Exploring care pathways for hypertensive patients at government subdistrict health facility in Bangladesh: a qualitative study

Abstract

Introduction: Hypertension prevalence is 26.4% in Bangladesh (Naheed et al., 2018), which is a significant contributor to high morbidity and mortality. The rising prevalence and current state of NCD intervention at the primary healthcare (PHC) level are often insufficient to manage the condition. Therefore, understanding the care pathways that patients navigate throughout their lives is crucial for managing this disease. Methods: This facility-based qualitative exploratory study was conducted at the Upazila Health Complex in Keraniganj, Dhaka, Bangladesh Applying convenient sampling a total 24 in-depth interviews were conducted with respondents visiting the NCD corner of the UHC during from November 22, 2024 to December 11, 2024. Descriptive statistics about the respondents were evaluated using STATA V17. Thematic analysis of the interviews was done. Findings: Majority of the respondents were aged 40-69 years, female, married and lived in periurban areas. A significant portion had no formal education (37.5%), and most were unemployed (75%). Respondents navigating a complex pathway. Among all respondents, we have identified four points of hypertensive care pathways. As their first contact for care services, 50.0% of the respondents had consultations with drug sellers. The remaining, 22.7% at private practitioner’s care, 4.5% at tertiary care, and 27.3% at UHC for their first point of care. Only 5 of them, continue their services at UHC. Then, simultaneously, the second point 9 of them reached UHC, the third point 8 of them, and at final point 2 of them reached UHC after all the transition. The main care providers identified are UHC, drug sellers, private practitioners, tertiary, and traditional healers. Most respondents delayed seeking care due to attributing symptoms to other diseases, managing the symptoms through self-management. Factors such as accessibility, and affordability played a main role for decision-making to choose each service. UHCs were preferred for their affordability, accessibility and ability to manage comorbidities. Although respondents rated UHC services as good, still they mentioned challenges regarding the unavailability of essential medicine. They viewed this condition as a burden as it caused health issues as well as a financial burden. Conclusion: The majority of the respondents with hypertension in Bangladesh access various categories of providers before reaching UHC care, and use a diverse range of pathways and loops, which results in a delay or missing appropriate care. We hope that our findings are useful for planning interventions to improve access to hypertension care in general, in Bangladesh.