ABSTRACT
Hypertension is a major public health problem that affects approximately 26% of adult population worldwide. It is a significant risk factor for cardiovascular diseases, stroke and renal failure, and causes about 7.1 million deaths per year worldwide. The prevalence of hypertension is suggested to be increasing worldwide, particularly in developing countries due to nutritional transition and westernization. Moreover, lack of awareness regarding the disease status increases incidence of complications and mortality. Although modifiable through lifestyle interventions and medical management, hypertension accounts for approximately 64% of stroke cases in Nigeria. There is little information regarding awareness of hypertension status and risk factors among patients seeking healthcare from public hospitals in Nigeria, including Civil Service Hospital. The study aimed to determine the awareness of hypertension status and risk factors among adult patients attending Civil Service Hospital, in Rivers state. The study used hospital-based cross-sectional design. A sample of 393 participants aged 18 years and above presenting at the out -patient clinic of the hospital for treatment between February and March 2015, were selected using systematic sampling with a random start. Blood pressure and anthropometric measurements were taken for all participants. A field-tested, structured questionnaire was used to collect information on demographics, awareness and risk factors for hypertension. Descriptive statistics was used to calculate percentage of participants who were classified to be aware of their hypertension status, with the total hypertensive participants as the denominator. Logistic regression analysis was used to test the association between significant variables and hypertension. All tests were two-tailed and a p-value < 0.05 was considered as statistically significant. Of the 145 (36.9%) study participants who were hypertensive, 60 (41.4%) were not aware of their hypertension status. Binary logistic regression showed that age above 30 years (OR=12.0; 95% CI=2.7 to 52.3), marital status (Widowed OR= 16; 95% CI=6.34 to 40.52), smoking, BMI (overweight OR 2.98; 95% CI= 1.85 to 4.79 Obese OR=4.23; 95% CI= 2.15 to 8.30 p <0.001), waist circumference (OR= 2.39; 95% CI= 1.57 to 3.64 p< 0.001) were independent predictors of hypertension. However, increasing level of education was inversely related to hypertension. In conclusion, the high proportion unaware of their hypertension status could lead to delay in treatment initiation which ultimately increases complications arising from the disease. All the identified risk factors except age are modifiable through lifestyle change interventions. Therefore there is need for the health care workers to hold regular health education to increase awareness of hypertension status and promote healthy lifestyle.
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Hypertension is the intermittent or sustained elevation in diastolic or systolic blood pressure above the normal. It is defined as having a systolic blood pressure (SBP) of ≥140 and/or a diastolic blood pressure (DBP) of ≥90 mm Hg. (WHO, 2003). Hypertension is a significant public health problem, with prevalence estimates of approximately 1 billion individuals worldwide (WHO 2008). It is the main risk factor for stroke, renal failure and also cardiovascular disease mortality, which accounts for 20 – 50% of all deaths (Kearney et al. 2004).
Epidemiological studies have shown that the prevalence of HTN varies between different countries (Kearney et al. 2004). Several studies have also shown rural versus urban differences on blood pressure levels throughout sub-Saharan Africa (Fuentes et al. 2000; Agyemang 2006; Addo et al. 2007). The rapid increase in prevalence of hypertension in developing countries is most marked in the urban population, and is likely related to changing life-styles (Godfrey et al. 2005). Although once considered a lifestyle disease in urban setting (Ezzati et al. 2005; Addo et al. 2007), the modern technological advances and economic development have led to reduction in level of physical activity, increase in stresses of life and unhealthy diets amongst the rural population as well (Mittal and Singh 2008; Maletnlema 2002; Adedoyin et al. 2008). This in turn may increase the risk of conditions such as hypertension in rural areas (Ejim et al. 2011). Obiokpo in Oyigbo LGA Nigeria is a rural area where rapid urbanization, economic development and rise in affluence are being witnessed. This study therefore, aimed to identify the possible risk factors for hypertension among adult patients seeking health care at Civil Service Hospital.
Individual’s awareness of their hypertension status is an important component required for adopting preventive and therapeutic measures for this illness and hence reduction in occurrence of its detrimental sequel (Knight et al. 2001). In some sub-Saharan Africa countries like Malawi, population based studies have reported up to 95% of hypertension cases being undiagnosed and about three quarters of the participants reported to have never had their blood pressure checked (Msyamboza et al., 2012). In Nigeria, there is limited data on awareness of hypertension status among clients visiting hospitals. The few documented community hypertension surveys in Nigeria showed varied awareness of hypertension status. For instance a study done by Hendriks et al., (2012) in rural areas of Nandi district showed an awareness status of hypertension at 6%, and among slum dwellers in Abuja revealed an overall awareness status of hypertension at 19.5%. (Van de Vijver et al., 2013).
Hypertension data from Nigeria Health Sector Strategic and Investment Plan (KHSSPI) 2013- 2017, ranks hypertension at number nine cause of mortality (1.6% of total deaths) and number five (3.1% of total DALYs) in terms of risk factor for DALYS (KHSSPI-MOH 2013). In addition, a study by Ogeng’o et al., 2015 showed that the most common comorbidity for ischemic stroke was hypertension at 64.1%. With this background, coupled with paucity of data from other hospitals in Nigeria, the present study aimed to determine the awareness of hypertension status among clients attending Civil Service Hospital.
1.2 Statement of the Problem
Despite being modifiable through lifestyle interventions and medical management, hypertension accounts for approximately 64% of stroke cases in Nigeria, thus suggesting inadequately controlled blood pressure of most patients in Nigeria.
The prevalence of hypertension is suggested to be increasing in Nigeria where modern technological advances and economic development have led to rise in adoption of unhealthy lifestyles including reduction in level of physical activity and unhealthy diets amongst both urban and rural population. Obiokpo, in Oyigbo LGA, is one of the rural places where rapid urbanization, economic development and rise in affluence are being witnessed in Nigeria. This in turn increases the risk of conditions such as hypertension.
In Nigeria, episodic health education is usually done in the health care facilities for the few patients already diagnosed with hypertension. Such an approach makes self-management strategies and other cost effective interventions inaccessible to those at risk or those with undiagnosed hypertensive individuals (Kiberenge et al., 2010). Individual’s awareness of hypertension status and identification of its Environmental Health Risk Factors is important in order to adopt preventive and therapeutic measures for this illness (Knight et al. 2001).
1.3 Significance of this Study
Hypertension in adults has a great impact on the quality of life of individuals with important implications on the economy (Lloyd-Jones et al.; Knight et al. 2001; Lopez et al. 2006). Uncontrolled hypertension may also result in detrimental illnesses ((Kearney et al. 2004; Kearney et al. 2005; Gaddam et al. 2009; Murphy et al. 2009) that place a great strain on health care delivery system. Indeed coronary heart disease (CHD) has emerged as the leading cause of death among older Africans (Alberts et al. 2005). However, hypertension represents one of the most preventable cause of death in humans (WHO 2008) and one of the most significant modifiable risk factors for cardiovascular diseases (Kengne et al. 2009).
Lifestyle interventions (Haslam et al. 2005; Dickinson et al. 2006; He et al. 2013) and effective medical management of hypertension are well-established targets to decrease morbidity, prevent its complications and mortality in patients (Law et al. 2003). Effective interventions will therefore require increased individual’s awareness of hypertension status and the identification of its Environmental Health Risk Factors.
The study aimed to assess the awareness of hypertension status and Environmental Health Risk Factors of hypertension among patients seeking health care from Civil Service Hospital, in Oyigbo LGA. Data obtained from the study could be used by policy makers in the development and implementation of effective hypertension prevention and control strategies to reduce the detrimental sequel of the disease.
1.4 Objectives of the Study
1.4.1 General Objective
To determine the awareness of hypertension status and Environmental Health Risk Factors among adult patients attending Civil Service Hospital.
1.4.2 Specific Objectives
1. To determine the awareness of hypertension status among adult patients attending Civil Service Hospital.
2. To assess the non-modifiable risk factors for hypertension among adult patients attending outpatient services at Civil Service Hospital.
3. To assess the modifiable risk factors for hypertension among adult patients attending outpatient services at Civil Service Hospital.
1.5 Research Questions
1. What is the awareness of hypertension status among adult patients attending Civil Service Hospital.?
2. What are the non-modifiable risk factors for hypertension among adult patients attending outpatient services at Civil Service Hospital?
3. What are the modifiable risk factors for hypertension among adult patients attending outpatient services at Civil Service Hospital?
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