Hypertension and diabetes prevalence, associated factors, care cascade, and quality of life in older adults: A cross-sectional population-based study in The Gambia, South Africa, and Zimbabwe

by Anthony Muchai Manyara, Suad Abdullah, Ayaan Balshaf, Tadios Manyanga, Momodou Jallow, Etheldreda I. Yoliswa Madela, Hannah Wilson, Anya Burton, Farhanah Paruk, Chris Grundy, Camille Pearse, Tafadzwa Madanhire, Lucy Gates, Bilkish Cassim, Rashida A. Ferrand, Kate A. Ward, Celia L. Gregson

Background Hypertension and diabetes prevalence are increasing across Africa. We investigated the prevalence, associated factors, achievement of stages within the care cascade (diagnosis, treatment, control), and health-related quality of life (HRQoL) in three countries in Africa.

Methods and findings This cross-sectional study recruited adults aged ≥40 years in five settings: rural (n = 1,052) and urban (n = 1,218) The Gambia, rural (n = 948) and urban (n = 968) South Africa (SA), and urban (n = 1,110) Zimbabwe between 2022 and 2024. Data were collected using researcher-administered questionnaires and assessments. Hypertension and diabetes were defined using self-reported diagnosis, medication use, and blood pressure and glucose measurements. HRQoL was assessed using EuroQol-5 Dimension 5 Level questionnaire, with a minimally important difference (MID) defined as half a standard deviation (SD). Diabetes complications included neuropathy, cardiovascular disease, and kidney disease. Associations between hypertension and diabetes and risk factors were assessed using study site, age, sex, educational attainment, and wealth index-adjusted Generalised Linear Mixed Effects Models. Associations between care cascade stages and HRQoL were assessed using linear models.Analysis included 5,296 adults, 53% female, and 52% age ≥60 years. Overall hypertension prevalence was 55.6% (95% confidence intervals [CI] 54.2%, 56.9%); ranging from 39.6% (95% CI: 36.7, 42.7) in rural The Gambia to 66.9% (64.1, 69.7) in urban Zimbabwe. Overall, diabetes prevalence was 14.0% (13.1%, 15.0%), ranging from 9.2% (7.6, 11.0) in urban Zimbabwe to 19.4% (16.9, 22.1) in rural SA. Both overweight and obesity, compared to normal weight, were associated with higher odds of hypertension (adjusted odds ratios: 1.73 (95% CI [1.47, 2.03]; p p p p p p = 0.028) in The Gambia and −0.08 (95% CI [−0.03, −0.12]; p p The high prevalence of hypertension and diabetes in mid-age and older adults in rural and urban Africa necessitates urgent diagnostic, preventive, and control interventions. This can include interventions targeted at obesity, screening of all adults aged ≥40 years, prompt and optimal treatment for those diagnosed, and ongoing monitoring to limit complications.