Use of traditional medicine and control of hypertension in 12 African countries

Abstract

BackgroundUse of traditional medicine (TM) is widespread in sub-Saharan Africa as a treatment option for a wide range of disease. We aimed to describe main characteristics of TM users and estimate the association of TM use with control of hypertension.MethodsWe used data on 2128 hypertensive patients of a cross-sectional study (convenience sampling), who attended cardiology departments of 12 sub-Saharan African countries (Benin, Cameroon, Congo, Democratic Republic of the Congo, Gabon, Guinea, Côte d’Ivoire, Mauritania, Mozambique, Niger, Senegal, Togo). To model association of TM use with odds of uncontrolled, severe and complicated hypertension, we used multivariable mixed logistic regressions, and to model the association with blood pressure (systolic (SBP) and diastolic (DBP)) we used mixed linear models. All models were adjusted for age, sex, wealth, adherence to hypertension conventional treatment and country (random effect).ResultsA total of 512 (24%) participants reported using TM, varying across countries from 10% in the Congo to 48% in Guinea. TM users were more likely to be men, living in rural area, poorly adhere to prescribed medication (frequently due to its cost). Use of TM was associated with a 3.87 (95% CI 1.52 to 6.22)/1.75 (0.34 to 3.16) mm Hg higher SBP/DBP compared with no use; and with greater odds of severe hypertension (OR=1.34; 95% CI 1.04 to 1.74) and of any hypertension complication (OR=1.27; 95% CI 1.01 to 1.60), mainly driven by renal complication (OR=1.57; 95% CI 1.07 to 2.29) after adjustment for measured confounders.ConclusionsThe use of TM was associated with higher blood pressure, more severe hypertension and more complications in Sub-Saharan African countries. The widespread use of TM needs to be acknowledged and worked out to integrate TM safely within the conventional healthcare.

Blood pressure and the hypertension care cascade in The Gambia: Findings from a nationwide survey

“…23 In Peru however, those unaware of their hypertension had the highest mean BP, followed by the treated, then those aware but not receiving treatment. 24 Treatment failure in our study could be explained by several patient-related factors including poor adherence which might be related to side effects and local beliefs or misconceptions around hypertension, [25][26][27] or a lack of awareness of the serious risks to their future health. Medication adherence is a vital component to treatment success which has been previously evaluated in The Gambia and found to be sub-optimal.…”

Evaluating the hypertension care cascade in middle-aged and older adults in The Gambia: findings from a nationwide survey

“…A lot of patients fear initiating antihypertensive treatment and commonly resort to traditional practices even after being initiated on treatment, as has been reported in a study in 12 African countries. 45 The limited understanding and the asymptomatic nature of the condition also has a big impact on medication adherence. 46 , 47 …”

Descriptive epidemiology of prevalence of exercise habits among participants with hypertension: The National Health and Nutrition Survey 2013–2018

“…Several studies have reported the prevalence of regular exercise among patients with HTN 11–13 ; however, these studies had small sample sizes and were limited to patients in low‐ and middle‐income countries, including Ethiopia, Iran, and China 11–13 . Moreover, medical resources, healthcare systems, and treatment strategies available in low‐ and middle‐income countries differ from those in high‐income countries 5,9,14–16 . Therefore, exercise habits in patients with HTN may differ among low‐, middle‐, and high‐income countries.…”

“… 11 , 12 , 13 Moreover, medical resources, healthcare systems, and treatment strategies available in low‐ and middle‐income countries differ from those in high‐income countries. 5 , 9 , 14 , 15 , 16 Therefore, exercise habits in patients with HTN may differ among low‐, middle‐, and high‐income countries. Hence, it is crucial to assess the proportion of patients engaging in exercise in each country in order to enhance the approach to exercise therapy in the healthcare system.…”