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Abu Hamad BA, Jamaluddine Z, Safadi G, Ragi ME, Ahmad RES, Vamos EP, Basu S, Yudkin JS, Jawad M, Millett C, Ghattas H. The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip. J Hum Hypertens 2023; 37:957-968. [PMID: 36509988 PMCID: PMC9744039 DOI: 10.1038/s41371-022-00783-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
Although hypertension constitutes a substantial burden in conflict-affected areas, little is known about its prevalence, control, and management in Gaza. This study aims to estimate the prevalence and correlates of hypertension, its diagnosis and control among adults in Gaza. We conducted a representative, cross-sectional, anonymous, household survey of 4576 persons older than 40 years in Gaza in mid-2020. Data were collected through face-to-face interviews, anthropometric, and blood pressure measurements. Hypertension was defined in anyone with an average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg from two consecutive readings or a hypertension diagnosis. The mean age of participants was 56.9 ± 10.5 years, 54.0% were female and 68.5% were Palestinian refugees. The prevalence of hypertension was 56.5%, of whom 71.5% had been diagnosed. Hypertension was significantly higher among older participants, refugees, ex-smokers, those who were overweight or obese, and had other co-morbidities including mental illnesses. Two-thirds (68.3%) of those with hypertension were on treatment with one in three (35.6%) having their hypertension controlled. Having controlled hypertension was significantly higher in females, those receiving all medications for high blood pressure and those who never or rarely added salt to food. Investing in comprehensive but cost-effective initiatives that strengthen the prevention, early detection and timely treatment of hypertension in conflict settings is critical. It is essential to better understand the underlying barriers behind the lack of control and develop multi-sectoral programs to address these barriers.
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Affiliation(s)
| | - Zeina Jamaluddine
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gloria Safadi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Marie-Elizabeth Ragi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Raeda El Sayed Ahmad
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Sanjay Basu
- Research and Development, Waymark, San Francisco, CA, USA
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Comprehensive Health Research Centre and Public Health Research Centre, National School of Public Health, NOVA University, Lisbon, Portugal
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
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Gusty R, Effendi N, Abdullah KL, Syafrita Y. Association between Knowledge and Self-care Adherence among Elderly Hypertensive Patient in Dwelling Community. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Hypertension contributes significantly to the increase in cardiovascular disease cases, especially in the elderly. Knowledge and self-care compliance are needed, but in reality, awareness and regularity of control are still lacking in hypertensive patients in urban communities.
AIM: The aim of the study was to determine the relationship of knowledge with self-care and get an overview of existing knowledge and self-care in the elderly with hypertension.
METHODS: This is a quantitative and cross-sectional design recruited 383 hypertensive patients in three community health centers. Sampling with proportional random sampling from three health centers that have the highest cases of hypertension in the city of Padang. Knowledge instrument using hypertension knowledge-level scale. Moreover, hypertension self-care adherence using hypertension self-care activity level effects. Analysis using Chi-square test
RESULTS: The sample of this study was 383 respondents. About 66.3% are women, 88.3% have low education, and 86.9% do not work. 51.2% had duration of hypertension 0–5 years and the average age was 60.89 ± 8.072 years. About 94.8% of respondents have poor knowledge. Self-care practice showed 64% non-adherence to medication, 88.5% non-adherence to the DASH diet, and 82.5% non-adherence to weight management. However, 78.6% indicated non-smoking adherence and 100% alcohol avoidance adherence. There was a relationship between knowledge and adherence to weight management (p=0.000; odds ratio [OR] 6.7 (95% confidence interval [CI] for Exp B; 2.65–16.91)) and physical activity (p=0.000; OR 14.99 (95% CI for Exp B; 5.65–39.79)).
CONCLUSION: Providing comprehensive and repeated health education for the elderly with hypertension can increase their knowledge. The involvement of patients and families is needed to improve self-care behavior.
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Gebremedhin MH, Lake EA, Gebrekirstos LG. Heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in Southwest, Ethiopia: Unmatched case-control study. PLoS One 2021; 16:e0259078. [PMID: 34699551 PMCID: PMC8547649 DOI: 10.1371/journal.pone.0259078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The burden of hypertension is more devastating in low-and middle-income countries, including sub-Saharan Africa than in high-income countries. Among the modifiable risk factors, dyslipidemia and khat chewing were expanding at an alarming rate in Ethiopia but were still underestimated. Thus, this study aimed to assess heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in the southwest, Ethiopia. METHODS A facility-based case-control study was conducted among 136 cases and 270 controls from May 15 to July 30, 2017. A consecutive sampling technique was used in this study. Epi data version 3.1.1 and SPSS version 21 were used for data entry and analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. Both crude and adjusted odds ratios and 95% confidence intervals were reported. RESULTS The majority of the cases had a total cholesterol to high-density lipoprotein ratio of >5 (72.1%). The odds of hypertension increased among participants who had attended no formal education [AOR = 2.25, 95% CI: (1.05-4.82)], history of alcohol consumption [AOR = 5.93,95% CI:(3.11-11.30)], moderate khat chewing [AOR = 3.68, 95% CI:(1.69,8.01)], heavy khat chewing [AOR = 18.18, 95% CI: (3.56-92.89)], mild intensity physical activity [AOR = 3.01, 95% CI: (1.66-5.47)], type of oil used for food preparation [AOR = 2.81, 95% CI: (1.49-5.28)], and dyslipidemia [AOR = 6.68, 95% CI: (2.93-15.23)]. CONCLUSION The study showed that modifiable risk factors were the major factors associated with the development of hypertension. The findings of this study highlighted that health education is needed to focus on physical exercise, quitting excess alcohol consumption, quitting khat chewing by giving special emphasis to those who had no formal education. In addition, consideration should be given to a healthy diet free of cholesterol and unhealthy behavior.
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Affiliation(s)
- Meron Hadis Gebremedhin
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eyasu Alem Lake
- Department of Pediatrics and Child Health Nursing, Wolaita Sodo University, Wolaita Sodo, Southern Ethiopia
| | - Lielt Gebreselassie Gebrekirstos
- Department of Maternity and Reproductive Health Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Khadoura K, Shakibazadeh E, Mansournia MA, Aljeesh Y, Fotouhi A. Determining the Prevalence of and the Factors Associated with Antihypertensive Medication Non-Adherence in the Gaza Strip. Korean J Fam Med 2020; 42:150-158. [PMID: 32114750 PMCID: PMC8010434 DOI: 10.4082/kjfm.19.0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/05/2019] [Indexed: 01/19/2023] Open
Abstract
Background This study aimed to estimate the prevalence of and determine the factors associated with antihypertensive medication (A-HTNM) non-adherence among hypertension care seekers attending primary health clinics in the Gaza Strip. Methods A cross-sectional survey was conducted as the recruitment phase of a clustered randomized controlled trial including 538 participants. The participants were randomly selected from 10 primary health care centers by two-stage cluster random sampling. A structured questionnaire was used to collect data through face-to-face interview. The questionnaire was developed based on the World Health Organization determinants for medication non-adherence and the Health Belief Model. The main outcomes of this study were the prevalences of A-HTNM non-adherence and its associated factors. Adherence status was assessed using the eight-item Morisky Self-Report Medication Adherence Scale. Data were analyzed by STATA ver. 14.0 (Stata Corp., College Station, TX, USA) using a standard complex survey, accounting for unresponsiveness and the clustering sampling approach. Results The overall prevalence of A-HTNM non-adherence was 65.8% (95% confidence interval [CI], 59.2–71.8). Among all studied predictors, only self-efficacy of participants (odds ratio [OR], 3.8; 95% CI, 1.79–2.84) and social support (OR, 2.26; 95% CI, 2.82–5.11) remained significantly associated with A-HTNM non-adherence after adjusting for age, education level, number and frequency of A-HTNM doses per day, and comorbidities. Conclusion The high prevalence of non-adherence highlights the need for serious intervention to enhance the adherence rate among hypertension patients. The associated factors can be considered when developing appropriate interventions.
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Affiliation(s)
- Khalid Khadoura
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences International Campus, Tehran, Iran.,Department of Nursing, Faculty of Health Professions, Israa University, Gaza, Palestine
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Aljeesh
- Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Effect of vitamin E supplementation on blood pressure: a systematic review and meta-analysis. J Hum Hypertens 2019; 33:499-507. [DOI: 10.1038/s41371-019-0192-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
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Abd Elaziz KM, Dewedar SA, Sabbour S, El Gafaary MM, Marzouk DM, Aboul Fotouh A, Allam MF. Screening for hypertension among adults: community outreach in Cairo, Egypt. J Public Health (Oxf) 2014; 37:701-6. [PMID: 25355687 DOI: 10.1093/pubmed/fdu085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Studies have shown alarming levels of hypertension among adults in the Middle East. The aim of our study is to measure the prevalence rate of hypertension among adults in Cairo (Egypt), identify possible risk factors for the development of hypertension and assess the rates of undiagnosed and uncontrolled hypertension. METHODS Cluster sampling was utilized and the fieldwork was conducted by 12 teams; each team consisted of a house officer, community worker and senior epidemiologist. A formulated questionnaire that addresses risk factors for hypertension was filled by all participants. Also, weight and height measurements were done to calculate the body mass index. Blood pressure measurement was done by calibrated sphygmomanometers. Blood pressure measurement was done twice, and a mean recording was calculated. A case which recorded both systolic blood pressure of ≥140 and diastolic blood pressure of ≥90 was considered hypertensive. RESULTS The study included 774 adult residents of Al-Waily District (Western Zone of Cairo) in late 2011 and early 2012. The mean age of the study participants was 46.5 (SD 17.9) years. Female subjects constituted 67.1% of the studied sample. The prevalence rate of hypertension in our study was 16.5% (95% confidence interval (CI): 13.9-19.3). The rate of hypertension was higher among females and three times higher among obese compared with normal or overweight adults. The prevalence of undiagnosed hypertension was 11% (95% CI: 8.4-13.9), and uncontrolled hypertension was 30% (95% CI: 24.2-37). CONCLUSIONS Community outreach campaigns should be conducted regularly in the future for early detection of hypertension cases and proper health education about hypertension and its dangerous consequences.
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Affiliation(s)
- Khaled M Abd Elaziz
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Sahar A Dewedar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Sahar Sabbour
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Maha M El Gafaary
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Diaa M Marzouk
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Aisha Aboul Fotouh
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Mohamed Farouk Allam
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
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