Comparative Evaluation of Hypertension Prevention, Treatment and Control Efforts among Pilot and Non-pilot Health Facilities in Amhara Region, Northern Ethiopia, 2022: a Parallel Evaluation Design

Abstract

Background With increasing trends of hypertension, Ethiopia has been piloting hypertension program whose effectiveness was not ascertained yet. Therefore, this study aimed to determine effectiveness of pilot hypertension program in the Amhara region of Ethiopia. Methods We followed a parallel evaluation design to describe hypertension prevention, treatment and control efforts of four pilot and four non-pilot facilities in Amhara region from April 1–30, 2022. We used checklist with a structured questionnaire to collect data from record reviews, patient interviews and observations. Data were analyzed using SPSS version 25.0. The statistical comparison was made using chi-square test, t-test, 95% CI and p < 0.05. Result Pilot facilities demonstrated better performances in hypertension prevention (72.8% vs 43.6%), hypertension treatment (85.3% vs 55.0%) and hypertension control (49.8% vs 42.4%) domains. The rate of opportunistic blood pressure (BP) screening was higher in pilot facilities (91%) 95% CI: 87.8–93.5% than non-pilot facilities (74.4%), 95% CI: 71.2–79.7%. There was a statistically significant difference in hypertension detection rates between pilot facilities (19.9%), 95% CI: 16.2–24.0%) and non-pilot facilities (14.9%), 95% CI: 11.7–18.6%. Half (51.8%) of hypertensive patients in pilot and 42.4% in non-pilot facilities had controlled thier BP with a statistically significant difference between facilities, chi-square, X² = 0.823; p < 0.001. The mean performances across three domains was better in pilot facilities than non-pilot facilities (76.1% vs51.2%), t-test, t = 2.125; p = 0.042. Conclusion the evaluation of the pilot hypertension program in the Amhara region of Ethiopia has demonstrated promising results. Pilot facilities showed better performances across the three domains. They demonstrated better opportunistic BP screening, case detection and retention into care, and BP control compared to non-pilot facilities. Based on these findings, pilot hypertension program in the Amhara region should be scaled up into nationwide program and the successful components pilot program such as structured approach to hypertension management, protocol adherence, and integration of hypertension service into primary healthcare should be replicated.