Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2016 Nov;34(11):2172-9.
doi: 10.1097/HJH.0000000000001070.

Accessing clinical services and retention in care following screening for hypertension and diabetes among Malawian adults: an urban/rural comparison

Crispin Musicha  1 , Amelia C Crampin, Ndoliwe Kayuni, Olivier Koole, Alemayehu Amberbir, Beatrice Mwagomba, Shabbar Jaffar, Moffat J Nyirenda
Affiliations
Comparative Study

Accessing clinical services and retention in care following screening for hypertension and diabetes among Malawian adults: an urban/rural comparison

Crispin Musicha et al. J Hypertens. 2016 Nov.

Abstract

Objective: Interventions to impact on the burden of chronic noncommunicable diseases, such as hypertension and diabetes, include screening of asymptomatic adults, but little is known about the subsequent course of clinical care. We report on the uptake of referral for clinical assessment and retention in care, following a large urban/rural population screening program in Malawi.

Methods: Adult residents were screened for raised blood pressure and raised fasting blood glucose at a demographic surveillance site in rural Karonga District and in urban Area 25, Lilongwe with well supported chronic care clinics. Successful uptake was defined as presenting for clinical assessment within 6 weeks of referral, and nonattenders were followed at home. Logistic regression was used to examine association of uptake with demographic and clinical factors. Retention was assessed using survival analysis techniques.

Results: A total of 27 305 participants were screened for hypertension and diabetes between May 2013 and September 2015. Of these, 4075 (14.9%) were referred for suspected hypertension (3640), diabetes (172), or both (263). Among those referred, 2480 (60.9%), reported for clinical assessment. Factors associated with uptake of care included being female, rural residency, older age, unemployment, prior medication, and diabetes. Retention, for those enrolled in care following a formal clinical assessment, was associated with the final diagnosis following clinical assessment, rural residency, and older age.

Conclusion: Screening for hypertension and diabetes identifies large numbers of individuals who need further clinical assessment, but strategies are needed to ensure better linkage and retention into care.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest/Disclosures

All the authors report no conflicts of interest or disclosures.

Figures

Figure 1
Figure 1
Consort diagram showing those screened, identified with hypertension or diabetes, referred for care, and attending for care.
Figure 2
Figure 2
Retention in care by site over time
Figure 3
Figure 3
Retention in care following clinical assessment by reason for continuing care
Figure 4
Figure 4
Clinic case-load over time, expected and actual, for patients started on anti-hypertensive medication
See this image and copyright information in PMC

References

    1. Streatfield PK, Khan WA, Bhuiya A, et al. Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites. Glob Health Action. 2014;7:25365. - PMC - PubMed
    1. World Health Organisation. Noncommunicable Diseases Country Profiles 2014. [Accessed 09 February 2016]; [ONLINE] Available at: http://www.who.int/nmh/publications/ncd-profiles-2014/en/.
    1. Duboz P, Boëtsch G, Gueye L, Macia E. Hypertension prevalence, awareness, treatment and control in Dakar (Senegal) J Hum Hypertens. 2014;28:489–493. - PubMed
    1. Lloyd-Sherlock P, Beard J, Minicuci N, Ebrahim S, Chatterji S. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol. 2014;43:116–128. - PMC - PubMed
    1. Peck R, Mghamba J, Vanobberghen F, Kavishe B, Rugarabamu V, Smeeth L, Hayes R, Grosskurth H, Kapiga S. Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey. Lancet Glob Health. 2014;2:e285–92. - PMC - PubMed

Publication types