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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 26-41

Hypertension in sub-Saharan Africa: A scoping review…


1 Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
2 INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST; Department of Thoracic and Vascular Surgery and Vascular Medicine, Dupuytren University Hospital, 2, Ave. Martin Luther King, 87042 Limoges, France
3 INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France

Date of Submission01-Sep-2020
Date of Acceptance13-Oct-2020
Date of Web Publication27-Mar-2021

Correspondence Address:
Dr. Jacques Joubert
Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcpc.jcpc_55_20

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  Abstract 


Like much of the developing world, sub-Saharan Africa (SSA) is facing a major challenge. This challenge is due to noncommunicable diseases (NCDs) whose rates are rising dramatically in SSA. Two conditions that frequently coexist head the list of NCDs as either established disease entities or risk factors for NCDs. These are hypertension and diabetes. Hypertension is the foremost cardiovascular condition. The objective of this scoping review is to examine peer-reviewed publications for the period 2009–2019 related to the detection and management of hypertension in SSA. We seek to define the issues confronted in managing hypertension in SSA, what measures have been implemented and evaluated, and what barriers and facilitators have been found. By mapping the complex, heterogeneous literature, we aim to identify the key concepts that underpin a major public health issue in SSA. The central question that this review addresses is how to control hypertension in SSA.

Keywords: Control, hypertension, management, sub-Saharan Africa


How to cite this article:
Joubert J, Lacroix P, Preux PM, Dumas M. Hypertension in sub-Saharan Africa: A scoping review…. J Clin Prev Cardiol 2021;10:26-41

How to cite this URL:
Joubert J, Lacroix P, Preux PM, Dumas M. Hypertension in sub-Saharan Africa: A scoping review…. J Clin Prev Cardiol [serial online] 2021 [cited 2021 Aug 2];10:26-41. Available from: https://www.jcpconline.org/text.asp?2021/10/1/26/312227




  Introduction Top


In sub-Saharan Africa (SSA) where infectious diseases have dominated health for decades, there has, in recent years, been an increase in the prevalence of noncommunicable diseases (NCDs). NCDs are, according to the United Nations Secretary General Ban Ki-Moon, a “public health emergency in slow motion”[1] and the George Institute calls the rise of NCD in SSA a “looming epidemic.”[2] Sir Seretse Khama Ian Khama at the 2017 State of the Nation Address in Botswana noted that “…deaths due to NCDs exceed those due to TB, malaria, and HIV combined.” Mortality aside, chronic disability is a major result of NCDs, and a recent review based on data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) for the first time comprehensively examined the trends in disability-adjusted life-years (DALYs) in SSA. Between 1990 and 2017, the all-age rates for NCDs in SSA have risen by 67%.[3] According to this report, the rates of DALYs for NCDs in all regions of SSA surpassed those in other countries worldwide.[3] Cardiovascular diseases (CVDs) constitute the second-leading group of NCDs, and worldwide, 85% of cardiovascular (CVD) deaths are predicted to occur in low- and middle-income countries.[4] NCDs in the developing world are coupled with an alarming shortage of health workers.[5] In SSA, the uncontested leader as a risk factor for CVD and by implication for NCDs is hypertension.


  Methodology Top


We performed a systematic search of the literature pertaining to hypertension limited to SSA and the years 2009–2019. We interrogated electronic databases with the assistance of the research librarian at the University of Melbourne. We used the electronic databases MEDLINE/Ovid and Scopus using keywords and MeSH strategy following guidelines developed for conducting a scoping review.[6] We employed the system for Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA).[6] We assessed article quality using the PEDro scoring method discarding articles with a score <6/10.[7] We did not interrogate the grey literature. The results of the search strategy are shown in [Table 1] and [Table 2] as well as [Figure 1]. The initial research strategy included diabetes as well as obesity as these are often combined in articles regarding NCDs in SSA and would provide a good overall picture of NCD in SSA. This resulted in 162 articles. After removal of those articles where obesity and diabetes were the main focus, 81 articles remained where the main emphasis was on hypertension.
Table 1: Medline/Ovid search strategy and results

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Table 2: Medline/Ovid search strategy and results

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Figure 1: Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA)(6).

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  Results Top


Prevalence data

Prevalence and trajectory of hypertension in sub-Saharan Africa as a cause for concern [Table 3]
Table 3: Selected articles demonstrating awareness, treatment, adherence and control of hypertension in SSA

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As opposed to diabetes, the true prevalence of which is not known in SSA,[3] the prevalence of hypertension has been well studied.[8] Despite low initial assessments of hypertension prevalence in SSA, Ataklte et al. in a recent systematic review found a total pooled prevalence of 30%.[8]

Bosu et al.[9] in a systematic review of 34 studies found the overall pooled prevalence to be 57%. In rural South Africa, hypertension prevalence in a cohort of 5890 subjects was 58.4%.[10]

Hypertension prevalence is rising in SSA while there is a decline in the developed world.[11] Between 1990 and 2016, systolic hypertension in SSA increased by 82%.[9] In Mozambique, between 2005 and 2015, the prevalence increased from 33.1% to 38.9% (P = 0.048).[11] In Benin, the hypertension prevalence was 32.9% demonstrating a significant rise since a previous study prevalence being then 27.9%.[12] Adeloye and Basqill[13] estimated that 54.6 million persons had raised blood pressure (BP) in SSA, with an age-adjusted prevalence of 19.1%. This figure increased to 130.2 million cases in 2010 with an age-adjusted prevalence of 25.9%, projected to increase by 2030 to 162.2 million. In a landmark prospective cohort study in Soweto,[14] CVD was found to be dominated by hypertension (56.3%) followed by heart failure (53.0%), with the second most frequent cause of heart failure being hypertension (33%). In Zimbabwe, in a cross-sectional hospital study, one in five hypertensive subjects had complications of hypertension such as cardiac failure.[15]

In a Tanzanian hospital study of 11,045 consecutive admissions, hypertension resulted in 33.9% of NCD mortality.[16] In South Africa, hypertension was in a calendar year cause of 46,888 deaths and 390,860 DALYs.[17] Moreover, in Black South Africans, hypertension is more prevalent, more aggressive, and more difficult to control,[18] with end-stage renal failure a common complication.[19]

Standardized prevalence studies of hypertension in sub-Saharan Africa (2009–2019)

Amberbir et al.[20] in a review of hypertension studies performed in Malawi noted four large studies, one being a WHO-STEPS approach to NCD surveillance. By 2016, a total of 39 WHO-STEPS surveillance studies had been performed in SSA.[10] The WHO-STEPS protocol provides nuanced, standardized information.[21] Cohort studies such as the TAnve Health STEPS Study[12] examine the effect of population migrations and urbanization in SSA.[22] In South Africa, a longitudinal cohort study is continuing in the Agincourt district of South Africa.[10]

Interventions

Nurse-led, protocol-driven interventions (2009 and 2019)

Good-quality randomized control trials in the period 2009–2019 are still rare [Table 4]. A Nigerian nurse-led, protocol-driven, two-arm randomized controlled trial[23] achieved target goals at six months in 62% of rural and 70% of urban hypertensives, with a mean systolic BP reduction being 30 mmHg and 15 mm Hg for diastolic BP with adherence at 6 months of 77%. In the Cameroun, Kengne et al.[24] achieved significant reductions in both systolic (11.7 mmHg) and diastolic BP (7.8 mmHg), (P < 0.001) reductions sustained over 6 months. Contrasting to the poor retention in this study, a cluster-randomized trial of nurse-led management in the Cameroun[25] achieved retention of 60% and 65%, while in the control arm it was only 29%. A Nigerian prospective cohort study achieved a control rate of 64% and retention rate of >90%.[26] A cluster-randomized Ghanaian trial[27] preceded by a detailed exploration of stakeholders' attitudes and perceptions[28] and training in hypertension management[29] demonstrated a 85% retention and significant change (P = 0.021) in systolic BP at 12 months. Conversely, in a WHO-funded multisite study[30] implementing nurse-led, protocol-driven hypertension management, 50% of subjects in the intervention group had persistently uncontrolled hypertension after 1 year. The Kenyan Sustainable model for Cardiovascular health by Adjusting Lifestyle and treatment with Economic perspective in settings of Urban Poverty (SCALE-UP) study[31] demonstrated improvement in BP in the intervention group as well as the control group at the end of the study period, but no inter-group statistically differences. Retention to care was 28% of those referred and control of blood pressure only 9%.[32]
Table 4: Selected Randomized Controlled Trials performed in SSA between 2009 and 2020. Evaluated by PEDro and scored according to level 6 and higher in terms of evidence

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Task-shifting to community health workers and pharmacists (2009–2019)

Five research projects relating to community health workers (CHWs) took place in SSA in the decade 2009–2019, two relating to training and supervision of CHWs while three investigating the impact of CHWs on NCDs.[5],[33],[34],[35] Abegunde et al.[33] tested a 3-day training package for CVD risk, finding an 80% concordance in all three areas (history and risk mapping, health behavior, and “treatment tracks”) between CHWs and medical doctors. In a similar project, Gaziano et al.[5] examined whether CHWs could be trained in metrics such as the calculation of body mass index, taking BP with an automated machine, and accurately weighing a subject as well as applying a validated CVD risk score. CHW knowledge and skills at 3–6 months had increased from 40% pretest to 80.2% posttest with retention of knowledge of 75.3% on follow-up testing. Vedanthan et al.[34] in the Linkage and Retention to Hypertension Care in Rural Kenya study described effective screening for CVD by CHWs using a smartphone with a decision-making algorithm to engage in a motivational and behavioral process. Kok et al.[35] demonstrated group that supervision of CHWs in SSA was effective particularly when combined with a practical problem-solving focus. The perceived supervision scale promoting communication, bilateral decision-making, and contact for CHWs has been validated.[36] Finally, CHWs delivering group health education[37] resulted in significantly improved systolic and diastolic BP control. By contrast, in a pragmatic cluster-randomized trial in eight rural clinics evaluating the effect on BP where CHWs acted as a support for the clinic nursing staff, there was increased clinic attendance but no change in the rate of uncontrolled hypertension compared to control clinics without CHW support.[38] Results of task-shifting to pharmacists were encouraging in Ghana,[39] and in the Sudan, 70% of community pharmacists were willing to participate in hypertension education programs.[40]

Interventions using mHealth for hypertension in sub-Saharan Africa (2009–2019)

In Cape Town a single-blind, randomized, three-arm trial testing short message system (SMS) messages designed to improve adherence in hypertensive patients demonstrated only minimal improvement in systolic BP at 12 months.[41] Hacking et al.[42] found no improvement in hypertension knowledge after 17 weeks of 90 SMS educative messaging to subjects with raised BP. Rotherham-Borus et al.[43] reported a paradoxical raise in diastolic BP following an SMS supportive intervention. In contrast, Vedanthan et al.[34] in a cluster randomized trial demonstrated statistically increased linkage to care by CHWs using mHealth. Sarfo et al.[44] demonstrated the feasibility of using a Bluetooth-supported BP control in a study in Ghana.

Education of health professionals (2009–2019)

According to Folb et al.,[45] nursing staff in SSA often do not have adequate skills for NCD management such as hypertension. This was echoed by Mungati et al. .from Zimbabwe[15] and Ogola et al.[46] in Kenya. Encouragingly, Katende et al.[47] implemented an innovative, culturally adapted WHO-ISH educational program for community nurses, resulting in significant improvement of knowledge, skills, and attitudes. Knowledge, in this study, increased from 62.8% pretest to 82.9% posttest while attitudes toward implementing evidence-based practices improved by 75%. In the Cameroun, intensive nurse education forms an integral part of the (current) nation-wide task-shifting initiative.[24] Gyamfi et al.[29] reported the results of the Task Shifting Strategies for Hypertension Control course that only 26.9% of nurses were “proficient” initially, while proficiency increasing to 95.7% at the end of the course. In Rwanda, a weeklong training program focusing on hypertension demonstrated significant increases in knowledge.[48] Conversely, the Healthy Heart Africa project improved frequency of BP measurements but not knowledge of consequences of hypertension as compared to controls.[46]

Similarly, a cluster randomized controlled trial in South Africa testing the effect of an education in 38 clinics reported no increase in treatment intensification and persistently poor control of BP after the education input.[49]

Education of communities and patients (2009–2019)

In a Nigerian study,[50] retirees exposed to an educational intervention based on the Information-Motivation-Behavioural model demonstrated improved medication adherence and knowledge of hypertension, the knowledge increasing significantly (P < 0.000) compared to controls. The Chronic Care Management model for hypertension employed in Matabeleland, Zimbabwe, used informal hypertension talks to transfer knowledge, an intervention that was shown to be effective.[51] By contrast, a South African study testing mHealth as an educational tool with educational SMS messages did not improve knowledge of hypertension.[42]

Participatory research and inclusion of communities (2009–2019)

Key to sustainability at primary care level is community involvement and ownership. Ajayi et al.[52] using the Community Directed Interventions approach, evaluated what resources there were at community level in Southern Nigeria. Chimberengwa and Naidoo[51] in Zimbabwe, reporting on a community-based participatory research project, noted that community-engagement aimed to combat hypertension has been reported in Ghana.[28] In Rwanda, there is a comprehensive program working with stakeholders and communities to engage in participatory research based on evidence-based practices. Projects in Ghana,[53] Zambia,[54] and Western Kenya[55] have successfully engaged with communities, patients, and stakeholders to better understand the facilitators, barriers, and perceptions regarding hypertension.


  Persistence of Poor Control of Hypertension in sub-Saharan Africa (2009–2019) Top


Folb et al.[45] studied the records of 3227 hypertensive attendees at 38 clinics. Of these, 59% of the patients' hypertension was uncontrolled. Maepe and Outhoff[18] reported in 2009/2010 that in a cohort of 4297 miners in South Africa, only 42% were on treatment and 69% were poorly controlled.

BP control was achieved in only 52% of hypertensive patients in a Zimbabwean tertiary referral center.[56] In Northern Tanzania, a rigorous study using random community-based sampling found that 95.3% of the subjects identified as being hypertensive had uncontrolled blood pressure.[57] In a multinational study,[58] blood pressure control ranged between 2.6% in Kenya and 18% to Namibia. A hospital-based cross-sectional study reported effective hypertension control in only 42.4% of subjects in Ethiopia.[59] In Lesotho, only 21.4% of 70 hypertensive patients studied had their BP controlled.[60] In Mafia Island, Tanzania, in just over half (57.6%) of hypertensives, treated control was achieved in only 20.6%.[4] Among 2400 Ghanaians hypertensives, only 9% were on treatment and control was achieved in a mere 1.3%.[61] Ataklte et al.[8] performed a systematic review of hypertension in SSA between 2000 and 2013. Pooled data from 33 surveys in this review indicated that control was achieved in only 7% (95% confidence interval [CI], 5%–8%).

In our literature survey, only 10 publications addressed adherence and compliance as metrics. Only three studies employed the Morisky scale for medication adherence while one used the Hill-Bone compliance scale. In Nigeria, only one-third of hypertensive patients at both a specialty clinic and general outpatient clinic demonstrated high adherence.[62] Nashilongo et al.[63] in Namibia found that less than 50% of patients attending four peri-urban primary healthcare centers demonstrated adequate compliance in hypertension management. In the Cameroun, only 24.6% of hypertensives were controlled.[64] In Ethiopia, over three hospital sites, despite good adherence to medication (67.2%), according to the Morisky medication adherence scale, 60% of subjects' BP remained uncontrolled.[65]


  Barriers for Hypertension Control Top


Patient factors

Patients' lack of awareness of hypertensive status

In the Cameroun, less than a third (31.7%),[64] and in Nigeria, only 33.8% of people with elevated BP were aware of their hypertension.[66] A systemic review by Ataklte et al.[8] of 110,414 subjects found only 18% awareness present in pooled studies. In Namibia, more than half the subjects were unaware of the consequences of uncontrolled hypertension as well as the need for continued adherence to an antihypertensive medication regimen.[63]

Lack of knowledge about hypertension and its consequences

An Ethiopian study of 278 hypertensive patients found that only 3.6% knew that hypertension was a risk factor for stroke.[67] In the Gweru, urban district of Zimbabwe, Wariva et al.[68] showed a significant association between knowledge and medication adherence (P = 0.001). Adherence to medication in the two facilities (university specialist clinic and a general outpatient clinic) studied by Akintunde and Akintunde[62] in Nigeria differed significantly, ascribed to the more comprehensive educational input in the former. Price et al.,[69] implementing a diabetic educational program as the sole intervention, reported that at 18 months, the levels of HbA1c had fallen from 10.6 to 7.6 (P < 0.001) and were still significantly lower than baseline 4 years after intervention (P = 0.015). In the South African Masiluleke project, text messages with pertinent health information about HIV/AIDS and tuberculosis are transmitted daily to a total of one million mobile phones.[70]

The barrier of cost and poverty

Wariva et al.[68] found that adherence to medication correlated directly with even moderate differences in income. In a setting where medication was free, the level of nonadherence in this study was high (60%). Over 75% of patients lived more than 10 km from the health center, 66% being unable to afford paying for transport costs on a monthly basis. In the large population-based study in KwaZulu-Natal, 84.8% of the subjects were unemployed.[71] In Nigeria, Ajayi et al.[52] in eight communities (376,996 persons) reported that the majority of these had only access to well-water and in half the communities there was only one clinic serving on average 30,000 persons, most most paying out of pocket expenses for clinic services. In Nigeria, non-compliance with medication was attributed in 69% of cases to cost issues compared to only 6% related to drug side effects.[72] Akintunde and Akintunde[62] found that personal income was related to adherence. In Namibia, nonadherence was directly related to income.[63] In Kenya, healthcarecost was, according to the Delphi ranking system, second only to accessibility of medication.[73] This was poignantly recorded from a patient recorded to say “ No, I don't forget. I run out of medication…when I come, they say it's not there (medications), we go and buy, and you don't even have transport (funds) to travel. The other day I took a bit of my transport (funds) so I can buy some medicine…” (Vedanthan et al., 2016,P 318).[73]

Literacy

In Nigeria, 44% of the population in 2008 could neither read nor write.[72] Awad et al.[74] reported that 56% of women aged between 35 and 50 years and 34% of males aged between 35 and 50 years were illiterate. In Ethiopia, Desalegn et al.[75] reported in a cross-sectional population-based study that 22.6% of 526 subjects could not read.

Multiple medications

Josephs[72] reporting on data from 770 hypertensive patients seen at the cardiology clinic at the University of Benin, Nigeria, found that the average number of medications per patient was 4.1 and compliance was 30.8%. By contrast, in a Kenyan slum, 99% of the patients took only one antihypertensive medication.[76] In Ethiopia, only 20% of hypertensives were on three or more antihypertensive medications,[65] and in the Western Cape, South Africa 15% of hypertensives were taking three or more medications.[45]

Healthcare systemic factors and lack of medication and equipment

Poor linkage to healthcare services

After the identification of hypertensive status, linkage and retention are major issues. These relate to education, diagnosis acceptance, and physical factors such as transport, distance, and cost. In Western Kenya, linkage and retention remain significant problems.[55] Siedner et al.[71] in KwaZulu-Natal demonstrated that in a large population-based cohort study (2010), after screening at home, of 1706 hypertensives not previously identified, at 2 years of follow-up, only 26.9% had sought and obtained treatment, and after 5 years, this figure dropped to 38.1%.

Clinic and healthcare center processes and issues

The physical lack of sphygmomanometers and suboptimal flow of medication has been a factor mentioned repeatedly in the literature. The experience of patients at primary healthcare facilities is waiting, often for hours before seeing the health professional, only to find medication unavailable.[77]

Factors related to medical and nursing personnel

Lack of knowledge and suboptimal approach to management of noncommunicative diseases by health professionals

In a study of South African primary care 16 doctors, only 10 stated that they would treat hypertension to target and only two knew the South African hypertension guidelines which had been displayed in the two clinics where the study took place.[78] A study by Ogola et al.[46] provided important insights into the complexity of nurse training reporting on the results of Healthy Heart Africa, a program including provision of a training manual, hypertension management algorithm, access to medications through a pharmaceutical company as well as to equipment. At 12 months, there was improved knowledge and behavior of health providers relating to hypertension, but no change in their knowledge of the consequences to hypertension. In fact, the control group more frequently, on questioning, identified sequelae such as death, heart attack, and stroke than the intervention group.

Clinic nursing staff overwhelmed, on the edge of “burn-out,” lack of support

Katz et al. described the South African Chronic Disease Outreach program and its challenges.[79] Feedback from nursing staff employed in this model were “they remained concerned about litigation;” “having responsibility without the authority to act;” “frustration at being overworked and that doctors do not respect the role they play;” “no doctors to help with up-scaling of medication;” “.nurses/PHCNs were constantly rotated through different areas and never allowed them time to develop confidence in managing chronic diseases”; “… not very confident”. The study revealed the staff in the Chronic Disease Outreach program as being exhausted, lacking support, lacking adequate training, and experiencing frustration.

Poor attitude of medical and nursing staff toward patients

The need for a more patient-centered, education-supported model was found by Murphy et al.[80] in the South African study which examined hypertension as one of several noncommunicable conditions from a patient's perspective. This qualitative study was based on and guided by the principles of self-determination, which is in line with the approach advocated by the WHO which emphasizes the need to increase the knowledge base and the motivation of patients. Hypertensive patients' recurrent themes relating to health provider attitudes were as follows: “no time,” “no emotional support,” no inclination to explain,” “impatient,” “rude,” and having questions but feeling apprehensive about asking.” The traditional healers understand the culture and the needs of the population and are able to “tap” into that. In particular, they provide patients with reasons for their condition.[81]


  Conclusions Top


In the last decade, there have been significant positive achievements related to hypertension across many domains. Studies have been made of hypertension prevalence using the WHO-STEPS methodology[12] as well as other models of population surveys such as on Mafia Island in Tanzania[4] and the HAALSI project in Agincourt, South Africa.[10] These have demonstrated the feasibility of obtaining accurate, repeatable population-based data, in SSA. Studies testing task-shifting from doctor to nurse-led management have yielded positive results[24] and in some studies excellent adherence.[26] Positive results have been demonstrated in nurse education.[29] Increased training, supervision, and deployment of CHWs have been done.[5],[35] Despite these positive steps, detection, awareness of being hypertensive, having treatment, and achieving control of hypertension in SSA continue to remain suboptimal.[10] Dramatically, different results are documented. For example, excellent hypertensive control such as in reported by Ademoye et al.[23] This can be compared to the study by Mendis et al.[30] where control was very poor. The high early drop-out figure reported by Kengne[24] can likewise be compared to the high retention of patients reported by other authors.[26] Possibly, answers may arise through the analysis of two recent community-based interventions for hypertension management, one in Africa and the other outside Africa.[32],[82] The findings in these two well-constructed studies were substantially different. The SCALE UP intervention[31] was intense and included an awareness (radio) program, monetary incentives to CHWs, and text (SMS) messages for appointments and taking of medications; however, at the end of the study period there was no difference compared to controls. The HOPE 4 intervention,[82] conducted in Bolivia and Malaysia included medical support from physicians, support from family members and tablet computer-based simplified algorithms for treatment, the latter managed by CHWs who liaised with physicians. There was a significant difference in hypertension control in the intervention group. The answer to future effective models of hypertension care may lie in subtle system-based differences in approach.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
3rd_plenary_meeting.pdf. Available from: https://www.who.int/nmh/events/un_ncd_summit2011/3rd_plenary_meeting.pdf. [Last accessed on 2020 Apr 27].  Back to cited text no. 1
    
2.
Kengne AP, Anderson CS. The neglected burden of stroke in Sub-Saharan Africa. Int J Stroke 2006;1:180-90.  Back to cited text no. 2
    
3.
Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: Results from the Global Burden of Disease Study 2017. Lancet Glob Health 2019;7:e1375-87. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2214109X19303742. [Last accessed on 2020 Feb 02].  Back to cited text no. 3
    
4.
Muhamedhussein MS, Nagri ZI, Manji KP. Prevalence, risk factors, awareness, and treatment and control of hypertension in mafia island, Tanzania. Int J Hypertens 2016;2016:1281384.  Back to cited text no. 4
    
5.
Gaziano TA, Abrahams-Gessel S, Denman CA, Montano CM, Khanam M, Puoane T, et al. An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: An observational study. Lancet Glob Health 2015;3:e556-63. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2214109X15001436. [Last accessed on 2020 Feb 19].  Back to cited text no. 5
    
6.
Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews: Int J Evid Based Healthc 2015;13:141-6. Available from: http://journals.lww.com/01787381-201509000-00005. [Last accessed on 2020 Jul 14].  Back to cited text no. 6
    
7.
Sherrington C, Herbert RD, Maher CG, Moseley AM. PEDro. Database of randomized trials and systematic reviews in physiotherapy. Man Ther 2000;5:223-6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1356689X00903722. [Last accessed on 2020 Jul 14].  Back to cited text no. 7
    
8.
Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in Sub-Saharan Africa: A systematic review and meta-analysis. Hypertension 2015;65:291-8. Available from: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.114.04394. [Last accessed on 2019 Jun 10].  Back to cited text no. 8
    
9.
Bosu WK, Reilly ST, Aheto JM, Zucchelli E. Hypertension in older adults in Africa: A systematic review and meta-analysis. PLoS One 2019;14:e0214934. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450645/. [Last acessed on 2020 Jan 12].  Back to cited text no. 9
    
10.
Jardim TV, Reiger S, Abrahams-Gessel S, Gomez-Olive FX, Wagner RG, Wade A, et al. Hypertension management in a population of older adults in rural South Africa. Hypertens 2017;35:1283-9. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018340312&doi=10.1097%2fHJH.0000000000001312&partnerID=40&md5=7da59efe54c55933453a64c677118b13.  Back to cited text no. 10
    
11.
Jessen N, Damasceno A, Silva-Matos C, Tuzine E, Madede T, Mahoque R, et al. Hypertension in Mozambique: Trends between 2005 and 2015. Hypertens 2018;36:779-84. Available from: http://Insights.ovid.com/crossref?an=00004872-201804000-00012. [Last accessed on 2020 Feb 04].  Back to cited text no. 11
    
12.
Desormais I, Amidou SA, Houehanou YC, Houinato SD, Gbagouidi GN, Preux PM, et al. The prevalence, awareness, management and control of hypertension in men and women in Benin, West Africa: The TAHES study. BMC Cardiovasc Disord 2019;19:303. Available from: https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-01273-7. [Last accessed on 2020 Jan 16].  Back to cited text no. 12
    
13.
Adeloye D, Basquill C. Estimating the prevalence and awareness rates of hypertension in Africa: A systematic analysis. PLOS One 2014;9:e104300. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone0.0104300. [Last accessed on 2020 Apr 27].  Back to cited text no. 13
    
14.
Sliwa K, Wilkinson D, Hansen C, Ntyintyane L, Tibazarwa K, Becker A, et al. Spectrum of heart disease and risk factors in a black urban population in South Africa (the heart of Soweto study): A cohort study. Lancet 2008;371:915-22.  Back to cited text no. 14
    
15.
Mungati M, Manangazira P, Takundwa L, Gombe NT, Rusakaniko S, Tshimanga M. Factors affecting diagnosis and management of hypertension in Mazowe District of Mashonaland Central Province in Zimbabwe: 2012. BMC Cardiovasc Disord 2014;14:102. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84906831561&doi=10.1186%2f1471-2261-14-102&partnerID=40&md5=695ff81f3c4ff2b0ab7be9401958a98b. [Last acessed on 2021 Apr 13].  Back to cited text no. 15
    
16.
Peck et al_2013_Hypertension-Related Diseases as a Common Cause of Hospital Mortality in.pdf. Available from: https://europepmc.org/articles/pmc4005815?pdf=render. [Last accessed on 2019 Sep 30].  Back to cited text no. 16
    
17.
Peltzer K, Phaswana-Mafuya N. Hypertension and associated factors in older adults in South Africa. Cardiovasc J Afr 2013;24:67-71.  Back to cited text no. 17
    
18.
Maepe LM, Outhoff K. Hypertension in goldminers. Afr Med J 2011;102:30. Available from: http://www.samj.org.za/index.php/samj/article/view/5196. [Last accessed on 2020 Jan 05].  Back to cited text no. 18
    
19.
Seedat Y. Hypertension in black South Africans. Hum Hypertens 1999;13:97-103. Available from: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=edswsc&AN=000079271400004&site=eds-live&scope=site&custid=s2775460. [Last accessed on 2020 Feb 09].  Back to cited text no. 19
    
20.
Amberbir A, Lin SH, Berman J, Muula A, Jacoby D, Wroe E, et al. Systematic review of hypertension and diabetes burden, risk factors, and interventions for prevention and control in Malawi. Glob Heart 2019;14:109-18. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2211816019300766. [Last accessed on 2020 Feb 21].  Back to cited text no. 20
    
21.
Ezzati M. How can cross-country research on health risks strengthen interventions? Lessons from INTERHEART. Lancet 2004;364:912-4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673604170359. [Last accessed on 2020 Mar 08].  Back to cited text no. 21
    
22.
Steyn K, Sliwa K, Hawken S, Commerford P, Onen C, Damasceno A, et al. Risk factors associated with myocardial infarction in Africa: The INTERHEART Africa study. Circulation 2005;112:3554-61.  Back to cited text no. 22
    
23.
Adeyemo A, Tayo BO, Luke A, Ogedegbe O, Durazo-Arvizu R, Cooper RS. The Nigerian antihypertensive adherence trial: A community-based randomized trial. Hypertens 2013;31:201-7. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP: landingpage&an=00004872-201301000-00029. [Last accessed on 2019 Jun 28].  Back to cited text no. 23
    
24.
Kengne AP, Awah PK, Fezeu LL, Sobngwi E, Mbanya JC. Primary health care for hypertension by nurses in rural and urban sub-saharan Africa. Clin Hypertens 2009;11:564-72. Available from: http://doi.wiley.com/10.1111/j. 1751-7176.2009.00165.x. [Last accessed on 2019 Jun 19].  Back to cited text no. 24
    
25.
Labhardt ND, Balo JR, Ndam M, Manga E, Stoll B. Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: A cluster-randomised trial. Trop Med Int Health 2011;16:1276-84. Available from: http://onlinelibrary.wiley.com/doi/abs/10.1111/j. 1365-3156.2011.02827.x. [Last accessed on 2020 Jan 26].  Back to cited text no. 25
    
26.
Hendriks ME, Bolarinwa OA, Wit FW, Brewster LM, Odusola AO, Rosendaal NT, et al. Feasibility and quality of cardiovascular disease prevention within a community-based health insurance program in rural Nigeria: An operational cohort study. Hypertens 2015;33:366-75. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00004872-201502000-00024. [Last accessed on 2019 Dec 18].  Back to cited text no. 26
    
27.
Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, et al. cluster-randomized trial of task shifting and blood pressure control in Ghana: Study protocol. Implement Sci 2014;9:73. Available from: http://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-9-73. [Last accessed on 2019 Jun 26].  Back to cited text no. 27
    
28.
Iwelunmor J, Gyamfi J, Plange-Rhule J, Blackstone S, Quakyi NK, Ntim M, et al. Exploring stakeholders' perceptions of a task-shifting strategy for hypertension control in Ghana: A qualitative study. BMC Public Health 2017;17:216. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4127-9. [Last accessed on 2020 Jan 13].  Back to cited text no. 28
    
29.
Gyamfi J, Plange-Rhule J, Iwelunmor J, Lee D, Blackstone SR, Mitchell A, et al. Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: A mixed-methods study. BMC Health Serv Res 2017;17:104. Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2026-5. [Last accessed on 2020 Jan 13].  Back to cited text no. 29
    
30.
Mendis S, Johnston SC, Fan W, Oladapo O, Cameron A, Faramawi MF. Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: A cluster-randomized trial. Bull World Health Organ 2010;88:412-9. Available from: http://www.who.int/bulletin/volumes/88/6/08-062364.pdf. [Last accessed on 2019 Jun 27].  Back to cited text no. 30
    
31.
van de Vijver S, Oti SO, Gomez GB, Agyemang C, Egondi T, van Charante EM, et al. Impact evaluation of a community-based intervention for prevention of cardiovascular diseases in the slums of Nairobi: The SCALE-UP study. Glob Health Action 2016;9:30922. Available from: https://www.tandfonline.com/doi/full/10.3402/gha.v9.30922. [Last accessed on 2020 Feb 22].  Back to cited text no. 31
    
32.
Oti SO, van de Vijver S, Gomez GB, Agyemang C, Egondi T, Kyobutungi C, et al. Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya. Bull World Health Organ 2016;94:501-9. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84977178251&doi=10.2471%2fBLT.15.156513&partnerID=40&md5=c0fa5f727c7d0d9129145d7c11378f11. [Last acessed on 2021 Apr 13].  Back to cited text no. 32
    
33.
Abegunde DO, Shengelia B, Luyten A, Cameron A, Celletti F, Nishtar S, et al. Can non-physician health-care workers assess and manage cardiovascular risk in primary care? Bull World Health Organ 2007;85:432-40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636344/. [Last accessed on 2020 Feb 19].  Back to cited text no. 33
    
34.
Vedanthan R, Kamano JH, DeLong AK, Naanyu V, Binanay CA, Bloomfield GS, et al. Community health workers improve linkage to hypertension care in western Kenya. J Am Coll Cardiol 2019;74:1897-906.  Back to cited text no. 34
    
35.
Kok MC, Vallières F, Tulloch O, Kumar MB, Kea AZ, Karuga R, et al. Does supportive supervision enhance community health worker motivation? A mixed-methods study in four African countries. Health Policy Plan 2018;33:988-98. Available from: https://academic.oup.com/heapol/article/33/9/988/5105818. [Last accessed on 2020 Jan 26].  Back to cited text no. 35
    
36.
Millington KA. Effectiveness of Community Health Workers. K4D Helpdesk Report. Brighton, UK: Institute of Developmental Studies; 2018.  Back to cited text no. 36
    
37.
Mash R, Kroukamp R, Gaziano T, Levitt N. Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in cape town, south Africa. Patient Educ Couns 2015;98:622-6.  Back to cited text no. 37
    
38.
Goudge J, Chirwa T, Eldridge S, Gómez-Olivé FX, Kabudula C, Limbani F, et al. Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa. BMJ Glob Health 2018;3:e000577. Available from: http://gh.bmj.com/lookup/doi/100.1136/bmjgh-2017-000577x. [Last accessed on 2020 Jan 05].  Back to cited text no. 38
    
39.
Marfo AF, Owusu-Daaku FT. Exploring the extended role of the community pharmacist in improving blood pressure control among hypertensive patients in a developing setting. J Pharm Policy Pract 2017;10:39.  Back to cited text no. 39
    
40.
Mohamed SS, Mahmoud AA, Ali AA. Involvement of Sudanese community pharmacists in public health activities. Int J Clin Pharm 2013;35:393-400.  Back to cited text no. 40
    
41.
Bobrow K, Brennan T, Springer D, Levitt NS, Rayner B, Namane M, et al. Efficacy of a text messaging (SMS) based intervention for adults with hypertension: Protocol for the stAR (SMS text-message adherence suppoRt trial) randomised controlled trial. BMC Public Health 2014;14:28.  Back to cited text no. 41
    
42.
Hacking D, Haricharan HJ, Brittain K, Lau YK, Cassidy T, Heap M. Hypertension health promotion via text messaging at a community health center in South Africa: A mixed methods study. JMIR MHealth UHealth 2016;4:e22. Available from: http://mhealth.jmir.org/2016/1/e22/. [Last accessed on 2020 Jan 20].  Back to cited text no. 42
    
43.
Rotheram-Borus MJ, Tomlinson M, Gwegwe M, Comulada WS, Kaufman N, Keim M. Diabetes buddies: Peer support through a mobile phone buddy system. Diabetes Educ 2012;38:357-65. Available from: http://journals.sagepub.com/doi/100.1177/0145721712444617. [Last acessed on 2019 Jun 27].  Back to cited text no. 43
    
44.
Sarfo FS, Treiber F, Gebregziabher M, Adamu S, Nichols M, Singh A, et al. Phone-based intervention for blood pressure control among Ghanaian stroke survivors: A pilot randomized controlled trial. Int J Stroke 2019;14:630-8.  Back to cited text no. 44
    
45.
Folb N, Timmerman V, Levitt NS, Steyn K, Bachmann MO, Lund C, et al. Multimorbidity, control and treatment of non-communicable diseases among primary healthcare attenders in the Western Cape, South Africa. South Afr Med J Suid-Afr Tydskr Vir Geneeskd 2015;105:642-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797628/. [Last accessed on 2020 Jan 03].  Back to cited text no. 45
    
46.
Ogola EN, Okello FO, Herr JL, Macgregor-Skinner E, Mulvaney A, Yonga G. Healthy Heart Africa–Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers' Knowledge and Treatment of Hypertension. Glob Heart 2019;14:61-70. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064664194&doi=10.1016%2fj.gheart. 2019.02.002&partnerID=40&md5=c083ab7bd48664e2ad4a8e438ede1a84. [Last acessed on 2021 Apr 13].  Back to cited text no. 46
    
47.
Katende G, Groves S, Becker K. Hypertension education intervention with ugandan nurses working in hospital outpatient clinic: A pilot study. Nurs Res Pract 2014;2014:1-6. Available from: http://www.hindawi.com/journals/nrp/2014/710702/. [Last accessed on 2019 Oct 21].  Back to cited text no. 47
    
48.
Baumann AA, Mutabazi V, Brown AL, Hooley C, Reeds D, Ingabire C, et al. Dissemination and implementation program in hypertension in Rwanda: Report on initial training and evaluation. Glob Heart 2019;14:135-41. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068957418&doi=10.1016%2fj.gheart. 2019.06.001&partnerID=40&md5=7cfae77c8652bcd17281bb221f0cc758. [Last acessed on 2021 Apr 13].  Back to cited text no. 48
    
49.
Fairall LR, Folb N, Timmerman V, Lombard C, Steyn K, Bachmann MO, et al. Educational outreach with an integrated clinical tool for nurse-led non-communicable chronic disease management in primary care in South Africa: A pragmatic cluster randomised controlled trial. PLOS Med 2016;13:e1002178. Available from: https://ezp.lib.unimelb.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edswsc&AN=000391233800014&site=eds-live&scope=site. [Last accessed on 2019 Jun 19].  Back to cited text no. 49
    
50.
Ozoemena EL, Iweama CN, Agbaje OS, Umoke PC, Ene OC, Ofili PC, et al. Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: A quasi-experimental study. Arch Public Health 2019;77:23.  Back to cited text no. 50
    
51.
Chimberengwa PT, Naidoo M. Description of community-based participatory research of hypertension awareness, prevention and treatment in a district of Matabeleland South Province, Zimbabwe. Afr J Prim Health Care Fam Med 2019;11:e1-9. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85062595024&doi=10.4102%2fphcfm.v11i1.1839&partnerID=40&md5=8141cde6b41af3fa32386004ae64047e. [Last acessed on 2021 Apr 13].  Back to cited text no. 51
    
52.
Ajayi IO, Jegede AS, Falade CO, Sommerfeld J. Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: A qualitative study. Infect Dis Poverty 2013;2:25.  Back to cited text no. 52
    
53.
Laar AK, Adler AJ, Kotoh AM, Legido-Quigley H, Lange IL, Perel P, et al. Health system challenges to hypertension and related non-communicable diseases prevention and treatment: Perspectives from Ghanaian stakeholders. BMC Health Serv Res 2019;19:693. Available from: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=mnh&AN=31615529&site=eds-live&scope=site&custid=s2775460. [Last accessed on 2020 Jan 24].  Back to cited text no. 53
    
54.
Oelke ND, Rush KL, Goma FM, Barker J, Marck P, Pedersen C, et al. Understanding perceptions and practices for Zambian adults in western province at risk for hypertension: An exploratory descriptive study. Glob J Health Sci 2015;8:248-59.  Back to cited text no. 54
    
55.
Vedanthan R, Fuster V. Cardiovascular disease in Sub-Saharan Africa: A complex picture demanding a multifaceted response. Nat Clin Pract Cardiovasc Med 2008;5:516-7. Available from: http://www.nature.com/articles/ncpcardio1281. [Last cited on 2020 Feb 02].  Back to cited text no. 55
    
56.
Mukora-Mutseyekwa FN, Chadambuka EM. Drug adherence behavior among hypertensive out-patients at a tertiary health institution in Manicaland province, Zimbabwe, 2011. Patient Prefer Adherence 2013;7:65-70.  Back to cited text no. 56
    
57.
Galson SW, Staton CA, Karia F, Kilonzo K, Lunyera J, Patel UD, et al. Epidemiology of hypertension in Northern Tanzania: A community-based mixed-methods study. BMJ Open 2017;7:e018829. Available from: http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-018829. [Last cited on 2019 Jun 03].  Back to cited text no. 57
    
58.
Hendriks ME, Wit FW, Roos MT, Brewster LM, Akande TM, de Beer IH, et al. Hypertension in Sub-Saharan Africa: Cross-sectional surveys in four rural and urban communities. PLoS One 2012;7:e32638. Available from: https://dx.plos.org/10.1371/journal.pone. 0032638. [Last accessed on 2019 May 06].  Back to cited text no. 58
    
59.
Teshome DF, Bekele KB, Habitu YA, Gelagay AA. Medication adherence and its associated factors among hypertensive patients attending the Debre Tabor General Hospital, Northwest Ethiopia. Integr Blood Press Control 2017;10:1-7. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85021711707&doi=10.2147%2fIBPC.S128914&partnerID=40&md5=874af0a01781b77f713cdeff7888ab0b. [Last acessed on 2021 Apr 13].  Back to cited text no. 59
    
60.
Thinyane KH, Mothebe T, Sooro M, Namole LD, Cooper V. An observational study of hypertension treatment and patient outcomes in a primary care setting. Pan Afr Med J 2015;20:424. Available from: http://www.panafrican-med-journal.com/content/article/20/424/full/. [Last accessed on 2020 Jan 10].  Back to cited text no. 60
    
61.
Lamptey P, Laar A, Adler AJ, Dirks R, Caldwell A, Prieto-Merino D, et al. Evaluation of a community-based hypertension improvement program (ComHIP) in Ghana: Data from a baseline survey. BMC Public Health 2017;17:368. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410035/. [Last accessed on 2020 Feb 20].  Back to cited text no. 61
    
62.
Akintunde AA, Akintunde TS. Antihypertensive medications adherence among Nigerian hypertensive subjects in a specialist clinic compared to a general outpatient clinic. Ann Med Health Sci Res 2015;5:173-8.  Back to cited text no. 62
[PUBMED]  [Full text]  
63.
Nashilongo MM, Singu B, Kalemeera F, Mubita M, Naikaku E, Baker A, et al. Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications. Cardiovasc Drugs Ther 2017;31:565-78. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85031427999&doi=10.1007%2fs10557-017-6756-8&partnerID=40&md5=cbdcbdab57f9f9e82b9194c077f1d89e. [Last acessed on 2021 Apr 13].  Back to cited text no. 63
    
64.
Dzudie A, Kengne AP, Muna WF, Menanga A, Kouam CK, Abah J, et al. Prevalence, awareness, treatment and control of hypertension in a self- selected sub-Saharan African urban population: A cross-sectional study. BMJ Open 2012;2:e001217.  Back to cited text no. 64
    
65.
Mekonnen HS, Gebrie MH, Eyasu KH, Gelagay AA. Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia. BMC Pharmacol Toxicol 2017;18:27. Available from: http://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-017-0134-9. [Last accessed on 2020 Jan 08].  Back to cited text no. 65
    
66.
Akindele YT, Ayankogbe OO. Knowledge and awareness of high blood pressure in Ward F, Ifako-Ijaiye local government area, Lagos State, Nigeria. South Afr Fam Pract 2013;55:270-4. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84879958628&doi=100.1080%2f20786204.2013.10874349&partnerID=40&md5=9071837d82348cfa21366da5fb7416d5. [Last acessed on 2021 Apr 13].  Back to cited text no. 66
    
67.
Abate AT, Bayu N, Mariam TG. Hypertensive Patients' Knowledge of Risk Factors and Warning Signs of Stroke at Felege Hiwot Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study. Neurol Res Int 2019;2019:8570428.  Back to cited text no. 67
    
68.
Wariva E, January J, Maradzika J. Medication adherence among elderly patients with high blood pressure in Gweru, Zimbabwe. Public Health Afr 2014;5:304. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345458/. [Last accessed on 2020 Jan 08].  Back to cited text no. 68
    
69.
Price C, Shandu D, Dedicoat M, Wilkinson D, Gill GV. Long-term glycaemic outcome of structured nurse-led diabetes care in rural Africa. QJM 2011;104:571-4. Available from: https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcr005. [Last accessed on 2019 Jul 10].  Back to cited text no. 69
    
70.
Bloomfield GS, Vedanthan R, Vasudevan L, Kithei A, Were M, Velazquez EJ. Mobile health for non-communicable diseases in Sub-Saharan Africa: A systematic review of the literature and strategic framework for research. Glob Health 2014;10:49. Available from: http://globalizationandhealth.biomedcentral.com/articles/10.1186/1744-8603-10-49. [Last accessed on 2019 May 06].  Back to cited text no. 70
    
71.
Siedner MJ, Baisley K, Orne-Gliemann J, Pillay D, Koole O, Wong EB, et al. Linkage to primary care after homebased blood pressure screening in rural KwaZulu-Natal, South Africa: A population-based cohort study. BMJ Open 2018;8:e23369. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85058379415&doi=10.1136%2fbmjopen-2018-023369&partnerID=40&md5=9386e5881c032e222aab32992341e143. [Last acessed on 2021 Apr 13].  Back to cited text no. 71
    
72.
Josephs VA. Compliance of Nigerians with drug treatment of systemic hypertension: Is this just a literacy problem. Med Biomed Res 2013;12:113-9. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84881127786&partnerID=40&md5=70d864d9fe9047adc43081bdf8a124d6. [Last acessed on 2021 Apr 13].  Back to cited text no. 72
    
73.
Vedanthan R, Tuikong N, Kofler C, Blank E, Kamano JH, Naanyu V, et al. Barriers and facilitators to nurse management of hypertension: A Qualitative analysis from western Kenya. Ethn Dis 2016;26:315-22.  Back to cited text no. 73
    
74.
Awad M, Ruzza A, Mirocha J, Setareh-Shenas S, Pixton JR, Soliman C, et al. Prevalence of hypertension in the Gambia and sierra Leone, western Africa: A cross-sectional study. Cardiovasc J Afr 2014;25:269-78.  Back to cited text no. 74
    
75.
Desalegn H, Fekadu S, Deribew A. Clinical assessment of cardiovascular disease associate with risk factors in Jimma Town, Southwest Ethiopia: Community-based cross-sectional study. Ethiop Med J 2017;55:3-9.  Back to cited text no. 75
    
76.
Kuria N, Reid A, Owiti P, Tweya H, Kibet CK, Mbau L, et al. Compliance with follow-up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: Comparison of three models of care. Trop Med Int Health 2018;23:785-94. Available from: http://onlinelibrary.wiley.com/doi/abs/10.1111/tmi. 13078. [Last accessed on 2019 Dec 18].  Back to cited text no. 76
    
77.
Odusola AO, Hendriks M, Schultsz C, Bolarinwa OA, Akande T, Osibogun A, et al. Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: A qualitative study. BMC Health Serv Res 2014;14:624. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84988600969&doi=10.1186%2fs12913-014-0624-z&partnerID=40&md5=ff33656bf51996f6be95603d18d409b7. [Last acessed on 2021 Apr 13].  Back to cited text no. 77
    
78.
Parker A, Nagar B, Thomas G, Badri M, Ntusi NB. Health practitioners' state of knowledge and challenges to effective management of hypertension at primary level. Cardiovasc J Afr 2011;22:186-90. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-80052204921&doi=10.5830%2fCVJA-2010-066&partnerID=40&md5=7bc3de78f24ca02332d931ec2f837d9d. [Last acessed on 2021 Apr 13].  Back to cited text no. 78
    
79.
Katz I, Schneider H, Shezi Z, Mdleleni G, Gerntholtz T, Butler O, et al. Managing type 2 diabetes in Soweto – The South African Chronic Disease Outreach Program experience. Prim Care Diabetes 2009;3:157-64.  Back to cited text no. 79
    
80.
Murphy et al._2015_A Qualitative Study of the Experiences of Care and Motivation for Effective.pdf. Available from: https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-015-0969-y. [Last accessed on 2019 Sep 25].  Back to cited text no. 80
    
81.
Lotika AA, Mabuza LH, Okonta HI. Reasons given by hypertensive patients for concurrently using traditional and Western medicine at Natalspruit Hospital in the Gauteng Province, South Africa. Afr J Prim Health Care Fam Med 2013;5:458. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84906253217&doi=10.4102%2fphcfm.v5i1.458&partnerID=40&md5=76b97f901f2848f9cb87db8ac69bb94c.  Back to cited text no. 81
    
82.
Schwalm J-D, McCready T, Lopez-Jaramillo P, Yusoff K, Attaran A, Lamelas P, et al. Community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): A cluster-randomised controlled trial. Lancet 2019;394:1231-42. Available from: https://linkinghub.elsevier.comretrieve/pii/S014067361931949X. [Last accessed on 2020 May 03].  Back to cited text no. 82
    


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