Patients’ and Health Care Workers’ Perspectives on Barriers to Hypertension Care in a Pastoralist Setting Mandera West Sub-County, Kenya
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Abstract
Hypertension affects about one in four Kenyan adults, yet only 15.5% of those affected are aware of their status. No measured prevalence estimate exists for Mandera County, where pastoral mobility, 77% absolute poverty and sparse health services are likely to compound underdetection, while evidence from transitioning pastoralist populations shows that their historically low cardiovascular risk is rising. This study compared patients' and health care workers' (HCWs) perceptions of socioeconomic, cultural, health-system and geographic barriers to hypertension care in Mandera West Sub-County, Kenya. A comparative cross-sectional survey was conducted from June to August 2026 among 100 patients aged 35–68 years with a clinician-confirmed diagnosis of hypertension, randomly sampled from facility hypertension registers and interviewed at hypertension clinics, and 100 HCWs selected by stratified total enumeration. Structured questionnaire data were analysed in SPSS version 27 using descriptive statistics and Pearson’s chi-square tests (α = .05). Most patients were aged 45–64 years (68%), female (61%), pastoralists (44%) and had Madrassa-only education (45%). Lack of health insurance (90%), treatment costs (78%), poor roads (74%) and distance (58%) were the leading barriers reported by patients, whereas cultural beliefs (8%), herbal medicine (8%) and stigma (18%) were minor. Patients and HCWs agreed on geographic, cultural, staffing and screening barriers (p > .05) but diverged significantly on cost of care (78% vs. 56%; χ² = 10.95, p < .001) and medication availability (37% vs. 20% reporting that drugs were rarely available; χ² = 7.12, p = .028). Barriers to hypertension care in Mandera West are predominantly structural rather than cultural, and providers underestimate the financial and supply burden borne by patients. The county should fund Social Health Authority (SHA) premiums for indigent patients, adopt multi-month dispensing backed by buffer stocks of essential antihypertensives, and equip community health promoters to screen and refill medication along migration routes.
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References
Adeloye, D., Owolabi, E. O., Ojji, D. B., Auta, A., Dewan, M. T., Olanrewaju, T. O., Ogah, O. S., Omoyele, C., Ezeigwe, N., Mpazanje, R. G., Gadanya, M. A., Agogo, E., Alemu, W., Adebiyi, A. O., & Harhay, M. O. (2021). Prevalence, awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence. The Journal of Clinical Hypertension, 23(5), 963–977. https://doi.org/10.1111/jch.14220
Brendon J. Cannon & Jacob Haji Ali. (2018). Devolution in Kenya Four Years On: A Review of Implementation and Effects in Mandera County. African Conflict and Peacebuilding Review, 8(1), 1. https://doi.org/10.2979/africonfpeacrevi.8.1.01
Elnaem, M. H., Mosaad, M., Abdelaziz, D. H., Mansour, N. O., Usman, A., Elrggal, M. E., & Cheema, E. (2022). Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review. International Journal of Environmental Research and Public Health, 19(21), 14571. https://doi.org/10.3390/ijerph192114571
Geldsetzer, P., Manne-Goehler, J., Marcus, M.-E., Ebert, C., Zhumadilov, Z., Wesseh, C. S., Tsabedze, L., Supiyev, A., Sturua, L., Bahendeka, S. K., Sibai, A. M., Quesnel-Crooks, S., Norov, B., Mwangi, K. J., Mwalim, O., Wong-McClure, R., Mayige, M. T., Martins, J. S., Lunet, N., … Jaacks, L. M. (2019). The state of hypertension care in 44 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level data from 1·1 million adults. The Lancet, 394(10199), 652–662. https://doi.org/10.1016/S0140-6736(19)30955-9
Geremew, G., Ambaw, F., Bogale, E., & Yigzaw, Z. (2023). Adherence to Lifestyle Modification Practices and Its Associated Factors Among Hypertensive Patients in Bahir Dar City Hospitals, North West Ethiopia. Integrated Blood Pressure Control, Volume 16, 111–122. https://doi.org/10.2147/IBPC.S436815
Gladys, M. M., Gachohi, J., & Muriithi, A. (2021). Prevalence of uncontrolled hypertension and associated factors among hypertensive patients attending medical outpatient clinic, Thika level 5 hospital, Kenya. International Journal Of Community Medicine And Public Health, 8(6), 2733. https://doi.org/10.18203/2394-6040.ijcmph20211976
Haque, M., Islam, T., Rahman, N. A. A., McKimm, J., Abdullah, A., & Dhingra, S. (2020). Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries. Risk Management and Healthcare Policy, Volume 13, 409–426. https://doi.org/10.2147/RMHP.S239074
Hendriks, M. E., Wit, F. W. N. M., Roos, M. T. L., Brewster, L. M., Akande, T. M., De Beer, I. H., Mfinanga, S. G., Kahwa, A. M., Gatongi, P., Van Rooy, G., Janssens, W., Lammers, J., Kramer, B., Bonfrer, I., Gaeb, E., Van Der Gaag, J., Rinke De Wit, T. F., Lange, J. M. A., & Schultsz, C. (2012). Hypertension in Sub-Saharan Africa: Cross-Sectional Surveys in Four Rural and Urban Communities. PLoS ONE, 7(3), e32638. https://doi.org/10.1371/journal.pone.0032638
Kayima, J., Nankabirwa, J., Sinabulya, I., Nakibuuka, J., Zhu, X., Rahman, M., Longenecker, C. T., Katamba, A., Mayanja-Kizza, H., & Kamya, M. R. (2015). Determinants of hypertension in a young adult Ugandan population in epidemiological transition—The MEPI-CVD survey. BMC Public Health, 15(1), 830. https://doi.org/10.1186/s12889-015-2146-y
Kimani, S., Mirie, W., Chege, M., Okube, O. T., & Muniu, S. (2019). Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: A cross-sectional study. BMJ