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. 2023 Sep 7;3(9):e0002055.
doi: 10.1371/journal.pgph.0002055. eCollection 2023.

Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011-2017

Mariet Benade  1   2 , Zandile Mchiza  3   4 , Rafeya V Raquib  1 , Sridevi K Prasad  1 , Lily D Yan  5 , Alana T Brennan  1   2   6 , Justine Davies  7 , Nikkil Sudharsanan  8 , Jennifer Manne-Goehler  9 , Matthew P Fox  1   2   6 , Jacob Bor  1   2   6 , Sydney B Rosen  1   2 , Andrew C Stokes  1
Affiliations

Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011-2017

Mariet Benade et al. PLOS Glob Public Health. .

Abstract

Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests:Dr Stokes reported receiving grants from Swiss Re and Johnson & Johnson outside the submitted work. No other disclosures were reported.

Figures

Fig 1
Fig 1. Conceptual design figure.
SBP, Systolic Blood Pressure. DBP, Diastolic Blood Pressure.
Fig 2
Fig 2. Incident Hypertension Care Cascades, South Africa 2011–2017.
Fig 3
Fig 3. Incident Hypertension Care Cascades by Wave, South Africa 2011–2017.
See this image and copyright information in PMC

References

    1. Institute for Health Metrics and Evaluation (IHME). Findings from the Global Burden of Disease Study 2017. The Lancet. Seattle, WA; 2018.
    1. Wang JG, Hering D, Burger D, Rietzschel ER, Martinez F, Gimenez-Roqueplo A-P, et al.. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. The Lancet. 2016. doi: 10.1016/S0140-6736(16)31134-5 - DOI - PubMed
    1. Jongen VW, Lalla-Edward ST, Vos AG, Godijk NG, Tempelman H, Grobbee DE, et al.. Hypertension in a rural community in South Africa: what they know, what they think they know and what they recommend. doi: 10.1186/s12889-019-6642-3 - DOI - PMC - PubMed
    1. Arima H, Barzi F, Chalmers J. Mortality patterns in hypertension. J Hypertens. 2011;29 Suppl 1: S3–7. doi: 10.1097/01.hjh.0000410246.59221.b1 - DOI - PubMed
    1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al.. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies from 90 Countries. Circulation. 2016;134: 441–450. doi: 10.1161/CIRCULATIONAHA.115.018912 - DOI - PMC - PubMed

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