title: Screening for diabetes and hypertension in a rural low income setting in western Kenya utilizing home-based and community-based strategies.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Purdue University College of Pharmacy, W7555 Myers Building, 1001 W. 10th Street, Indianapolis, Indiana, USA. spastaki@gmail.com
authors.forename: Sonak D
authors.initials: SD
authors.lastname: Pastakia
authors.forename: Shamim M
authors.initials: SM
authors.lastname: Ali
authors.forename: Jemima H
authors.initials: JH
authors.lastname: Kamano
authors.forename: Constantine O
authors.initials: CO
authors.lastname: Akwanalo
authors.forename: Samson K
authors.initials: SK
authors.lastname: Ndege
authors.forename: Victor L
authors.initials: VL
authors.lastname: Buckwalter
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Bloomfield
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005240:Feasibility Studies; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D007630:Kenya; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011203:Poverty; D019035:Rural Health Services / Q000706:statistics & numerical data*