Patients’ and Health Care Workers’ Perspectives on Barriers to Hypertension Care in a Pastoralist Setting
Abstract
Hypertension affects about one in four Kenyan adults, yet only 15.5% of those affected are aware of their status. No measured prevalence estimate exists for Mandera County, where pastoral mobility, 77% absolute poverty and sparse health services are likely to compound underdetection, while evidence from transitioning pastoralist populations shows that their historically low cardiovascular risk is rising. This study compared patients' and health care workers' (HCWs) perceptions of socioeconomic, cultural, health-system and geographic barriers to hypertension care in Mandera West Sub-County, Kenya. A comparative cross-sectional survey was conducted from June to August 2026 among 100 patients aged 35–68 years with a clinician-confirmed diagnosis of hypertension, randomly sampled from facility hypertension registers and interviewed at hypertension clinics, and 100 HCWs selected by stratified total enumeration. Structured questionnaire data were analysed in SPSS version 27 using descriptive statistics and Pearson’s chi-square tests (α = .05). Most patients were aged 45–64 years (68%), female (61%), pastoralists (44%) and had Madrassa-only education (45%). Lack of health insurance (90%), treatment costs (78%), poor roads (74%) and distance (58%) were the leading barriers reported by patients, whereas cultural beliefs (8%), herbal medicine (8%) and stigma (18%) were minor. Patients and HCWs agreed on geographic, cultural, staffing and screening barriers (p > .05) but diverged significantly on cost of care (78% vs. 56%; χ² = 10.95, p < .001) and medication availability (37% vs. 20% reporting that drugs were rarely available; χ² = 7.12, p = .028). Barriers to hypertension care in Mandera West are predominantly structural rather than cultural, and providers underestimate the financial and supply burden borne by patients. The county should fund Social Health Authority (SHA) premiums for indigent patients, adopt multi-month dispensing backed by buffer stocks of essential antihypertensives, and equip community health promoters to screen and refill medication along migration routes.