Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries

Background: Hypertension control is poor everywhere, especially in low- and middle-income countries (LMICs). An effective response requires understanding factors acting at each stage on the patients’ pathway through the health system from entry or first contact with the health system, through to treatment initiation and follow up. This systematic review aimed to identify barriers to and facilitators of hypertension control along this pathway and, respectively, ways to overcome or strengthen them. Methods: MEDLINE, EMBASE, Global Health, CINAHL Plus, and Africa-Wide Information (1980-April 2019) were searched for studies of hypertensive adults in LMICs reporting details of at least 2 adequately described health system contacts. Data were extracted and analysed by 2 reviewers. Themes were developed using NVivo in patient-related (sociodemographic, knowledge and health beliefs, health status and co-morbidities, trade-offs), social (social relationships and traditions) and health system domains (resources and processes). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: From 2584 identified records, 30 were included in the narrative synthesis. At entry, ‘health systems resources and processes’ and ‘knowledge and beliefs about hypertension’ dominated while ‘social relations and traditions’ and ‘comorbidities’ assume greater importance subsequently, with patients making ‘trade-offs’ with family priorities during follow up. Socio-demographic factors play a role, but to a lesser extent than other factors. Context matters. Conclusion: Understanding the changing barriers to hypertension control along the patient journey is necessary to develop a comprehensive and efficient response to this persisting problem.

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SM 03-2309 Innovative approaches to capacity development for injury prevention in low- and middle-income countries

10.1136/injuryprevention-2018-safety.732 ◽

2018 ◽

Author(s):

Abdulgafoor Bachani ◽

Nhan Tran ◽

Olive Kobusingye ◽

Shirin Wadhwaniya ◽

Adnan A Hyder

Keyword(s):

Injury Prevention ◽

Capacity Development ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income ◽

Innovative Approaches

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Estimation of the Global Gap in Clinic Visits for Hypertension Care Between Patient Need and Physician Capacity

Hypertension ◽

10.1161/hypertensionaha.121.17660 ◽

2021 ◽

Vol 78 (3) ◽

pp. 779-786

Author(s):

Dinesh Neupane ◽

Yumin Gao ◽

Yijing Feng ◽

Kunihiro Matsushita ◽

Lawrence J. Appel

Keyword(s):

Low Income ◽

High Capacity ◽

World Health ◽

Low Income Countries ◽

Hypertension Control ◽

Middle Income ◽

Physician Visits ◽

Middle Income Countries ◽

Low And Middle Income ◽

Clinic Visits

In most countries, only physicians are allowed to prescribe antihypertensive medication. Thus, physician capacity (number of physician clinic visits available for hypertension care) is a critical determinant of hypertension control. This study estimates the global gap between physician capacity and patient need. We used World Health Organization and World Bank data and assumed that on average a physician conducts 5000 clinic visits/year (base scenario), with 10% time spent on hypertension care. For high-capacity scenarios, we assumed 10 000 visits/year. We estimated the effects of different numbers of physician visits/y per patient: 12 (common in low and middle-income countries for monthly prescription refills), 6, and 3 annual visits. At 12 visits/year, most countries have a deficit in physician capacity. Even assuming 6 visits/year, the deficit in most African and South Asian countries still exists. At 3 visits/year, a gap persists in 69% of lower middle income countries and 89% of low-income countries. Assuming 3 visits/year per patient, the countries with the highest visit gaps are India at 73 million visits/year, Indonesia at 62 million visits/year, and Ethiopia at 30 million visits/year. Even in the high-capacity scenario, 50% of lower middle income countries and 86% of low-income countries have a physician capacity deficit. Even under plausible scenarios of 6 or 3 visits/year, a substantial deficit in physician capacity to provide hypertension care exists in many low and middle-income countries. To increase hypertension control globally, countries need to enact changes to their health systems and policies that promote task-sharing and that allow multi-month prescription refills.

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