Date Published: April 11, 2018
Author(s): Angela A. Morris-Paxton, Paul Rheeder, Rose-Marie G. Ewing, Dillon Ewing.
Non-communicable diseases, mainly cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, are responsible for approximately 63% of all deaths occurring worldwide in any given year. The majority of these deaths have occurred in low- and middle-income countries (LMICs). The latest World Health Organization (WHO) report shows that the increase in diabetes is also most pronounced in the LMICs. The South African Labour and Development Research Unit estimated a 9% prevalence within the adult population in 2016. In the Eastern Cape Province, hypertensive heart disease has become the second most common cause of death, followed by diabetes, the third most common cause of death.
The aim of this study was to report on the follow-up of patients in the community with known hypertension or diabetes or who were deemed at-risk (as identified during a prior community-wide survey).
Data were collected via a household primary health screening, monitoring and follow-up process, which included taking anthropometric measurements, blood pressure (BP) and blood glucose and referring to clinics for further testing and treatment where necessary.
Of the 1885 participants followed up by the community health outreach workers, 1702 were known to be hypertensive and 183 were deemed at-risk [of these, only 24 (13.2%) had normal or high normal systolic BP readings]. There were 341 participants with diabetes and 34 at-risk of diabetes [of these, 28 (82%) had levels of 11 mmol/l or higher at follow-up]. There was a significant improvement in BP and glucose control over repeated visits.
In this rural area of the Eastern Cape, South Africa, the follow-up of patients with hypertension or diabetes as well as those individuals at-risk adds value to hypertension and glucose control.
Of the 56 million deaths that occurred globally during 2012, 68% (38 million) was because of non-communicable diseases (NCDs), principally cardiovascular diseases, diabetes, cancer and chronic respiratory diseases.1 Nearly 80% of these NCD deaths (29 million) occurred in low- and middle-income countries (LMICs).1 The latest World Health Organization (WHO) report on diabetes shows a doubling in the prevalence of diabetes between 1980 and 2014. The increase in diabetes prevalence is most pronounced in the LMICs. The percentage of deaths attributed to high blood glucose in those aged 20–69 years in LMICs was 60.5% in men and 45.6% in women.2 The International Diabetes Federation (IDF) estimated that there were 2.28 million people living with diabetes in South Africa in 2015 (7% of adults).3 Shen et al. evaluated pre-diabetes and diabetes in certain areas in South America, South Asia and South Africa and found that the prevalence of diabetes and pre-diabetes was 14.0% and 17.8% in the Southern Cone of Latin America, 9.8% and 17.1% in Peru, 19.0% and 24.0% in South Asia and 13.8% and 9.9% in South Africa.4
The goal of antihypertensive therapy is the treatment and control of BP, without compromising quality of life.25 Hypertension is notoriously asymptomatic and often under-diagnosed, with frequent adverse outcomes for patients.25 The prevalence of type 2 diabetes in South Africa is currently estimated at 9%; however, about half of the cases are estimated to be undiagnosed and untreated and this can result in an increase in complications in the future, including blindness and amputations, if left unchecked.26 Reducing the burden of NCDs has been a neglected area of universal health coverage, and the maldistribution of health care workers between urban and rural health services is a global concern.25 Any shortage of health care workers in a given area, especially the rural areas, is a barrier to the implementation of universal health care coverage, one of the most basic human rights.27 This leads to the overloading of services in urban areas, when people migrate for health-related reasons, with adverse consequences for both patients and practitioners.27
The study demonstrates that a small but significant positive difference has been made to the control of BP and blood glucose between the first and final CHOW visits. The most important finding in the study was that the CHOW follow-up visits to patients are an independent factor in maintaining or improving BP and blood glucose control in both those diagnosed with hypertension or diabetes and those at-risk. Particular attention should be paid to those individuals with continued high risk determined by either very high glucose or BP readings as they would be most prone to complications.