Abstract:
Background: The burdens of hypertension and diabetes are increasing in low- and middle-income countries
(L Mics). It is important to identify patients with these conditions early in the disease process. The goal of this study,
therefore, is to compare community- versus home-based screening for hypertension and diabetes in Kenya.
Methods: This was a feasibility study conducted by the Academic Model Providing Access to Healthcare (AM PATH)
program in Webuye, a town in western Kenya. Home-based (door-to-door) screening occurred in March 2010 and
community-based screening in November 2011. HIV counselors were trained to screen for diabetes and
hypertension in the home-based screening with local district hospital based staff conducting the community-based
screening. Participants >18 years old qualified for screening in both groups. Counselors referred all participants with
a systolic blood pressure (SBP) ≥160 mmHg and/or a random blood glucose ≥7 mmol/L (126 mg/dL) to a local
clinic for follow-up. Differences in likelihood of screening positive between the two strategies were compared using
Fischer’s Exact Test. Logistic regression models were used to identify factors associated with the likelihood of
following-up after a positive screening.
Results: There were 236 participants in home-based screening: 13 (6%) had a BPS ≥160 mm Hg, and 54 (23%) had a
random glucose ≥ 7 moll/L. There were 346 participants in community-based screening: 35 (10%) had a BPS
≥160 mm Hg, and 27 (8%) had a random glucose ≥ 7 moll/L. Participants in community-based screening were
twice as likely to screen positive for hypertension compared to home-based screening (OR=1.93, P=0.06). In
contrast, participants were 3.5 times more likely to screen positive for a random blood glucose ≥7 mmol/L with
home-based screening (OR=3.51, P<0.01). Rates for following-up at the clinic after a positive screen were low for
both groups with 31% of patients with an elevated SBP returning for confirmation in both the community-based
and home-based group (P=1.0). Follow-up after a random glucose was also low with 23% returning in the home-based
group and 22% in the community-based group (P=1.0).
Conclusion: Community- or home-based screening for diabetes and hypertension in L Mics is feasible. Due to low
rates of follow-up, screening efforts in rural settings should focus on linking cases to care.
Keywords: Diabetes, Hypertension, Kenya, Cardiovascular disease, Home-based screening, Community-based screening