Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study.
BACKGROUND
Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management.


METHODS
A population-based survey of 9254 persons aged 25-64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP >or= 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval.


RESULTS
Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care.


CONCLUSIONS
Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.
Bovet
Pascal
P
University Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and University of Lausanne, rue du Bugnon 17, 1005 Lausanne, Switzerland. pascal.bovet@chuv.ch
Gervasoni
Jean-Pierre
JP
Mkamba
Mashombo
M
Balampama
Marianna
M
Lengeler
Christian
C
Paccaud
Fred
F
D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003151:Community Health Centers / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D050177:Overweight; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011204:Poverty Areas; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D013636:Tanzania