Providing early detection services to reduce hypertension-related mortality rates in rural Zambia.
Rhoda had been feeling unwell, but she could not identify what the problem was. When Nathan, a community health assistant (CHA) in Nakapata village found her at her home, he immediately realized something was amiss and began running tests.
“When I went for my routine household visits at Nakapata village I found Ms. Rhoda, in her eighties, looking unwell,” said Nathan. “I did a malaria test, which was negative, and decided to check her BP [blood pressure] as well. The result showed her BP to be in the range of 167/117 to 180/122. I suspected her BP was too high, and I immediately phoned Ms. Musonda Chibende, who is a registered nurse-in-charge at Shemu Rural Health Center [to notify her of a potential case]. [After our call], I organized an immediate referral to Shemu with the help of family members.”
Nathan continued to monitor her condition. Without him, Rhoda says she would have died.
Rhoda was rushed to the health center where a nurse reassessed her and confirmed her BP was very high. She was admitted to the clinic for half a day for observation by the nurse and was later discharged. Back at home, Nathan continued to monitor her condition. Without him, Rhoda says she would have died.
Rhoda is an example of many Zambians living with hypertension without knowing it. Hypertension, also known as high blood pressure, is a global health issue. It rarely causes any symptoms in the early stages, and many people go undiagnosed. Almost 35 percent of adults in Zambia are living with hypertension, and in 2016, the disease accounted for 3.3 percent of all deaths in the country.[1]
A high number of undetected cases in rural Zambia
Nakonde, a rural district in Muchinga province, has one of the highest numbers of hypertension cases in Zambia, which have been rising steadily over the last three to four years.[2] Similarly, across Zambia, rural primary health clinics report a higher prevalence of hypertension than rural clinics in other African countries. [3] Low community screening, case detection, and public awareness are among the key drivers for the low number of cases in rural Zambia as CHAs are ill-equipped for community health surveillance.
Hypertension cases in Nakonde 2018 -2020 (Source MoH’s DHIS-2 retrieved 28/6/2021)
CHAs like Nathan spread the footprint of local health posts into the communities they serve. This includes hypertension screening and detection; however, CHAs are not supplied with appropriate diagnostic tools such as BP machines and thermometers to facilitate their work.
To address this gap, the Zambia Ministry of Health, with CHAI and USAID support, procured and distributed BP machines, thermometers, and timers to 600 community health assistants for community surveillance activities in Northern, Muchinga, Luapula, Copperbelt, North-Western, and Central provinces. In addition, CHAI donated bicycles to increase CHAs’ ability to cover larger geographic areas and communities’ level of awareness on the dangers of high blood pressure and other non-communicable diseases.
Armed with their BP machines and other tools procured by CHAI, Nathan and 15 other CHAs are now at the frontlines of the Ministry of Health’s efforts to stem the rising tide of hypertension in Nakonde district. Without these devices, Nathan would not have been able to test Rhoda’s blood pressure or refer her to the health center that saved her life. Nathan’s work in Nakonde district has served to underscore the role community health assistants play in increasing awareness and early detection of potential cases of hypertension and non-communicable diseases in their communities.
[1] BM Katemba et al., “Hypertension Policy Brief: Reduced Morbidity and Mortality Due to Hypertension – the Health Press – Zambia,” The Health Press Zambia, January 24, 2020.
[2] MOH HMIS retrieved 28/6/2021
[3] Yan, Lily D., Benjamin H. Chi, Ntazana Sindano, Samuel Bosomprah, Jeffrey SA Stringer, and Roma Chilengi. “Prevalence of Hypertension and Its Treatment among Adults Presenting to Primary Health Clinics in Rural Zambia: Analysis of an Observational Database.” BMC Public Health. BioMed Central, September 21, 2015. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2258-4.
