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Knowledge, attitudes, beliefs, and blood pressure control in a community-based sample in Ghana.

Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA.
Ethnicity & disease (Impact Factor: 1.12). 02/2005; 15(4):748-52.
Source: PubMed
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    ABSTRACT: Chronic non-communicable diseases (NCDs) in Ghana have caused significant illness and death in Ghana for many years. Yet, until recently, they have been neglected and not considered a health priority. This paper reviews the national policy and programme response to chronic NCDs over the period 1992 to 2009. Unpublished reports, documents, relevant files of the Ghana Health Service (GHS) were examined to assess programmatic response to chronic NCDs. Literature was searched to locate published articles on the epidemiology of chronic NCDs in Ghana. The websites of various local and international health institutions were also searched for relevant articles. Several policy and programme initiatives have been pursued with limited success. A national control programme has been established, NCDs are currently a national policy priority, draft tobacco control legislation prepared, public education campaigns on healthy lifestyles, instituted cervical cancer screening and a national health insurance system to reducing medical costs of chronic NCD care. Major challenges include inefficient programme management, low funding, little political interest, low community awareness, high cost of drugs and absence of structured screening programmes. Emerging opportunities include improving political will, government's funding of a national cancer screening programme; basic and operational research; and using funds from well-resourced health programmes for overall health system strengthening. Although Ghana has recently determined to emphasise healthy lifestyles and environment as a major health policy for the prevention and control of chronic NCDs, low funding and weak governance have hindered the effective and speedy implementation of proposed interventions.
    Ghana medical journal 06/2012; 46(2 Suppl):69-78.
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    ABSTRACT: Hypertension is an important condition among adults, affecting nearly one billion people worldwide. Treatment with appropriate medication is a key factor in the control of hypertension and reduction in associated risk of complications. However, compliance with treatment is often sub-optimal, especially in developing countries. The present study investigated the factors associated with self-reported compliance among hypertensive subjects in a poor urban community in southwest Nigeria. This community-based cross-sectional study employed a survey of a convenience sample of 440 community residents with hypertension and eight focus-group discussions (FGDs) with a subset of the participants. Of the 440 hypertensive respondents, 65.2% were women, about half had no formal education, and half were traders. Over 60% of the respondents sought care for their condition from the hospital while only 5% visited a chemist or a patent medicine vendor (PMV). Only 51% of the subjects reported high compliance. Factors associated with high self-reported compliance included: regular clinic attendance, not using non-Western prescription medication, and having social support from family members or friends who were concerned about the respondent's hypertension or who were helpful in reminding the respondent about taking medication. Beliefs about cause of hypertension were not associated with compliance. The findings of the FGDs showed that the respondents believed hypertension is curable with the use of both orthodox and traditional medicines and that a patient who 'feels well' could stop using antihypertensive medication. It is concluded that treatment compliance with antihypertensive medication remains sub-optimal in this Nigerian community. The factors associated with high self-reported compliance were identified. More research is needed to evaluate how such findings can be used for the control of hypertension at the community level.
    Journal of Health Population and Nutrition 12/2011; 29(6):619-28. · 1.12 Impact Factor
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    ABSTRACT: To synthesise the findings from individual qualitative studies on patients' understanding and experiences of hypertension and drug taking; to investigate whether views differ internationally by culture or ethnic group and whether the research could inform interventions to improve adherence. Systematic review and narrative synthesis of qualitative research using the 2006 UK Economic and Social Research Council research methods programme guidance. Medline, Embase, the British Nursing Index, Social Policy and Practice, and PsycInfo from inception to October 2011. Qualitative interviews or focus groups among people with uncomplicated hypertension (studies principally in people with diabetes, established cardiovascular disease, or pregnancy related hypertension were excluded). 59 papers reporting on 53 qualitative studies were included in the synthesis. These studies came from 16 countries (United States, United Kingdom, Brazil, Sweden, Canada, New Zealand, Denmark, Finland, Ghana, Iran, Israel, Netherlands, South Korea, Spain, Tanzania, and Thailand). A large proportion of participants thought hypertension was principally caused by stress and produced symptoms, particularly headache, dizziness, and sweating. Participants widely intentionally reduced or stopped treatment without consulting their doctor. Participants commonly perceived that their blood pressure improved when symptoms abated or when they were not stressed, and that treatment was not needed at these times. Participants disliked treatment and its side effects and feared addiction. These findings were consistent across countries and ethnic groups. Participants also reported various external factors that prevented adherence, including being unable to find time to take the drugs or to see the doctor; having insufficient money to pay for treatment; the cost of appointments and healthy food; a lack of health insurance; and forgetfulness. Non-adherence to hypertension treatment often resulted from patients' understanding of the causes and effects of hypertension; particularly relying on the presence of stress or symptoms to determine if blood pressure was raised. These beliefs were remarkably similar across ethnic and geographical groups; calls for culturally specific education for individual ethnic groups may therefore not be justified. To improve adherence, clinicians and educational interventions must better understand and engage with patients' ideas about causality, experiences of symptoms, and concerns about drug side effects.
    BMJ (Clinical research ed.). 01/2012; 345:e3953.

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