Detection, referral and control of diabetes and hypertension in the rural Eastern Cape Province of South Africa by community health outreach workers in the rural primary healthcare project: Health in Every Hut

Abstract

BackgroundNon-communicable diseases, mainly cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, are responsible for approximately 63% of all deaths occurring worldwide in any given year. The majority of these deaths have occurred in low- and middle-income countries (LMICs). The latest World Health Organization (WHO) report shows that the increase in diabetes is also most pronounced in the LMICs. The South African Labour and Development Research Unit estimated a 9% prevalence within the adult population in 2016. In the Eastern Cape Province, hypertensive heart disease has become the second most common cause of death, followed by diabetes, the third most common cause of death.Aim and settingThe aim of this study was to report on the follow-up of patients in the community with known hypertension or diabetes or who were deemed at-risk (as identified during a prior community-wide survey).MethodsData were collected via a household primary health screening, monitoring and follow-up process, which included taking anthropometric measurements, blood pressure (BP) and blood glucose and referring to clinics for further testing and treatment where necessary.ResultsOf the 1885 participants followed up by the community health outreach workers, 1702 were known to be hypertensive and 183 were deemed at-risk [of these, only 24 (13.2%) had normal or high normal systolic BP readings]. There were 341 participants with diabetes and 34 at-risk of diabetes [of these, 28 (82%) had levels of 11 mmol/l or higher at follow-up]. There was a significant improvement in BP and glucose control over repeated visits.ConclusionIn this rural area of the Eastern Cape, South Africa, the follow-up of patients with hypertension or diabetes as well as those individuals at-risk adds value to hypertension and glucose control.

Factors associated with glycemic control among South African adult residents of Mkhondo municipality living with diabetes mellitus

“…The overall prevalence of poor glycemic control was 77.71%. This finding is worse than previous reports from South Africa [ 3 – 6 ] where the prevalence of poor glycemic controlled ranged from 7.6% to 60.0%; however, it is better than the 82.35% [ 23 ] and 83.8% [ 24 ] reported in the rural and semi-urban communities in the Eastern Cape, South Africa. In comparison to other studies conducted in other African countries, the rate reported in this study is better than previous reports from Ghana (86.4%) [ 25 ] and Sudan (85.0%).…”

Observational stepped-wedge analysis of a community health worker-led intervention for diabetes and hypertension in rural Mexico

“…The 10 mm Hg reduction in SBP we observed among patients with uncontrolled hypertension is on par with recent cluster-randomised trials from India (−8.9 mm Hg),10 Argentina (−6.6 mm Hg),13 Colombia and Malaysia (−11.5 mm Hg) 15. Our study further adds to the literature by supporting the role for CHWs in patients with diabetes, where studies have produced promising but sometimes inconclusive results 8–10…”

“…A recent systematic review of CHWs in LMICs for prevention and management of diabetes found positive outcomes in a majority of studies, but identified significant heterogeneity among structures of CHW interventions and limitations due to study design, high rates of attrition, absence of detailed reporting on operational design and variable programme fidelity 7. Observational studies of CHW-led interventions demonstrated improvement in fasting plasma glucose,8 9 though a recent cluster-randomised trial found inconclusive results, potentially due to a lack of power 10. For cardiovascular disease, two systematic reviews, including one meta-analysis of randomised trials, identified improvements in blood pressure with CHW interventions 4 11.…”

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…Published prevalence rates for diabetes vary between 7.2% and 10.1% or higher of the population depending whether undiagnosed patients are included (Manyema et al, 2015;Bailey et al, 2016;Shen et al, 2016;Stokes et al, 2017;Morris-Paxton et al, 2018). Overall, it is estimated that 4 million South Africans currently have diabetes (1.2-4.6 million) (SEMDSA, 2017;Juma et al, 2019) However, based on the SANHANES data there is a higher prevalence of diabetes in South Africa (15.3%) should a high percentage of patients with diabetes actually be diagnosed and treated (Stokes et al, 2017;Basu et al, 2019) A recent report from Johannesburg found 66% obesity and overweight in a random population attending primary healthcare (PHC) clinics, with a 4.9% undiagnosed diabetes.…”

“…to demonstrate the need for strategies to improve guideline adherence and to assess their impact in practice (Igbojiaku et al, 2013;Mukanu et al, 2017;Pastakia et al, 2017;SEMDSA, 2017). There have also been strategies to improve access and availability of medicines (Sandoz -A Novartis Division, 2015;Meyer et al, 2017;Nuche-Berenguer and Kupfer, 2018;Shannon et al, 2019;Rockers et al, 2019), as well as strategies to improve the monitoring and follow-up of patients including advice on the doses of medicines prescribed (Pastakia et al, 2015;Morris-Paxton et al, 2018;Chang et al, 2019). However, such activities are not universal across Africa.…”