, to support health system improvements. METHODS: Data was from a population based nationally representative survey. Prevalence of hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or a self-reported diagnosis of hypertension; diabetes was defined as a fasting blood glucose ≥6.1 mmol/L or a self-reported diagnosis of diabetes. Care-cascades for hypertension and diabetes were created with four stages: being tested, diagnosed, treated, and achieving control. Multivariable logistic regression models were constructed to evaluate individual-level factors – including symptoms of mental illness - associated with having hypertension or diabetes, and with progressing through the hypertension care cascade. Whether people at overt increased risk of hypertension or diabetes (defined as > 50 years old, BMI > 30 kg/m2, or currently smoking) were more likely to be tested was assessed using chi squared. RESULTS: Prevalence of hypertension was 33.5% (CI 30.6–36.5). Older age (OR 7.7, CI 4.93–12.02), some education (OR 0.6, CI 0.44–0.89), obesity (OR 3.1, CI 2.12–4.44), and raised fasting blood glucose (OR 2.4, CI 2.38) were significantly independently associated with hypertension. Only 10.9% (CI 8.6–13.8) of the entire hypertensive population achieved blood pressure control, associated factors were being female (OR 4.8, CI 2.33–9.88), formally employed (OR 3.0, CI 1.26–7.17), and overweight (OR 2.5, CI 1.29–4.76). The prevalence of diabetes was 4.4% (CI 3.4–5.5), and associated with old age (OR 14.1, CI 6.05–32.65) and almost significantly with obesity (OR 2.1, CI 1.00–4.37). Only 11.9% (CI 6.6–20.6) of the diabetic population had achieved control. Individuals at overt increased risk were more likely to have been tested for hypertension (chi2 19.4) or diabetes (chi2 33.2) compared to the rest of the population. Symptoms of mental illness were not associated with prevalence of disease or progress through the cascade. CONCLUSION: High prevalence of hypertension and suboptimal management along the care cascades indicates a large unmet need for hypertension and diabetes care in Zanzibar. |
format | Online Article Text |
id | pubmed-7472575 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74725752020-09-08 Hypertension and diabetes in Zanzibar – prevalence and access to care Jorgensen, Jutta M. Adelin Hedt, Kaya Helene Omar, Omar Mwalim Davies, Justine I. BMC Public Health Research Article BACKGROUND: Cardiovascular diseases are among the most common causes of hospital admissions and deaths in Zanzibar. This study assessed prevalence of, and antecedent factors and care access for the two common cardiovascular risk factors, hypertension and diabetes, to support health system improvements. METHODS: Data was from a population based nationally representative survey. Prevalence of hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or a self-reported diagnosis of hypertension; diabetes was defined as a fasting blood glucose ≥6.1 mmol/L or a self-reported diagnosis of diabetes. Care-cascades for hypertension and diabetes were created with four stages: being tested, diagnosed, treated, and achieving control. Multivariable logistic regression models were constructed to evaluate individual-level factors – including symptoms of mental illness - associated with having hypertension or diabetes, and with progressing through the hypertension care cascade. Whether people at overt increased risk of hypertension or diabetes (defined as > 50 years old, BMI > 30 kg/m2, or currently smoking) were more likely to be tested was assessed using chi squared. RESULTS: Prevalence of hypertension was 33.5% (CI 30.6–36.5). Older age (OR 7.7, CI 4.93–12.02), some education (OR 0.6, CI 0.44–0.89), obesity (OR 3.1, CI 2.12–4.44), and raised fasting blood glucose (OR 2.4, CI 2.38) were significantly independently associated with hypertension. Only 10.9% (CI 8.6–13.8) of the entire hypertensive population achieved blood pressure control, associated factors were being female (OR 4.8, CI 2.33–9.88), formally employed (OR 3.0, CI 1.26–7.17), and overweight (OR 2.5, CI 1.29–4.76). The prevalence of diabetes was 4.4% (CI 3.4–5.5), and associated with old age (OR 14.1, CI 6.05–32.65) and almost significantly with obesity (OR 2.1, CI 1.00–4.37). Only 11.9% (CI 6.6–20.6) of the diabetic population had achieved control. Individuals at overt increased risk were more likely to have been tested for hypertension (chi2 19.4) or diabetes (chi2 33.2) compared to the rest of the population. Symptoms of mental illness were not associated with prevalence of disease or progress through the cascade. CONCLUSION: High prevalence of hypertension and suboptimal management along the care cascades indicates a large unmet need for hypertension and diabetes care in Zanzibar. BioMed Central 2020-09-04 /pmc/articles/PMC7472575/ /pubmed/32887593 http://dx.doi.org/10.1186/s12889-020-09432-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Jorgensen, Jutta M. Adelin Hedt, Kaya Helene Omar, Omar Mwalim Davies, Justine I. Hypertension and diabetes in Zanzibar – prevalence and access to care |
title | Hypertension and diabetes in Zanzibar – prevalence and access to care |
title_full | Hypertension and diabetes in Zanzibar – prevalence and access to care |
title_fullStr | Hypertension and diabetes in Zanzibar – prevalence and access to care |
title_full_unstemmed | Hypertension and diabetes in Zanzibar – prevalence and access to care |
title_short | Hypertension and diabetes in Zanzibar – prevalence and access to care |
title_sort | hypertension and diabetes in zanzibar – prevalence and access to care |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472575/ https://www.ncbi.nlm.nih.gov/pubmed/32887593 http://dx.doi.org/10.1186/s12889-020-09432-8 |
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