Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P’s (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review

Table 1 Prevalence of hypertension and related CVD risk factors in selected Eastern Sub-Saharan Countries

S.No	Country	Raised blood pressure, adults aged 18 + (%)	Proportion patients not taking antihypertensive drugs	Percentage of patients achieved BP control	Current tobacco smoking, adults aged 15 + (%)	Prevalence of obesity (BMI ≥ 30 kg/m² in 18 + (%)	Physical inactivity, adults aged 18 + (%)	Harmful (heavy) alcohol consumption	Mean population salt intake, adults aged 20 + (g/day)	Parentage consuming fruits and vegetables < 5 servings/day
1	Ethiopia	16	71.6	< 30	4.0	4	14	12.4	6	97.6
2	Kenya	23.8	50.9		10	6	14	12.7	4.3	94.0
3	Malawi	22	94.9	1.5	12	5	14	7.7	4	97.5
4	Mozambique	23	50	Low	16	6	5	2	6	95.6
5	Rwanda	20	78	–	12.8	5	13.3	9	4	99.3
6	Seychelles	24	25	20.0	21	15	19	12	11	37.5%
7	Tanzania	25.9	77.1	3.1	14.1	7	7.5	9	7	97.2
8	Uganda	24.3	76.1	9.4	11	4	4.3	9	5	87.5
9	Zambia	20	80	6.7	15.8	7	20	5	6	90.4
10	Zimbabwe	20	–	–	11.8	12	25	5	8	–

S.No	Country	Availability essential NCD medicines	Raised blood glucose, adults aged 18 + (%)	Prevalence total cholesterol ≥ 5 mmol/L	Percentage with at least one risk factor	Proportion of 40–69 old with ≥ 30% CVD risk	Proportion of primary healthcare centres reported as offering CVD risk stratification	Having CVD guidelines that are utilized in at least 50% of health facilities	Availability essential technologies	References
1	Ethiopia	54.7	6	5.6	98.4	4.7	< 25%	0	50	[20,21,22,23]
2	Kenya	90	3.1	10.1	97	7.6	< 25%	0	66.7	[23, 24, 26,27,28]
3	Malawi	50	5.6	8.7	99	16.5	0	100	33.3	[23,24,25]
4	Mozambique	70	2.9	–	99.6	16.4	< 25%	0	66.7	[23, 24, 29]
5	Rwanda	100	3.1	2.6	99.6	16.35	0	100	83.3	[23, 24, 30]
6	Seychelles	100	10	36.7	–	–	< 25%	100	83.3	[23, 31]
7	Tanzania	60	9.1	4.4	82.6	16.6	< 25%	0	66.7	[23, 24, 32]
8	Uganda	50	3.3	6.7	–	–	< 25%	100	66.7	[23, 24, 33, 34]
9	Zambia	60	6.0	7.4	94.7	4.0	< 25%	100	66.7	[23, 24, 35, 36]
10	Zimbabwe	40	11.5	20.2	–	–	0	100	50	[23, 24, 37, 38]

Interventions to reduce body weight at the individual level often have little efficacy, except bariatric surgery. Therefore, weight control interventions should focus on the societal causes of the obesogenic environment and include interventions in all sectors (e.g. education, agriculture, finance, transports, nutrition, food industry, etc.) to enable people to choose healthier diets, including adequate food labeling, tax/subsidies on healthy/unhealthy foods; ban on advertising of unhealthy foods, healthy food in canteens in schools/workplaces. Multisectoral interventions should also address the structural environment to help people engage in more physical activity in their daily lives (e.g. bus/cycling lanes, safe sidewalks, promotion of public transports, disincentives to use private cars, etc.)
CVD cardiovascular disease, NCD non-communicable disease, BP blood pressure, g/day gram per day

ISSN: 1471-2261