title: Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa.
abstract: BACKGROUND
  In West Africa, hypertension, once rare, has now emerged as a critical health concern and the trajectory is upward and factors are complex. The true magnitude of hypertension in some West African countries, including in-depth knowledge of underlying risk factors is not completely understood. There is also a paucity of research on adequate systems-level approaches designed to mitigate the growing burden of hypertension in the region.
  
  
  OBJECTIVE
  In this review, we thematically synthesize available literature pertaining to the prevalence of hypertension in West Africa and discuss factors that influence its diagnosis, treatment and control. We aimed to address the social and structural determinants influencing hypertension in the sub-region including the effects of urbanization, health infrastructure and healthcare workforce.
  
  
  RESULTS
  The prevalence of hypertension in West Africa has increased over the past decade and is rising rapidly with an urban-rural gradient that places higher hypertension prevalence on urban settings compared to rural settings. Overall levels of awareness of one's hypertension status remain consistently low in West African. Structural and economic determinants related to conditions of poverty such as insufficient finances have a direct impact on adherence to prescribed antihypertensive medications. Urbanization contributes to the increasing incidence of hypertension in the sub-region and available evidence indicates that inadequate health infrastructure may act as a barrier to optimal hypertension control in West Africa.
  
  
  CONCLUSIONS
  Given that optimal hypertension control in West Africa depends on multiple factors that go beyond simply modifying the behaviors of the individuals alone, we conclude by discussing the potential role systems-thinking approaches can play to achieve optimal control in the sub-region. In the context of recent advances in hypertension management including new therapeutic options and innovative solutions to expand health workforce so as to meet the high demand for healthcare, the success of these strategies will rely on a new understanding of the complexity of human behaviors and interactions most aptly framed from a systems-thinking perspective.
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, 123 Huff Hall, 1206 S, Fourth St, Champaign, IL 61820, USA. jiwez@illinois.edu.
authors.forename: Juliet
authors.initials: J
authors.lastname: Iwelunmor
authors.forename: Collins O
authors.initials: CO
authors.lastname: Airhihenbuwa
authors.forename: Richard
authors.initials: R
authors.lastname: Cooper
authors.forename: Bamidele
authors.initials: B
authors.lastname: Tayo
authors.forename: Jacob
authors.initials: J
authors.lastname: Plange-Rhule
authors.forename: Richard
authors.initials: R
authors.lastname: Adanu
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D005102:Health Expenditures / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014507:Urbanization