High prevalence of several cardiovascular risk factors in the urban population of a low-income country stresses the need for early public health interventions and adaptation of the health care infrastructure to meet the emerging challenge of cardiovascular disease. The direct SES-BMI association may drive increasing BMI and BP while the population becomes more affluent.

BackgroundDrug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management.MethodsA population-based survey of 9254 persons aged 25–64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP ≥ 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval.ResultsAmong the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care.ConclusionLow utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.

Abstract-Assessment of knowledge, attitudes, and practices (KAP) is a crucial element of hypertension control, but little information is available from developing countries where hypertension has lately been recognized as a major health problem. Therefore, we examined KAP on hypertension in a random sample of 1067 adults aged 25 to 64 years from the Seychelles Islands (Indian Ocean). KAP were assessed from an administered structured questionnaire. The age-standardized prevalence of hypertension (screening blood pressure [BP] Ն160/95 mm Hg or taking antihypertensive medication) was 36% in men and 25% in women aged 25 to 64 years. Among hypertensive persons, 50% were aware of the condition, 34% were treated, and 10% had controlled BP (ie, BP Ͻ160/95 mm Hg). Most persons, whether nonhypertensive, unaware hypertensive, or aware hypertensive, had good basic knowledge related to hypertension determinants and consequences, possibly an effect of a nationwide cardiovascular disease prevention program over the last years. However, favorable outcome expectation, positive attitudes, and appropriate practices for hypertension and relevant healthy lifestyles were found in smaller proportions of participants, with little difference between aware hypertensives, unaware hypertensives, and nonhypertensives. Furthermore, hypertensive persons with other concurrent cardiovascular risk factors affecting the overall heart risk knew well the detrimental effects of these other factors but reported making little actual change to control them (particularly regarding overweight and sedentary habits). These data point to the need to maximize the efficiency of hypertension prevention and control programs so that delay in achieving effective hypertension control is minimized in countries experiencing recent emergence of hypertension as a major public health problem. (Hypertension. 1998;31:1136-1145.)Key Words: knowledge, attitudes, practices Ⅲ developing countries Ⅲ epidemiology Ⅲ Africa Ⅲ Indian Ocean islands H ypertension has become a significant problem in many developing countries experiencing epidemiological transition from communicable to noncommunicable chronic diseases.1-3 The emergence of hypertension and other CVDs as a public health problem in these countries is strongly related to the aging of the populations, urbanization, and socioeconomic changes favoring sedentary habits, obesity, alcohol consumption, and salt intake, among others.4,5 A cost-effective use of health services to control these emerging chronic diseases is particularly needed in developing countries because resources are limited and generally must be shared with the concurrent burden of persistent communicable diseases.In this context, hypertension presents a major area of intervention because it is a frequent condition and is amenable to control through both nonpharmacological lifestyle factors and pharmacological treatment. Pharmacological treatment for hypertension has been shown to be effective in decreasing BP and subsequently cardiovascular events, 6 althoug...