Awareness, treatment, and control among adults living with arterial hypertension or diabetes mellitus in two rural districts in Lesotho

PLOS Glob Public Health. 2024 Sep 30;4(9):e0003721. doi: 10.1371/journal.pgph.0003721. eCollection 2024.

Abstract

In Lesotho, the hypertension and diabetes care cascades are unknown. We measured awareness, treatment, and control of hypertension and diabetes among adults ≥18 years and identified factors associated with each step of the cascade, based on data from a population-based, cross-sectional survey in 120 randomly sampled clusters in the districts of Butha-Buthe and Mokhotlong from 1st November 2021 to 31st August 2022. We used multivariable logistic regression to assess associations. Among participants with hypertension, 69.7% (95%CI, 67.2-72.2%, 909/1305) were aware of their condition, 67.3% (95%CI 64.8-69.9%, 878/1305) took treatment, and 49.0% (95%CI 46.3-51.7%, 640/1305) were controlled. Among participants with diabetes, 48.4% (95%CI 42.0-55.0%, 111/229) were aware of their condition, 55.8% (95%CI 49.5-62.3%, 128/229) took treatment, and 41.5% (95%CI 35.1-47.9%, 95/229) were controlled. For hypertension, women had higher odds of being on treatment (adjusted odds ratio (aOR) 2.54, 95% CI 1.78-3.61) and controlled (aOR 2.44, 95%CI 1.76-3.37) than men. Participants from urban areas had lower odds of being on treatment (aOR 0.63, 95% CI 0.44-0.90) or being controlled (aOR 0.63, 95% CI 0.46-0.85). Considerable gaps along the hypertension and diabetes care cascades in Lesotho indicate that access and quality of care for these conditions are insufficient to ensure adequate long-term health outcomes.

Grants and funding

This study is part of the ComBaCaL project which is funded by the TRANSFORM grant of the Swiss Agency for Development and Cooperation (project number 7F-10345.01.01) and a grant by the World Diabetes Foundation (WDF-1778). NDL receives his salary from the Swiss National Science Foundation (SNSF Eccellenza PCEFP3_181355). AA’s salary is funded through a career grant of the University of Basel (Junior Research Fund) and EU RESPONSE. EF receives his salary from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement (No 801076), through the SSPH+ Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.