Academic journal article Iranian Journal of Public Health

Screening of Arterial Hypertension in the Republic of Kazakhstan: Advantages, Disadvantages and Ways of Improving

Academic journal article Iranian Journal of Public Health

Screening of Arterial Hypertension in the Republic of Kazakhstan: Advantages, Disadvantages and Ways of Improving

Article excerpt

Introduction

In Kazakhstan, as in most countries of the world, arterial hypertension is one of the most common diseases and poses a serious challenge to public health. According to official statistics, the prevalence of hypertension among adults in Kazakhstan is 24.3% (1-3). Between 2009 and 2013, this prevalence has significantly increased from 10777.7 to 13391.6 per 100.000 inhabitants (1,4). At the same time, mortality rates related to hypertension rose as well and now rank first among the causes of death. Approximately 40% of the deaths are observed during active working age (20-64 years), of which 64% in the male population (3). According to World Health Organization (WHO), premature mortality from CVD in Kazakhstan is the second largest amongst the countries of the European region (5, 6).

To curb this epidemic, the State Health System of Kazakhstan established a screening program for early detection of cardiovascular diseases and their risk factors within the State Health system development Program (3,7,8). The screening program was established from 2008 onwards, targeted to the population aged between 18 and 64 years old, and conducted by trained physicians and nurses at primary health care facilities (territorial policlinics). Screenings for all non-communicable diseases are free of charge in Kazakhstan, and are covered within the guaranteed volume of free medical care at primary health care level.

Screening for early detection of cardiovascular diseases (arterial hypertension, ischemic heart disease) and diabetes is carried out in several stages following a well-developed scheme. Firstly, men and women aged 18, 25, 30, 35, 40 and each two years after 40 to 64 years are identified as the target groups. Secondly, a two stage screening process was implemented. The first stage is carried out by nurses of prevention care departments of policlinics. The second stage is performed by a physician and is conducted only among those patients who have indications for specialized surveys a specialist (7-9).

However, despite of the health system's and health professionals' efforts, the involvement of the population in the screening remains very low (3). This lack of response by the population leads to a delayed onset of the treatment for hypertension, with more severe stages of the disease and complications. In addition, it increases the expenses both for the patients and for the health system, and increases the burden of the disease to the society (10-13). It is well established that reduction of the risk factors for hypertension, early detection and adhering to physicians' recommendations considerably reduces the risks of stroke and heart attack (9, 14).

In an effort to enhance the participation of the target population in the hypertension screening, the current study aimed to explore the attitudes, perceived advantages and disadvantages, and potential barriers to hypertension screening in Kazakhstan, taking into consideration the differences between urban and rural groups. As education level, employment and income level is lower in rural areas, and accessibility to health care services is not equal in urban and rural places, we expect significant difference in terms of information level, participation rate, and severity of the disease.

Method

Participants

A cross-sectional survey was conducted from September 2012 until May 2013 among patients between 18 to 64 years of age with diagnosed arterial hypertension. A multistage sampling approach was used to select patients from 8 primary health care facilities of Almaty city and the Almaty region of Kazakhstan. The sites represent a representative sample from the primary health care facilities (policlinics) providing AH screenings in Kazakhstan. The list of participating policlinics was approved by the Health Care Department of Almaty region. Using the patients' medical charts, 4800 (18% of all patients with AH in the region) patients with arterial hypertension were identified. …

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