Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Sudan has the second highest prevalence of hypertension in North Africa. One in four people with a non-communicable disease has hypertension. May Measurement Month (MMM) is a global initiative, aimed at raising awareness of high BP to act as a temporary solution to the lack of screening programs worldwide. The MMM screening survey provided an opportunity to correlate between unique risk factors and BP levels among Sudanese population. Such an approach allows for directing efforts towards setting the appropriate preventive measures as opposed to disease treatment. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted at 100 sites distributed in four states: Khartoum, Gezira, Blue Nile, and Kassala. Overall, a total of 44 413 participants were enrolled in the survey. After imputation, 7332 out of 44 118 participants with an available mean of the second and third readings had hypertension (16.6%). A total of 6956 (15.9%) participants were found to have hypertension of the 43 742 who were not receiving treatment. Among participants who were on treatment, 155 out of 374 (41.3%) had uncontrolled BP. After adjusting for age and sex, systolic and diastolic BP’s were significantly higher in those receiving antihypertensive treatment, with a previous history of stroke and with elevated body mass index. Systolic BP was significantly higher in people with diabetes and with previous myocardial infarction. Smoking was associated with increased diastolic BP and decreased systolic BP. Alcohol intake as well as BP measurement on left vs. right arm had no association with BP reading. The MMM17 was the largest BP screening campaign ever held in the country. A considerable percentage of detected hypertensives were not on treatment with a significant proportion of uncontrolled hypertension among those on treatment. These results suggest that opportunistic screening can identify significant numbers with raised BP.
Background: Primary health care is the level where promotive, preventive, curative services are provided at the same place. It is thus the level in which modifiable risk factors for hypertension can be addressed together with treatment of known hypertensive patients. Objectives: This study addressed the quality of management of hypertension in Public Primary Health Care Facilities in East-Nile locality, Khartoum State, Sudan. Methodology: A Facility-based cross-sectional study was conducted, in which 26 primary public health centers and 3 rural hospitals were included. All the health care providers-119-in the public health facilities available during the data collection period, using 2 well-structured questionnaires were used. An ethical approval was obtained from the Sudan Medical Specialization Board (SMSB), and verbal consent was obtained from each health care provider prior to the interview. The collected data were analyzed using the Statistical Package for Social Science (SPSS) version 15. Results: The majority of care providers, (71.4% of the physicians, and 93.5% of other care providers) were not trained on hypertension management. The study revealed marked gaps in the knowledge domain of the other health care providers, such as the standard management of hypertension, the proper measurement of blood pressure; lifestyle modification and serious complications of hypertension. Conclusions: There is a need for strengthening the management of hypertension at primary care level through training and regular supervision.
AMAA. Patients' satisfaction with the quality of provided services for management of hypertension in public primary health care facilities, Sharg-Alneel locality, Khartoum state, Sudan.
Abstract:Introduction: Hypertension is already a high prevalent risk factor for Cardio Vascular Diseases (CVDs) throughout the world due to prevalence of contributing modifiable risk factors such as unhealthy diet, physical inactivity, tobacco use, and Hyperlipidemia. Worldwide hypertension estimated to cause 7.1 million premature death and 4.5% of disease burden (64 million disability adjusted life years (DALYs), it is eminently preventable, and this can be achieved by targeted life-related risk factors. Objective: To study the availability of resources needed for standard management of hypertension in Public Primary Health Care Facilities, in Sharg-Alneel locality, Khartoum State, aiming to generate information for establishing quality control program. Methodology: Facility-based cross-sectional descriptive study was conducted at Sharg-Alneel locality, Khartoum State, Sudan. The study Population composed of 26 public primary health care facilities and 3 rural hospitals, and all health care providers available during the data collection period and they were 119 care providers. Standardized administered questionnaire and checklist were developed, pre-test and used for data collection. The data was analyzed using the Statistical Package for Social Science (SPSS) version 15. Results: Marked shortage in care providers (physicians and nurses), only 0.5-physician per10,000 populations, and 0.6 nurse per10,000 populations. In addition, 71.4% of the physician and 93.5% of other health care providers were not subjected to training on standard management of hypertension. Standard referral, reporting and recording systems, were not established yet, as well, hypertension health education materials and national hypertension guidelines were not available in all health facilities. Sphygmomanometer, adult weighing scale, ophthalmoscope, x-ray machine and ECG machines, were available in 96.6%, 93.1%, 24.2%, 20.7%, 17.2% of the health facilities respectively. In addition, essential investigations e.g. reagent for cholesterol, blood creatinine & blood urea kits, and reagent for uric acid test, were available in 20.7%, 31%, 62.1%, and 37.9% of the health facilities respectively. Only three out of 13 anti-hypertensive drugs included in the national drug list of primary health care level were available in the health facilities, and these were; Aspirin (86%), Furosemide (62%) and Atenolol (52%). Conclusion: There was a marked shortage in health care providers, only 0.5-physician per 10,000 populations, and 0.6 nurses per 10, 000 populations. Other resources were inadequate to provide quality services for hypertensive patients at the primary health care level.
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