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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020
AFRICA
11
Healthcare facilities participating in the HHA programme
received educational materials (examples provided in
supplementary information) to use at these outreach events.
In addition, participating healthcare facilities received access
to key hypertension medications, basic resources (equipment
and educational and training materials), and a hypertension
diagnosis and treatment protocol, which described hypertension
risk factors and management methods but not the consequences
of hypertension.
7
Of note, during the study period, some
healthcare providers who were trained at an intervention facility
may have been transferred to either a control or non-participating
healthcare facility as part of routine transfer or due to the
devolution of the Kenyan government that occurred during the
study period.
8
A 12-month prospective, controlled study evaluated the
effect of HHA intervention on facility services for hypertension
care, and the knowledge of hypertension among healthcare
providers and the general study population. Two separate
surveys, the Facility Survey
7
and the Household Survey, were
conducted before (baseline) and 12 months after (end point) the
implementation of HHA. Initially the Facility Sample included
150 healthcare facilities (75 randomly selected intervention
facilities and 75 matched control facilities, paired based on
the implementation partner and location) and the Household
Sample reflected the catchment areas near 50 facilities (25
intervention facilities chosen at random from the initial 75, and
their 25 matched controls). Due to attrition, the final analysis
included 132 facilities in the Facility Survey, and the catchment
area of 42 facilities in the Household Survey. Sample sizes
declined because facilities closed or refused to participate in the
end-point survey, or were dropped because their (or their pair’s)
treatment status was switched after the initial samples were
chosen, and they could not be matched to another comparable
facility in the other treatment group.
The impact of HHA on facility services and healthcare
providers’ knowledge of hypertension was evaluated by the
Facility Survey and has been reported on by Ogola
et al
.
7
Here,
we report the results from the Household Survey, which evaluated
the effect of HHA intervention on the knowledge of and
attitudes toward hypertension and the frequency of BP screening
and hypertension diagnosis among the study population.
The Household Survey (supplementary information)
was developed by the investigators to evaluate individuals’
awareness and knowledge of hypertension and their attitudes
and health-seeking behaviour towards hypertension. The survey
was administered to individuals residing near a subset of 25
intervention facilities (randomly selected from the original group
of 75 facilities assigned to the intervention) and their matching
control facilities at baseline and the end point. The selected
facilities were located in rural and urban areas.
The intervention population was defined as individuals
residing in the catchment areas of the facilities participating in
the HHA programme. The control population was defined as
individuals residing in the catchment areas of matched facilities
that did not receive HHA intervention. Data for BP screening
and hypertension diagnosis were also abstracted from the service
delivery registers (used at the point of service) of the selected
facilities.
The Household Survey was pilot-tested before fielding by
Ipsos Synovate Kenya (Nairobi, Kenya), a contracted survey
consulting firm. Trained staff conducted face-to-face interviews
with individuals residing in the catchment areas surrounding the
participating intervention and control facilities. Each catchment
area was divided into four non-overlapping enumeration areas,
of which two enumeration areas [one near (1–4 km) and one far
(5–7 km) from the facility] were randomly surveyed. For each
enumeration area, a random starting point was selected and the
right-hand rule (household to the right of the data collector) was
used to select every household after 200 metres. The baseline and
end-point surveys were conducted at the same enumeration sites;
however, different households were randomly surveyed at each
time point, resulting in two separate sample populations.
Adults (aged
≥
18 years) were surveyed if they lived in the
same compound, had the same household head and same
cooking arrangements, and had lived in the household during
the last six months. The surveyors visited each household two
additional times to establish contact with adult household
members who were not present at the time of the first interview.
Households were assigned to the treatment group associated
with their local facility (intervention or control); however, the
survey did not capture where the survey respondents sought and/
or received care (at the facility to which they were assigned or
outside the study area or non-traditional medicine).
This study was reviewed and approved by the Kenyatta
National Hospital and the University of Nairobi Ethics and
Research Committee (KNH/UON-ERC). Written informed
consent was obtained from all survey respondents before the
start of the study.
Table 1. Healthy Heart Africa implementing partners
AMPATH
Amref Health Africa
CHAK
Jhpiego
PSK
Approach Extension of existing hyper-
tension programme into
Ministry of Health sites in
rural West Kenya
Community-based screening
clustered around Ministry
of Health sites in the Kibera
slum area
Initial focus on church/reli-
gious leaders and expand-
ing outreach efforts across
church, community, facility
and workplace
Informal integration of
the programme into HIV
network in Ministry of
Health sites with a signifi-
cant focus on facility-based
screening
Private clinics part of
the Tunza Family Health
Network, with significant
focus on outreach events and
ad hoc
screening at various
gatherings of people (e.g.
bus stops, parties, funerals
and sporting events)
Implementa-
tion sites
Public health dispensaries
and primary-care facilities
Public health facilities and
Ministry of Health sites in
the Kibera slum area
Faith-based facilities and
community sites (e.g.
markets, group meetings, bus
stops and workplaces)
Public health facilities
Private clinics, pharma-
cies, and non-traditional
sites (e.g. taxi stands, gyms,
market places, primary
schools, social halls, road-
side, youth bases and
women’s group)
AMPATH: Academic Model Providing Access to Healthcare; CHAK: Christian Health Association of Kenya; HIV: human immunodeficiency virus; PSK: Population
Services Kenya.