Zambia Hypertension Treatment Guidelines “Global to Local” in association with Cadila & ZAHESFO

Dr. Goma shares his story of how he dealt with the challenges while launching the Zambia Hypertension Treatment Guidelines.

Cadila Pharmaceuticals in association with Zambia Heart and Stroke Foundation (ZAHESFO) launched a Hypertension Treatment Guideline on 24th July 2019. The whole process was headed by Dr Fastone Goma, the president of ZAHESFO. He talks about the trigger that encouraged him and his team to take up this initiative and the challenges they faced.

“I was having lunch with one of my colleagues who had just come back to work after a week-long stay at his hometown. His hometown is a small village in Zambia. When I asked about his stay, he revealed that his mother suffers from hypertension and yet could not find proper treatment in the village. A small clinic is active in the village but the professionals there have very limited knowledge about the condition. This ignited a spark in my mind and I started researching.

The Zambian STEPS Survey 2017 reports a national prevalence of HTN of 19.1% (20.5% in men and 17.6% in women), which rises with age to 50.5% (38.6% in males and 59.4% in females) in the 60-69 age group. Our country has also reported a rise in complications of hypertension such as heart failure, strokes, kidney failure and heart attacks (MOH, 2014). Hypertension has been said to cause around 50% of strokes, 42% of heart attack and nearly 10% of deaths.

On researching more, we found out that two thirds (62.2%) of the men and one third (34.9%) of the women in the STEPS Survey had never been screened for hypertension, while 80.0% (91.0% men and 77.3% women) of the respondents with hypertension were not on medication, while of those on medication only 6.7% (11.4% men and 2.5% of women) of them had controlled BP.

I was completely taken aback by these findings. Especially since hypertension is something that can be easily controlled with adequate management. The WHO lists a lack of treatment guidelines at top of the list for major barriers to adequate management of HTN.

Using this data, we started working towards a treatment guideline. However, we needed professional help. We had a meeting with the Cadila team, represented by Mr. Praveen, country Manager, Zambia, which very soon converted into a movement and involved many senior doctors from Zambia and a core team was formed including Dr. Vipin Sethi from Cadila. The next step was to define a goal. We set up a 90-90-90 strategy in HTN-that 90% of adults would have their BP checked, while 90% of those found to have raised BP would be put on adequate treatment to attain 90% control of BP.

Setting this audacious goal, both the teams started working towards making a simplified guideline to help every person in our country. We started with understanding the international guidelines and various available medicine and pharmacology. Finally, after months of hard work we managed to come up with a comprehensive guideline in the form of a pocket booklet.

On 24th July 2019, ZAHESFO in association with Cadila Pharmaceuticals successfully launched Zambia’s first-ever Hypertension Treatment Guidelines in the form of CME program. This event was attended by 150+ doctors from various departments and hospitals of Lusaka. With these guidelines, we aim to provide a simplified treatment guideline for use in primary healthcare settings where the majority of patients are seen. We hope that frontline healthcare workers including clinical officers, nurses, and pharmacists can easily follow them.

The process was very difficult as we were trying to achieve something that had never been done in the country. But the success was worth it. We hope that these guidelines will bring a significant change in the community. My way of measuring will be when my colleague visits his hometown, his mother should be getting proper medication and shouldn’t have to worry about her health.”