Screening for diabetes and hypertension in a rural low income setting in western Kenya utilizing home-based and community-based strategies

Globalization and Health

Gerald S Bloomfield³  Rajesh Vedanthan²  Victor L Buckwalter⁵  Samson K Ndege⁶  Constantine O Akwanalo³  Jemima H Kamano¹  Shamim M Ali⁴  Sonak D Pastakia¹ 

[1] Academic Model Providing Access to Healthcare (AMPATH), Nandi Road, PO Box 4606, Eldoret, Kenya;Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY, USA;Division of Cardiovascular Medicine, Duke University Medical Center and Duke Clinical Research Institute, North Pavilion, 2400 Pratt Street, Durham, NC, USA;Moi Teaching and Referral Hospital, Nandi Road, Po Box 3, Eldoret, Kenya;Department of Family Medicine, School of Medicine, College of Health Science, Moi University, Nandi Road, PO Box 4606, Eldoret, Kenya;Department of Epidemiology and Nutrition, School of Public Health, College of Health Sciences, Moi University, Nandi Road, PO Box 4606, Eldoret, Kenya

关键词: Community-based screening;    Home-based screening;    Cardiovascular disease;    Kenya;    Hypertension;    Diabetes;   

Others  :  819314
DOI  :  10.1186/1744-8603-9-21

 received in 2013-01-08, accepted in 2013-05-10,  发布年份 2013

【 摘 要 】

Background

The burdens of hypertension and diabetes are increasing in low- and middle-income countries (LMICs). It is important to identify patients with these conditions early in the disease process. The goal of this study, therefore, is to compare community- versus home-based screening for hypertension and diabetes in Kenya.

Methods

This was a feasibility study conducted by the Academic Model Providing Access to Healthcare (AMPATH) program in Webuye, a town in western Kenya. Home-based (door-to-door) screening occurred in March 2010 and community-based screening in November 2011. HIV counselors were trained to screen for diabetes and hypertension in the home-based screening with local district hospital based staff conducting the community-based screening. Participants >18 years old qualified for screening in both groups. Counselors referred all participants with a systolic blood pressure (SBP) ≥160 mmHg and/or a random blood glucose ≥7 mmol/L (126 mg/dL) to a local clinic for follow-up. Differences in likelihood of screening positive between the two strategies were compared using Fischer’s Exact Test. Logistic regression models were used to identify factors associated with the likelihood of following-up after a positive screening.

Results

There were 236 participants in home-based screening: 13 (6%) had a SBP ≥160 mmHg, and 54 (23%) had a random glucose ≥ 7 mmol/L. There were 346 participants in community-based screening: 35 (10%) had a SBP ≥160 mmHg, and 27 (8%) had a random glucose ≥ 7 mmol/L. Participants in community-based screening were twice as likely to screen positive for hypertension compared to home-based screening (OR=1.93, P=0.06). In contrast, participants were 3.5 times more likely to screen positive for a random blood glucose ≥7 mmol/L with home-based screening (OR=3.51, P<0.01). Rates for following-up at the clinic after a positive screen were low for both groups with 31% of patients with an elevated SBP returning for confirmation in both the community-based and home-based group (P=1.0). Follow-up after a random glucose was also low with 23% returning in the home-based group and 22% in the community-based group (P=1.0).

Conclusion

Community- or home-based screening for diabetes and hypertension in LMICs is feasible. Due to low rates of follow-up, screening efforts in rural settings should focus on linking cases to care.

【 授权许可】

   
2013 Pastakia et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization: Cardiovascular Diseases in the African Region: Current Situation and Perspectives. Geneva: Report of the Regional Director; 2005.
• [2]Bloomfield GS, Kimaiyo S, Carter EJ, Binanay C, Corey GR, Einterz RM, Tierney WM, Velazquez EJ: Chronic noncommunicable cardiovascular and pulmonary disease in sub-Saharan Africa: An academic model for countering the epidemic. Am Heart J 2011, 161:842-847.
• [3]Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK: The Global burden of hypertension: analysis of worldwide data. Lancet 2005, 365:217-223.
• [4]Mufunda J, Chatora R, Ndambakuwa Y, Nyarango P, Kosia A, Chifamba J, Filipe A, Usman A, Sparks VH: Emerging non-communicable disease epidemic in Africa: preventive measures from the WHO Regional Office for Africa. Ethn Dis 2006, 16:521-526.
• [5]International Diabetes Federation. Brussels; 2009. website. http://www.idf.org/diabetesatlas/ webcite
• [6]Mbanya JC, Motala AA, Sobngwi , Assah FK, Enoru ST: Diabetes in sub-Saharan Africa. Lancet 2010, 375:2254-2266.
• [7]Mathenge W, Foster A, Kuper H: Urbanization, ethnicity and cardiovascular risk in a population in transition in Nakuru, Kenya: a population-based survey. BMC Publ Health 2010, 10:569. BioMed Central Full Text
• [8]Addo J, Smeeth L, Leon DA: Hypertension in sub-saharan Africa: a systematic review. Hypertension 2007, 50:1012-1018.
• [9]Kimaiyo S, Were MC, Shen C, Ndege S, Braitstein P, Sidle J, Mamlin J: Home-based HIV counseling and testing in western Kenya. East African Med J 2010, 87:100-108.
• [10]Einterz RM, Kimaiyo S, Mengech HN, Khwa-Otsyula BO, Esamai F, Quigley F, Mamlin JJ: Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med 2007, 82:812-818.
• [11]IU–Kenya Partnership website. http://www.iukenya.org webcite
• [12]Wachira J, Kimaiyo S, Ndege S, Mamlin J, Braitstein P: What is the impact of home-based HIV counseling and testing on the clinical status of newly enrolled adults in a large HIV care program in western Kenya? Clin Infect Dis 2012, 54:275-281.
• [13]Pastakia SD, Karwa R, Kahn CB, Nyabundi JS: Evolution of Diabetes Care Through Partnerships in a Rural Resource-Constrained Setting. Ann Pharmacother 2011, 45:1-6.
• [14]Bland JM, Altman DG: Some examples of regression towards the mean. BMJ 1994, 309:780.
• [15]Kario K, Schwartz JE, Pickering TG: Changes of nocturnal blood pressure dipping status in hypertensives by nighttime dosing of alpha-adrenergic blocker, doxazosin: results from the HALT study. Hypertension 2000, 35:787-794.
• [16]Opie LH, Seedat YK: Hypertension in sub-Saharan African populations. Circulation 2005, 112:3562-3568.
• [17]Bovet P, Gervasoni JP, Mkamba M, Balampama M, Lengeler C, Paccaud F: Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study. BMC Publ Health 2008, 8:1-8. BioMed Central Full Text
• [18]Seedat YK, Rayner BL: South African Hypertension Guideline 2011. S Afr Med J 2012, 102:57-84.
• [19]Tin LL, Beevers DG, Lip GY: Systolic vs diastolic blood pressure and the burden of hypertension. J Hum Hypertens 2002, 16:147-150.
• [20]Joint National Commission 7. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf webcite
• [21]Steyn K, Sliwa K, Hawken S, Commerford P, Onen C, Damasceno A, Ounpuu S, Yusuf S, INTERHEART Investigators in Africa: Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study. Circulation 2005, 112:3554-3561.
• [22]van den Donk M, Sandbaek A, Borch-Johnsen K, Lauritzen T, Simmons RK, Wareham NJ, Griffin SJ, Davies MJ, Khunti K, Rutten GEHM: Screening for type 2 diabetes. Lessons from the ADDITION-Europe study. Diabet Med 2011, 28:1416-1424.
• [23]American Diabetes Association: Standards of Medical Care in Diabetes–2010. Diabetes Care 2010, 33(Suppl 1):s11-s61.
• [24]Nasir MN, Thevarajah M, Yean YC: Hemoglobin variants detected by hemoglobin A1c analysis and the effects on HbA1c measurements. Int J Diabetes Dev Ctries 2010, 30:86-90.
• [25]Kirk JK, D’Agostino RB, Bell RA, Passmore LV, Bonds DE, Karter AJ, Narayan KMV: Disparities in HbA1c levels between African-American and Non-Hispanic white adults with diabetes. Diabetes Care 2006, 29:2130-2136.
• [26]International Diabetes Federation. http://www.idf.org/webdata/docs/IDF%20GGT2D.pdf webcite