Undiagnosed elevated blood pressure and central obesity among adults in rural Rwanda: risk factors and scalability of a pilot community outreach screening to close care cascade gaps

Abstract

Non-communicable diseases (NCDs), driven by a rising burden of hypertension, are projected to become the leading cause of morbidity and mortality in Africa by 2030. This increasing burden is attributed to substantial gaps in the NCD and hypertension care cascade. For instance, in Rwanda, 22% of hypertensive people have been diagnosed and are receiving treatment. We aimed to assess the prevalence of undiagnosed elevated blood pressure and central obesity among adults during an outreach screening and to evaluate the approach’s scalability. We conducted a cross-sectional screening during the International Nursing Day commemoration at Rusumo football pitch in Butaro, Rwanda. Up to 192 consenting adults with no prior diagnosis of hypertension were screened for elevated blood pressure, Body Mass Index (BMI), Waist-to-Hip Ratio (WHR), and Waist-to-Height Ratio (WHtR), and data on risk factors were collected. The mean age was 36 years (SD = 14.2 years), with 114 (59.4%) males, all from wealth categories 1, 2, and 3. Dietary sodium intake was low, with 169 (88.0%) consuming below 2 g per day. Tobacco smoking prevalence was 10.4% (95%CI = 6.8; 15.6%), while 63.5% (95%CI = 56.5; 70.1%) consumed alcohol. Central obesity, defined by waist-to-hip ratio (WHR), was prevalent in 45.3% (95% CI = 38.4%; 52.5%); using waist-to-height ratio (WHtR ≥ 0.5), obesity prevalence was higher, at 57.3% (95% CI = 50.2%; 64.1%). Meanwhile, 29.69% (95% CI: 23.62%- 36.57%) screened positive for elevated blood pressure. Being 40 years of age or older was associated with higher odds of central obesity than being younger than 40 years (aOR = 4.52; 95% CI = 2.01, 10.17). Additionally, being male compared to being female (aOR = 0.20, 95%CI = 0.08; 0.50) and fasting at least once monthly, compared to never fasting at all (aOR = 0.43, 95%CI = 0.19; 0.96), was associated with lower odds of obesity as measured through WHtR. Outdoor screening was seen as acceptable by 94.3% of participants and appropriate by 98.95% participants. Nearly a third of adults in Burera had undiagnosed elevated blood pressure, a proportion almost double the national estimated prevalence of diagnosed hypertension. Additionally, almost half of the adults have central obesity, with being of age 40 and above being a significant risk. Open-space screening proved appropriate and acceptable.