Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers' Knowledge and Treatment of Hypertension.

BACKGROUND: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public. OBJECTIVE: The impact of Healthy Heart Africa on HCPs' knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study. METHODS: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, and improved medical supply chain, whereas control facilities did not. HCPs responsible for hypertension care were surveyed at baseline and 12 months later. Hypertension screening and treatment data were abstracted from service delivery registers. A differences-in-differences analysis estimated the impact of Healthy Heart Africa on HCPs' knowledge, hypertension services, and the number of patients diagnosed with and seeking treatment for hypertension. RESULTS: Sixty-six intervention and 66 control facilities were surveyed. Healthy Heart Africa improved HCPs' knowledge of ≥5 hypertension risk factors and ≥5 methods for reducing/managing hypertension but not hypertension consequences. At end line, more intervention than control facilities measured blood pressure more than once during the same visit to diagnose hypertension, dedicated days to hypertension care, used posters to increase hypertension awareness, and provided access to hypertension medications. The number of patients diagnosed with hypertension and those seeking treatment for hypertension increased with intervention, but the change was not significant relative to control subjects. CONCLUSIONS: HCP-directed hypertension education and provision of basic resources positively influenced hypertension care in Kenya in the first 12 months of implementation.

Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review.

BACKGROUND: The consumption of sugar-sweetened beverages (SSBs), which can lead to weight gain, is rising in middle-income countries (MICs). Taxing SSBs may help address this challenge. Systematic reviews focused on high-income countries indicate that taxing SSBs may reduce SSB consumption. Responsiveness to price changes may differ in MICs, where governments are considering the tax. To help inform their policy decisions, this review compiles evidence from MICs, assessing post-tax price increases (objective 1), changes in demand for SSBs and other products, overall and by socio-economic groups (objective 2), and effects on overweight and obesity prevalence (objective 3). METHODS AND FINDINGS: We conducted a systematic review on the effectiveness of SSB taxation in MICs (1990-2016) and identified nine studies from Brazil, Ecuador, India, Mexico, Peru, and South Africa. Estimates for own-price elasticity ranged from -0.6 to -1.2, and decreases in SSB consumption ranged from 5 to 39 kilojoules per person per day given a 10% increase in SSB prices. The review found that milk is a likely substitute, and foods prepared away from home, snacks, and candy are likely complements to SSBs. A quasi-experimental study and two modeling studies also found a negative relationship between SSB prices and obesity outcomes after accounting for substitution effects. Estimates are consistent despite variation in baseline obesity prevalence and per person per day consumption of SSBs across countries studied. CONCLUSIONS: The review indicates that taxing SSBs will increase the prices of SSBs, especially sugary soda, in markets with few producers. Taxing SSBs will also reduce net energy intake by enough to prevent further growth in obesity prevalence, but not to reduce population weight permanently. Additional research using better survey data and stronger study designs is needed to ascertain the long-term effectiveness of an SSB tax on obesity prevalence in MICs.