Evidence mapPaperPMID 41736697Full record

ArticlePrimary health care research & development2026

Assessing the burden and inequality in the unmet need for hypertension and type 2 diabetes care using a care cascade framework in Tanzania, Lesotho, and South Africa.

Denis Okova, Akim Tafadzwa Lukwa, Robinson Oyando, Folahanmi Tomiwa Akinsolu, Abodunrin Olunike, Plaxcedes Chiwire, Charles Hongoro

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Article in Primary health care research & development, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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5 · Who and what money

Authors and funding

7 authors.

Denis OkovaHealth Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Townhttps://ror.org/03p74gp79, Cape Town, South Africa.ORCID 0009-0006-1482-0730
Akim Tafadzwa LukwaHealth Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Townhttps://ror.org/03p74gp79, Cape Town, South Africa.ORCID 0000-0003-2534-3731
Robinson OyandoHealth Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.ORCID 0000-0001-8768-6014
Folahanmi Tomiwa AkinsoluCenter for Reproduction and Population Health Studies (CeRPHS), Nigerian Institute of Medical Research, Lagos, Nigeria.ORCID 0000-0002-6782-9820
Abodunrin OlunikeCenter for Reproduction and Population Health Studies (CeRPHS), Nigerian Institute of Medical Research, Lagos, Nigeria.ORCID 0009-0000-5258-1220
Plaxcedes ChiwireDepartment of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.ORCID 0000-0002-3825-2321
Charles HongoroSchool of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng Province, South Africa.ORCID 0000-0002-9715-4940

Funding

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6 · The paper itself

Abstract

backgroundThe rapidly growing burden of non-communicable diseases (NCDs) in sub-Saharan Africa necessitates a better understanding of access gaps along the care continuum. This study assessed the prevalence and inequality in unmet need for hypertension and diabetes care in Tanzania, South Africa, and Lesotho using a care cascade framework.

methodsWe conducted a cross-sectional analysis of nationally representative Demographic Health Survey (DHS) datasets from Tanzania (2022), South Africa (2016), and Lesotho (2023/24), focusing on adults aged 15 years and older. The study estimated the proportion of adults with hypertension or diabetes who had not been screened, diagnosed, treated, or achieved disease control. Inequality was assessed using Erreygers Normalized Concentration Indices (ENCI), stratified by sex and residence.

resultsHypertension prevalence was 12.6% (95% CI: 11.7-13.4) in Tanzania, 46.7% (95% CI: 45.0-48.4) in South Africa, and 15.4% (95% CI: 13.8-17.2) in Lesotho. In Lesotho, 9.1% (95% CI: 7.8-10.6) of adults had diabetes. Unmet need was substantial across all countries: 96.5% for hypertension in Tanzania, 84.2% in South Africa, 65.8% in Lesotho, and 84.2% for diabetes in Lesotho. The care cascade framework revealed critical bottle-necks at screening and treatment stages. Inequality analyses revealed strong pro-poor gradients, particularly in screening (ENCIs: Tanzania -0.19, South Africa -0.17, Lesotho hypertension -0.15, Lesotho diabetes -0.24; all

conclusionSubstantial and inequitable gaps exist in hypertension and diabetes care. Policy strategies should prioritize community-based screening, primary care integration, and equity-focused interventions targeting poor men to improve NCD outcomes in the region.

Indexed as

Diabetes Mellitus, Type 2Healthcare DisparitiesHealth Services Needs and DemandHypertensionAdolescentAdultAgedCross-Sectional StudiesFemaleHumansLesothoMaleMiddle AgedPrevalenceSocioeconomic Disparities in HealthSouth AfricaCare cascadediabetesgender disparitieshealth inequalitieshypertensionnon-communicable diseasessocioeconomic statussub-Saharan Africaunmet need

Identifiers

PMID41736697
PMCPMC12951333

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.