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01.12.2014 | Review | Ausgabe 1/2014 Open Access

Globalization and Health 1/2014

Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa

Globalization and Health > Ausgabe 1/2014
Juliet Iwelunmor, Collins O Airhihenbuwa, Richard Cooper, Bamidele Tayo, Jacob Plange-Rhule, Richard Adanu, Gbenga Ogedegbe
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1744-8603-10-42) contains supplementary material, which is available to authorized users.

Competing interests

The author declares that they have no competing interests.

Authors’ contributions

JI had the original idea for this paper which was refined by CA and GB. CA and GB were involved throughout in supervising the writing of the paper and in discussing the findings. RC, BT, JPR, and RA provided comments on various drafts and contributed to writing the final manuscript. All authors have read and approved the final manuscript.



In West Africa, hypertension, once rare, has now emerged as a critical health concern and the trajectory is upward and factors are complex. The true magnitude of hypertension in some West African countries, including in-depth knowledge of underlying risk factors is not completely understood. There is also a paucity of research on adequate systems-level approaches designed to mitigate the growing burden of hypertension in the region.


In this review, we thematically synthesize available literature pertaining to the prevalence of hypertension in West Africa and discuss factors that influence its diagnosis, treatment and control. We aimed to address the social and structural determinants influencing hypertension in the sub-region including the effects of urbanization, health infrastructure and healthcare workforce.


The prevalence of hypertension in West Africa has increased over the past decade and is rising rapidly with an urban-rural gradient that places higher hypertension prevalence on urban settings compared to rural settings. Overall levels of awareness of one’s hypertension status remain consistently low in West African. Structural and economic determinants related to conditions of poverty such as insufficient finances have a direct impact on adherence to prescribed antihypertensive medications. Urbanization contributes to the increasing incidence of hypertension in the sub-region and available evidence indicates that inadequate health infrastructure may act as a barrier to optimal hypertension control in West Africa.


Given that optimal hypertension control in West Africa depends on multiple factors that go beyond simply modifying the behaviors of the individuals alone, we conclude by discussing the potential role systems-thinking approaches can play to achieve optimal control in the sub-region. In the context of recent advances in hypertension management including new therapeutic options and innovative solutions to expand health workforce so as to meet the high demand for healthcare, the success of these strategies will rely on a new understanding of the complexity of human behaviors and interactions most aptly framed from a systems-thinking perspective.
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