Prevalence and associated factors of hypertension: a crossectional community based study in northwest ethiopia

The Association of Iron Intake and Hypertension, Does Iron Intake Decrease Blood Pressure?

Previous studies reported that iron may have an indispensable role in the risk of hypertension (HTN). However, the result of the studies on the relationship between iron and risk of HTN is inconsistent. This study aimed to assess the association between the association of dietary iron intake and HTN in the Iranian population. This case-control study was conducted on 4184 people aged 35 to 70, including 1239 people with HTN and 2945 people with normal blood pressure (BP) in Sabzevar, Iran. Dietary intake was assessed using a food frequency questionnaire (FFQ). The Nutritionist IV software was used in terms of the assessment of dietary intake of iron. An inverse association was found between iron intake and HTN (OR = 0.97, CI 95%: 0.94-0.99, P = 0.04). The association remained significant after adjustment for age, gender, smoking, drinking alcohol, calorie intake, and BMI (OR = 0.94, CI 95%: 0.89-0.98, P = 0.01). As a conclusion, iron intake was inversely associated with HTN. Further longitudinal studies on the effect of iron intake on BP are required to confirm this finding.

Health system's availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys

INTRODUCTION

Non-communicable diseases (NCDs) currently cause more deaths than all other causes of deaths. Cardiovascular disease, diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. This study aimed to assess the availability and readiness of health facilities for chronic non-communicable diseases (NCDs) and describe the changes of service availability for common NCDs in Ethiopia. Methods We used data from the 2014 Ethiopia Service Provision Assessment Plus (ESPA +) and 2016 and 2018 Service Availability and Readiness Assessment (SARA) surveys, which were cross-sectional health facility-based studies. A total of 873 health facilities in 2014, 547 in 2016, 632 in 2018 were included in the analysis. (ESPA+) and SARA surveys are conducted as a census or a nationally/sub-nationally representative sample of health facilities. Proportion of facilities that offered the service for diabetes, cardiovascular disease, chronic respiratory disease, cancer diseases, mental illness, and chronic renal diseases was calculated to measure health service availability. The health facility service readiness was measured using the mean availably of tracer items that are required to offer the service. Thus, 13 tracer items for diabetes disease, 12 for cardiovascular disease, 11 for chronic respiratory disease and 11 cervical cancer services were used.

RESULTS

The services available for diagnosis and management did not show improvement between 2014, 2016 and 2018 for diabetes (59%, 22% and 36%); for cardiovascular diseases (73%, 41% and 49%); chronic respiratory diseases (76%, 45% and 53%). Similarly, at the national level, the mean availability of tracer items between 2014, 2016 and 2018 for diabetes (37%, 53% and 48%); cardiovascular diseases (36%, 41% and 42%); chronic respiratory diseases (26%, 27% and 27%); and cancer diseases (6%, 72% and 51%). However, in 2014 survey year, the mean availability of tracer items was 7% each for mental illness and chronic renal diseases, respectively.

CONCLUSIONS

The majority of the health facilities have low and gradual decrement in the availability to provide NCDs services in Ethiopia. There is a need to increase NCD service availability and readiness at primary hospitals and health centers, and private and rural health facilities where majority of the population need the services.

Hypertension prevalence in Iran's elderly according to new criteria: the Tehran Geriatric Eye Study

Purpose

To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors.

Methods

A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications.

Results

Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension.

Conclusion

A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.

Sex-specific prevalence, awareness, treatment and control of hypertension in adults in India: a study for developing sex-specific public policy from the longitudinal ageing study in India (LASI) data 2017-2018

BACKGROUND AND OBJECTIVE

Hypertension is a key risk factor for cardiovascular disease and the leading cause of mortality among Indian adults. The difference in health status between men and women is becoming a great burden in itself worldwide. This study aimed to examine the differences between men and women in the prevalence, awareness, treatment, and control of hypertension and related risk factors among people aged 45 and older in India using data from the Longitudinal Ageing Study in India in 2017-2018.

METHODS

Descriptive statistics were presented separately for males and females. Multivariable logistic regression was used to analyze the socio-demographic, lifestyle behaviours, and biological factors associated with the prevalence of hypertension. All statistical analyses were conducted using Stata Version 16.0 statistical software. The study of the data was conducted using survey weights available in the LASI datasets.

KEY FINDINGS

Overall, the study found that 45.1% of the study population had hypertension, with 26.9% self-reporting their condition and 30% having hypertension at the time of measurement. Approximately 41% of males and 59% of females had hypertension. The self-reported hypertension of men was found to differ significantly from measured hypertension by 8.7%, while in women the difference was only 1.2%. Diabetes was found to increase the odds of having hypertension in both males (OR = 3.65, 95% CI (3.37-3.97)) and females (OR = 3.46, 95% CI (3.21-3.74)).

CONCLUSION

The difference between self-reported and measured hypertension in men and women is contributing to sex-gender and health inequalities that must be addressed. For adult females with hypertension, it is important to prioritize obesity, education level, physical activity, and regular clinic visits to manage chronic conditions. Based on our findings, policy recommendations can be made to focus on increasing women's literacy, promoting men's screening for hypertension, banning tobacco and alcohol sales, and organizing hypertension awareness campaigns specifically for men and in rural areas.

Prevalence of Undiagnosed Hypertension and Associated Factors among Adults in Mizan-Aman Town, Bench Sheko Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study

Objectives

This study aimed to assess the prevalence of undiagnosed hypertension and associated factors among people aged 18 years and above in Mizan-Aman town of Bench Sheko Zone in Southwest Ethiopia. Study Design. A community-based cross-sectional study design was carried out among people aged 18 years old and above from April 1 to 30, 2021, in Mizan Aman town.

Methods

A community-based cross-sectional study design was carried out among people aged 18 years old and above from April 1 to 30, 2021, in Mizan Aman town. Seven hundred fifty-nine subjects were selected by the multistage sampling technique. A structured pretested STEPwise questionnaire was used to interview the participants. Data entry and analysis were done using EpiData 3.1 and SPSS version 25 statistical software, respectively. Descriptive analysis was undertaken, and the results were presented using frequency tables, graphs, and statistical summaries. The dependent variable has a dichotomized response of yes and no, and hence binary logistic regression was used to predict a dependent variable based on independent variables, and predictors having p ≤ 0.25 on the bivariable analysis were considered as candidates for the multivariable analysis. Odds ratios with their 95% confidence intervals were calculated to measure the strength of association, and finally a p value <0.05 was considered statistically significant.

Result

The prevalence of undiagnosed hypertension was 14.8% with 95% CI [12.3-15.6]. Older age (AOR = 3.1, 95% CI [1.5-6.5]), male (AOR = 2.2, 95% CI [1.3-3.9]), low physical activity (AOR = 3.9, 95% CI [1.8-8.3]), low consumption of fruit and vegetable (AOR = 4.5, 95% CI [2.4-8.8]), and higher BMI (AOR = 2.7, 95% CI [1.6-4.6]) were significantly associated with undiagnosed hypertension.

Conclusion

The current study outlined that the prevalence of undiagnosed hypertension was high in the study area. In addition, most of the risk factors identified were modifiable, and hence community-based preventive approaches like lifestyle modification, increasing awareness, and strengthening routine screening at primary health service facilities resulted in a substantial change in tackling the burden effectively.

Blood Pressure Examination Habit and Its Determinants Among Civil Servants in Arba Minch Town: A Cross-Sectional Study - Using Hurdle Poisson Regression Model

Background

Hypertension is a common non-communicable disease detected through blood pressure measurement that makes periodic health examinations crucial for the detection, prevention, and timely treatment.

Objective

To assess the frequency of blood pressure examination and its determinant among civil servants in Arba Minch Town, south Ethiopia.

Methods

From February to March 2020 an organization-based cross-sectional study design was employed among civil servants in Arba Minch town. Data were collected from 580 randomly selected civil servants using a well-structured questionnaire. Hurdle Poisson regression model was conducted to identify determinants of frequency of blood pressure examination using R version 4.0.2.

Results

A total of 407 (70.2%) civil servants had never examined their blood pressure within a year before the study time. The mean frequency of blood pressure examination was 0.71 with a standard deviation of 1.46. The hurdle Poisson regression analysis indicates age above 40 years (IRR = 6.11, p < 0.001), elevated blood pressure (IRR = 1.48, p < 0.001), no family history of hypertension (IRR = 0.59, p < 0.001) had significant effects on the expected number of non-zero counts blood pressure examination. And education status (OR; 2.39, p < 0.05), poor knowledge about hypertension, not getting advice from health professionals (OR = 8.93, p < 0.001), and age above 40 years had significant effects on not taking blood pressure examination.

Conclusion

The frequency of blood pressure examinations among civil servants was found to be low. This study reveals age, elevated blood pressure, family history of hypertension, getting advice, and knowledge on hypertension were found to be determinants of the frequency of blood pressure examination. Thus, concerned health authorities and medical workers should work on these factors to prevent and detect hypertension among apparently healthy civil servants.

Undiagnosed hypertension and its determinants among hypertensive patients in rural districts of northwest Ethiopia: a mediation analysis

BACKGROUND

Early detection of hypertension is associated with improved blood pressure control and a reduced risk of cardiovascular diseases. However, in rural areas of Ethiopia, evidence is scarce where access to healthcare services is low. This study aimed to estimate the proportion of undiagnosed hypertension and identify its determinants and mediators among patients with hypertension in rural northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from September to November 2020. A three-stage sampling technique was used to select a total of 2436 study participants. Blood pressure was measured using an aneroid sphygmomanometer two times, 30 min apart. A validated tool was used to assess participants' beliefs and knowledge of hypertension. The proportion, determinants, and mediators of undiagnosed hypertension were determined among patients with hypertension. The regression-based approach used to calculate the direct and indirect effects of determinants of undiagnosed hypertension. Joint significance testing was used to determine the significance of the indirect effect.

RESULTS

The proportion of undiagnosed hypertension was 84.0% (95% CI: 81.4-86.7%). Participants aged 25-34 years (AOR = 6.03; 95% CI: 2.11, 17.29), who drank alcohol (AOR = 2.40; 95% CI: 1.37, 4.20), were overweight (AOR = 0.41; 95% CI: 0.18, 0.98), had a family history of hypertension (AOR = 0.32; 95% CI: 0.20, 0.53), and had comorbidities (AOR = 0.28; 95% CI: 0.15, 0.54) were significantly associated with undiagnosed hypertension. The mediation analysis revealed that hypertension health information mediated 64.1% and 68.2% of the effect of family history of hypertension and comorbidities on undiagnosed hypertension, respectively. Perceived susceptibility to hypertensive disease mediated 33.3% of the total effect of age on undiagnosed hypertension. Health facility visits also mediated the effect of alcohol drinking (14.2%) and comorbidities (12.3%) on undiagnosed hypertension.

CONCLUSION

A higher proportion of hypertensive patients remain undiagnosed. Being young, drinking alcohol, being overweight, having a family history of hypertension, and having comorbidities were significant factors. Hypertension health information, knowledge of hypertensive symptoms, and perceived susceptibility to hypertension were identified as important mediators. Public health interventions aimed at providing adequate hypertension health information, particularly to young adults and drinkers, could improve knowledge and perceived susceptibility to hypertensive disease and reduce the burden of undiagnosed hypertension.

Blood pressure self-monitoring practice and associated factors among adult hypertensive patients on follow-up at South Wollo Zone Public Hospitals, Northeast Ethiopia

BACKGROUND

Hypertension is a silent killer that causes serious health issues in all parts of the world. It is risk factor for cardiovascular disease, stroke and kidney disease. Self-monitoring practice has been identified as an important component of hypertension management. Hence, this study aimed to assess blood pressure (BP) self-monitoring practice and associated factors among adult hypertensive patients on follow-up in South Wollo Zone public hospitals, Northeast Ethiopia.

METHODS

Hospital-based cross-sectional study was conducted from 1 June 2022 to 30 June 2022, among 336 adult hypertensive patients on follow-up at selected South Wollo Zone public hospitals. Data were collected by using self-administered pretested structured questionnaires; the collected data were entered into Epi-data V.4.6 and then exported to SPSS V.25 software for analysis. Descriptive statistics such as frequency and percentage were used to describe the study participants. Tables and texts were used for data presentation. Binary logistic regression was conducted to test the association between the independent and dependent variables. Adjusted OR (AOR) with 95% CI was estimated to identify the factors associated with BP self-monitoring and the level of significance was declared at p<0.05.

RESULTS

The proportion (95% CI) of BP self-monitoring practice among hypertensive patients in South Wollo Zone Public Hospitals was 8.93% (95% CI 6.3% to 12.5%). In the multivariable analysis, urban residence (AOR 3.97, 95% CI (1.11 to 14.20)), comorbidity (AOR 4.80, 95% CI (1.23 to 18.69)), regular healthcare professional visit (AOR 4.64, 95% CI (1.02 to 21.14)), advice on the type of devices used for BP self-monitoring (AOR 5.26, 95% CI (1.49 to 18.58)) and knowledge on hypertension self-care (AOR 13.13, 95% CI (4.21 to 40.99)) were positively associated with BP self-monitoring practice.

CONCLUSION

The proportion of BP self-monitoring practice was low. Living in urban areas, comorbidity, regular healthcare professional visits, advice on the type of devices used for BP self-monitoring, and knowledge of hypertension self-care were positively associated with BP self-monitoring practice.

Prevalence and Associated Factors of Hypertension Among Adults in Gurage Zone, Southwest Ethiopia, 2022

Introduction

Hypertension affects over a billion people worldwide, making it a major public health problem. The problem is significant in both developed and developing countries. However, studies are scarce in developing countries such as Ethiopia.

Objectives

This study aimed to assess the prevalence of hypertension and its associated factors at the community level, in South Ethiopia.

Methods

A cross-sectional study design was employed on a sample of 680 participants in the study from April 1 to June 30, 2022. An interview administer was conducted using a standardized and pretested questionnaire was employed. The Epi data 3.1 versions were used to enter data and then exported into SPSS version 23 for analysis. All variables in the multivariable logistic analysis were a candidate with a bi-variable at p < .25. The multivariable logistic regressions were performed to determine the predictors of hypertension, and the significance level was established with p < .05.

Results

There were a total of 635 participants and the response rate was 93.4%. The prevalence of hypertension was found to be 22.0% [95% CI; 19.1-25.4]. The mean age of the participants was 40.8 ± 12.88 years. Being older age (AOR: 1.95; 95%CI; 1.13-3.36), family history [AOR: 2.65, 95%; CI (1.29-5.45)], eating animal fat [AOR: 0.21, 95%; CI (0.08-0.52)], smoking cigarettes [AOR: 4.06, 95%; CI (2.24-7.36)] and had poor knowledge about hypertension [AOR: 2.69, 95%; CI (1.61-4.49)] were significantly associated with raised blood pressure.

Conclusions

Hypertension was prevalent in one out of every five study participants. Older age, family history of hypertension, animal fat intake, cigarette smoking, and lack of knowledge were found to be significant factors for hypertension. To address the burden of hypertension, health care practitioners should provide broad health education, routine screening, and promotion of recommended lifestyle measures.

The Burden of Hypertension and Prehypertension in a Community Health Centre of Haryana

Background Hypertension (HTN) is endemic in India and it is considered a public health challenge in both economically developed and developing nations. Unfortunately, despite its high prevalence, its awareness, treatment, and control status are low in urban as well as rural Indian populations. Objectives To determine the burden of hypertension and prehypertension in a Community Health Center (CHC) and to find the association of hypertension with the age group and sex of study subjects. Methodology A cross-sectional study was carried out among 713 patients of age 20 years and above attending the Out Patient Department (OPD) of the Community Health Centre (CHC), Barwala in the Hisar district of Haryana. JNC 7 classification of blood pressure was used to diagnose hypertension. The collected data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Appropriate statistical tests were used. Result Out of the total patients enrolled, 200 (28.1%) were found to be hypertensives. The burden of prehypertension was further observed to be 28.1%. About (61.6%) of OPD patients were female. Among hypertensive patients, nearly half (48.8%) were in the age group of 60-80 years whereas the majority of the hypertensives (56%) were females. Conclusion In our study, more than 50 percent of OPD patients were found to have hypertension and pre-hypertension. Health-seeking behavior was more among females.

The effect of angiotensin converting enzyme gene insertion/deletion polymorphism on anthropometric and biochemical parameters among hypertension patients: A case-control study from Northwest Ethiopia

INTRODUCTION

The angiotensin-converting enzyme (ACE) gene polymorphism has recently been linked with altered anthropometric and biochemical parameters in hypertensive patients. However, these links are still poorly understood and there is scarce evidence on the topic. Therefore, this study aimed to assess the effect of ACE gene insertion/deletion (I/D) polymorphism on anthropometric and biochemical parameters among essential hypertension patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

MATERIALS AND METHODS

A case-control study with 64 cases and 64 controls was conducted from October 07, 2020, to June 02, 2021. The anthropometric measurements, biochemical parameters, and ACE gene polymorphism were determined using standard operating procedures, enzymatic colorimetric method, and polymerase chain reaction, respectively. A one-way analysis of variance was used to determine the association of genotypes with other study variables. P value < 0.05 was regarded as statistically significant.

RESULT

The systolic/diastolic blood pressure and blood glucose level (P-value<0.05) were significantly higher among study hypertensive patients with the DD genotype. However, anthropometric measures and lipid profiles of cases and controls were not associated with ACE gene polymorphism (P-value>0.05).

CONCLUSION

The DD genotype of the ACE gene polymorphism was found to have a significant association with high blood pressure and blood glucose levels in the study population. Advanced studies with a considerable sample size may be needed to utilize the ACE genotype as a biomarker for the early detection of hypertension-related complications.

Compliance With Guidelines of Hypertension Management, and Associated Factors Among the Health Practitioners

The consequences of uncontrolled hypertension such as stroke, myocardial infarction, retinal damage and others are significantly affecting individual and the community in large. The patients are suffering from compromised quality of life, permanent disability, and premature death in developing countries. The reason for the existence of the gap hasn't been clear yet. An institutional-based retrospective cross-sectional study designed from patient medical record data was used to assess compliance with the federal democratic and republic of Ethiopia ministry of health hypertension management guideline. Medical records of adult Patients treated for hypertension from March 2019 to March 2020 were reviewed. Systematic sampling technique from patients' medical records every 10th interval was taken to reach the total sample size. The collected data were checked for completeness, consistency, and accuracy before analysis. Data were coded, entered, and cleaned using Epi-data 7 and exported to SPSS version 25 for analysis. Overall compliance with the hypertension guideline was found to be poor; only 75 (19.5%) patients managed according to the guideline in these institutions. The majority of health practitioners complied with the pharmacological Antihypertensive treatment protocols for 238 (62.0%) patients, while for 146 (38.0%) of the patients the guideline was not followed. Combining the lifestyle modification recommendations and pharmacological antihypertensive treatment to assess compliance with the hypertension management guideline, only 75 (19.5%) patients managed as per the guideline, while 309 (80.5%) did not. Nearly more than two-thirds of the patients were not managed following the national hypertension guideline, and health practitioners are failed to recommend lifestyle modifications for most of the patients, as a result, the majority of the hypertensive patients are being exposed to complications and urgent intervention is demanded against the gap.

The association of lipid-lowering therapy and blood pressure control among outpatients with hypertension at the Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia

Background

The lipid-lowering medications known as statins have been shown in controlled clinical trials to have pleiotropic properties, such as lowering blood pressure, in addition to lowering cholesterol levels. The purpose of this study was to see if there was a possible link between blood pressure control and statin therapy in outpatients with hypertension in a real clinical setting.

Patients and methods

A retrospective comparative cohort study of 404 patients with hypertension was carried out. A systematic random sampling technique was used. For data entry, Epi-Data version 4.6 was used, and SPSS version 25 was used for further analysis. For group comparisons, chi-square and independent t-tests were computed. To determine the relationship between statin use and blood pressure control, a binary logistic regression model was employed. To declare statistical significance, a 95% confidence interval and a P-value of <0.05 were used.

Results

Half of the study participants who were using a prescribed statin were assigned to the statin group, whereas the remaining participants who do not take statins were assigned to the control group. After 3 months of statin treatment, BP control to <130/80 mmHg was significantly greater (P = 0.022) in the statin group (52.5%) than in the control group (41.0%). The use of statins raises the likelihood of having blood pressure under control by 1.58 times when compared to statin non-users. After controlling for possible confounders, statin therapy still increased the odds of having controlled BP by a factor of 5.98 [OR = 5.98; 95% CI: 2.77-12.92].

Conclusion

This study revealed that blood pressure control was higher among statin user hypertensive patients. Favorable effects of statin use were independently observed, even after correction for age, presence of dyslipidemia, and duration of antihypertensive therapy. Therefore, the importance of concomitantly added lipid-lowering drugs such as statins and their role in managing poor blood pressure control should be given due emphasis.

Out-of-pocket health expenditure and associated factors among patients with hypertension in Debre-Tabor Comphrensive Specialized Hospital, South Gondar zone, Northwest Ethiopia, 2020

Introduction

Hypertension is a non-communicable chronic disease that has a wide financial effect at the individual and household levels especially in developing countries due to its complexity and chronicity. Nevertheless, there are limited studies in Ethiopia. Therefore the aim of this study was to assess out-of pocket health expenditure and associated factors among adult patients with hypertension in Debre-Tabor Comphrensive Specialized Hospital.

Methods

A facility-based cross-sectional study was conducted in total of 357 adult hypertensive patients from March to April 2020 using a systematic random sampling technique. Descriptive stastics were used to estimate the magnitude of out-of-pocket health expenditure, while after checking the assumptions linear regression model was fitted for identifying the factors associated with the outcome variable at a significance level of value of p < 0.05 and 95% confidence interval.

Result

A total of 346 study participants interviewed with a response rate of 96.92%. Annual mean out of pocket health expenditure of the participant was $113.40 ± $10.18 with 95% CI = (102.63, 124.16) per patient. The direct medical mean out of pocket health expenditure of the participant was $68.86 per patient per year and the median of non-medical components of the out of pocket health expenditure of the participant was $3.53. Sex, wealth status, distance from hospital, comorbidity, health insurance and number of visit are factors significantly associated to out-of-pocket expenditure.

Conclusion

This study revealed that out of pocket health expenditure among adult patients with hypertension was found high compared to the national per capita health expenditure. Sex, wealth index, distance away from hospital, frequency of visit, comorbidities, and health insurance coverage were factors significantly associated with high out-of-pocket health expenditure. Ministry of health together with regional health bureaus and other concerned stakeholders work on strengthening early detection and prevention strategies of chronic comorbidities of hypertensive patients,promote health insurance coverage and better to subsidize medication costs for the poors.

Diabetes, Hypertension, and Comorbidity among Bangladeshi Adults: Associated Factors and Socio-Economic Inequalities

Diabetes, hypertension, and comorbidity are still crucial public health challenges that Bangladeshis face. Nonetheless, very few studies have been conducted to examine the associated factors, especially the socioeconomic inequalities in diabetes, hypertension, and comorbidity in Bangladesh. This study explored the prevalence of, factors connected with, and socioeconomic inequalities in diabetes, hypertension, and comorbidity among Bangladeshi adults. We used the Bangladesh Demographic and Health Survey (BDHS) data set of 2017−2018. A total of 12,136 (weighted) Bangladeshi adults with a mean age of 39.5 years (±16.2) participated in this study. Multilevel (mixed-effect) logistic regression analysis was employed to ascertain the determinants of diabetes, hypertension, and comorbidity, where clusters were considered as a level-2 factor. The concentration curve (CC) and concentration index (CIX) were utilized to investigate the inequalities in diabetes, hypertension, and comorbidity. The weighted prevalence of diabetes, hypertension, and comorbidity was 10.04%, 25.70%, and 4.47%, respectively. Age, body mass index, physical activity, household wealth status, and diverse administrative divisions were significantly associated with diabetes, hypertension, and comorbidity among the participants. Moreover, participants’ smoking statuses were associated with hypertension. Women were more prone to hypertension and comorbidity than men. Diabetes (CIX: 0.251, p < 0.001), hypertension (CIX: 0.071, p < 0.001), and comorbidity (CIX: 0.340, p < 0.001) were higher among high household wealth groups. A pro-wealth disparity in diabetes, hypertension, and comorbidity was found. These inequalities in diabetes, hypertension, and comorbidity emphasize the necessity of designing intervention schemes geared towards addressing the rising burden of these diseases.

Undiagnosed status and associated factors of hypertension among adults living in rural of central, Ethiopia, 2020: Uncovering the hidden magnitude of hypertension

BACKGROUND

Hypertension is a major risk factor for cardiovascular (CVD) disease related deaths worldwide. It affects more than 20% of adults in Ethiopia, making it a major public health concern. Although it is important to uncover the hidden extent of hypertension, there is limited information on the proportion of undiagnosed hypertension in rural areas of the country.

OBJECTIVE

This study aimed to determine the magnitude of undiagnosed hypertension and associated factors among adults living in the rural Dano district, Central Ethiopia 2020.

METHODS AND MATERIALS

A quantitative, community-based cross-sectional study conducted from May to July 2020. A three-stage sampling technique was used to select a total of 605 study participants. A Validated tool was used to assess the participant's behavioral characteristics. Blood pressure was measured using digital blood pressure apparatus. The mean of three blood measurements was used to classify hypertension after intra-class correlation was tested. Standardized instruments were used to assess participants' health-seeking behavior and knowledge of the hypertensive disease. The proportion of undiagnosed hypertension was determined among patients with hypertension. The regression analyses were done to determine factors associated with undiagnosed hypertension. The adjusted odds ratio with 95% CI was estimated to measure the strength of the association. The level of statistical significance was set at a p-value < 0.05.

RESULTS

The prevalence of undiagnosed hypertension was 21.32% (CI: 19.95%, 25.8%). Living in a household with the low wealth index [(AOR: 3.5,95%CI: (1.6,6.4)], far distance to health facility, [(AOR: 0.155,95%CI: (0.11.0.67)], underweight, [AOR = 2.2.1,95%CI:(2.00,4.22)], use of smokeless tobacco products, [AOR = 3.2,95%Cl:(1.88,4.75)], and participants' knowledge of hypertension were independently associated with undiagnosed hypertension.

CONCLUSION

This study shows that undiagnosed hypertension is a major public health problem in the study area. Living in a household with a low wealth index, being far from a health facility, being underweight, using smokeless tobacco products, and having little knowledge about hypertension increase the likelihood of having undiagnosed Hypertension. Hypertension health information, particularly to smokes tobacco users, could improve the perceived susceptibility to hypertensive disease, and reduce the hidden extent of hypertension.

Association of angiotensin-converting enzyme gene insertion/deletion polymorphisms with risk of hypertension among the Ethiopian population

Introduction

Although the pathophysiological mechanism of hypertension is not fully elucidated yet, a large number of pieces of evidence have shown that genetic alterations in the renin-angiotensin-aldosterone system play a central role. However, the association of insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene with essential hypertension is controversial yet, and there is a limited number of publications among the Ethiopian population. Therefore, this study aimed to determine the association of ACE gene I/D polymorphism with the risk of hypertension among essential hypertension patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

Materials and methods

A case-control study was conducted from October 07, 2020, to June 02, 2021, among hypertensive patients and normotensive control groups at the University of Gondar Comprehensive Specialized Hospital. A structured questionnaire was used to collect socio-demographic data and anthropometric measurements. Five milliliters of blood were drawn from each of the randomly selected 64 hypertensive and 64 normotensive participants for molecular test analysis. Genetic polymorphism of the ACE gene was identified using polymerase chain reaction (PCR) and electrophoresis. Data analysis was done using SPSS version 25.0 software. The strength of association between the genotype and hypertension was estimated through the calculation of adjusted odds ratio and 95% confidence intervals using logistic regression. P-value < 0.05 was considered statistically significant.

Result

The distribution of DD genotypes and D allele of the ACE gene were 48.4% and 63% in essential hypertensive patients, respectively, while it were 29.7% and 42.2% in control subjects respectively. The ACE DD genotype (p-value = 0.005) and D allele (p-value = 0.001) were more frequent among hypertensive patients as compared to controls.

Conclusion

The present study found that the DD genotype and D allele of the ACE gene has had a strong association with a high risk of hypertension in the study population.

Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

Suboptimal blood pressure control among people living with diabetes mellitus (DM) is one of the primary causes of cardiovascular complications and death in sub-Saharan Africa (SSA). However, there is a paucity of evidence on the prevalence and associated factors of suboptimal blood pressure control in SSA. Therefore, this review aimed to estimate its pooled prevalence and associated factors among people living with DM in SSA.  METHODS: We systematically searched PubMed, African Journals OnLine, HINARI, ScienceDirect, Google Scholar, and direct Google to access observational studies conducted in SSA. Microsoft Excel spreadsheet was used to extract the data, which was exported into STATA/MP version 16.0 for further analyses. Heterogeneity across studies was checked using Cochran's Q test statistics and I² test, and small study effect was checked using Funnel plot symmetry and Egger's statistical test at a 5% significant level. A random-effects model was used to estimate the pooled prevalence and associated factors of suboptimal blood pressure control at a 95% confidence interval (CI) and significance level of p < 0.05.

RESULTS

Of the 7329 articles retrieved, 21 articles were eligible for the meta-analysis. After performing random-effects model, the pooled prevalence of suboptimal blood pressure control was 69.8% (95% CI: 63.43, 76.25%). Poor adherence to antihypertensive treatment (OR = 1.7; 95% CI: 1.03-2.80, I² = 0.0%, p = 0.531) and overweight (OR = 2.4, 95% CI: 1.57-3.68, I² = 0.00%, p = 0.47) were significantly associated with suboptimal blood pressure control.

CONCLUSIONS

The prevalence of suboptimal blood pressure control among diabetic patients in SSA was high, and poor adherence to antihypertensive treatment and overweight were significantly associated with suboptimal blood pressure control. Hence, there is an urgent need for initiatives to improve and control hypertension, and preventive measures should concentrate on modifiable risk factors.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020187901.

High burden of hypertension amongst adult population in rural districts of Northwest Ethiopia: A call for community based intervention

BACKGROUND

Hypertension is a serious public health issue in Ethiopia, but there is a paucity of evidence in the country's rural areas. The aim of this study was to determine the prevalence of hypertension and its risk factors among adults in rural districts in northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from June to October 2020. The 1177 study participants were chosen using a multistage sampling procedure. A face-to-face interview was conducted using an adapted version of the WHO STEPwise approach questionnaire. Blood pressure was measured three times using an aneroid sphygmomanometer, and the mean of the last two readings were used for the analysis. Data was entered using Epidata and analyzed using STATA-16. Multivariable logistic regression was used to identify risk factors associated with hypertension.

RESULTS

Of the total participants, 218 (18.5%) were found to be hypertensive. The prevalence of hypertension consistently increases with age. Hypertension was positively and significantly associated with female sex ((adjusted odd ratio (AOR) = 2.30, 95% CI: 1.53, 3.45)), age group 45-54 years (AOR = 4.63, 95% CI: 1.01, 21.37), 55-64 years (AOR = 14.40, 95% CI: 3.07, 67.63), ≥65 years (AOR = 19.37, 95% CI: 4.03, 93.09), having history of alcohol consumption (AOR = 3.25, 95% CI: 1.17, 9.02), used much amount of salt (AOR = 2.37, 95% CI: 1.53, 3.60) and too much amount of salt (AOR = 3.78, 95% CI: 1.85, 7.72), sleeping for a short duration (AOR = 2.05, 95%CI: 1.30, 3.24), and having family history of hypertension (AOR = 2.12, 95% CI; 1.32, 3.39).

CONCLUSIONS

Hypertension was significantly high among the rural population we studied and is emerging as a public health problem. Female sex, advanced age, ever used alcohol, excessive salt intake, insufficient sleep, and a family history of hypertension were factors that were positively and significantly associated with hypertension. We recommend local health authorities integrate promotion of hypertension health education, lifestyle modification intervention on salt and alcohol reduction, and hypertension detection, particularly for the female and elderly population, at the health post level to avert the problem.

Perceived barriers and enablers influencing health extension workers toward home-based hypertension screening in rural northwest Ethiopia: interpretive descriptive study

Background

Hypertension, a major but modifiable risk factor for cardiovascular diseases, is a global health problem including Ethiopia. In a limited infrastructure task sharing of hypertension screening for community health workers is a feasible strategy to improve hypertension management. Recent finding have shown that trained health extension workers (HEWs) can identify high blood pressure, which was effective and feasible. Identifying barriers and enablers for home-based hypertension screening by HEWs is crucial for its implementation. This study aimed to explore barriers and enablers that influence health extension workers’ home-based hypertension screening in the community.

Methods

The interpretive descriptive design was implemented. In-depth interviews were conducted during October, 2020. A total of 26 participants including HEWs, supervisors, and heads of district health office were purposively selected. They were asked to describe their perception toward home-based hypertension screening by the HEWs. The interviews were audio-recorded, transcribed verbatim into Amharic, and translated into English. The transcripts were coded and themes were identified. Thematic approach was used for data analysis.

Results

The participants identified key perceived barriers and enablers of HEWs home-based hypertension screening. The most common barriers were a lack of hypertension training, blood pressure measuring devices, blood pressure guidelines and manuals, skilled HEWs, financial incentives, and poor community awareness of the disease. The most common enablers were support from community leaders, presence of functional development army and community trust for HEWs, presence of routine campaign on vaccination and community based health insurance, and an integrated health system.

Conclusions

Our findings have implications for the HEWs' ongoing implementation of home-based hypertension screening. Successful implementation of this strategy requires scaling up of hypertension training programs for health extension workers and their supervisors, provision of standardized protocols, provision of adequate blood pressure measuring equipment, and regular supportive supervision.

Geospatial epidemiology of hypertension and its risk factors in India: Findings from National Family Health Survey (2015-2016)

Background

The fourth round of National Family Health Survey (2015-2016) measured blood pressure for the first time and provided a unique opportunity of exploring trends in hypertension prevalence across states and districts for the first time.

Aim

This study will be the first in India to estimate the geospatial variation of hypertension among those in the 15-49 years age group in India.

Materials and Methods

Out of a total of 616,346 selected occupied households, 601,509 were successfully interviewed, giving a response rate of 98%. We adjusted the proportion of hypertension obtained by using national sample weights. We built a multivariable logistic regression model to assess the determinants of hypertension.

Results

The overall weighted prevalence of hypertension was 11.7%, and the prevalence was 11.1% in females and 11.0% in males. Urban areas had a higher prevalence (13.0%) compared to rural areas (11.0%). Those with no education (14.4%) and those who reported smoking (16.5%) had hypertension. Consumption of alcohol, fruits, and eggs was also found to be significantly related to hypertension.

Conclusion

Hypertension epidemic is spreading alarmingly in India across rural and urban populations. Disturbingly, the hypertension prevalence is now becoming more concentrated among the poor. This phenomenon has serious implications for the country's social and economic well-being. Urgent preventive measures need to be taken at a multidisciplinary level.

Factors associated with positive attitude towards hypertension control in Hawassa city administration: Community based cross‐sectional study

Background and Aims

In low‐income countries where there is shortage of appropriate medical care to manage hypertension (HTN), understanding dynamics of communities' knowledge and attitude to prevent through lifestyle is crucial. Despite this fact, there was limited information on levels of awareness and attitude towards HTN and its prevention in the study setting. So, this study was conducted to assess level and factors associated with positive attitude in Hawassa city, Southern Ethiopia.

Methods

A community level study using cross‐sectional design was done in Hawassa city administration in 2017. Six hundred and twelve respondents were selected using a multi‐stage sampling technique. Knowledge and attitude were assessed using multiple questions and responses were categorized considering mean as cutoff points. Descriptive statistics and binary logistic regression analysis at 95% confidence interval (CI) were performed.

Results

The level of mean score of knowledge was 62.7% (SD = 22.2) [95% CI: 60.9–64.4] while that of attitude was 68.1% (SD = 8.8) [95% CI: 67.4–68.8]. Divorced/widowed respondents were 73% less likely to have positive attitude as compared to married respondents (adjusted odds ratio [AOR] 95% CI: 0.27 [0.14–0.51], p‐<0.001). Respondents who attended primary, secondary and higher education were 2.84 times (AOR 95% CI: [1.48–5.42], p 0.002), 5.59 times (AOR 95% CI: [2.87–10.89], p‐<0.001) and 9.28 times (AOR 95% CI: [4.39–19.65], p‐<0.001) more likely to have positive attitude as compared to those who cannot read and write. Moreover, respondents who have good knowledge were 2.24 times (AOR 95% CI: [1.49–3.37], p‐<0.001) more likely to have positive attitude as compared with those who have poor knowledge.

Conclusion

The overall levels of knowledge and attitude related to HTN and its prevention were moderate but not adequate to bring lifestyle modifications required to prevent and control HTN. Health promotion activities should be strengthened to improve awareness and attitude that are pillars to bring lifestyle modification practices.

Prevalence of Hypertension and Its Associated Risk Factors Among Patients with Rheumatoid Arthritis in the Kingdom of Saudi Arabia

Purpose

Data regarding hypertension prevalence among patients with rheumatoid arthritis in Saudi Arabia are scarce. This study was aimed at estimating the prevalence of hypertension and its associated risk factors among patients with rheumatoid arthritis in Saudi Arabia.

Patients and Methods

This was a cross-sectional study of adult patients with rheumatoid arthritis who presented at the OPD of two major hospitals in Riyadh city. Patient information such as demographic characteristics, comorbidities, drug use, and other clinical data were captured through medical record review and supplemented by patient interviews. Multivariate logistic regression was used to identify the significant factors for hypertension.

Results

The prevalence of hypertension was found in 32.35% of the 1490 rheumatoid arthritis patients who participated in our study. Logistic regression analyses revealed that advanced age, female sex, low education level, unemployment, smoking, and consulting with physicians less than two times within the past 12 months were risk factors for increased hypertension prevalence among patients with rheumatoid arthritis. A significantly higher risk of hypertension was observed among RA patients with obesity, diabetes, hyperlipidemia, cancer, kidney disease, osteoporosis, and Parkinson’s disease than among patients without these comorbidities.

Conclusion

Hypertension is highly prevalent among patients with rheumatoid arthritis, and advanced age, sex, low educational level, unemployment, smoking, and comorbidities are risk factors for increased hypertension prevalence.

Blood Pressure Control and Associated Factors Among Hypertensive Patients Attending Shashemene Referral Hospital, Oromia, Ethiopia

BACKGROUND

Hypertension is public health challenge worldwide. It is defined as persistently elevated arterial blood pressure (BP), systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or use of antihypertensive medication in adults older than 18 years. The aim of this study was to assess blood pressure control and associated factors among hypertensive patients attending the outpatient department of Shashemene Referral Hospital.

METHODS

Hospital based cross sectional study was conducted to determine level of blood pressure control and associated factors among hypertensive patients on medical follow-up. A medical chart review and interview was conducted from July 1 to October 31 2018.

RESULT

A total of 325 participants were included in this study with response rate of 320 (98.5%). More than half of study participants were males 171 (53.4%). The mean age of the respondents was 55.10 (SD ± 12.7) years and majority of the respondents 191 (59.7%) were within age of less than 60 years old. The mean Systolic blood pressure (SBP) was 131.80 mmHg (SD ± 20.92) while the mean diastolic blood pressure (DBP) was 82.30 mmHg (SD ± 10.52). About 51.30% of study participants had a controlled SBP and 54.7% had a controlled DBP. The overall control of BP was achieved in 40.3% of the study participants. Multivariable logistic regression analysis showed that age, experience of side effects, frequency of BP measuring, number of antihypertensive drugs used, duration on antihypertensive, source of medication and physical exercise showed significant association with blood pressure control.

CONCLUSION

Blood pressure control level among chronic hypertensive patients at outpatient department was low. Age of patients, educational level, experience of side effects, and number of antihypertensive drugs used were important determinant factors associated with blood pressure control among study participants.

Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia

Background

Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients’ risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).

Methods

A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants’ risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.

Results

Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18–82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43–18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36–14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants’ CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.

Conclusion

Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients’ CVD risk perception to reduce adverse CVD events.

Socio-economic Correlates of Body Mass Index, Blood Pressure and Contraceptive Use by Reproductive age-group Females

Background: Oral Contraceptive use, BP and BMI are strongly associated variables in terms of socio economic conditions.  Oral Contraceptives are an important and widely accepted contraceptive modality used throughout the world. Aim & Objective: This study aims to examine the effects of socio-economic factors on Body Mass Index (BMI), Blood pressure (BP) and contraceptive use by reproductive age-group females of Uttarakhand. Settings and Design: This study utilizes nationwide data from the Fourth National Family Health Survey (NFHS-IV). Methods and Material: Information was collected from Indian Institute of Population Sciences (IIPS) Mumbai and 17,300 women of Uttarakhand were considered for this study. Statistical analysis used: For inter age-group comparisons of blood pressure, BMI and socio-demographic indicators, analysis of variance (ANOVA) technique has been used. Results: The variation in mean age at menarche was found to be significant (p< 0.01, ANOVA). The numbers of live births over the women's total lifetime were lower in the younger age groups (p<0.01, ANOVA). Conclusions: The important findings of present study were that the use of contraceptive tended to have increased BMI and elevated blood pressure, even though the magnitude of these was little (equal to 4% and 40% respectively).

The association between glycosylated haemoglobin and newly diagnosed hypertension in a non-diabetic Sudanese population: a cross-sectional study

BACKGROUND

Glycosylated haemoglobin (HbA1c) is considered reliable for diagnosing and monitoring diabetes mellitus (DM). It also indicates cardiovascular complications related to DM. However, only a few studies have been conducted on this topic.

METHODS

We conducted a cross-sectional study to investigate the association between newly diagnosed hypertension and HbA1c among non-diabetic Sudanese adults. The sociodemographic characteristics of the participants in the sample were gathered using a questionnaire, and HbA1c was measured using an Ichroma machine.

RESULTS

Three hundred and eighty-four healthy participants were enrolled in this study. The median (interquartile range [IQR]) age was 56.0 (14.0) years, and 72.1% of the participants were female. The median (IQR) body mass index (BMI) was 31.2 (8.7) kg/m². One hundred and fifteen (29.9%) participants presented newly diagnosed hypertension. The results of the multivariate analysis showed that age (adjusted odd ratio [AOR] = 1.03; 95% confidence interval [CI] = 1.01‒1.05); BMI (AOR = 1.09; 95% CI = 1.05‒1.14); HbA1c levels (AOR = 2.18; 95% CI = 1.29‒3.67) was positively associated with newly diagnosed hypertension. For an HbA1c level of 5.0% or more, the sensitivity and specificity of newly diagnosed hypertension were 91.3% and 28.2%, respectively (area under the curve = 0.61; 95% CI = 0.55-0.67; P ˂ 0.001). Participants who presented HbA1c levels of 5.0% or more were found to be at higher risk for newly diagnosed hypertension (AOR = 2.53; 95% CI = 1.14‒5.61).

CONCLUSION

The results of this study indicated a high prevalence of newly diagnosed hypertension, and HbA1c levels were positively associated with newly diagnosed hypertension.

The Magnitude of NCD Risk Factors in Ethiopia: Meta-Analysis and Systematic Review of Evidence

Background: Non-communicable Diseases (NCDs) and their risk factors are the leading contributors to morbidity and mortality globally, particularly in low- and middle-income countries including Ethiopia. To date, there has been no synthesis of the literature on the relative prevalence of NCD risk factors in Ethiopia. Methodology: We conducted a systematic review and meta-analysis of primary studies reporting on the prevalence of NCD risk factors in Ethiopia published in English from 2012 to July 2020. Pre-tested NCD search terms were applied to Medline, Embase, Scopus, CINAHL, and Global Health. Three reviewers screened and appraised the quality of the identified papers. Data extraction was conducted using a pilot tested proforma. Meta-analysis was conducted using Stata 16 and pooled prevalence estimated with associated 95% confidence intervals. Clinically heterogeneous studies that did not fulfil the eligibility criteria for meta-analysis were narratively synthesised. I² was used to assess statistical heterogeneity. Results: 47 studies fulfilled the inclusion criteria and contributed 68 NCD risk factor prevalence estimates. Hypertension was the most frequently examined NCD risk factor, with a pooled prevalence of 21% (n = 27 studies). The pooled prevalence percentages for overweight and obesity were 19.2% and 10.3%, respectively (n = 7 studies each), with a combined prevalence of 26.8% (n = 1 study). It was not possible to pool the prevalence of alcohol consumption, smoking, metabolic disorders, or fruit consumption because of heterogeneity across studies. The prevalence of alcohol use, as reported from the included individual studies, ranged from 12.4% to 13.5% (n = 7 studies). More than 90% of participants met the WHO-recommended level of physical activity (n = 5 studies). The prevalence of smoking was highly variable, ranging between 0.8% and 38.6%, as was the prevalence of heavy alcohol drinking (12.4% to 21.1%, n = 6 studies) and metabolic syndrome (4.8% to 9.6%, n = 5 studies). Fruit consumption ranged from 1.5% up to the recommended level, but varied across geographic areas (n = 3 studies). Conclusion and recommendations: The prevalence of NCD risk factors in Ethiopia is relatively high. National NCD risk factor surveillance is required to inform the prioritisation of policies and interventions to reduce the NCD burden in Ethiopia.

Trained health extension workers correctly identify high blood pressure in rural districts of northwest Ethiopia: a diagnostic accuracy study

Background

Hypertension is a public health issue in Ethiopia. The vast majority of cases remain undiagnosed and untreated. Early and accurate identification of hypertension can help with timely management and reduce the risk of complications. In resource-constrained rural settings where poor access to care and a shortage of healthcare providers are major barriers, task-sharing of some primary healthcare duties from well-trained healthcare workers to community health workers has been found to be a cost-effective strategy. This study aimed to assess the ability of trained health extension workers to correctly identify high blood pressure among adults in rural areas of northwest Ethiopia.

Methods

A cross-sectional study was conducted in rural areas of northwest Ethiopia from June to October 2020. Trained health extension workers and health professionals measured the blood pressure of 1177 study participants using a calibrated aneroid sphygmomanometer. A Kappa test statistic was used to compare the two sets of measurements for agreement. The sensitivity, specificity, positive, and negative predictive values were used to assess the validity of health extension workers’ ability to identify high blood pressure in comparison to health professionals.

Results

The trained health extension workers and health professionals identified 219 (18.6%) and 229 (19.5%) of the participants with high blood pressure, respectively. The inter-rater agreement between health extension workers and health professionals for high blood pressure detection was 91.2% (k = 0.912, 95% CI: 0.88, 0.94, p-value = 0.000). The sensitivity and specificity of high blood pressure detection by health extension workers were 90.8% (95% CI: 89.6, 92.0) and 98.8% (95% CI: 98.1, 99.5), respectively. While the positive and negative predictive values were 95.0% (95% CI: 92.1, 97.9) and 97.8% (95% CI: 97.3, 98.3), respectively.

Conclusions

The inter-rater agreement between the trained health extension workers and health professionals on high blood pressure detection was excellent. The findings indicate that training health extension workers is a reliable and valid strategy for early detection of hypertension. Thus, the strategy can be integrated with the essential services provided by primary health care units at the village and health post level in rural settings.

Effect of health extension workers led home-based intervention on hypertension management in Northwest Ethiopia, 2021: study protocol for a cluster randomised controlled trial

INTRODUCTION

Although hypertension is highly prevalent in Ethiopia, it is poorly diagnosed, treated and controlled. Poor access to care and a shortage of healthcare providers are major barriers. This study aims to evaluate the effects of health extension workers' led home-based intervention on hypertension management in patients with hypertension in rural districts of northwest Ethiopia.

METHODS AND ANALYSIS

A two-arm cluster randomised controlled trial will be conducted among 456 hypertensive patients. Adults aged ≥25 years who have a diagnosis of hypertension both in the home-based hypertension screening study and at another measurement prior to recruitment will be eligible for the study. Randomisation will be done at the kebele level. In the intervention clusters, trained health extension workers will provide home-based intervention for hypertensive patients every 2 months for 9 months. The primary outcomes of the trial will be clinical linkage and blood pressure changes, whereas the secondary outcomes will be lifestyle modification, medication adherence and blood pressure control. Intention-to-treat analysis will be used for all primary analyses. A linear mixed-effect regression model will be used to model the change in blood pressure, while a mixed effect logistic regression model will be used to evaluate the intervention's effect on the binary outcomes. Effect sizes such as mean difference for the continuous outcomes and relative risk, attributable risk and population attributable risk for binary outcomes will be used. All statistical analyses are two sided and a p<0.05 will be used.

ETHICS AND DISSEMINATION

This study has been approved by institutional review board of the University of Gondar (Ref. No: V/P/RCS/05/2293/2020). The district's health office will grant permission for cluster randomisation, and each participant will provide written informed consent for participation. The findings will be presented at scientific conferences and published in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

PACTR202102729454417.

Prevalence of hypertension and its associated factors in Hawassa city administration, Southern Ethiopia: Community based cross-sectional study

Background

In association with the epidemiological, nutritional and demographic transition, many research findings showed that the number of risk factors that leads to increased prevalence of hypertension in low and middle income countries like Ethiopia is increasing. Several urban specific studies conducted in Ethiopia showed varying prevalence of hypertension. The aim of this study was to determine prevalence of hypertension and to identify factors associated with hypertension in Hawassa city administration, Southern Ethiopia.

Methods

A community-based cross sectional study was carried out in Hawassa city administration in 2017. A multi-stage sampling technique was used to select 612 study participants. Descriptive statistics was used to describe socio-demographic, behavioral and anthropometric variables. The economic status of household, ‘wealth index’, was constructed by running principal component analysis. Binary logistic regression analysis was performed to assess factors associated with hypertension at 95%CI.

Results

The overall prevalence of hypertension was 21.2% (95% CI: 18.1–24.7), (24.5% for urban and 14.7% for peri-urban). About two fifths of hypertension cases (42.3%) were newly diagnosed with elevated blood pressure during data collection. Age, occupation, wealth status, consuming vegetables and animal fat, usual mode of transport, body mass index (BMI), family history of hypertension and existence of diabetes were associated with presence of hypertension at 95%CI. The average diastolic blood pressure for urban was 2.18mmHg higher than that of peri-urban groups (p-0.01).

Conclusion

More than one fifth of study participants had hypertension and about two fifths of hypertension cases were newly diagnosed. Health communication should be strengthened focusing on identified risk factors and attention should be given to early detect and tackle the effects of hypertension in resource limited setting.

Uncontrolled blood pressure among hypertensive adults with rheumatoid arthritis in Saudi Arabia: A cross-sectional study

ABSTRACT

Despite the availability and advancement of diagnostic and treatments with demonstrated benefits in minimizing cardiovascular morbidity and mortality, hypertension control rates remain suboptimal. Therefore, this research aimed to determine the prevalence of uncontrolled BP in rheumatoid arthritis (RA) patients and understand all potential risk factors for uncontrolled BP.We conducted a cross-sectional study on RA patients in 2 rheumatology clinics in 2 public hospitals in Riyadh. Patients' information such as demographics, comorbidities, drug use, and other clinical data were captured through a review of medical records and supplemented by patient interviews. Multivariate logistic regression was utilized for the analysis to identify the significant factors of uncontrolled BP (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg).In total, 834 subjects with RA and concomitant BP were involved in this cross-sectional study. The prevalence of uncontrolled BP was found to be 31.65% among all the study population. Multivariate analysis showed that males, subjects above 60 years of age, and smokers had a distinctly higher occurrence of uncontrolled BP. Among the patients with comorbid conditions, those with obesity, hyperlipidemia, diabetes, anemia, cancer, and reflex or gastroesophageal reflux disease also showed a significantly higher risk of uncontrolled BP (P < .05).The rate of uncontrolled BP was found to be alarmingly high in the study population. Age, gender, smoking, diabetes, obesity, hyperlipidemia, cancer, gastroesophageal reflux disease, and osteoporosis are independently linked with lack of BP control.

Addressing the Impact of Noncommunicable Diseases and Injuries (NCDIs) in Ethiopia: Findings and Recommendations from the Ethiopia NCDI Commission

BACKGROUND

Noncommunicable diseases and injuries (NCDIs) are the leading causes of premature mortality globally. Ethiopia is experiencing a rapid increase in NCDI burden. The Ethiopia NCDI Commission aimed to determine the burden of NCDIs, prioritize health sector interventions for NCDIs and estimate the cost and available fiscal-space for NCDI interventions.

METHODS

We retrieved data on NCDI disease burden and concomitant risk factors from the Global Burden of Disease (GBD) Study, complemented by systematic review of published literature from Ethiopia. Cost-effective interventions were identified through a structured priority-setting process and costed using the One Health tool. We conducted fiscal-space analysis to identify an affordable package of NCDI services in Ethiopia.

RESULTS

We find that there is a large and diverse NCDI disease burden and their risk factors such as hypertension and diabetes (these conditions are NCDIs themselves and could be risk factors to other NCDIs), including less common but more severe NCDIs such as rheumatic heart disease and cancers in women. Mental, neurological, chronic respiratory and surgical conditions also contribute to a substantial proportion of NCDI disease burden in Ethiopia. Among an initial list of 235 interventions, the commission recommended 90 top-priority NCDI interventions (including essential surgery) for implementation. The additional annual cost for scaling up of these interventions was estimated at US$550m (about US$4.7 per capita).

CONCLUSIONS

A targeted investment in cost-effective interventions could result in substantial reduction in premature mortality and may be within the projected fiscal space of Ethiopia. Innovative financing mechanisms, multi-sectoral governance, regional implementation, and an integrated service delivery approach mainly using primary health care are required to achieve these goals.

Estimating the burden of hypertension and its significant risk factors among male commercial drivers in sub-Saharan Africa: A systematic review and meta-analysis

OBJECTIVE

The study was designed to assess the burden and significant risk factors among male commercial drivers in sub-Saharan Africa (SSA).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline via PubMed, Google Scholar, Cochrane databases and Africa Journal Online were searched from January 2010 to December 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The authors included observational studies reporting on the burden and/or risk factors for hypertension among commercial drivers in SSA. Male adult population ≥18 years working as a commercial driver in SSA as well articles published in English.

DATA EXTRACTION AND SYNTHESIS

Two independent coauthors used a prepared data extraction form to extract data from the eligible published papers and assessed the risk of bias. DerSimonian and Laird random effects model was used to pool the burden of hypertension and significant risk factors among male commercial drivers in SSA. The presence of heterogeneity among studies was quantified by estimating variance using both Cochrane's Q statistics and the I² statistics. A subgroup and sensitivity analyses were performed.

RESULTS

Overall, 14 articles met the inclusion criteria involving a total of 4285 male commercial drivers in SSA. The estimated pooled burden of hypertension among the male commercial drivers in SSA was 32% (95% CI 24% to 39%). The risk factors identified were age OR=1.10 (95% CI 1.06 to 1.15), overweight/obese OR=3.38 (95% CI 2.46 to 4.29), alcohol consumption OR=3.00 (95% CI 2.05 to 3.95) and duration of driving (≥5 years) OR=1.83 (95% CI 1.03 to 2.63). Funnel plot inspection and Egger's regression test of small effect (0.5838) showed no evidence of publication bias.

CONCLUSIONS

Our review showed that nearly one-third of male commercial drivers in SSA have hypertension. Reduction of modifiable risk factors such as overweight/obesity, alcohol consumption and long-term driving through multifaceted implementation strategies are recommended for prevention and control of hypertension among male commercial drivers in SSA.

TRIAL REGISTRATION NUMBER

CRD42021250910.

Prevalence of hypertension, and related factors among adults in Wolaita, southern Ethiopia: A community-based cross-sectional study

INTRODUCTION

Hypertension is a global public health challenge. There is a lack of evidence on the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia.

AIM

To assess the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted on 2483 adult residents, selected using a two-stage random sampling technique. The quantitative data collected from structured questionnaires; anthropometric and biochemical measurements were entered into EpiData version 3.1 using double-entry systems. We determined the weighted prevalence of hypertension and pre-hypertension for the two-stage survey. The multivariate logistic regression analysis was used to assess factors associated with hypertension and carried out after declaring the data set as survey data to account for the effect of clustering. An adjusted coefficient with 95% CI was used to ascertain the significance of the association.

RESULTS

The weighted prevalence of hypertension and prehypertension in the Wolaita area was 31.3% (27.7%-35.1%) and 46.4% (42.9%-50.0%) respectively. The weighted prevalence of hypertension of those who were not aware of their hypertension until the time of the survey was 29.8%% (26.5%-33.3%). Where the weighted prevalence of self-reported cases of hypertension was 2.2% (1.2%-3.8%). Obesity, sugar-sweetened food consumption, male sex, elevated total cholesterol, raised fasting blood sugar, and advancing age were positively associated with hypertension.

CONCLUSION

The prevalence of hypertension among adults in Wolaita was high. A small proportion of the affected people are aware of their high blood pressure. This study reported a high prevalence of pre-hypertension; which indicates a high percentage of people at risk of hypertension. It is essential to develop periodic screening programs, and primary intervention strategies such as the prevention of obesity, and reduction of sugar-sweetened food consumption.

Development and Psychometric Validation of the Hypertension Beliefs Assessment Tool Among Adult Population in Northwest Ethiopia

BACKGROUND

In Ethiopia, the majority of hypertension cases remain undiagnosed, untreated, and uncontrolled. Beliefs about hypertension and its complications play an important role in hypertension management behaviors. Accurate assessment of individuals' beliefs towards the disease is of paramount importance in the design of hypertension education. This study aimed to develop and validate a hypertension belief assessment tool based on the Health Belief Model for the general population among rural adults in northwest Ethiopia.

METHODS

The study included item construction, face and content validation, factor analysis, and establishment of reliability and validity of the tool. A total of 308 rural adults participated in the study. Inter-item and item-to-total correlations were used to examine the items assessed with the same content on a scale. Principal component analysis with promax rotation was used to extract the factors. Internal consistency reliability was assessed using Cronbach's alpha coefficient. Convergent and discriminant validity were assessed using average variance extraction and maximum shared variance.

RESULTS

The median age of the participants was 41 (IQR: 31-55) years. Of the participants, 175 (56.8%) were female and 287 (93.2%) were farmers. Kaiser-Meyer-Olkin test value of 0.84 and significant Bartlett's test of sphericity (p=0.000) revealed that the data were suitable for exploratory factor analysis. The principal component analysis identified 6 factors, which explained 70.06% of the variation of the hypertension belief. Cronbach's alpha was 0.85 for the entire scale, ranging from 0.74 to 0.92 for the sub-domains. The average variance extracted was above 0.5 for all factors, indicating convergent validity. The maximum shared variance between the two constructs was lower than the average variance extracted from each factor, indicating that discriminating validity had been established.

CONCLUSION

The hypertension belief assessment tool was found to be valid and reliable, which can be used to measure the health beliefs on hypertension for the rural adult population.

Metabolic risk factors for non-communicable diseases in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Non-communicable diseases (NCDs) are causing a new and yetsignificant health challenge in low-income countries. In Ethiopia, although 39% of deaths are NCD related, the health system remains underprepared, highlighting the clear need for evidence on risk factor distributions to inform resource planning and the health response. Therefore, this review investigates prevalence distributions and sex and age variations of metabolic risk factors among Ethiopian adults.

RESEARCH DESIGN AND METHODS

This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published until 6 January 2021 were searched from PubMed, Scopus, ProQuest and Web of Science databases, reference lists of selected studies and grey literature. Studies reporting prevalence of metabolic risk factors: overweight/obesity, hypertension, impaired glucose homoeostasis and metabolic syndrome among Ethiopian adults were eligible for this systematic review and meta-analysis. Two authors independently extracted data and used the Joanna Briggs Institute tool for quality appraisal. The random effects model was used to conduct meta-analysis using Stata V.16. Subgroup analyses examined prevalence differences by region, study year, sample size and settings.

RESULTS

From 6087 records, 74 studies including 104 382 participants were included. Most showed high prevalence of metabolic risk factors. Meta-analysis revealed pooled prevalence of metabolic risk factors from 12% to 24% with the highest prevalence observed for overweight/obesity (23.9%, 95% CI 19.9% to 28.0%) and hypertension (21.1%, 95% CI 18.7% to 23.5%), followed by metabolic syndrome (14.7%, 95% CI 9.8% to 19.6%) and impaired glucose tolerance (12.4%, 95% CI 8.7% to 16.1%). The prevalence of overweight/obesity was higher in women. All metabolic risk factors were higher among people aged above 45 years.

CONCLUSIONS

A signficant proportion of Ethiopian adults have at least one metabolic risk factor for NCDs. Despite heterogeneity of studies limiting the certainty of evidence, the result suggests the need for coordinated effort among policymakers, healthcare providers, non-governmental stakeholders and the community to implement appropriate preventive measures to reduce these factors.

Prevalence and predictors of prehypertension and hypertension in adult population of rural Southern India-An epidemiological study

Introduction:

Hypertension is considered as one of the major health problem worldwide and the most important risk factor for non-communicable diseases.

Aims:

To estimate the prevalence and the risk factors of prehypertension and hypertension.

Methods and Material:

A community-based cross-sectional study was conducted among adult population of rural area of Chittoor District. WHO STEPS was applied for data collection from 1,742 study participants aged 18 years and above. Chi-square test, Fisher exact, and ANOVA test applied to find out the intragroup and intergroup variable association with raised blood pressure.

Results:

The overall prevalence of hypertension and prehypertension in our study was 21.5% [95% CI: (19.6–23.5)] and 42.8% [95% CI: (39.5–46.3)], respectively. Males had higher prevalence when compared to females. The mean systolic and diastolic blood pressure was 118.7 ± 17.6 mmHg and 77.1 ± 9.7 mmHg, respectively. The odds of being hypertensive was higher among older age group (OR: 3.83), male study participants (OR: 1.83), either widowed or separated (OR: 2.03), unemployed (OR: 1.51), and those who belonged to upper socioeconomic status (OR: 2.01). Those who were overweight (OR: 3.15), obese (OR: 2.55) and having central obesity (OR: 1.74), and also tobacco smokers (OR: 1.53) were having higher odds of hypertension. Significant association was found between hypertension and age, gender, marital status, body mass index, abdominal obesity, tobacco smoking, and physical inactivity.

Conclusion:

The prevalence of prehypertension and hypertension in this study was found to be high in rural area of Andhra Pradesh. There is a need to develop a community-based program, which would aim at minimizing the risk factors of hypertension.

Prevalence of and risk factors for hypertension in Ethiopia: A systematic review and meta-analysis

BACKGROUND

A number of epidemiological studies were performed to know the prevalence of and the risk factors for hypertension. However, these studies reported inconsistent results. As a result, this systematic review and meta-analysis were planned to generate representative data on the prevalence of and risk factors for hypertension among the Ethiopian adult population.

METHODS

Five electronic databases, namely, PubMed, Science Direct, Google Scholar, Hinari, and African Journals Online, were searched for studies published in English from 1 January 2010 to 31 August 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa scale were used for data extraction and quality assessment for this review. Stata version 14 statistical software was used for the analysis, and due to high heterogeneity a random effects model was used for meta-analysis at 95% confidence interval (CI).

RESULTS

In this review, 35 observational studies were included. The pooled prevalence of hypertension in Ethiopia was 20.63% (95% CI [18.70, 22.55]) with the I 2 value of 96.1%. Older age (≥40 years) (adjusted odds ratio [AOR]: 3.46 [95% CI: 2.67, 4.49]), urban residence (AOR: 1.47 [95% CI: 1.28, 1.70]), educational status less than grade 12 (AOR: 1.67 [95% CI: 1.38, 2.01]), family history of hypertension (AOR: 4.33 [95% CI: 2.95, 6.34]), diabetes mellitus (DM) (AOR: 5.18 [95% CI: 3.01, 8.88]), body mass index (BMI) ≥25 (AOR: 3.79 [95% CI: 2.61, 5.50]), central obesity (AOR: 1.91 [95% CI: 1.09, 3.36]), and alcohol consumption (AOR: 1.72 [95% CI: 1.26, 2.34]) were the identified risk factors for hypertension.

CONCLUSION

The pooled prevalence of hypertension is relatively higher as compared to the previous reports in Ethiopia. Older age, urban residence, lower educational coverage, family history of hypertension, DM, BMI ≥25, alcohol consumption, and central obesity were the risk factors for hypertension. The governments and stakeholders should design an appropriate strategy to prevent and control the disease in the Ethiopian population.

Interaction of multiple risk factors and population attributable fraction for type 2 diabetes and hypertension among adults aged 15-49 years in Northeast India

AIMS

The aim is to assess the association and population attributable fraction (PAF) of multiple risk factors combination for diabetes and hypertension among adults in the Northeast region of India.

METHODS

Data used is from the Indian Demographic Health Survey conducted in 2015-16. The study comprised 107, 766 respondents (95,153 females and 12, 613 males) aged 15-49 years. We examined four modifiable risk factors: smoking, alcohol consumption, aerated drinks consumption, and overweight or obesity. PAF was calculated using the relative risk from the multivariable logistic regression models.

RESULTS

Overweight or obesity in conjunction with smoking was associated with 43.9 % of patients with diabetes. Smoking in conjunction with alcohol and overweight or obesity contributed to 53% of patients with diabetes (PAF = 53 %). The three risk factors combination (i.e., smoking, alcohol, and overweight or obesity) is associated with the most hypertension cases (PAF = 50.7 %). Experiencing all four risk factors is associated with 50.3 % of patients with hypertension. In women, the four-risk combination contributed the most hypertension cases (PAF = 46.8 %).

CONCLUSIONS

Overweight or obesity was the single most significant factor leading to hypertension and diabetes among the study population. Also, smoking, alcohol, and overweight or obesity together are prominent risk factors for hypertension and diabetes.

Risk factors associated with hypertension in Bhutan: findings from the National Health Survey

Purpose

This study examined the risk factors associated with hypertension in Bhutan.

Design/methodology/approach

The cross-sectional data of 30,889 adults from the National Health Survey of Bhutan was used in this study. Multivariable regression accounting for the complex survey design was performed to identify the risk factors. The backward elimination approach was applied in the multivariable analysis.

Findings

The prevalence of hypertension was 17%. Increasing age, being female, being previously married, higher wealth status, past alcohol use, having diabetes, loneliness, health service use and low vegetable intake was associated with increased hypertension risk, whereas, higher education level, being employed and residing in the eastern region was associated with reduced risk. Age, gender, education, wealth status, diabetes status, loneliness and health service use were common factors in all the regions. Marital status and vegetable intake were associated with hypertension in the western and central regions, and alcohol use in the eastern and central regions.

Originality/value

Affecting around one-sixth of the population, hypertension is a significant public health problem in Bhutan. Interventions to improve health education and access, motivate healthy lifestyles, and reduce harmful alcohol use, and strategies to create health-promoting social and built environments are needed to curb the hypertension epidemic and its consequences.

Joint modeling of blood pressure measurement and survival time of hypertension patients

Hypertension is a chronic disease that has a major health problem over the centuries due to its significant contribution to the global burden. The objective of this study was to examine the association of survival time and longitudinal Systolic Blood Pressure (SBP) measurement and finding potential barrier that affects SBP measurement and the survival time of hypertension patients. The study considered a cohort of 318 hypertension patients who were aged 18 years or older and were under follow-up from January 1, 2012, to February 30, 2020, at Arba Minch General Hospital. To analyze the data we employed linear mixed effect model, Weibull model, and joint modeling approach for longitudinal and survival data. The results from joint model analysis indicate that systolic blood pressure measurement is significantly associated with survival time of hypertension patients. The results from the longitudinal sub-model reveals that alcohol use, Khat intake, smoking tobacco, stages of hypertension diseases, adherence to treatment, related diseases, and family history had statistical significant relationship with mean change in the [Formula: see text] measurement. Furthermore, from the survival sub-model, we found the survival probability of hypertension patients was determined by family history, stages of hypertension disease, related diseases, and smoking tobacco. The analysis suggests that there is a strong association between SBP measurement and survival time of hypertension patients. Thus we recommend aggressive work by all concerned bodies towards awareness creation about the effect of potential barriers.

The association between social support and medication adherence in patients with hypertension: A systematic review

Background:

Medication adherence is a primary determinant of treatment success in hypertensive patients. One of the challenges for healthcare providers that has received little attention is the impact of patients’ social supports on medication adherence.

Objective:

This review evaluates the impact of patients’ social supports on medication adherence in hypertensive patients.

Methods:

A systematic review methodology was used. Pubmed, CINAHL, Embase, and PsycINFO databases were searched systematically for relevant articles. The outcome measure in the studies was medication adherence in hypertension.

Results:

From 1155 articles, 238 were retained for further assessment, and finally, 14 met the inclusion criteria. Statistically significant positive associations between medication adherence and social support were found in nine studies (p<0.05).

Conclusions:

This review evaluated the impact of social support on medication adherence and highlighted gaps in the literature regarding the impact of social support on adherence. Family members or peer support may promote better adherence in some patient groups. This review suggests that healthcare providers may need to consider whether patients have appropriate social supports in place which will assist them adhering to and benefiting from treatment recommendations.

Prevalence of Hypertension and Associated Factors Among Public Servants in North Wollo Zone, Amhara Region, Ethiopia, 2020

Background

The leading preventable risk factor for premature death and disability worldwide is hypertension. Globally, 31.1% of adults (1.39 billion people) have hypertension and 9.4 million deaths are recorded annually, accounting for 13% of overall mortality.

Objective

The objective of this study is to assess the prevalence of hypertension and associated factors among public servants in North Wollo Zone, Amhara Region, Ethiopia.

Materials and Methods

An institutional-based cross-sectional study was conducted among 627 public servants. To classify candidate variables for multivariable logistic regression, a binary logistic regression model was applied. In order to analyze factors associated with hypertension among participants, all variables with a P-value<0.2 were entered into the multivariable logistic regression model. In order to determine statistical significance, a p value of less than 0.05 was taken. The assumptions of Chi square and multi-collinearity were verified. For model fitness, the Hosmer–Lemeshow goodness-of-fit was checked.

Results

The total hypertension rate was 27.6% (95% CI: 24.1–31.3). The prevalence was higher in males 129 (32.5%) than in females 444 (19.1%). History of diabetes mellitus (AOR= 9.64, 95% CI: 3.20–29.30), age >35 years (AOR= 2.94, 95% CI: 1.91–4.51) and body mass index 25kg/m² and above (AOR= 3.44, 95% CI: 2.21–5.34) have been found to be separately associated with hypertension.

Conclusion and Recommendation

Among public servants in the study setting (study area), hypertension has become a major public health issue. Half of the newly reported cases is hypertensive. The conclusion of this study calls for a more holistic approach to hypertension in terms of hypertension prevention, screening, and proper management.

Participants' Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals

This study aimed to investigate the view of prediabetes and prehypertension elderly patients living around temple on long-term self-management in proficient way underneath the lifestyle intervention program based on both focus-group discussion and In-depth interview methods to fill the gap in partially successful intervention. 62 participants were selected from 220 participants of the quantitative published study by 2 researchers. The triangulation method was used to put great emphasis on the consistency and the credibility of the results. Almost all of the participants had benefited from the program regarding proper foods, suitable exercise and an inspiration of lifestyle modification. They made changes of eating behavior and exercise behavior during program attendance, however, after the program had finished, they had minimal concern to take care of themselves. Nonetheless, more than half of them demonstrated some health-related behaviors changes due to they gave the value of the suggestion in different aspects. Moreover, high-frequency program attendance was not related to blood results improvement. The knowledge obtained from program intervention together with adequate contact between the patient and the program staff, personal problems solving, personal attitude, practice and acceptable played a key role for long-term lifestyle modification and completely successful intervention.

Epidemiology of hypertension in selected towns of Wollega zones, Western Ethiopia, 2019: A community-based cross-sectional study

Introduction:

Hypertension remains an emerging public health problem globally, particularly in developing countries. Age, income level, obesity, alcohol consumption, smoking, vegetables and fruit consumption, physical activity and chat chewing were some risk factors of hypertension. However, there are limited data on the epidemiology of hypertension in Ethiopia. This study aimed to assess Epidemiology of Hypertension among the community of selected towns of Wollega zones.

Methods:

A community-based cross-sectional study was conducted from 1 to 30 June 2019 in selected towns of Wollega zones. A multistage sampling technique was used to select 840 study participants. Data were collected using the WHO STEP wise approach. The data were coded and entered into EpiData 3, and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regression analyses were conducted. Statistical significance was declared at p-value < 0.05.

Results:

The study included a total of 838 respondents with a response rate of 99.7%. The prevalence of hypertension was found to be 189 (22.6%) (95% confidence interval = 19.9%–25.2%). Of this, 108 (12.9%) and 81 (9.7%) of female and male were hypertensive, respectively. Age groups of 30–44 years (adjusted odds ratio = 2.65 (1.43, 4.89)), 45–59 years (adjusted odds ratio = 3.55 (1.79, 7.04)), above 60 years (adjusted odds ratio = 2.97 (1.43, 6.18)), having history of alcohol consumption (adjusted odds ratio = 4.29 (2.4, 7.66)), involving in vigorous physical activity (adjusted odds ratio = 0.096 (0.028, 0.33)), not walking to and from the work (adjusted odds ratio = 13.12 (8.34, 20.67)), being overweight (adjusted odds ratio = 1.98 (1.21, 3.25)), inadequate fruits serving per day (adjusted odds ratio = 2.93 (1.75, 4.88)) were significantly associated with hypertension.

Conclusion:

The prevalence of hypertension was found to be high in the study area. Older age, alcohol consumption, not engaging in vigorous activity, physical inactivity, being overweight and inadequate intake of fruits were found to be risk factors for hypertension. Therefore, health care providers should provide extensive health education and promotion on recommended lifestyle modification to tackle the burden of hypertension.

Survival Time to Development of Hypertension and Its Predictors among a Cohort of Diabetic Patients in Health Facilities of Gurage Zone: A Retrospective Follow-Up Study

Background

It is expected that around 50% of individuals with diabetes mellitus will develop hypertension in the course of medical follow-up. However, with strict medical follow-up and adherence to medical advice the incidence of hypertension can be highly reduced and the time to occurrence can be delayed. Therefore, this paper aimed to measure the time to development of hypertension and identify its predictors among a 10-year cohort of diabetic patients who have medical follow-up in health facilities of Gurage Zone.

Methods

An institution-based retrospective cohort study was conducted in diabetic follow-up clinics of Gurage Zone by reviewing 540 consecutively selected records among the records enrolled from January 1, 2010 to December 31, 2019. The outcome variable was incidence rate and survival time to the occurrences of hypertension (a systolic blood pressure at or above 140 mmHg and/or a diastolic blood pressure at or above 90 mm Hg and known hypertensive cases taken from adults’ age ≥18 years) among admitted diabetic patients (fasting blood sugar ≥126 mg/dL or random blood sugar ≥200 mg/dL). Data were collected using a standardized checklist by trained professionals by reviewing records of all clients ever enrolled. Data were cleaned and entered by Epi info version 7 and analyzed by STATA. A Cox-proportional hazard regression model was built to identify predictors of development of hypertension.

Results

A total of 540 clients were followed for different periods with a median follow-up period of 2.3 years which gives 3,200 person-years of observation. Two hundred and seventy-six (51.1%) participants were males and the mean age of was 52.2 (+11.7) years. Three hundred (55.6%) participants were urban dwellers. The overall incidence density rate (IDR) of hypertension in the cohort was 48.6 cases per 1,000 persons-year. Older ages adjusted hazard ratio (AHR)=4.0 (95% CI=2.26–7.82), body mass index (BMI) >25 kg/m² AHR=2.3 (95% CI=1.06–3.68), Type II diabetes mellitus (DM) AHR=2.0 (95% CI=1.16–3.04), presence of comorbidity AHR=2.9 (95% CI=1.74–4.58), and poor drug adherence AHR=2.5 (95% CI=1.45–4.65) predicted the development of hypertension.

Conclusion

The risk of occurrences of hypertension among diabetic patients was high at the early periods and the risk was less at the late diabetic periods and the incidence density rate of hypertension among diabetic patients was high. In addition, age, BMI, type of DM, comorbidity, and drug adherence were independent predictors of occurrences of hypertension. Therefore, intervention to further reduce its occurrence has to focus on drug adherence and prevention of infection.