Admission and Inpatient Mortality of Hypertension Complications in Addis Ababa

Undiagnosed hypertension and associated factors among long-distance bus drivers in Addis Ababa terminals, Ethiopia, 2022: A cross-sectional study

INTRODUCTION

Hypertension is a major public health problem that is often unrecognized, and its detection and control should be prioritized. The level of undiagnosed hypertension and its associated factors among long-distance bus drivers in Ethiopia is unknown.

OBJECTIVE

This study aimed to assess the magnitude of undiagnosed hypertension and its associated factors among long-distance bus drivers in Addis Ababa bus terminals.

METHODS

A facility-based cross-sectional study was conducted on 391 long-distance bus drivers from December 15, 2021, to January 15 2022 at five cross-country bus terminals in Addis Ababa. A standardized and structured questionnaire was adapted based on the WHO stepwise approach to a non-communicable disease study and translated into Amharic. Data were coded, cleaned, and entered using Epi-data version 4.6 and exported to SPSS version 26. Logistic regression analysis was performed. Variables with a P-value < 0.25 in the bivariable analysis were selected for multivariable logistic regression analysis. Independent variables with a P-value < 0.05 were considered statistically significant. The magnitude of association between independent and dependent variables was measured by odds ratio with a 95% confidence interval.

RESULTS

In this study, 391 study participants were involved with a response rate of 97.1%. The prevalence of undiagnosed hypertension was 22.5% (CI: 18.7%, 26.6%). Poor level of knowledge (AOR: 2.00, CI: 1.08, 3.70), long duration of driving per day (AOR: 2.50, 95% CI: 1.37-4.56), habit of chewing of chat (AOR: 2.61, 95% CI: 1.44, 4.73), regular alcohol consumption (AOR = 3.46; 95% CI: 1.70, 7.05), overweight (AOR:3.14, 95%CI: 1.54,6.42) obesity (AOR: 3.21, 95% CI 1.35, 7.61) and regular physical exercise (AOR: 0.16, 95% CI: 0.09, 0.29) were statistically significantly associated with undiagnosed hypertension.

CONCLUSION

This study revealed that the prevalence of undiagnosed hypertension among long-distance bus drivers was 22.5%, which was associated with modifiable behavioral factors, lack of regular physical exercise, lack of adequate awareness and high body mass index.

RECOMMENDATION

Stakeholders must implement the necessary preventive measures. These include increasing the level of awareness of hypertension among long-distance drivers and developing prevention of hypertension strategies and policies focusing on lifestyle and behavioral modifications.

Incidence and predictors of hypertension among diabetic patients attending a diabetic follow-up clinic in Ethiopia: a retrospective cohort study

OBJECTIVE

To assess the incidence and predictors of hypertension among patients with diabetes attending a diabetes follow-up clinic.

METHODS

This institution-based retrospective cohort study was conducted among patients with diabetes who attended a diabetic follow-up clinic at Asella Referral and Teaching Hospital between January 2017 and December 2021. Patients diagnosed with hypertension prior to diabetes, or diagnosed with hypertension at the start of follow-up, were excluded. Data were extracted from medical records and analysed.

RESULT

A total of 351 patients with diabetes were included. The incidence density rate (IDR) of hypertension during 688.98 person-years of observation was 58.05 per 1000 (95% confidence interval [CI] 42.58, 79.14) person-years. The cumulative incidence of hypertension was 11.4% (95% CI 8.05, 14.7%) over 5 years. The 25th percentile survival time to hypertension development was 4.6 years. Multivariable Cox proportional hazard regression analysis showed that older age (adjusted hazard ratio [HR] 6.24, 95% CI 3.13, 12.45), family history of hypertension (adjusted HR 1.67, 95% CI 1.22, 9.65), comorbidity (adjusted HR 2.20, 95% CI 1.94, 5.21) and higher body mass index (adjusted HR 2.07, 95% CI 1.23, 5.63) were statistically significant predictors of hypertension development.

CONCLUSION

Among patients with diabetes in Ethiopia, the IDR of hypertension was high; and older age, family history of hypertension, comorbidity and higher body mass index were statistically significant predictors of hypertension development.

Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study

INTRODUCTION

Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS.

MATERIALS AND METHODS

This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS.

RESULTS

A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria.

CONCLUSION

This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

Correlation of polypill and blood pressure level: A systematic review of clinical trials

BACKGROUND

High blood pressure (BP) is considered as the most important risk factor for cardiovascular disease (CVD). The main aim of this study was to investigate the effect of polypill on BP by reviewing clinical trial studies.

MATERIALS AND METHODS

In this systematic review study, online databases such as PubMed, Scopus, and Web of Science databases with no limited time were systematically searched until July 10, 2020. Clinical trial studies published in English that examined the effect of polypill on BP were included. BP was the main outcome investigated.

RESULTS

Eleven original articles with a population of 17,042 people were reviewed. The polypill drugs studied in this study had different compounds. Compared to conventional care, treatment with polypill compounds has a positive and significant effect on lowering BP (P < 0.05).

CONCLUSION

Our finding confirmed that polypills could reduce BP in patients. It seems that changing routine care and replacing it with a polypill strategy could facilitate the achievement of BP control goals.

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.

Predictors of inpatient admission likelihood and prolonged length of stay among cerebrovascular disease patients: A nationwide emergency department sample analysis

PURPOSE

To examine the hospital- and patient-related factors associated with increased likelihood of inpatient admission and extended hospitalization.

METHODS

We applied multivariate logistic regression to a subset of ED hospital and patient characteristics linearly extrapolated from the 2019 National Emergency Department Sample database (n=626,508). Patient characteristics with 10 or fewer ED visits after national extrapolation were not reported in the current study to maintain patient confidentiality, in accordance with the HCUP Data Use Agreement. All selected ED visits represented a primary diagnosis of CVD (ICD-10 codes 160-168). All reported hospital and patient characteristics were subject to adjustment for covariates. P-values < 0.05 were considered statistically significant.

MAIN FINDINGS

Medicare beneficiaries report higher inpatient admission rates than uninsured OR 0.81 (0.73-0.91) and privately insured OR 0.86 (0.79-0.94) individuals. Black and Native-American patients were 37% and 55% more likely to be hospitalized long (>75^th percentile) (OR 1.37 [1.25-1.50], OR 1.55 [1.14-2.10]). Northeast emergency departments reported an increased odds of admission compared to the Midwest OR (0.40-0.62), South OR 0.79 (0.63-0.98) and West OR 0.52 (0.39-0.69). Patients with multiple comorbidities (mCCI = 3+) were 226% more likely to have a longer stay OR 3.26 (3.09-3.45) than patients presenting with zero or few comorbidities. Level I, II, and III trauma centers report distinctly high odds of inpatient admission (OR 3.54 [2.84-4.42], OR 2.68 [2.14-3.35], OR 1.51 [1.25-1.84]).

PRINCIPAL CONCLUSIONS

Likelihoods of inpatient admission and long hospital stays were observably stratified through multiple, independently acting hospital and patient characteristics. Significant associations were stratified by race/ethnicity, location, and clinical presentation, among others. Attention to the factors reported here may serve well to mitigate emergency department crowding and its sobering impact on United States healthcare systems and patients.

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.

In‐hospital outcomes of patients with a hypertensive emergency at a medical center, Ethiopia: A prospective observational study

Background

Hypertensive emergency is associated with substantial complications and loss of life across the world. Early identification and treatment of hypertensive emergency complications are critical to prevent or avoid any consequences. Despite this, in Ethiopia, studies addressing mortality rate and its predictors as well as complications of hypertensive emergency are limited.

Aims

This study aim to evaluate in‐hospital mortality of patients admitted with a hypertensive emergency at the emergency ward of Jimma Medical Center.

Methods

A consecutive sample of 140 adult (≥18 years of age) patients with a hypertensive emergency were recruited from September 1, 2020 to February 25, 2021 at Jimma Medical Center, Ethiopia and were followed up from admission to discharge/death. Patients who declined to participate and readmitted during the study period were excluded. To assess factors associated with in‐hospital mortality, bivariate and multivariate Cox regression analyses were performed. A p value of less than 0.05 was used to declare the statistical significance.

Results

Over three‐fourths of the study participants, that is, 108 (77.1%), were males with a mean (±standard deviation) age of 52.8 ± 13.6 years. Hemorrhagic stroke, 53 (38.0%), and acute kidney injury, 38 (27.1%), were the most common complications of hypertensive emergency. The average (±standard deviation) length of stay in the hospital was 8.53 ± 3.61 days. During in‐hospital follow‐up, 16 patients (11.4%, 95% confidence interval: 6.7–17.9) died. Multivariate Cox regression analysis showed that there was a significant relationship between patients not doing regular physical exercise before the current admission (adjusted hazard ratio = 4.629, 95% confidence interval: 1.171–18.294, p = 0.015) and in‐hospital mortality.

Conclusion

More than one‐tenth of patients with hypertensive emergency death was recorded at Jimma Medical Center. The frequent complications of hypertensive emergency were hemorrhagic stroke and acute renal injury. Not doing regular physical exercise before the current admission raises the likelihood of in‐hospital death. Therefore, strengthening and encouraging patients to perform regular physical exercise is imperative.