Abstract:
Hypertension is a common non-communicable diseases and the major risk factor for
cardiovascular disease, stroke and chronic kidney disease.
Methods
We conducted a cross-sectional study in four rural Rwandan DH from April to July 2014 to
review factors associated with adherence in population of low socio-economic status, cost and
availability of antihypertensive drugs; knowledge of clinicians on antihypertensive drug
prescription, cost and availability of these drugs in the hospitals and their communication to
patients, all of which would contribute to poor BP control. The study targeted hypertensive
patients, clinicians and registries for medication availability and costs.
Results
Of 112 study patients, 90 (80.4%) were female; 102 (91.1%) lived from subsistence farming,
95.5% are covered by community health insurance and 47 (42.3%) were illiterate. The median
age was 61 years. Mean weight was 60.2 kg [SD 12.8], mean height of 159.1 cm [SD 10cm]
giving a mean BMI of 23.5 kg/m2 [SD 4.4]. Mean systolic BP was 152.6 mmHg [SD 23.7] and
mean diastolic BP was 90.9 mmHg [SD 14.2] and 63 (76.4%) did not meet BP goal value.
High adherence was found in 86 (76.8%) patients and was associated with hospital in which
patients were followed (p 0.001), to whether the patient received his medication in the hospital
pharmacy (p 0.004) and education with ability to read (p 0.01). Antihypertensive drugs;
Nifedipine, hydrochlorothiazide, furosemide, captopril, methyldopa, atenolol and spironolactone
had been available in all hospitals for the previous four months and at affordable price
considering community health insurance coverage. Half of clinicians (15/30, 50%) admitted to
be non adherence to hypertension treatment guidelines and to constitute a key barrier to BP
control of their patients. Loop diuretic was chosen as class of first choice to start to a newly
diagnosed patient of hypertension without associated complications or other diagnoses by
36.7% clinicians and is most used in monotherapy to treat hypertension by 43.3%.
Conclusions
Patients characteristics including adherence and health facility factors involving cost and
availability of antihypertensive drugs are conducive at DH, despite, patients followed at DH have
low level of BP control. Clinician factors including knowledge of standard of care of hypertension
and communication are barriers to be improved.
From this study, key interventions in Rwandan DH should be hypertension treatment guideline
training for clinicians and initiating patient-centered care systems to improve BP control.
