scholarly journals Self-monitoring of blood pressure to improve hypertension management in a middle-income country: A proof of concept study

2020 ◽  
Author(s):  
Christelle Akl ◽  
Nadine Rashidi ◽  
Chaza Akik ◽  
Eveline Hitti ◽  
Ghassan Hamadeh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Trial ◽  
Standard Of Care ◽  
The Self ◽  
Health Centers ◽  
Proof Of Concept ◽  
Middle Income ◽  
Self Monitoring ◽  
Middle Income Countries ◽  
Monitoring Group

Abstract Background Self-monitoring of blood pressure has been shown to optimize the management of blood pressure in high-income settings, but there is less evidence from low-to-middle income countries. We designed a proof-of-concept pilot trial to assess the feasibility and acceptability of an intervention built around self-monitoring of blood pressure and health education, and to measure its association with reduced blood pressure among hypertensives. The study was conducted in Lebanon, a country where the management of hypertension presents challenges similar to those faced in countries of the Arab region and other middle-income countries. Methods We conducted a parallel two-arm pilot trial with a mixed-method approach to investigate the effect of the intervention on patient experience. Hypertensive patients (n = 80) were recruited at two primary and one tertiary health centers in Beirut, and were randomly allocated (1:1) to either an intervention group where patients received blood pressure devices, diaries and educational sessions, or a control group where patients received standard of care as practiced in their health centers. The main outcomes were feasibility (recruitment, retention and adherence), acceptability, and changes in systolic blood pressure. Quantitative and qualitative data were obtained at baseline and 6 weeks later. Results The recruitment rates for the study was 52% and retention was 95%. Most participants in the self-monitoring group (33/38) reported that the device was convenient and easy to use. Complete case analysis showed that blood pressure monitoring was associated with a greater reduction in systolic (-6.3 mmHg, 95%CI [-12.4; − 0.17]) and diastolic (-1.9 mmHg, 95%CI [-6.34; 2.58]) blood pressure in the self-monitoring group (n = 36) as compared to the standard of care group (n = 36). Improved knowledge of hypertension was also observed in the self-monitoring group. There were no adverse events related to study participation. Conclusions Self-monitoring is acceptable and feasible and has the potential to improve hypertension management. Our results should be further tested in trials with adequate statistical power and longer follow-up periods to examine the effectiveness of the intervention on blood pressure levels. Trial Registration and funding: Retrospectively Registered on April 3, 2020. ISRCTN 16450193. Funded by the Harvard Medical School Center for Global Health Delivery.

scholarly journals Patients' perceptions of self-management of high blood pressure in three low- and middle-income countries: findings from the BPMONITOR study

2020 ◽  
Vol 5 ◽  
Author(s):  
Tala Al-Rousan ◽  
M. Amalia Pesantes ◽  
Sufia Dadabhai ◽  
Namratha R. Kandula ◽  
Mark D. Huffman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Cost Effective ◽  
Self Management ◽  
Middle Income ◽  
Self Monitoring ◽  
Caregiver Support ◽  
Middle Income Countries ◽  
Perceptions And Attitudes ◽  
Low And Middle Income

Abstract Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient–physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.

Stock-Outs of Essential Medicines Among Community Health Workers (CHWs) In Low- And Middle-Income Countries (LMICs): A Systematic Literature Review of The Extent, Reasons, And Consequences

2021 ◽  
Author(s):  
Abimbola Olaniran ◽  
Jane Briggs ◽  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Grey Literature ◽  
Community Level ◽  
Health Centers ◽  
Essential Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background: This paper explores the extent of community-level stock-out of essential medicines among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006 - March 2021. Papers containing information on (i) the percentage of CHWs stocked out or (ii) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. Results: Two reviewers screened 1083 records; 78 evaluations were included. Over the last fifteen years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79 - 29.07] vs 9.17 % [CI 95%: 8.64 - 9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22 -26.50] to 48.65% [CI 95%: 48.02- 49.28] while that of health centers increased from 7.79% [95% CI: 7.16 - 8.42] to 14.28% [95% CI: 11.22- 17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. Conclusion: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.

scholarly journals Self-monitoring of blood pressure for preeclampsia patients: Knowledge and attitudes

Curationis ◽  
2021 ◽  
Vol 44 (1) ◽  
Author(s):  
Johanna Munyungula ◽  
Simangele Shakwane
Keyword(s):  
Blood Pressure ◽  
Low Socioeconomic Status ◽  
The Self ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Maternal Deaths ◽  
Self Monitoring ◽  
Knowledge And Attitudes ◽  
Positive Attitudes ◽  
Positive Outlook

Background: Preeclampsia is one of the causes of maternal deaths and is also responsible for complications such as premature births worldwide. In South Africa, hypertensive disorders cause 14% of all maternal deaths. Evidence indicates that it may be beneficial to empower women to monitor their blood pressure (BP) in the comfort of their homes.Objectives: The purpose of this study was to explore and describe preeclampsia patients’ knowledge and attitudes towards the self-monitoring of their BP.Method: An exploratory, descriptive and contextual qualitative research study was conducted. Fourteen preeclampsia patients were purposively sampled and participated in the study. In-depth semi-structured interviews were used to collect data. Data were analysed using the thematic analytic approach.Results: The knowledge and attitudes towards the self-monitoring of blood pressure (SMBP) were explored. Four themes emerged, namely understanding of hypertension disorders during pregnancy, openness on self-monitoring at home, its hindrances and benefits. The participants portrayed limited understanding and knowledge of preeclampsia, yet they had positive attitudes towards monitoring BP themselves and were open and willing to do self-monitoring at home.Conclusion: The use of SMBP may relieve overcrowding in public healthcare institutions. Encouraging patients to participate in self-monitoring could promote active participation and a positive outlook on their pregnancies. The unavailability and unaffordability of the equipment may pose a challenge to women with a low socioeconomic status.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kane ◽  
P Cavagna ◽  
I B Diop ◽  
B Gaye ◽  
J B Mipinda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Low Income ◽  
Democratic Republic ◽  
Antihypertensive Drugs ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sub Saharan

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

Trend in the use of neo-adjuvant chemotherapy for the management of muscle invasive bladder cancer at a major tertiary care hospital in Pakistan.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16033-e16033
Author(s):  
Adnan Abdul Jabbar ◽  
Muhammad Asad Maqbool ◽  
Muhammad Bilal Mirza
Keyword(s):  
Bladder Cancer ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Invasive Bladder Cancer ◽  
Care Hospital ◽  
Muscle Invasive Bladder Cancer ◽  
Middle Income ◽  
Middle Income Countries ◽  
Muscle Invasive

e16033 Background: Although the use of Neoadjuvant Chemotherapy (NAC) has now become the standard of care for Muscle Invasive Bladder Cancer (MIBC) in the world, most patients in lower- middle-income countries (LMIC), like Pakistan, are still undergoing upfront surgery despite being ideal candidates for chemotherapy. Multi-disciplinary tumor boards have been critical in the change of this trend in the developed world. We aimed to assess the trends in the use of NAC for patients with muscle invasive bladder cancer before undergoing definitive surgery. Methods: We included patients who underwent surgery for ≥ cT2 MIBC without distant metastasis between 2011 and 2015 at a tertiary care hospital in Karachi, Pakistan. We retrospectively assessed the trends in NAC compared to upfront surgery in these patients. Results: Among the 171 patients included in our study, only 4 (2.34%) received NAC, whereas the other 167 (97.67%) underwent upfront surgery without NAC. Out of the 90 patients who underwent surgery for MIBC between 2011 and 2013, none of them received NAC and underwent upfront surgery. Among the 81 patients with MIBC in 2014 and 2015, 4 patients received NAC before surgery whereas the other 77 underwent upfront surgery. Conclusions: The adoption of NAC for MIBC remains a challenge in lower- middle-income countries such as Pakistan. Introduction of a multidisciplinary tumor board in our hospital since 2014 has shown a slight change in this trend. Better communication between different departments remains the key in significantly changing the trend of a much desired standard of care.

scholarly journals A Low-Cost, Easy-to-Assemble Device to Prevent Infant Hyperthermia under Conditions of High Thermal Stress

2021 ◽  
Vol 18 (24) ◽  
pp. 13382
Author(s):  
Ramon Farré ◽  
Miguel A. Rodríguez-Lázaro ◽  
Anh Tuan Dinh-Xuan ◽  
Martí Pons-Odena ◽  
Daniel Navajas ◽  
...  
Keyword(s):  
Heat Stress ◽  
Air Conditioning ◽  
Low Cost ◽  
High Ambient Temperature ◽  
Proof Of Concept ◽  
Climatic Chamber ◽  
Middle Income ◽  
Novel Device ◽  
Middle Income Countries ◽  
Temperature And Humidity

High ambient temperature and humidity greatly increase the risk of hyperthermia and mortality, particularly in infants, who are especially prone to dehydration. World areas at high risk of heat stress include many of the low- and middle-income countries (LMICs) where most of their inhabitants have no access to air conditioning. This study aimed to design, evaluate, and test a novel low-cost and easy-to-assemble device aimed at preventing the risk of infant hyperthermia in LMICs. The device is based on optimizing negative heat transfer from a small amount of ice and transferring it directly to the infant by airflow of refrigerated air. As a proof of concept, a device was assembled mainly using recycled materials, and its performance was assessed under laboratory-controlled conditions in a climatic chamber mimicking realistic stress conditions of high temperature and humidity. The device, which can be assembled by any layperson using easily available materials, provided sufficient refrigerating capacity for several hours from just 1–2 kg of ice obtained from a domestic freezer. Thus, application of this novel device may serve to attenuate the adverse effects of heat stress in infants, particularly in the context of the evolving climatic change trends.

scholarly journals May Measurement Month 2019: an analysis of blood pressure screening results from Colombia

2021 ◽  
Vol 23 (Supplement_B) ◽  
pp. B46-B48
Author(s):  
Patricio Lopez-Jaramillo ◽  
Jose P Lopez-Lopez ◽  
Johanna Otero ◽  
Natalia Alarcon-Ariza ◽  
Margarita Mogollon-Zehr ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Medication ◽  
Hypertension Detection ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Third ◽  
Hypertension Awareness ◽  
Low Levels ◽  
And Control ◽  
Implementing Strategies

Abstract Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.

scholarly journals Effectiveness of Interventions To Enable Hypertension Medication Adherence In Low-And Middle-Income Countries: A Systematic Review And Meta-analysis

2021 ◽  
Author(s):  
Olivia Nakwafila ◽  
Benn Sartorius ◽  
Sphamandla Josias Nkambule ◽  
Tivani Mashamba Thompson
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Meta Analysis ◽  
Pharmacological Interventions ◽  
Middle Income ◽  
Quality Of Evidence ◽  
Middle Income Countries ◽  
Secondary Outcomes

Abstract Background: In recent decades low- and middle-income countries (LMICs) are witnessing an increase in hypertension and thus becoming a significant public health issue due to associated Cardiovascular disease (CVD) outcomes. Antihypertensive medication adherence is crucial to controlling blood pressure; therefore, this systematic review aimed to evaluate the effectiveness of non-pharmacological interventions on improving blood pressure control and medication adherence in patients with hypertension in LMICs.Methods: We searched the following databases for relevant literature published between Jan 2005 – Dec 2020: PubMed, EBSCOhost included Academic Search; CINAHL and MEDLINE complete; PubMed; WEB of Science; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews and Google Scholar. Cochrane risk of bias tool (RoB 2) was used to appraise included studies critically, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to measure the quality of evidence. We conducted a meta‑analysis using DrSimonian-Laid's random-effect model at 95% confidence intervals (CIs). The secondary outcomes of interests were synthesised descriptively as changes in BP adherence outcomes. Results: We identified 14 eligible randomised controlled trials that presented blood pressure (BP) effectiveness and medication adherence among BP patients aged between 18-75 years. The overall quality of evidence with the majority of trials was moderate. Meta weighed effect (SBP) for 12/14 studies was -4.74 (95% CI:-6.07 to -3.47) and I2 = 57%. Out of 14 eligible studies, (86%) suggested a significant improvement in the proportion of patients with controlled blood pressure (BP < 140/90mmHG) with a positive effect on secondary outcomes such as quality of life.Conclusion: Non-pharmacological interventions could be effective in managing hypertension. In recommending the need to investigate the feasibility of non-pharmacological evidence in specific LMIC settings, focus should be on an intervention strategy consisting of an educational intervention directed toward the patients, health professionals and organisation. Considering heterogeneity, randomised trials that are well-designed with larger sample sizes are encouraged in LMICs` to help policymakers make well-informed decisions on hypertension management.Systematic review Registration: PROSPERO registration number: CRD42020172954

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