title: Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania.
abstract: Objectives To assess the prevalence of high blood pressure amongst postpartum women in rural Tanzania, and to explore factors associated with hypertension prevalence, awareness, treatment, and control. Methods 1849 women in Tanzania's Pwani Region who delivered a child in the prior year participated in the study. We measured blood pressure, administered a structured questionnaire and assessed factors associated with the prevalence, awareness, treatment, and control of hypertension (HTN) using bivariable and multivariable logistic regressions. Findings 26.7% of women had high blood pressure and/or were taking antihypertensive medication. Women were on average 27.5 years old (range 15-54). Nearly all women (99.5%) reported contact with the health system during their pregnancy and delivery, with an average of 5.2 visits for their own care in the past year. Only 23.5% of those with HTN were aware of their diagnosis, 17.4% were taking medication, and only 10.5% had controlled blood pressure. In multivariable analysis, facility delivery, health insurance, and increased distance from a hospital were associated with increased likelihood of HTN awareness; facility delivery and hospital distance were associated with current hypertensive treatment; younger age and increased hospital distance were associated with control of HTN. Conclusion The prevalence of high blood pressure in this postpartum population was high, and despite frequent recent contacts with the health system, awareness, treatment and control of HTN were low. These findings highlight an important missed opportunity to improve women's health during antenatal and postnatal care.
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, 11th floor, Boston, MA, 02115, USA. elarson@mail.harvard.edu.
authors.forename: Elysia
authors.initials: E
authors.lastname: Larson
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rabkin
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Godfrey M
authors.initials: GM
authors.lastname: Mbaruku
authors.affiliation: Tanzania Health Promotion Support, Dar es Salaam, Tanzania.
authors.forename: Redempta
authors.initials: R
authors.lastname: Mbatia
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, 11th floor, Boston, MA, 02115, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011181:Postnatal Care / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: Health services research; Hypertension; Obstetrics and gynecology; Primary care