Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study

BMC Public Health. 2008 Dec 16:8:407. doi: 10.1186/1471-2458-8-407.


Background: Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management.

Methods: A population-based survey of 9254 persons aged 25-64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP >or= 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval.

Results: Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care.

Conclusion: Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Ambulatory Care / statistics & numerical data*
  • Community Health Centers / statistics & numerical data
  • Continuity of Patient Care
  • Female
  • Health Care Surveys
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / drug therapy
  • Hypertension / therapy*
  • Male
  • Mass Screening*
  • Middle Aged
  • Outpatient Clinics, Hospital / statistics & numerical data
  • Overweight
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data*
  • Poverty Areas
  • Preventive Health Services / statistics & numerical data*
  • Prospective Studies
  • Risk Factors
  • Smoking
  • Tanzania