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CAUTION: Scientists advise on high burden of NCDs, low control levels

Dec. 16, 2022
CAUTION: Scientists advise on high burden of NCDs, low control levels
A snip from the PLOS journal with insets of Ifakara Health Institute researchers Sally Mtenga and Grace Mhalu who contributed to the study and publication. GRAPHIC | IFAKARA/KMC.

Scientists from Tanzania and Switzerland have underscored the importance of improving the awareness and treatment of noncommunicable diseases against the backdrop of the high burden of the diseases and low levels of control in sub-Saharan Africa.

Two common NCDs: hypertension and diabetes are rapidly rising in the sub-Saharan Africa region, necessitating health systems transformations. In Tanzania, current policies aim to improve control of hypertension and diabetes, but scientists believe information is still needed to assess the gaps in treatment.

Ifakara Health Institute researchers and their colleagues from the Swiss Tropical and Public Health Institute (Swiss TPH) highlighted this in a new study on NCDs – the first of its kind – that measured four levels of care cascade – engagement, treatment, and control – for hypertension and diabetes among adults aged 18 to 89 years. A total of 784 adults were surveyed in the study between November 2020 and January 2021. 

Their findings were published in the PLOS Medicine journal on December 5, 2022. The contributors include Dr. Sally Mtenga and Dr. Grace Mhalu from Ifakara; and Brianna Osetinsky and Fabrizio Tediosi from the Swiss TPH.

“The high burden of hypertension and low levels of control in our study underscores the importance of improving the awareness and treatment of hypertension. The differences in the care cascades for hypertension and diabetes demonstrate that chronic NCD treatment is possible in this setting, but efforts will be needed across the entire care cascade to improve hypertension control,” they remark, adding:

“The increasing burden of NCDs such as hypertension and diabetes is one of the major challenges for contemporary health systems, especially in low-resource settings. Our study shows that controlling hypertension and diabetes requires broad systemic approaches to strengthen both prevention and treatment, especially in rural settings.”

According to the scientists, while the results from the survey showed a smaller number of respondents testing positive for diabetes compared to hypertension, the diabetes patients had high levels of awareness, treatment, and control than hypertension patients to which they suggested improvements in care cascades for hypertension treatment within the same settings with targeted interventions.

“The care cascades for hypertension and diabetes demonstrate differences in drop-off for each step in the cascade; awareness, care engagement, treatment, and control. Understanding differences in care delivery, health education, and patient demand between the two conditions could help design policies to improve care cascaded for hypertension control,” they urged.

The study took place in Kilombero district in the Morogoro region, and Same district in the Kilimanjaro region. The two districts have closer access to the highest levels of care due to the hierarchical structure of the health system that comprises village-level dispensaries, health centers, and district hospitals. All provide care for hypertension and diabetes except village-level dispensaries which only provide basic care.

Respondents who tested positive for diabetes were mostly from Kilombero district, older, retired, and enrolled in a social health protection program compared to those who were not tested positive. Those positive for hypertension were older, more likely to be retired, enrolled in a social health protection program, and with lower educational attainment than those who were not screened positive for hypertension. 

The study had its own limitations which were; reliance on patient self-report that a healthcare provider had given them a prior diagnosis of an NCD, the timing of the most recent healthcare visits for a chronic condition, and current treatment use. 

“Despite these limitations, this study is, to our knowledge, the first study that measured the care cascade for both hypertension and diabetes among adults of all ages in Tanzania.”

In Tanzania, recent studies have found low levels of diagnostic tools, training of healthcare providers, and availability of essential medicines for NCDs across all levels of the health system. The scientists believe, designing improved policies will promote a systemic approach to strengthen the whole social health protection system to address all barriers to hypertension and diabetes control.

>> Link to full article: https://doi.org/10.1371/JOURNAL.PMED.1004140