Health in Africa
Sustained effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria
available nor affordable. We assessed the effect of a voluntary health insurance program, including quality improvement
of healthcare facilities, on blood pressure (BP) in hypertensive adults in rural Nigeria.
Methods: We compared changes in outcomes from baseline (2009) to midline (2011) and endline (2013) between
non-pregnant hypertensive adults in the insurance program area (PA) and a control area (CA), through
household surveys. The primary outcome was the difference between the PA and CA in change in BP, using
Results: Of 1500 eligible households, 1450 (96.7%) participated, including 559 (20.8%) hypertensive individuals,
ofwhich 332 (59.4%) had follow-up data. Insurance coverage increased from 0% at baseline to 41.8% at endline in
the PA and remained under 1% in the CA. The PA showed a 4.97mmHg (95% CI:−0.76 to+10.71mmHg) greater
decrease in systolic BP and a 1.81mmHg (−1.06 to+4.68mmHg) greater decrease in diastolic BP frombaseline
to endline compared to the CA. Respondents with stage 2 hypertension showed an 11.43 mm Hg (95% CI:
1.62 to 21.23mmHg) greater reduction in systolic BP and 3.15mmHg (−1.22 to+7.53mmHg) greater reduction
in diastolic BP in the PA compared to the CA. Attrition did not affect the results.
Conclusion:Access to improved quality healthcare through an insurance program in rural Nigeriawas associated
with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertension.
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