Akinlua, James Tosin; (2019) An exploration of the risk factors, beliefs and management of hypertension in primary care in Nigeria - a mixed methods study. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Objective: To explore ways to improve care of hypertension at the primary care level in Nigeria Background: Although the burden of communicable diseases is still present in Africa, the burden of non-communicable diseases is rapidly increasing. Chronic conditions like hypertension are common among both rural and urban populations in Nigeria. In many regions of Nigeria, the primary health care (PHC) facility is usually the only source of formal health care available. Many clients who use PHC facilities in Nigeria may have hypertension yet they often go undetected and untreated. Setting: Twenty (20) rural (N=10) and urban (N=10) primary health care centres in the Federal Capital Territory Nigeria Methods: A multi-level triangulation mixed method design was used. Participants: Forty-one (41) primary health care clients and forty-one (41) primary health care workers participated in the qualitative study while 650 clients participated in the quantitative study which investigated the prevalence of hypertension and cardiovascular risk factors. Results: Overall, the study revealed a substantial unmet need for hypertension in primary care in Nigeria. The sample population for this study is very young with about 90% of the population aged between 18-44 years old. Overall, among those 40years and older, 94.4% (95%CI: 88.9-97.7) had 10-year risk of cardiovascular event less than 10%. Most participants had 1-2 risk factors (58.4% [95%CI: 54.5-62.3]) while 32.3% [95%CI: 28.7-36.1]) had 3-5 risk factors for cardiovascular diseases. The overall hypertension service readiness and availability of the 20 primary care facilities was very low. The overall prevalence of hypertension was 27.9% (95%CI: 24.5- 31.6). The qualitative study identified important ethnic differences and similarities in beliefs about meaning, risk factors, symptoms and treatment of hypertension between PHC clients and workers. It also revealed that non-physician PHC workers were enthusiastic to take on additional roles in managing hypertension which is currently beyond their scope of duty. Conclusions: This study provides important information for improving care of hypertension in primary care in Nigeria by first highlighting the burden of hypertension and risk factors among primary care clients. Then it identifies differences and similarities in beliefs between PHC clients and PHC workers as well as current experiences of PHC workers with managing hypertension which could help inform appropriate hypertension management program in Nigeria.

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