title: Capacity of Health Facilities to Manage Hypertension in Mukono and Buikwe Districts in Uganda: Challenges and Recommendations.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 10th 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.|International Health, Department of Epidemiology and Biostatistics, University of Antwerp, Antwerp, Belgium.
authors.forename: Geofrey
authors.initials: G
authors.lastname: Musinguzi
authors.affiliation: Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
authors.forename: Hilde
authors.initials: H
authors.lastname: Bastiaens
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Rhoda K
authors.initials: RK
authors.lastname: Wanyenze
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.|International Health, Department of Epidemiology and Biostatistics, University of Antwerp, Antwerp, Belgium.
authors.forename: Aggrey
authors.initials: A
authors.lastname: Mukose
authors.affiliation: International Health, Department of Epidemiology and Biostatistics, University of Antwerp, Antwerp, Belgium.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Van Geertruyden
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Nuwaha
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D019468:Disease Management; D005260:Female; D019538:Health Care Surveys; D006268:Health Facilities; D006282:Health Personnel; D006295:Health Resources; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D014454:Uganda