Quality of antenatal care and outcomes of Hypertensive Disorders in Pregnancy among antenatal attendees: A comparison of urban and periurban health facilities in Ghana.

Rural-urban-peri urban disparity assessments on health outcomes have been considered as critical determinants of health and health service outcomes. It is policy relevant in terms of the burden of disease and also provides focus on target interventions. This study aimed to assess the differences in the quality of Ante-natal Care (ANC) and the outcomes of Hypertensive Disorders in Pregnancy (HDPs) from selected health facilities in Ghana. This was a questionnaire-based cross-sectional study. Data on demographics, proportions of HDPs, quality of ANC and the outcomes of HDPs were collected. Logistic regression models were used to examine the association of the independent variables with the location of the health of facility. A total of 500 pregnant women were included in this study. There were 270 (54%) urban and 230 (46%) peri-urban dwellers. The proportion of HDPs varied with the location of the health facility. Women attending urban health facilities were more likely to be hypertensive (µ2 = 126.4; p<0.001), have chronic hypertension with superimposed pre-eclampsia (p< 0.001), have good quality ANC (µ2 = 41.28; p< 0.001), deliver full term (µ2 = 4.83; p = 0.028), and have excellent knowledge on HDPs (µ2 = 227.65; p< 0.001) compared to women receiving care in peri-urban health facilities. The method of delivery and outcome of birth did not statistically vary amongst the periurban and urban health facilities. There was an increase in the proportion in preterm in urban compared to periurban. The burden of HDPs was high in urban health facilities with high proportion of its mothers receiving quality ANC as well as having excellent knowledge on HDPs compared to mothers receiving care at the periurban health facilities. There is a need to target maternal care interventions to the periurban health facilities to improve obstetric health outcomes.

Utilization of telepharmacy in the management of hypertension.

BACKGROUND: Deaths due to cardiovascular diseases is on the rise, with hypertension as its most important risk factor. Effective management of hypertension, however, remains a challenge. Globally, only one in five adults with hypertension have it under control. The situation is worse in sub-Saharan Africa where hypertension prevalence is highest. Telepharmacy presents a great opportunity to enhance the way we address hypertension management. OBJECTIVES: This study sought to determine the effectiveness of pharmaceutical care interventions implemented through telepharmacy on medication adherence, practice of therapeutic lifestyles and overall blood pressure control among patients with hypertension. METHODS: This was a randomized control trial conducted among individuals with hypertension recruited from two Ghanaian hospitals from May 2022 to December 2022. Patients with confirmed diagnosis of hypertension were recruited and assigned into a control or intervention group. Both groups were followed for six months with the intervention group receiving telepharmacy services in addition to standard clinical care. Outcome measures included changes in blood pressure, medication adherence, lifestyle modifications, identification and resolution of pharmaceutical care issues. RESULTS: One hundred and eighteen (118) patients with hypertension were involved in the study. There was a statistically significant reduction in mean blood pressures for the intervention group after six months (Systolic-148.1 + 23.6, to 134.8 + 13.7, Diastolic- 85.8 + 9.8, to 79.5 + 8.7) (p < 0.05). The proportion of patients with adequately controlled blood pressure increased from 39.0% to 66.1%. There was also an increase in the mean adherence score (p < 0.05). The number of participants who adopted lifestyle modifications such as reducing salt consumption (89.5%) and exercising (77.2%) increased. The majority (87%) of all pharmaceutical care issues were identified and resolved over the six-month period. CONCLUSION: Telepharmacy service provided via phone calls was effective in improving the control of blood pressure. It also promoted the practice of therapeutic lifestyle modifications, medication adherence and identification of pharmaceutical care issues among patients with hypertension.

Evaluation of workplace hypertension preventative and detection service in a Ghanaian University.

OBJECTIVES: This study sought to evaluate the effectiveness of a pharmacist-led hypertension screening, preventative and detection services at the workplace. METHODS: This was a prospective study conducted among staff at the Kwame Nkrumah University of Science and Technology from September 2019 to September 2020. Staff were screened for hypertension and interviewed via a structured questionnaire to gather data on their lifestyle practices and risk of hypertension. Prehypertensive individuals were educated and followed up for 6 months and all participants who had blood pressure consistently above 140/90 mmHg (hypertension) were referred to the University Hospital. KEY FINDINGS: Out of 162 participants screened, 19 (11.7%) were classified as stage 1 hypertensive, 5 (3.1%) as stage 2 hypertensive and 74 (45.7%) as prehypertensive. The commonest modifiable risk factor identified was body mass index > 25 kg/m2 (99, 61.1%) and physical inactivity (97, 59.9%). Eleven (61%) out of 18 participants referred to the physician were confirmed hypertensive and prescribed medications. After a 6 month follow-up, there was a reduction in the mean systolic and diastolic blood pressures (P < 0.05); and 47 (63.5%) out of 74 initially classified as prehypertensive had their blood pressures within the normal range. CONCLUSION: Workplace preventative and detection services can effectively lead to the identification of risk factors, promotion of lifestyle changes and detection of hypertension. Such services should be integrated into workplace systems to aid the prevention and detection of chronic conditions such as hypertension.