Evaluating the Effectiveness of Pilot Hypertension Program on Hypertension Prevention, Treatment and Control: Insights from Amhara region (Preprint)

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Abstract
BACKGROUND Hypertension is one of the rising non-communicable diseases in Ethiopia. To achieve optimal hypertension control, and reduce the risk of cardiovascular complications, Ethiopia had initiated a hypertension program in primary healthcare settings whose effectiveness has not yet been ascertained OBJECTIVE This study aimed to determine the effectiveness of a pilot hypertension program in the Amhara region of Ethiopia METHODS A parallel evaluation design guided by the CDC’s Framework of evaluating public health programs was conducted at four pilot and four non-pilot health facilities in the Amhara region of Ethiopia. Data were collected using checklist with a structured questionnaire from face-to face interviews, record reviews and observations. Data were analyzed using SPSS version 25.0. Statistical comparisons were made using chi-square tests, t-tests, 95% confidence intervals, and p < 0.05 RESULTS Opportunistic blood pressure (BP) screening was significantly higher in pilot facilities (91%, 95% CI: 87.8–93.5%) than in non-pilot facilities (74.4%, 95% CI: 71.2–79.7%). Hypertension detection rate was significantly higher in pilot facilities (19.9%, 95% CI: 16.2–24.0%) compared to non-pilot facilities (14.9%, 95% CI: 11.7–18.6%). Half (51.8%) of the hypertensive patients in the pilot facilities and 42.4% in the non-pilot facilities had controlled BP, with a statistically significant difference in BP control rates between facilities (chi-square, X2=0.823; p < 0.001). Overall, pilot facilities showed better performance in the hypertension prevention (72.8% vs 43.6%), treatment (85.3% vs 55.0%) and control domains (49.8% vs 42.4%). The mean performance across the three domains was higher in pilot facilities (76.1%) compared to non-pilot facilities (51.2%) (t = 2.125; p = 0.042) CONCLUSIONS The pilot program in the Amhara region showed promising results in hypertension prevention, treatment, and control. These results support the scale-up of pilot components into nationwide program such as structured approaches in hypertension management, protocol adherence and integration into community level care

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