An integrated community-based hypertension improvement program improves hypertension awareness in Ghana

Background: We evaluated the impact of an integrated community-based hypertension intervention on hypertension awareness (defined as prior diagnosis of hypertension among persons with elevated blood pressure), prevalence of hypertension, and behavioural risk factors for hypertension. Methods: The community-based hypertension improvement program implements an integrated package of interventions in one health district in Ghana. The project is evaluated using a quasi-experimental design consisting of population-based cross-sectional surveys (the focus of this paper) in an intervention and a comparison districts, plus a cohort study in the intervention district-only. The cohort study determined hypertension control. Results: At baseline, we interviewed 2,400 respondents (1,200 each from the Lower Manya Krobo (intervention district) and Akuapim South (comparison district) and interviewed 2,533 adults aged 30 years or older from same districts at endline – 1,306 from the Lower Manya Krobo and 1,227 from Akuapim South districts. Hypertension awareness significantly increased in the intervention district from 47.7%; 95% confidence interval (CI) (42.0–53.7) at baseline to 59.2%; 95% CI (53.8–64.6) at endline, while in the comparison district, there was a small, non-significant decrease from 44.7%; 95% CI (38.8–50.8) to 36.6%; 95% CI (31.3–42.2). There is strong evidence of difference between these two districts OR (P = 0.005). There were no significant differences in changes of hypertension prevalence or treatment from baseline to endline between the two districts The proportion of people that know more than 2 risk factors increased in the control groups (odds ratio [OR], 1.770; 95% CI, 1.242–2.5142) while this does not change significantly in the intervention group (OR, 0.865; 95% CI, 0.61–1.210). Conclusion: This integrated community-based program improved hypertension awareness, and some behavioural risk factors, but not hypertension prevalence at the community level.