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Evidence insufficient to confirm the value of population screening for diabetes and hypertension in low- and-middle-income settings

Solange Durao, Oluwayemisi Ajumobi, Tamara Kredo, Celeste Naude, Naomi S Levitt, Krisela Steyn, Debbie Bradshaw, Taryn Young

Abstract


To assess the evidence from systematic reviews on the effect on morbidity and mortality of blanket screening for hypertension or diabetes mellitus compared with targeted, opportunistic or no screening, we searched for relevant systematic reviews and conducted duplicate study selection, data extraction and quality appraisal. Results were summarised narratively. We included two completed reviews of moderate quality and one ongoing Cochrane review. In one completed review, general health checks had no effect on total morbidity or mortality or on healthcare services compared with no health checks. In the other, intensive hypertension screening methods were ineffective in increasing screening uptake or detecting new cases compared with less intensive methods. Both reviews included studies in high-income settings. There is insufficient evidence from currently available systematic reviews to confirm a beneficial effect of blanket screening for hypertension and/or diabetes compared with other types of screening methods in low- and middle-income settings. Scarce resources are being mobilised to implement mass screening intervention for diabetes and hypertension without adequate evidence of its effects. A systematic review is needed to assess clinical effectiveness, cost-effectiveness and overall impact on the health system of screening strategies, especially in low- and middle-income settings such as exist in South Africa. Robust evaluation of these outcomes would then be necessary to inform secondary prevention strategies.

Authors' affiliations

Solange Durao, South African Cochrane Centre, South African Medical Research Council, Cape Town South Africa

Oluwayemisi Ajumobi, World Bank, Health, Nutrition and Population Global Practice

Tamara Kredo, South African Cochrane Centre, South African Medical Research Council, South Africa

Celeste Naude, Centre for Evidence-based Health Care, Stellenbosch University, Tygerberg, Cape Town, South Africa

Naomi S Levitt, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa

Krisela Steyn, Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa

Debbie Bradshaw, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

Taryn Young, Centre for Evidence-based Health Care, Stellenbosch University, Tygerberg, Cape Town, South Africa; South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa

Full Text

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Keywords

Hypertension; Diabetes; Screening; Systematic review

Cite this article

South African Medical Journal 2015;105(2):98-102. DOI:10.7196/SAMJ.8819

Article History

Date submitted: 2014-08-15
Date published: 2015-01-08

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