TAND denounced what it called the undemocratic tendencies of the Ethiopian government ibid. A Toronto-based representative of the TAND stated in a telephone interview on 5 September that the organization is an informally structured coalition of people opposed to the Marxist tendencies of the current Ethiopian government. According to this source, the TAND is not active in Ethiopia, nor would it be possible given the current government's negative attitude toward opposition parties in general and the dislike of the TPLF for people who have defected from the party ibid. This source added that TAND members would not risk going to Ethiopia at the present time and that family members remaining in Ethiopia try to maintain a low profile, so as to avoid drawing the government's attention ibid. Recent TAND activities have consisted of organizing discussion forums on the current Ethiopian political scene ibid.
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Metrics details. Uncontrolled hypertension is one of the major risk factors of cardiovascular and cerebrovascular diseases. The aim of this study was to determine the prevalence of uncontrolled hypertension among hypertensive patients on treatment in Ethiopia.
A total of 13 studies with hypertension patients were included for systematic review and meta-analysis. Univariate meta-regression revealed that sampling distribution was not a source of heterogeneity for the pooled estimate as well as the sub group analysis.
The prevalence of uncontrolled hypertension was high in Ethiopia. This alarming public health issue fuels the ever-increasing cardiovascular and cerebrovascular diseases. The ministry of health has to design a policy and implementation mechanisms to reduce uncontrolled hypertension prevalence and improve awareness on blood pressure control. Peer Review reports. Hypertension is the major contributor to global burden of cardiovascular morbidity and mortality [ 1 ].
Currently, more than 1. The cardiovascular and cerebrovascular complications of hypertension are the most important causes of non-communicable diseases NCD related morbidities and mortalities [ 4 ].
As hypertension is a preventable risk factor, collaborated actions can prevent the development of complications [ 5 ]. Uncontrolled hypertension is one of the major causes of heart failure, chronic renal failure, and ischemic and hemorrhagic strokes which impose severe financial and service burdens on health systems [ 9 , 10 ].
The control of hypertension within a target goal of blood pressure BP plays a critical role in reducing associated CVD. However, hypertension remains inadequately controlled in clinical practice [ 11 , 12 ]. This would increase the burden of CVD on the health system. The proportions of patients treated for hypertension with uncontrolled BP reported across the country vary substantially. However, these data have not been meta-analyzed to provide pooled estimate of the prevalence of uncontrolled BP among treated hypertensive patients.
Therefore, the aim of this study is to examine the prevalence of uncontrolled BP among treated hypertensive patients in Ethiopia. Determining the prevalence will help to comprehend the magnitude of the problem and develop strategies to reduce the imposed burden of CVD. The Preferred Reporting Items for Systematic reviews and Meta-analyses PRISMA was used in the identification of records, screening of titles and abstracts accompanied by evaluation of eligibility of full texts for final inclusion [ 13 ].
Advanced search strategies were used to retrieve relevant findings, by restricting the search for studies on human and published in English. Gray literatures from organizations and online university repositories were accessed through Google Scholar. Key words and indexing terms were used to retrieve articles that were published from onwards.
The search was conducted from February 1 to 14, and all published and unpublished articles available online from January 1, till the day of data collection were considered. With the help of the reference manager, duplicate records were identified, recorded and removed.
Due to variation in reference styles from different sources, some references were managed manually. Thereafter, two authors FA and BH independently screened the titles and abstracts with predefined inclusion criteria. Two authors MS and BM independently collected full texts and evaluated the eligibility of them for final inclusion. In each case, the third author played a critical role in solving discrepancies that arose between two authors and in coming to a final consensus.
Predefined inclusion-exclusion criteria were used to screen titles and abstracts; and evaluate full texts for eligibility. Observational studies addressing hypertension control among treated adult hypertensive patients in Ethiopia were included.
Literatures published from onwards in the English language were considered. Data abstraction format was prepared in Microsoft Excel. Two authors FA and BH independently extracted data related to study characteristics study area, first author, and year of publication, study design, population characteristics, and sample size and outcome of interest hypertension control.
The internal and external validity of included studies was assessed by using the Johanna Briggs institute JBI critical appraisal checklist for studies reporting prevalence data. Studies with the number of positive responses yes greater than half of the number of checklists i.
The primary outcome measure in this meta-analysis is the prevalence of uncontrolled hypertension in Ethiopia. It is aimed to assess the pooled estimates of uncontrolled hypertension among treated hypertensive patients in the country.
The sample size was intentionally adjusted to response rates in individual study to reduce bias in calculating the overall prevalence. A format prepared in Microsoft Excel was used to extract data from the included studies. The percentage of variance attributable to study heterogeneity was assessed using I 2 statistics.
Funnel plots of standard error and precision with Logit event rate was used to present the publication bias assessment. A p -value less than 0. Eight other articles were identified through reference tracing and other sources. After removing 82 duplicates through ENDNOTE reference manager and manual tracing, a total of records were screened using their titles and abstracts.
Then, full text assessment of 26 potentially relevant articles resulted in 13 studies that passed the eligibility criteria and quality assessment and hence included in the systematic review and meta-analysis Fig. A total of 13 studies with hypertensive patients were included in this systematic review and meta-analysis. Among the included hypertensive patients, were found to have uncontrolled BP. Eleven of the included studies used cross-sectional study design [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] while the remaining two were cohort in design [ 25 , 26 ].
Almost all the included studies were hospital based except for one which was conducted at health centers [ 18 ]. The year of publication of included studies ranged from to The prevalence of uncontrolled hypertension ranged from Forest plot depicting the pooled estimate of the prevalence of uncontrolled hypertension among treated hypertensive patients in Ethiopia.
Sensitivity analysis was conducted by excluding outliers from the analysis. However, there was no significant change on the degree of heterogeneity even when outliers were excluded from the analysis. Therefore, all the studies that passed the quality assessment were included for the meta-analysis.
A subgroup analysis was conducted based on the year of publication of the studies. Publication bias was assessed by using funnel plots of standard error with logit effect size event rate.
The analysis showed that there is no evidence of publication bias on the included studies. Funnel plot illustrating publication bias of included studies with Logit event rate and standard error.
A total of 13 institution based studies with hypertensive patients were included in this systematic review and meta-analysis. This finding indicated that almost half of hypertensive patients who were following their treatment in health institutions hospitals and health centers in Ethiopia did not achieve a target BP, proven to reduce CVD risk associated with hypertension. The prevalence of uncontrolled hypertension in this study is close to the proposed WHO target control rate [ 1 ].
The result of the subgroup analysis showed the increment in the prevalence of uncontrolled hypertension from to This clearly shows the quality of health service provided for patients with hypertension. Additionally, the national burden of cardiovascular and cerebrovascular diseases, chronic renal failure and the associated morbidity and mortality are expected to rise with the uncontrolled BP [ 27 ].
Moreover, a study has shown that treated hypertensive patients but not having control were at increased risk of all cause, CVD specific, heart disease-specific or cerebrovascular disease specific mortality [ 28 ]. Similarly, the current prevalence was lower than a report from India rural This difference might have resulted as the studies included in this meta-analysis were only institution based where there is strict control in the measurement of BP and management of hypertension.
On the other hand, the prevalence of uncontrolled hypertension in this study is in trajectory with a Kenyan national survey The high prevalence of uncontrolled hypertension observed in this study might have resulted from socioeconomic factors; low educational status and poverty [ 35 ]. Additionally, unavailability of or interrupted supply of medicines could have contributed to the high prevalence.
As WHO stated, only 1 in 10 essential NCD medicines are reported to be available at health facilities of the country [ 8 ]. In the sub-group analysis, uncontrolled hypertension increased over the years. Given the developing nature of the country and the burden of communicable diseases, the increase in uncontrolled blood pressure should be alarming. In order to decrease the burden of CVD associated with uncontrolled hypertension, home BP monitoring [ 37 ] and a holistic approach of patient care including pharmacists to manage patients drug therapy should be used [ 38 ].
This is alarming as uncontrolled hypertension is associated with an increased risk of cardiovascular complications. This would impose additional burden on the health care system of the country, which is struggling to contain communicable diseases. The prevalence of uncontrolled hypertension is increasing over the years. This evidence suggests that double burden diseases are increasingly affecting Ethiopia. In light of this evidence, policy makers and health care professionals working in the area should implement interventional strategies focusing on achieving an optimal BP among treated hypertensive patients.
The study has extensively addressed all relevant data regarding hypertension control among treated hypertensive patients in Ethiopia. However, there are certain limitations to mention.
The studies included for the meta-analysis used different cut-off point to define control of BP as there was change in guideline recommendation regarding optimal BP. Additionally, the number of BP measurement used to define uncontrolled hypertension across the included studies was inconsistent. A global brief on hypertension. Silent killer, global public health crisis. Google Scholar. The global burden of hypertension exceeds 1.
J Hypertens. Global burden of hypertension : analysis of worldwide data. Global status report on non-communicable diseases: Description of the global burden of NCDs, their risk factors and determinants. Global status report on noncommunicable diseases Molla M. Systematic reviews of prevalence and associated factors of hypertension in Ethiopia : finding the evidence. Kibret KT. Prevalence of hypertension in Ethiopia: a systematic meta analysis.
The system can't perform the operation now. Try again later. Citations per year. Duplicate citations. The following articles are merged in Scholar. Their combined citations are counted only for the first article. Merged citations.
There are new breed of historians in town that are endorsed by the TPLF to rewrite and narrate Ethiopian history. Mysteriously enough, no one in the United States attended Prof. Nonetheless, it should be noted from the outset that the effort of this writer to locate the American university where Prof. Amare claimed to work as a professor could not bear any fruits. One may wonder why but the simple truth is that Prof.