Awareness, treatment, and control among adults living with arterial hypertension or diabetes mellitus in two rural districts in Lesotho

Abstract In Lesotho, the hypertension and diabetes care cascades are unknown. We measured awareness, treatment, and control of hypertension and diabetes and identified factors associated with each step of the cascade, based on data from a population-based, cross-sectional survey among adults ≥ 18 years in 120 randomly sampled clusters in the districts of Butha-Buthe and Mokhotlong from 1st November 2021 to 31st August 2022. We used multivariable logistic regression to assess associations. Among participants with hypertension, 69.7% (95%CI, 67.2–72.2%, 909/1305) were aware of their condition, 67.3% (95%CI 64.8–69.9%, 878/1305) took treatment, and 49.0% (95%CI 46.3–51.7%, 640/1305) were controlled. Among participants with diabetes, 48.4% (95%CI 42.0–55.0%, 111/229) were aware of their condition, 55.8% (95%CI 49.5–62.3%, 128/229) took treatment, and 41.5% (95%CI 35.1–47.9%, 95/229) were controlled. For hypertension, women had higher odds of being on treatment (adjusted odds ratio (aOR) 2.54, 95% CI 1.78–3.61) and controlled (aOR 2.44, 95%CI 1.76–3.37) than men. Participants from urban areas had lower odds of being on treatment (aOR 0.63, 95% CI 0.44–0.90) or being controlled (aOR 0.63, 95% CI 0.46–0.85). Considerable gaps along the hypertension and diabetes care cascades in Lesotho indicate that access and quality of care for these conditions are insufficient to ensure adequate health outcomes.