Capacity of Health Facilities to Manage Hypertension in Mukono and Buikwe Districts in Uganda: Challenges and Recommendations

<div><p>Background</p><p>The burden of chronic diseases is increasing in both low- and middle-income countries. However, healthcare systems in low-income countries are inadequately equipped to deal with the growing disease burden, which requires chronic care for patients. The aim of this study was to assess the capacity of health facilities to manage hypertension in two districts in Uganda.</p><p>Methods</p><p>In a cross-sectional study conducted between June and October 2012, we surveyed 126 health facilities (6 hospitals, 4 Health Center IV (HCIV), 23 Health Center III (HCIII), 41 Health Center II (HCII) and 52 private clinics/dispensaries) in Mukono and Buikwe districts in Uganda. We assessed records, conducted structured interviews with heads of facilities, and administered questionnaires to 271 health workers. The study assessed service provision for hypertension, availability of supplies such as medicines, guidelines and equipment, in-service training for hypertension, knowledge of hypertension management, challenges and recommendations.</p><p>Results</p><p>Of the 126 health facilities, 92.9% reported managing (diagnosing/treating) patients with hypertension, and most (80.2%) were run by non-medical doctors or non-physician health workers (NPHW). Less than half (46%) of the facilities had guidelines for managing hypertension. A 10^th of the facilities lacked functioning blood pressure devices and 28% did not have stethoscopes. No facilities ever calibrated their BP devices except one. About a half of the facilities had anti-hypertensive medicines in stock; mainly thiazide diuretics (46%), beta blockers (56%) and calcium channel blockers (48.4%). Alpha blockers, mixed alpha & beta blockers and angiotensin II receptor antagonists were only stocked by private clinics/dispensaries. Most HCIIs lacked anti-hypertensive medicines, including the first line thiazide diuretics. Significant knowledge gaps in classification of patients as hypertensive were noted among respondents. All health workers (except 5, 1.9%) indicated that they needed additional training in hypertension management. Several provider and patient related challenges were also observed in this study.</p><p>Conclusions</p><p>Health facilities in this setting are inadequately equipped to provide services for management of hypertension. Diagnostic equipment, anti-hypertensive drugs and personnel present great challenges. To address the increasing burden of hypertension and other chronic diseases, measures are needed to substantially strengthen the healthcare facilities, including training of personnel in management of hypertension and other chronic diseases, and improving diagnostic and treatment supplies.</p></div

Statistical analysis comparing correlation coefficients (R) of sub groups of outcome variables with Health facility level.

<p>**. Correlation is significant at the 0.01 level (2-tailed).</p><p>*. Correlation is significant at the 0.05 level (2-tailed).</p><p>Statistical analysis comparing correlation coefficients (R) of sub groups of outcome variables with Health facility level.</p

Availability of different anti-hypertensive medicines by health facility level.

<p>*Reported drugs</p><p>Diuretics–Hydrochlorothiazide and chlorothiazide; Bendroflumethiazide, Spironolactone, Amiloride</p><p>Beta Blockers–Atenelol, Propranolol</p><p>Alpha blockers–Indormine, Phenoxybenzamine</p><p>Mixed Alpha and Beta Blockers–Carvedilol, Labetalol</p><p>Calcium Channel Blockers–Amlodipine, Nifedipine, Nimodipine</p><p>Angiotensin Converting Enzyme (ACE) Inhibitors–Captopril, Enalapril</p><p>Angiotensin II Receptor antagonists–Losartan</p><p>Alpha-2 agonists–Methyldopa</p><p>P- Value is significant at P < 0.05</p><p>Availability of different anti-hypertensive medicines by health facility level.</p

Suggested recommendations to improve hypertension management in Mukono and Buikwe in Uganda.

<p>Suggested recommendations to improve hypertension management in Mukono and Buikwe in Uganda.</p

Framework illustrating the study design and data structure.

<p>Framework illustrating the study design and data structure.</p

Availability of guidelines and functioning equipment for hypertension diagnosis and management.

<p>P- Value is significant at P < 0.05</p><p>Availability of guidelines and functioning equipment for hypertension diagnosis and management.</p

Distribution of studied baseline characteristics by level of facility in Mukono and Buikwe districts in Uganda.

<p>Distribution of studied baseline characteristics by level of facility in Mukono and Buikwe districts in Uganda.</p

Bivariate and multivarable analysis for preference to be treated for HIV at the workplace among health care workers in Wakiso and Mukono in Uganda.

<p>CI = Confidence Interval, HC = Health Centre, PR = Prevalence Ratio.</p

Bivariate and multivariable analysis of willingness to disclose an HIV positive status to a supervisor/manager among health care workers in Wakiso and Mukono in Uganda.

<p>CI: Confidence Interval, HC = Health Centre, PNFP = Private-Not-For-Profit, PR = Prevalence Ratio.</p

Socio-demographic characteristics of health care workers from Mukono and Wakiso districts in Uganda.

<p>HC = Health Centre, PNFP = Private-Not-For-Profit.</p>*<p><i>included the general outpatient department, HIV clinic, laboratory, pharmacy, records, and maternal child health services</i>.</p