Primary health care for hypertension by nurses in rural and urban sub-Saharan Africa.
To implement a nurse-led protocol for the care of hypertension, 5 clinics were established in Yaounde (urban) and Bafut (rural) in Cameroon. International guidelines were adapted and 10 nurses were trained. The initial cohort of patients was referred from a field survey. The program proceeded for 26 months and 454 patients (45% urban) were registered in the clinics. Relative to urban participants, rural participants were more often women (59% vs 45%, P=.002) and less likely to have diabetes (7.2% vs 41.2%, P<.001). Between baseline and final visits, systolic and diastolic blood pressures dropped by 11.7 mm Hg (95% confidence interval, 8.9-14.4) and 7.8 (95% confidence interval, 5.9-9.6), respectively (P<.001). These changes were consistent in subgroups and after adjustment. Most dropouts occurred around the initial visit and among urban participants and nondiabetics. Nurse-led clinics are effective for improving hypertension care in these settings and require implementation and validation through controlled trials.
Kengne
Andre P
AP
The George Institute for International Health, The University of Sydney, Sydney, Australia. akengne@george.org.au
Awah
Paschal K
PK
Fezeu
Leopold L
LL
Sobngwi
Eugene
E
Mbanya
Jean-Claude
JC
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D011320:Primary Health Care; D012424:Rural Population; D016896:Treatment Outcome; D014505:Urban Population
D000959:Antihypertensive Agents