KNOWLEDGE OF HYPERTENSION AMONG ADULTS IN OWERRI SENATORIAL ZONE OF IMO STATE, NIGERIA

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ABSTRACT


The study was conducted to ascertain the knowledge of hypertension among adults in Owerri senatorial zone of Imo state, Nigeria. Eight specific objectives were formulated with eight corresponding research questions and four null-hypotheses were also postulated to guide the study. The descriptive survey research design was used for the study. The population for the study was three hundred and fifty five thousand, four hundred and fifty three adults while the sample for the study consisted of four hundred and thirty two adults. A five sectioned researcher designed questionnaire was the instrument for data collection. The instrument was validated by five experts from the Department of Health and Physical Education, University of Nigeria. Split half method using Cronbach Alpha statistic was utilized to establish the internal consistency of the instrument and had a reliability index of .76. Percentages using a slightly modified version of Okafor ’s (1997) of Ashur’s (1977) criteria for describing level of knowledge were utilized for answering research questions. Analysis of Variance (ANOVA) and Student t-Test statistic were used to analyze the data obtained and testing of the hypotheses. The results of the study showed that: adults’ had high level of knowledge regarding the concept of hypertension; there was moderate level of knowledge regarding the signs and symptoms of hypertension among adults; adults’ exhibited high level of knowledge regarding risk factors of hypertension and there was high level of knowledge regarding preventive measures of hypertension. Adults aged 35- 45 and 45 -55 years had high level of knowledge of the various dimensions of hypertension except that of signs and symptoms in which the level of knowledge was moderate level of knowledge according to age. Female adults’ level of knowledge was high for KCH, KRFH and KPMH while that of males were moderate for the same dimensions. Both male and female adults’ level of knowledge for KSSH was moderate. The level of knowledge for various dimensions of hypertension KCH, KRFH and KPMH was high for urban adults and moderate for KSSH while it was high for rural adults in KCH, KRFH and moderate in KPMH. Adults with no formal education had moderate level of knowledge in the various dimensions of hypertension except that of signs and symptoms in which the level of knowledge was low while adults with primary education possessed moderate level of knowledge for KCH and KRFH, and low level of knowledge for KSSH and KPMH. Furthermore, adults with secondary education possessed moderate level of knowledge while adults with tertiary education possessed high level of knowledge in the various dimensions of hypertension. There was significant difference in the level of knowledge of hypertension among adults’ according to age. However, there was significant difference in the level of knowledge of various dimensions of hypertension between male and female adults. There was significant difference on the level of knowledge of various dimensions of hypertension between urban and rural adults. There was significant difference in the level of knowledge of hypertension among adults according to level of education. Based on the findings, recommendations were made. Government and voluntary health agencies should sponsor intensive enlightenment campaign through print and electronic media in order to sustain the knowledge level of adults on hypertension and its complications.

TABLE OF CONTENTS

Title page
Table of contents
List of Tables
List of Figures
List of Acronyms
Abstract

CHAPTER ONE: Introduction
Background to the study
Statement of the problem
Purpose of the study
Research questions
Hypotheses
Significance of the study
Scope of the study

CHAPTER TWO: Review of related literature
Conceptual Framework
•           Knowledge of Hypertension
•           Adults
•  Measurement of knowledge of hypertension
•  Socio- demographic factors associated with knowledge of hypertension
Theoretical framework
•           Critical knowledge theory
•           Health belief model
•           Theory of reasoned action
Empirical studies on knowledge of hypertension
Summary of literature reviewed

CHAPTER THREE: Methods
Research design
Area of the Study
Population for the Study
Sample and Sampling Techniques
Instrument for data collection
•           Validity of the instrument
•           Reliability of the instrument
Method of data collection
Method of data analysis

CHAPTER FOUR: Results and Discussion
Results
Summary of Major findings
Discussion of findings
•           Knowledge of Hypertension
•  Differences in the knowledge of Hypertension among adults

CHAPTER FIVE: Summary, Conclusions and Recommendations
Summary
Conclusions
Recommendations
Limitations of the Study
Suggestions for Further Studies
References
Appendices

CHAPTER ONE

Introduction

Background to the Study

Hypertension remains a major global public health challenge that has been identified as the leading risk factor for cardiovascular morbidity and mortality (Kearney, Whelton, Reynolds, Muntner, Whelton & He, 2004). It increases hardening of the arteries, thus predisposing individuals to heart diseases, peripheral vascular diseases, stroke, heart failure and kidney failure. Hypertension is the commonest non-communicable disease in the world and all races are affected with variable prevalence. Castelli (2004) explained that its prevalence is on the increase in developing countries where adoption of western lifestyle and stress of urbanization, both of which are expected to increase morbidity associated with unhealthy lifestyle are not on the decline. Andreoli, Carpenter, Grigs and Loscalzo (2004) were of the opinion that hypertension produces disruptions in health, disability and death in the adult population worldwide. Ejike, Ezeanyika and Ugwu (2010) stated that hypertension causes one in every eight deaths worldwide, making it the third leading killer disease in the world. They also estimated that about one billion adults, the world over, had hypertension in the year 2010 and the number is expected to rise to 1.56 billion in the year 2025 if positive intervention programme is not made. Aram, George, Henry, Williams, Lee, and Joseph (2003) indicated that fifty million Americans have high blood pressure, approximately one in three adults.

In United States of America, approximately twenty eight (28) to thirty one per cent of adults have hypertension (Fields, Burt & Cutler (2004). Of this population, 90 to 95 per cent have primary hypertension (high blood pressure related to unidentified cause). The remaining five to ten


per cent of this group have secondary hypertension (high blood pressure related to identified cause). In China, almost 130 million people aged 35-74 years are estimated to be hypertensive (Camel & Delene, 2006). Similarly in Ghana, studies revealed a hypertension prevalence of forty per cent among rural dwellers and eight per cent to thirteen per cent in the urban areas. In sub-Saharan Africa, it is the most rapidly rising cardiovascular disease and affecting over 20 million people (Kadiri, 2005). He also stated that in Nigeria, hypertension is the commonest non-communicable disease with over 4.3 million Nigerians above the age of fifteen years classified as being hypertensive.

Hypertension, also known as high blood pressure is the persistent blood pressure in the arteries above ninety millimeters of mercury (mmHg) between the heart beats (diastolic) or over 140 millimeters of mercury (mmHg) at the beats (systolic) (Aquilla, 2008). According to Hyman and Parlik (2003), hypertension is the persistent raised levels of blood pressure in which the systolic pressure is above 140 mmHg and diastolic pressure above 90 mmHg. The normal blood pressure is below 120/80 mmHg; blood pressure between 120/80 and 139/89 is called ‘Pre-hypertension, and a pressure of 140/90 or above is considered high (abnormal) blood pressure. According to Expert Committee on Non-Communicable Diseases (1993), blood pressure of 120/80 mmHg is considered normal for a 30 year old person, while blood pressure of 140 mmHg is considered high for such a person. Similarly, blood pressure of 150/90 mmHg is considered normal for a 60-year old person, while blood pressure of 160/100 mmHg is high for such a person. Hypertension is sometimes called “the silent killer” because people who have it are often symptom-free. In this study, hypertension is perceived as a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg among adults. The top number which is the systolic pressure corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number which is the diastolic pressure represents the pressure in the arteries as the heart relaxes after contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed. Blood pressure is normally measured at the brachial artery with a sphygmomanometer (pressure cuff) in millimeters of mercury (mmhg) and given as systolic over diastolic pressure. Hypertension is classified into two namely; primary and secondary hypertension.

According to Stanler (2004), hypertension is categorized into primary and secondary hypertension. Primary hypertension has an unknown cause and accounts for ninety per cent to ninety five per cent of all hypertension cases (Chris, 2009). This type of hypertension is strongly associated with lifestyle. Usually, the patients do not have many signs and symptoms but may experience frequent headache, tiredness, dizziness or nose bleeds. Although the cause is not known, obesity, smoking, alcohol, diet and heredity play a role in essential or primary hypertension.

Secondary hypertension has a known cause and accounts for five per cent to ten per cent of all hypertension cases. Chris (2009) maintained that the most common cause of secondary hypertension is an abnormality in the arteries supplying blood to the kidneys. Other causes include airway obstruction during sleep, stress, diseases and tumors of the adrenal glands, lifestyle, spinal cord injury, hormone abnormalities (oral contraceptive estrogen replacement), thyroid disease, toxemia of pregnancy, renal problems such as vascular lesion of renal arteries, diabetic neuropathy, pains as well as anxiety and hypoglycemia. There are some factors which predispose adults to hypertension.
The risk factors of hypertension are genetic factor which can be inherited from parents, age which when the body does not retain the amount of elasticity as it used to in the early years of life, obesity which is an increase in weight of over ten per cent above normal body index due to generalized deposition of fat in the body, excessive salt intake which increases blood pressure, stress which produces chemical substances that cause generalized vasoconstriction, oral contraceptive which contains estrogen that causes salt retention that increases the volume of blood, sedentary lifestyle which has the tendency of increasing body weight and directly raises blood pressure, elevated levels of plasma lipids particularly cholesterol, excessive alcohol consumption which increases blood pressure and tobacco use (cigarette smoking) that contains nicotine which causes constriction of the blood vessels.

The signs and symptoms of hypertension recognized by Thatch and Schultz (2004) include occipital headache, dizziness, restlessness, failing vision, shortness of breath, and rapid increased heartbeat. Adults should possess the knowledge of risk factors in order to prevent hypertension. This will help them recognize and prevent or treat hypertension when these signs occur.

Knowledge is used to cover such related terms as facts, information, understanding, awareness, insight, wisdom, reasons, comprehension, meaning, concept and experience (Albelum, 1987). It is an organized body of knowledge shared by people. Nnachi (2007) conceptualized knowledge as the ability to understand or comprehend phenomena, the acquisition of positive information by the exercise of some capacity which humans presumably have in common. Health knowledge could be said to mean putting into reality the art of mobilization of resources by an individual, intellectually, physically and emotionally. Hamburg and Russell (2000) opined that health knowledge and understanding of related factors have a favourable effect on quality of overall well-being. They went further to state that one’s exposure to proper health knowledge will influence positively the person’s health attitude and practice, and thus, one could rightly say that knowledge is the key to optimum well-being. Umaru (2003) pointed out that knowledge comes about as a result of learning through cognitive, affective and psychomotor domains. In this study, knowledge is referred to as all understanding and familiarity gained by learning and experience that will enable adults to recognize risk factors as well as recognizing and use of preventive measures of hypertension. Knowledge of hypertension is an important prerequisite for an individual to implement desirable behavioural practices towards its prevention. Lack of such.....

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