Early detection, care and control of hypertension and diabetes in South Africa: A community-based approach

Background Non-communicable diseases (NCDs) are a major public health concern with raised blood pressure and glucose emerging as leading causes of death and disability. Aim This community-based demonstration project using community caregivers (CCGs) trained in screening for hypertension and diabetes aimed at improving early detection and linkage to care and management. Setting The project was conducted in KwaZulu-Natal province. Methods The CCGs were trained in NCD-related health education, promotion and screening for hypertension and diabetes using an accredited programme. The CCGs screened community members for hypertension and diabetes using three screening methods: door-to-door visits, community campaigns and workplaces. Results Twenty-five CCGs received the accredited NCD training. A total of 10 832 community members were screened for hypertension and 6481 had their blood glucose measured. Of those screened, 29.7% and 4.4%, respectively, had raised blood pressure (≥ 140/90 mmHg) and blood glucose (≥ 11.0 mmol/L) who required referral to a primary healthcare facility. More than one in five (21.0%, n = 1448), of those with no previous hypertension diagnosis, were found to have raised blood pressure at screening, representing newly detected cases. Less than a third (28.5%) of patients referred to the facilities for raised blood pressure actually presented themselves for a facility assessment, of which 71.8% had their hypertension diagnosis confirmed and were advised to continue, adjust or initiate treatment. Similarly, 29.1% of patients referred to the facilities for raised blood glucose presented themselves at the facility, of which 71.4% received a confirmatory diabetes diagnosis. Conclusion Community caregivers played an important role in early detection of raised blood pressure and raised blood glucose, and in referring patients to primary care.