Background: The prevalence of hypertension in sub-Saharan Africa has been on the rise but remains underdiagnosed, undertreated and poorly controlled. In Kenya, 92% of patients are not on treatment and 3% controlled. This study aimed to assess the performance of a hypertension screening and treatment program in five counties in Kenya with reference to identification of individuals at risk, retention on treatment and blood pressure (BP) control.
Methods: We conducted a retrospective cohort study using data routinely collected between March 2015 and December 2018. All patients 18 years and older screened and/or treated for hypertension at any of the program supported sites were included in the study. We calculated prevalence of high BP (systolic BP equal or more than 140 mmHg, diastolic BP equal or more than 90 mmHg) and related risk in the screening episodes, retention on treatment, BP control and related factors among patients enrolled for treatment of hypertension.
Results: A total of 663,028 screening encounters were recorded of which 70.4% were female, median age was 34 years and majority (73.9%) were screened at the community level. Of the encounters, 19% had high BP, significantly higher among males and older individuals. A total of 66,981 patients were enrolled on treatment with majority being females (71.2%), median age 55 years, 40.4% aged 60+ years and 36.2% enrolled in Level 5 health facilities (county referral hospitals). Only 12% of patients were retained in care at 12 months with younger patients and individuals treated at higher level facilities (levels 4 and 5) having the lowest retention rates (p<0.05). By 12 months of treatment, BP was controlled in 48.6% of patients retained on treatment. Over a 36-month follow-up period, the mean systolic and diastolic BP gradually reduced by 8.9mmHg and 2.5mmHg, respectively.
Conclusions: The program screened primarily females and younger individuals at lower risk of developing hypertension. Retention in care was poor especially among younger patients and those enrolled at higher level facilities. Close to half of the patients retained, attained blood pressure control by one year. Hypertension programs should target high risk populations, decentralize care and include retention and follow-up strategies.