Screening for Diabetes and Hypertension in a Rural Low Income Setting in Western Kenya Utilizing Home-Based and Community-Based Strategies

Authors

Sonak Pastakia, Purdue UniversityFollow
Shamim M. Ali
Jemima H. Kamano
Constantine O. Akwanalo
Samson K. Ndege
Victor L. Buckwalter
Rajesh Vedanthan
Gerald S. Bloomfield

Abstract

BACKGROUND:

The burdens of hypertension and diabetes are increasing in low- and middle-income countries (LMICs). It is important to identify patients with these conditions early in the disease process. The goal of this study, therefore, is to compare community- versus home-based screening for hypertension and diabetes in Kenya.

METHODS:

This was a feasibility study conducted by the Academic Model Providing Access to Healthcare (AMPATH) program in Webuye, a town in western Kenya. Home-based (door-to-door) screening occurred in March 2010 and community-based screening in November 2011. HIV counselors were trained to screen for diabetes and hypertension in the home-based screening with local district hospital based staff conducting the community-based screening. Participants >18 years old qualified for screening in both groups. Counselors referred all participants with a systolic blood pressure (SBP) ≥ 160 mmHg and/or a random blood glucose ≥ 7 mmol/L (126 mg/dL) to a local clinic for follow-up. Differences in likelihood of screening positive between the two strategies were compared using Fischer's Exact Test. Logistic regression models were used to identify factors associated with the likelihood of following-up after a positive screening.

RESULTS:

There were 236 participants in home-based screening: 13 (6%) had a SBP ≥ 160 mmHg, and 54 (23%) had a random glucose ≥ 7 mmol/L. There were 346 participants in community-based screening: 35 (10%) had a SBP ≥ 160 mmHg, and 27 (8%) had a random glucose ≥ 7 mmol/L. Participants in community-based screening were twice as likely to screen positive for hypertension compared to home-based screening (OR=1.93, P=0.06). In contrast, participants were 3.5 times more likely to screen positive for a random blood glucose ≥ 7 mmol/L with home-based screening (OR=3.51, P

CONCLUSION:

Community- or home-based screening for diabetes and hypertension in LMICs is feasible. Due to low rates of follow-up, screening efforts in rural settings should focus on linking cases to care.

Comments

This is the publisher pdf of Sonak D Pastakia, Shamim M Ali, Jemima H Kamano, Constantine O Akwanalo, Samson K Ndege, Victor L Buckwalter, Rajesh Vedanthan, Gerald S Bloomfield. Screening for Diabetes and Hypertension in a Rural Low Income Setting in Western Kenya Utilizing Home-Based and Community-Based Strategies. Globalization and Health 2013, 9:21 (16 May 2013) and is available at: 10.1186/1744-8603-9-21.

Date of this Version

5-16-2013

DOI

10.1186/1744-8603-9-21

Recommended Citation

Pastakia, Sonak; Ali, Shamim M.; Kamano, Jemima H.; Akwanalo, Constantine O.; Ndege, Samson K.; Buckwalter, Victor L.; Vedanthan, Rajesh; and Bloomfield, Gerald S., "Screening for Diabetes and Hypertension in a Rural Low Income Setting in Western Kenya Utilizing Home-Based and Community-Based Strategies" (2013). Department of Pharmacy Practice Faculty Publications. Paper 2.
http://dx.doi.org/10.1186/1744-8603-9-21