Awareness, treatment, and control among adults living with arterial hypertension or diabetes mellitus in two rural districts in Lesotho

Abstract

In Lesotho, the hypertension and diabetes care cascades are unknown. We measured awareness, treatment, and control of hypertension and diabetes and identified factors associated with each step of the cascade, based on data from a population-based, cross-sectional survey among adults ≥ 18 years in 120 randomly sampled clusters in the districts of Butha-Buthe and Mokhotlong from 1st November 2021 to 31st August 2022. We used multivariable logistic regression to assess associations. Among participants with hypertension, 69.7% (95%CI, 67.2–72.2%, 909/1305) were aware of their condition, 67.3% (95%CI 64.8–69.9%, 878/1305) took treatment, and 49.0% (95%CI 46.3–51.7%, 640/1305) were controlled. Among participants with diabetes, 48.4% (95%CI 42.0–55.0%, 111/229) were aware of their condition, 55.8% (95%CI 49.5–62.3%, 128/229) took treatment, and 41.5% (95%CI 35.1–47.9%, 95/229) were controlled. For hypertension, women had higher odds of being on treatment (adjusted odds ratio (aOR) 2.54, 95% CI 1.78–3.61) and controlled (aOR 2.44, 95%CI 1.76–3.37) than men. Participants from urban areas had lower odds of being on treatment (aOR 0.63, 95% CI 0.44–0.90) or being controlled (aOR 0.63, 95% CI 0.46–0.85). Considerable gaps along the hypertension and diabetes care cascades in Lesotho indicate that access and quality of care for these conditions are insufficient to ensure adequate health outcomes.

Community-based management of arterial hypertension and cardiovascular risk factors by lay village health workers for people with controlled and uncontrolled blood pressure in rural Lesotho: Joint protocol for two cluster-randomized trials within the ComBaCaL cohort study (ComBaCaL aHT Twic 1 & ComBaCaL aHT TwiC 2)

“…Sample sizes were calculated assuming an individual randomization in ated by a design effect that accounts for variation at cluster level, according to Rotondi and Donner (49). Based on preliminary results from an non-communicable disease prevalence survey in Lesotho (22), we expect an adult prevalence of aHT in rural Lesotho of 18%. Considering an average cluster size of 100 adult inhabitants, the mean number of inhabitants with aHT is estimated at 18 (10 being controlled and 8 uncontrolled).…”

“…The ComBaCaL cohort is maintained by local, trained and supervised VHWs and is a platform for the investigation of chronic diseases and their management in rural Lesotho. The intervention described here has been developed based on a local non-communicable diseases prevalence survey and burden assessment (22,23), a scoping literature review (24), multiple workshops with different stakeholders in Lesotho and the ComBaCaL pilot cohort study.…”

Community-based type 2 diabetes care by lay village health workers in rural Lesotho Protocol for a cluster-randomized trial within the ComBaCaL cohort study (ComBaCaL T2D TwiC)

“…In each ComBaCaL village, one lay VHW has been selected by the village population in a participatory process according to the Lesotho Ministry of Health (MoH) Village Health Program policy (21). Lesotho is a typical example of an African LMIC where a developing health system is facing the double burden of the still highly prevalent infectious diseases HIV/AIDS and tuberculosis in combination with a rapidly spreading NCD epidemic (2,20,22,23). In the Lesotho health system, VHWs play an important role in linking the community to facility-based health services and have effectively contributed to the improved control of HIV/AIDS, especially in remote rural areas (21,24,25).…”

“…The sample size for this TwiC was calculated assuming an individual randomization in ated by a design effect that accounts for variation at cluster level, according to the code developed by Rotondi and Donner (44). Based on preliminary results from an NCD prevalence survey in Lesotho (20), we expected the prevalence of T2D in the adult population in the rural setting in Lesotho to be approximately 4%, with about 60% of people living with T2D ful lling the criteria for the primary analysis set (non-pregnant, uncomplicated and uncontrolled T2D, no direct referral required). Considering an average cluster size of 100 adult inhabitants, the mean number of inhabitants eligible for the TwiC is 2.4 per village.…”

“…We developed a VHW-led care model for people living with T2D in rural Lesotho, based on a local noncommunicable disease (NCD) prevalence survey and burden assessment (20), a scoping literature review (18), and the ComBaCaL (Community-based chronic disease care Lesotho) pilot cohort study. In this care model, VHWs provide rst-line management for T2D, including oral antidiabetic, lipid-lowering, and antiplatelet treatment as well as lifestyle counselling at the community level, assisted by the ComBaCaL app, a tailored, tablet-based, digital clinical decision support system (CDSS).…”