HYPERTENS ERTENSION ION IN AF AFRICA CA IN 10 10 SIMP MPLE LE SLI LIDES ES Prof. Gerald Yonga FRC RCP (Edin in), , MBA BA, FESC SC, , FACC CC Visitin isiting g Profes fessor or, Schoo hool l of Medicin dicine, e, Univer iversity ity of Nairo irobi bi Chai air, East t Africa rica Non on-Co Communi unicabl cable e Disease seases (NCDs) NCDs) Allia iance nce
Ou Outline tline Prev eval alence ence in Afr frica a (ag age, e, gen ender er, , rural/ al/urban urban, , sev ever erity) y) - 3 Awar areness, eness, on on trea eatment, tment, con ontr trolle olled d - 1 Aet etiology logy/p /patho athophysi physiol ology ogy in Afr frican ans s – 1 (CR CREOLE LE study) y) Co Compli plicatio cations/ ns/Bur Burden en - 2 Hyp yperte ertensi nsion on Co Contr trol ol strateg ategies ies , Framew amework rk & Programs rams - 3 ( ( PASCA CAR/WHO /WHO road ad map ap, , HHA HHA, , SSA SSA sal alt red eductio tion n proje ject) ct) Partnerships in CVD Preventio ion and d care in Africa
Prevalence of hypertension awareness, treatment and control in 18 countries (154,000 people) Aware
Figure 2. Epidemiological model showing distribution of hypertension prevalence according to age in both sexes, with size of bubble corresponding to respective sample size (A: 1990, B: 2000, C: 2010). Adeloye D, Basquill C (2014) Estimating the Prevalence and Awareness Rates of Hypertension in Africa: A Systematic Analysis. PLOS ONE 9(8): e104300. https://doi.org/10.1371/journal.pone.0104300 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0104300
Prevalence, Awareness, Treatment and Control of Hypertension in Africa Prevalence 30 % (27-34%) Awareness 27 % (7-56%) Not aware 73 % Treated 18 % (14-22%) Untreated 72 % Controlled* 7 % (5-8%) Uncontrolled 93 % Adapted from original publication by Anastase DZUDIE; * BP < 140/90 mmHg Chair, PASCAR task force on hypertension
BP REGULATORY MECHANISM.(Summary)
Relationship of Obesity, with HTN, DM, RENAL.
COMPLICATIONS OF HTN. • Heart • Brain • Eye • Blood vessels • Kidney
DATA FOR HYPERTENSION CONTROL IN IN AFRICA • Risk factors/associated factors (behavioural/upstream drivers, age) • health burden – prevalence, attributable morbidity & mortality (missed work, complications, admissions, DALYs lost, death rates) • Economic burden (Direct costs, indirect costs, cost of inaction) • Health system data (WHO SARAM data & PEN packages,HRH, EMTs, supply chain studies- “No Empty Shelves” – PATH ) • Feasibility and impact of interventions – HHA, AMPATH, MSF Belgium, APHRA (Methods & levels of intervention and evaluation methods- ?implementation science ) • Costs of various intervention, comparative cost-effectiveness of intervention – “best - buys”) • Targets and Surveillance Systems/HIS (community, patient, facility level data – 25 by 25 goals, WHF/PASCAR HTN Road Map?”90 -90-90 targets”)
HHA Since HHA nce October tober 2014 14 HHA HHA has to date… 5,000 Identifi ified ed over Trained over Conducted ted over 5.7 1 million living with Activ tivate ated over r million scre reeni enings 1 5,000 health high blood press ssure re 1 675 health facil ilities ities 1 workers rs 1 Partner Partner Faith Based d Urban setti ting ng Large Faith Based Gove vern rnment nt Heath h Facilities Integrating into Health h System Health h System HIV services Ref 5. AstraZeneca data on file: Total Programme KPIs – Programme start to 31 October2017
PASCAR HYPERTENSION ROADMAP PASCAR has identified the fight against hypertension as N°1 priority action to achieve WHO/WHF 25 x 25 goal A Hypertension Task Force of continental experts:- -plan a 15% control rate of BP in the next 10 years, -Three successful meetings held. -Final document after 4th meeting 2016
Approach to Hypertension control in SSA • There are significant health and economic gains in to early detection, adequate treatment and good control of hypertension. • Treating the complications of hypertension is costly and less effective. • Addressing behavioural risk factors, e.g. unhealthy diet, tobacco consumption, harmful use of alcohol and physical inactivity can ameliorate hypertension burden. • Hypertension remains number one risk factor for increased morbidity and mortality in Africa
Th Than ank yo you
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