CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
186
AFRICA
Health practitioners’ state of knowledge and challenges
to effective management of hypertension at primary
level
A PARKER, B NAGAR, G THOMAS, M BADRI, NBA NTUSI
Abstract
Background:
Patient- and physician-related factors impact
on the management and control of hypertension.
Objectives:
To systematically examine: (1) South African
primary care doctors’ state of knowledge on the management
of hypertension; (2) primary health practitioners’ knowledge
on the South African hypertension guidelines; (3) current
approaches to management of hypertensive patients; and
(4) challenges to effective management of hypertension at
primary level.
Methods:
A cross-sectional, observational study using a
semi-structured questionnaire was carried out in two large
community health centres (CHCs) in the Cape Town metro-
pole. All 16 doctors employed at both CHCs were voluntar-
ily enrolled, seven (43.7%) of whom were female, with 14
(87.5%) younger than 40 years of age. The majority (81.2%)
of the doctors surveyed had been practicing for less than 10
years.
Results:
Ten (62.5%) of the doctors surveyed aimed to treat
hypertension to target, and recommendations on lifestyle
modifications were reportedly poorly done.While 11 (68.8%)
of the doctors were aware of the South African hypertension
guidelines, were (81.8%) of them were not conversant with
the contents thereof. Doctors estimated that only 35% of
their patients are treated to target. Poor patient adherence
to prescribed treatment, language difficulty, heavy patient
load, medical staff shortages, and patient loss to follow up
were identified by the doctors as significant impediments
to the effective management of hypertension at the primary
level of care.
Conclusion:
Primary healthcare practitioners’ knowledge
regarding hypertension and the South African hypertension
guidelines is poor. Management of hypertension by these
doctors is sub-optimal. There are significant challenges to
effective management of hypertension at this level of care.
Keywords:
hypertension, primary healthcare, South Africa,
challenges to healthcare
Submitted 18/4/10, accepted 19/8/10
Cardiovasc J Afr
2011;
22
: 186–190
DOI: 10.5830/CVJA–2010–066
Hypertension is common
1
and it increases cardiovascular morbid-
ity and mortality.
2
In 2001, 54% of all strokes and 47% of all
ischaemic heart disease were due to hypertension, with 80% of
this blood pressure-attributable disease burden occurring in low-
and middle-income countries. More than half occurred in people
of working age (45 to 69 years of age).
1
A recent Canadian study
demonstrated that a simplified hypertension treatment algorithm
administered to 45 general practices resulted in a significantly
higher proportion of patients achieving their target blood pres-
sure.
3
Factors that impact on doctors’ ability to provide good
management of hypertension have previously been investigated.
4
Both patient- and physician-related factors have significant
impact on blood pressure control in hypertensive patients.
5
The South African Hypertension Society published guidelines,
designed with expert consensus, to guide the management of
hypertension in South Africa, to minimise the gap between the
public and private sectors of healthcare, and to improve care
of individuals with hypertension.
6
Yet, the publication of these
guidelines does not seem to have significantly impacted on the
management practice of many doctors who treat hypertension.
There have been few studies in South Africa that have
systemically examined doctors’ impressions of the phenomena
that impede effective care of their hypertensive patients. Hence,
the objectives of the study were to systematically examine: (1)
South African primary care doctors’ state of knowledge on the
management of hypertension; (2) primary health practitioners’
knowledge on the South African hypertension guidelines; (3)
current approaches to management of hypertensive patients;
and (4) challenges to effective management of hypertension at
primary level.
Methods
Doctors working at two large community health centres (CHCs)
with a predominantly black patient population in the Cape
Town metropole were selected to participate in the study. The
study was designed to be an observational study, with the data-
collection tool in the form of a semi-structured questionnaire.
The investigators conducted all interviews and assessments in
English over a four-week period in 2008. Informed consent for
inclusion in the study was obtained from all the doctors.
The data in this study were collected as part of a project for a
fifth-year primary health block for the medical students enrolled
at the University of Cape Town Faculty of Health Sciences.
Permission for analysis of the data for the purpose of publication
Department of Medicine, Groote Schuur Hospital and the
University of Cape Town, South Africa
A PARKER, MB ChB
B NAGAR, MB ChB
G THOMAS, MB ChB
NBA NTUSI, FCP (SA),
Clinical Research Support Unit, Department of Medicine,
Groote Schuur Hospital and the University of Cape Town,
South Africa
M BADRI, PhD
