Healthy Heart Africa: a prospective evaluation of programme outcomes on individuals' hypertension awareness, screening, diagnosis and treatment in rural Kenya at 12 months.

OBJECTIVE: To evaluate the impact of Healthy Heart Africa (HHA), a comprehensive hypertension intervention programme, on hypertension awareness, knowledge, screening and diagnosis among rural communities in Kenya. METHODS: Individuals from rural households near intervention and matched control healthcare facilities were randomly surveyed at baseline and the end point (after 12 months). A difference-in-differences analysis estimated the impact of HHA. RESULTS: This analysis included 838 individuals (intervention, n = 432; control, n = 406) at baseline and 698 (n = 364 and n = 334, respectively) at the end point. At baseline, both groups had high hypertension awareness (> 80%) but poor knowledge. After 12 months, healthcare providers were the primary information source for the intervention group only (p < 0.05). At the end point, respondents' knowledge of hypertension risk factors, consequences and management trended higher among the intervention versus the control group. Hypertension screening/diagnosis and patient recall of provider recommendations remained unchanged in both groups. CONCLUSIONS: HHA improved hypertension knowledge but screening and diagnosis remained unchanged after 12 months.

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers' Knowledge and Treatment of Hypertension.

BACKGROUND: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public. OBJECTIVE: The impact of Healthy Heart Africa on HCPs' knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study. METHODS: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, and improved medical supply chain, whereas control facilities did not. HCPs responsible for hypertension care were surveyed at baseline and 12 months later. Hypertension screening and treatment data were abstracted from service delivery registers. A differences-in-differences analysis estimated the impact of Healthy Heart Africa on HCPs' knowledge, hypertension services, and the number of patients diagnosed with and seeking treatment for hypertension. RESULTS: Sixty-six intervention and 66 control facilities were surveyed. Healthy Heart Africa improved HCPs' knowledge of ≥5 hypertension risk factors and ≥5 methods for reducing/managing hypertension but not hypertension consequences. At end line, more intervention than control facilities measured blood pressure more than once during the same visit to diagnose hypertension, dedicated days to hypertension care, used posters to increase hypertension awareness, and provided access to hypertension medications. The number of patients diagnosed with hypertension and those seeking treatment for hypertension increased with intervention, but the change was not significant relative to control subjects. CONCLUSIONS: HCP-directed hypertension education and provision of basic resources positively influenced hypertension care in Kenya in the first 12 months of implementation.

Developing a system to monitor family planning and HIV service integration: results from a pilot test of indicators.

OBJECTIVES: To determine the feasibility of collecting data to calculate six indicators of family planning (FP) and HIV integration using existing health information systems (HIS); obtain information to refine indicators; and identify changes needed in existing HIS to calculate indicators. DESIGN: Data abstraction from HIS in a purposive sample of 39 health facilities in Ethiopia, Rwanda, Tanzania and Uganda to analyse data availability and quality undertaken between November 2010 and March 2011. METHODS: Teams reviewed patient record cards, registers, monthly and quarterly reports for the most recent complete month. Teams recorded all possible sources for each data element, indicated whether data are collated monthly, and whether disaggregation by age, sex and originating service was possible. RESULTS: With the exception of Uganda, all countries were able to report the proportion of service delivery points offering integrated services. Ethiopia was able to calculate the indicator for fixed sites but not for home-based care services. In most cases we were able to calculate the proportion of HIV clients receiving FP services or referral, and the proportion of FP clients receiving an HIV test or referral. It is feasible to collect data for these indicators under current circumstances in some countries. CONCLUSIONS: Several actions are proposed for national health systems, including adopting a system of unique client identifiers. Age group reporting bands should be aligned across services. More accurate counts of daily and active client loads are needed to provide programme managers with information to inform programme monitoring.