Effectiveness of behavioural therapy on the blood pressure of adults with hypertension: A systematic review in non-african populations.

Hypertension or high blood pressure is the foremost risk factor of cardiovascular diseases which in turn are the leading cause of death globally. Despite the widespread use of antihypertensive medication, the condition remains a global health concern. In a bid to ascertain that other therapies such as psychological treatment may be adopted as complementary treatments for hypertension, this paper therefore examines literature on the effectiveness of behavioural therapy in the treatment of hypertension, identify the technique which seems most effective though blood pressure reductions, highlight other hypertension-related domains and report sustainability of blood pressure control post-intervention. A systematic literature review of randomised control trials reporting the effectiveness of behaviour therapy on blood pressure among hypertensive adults, published between the years 2014 and 2018, was conducted. A total of 79 articles were identified from the database search after which 11 met the inclusion criteria, with 10 of the 11 studies reporting behavioural therapy to be effective in blood pressure control. Relaxation therapy and meditation training appeared to be most effective as they brought about the most significant decrements in blood pressure. The mean blood pressure reduction ranged from 2.88-36.33 mmHg (systolic) to 0.04-21.48 mmHg (diastolic). Blood pressure control was found to have been sustained from between 0.7 and 24 months post-intervention. From this current paper, behaviour intervention is a viable, albeit complementary treatment method for hypertension; however, there is the need for more research to be conducted in various parts of the world, specifically in Nigeria and in Africa at large to allow for more relatable report on this topic.

Evaluation of quality of TB control services by private health care providers in Plateau state, Nigeria; 2012.

INTRODUCTION: Tuberculosis (TB) is public health concern in Nigeria. The country uses the Directly Observed Treatment Short course (DOTS) strategy for its control. Plateau state started using the DOTS strategy in 2001 and had the Private health facilities (PHF) as an important stakeholder. We evaluated their contributions to case finding and quality of the services to identify gaps in monitoring and evaluation in the TB control services within the PHF to plan for intervention so as to meet the set target for TB control in the state. METHODS: We used the logical framework approach to identify and analyze the problem. We drew up an objective tree and from the objective tree developed a logical framework matrix including evaluation plan. We also conducted desk review to extract data on case findings, case management and outcomes of the treatment. We interviewed TB focal persons and laboratory personnel using structured questionnaire. The data was analyzed using excel spread sheet. RESULTS: Of the 127 health facilities with TB patients on treatment 27 (21.3%) were PHF. The PHF reported 54.6% (1494) of TB cases in 2011. The sputum conversion rates, cured rate, treatment success rate, and default rates were 85%, 73%, 81.4% and 6.6% respectively. The discordant rates were 3.1% and 1.2% for the state and private health facilities respectively. CONCLUSION: Log frame approach is a useful tool for evaluation of TB control services and helps provide evidence for decision making to improve quality of the TB services in the public and private health facilities in the state.

Factors associated with interruption of treatment among Pulmonary Tuberculosis patients in Plateau State, Nigeria. 2011.

INTRODUCTION: Nigeria has one of the highest tuberculosis (TB) burdens in the world with estimated incidence of 133 per 100,000 populations. Multi-drug resistant TB (MDR-TB) is an emerging threat of the TB control in Nigeria caused mainly by incomplete treatment. This study explored factors that affect adherence to treatment among patients undergoing direct observation of TB treatment in Plateau state, Nigeria. METHODS: Between June and July 2011, we reviewed medical records and interviewed randomly selected pulmonary TB patients in their eighth month of treatment. Information on patients? clinical, socio-demographic and behavioral characteristics was collected using checklist and structured questionnaire for knowledge of treatment duration and reasons for interruption of treatment. We conducted focus group discussions with patients about barriers to treatment adherence. Data were analyzed with Epi Info software. RESULTS: Of 378 records reviewed, 229 (61%) patients were male; mean age 37.6±13.5 years and 71 (19%) interrupted their treatment. Interruption of treatment was associated with living >5 km from TB treatment site (AOR: 11.3; CI 95%: 5.7-22.2), lack of knowledge of duration of treatment (AOR: 6.1; CI 95%: 2.8-13.2) and cigarette smoking (AOR: 3.4; CI 95%: 1.5- 8.0). Major reasons for the interruption were lack of transport fare (40%) and feeling well (25%). Focused group discussions revealed unfriendly attitudes of health care workers as barriers to adherence to treatment. CONCLUSION: This study revealed knowledge of the patients on the duration of treatment, distance and health workers attitude as the major determinants of adherent to TB treatment. Training for health care workers on patient education was conducted during routine supportive supervision.