An exploratory study on the quality of patient screening and counseling for hypertension management in Tanzania


Autoři: Anbrasi Edward aff001;  Lisa Hoffmann aff002;  Frank Manase aff003;  Kunihiro Matsushita aff004;  George William Pariyo aff001;  Tammy M. Brady aff005;  Lawrence J. Appel aff006
Působiště autorů: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America aff001;  Patient Safety and Risk Management Unit, World Health Organization, Geneva, Switzerland aff002;  Community Center for Preventive Medicine, Dar es salaam, Tanzania aff003;  Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America aff004;  Division of Pediatric Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America aff005;  Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, and Johns Hopkins School of Nursing, Baltimore, MD, United States of America aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227439

Souhrn

Background

The global burden of hypertension, currently estimated at 1 billion, is a leading Non-Communicable Disease (NCD) in Sub Saharan Africa. In Tanzania, the reported prevalence of hypertension is 25%. Inherent limitations of the healthcare system to control hypertension include inadequate provider knowledge, system capacity, medication access, and patient awareness, all of which hinder effective screening and disease management. To assess the quality of hypertension screening and patient counseling, we conducted a study in an ambulatory setting in Tanzania.

Methods

Observations of patient screening were conducted on 69 adult patients during routine outpatient care and screening camps. In addition, 33 healthcare providers participated in a pre-post knowledge assessment after observing instructional training videos.

Results

Patient observations indicated that blood pressure (BP) measurement was explained to 65% of patients, and 77% of the measurements were made with mercury sphygmomanometers. For several aspects of BP measurement, nurses performed better than doctors: patient’s arm supported on a flat surface (doctors, 58% vs nurses 67%, p<0.05), and patient’s back was supported (doctors, 50% vs nurses 88%, p<0.01). Among those diagnosed with hypertension, 7% were prescribed medications, 14% were advised on reduced salt during cooking, 29% on reduced salt consumption, 21% on reduced consumption of sodium rich foods, 21% on reducing caloric intake, 21% on increasing physical activity, and 43% were informed about follow up appointments. Provider knowledge assessments showed critical gaps in consequences of hypertension, 1st line medicines, and awareness of guidelines at baseline. Following the instructional videos there were improvements in some aspects: diagnostic criteria for hypertension (pre 45% vs post 91%, p<0.001) and counseling for controlling hypertension (pre 30% vs post 58%, p<0.01).

Conclusion

Enhancing knowledge and performance competencies of health providers at the primary care level is a critical prerequisite for effective hypertension management in low resource settings.

Klíčová slova:

Blood pressure – Health education and awareness – Health screening – Hypertension – Learning – Medical doctors – Nurses – Tanzania


Zdroje

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Článek vyšel v časopise

PLOS One


2020 Číslo 1