An exploration of the risk factors, beliefs and management of hypertension in primary care in Nigeria - a mixed methods study

Objective: To explore ways to improve care of hypertension at the primary care level in Nigeria Background: Although the burden of communicable diseases is still present in Africa, the burden of non-communicable diseases is rapidly increasing. Chronic conditions like hypertension are common among both rural and urban populations in Nigeria. In many regions of Nigeria, the primary health care (PHC) facility is usually the only source of formal health care available. Many clients who use PHC facilities in Nigeria may have hypertension yet they often go undetected and untreated. Setting: Twenty (20) rural (N=10) and urban (N=10) primary health care centres in the Federal Capital Territory Nigeria Methods: A multi-level triangulation mixed method design was used. Participants: Forty-one (41) primary health care clients and forty-one (41) primary health care workers participated in the qualitative study while 650 clients participated in the quantitative study which investigated the prevalence of hypertension and cardiovascular risk factors. Results: Overall, the study revealed a substantial unmet need for hypertension in primary care in Nigeria. The sample population for this study is very young with about 90% of the population aged between 18-44 years old. Overall, among those 40years and older, 94.4% (95%CI: 88.9-97.7) had 10-year risk of cardiovascular event less than 10%. Most participants had 1-2 risk factors (58.4% [95%CI: 54.5-62.3]) while 32.3% [95%CI: 28.7-36.1]) had 3-5 risk factors for cardiovascular diseases. The overall hypertension service readiness and availability of the 20 primary care facilities was very low. The overall prevalence of hypertension was 27.9% (95%CI: 24.5- 31.6). The qualitative study identified important ethnic differences and similarities in beliefs about meaning, risk factors, symptoms and treatment of hypertension between PHC clients and workers. It also revealed that non-physician PHC workers were enthusiastic to take on additional roles in managing hypertension which is currently beyond their scope of duty. Conclusions: This study provides important information for improving care of hypertension in primary care in Nigeria by first highlighting the burden of hypertension and risk factors among primary care clients. Then it identifies differences and similarities in beliefs between PHC clients and PHC workers as well as current experiences of PHC workers with managing hypertension which could help inform appropriate hypertension management program in Nigeria

Information Quality Frameworks for Digital Health Technologies:Systematic Review

Background: Digital health technologies (DHTs) generate a large volume of information used in health care for administrative, educational, research, and clinical purposes. The clinical use of digital information for diagnostic, therapeutic, and prognostic purposes has multiple patient safety problems, some of which result from poor information quality (IQ). Objective: This systematic review aims to synthesize an IQ framework that could be used to evaluate the extent to which digital health information is fit for clinical purposes. Methods: The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We searched Embase, MEDLINE, PubMed, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, ProQuest Dissertations and Theses Global, Scopus, and HMIC (the Health Management Information Consortium) from inception until October 2019. Multidimensional IQ frameworks for assessing DHTs used in the clinical context by health care professionals were included. A thematic synthesis approach was used to synthesize the Clinical Information Quality (CLIQ) framework for digital health. Results: We identified 10 existing IQ frameworks from which we developed the CLIQ framework for digital health with 13 unique dimensions: accessibility, completeness, portability, security, timeliness, accuracy, interpretability, plausibility, provenance, relevance, conformance, consistency, and maintainability, which were categorized into 3 meaningful categories: availability, informativeness, and usability. Conclusions: This systematic review highlights the importance of the IQ of DHTs and its relevance to patient safety. The CLIQ framework for digital health will be useful in evaluating and conceptualizing IQ issues associated with digital health, thus forestalling potential patient safety problems. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018097142; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=97142 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-02472

Beliefs about hypertension among primary health care workers and clients in Nigeria: A qualitative study.

OBJECTIVE:The main objective of the study was to elicit beliefs about hypertension among Nigerian Primary Health Care clients and workers. BACKGROUND:In many regions of Nigeria, the primary health care facility is usually the only source of formal health care available. Since hypertension is a chronic condition that requires lifelong life style modification and drug treatment, it is important to understand the context and background to the condition through the beliefs and perceptions among both lay persons and health care providers who manage the condition. SETTING:Rural and urban primary health care facilities in the Federal Capital Territory Nigeria. PARTICIPANTS:A total of Eighty-one (81) primary health care clients and workers participated in the study. METHODS AND OUTCOME MEASURE:A qualitative research using interviews, focus group discussions and reflective work as sources of data collection. The outcome measures were emerging themes from thematic framework analysis. RESULTS:There were four themes that summarize beliefs of both PHC workers and clients namely: (1) Meaning of hypertension (2) causes of hypertension, (3) Consequences of hypertension (4) Perceptions of treatment, one additional distinct theme was elicited among PHC workers "contextual explanation". However, under each of the shared four themes, there were both similarities and differences in beliefs expressed between PHC workers and clients. CONCLUSIONS:This study highlights important similarities and differences in beliefs about hypertension among primary health care clients and primary health care workers that have significant implications for management of hypertension in primary care settings in Nigeria

Themes, subthemes and concepts.

<p>Themes, subthemes and concepts.</p

Characteristics of participants (N = 27).

<p>Characteristics of participants (N = 27).</p

Flow diagram of included studies.

<p>Flow diagram of included studies.</p

Study characteristics (n = 16).

<p>Study characteristics (n = 16).</p

Eligibility Criteria.

<p>Eligibility Criteria.</p

Proportion of Lay persons with respective beliefs under EM categories: “definition”, “cause”, “Course”, “symptoms” &” treatment” in quantitative studies.

<p>Proportion of Lay persons with respective beliefs under EM categories: “definition”, “cause”, “Course”, “symptoms” &” treatment” in quantitative studies.</p

Forest Plot showing U-R difference of prevalence of hypertension in studies comparing rural and urban populations.

<p>U-R difference = Urban-Rural difference</p