Cardiovascular Journal of Africa: Vol 31 No 1 (January/February 2020)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020 AFRICA 9
Healthy Heart Africa: a prospective evaluation of
programme outcomes on individuals’ hypertension
awareness, screening, diagnosis and treatment in rural
Kenya at 12 months
Gerald Yonga, Francis O Okello, Jane L Herr, Ashling Mulvaney, Elijah N Ogola
Abstract
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 interven-
tion 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 infor-
mation 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 recommen-
dations remained unchanged in both groups.
Conclusion: HHA improved hypertension knowledge but
screening and diagnosis remained unchanged after 12 months.
Keywords: awareness, Healthy Heart Africa (HHA), hyperten-
sion, Kenya, rural
Submitted 9/7/18, accepted 21/6/19
Published online 27/11/19
Cardiovasc J Afr 2020; 31: 9–15
DOI: 10.5830/CVJA-2019-037
Hypertension is the leading cause of cardiovascular disease
(CVD) worldwide, affecting approximately 31% of the adult
population (1.4 billion people) in 2010.1 The growing prevalence
of hypertension is a challenge for developing countries, which
already face a high burden of infectious diseases, such as human
immunodeficiency virus (HIV), malaria and tuberculosis, and
have limited resources to dedicate towards hypertension care
and control.1
Kenya is one such country facing a growing burden of
hypertension, with studies reporting age-standardised prevalence
ranging from 18.4 to 22.8%.2,3 According to the recent Kenya
STEPwise survey, the overall national prevalence of raised blood
pressure (BP) was 23.8%.4 Prevalence increased with age, ranging
from 13.2% among Kenyans aged 18 to 29 years to 53.2% for
those aged 60 to 69 years.4
Despite the high prevalence of hypertension, overall
awareness and control remain low. 2,5,6 According to the Kenya
STEPwise survey, 56% of Kenyans have never been screened
for hypertension, and, of those previously diagnosed with
hypertension, only 22.3% were currently taking medication
prescribed by a healthcare worker.4 Since hypertension manifests
asymptomatically, individuals may not necessarily seek routine
BP screening, resulting in late detection and increased risk of
stroke, hypertensive heart disease or kidney failure and coronary
artery disease.2 Improving the public’s awareness and general
knowledge of hypertension may result in positive lifestyle
changes and allow for timely detection of hypertension and early
prevention of adverse outcomes.
Healthy Heart Africa (HHA), an AstraZeneca-sponsored
programme, was designed to provide a model for controlling the
growing burden of hypertension in Africa. The HHA programme
utilised a collaborative multi-level approach aimed to improve
hypertension control through education, BP screening and
diagnosis, with longer-term goals of improving retention in care
and attainment of treatment goals (Fig. 1). HHA was first initiated
in March 2015 across 21 counties in Kenya, including the capital
city, Nairobi, and the surrounding areas and parts of western
Kenya, and has since expanded across sub-Saharan Africa (Fig. 2).7
Here, we report results from a 12-month prospective,
controlled evaluation of the impact of HHA intervention on
hypertension awareness and knowledge and the frequency of BP
screening and hypertension diagnosis among individuals residing
in rural Kenya.
Methods
HHA collaborated with the Kenyan Ministry of Health and five
healthcare service-implementation partners [Academic Model
Providing Access to Healthcare (AMPATH); Amref Health
Africa, formerly the African Medical and Research Foundation
(AMREF); Christian Health Association of Kenya (CHAK);
Aga Khan University, Nairobi, Kenya
Gerald Yonga, MB ChB, MMed,
Abt Associates, Bethesda, Maryland, United States of America
Francis O Okello, MA
Jane L Herr, PhD
AstraZeneca, London, United Kingdom
Ashling Mulvaney,MBA
Clinical Medicine and Therapeutics, University of Nairobi,
Nairobi, Kenya
Elijah N Ogola, MD