{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:53:05Z","timestamp":1788313985676,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000135","name":"NIH Blueprint for Neuroscience Research","doi-asserted-by":"publisher","award":["#R01HL144708-06"],"award-info":[{"award-number":["#R01HL144708-06"]}],"id":[{"id":"10.13039\/100000135","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The aim of this study is to determine the capacity and readiness of Nigerian primary healthcare facilities to adopt a multi-level approach for the diagnosis, treatment, and control of hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a multi-stage sampling technique, 5 states were selected for the nationwide study, and 10 Primary Healthcare Centres (PHCs) were selected from each of the participating states. The 50 PHCs were evaluated using the World Health Organization-modified Service Availability and Readiness Assessment, focusing on the diagnosis and treatment of hypertension in Nigeria. The indicator scores for general and cardiovascular service preparedness were computed using the proportion of PHCs with accessible facilities, tools, diagnostic guidelines, and prescription drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A majority of PHCs (n\u2009=\u200943; 86%) reported having two or more full-time staff. The median number of full-time employees for the 50 PHCs was 6 (IQR\u2009=\u20092\u20139), and for the community health extension workers (CHEWs), the median was 2, the interquartile range (IQR) = 0\u20134. None of the PHCs had full-time physicians. Ninety-eight percent, 94%, and 84% of the 50 PHCs are able to provide screening services, diagnose, and confirm hypertension, respectively. In addition, 98% of the PHCs had functional blood pressure apparatus. However, only a minority of PHCs had the guidelines (24%), treatment algorithms (27%), and facilities. Most of the 50 PHCs (96%) use electronic patient records in their respective centres. Of the 50 PHCs studied, 66% had at least one 30-day antihypertensive treatment regimen in stock. The most commonly available drug classes were calcium channel blockers (72%), followed by diuretics (42%), central acting agents (38%), and angiotensin-converting enzyme inhibitors (36%). The median number of 30-day regimens in stock was 15 (IQR 0\u2013132).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This first large-scale systematic assessment of capacity and readiness for a system-level hypertension control program within five states of Nigeria demonstrated implementation feasibility based on the workforce, equipment, and health information systems, but there is a critical need for health-worker training and provision of protocols for hypertension treatment and control, as well as some need to strengthen the essential medicine supply chain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344011","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T17:22:28Z","timestamp":1773422548000},"page":"e0344011","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Capacity and site readiness for hypertension control program implementation in Nigeria: A nationwide cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1190-135X","authenticated-orcid":true,"given":"Innocent Ijezie","family":"Chukwuonye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejiroghene Martha","family":"Umuerri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Baldridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yekeen Ayodele","family":"Ayoola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud Umar","family":"Sani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okechukwu Samuel","family":"Ogah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olanike Allison","family":"Orimolade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miracle Erinma","family":"Chukwuonye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalu Ulu","family":"Kalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb Ogechi","family":"Raphael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyemike Simeon","family":"Awunor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obatavwe","family":"Ukoba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicity Chinyere","family":"Odoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry Ifeanyichukwu","family":"Okolie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustapha Abdulsalam","family":"Danimoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9067-0325","authenticated-orcid":true,"given":"Apollos","family":"Daniel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usman Muhammad","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabiu Mohammed","family":"Hamza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwatosin Zinnat","family":"Makinde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeyemi Sunday","family":"Adewole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dike Bevis","family":"Ojji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7412-2519","authenticated-orcid":true,"given":"Mark D.","family":"Huffman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Hypertension Treatment in Nigeria Program Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"pone.0344011.ref001","unstructured":"World Heart Federation. Hypertension: what we do. [Cited 2025 May 22]. https:\/\/world-heart-federation.org\/what-we-do\/hypertension\/"},{"issue":"6","key":"pone.0344011.ref002","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 international society of hypertension global hypertension practice guidelines","volume":"75","author":"T Unger","year":"2020","journal-title":"Hypertension"},{"issue":"6","key":"pone.0344011.ref003","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jash.2015.03.002","article-title":"Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension","volume":"9","author":"C Rosendorff","year":"2015","journal-title":"J Am Soc Hypertens"},{"issue":"3","key":"pone.0344011.ref004","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1161\/HYPERTENSIONAHA.118.11609","article-title":"Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis","volume":"72","author":"JA Lamprea-Montealegre","year":"2018","journal-title":"Hypertension"},{"key":"pone.0344011.ref005","doi-asserted-by":"crossref","first-page":"39480","DOI":"10.1038\/srep39480","article-title":"Height and prevalence of hypertension in a middle-aged and older Chinese population","volume":"6","author":"L Song","year":"2016","journal-title":"Sci Rep"},{"issue":"10304","key":"pone.0344011.ref006","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0140-6736(21)01330-1","article-title":"Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants","volume":"398","author":"NCD Risk Factor Collaboration (NCD-RisC)","year":"2021","journal-title":"Lancet"},{"key":"pone.0344011.ref007","unstructured":"World Health Organization. Global report on hypertension: the race against a silent killer. 2023. https:\/\/www.who.int\/publications\/i\/item\/9789240081062"},{"key":"pone.0344011.ref008","unstructured":"Coker T.Charting a healthier course: The state of Nigeria\u2019s primary care. 2023. [Cited 2026 September 28] https:\/\/www.tchealthng.com\/thought-pieces\/charting-a-healthier-course-the-state-of-nigerias-primary-care&ved=2ahUKEwiKo7rW1YOQAxVCXEEAHQdSIhkQ-tANegQIChAJ&usg=AOvVaw0SscNl40Hg9XNh58YoJ5ER"},{"issue":"1","key":"pone.0344011.ref009","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s43058-022-00328-9","article-title":"Hypertension Treatment in Nigeria (HTN) Program: rationale and design for a type 2 hybrid, effectiveness, and implementation interrupted time series trial","volume":"3","author":"AS Baldridge","year":"2022","journal-title":"Implement Sci Commun"},{"issue":"5","key":"pone.0344011.ref010","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1097\/HJH.0000000000003089","article-title":"Characteristics, treatment, and control of hypertension in public primary healthcare centers in Nigeria: baseline results from the Hypertension Treatment in Nigeria Program","volume":"40","author":"DB Ojji","year":"2022","journal-title":"J Hypertens"},{"issue":"1","key":"pone.0344011.ref011","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s41256-024-00368-9","article-title":"Improving hypertension control in Nigeria: early policy implications from the Hypertension Treatment in Nigeria program","volume":"9","author":"O Ogungbe","year":"2024","journal-title":"Glob Health Res Policy"},{"key":"pone.0344011.ref012","unstructured":"Nigeria Health Facility Registry. Hospital and clinic. [Cited 2025 May 4]. https:\/\/www.hfr.health.gov.ng\/facilities\/hospitals-search"},{"issue":"2","key":"pone.0344011.ref013","first-page":"206","article-title":"The primary health care services in Nigeria: constraints to optimal performance","volume":"14","author":"II Omoleke","year":"2005","journal-title":"Niger J Med"},{"key":"pone.0344011.ref014","unstructured":"World Health Organization. Primary health care. [Cited 2024 July 9]. https:\/\/www.who.int\/health-topics\/primary-health-care"},{"key":"pone.0344011.ref015","unstructured":"World Health Organization (WHO). Service availability and readiness assessment (SARA). [Cited16 November, 2026]. https:\/\/www.who.int\/publications\/i\/item\/WHO-HIS-HSI-2015.5"},{"issue":"1","key":"pone.0344011.ref016","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1186\/s12913-021-06320-8","article-title":"Capacity and site readiness for hypertension control program implementation in the Federal Capital Territory of Nigeria: a cross-sectional study","volume":"21","author":"IA Orji","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"pone.0344011.ref017","unstructured":"World Health Organization. Service availability and readiness assessment (SARA). 2020. https:\/\/www.who.int\/data\/data-collection-tools\/service-availability-and-readiness-assessment-(sara)"},{"issue":"1","key":"pone.0344011.ref018","doi-asserted-by":"crossref","first-page":"46","DOI":"10.2471\/BLT.07.042283","article-title":"How much is not enough? Human resources requirements for primary health care: a case study from South Africa","volume":"86","author":"E Daviaud","year":"2008","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pone.0344011.ref019","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1002\/hpm.2429","article-title":"WHO\u2019s service availability and readiness assessment of primary health care services of commune health centers in a rural district of Northern Vietnam","volume":"33","author":"N Van Huy","year":"2018","journal-title":"Int J Health Plann Manage"},{"key":"pone.0344011.ref020","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s12960-021-00670-4","article-title":"Determining staffing standards for primary care services using workload indicators of staffing needs in the Philippines","volume":"19","author":"MG Aytona","year":"2022","journal-title":"Hum Resour Health"},{"key":"pone.0344011.ref021","volume-title":"Task shifting\/ task sharing for essential health care 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Med"},{"issue":"2","key":"pone.0344011.ref030","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/cvr\/cvac130","article-title":"Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension","volume":"119","author":"AE Schutte","year":"2023","journal-title":"Cardiovasc Res"},{"issue":"12","key":"pone.0344011.ref031","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1111\/jch.14072","article-title":"Standardized treatment to improve hypertension control in primary health care: The HEARTS in the Americas Initiative","volume":"22","author":"DJ DiPette","year":"2020","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"1","key":"pone.0344011.ref032","doi-asserted-by":"crossref","DOI":"10.1111\/jch.14950","article-title":"Effectiveness and safety of using standardized treatment protocols for hypertension compared to usual care: a meta-analysis of randomized clinical trials","volume":"27","author":"G Satheesh","year":"2025","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"pone.0344011.ref033","doi-asserted-by":"crossref","first-page":"341","DOI":"10.3389\/fpubh.2019.00341","article-title":"How can digital health technologies contribute to sustainable attainment of universal health coverage in Africa? 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