Malawi Hypertension Intervention Control Study: Application of a Hierarchical Causal Model

Hypertension remains a significant public health challenge, especially in low-resource settings, disproportionately affecting vulnerable communities with limited access to healthcare services. This study evaluates the effectiveness of the CARROT-BUS hierarchical causal model in improving hypertension management in rural Malawi, focusing on the baseline conducted between December 9th and 14th, 2024. Using a controlled longitudinal study design, the research compares treatment and control groups to assess the impact of structured interventions on blood pressure control, health literacy, and community engagement. Quantitative methods, including logistic regression, were employed to analyze the intervention's effectiveness, while qualitative insights from focus group discussions provided a deeper understanding of community perspectives. Statistical analyses confirmed that factors such as age, sex, and systolic blood pressure levels were strong predictors of hypertension risk. However, systemic challenges—such as inadequate medical resources, inconsistent medication supply, and cultural beliefs regarding treatment-seeking for hypertension—hindered optimal disease management. The study underscores the importance of integrating hypertension screening into primary healthcare services, promoting health education tailored to local beliefs, and ensuring the sustainability of interventions through policy-driven approaches. The CARROT-BUS model demonstrated potential as a scalable framework that enhances transparency, accountability, and community ownership in healthcare initiatives. Addressing health inequities through community-centered approaches will be vital in reducing the hypertension burden in Malawi and similar settings.