Religious leaders, physicians fight hypertension in Tanzania and beyond

This is Part 2 of a five-part multimedia feature, Dispatches from Mwanza, about Weill Cornell Medicine's collaboration with Weill Bugando School of Medicine to improve health care in Tanzania, the U.S. and around the world.

When he looks out onto his congregation, Sheikh Hassani Yassini Mchondo sees a silent killer.

Fathers in their 30s and 40s collapse, suddenly disabled. Some even die. Destitute widows can't pay for their children's school uniforms and fees. Kids drop out of school and beg in the streets - all because of untreated hypertension.

"It hurts the heart to watch people suffer, and my primary job as a leader is to protect my people," said Mchondo, an imam who serves about 1,500 people in Tanzania's Mwanza region. "That's why we weren't hesitant to cooperate to spread awareness about high blood pressure."

Mchondo is one of 1,140 religious leaders in Tanzania collaborating on a large-scale studyby researchers at Weill Cornell Medicine's Center for Global Healthand Tanzanian colleagues. The project asks an innovative question: Can religious leaders use their influence to help lower life-threatening hypertension in their communities?

The stakes are high. Hypertension can result in heart disease, heart and kidney failure, stroke, dementia, blindness and more. It is the world's leading risk factor for premature death.

If successful, the strategy could prevent many thousands of deaths not only in Tanzania but throughout Africa, which has the highest age-adjusted rate of hypertension in the world. And it could benefit U.S. communities where hypertension outcomes are poor.

"Raising awareness about high blood pressure and letting people know about blood pressure, I think it's really critical and can help save a lot of people," said Dr. Bazil Baltazar Kavishe, who recently completed his Ph.D. at Weill Bugando School of Medicine, Weill Cornell Medicine's collaborator in Tanzania. Kavishe, who oversees the study's rollout, is now a senior researcher at Tanzania's National Institute for Medical Research.

The problem is, hypertension has few symptoms. Most people don't even know they have it. Although 28% of Tanzanians age 38 and older have hypertension, in rural areas only 2% were aware and 1% were being treated, according to the team's 2015 study. "People may not take it seriously, because they are not feeling that they are sick," Kavishe said. "It's really a challenge to get this knowledge to people."

To spread the word, the researchers are leveraging the clergy's significant influence.

"They're much more trusted than political leaders. They're much more trusted than even health care workers," said Dr. Robert Peck, co-principal investigator of the study and associate professor of medicine and of pediatrics at Weill Cornell Medicine.

The team has collaborated with a core group of clergy, including Mchondo, to educate other religious leaders in 10 communities in northwestern Tanzania. In turn, those leaders are educating and screening their own communities for hypertension and making referrals to local health facilities. In all, the intervention could reach up to 400,000 people.

"Working with religious leaders to bring those messages to communities and to talk about [how] you can have faith and still seek care for your health, and to show that those messages are consistent with scripture, both in Christianity and in Islam, has been an exciting approach to improving community health," said Dr. Jennifer Downs, co-principal investigator and the Ehrenkranz Family/Orli R. Etingin, M.D. Associate Professor in Women's Health at Weill Cornell Medicine.

Three years into the five-year study, it's too soon to say whether the strategy will achieve the study's goal of lowering the overall average blood pressure in these communities. Doing so could decrease hypertension deaths there by 13%.

But the early results are intriguing, Downs said.

"It's actually an exciting time in the trial," she said. "We're in the thick of it."