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Fifita SST, Nonaka D, Cama MT, Filise MI. Factors associated with undiagnosed hypertension among Tongan adults: a cross-sectional study. Trop Med Health 2024; 52:4. [PMID: 38163919 PMCID: PMC10759494 DOI: 10.1186/s41182-023-00570-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Hypertension is responsible for many premature deaths worldwide. However, many individuals with hypertension remain undiagnosed. Tonga is one of the countries that has had a steep increase in hypertension, thus undiagnosed hypertension could also be increasing. Purpose of this study was to assess the prevalence and factors associated with undiagnosed hypertension among Tongan adults. METHODS This cross-sectional study used data collected from conveniently sampled 473 participants using electronic questionnaire and digital sphygmomanometer through household visits between February and March 2023. Inclusion criteria were age of 18-65 years, residence in the villages for at least six months, and not being pregnant. Fisher's exact test and mixed-effect logistic regression were performed using the EZR software to assess the association between undiagnosed hypertension and predictor variables. RESULTS The prevalence of undiagnosed hypertension was 22.4% (106/473). Five variables that were significantly associated with undiagnosed hypertension in Fisher's exact test were included in the multivariate logistic regression. Overall, only three variables remained significant. First, participants who never had their blood pressure measured had higher prevalence compared to those who had it checked recently (33.3% vs. 19.1%); odds ratio: 2.24). Secondly, participants who were not aware of the risk of developing hypertension were significantly more likely to have undiagnosed hypertension compared to those who were aware (27.9% vs. 16.7%; odds ratio: 1.81). Lastly, middle-aged participants (30-49 years) and older (50-65 years), were significantly more likely to have undiagnosed hypertension compared to those who were 18-29 years old (30.0% and 23.7% vs. 11.8%; odds ratio: 3.58 and 3.38 vs. 1.00). CONCLUSION The prevalence of undiagnosed hypertension could be substantial among Tongan adults, implicating a need to address this issue by doing further research and review current public health work to address hypertension in Tonga. Undiagnosed hypertension was associated with having no experience of blood pressure measurement, lack of awareness about hypertension, and age. Tongan government should provide people with more opportunities to have their blood pressure measured and to improve their awareness.
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Affiliation(s)
- Seini Siahi Talanoafoou Fifita
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan.
- Faculty of Nursing and Health Sciences, Tonga National University, Nuku'alofa, Tonga.
| | - Daisuke Nonaka
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | - Mele Tilema Cama
- Faculty of Nursing and Health Sciences, Tonga National University, Nuku'alofa, Tonga
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Berman AN, Ginder C, Wang XS, Borden L, Hidrue MK, Searl Como JM, Daly D, Sun YP, Curry WT, Del Carmen M, Morrow DA, Scirica B, Choudhry NK, Januzzi JL, Wasfy JH. A pragmatic clinical trial assessing the effect of a targeted notification and clinical support pathway on the diagnostic evaluation and treatment of individuals with left ventricular hypertrophy (NOTIFY-LVH). Am Heart J 2023; 265:40-49. [PMID: 37454754 DOI: 10.1016/j.ahj.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Electronic health records contain vast amounts of cardiovascular data, including potential clues suggesting unrecognized conditions. One important example is the identification of left ventricular hypertrophy (LVH) on echocardiography. If the underlying causes are untreated, individuals are at increased risk of developing clinically significant pathology. As the most common cause of LVH, hypertension accounts for more cardiovascular deaths than any other modifiable risk factor. Contemporary healthcare systems have suboptimal mechanisms for detecting and effectively implementing hypertension treatment before downstream consequences develop. Thus, there is an urgent need to validate alternative intervention strategies for individuals with preexisting-but potentially unrecognized-LVH. METHODS Through a randomized pragmatic trial within a large integrated healthcare system, we will study the impact of a centralized clinical support pathway on the diagnosis and treatment of hypertension and other LVH-associated diseases in individuals with echocardiographic evidence of concentric LVH. Approximately 600 individuals who are not treated for hypertension and who do not have a known cardiomyopathy will be randomized. The intervention will be directed by population health coordinators who will notify longitudinal clinicians and offer to assist with the diagnostic evaluation of LVH. Our hypothesis is that an intervention that alerts clinicians to the presence of LVH will increase the detection and treatment of hypertension and the diagnosis of alternative causes of thickened myocardium. The primary outcome is the initiation of an antihypertensive medication. Secondary outcomes include new hypertension diagnoses and new cardiomyopathy diagnoses. The trial began in March 2023 and outcomes will be assessed 12 months from the start of follow-up. CONCLUSION The NOTIFY-LVH trial will assess the efficacy of a centralized intervention to improve the detection and treatment of hypertension and LVH-associated diseases. Additionally, it will serve as a proof-of-concept for how to effectively utilize previously collected electronic health data to improve the recognition and management of a broad range of chronic cardiovascular conditions. TRIAL REGISTRATION NCT05713916.
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Affiliation(s)
- Adam N Berman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Massachusetts General Physicians Organization, Boston, MA
| | - Curtis Ginder
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Xianghong S Wang
- Division of Performance Analysis and Improvement, Massachusetts General Physicians Organization, Boston, MA
| | - Linnea Borden
- Massachusetts General Physicians Organization, Boston, MA
| | - Michael K Hidrue
- Division of Performance Analysis and Improvement, Massachusetts General Physicians Organization, Boston, MA
| | | | - Danielle Daly
- Massachusetts General Physicians Organization, Boston, MA
| | - Yee-Ping Sun
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William T Curry
- Massachusetts General Physicians Organization, Boston, MA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marcela Del Carmen
- Massachusetts General Physicians Organization, Boston, MA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David A Morrow
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin Scirica
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Niteesh K Choudhry
- Department of Medicine, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA
| | - Jason H Wasfy
- Massachusetts General Physicians Organization, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Campbell E, Macey E, Shine C, Nafilyan V, Clark NC, Pawelek P, Ward I, Hughes A, Raleigh V, Banerjee A, Finning K. Sociodemographic and health-related differences in undiagnosed hypertension in the health survey for England 2015-2019: a cross-sectional cohort study. EClinicalMedicine 2023; 65:102275. [PMID: 38106553 PMCID: PMC10725049 DOI: 10.1016/j.eclinm.2023.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 12/19/2023] Open
Abstract
Background Hypertension is a leading cause of morbidity and mortality worldwide, yet a substantial proportion of cases are undiagnosed. Understanding the scale of undiagnosed hypertension and identifying groups most at risk is important to inform approaches to detection. Methods In this cross-sectional cohort study, we used data from the 2015 to 2019 Health Survey for England, an annual, cross-sectional, nationally representative survey. The survey follows a multi-stage stratified probability sampling design, involving a random sample of primary sampling units based on postcode sectors, followed by a random sample of postal addresses within these units. Within each selected household, all adults (aged ≥16 years) and up to four children, were eligible for participation. For the current study, individuals aged 16 years and over who were not pregnant and had valid blood pressure data were included in the analysis. The primary outcome was undiagnosed hypertension, defined by a measured blood pressure of 140/90 mmHg or above but no history of diagnosis. Age-adjusted prevalence of undiagnosed hypertension was estimated across sociodemographic and health-related characteristics, including ethnicity, region, rural-urban classification, relationship status, highest educational qualification, National Statistics Socio-Economic Classification (NS-SEC), Body Mass Index (BMI), self-reported general health, and smoking status. To assess the independent association between undiagnosed hypertension and each characteristic, we fitted a logistic regression model adjusted for sociodemographic factors. Findings The sample included 21,476 individuals, of whom 55.8% were female and 89.3% reported a White ethnic background. An estimated 30.7% (95% confidence interval 29.0-32.4) of men with hypertension and 27.6% (26.1-29.1) of women with hypertension were undiagnosed. Younger age, lower BMI, and better self-reported general health were associated with an increased likelihood of hypertension being undiagnosed for men and women. Living in rural areas and in regions outside of London and the East of England were also associated with an increased likelihood of hypertension being undiagnosed for men, as were being married or in a civil partnership and having higher educational qualifications for women. Interpretation Hypertension is commonly undiagnosed, and some of the groups that are at the lowest risk of hypertension are the most likely to be undiagnosed. Given the high lifetime risk of hypertension and its strong links with morbidity and mortality, our findings suggest a need for greater awareness of the potential for undiagnosed hypertension, including among those typically considered 'low risk'. Further research is needed to assess the impact of extending hypertension screening to lower-risk groups. Funding None.
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Affiliation(s)
- Emma Campbell
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Ellie Macey
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Chris Shine
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Vahé Nafilyan
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Nathan Cadogan Clark
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Piotr Pawelek
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Isobel Ward
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
| | - Andrew Hughes
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, SW1H 0EU, UK
| | - Veena Raleigh
- The King's Fund, 11–13 Cavendish Square, London, W1G 0AN, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Katie Finning
- Office for National Statistics, Government Buildings, Cardiff Rd, Duffryn, Newport, NP10 8XG, UK
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Ambaw Kassie G, Alemu A, Yosef Gebrekidan A, Asmare Adella G, Eshetu K, Wolie Asres A, Sisay Asgedom Y. Undiagnosed hypertension and associated factors among adults in ethiopia: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:278. [PMID: 37244992 PMCID: PMC10225092 DOI: 10.1186/s12872-023-03300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Hypertension is a major public health problem, resulting in 10 million deaths annually. Undiagnosed hypertension affects more people than ever before. It is more likely to be linked to severe hypertension, which can lead to stroke, cardiovascular disease, and ischemic heart disease. Thus, this systematic review and meta-analysis aimed to synthesize the prevalence of undiagnosed hypertension and its associated factors in Ethiopia. METHODS Databases, such as Medline/PubMed, Google Scholar, Science Direct, AJOL, and the Cochrane Library, were systematically searched to find potential studies published until December 2022. A Microsoft Excel spreadsheet was used to enter the extracted data. The pooled prevalence of undiagnosed hypertension and its associated factors was estimated using a random effect model. I2 statistics and the Cochrane Q-test were used to assess statistical heterogeneity across the studies. Begg's and Egger's tests were performed to identify possible publication bias. RESULTS A total of ten articles with 5,782 study participants were included in this meta-analysis. In the random effects model, the pooled prevalence of undiagnosed hypertension was 18.26% (95% CI = 14.94-21.58). Being older (OR = 3.8, 95% CI = 2.56, 5.66), having a body mass index > 25 kg/m2 (OR = 2.71, 95% CI = 2.1, 3.53), having a family history of hypertension (OR = 2.22, 95% CI = 1.47, 3.36), and having DM comorbidity (OR = 2.44, 95% CI = 1.38, 4.32) were significantly associated with undiagnosed hypertension. CONCLUSION In this meta-analysis, the pooled prevalence of undiagnosed hypertension was found to be high in Ethiopia. Being older, having a BMI > 25 kg/m2, having a family history of hypertension, and having DM comorbidity were found to be risk factors for undiagnosed hypertension.
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Affiliation(s)
- Gizachew Ambaw Kassie
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Afework Alemu
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abiyot Wolie Asres
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Teshome DF, Balcha SA, Ayele TA, Atnafu A, Gelaye KA. Undiagnosed hypertension and its determinants among hypertensive patients in rural districts of northwest Ethiopia: a mediation analysis. BMC Health Serv Res 2023; 23:222. [PMID: 36882833 PMCID: PMC9990316 DOI: 10.1186/s12913-023-09212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
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.
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Affiliation(s)
- Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bhatia M, Dixit P, Kumar M, Dwivedi LK. Comparing socio-economic inequalities in self-reported and undiagnosed hypertension among adults 45 years and over in India: what explains these inequalities? Int J Equity Health 2023; 22:26. [PMID: 36732766 PMCID: PMC9893593 DOI: 10.1186/s12939-023-01833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is a leading cause of mortality and morbidity in developing countries. For India, the hidden burden of undiagnosed hypertension is a major concern. This study aims to assess and explain socio-economic inequalities among self-reported and undiagnosed hypertensives in India. METHODS The study utilized data from the Longitudinal Aging Study in India (LASI), a nationally-representative survey of more than 72,000 older adults. The study used funnel plots, multivariable logistic regression, concentration indices, and decomposition analysis to explain the socio-economic gap in the prevalence of self-reported and undiagnosed hypertension between the richest and the poorest groups. RESULTS The prevalence of self-reported and undiagnosed hypertension was 27.4 and 17.8% respectively. Monthly per capita consumption expenditure (MPCE) quintile was positively associated with self-reported hypertension but negatively associated with undiagnosed hypertension. The concentration index for self-reported hypertension was 0.133 (p < 0.001), whereas it was - 0.047 (p < 0.001) for undiagnosed hypertension. Over 50% of the inequalities in self-reported hypertension were explained by the differences in the distribution of the characteristics whereas inequalities remained unexplained for undiagnosed hypertension. Obesity and diabetes were key contributors to pro-rich inequality. CONCLUSIONS Results imply that self-reported measures underestimate the true prevalence of hypertension and disproportionately affect the poorer MPCE groups. The prevalence of self-reported HTN was higher in the richest group, whereas socio-economic inequality in undiagnosed hypertension was significantly concentrated in the poorest group. As majority of the inequalities remain unexplained in case of undiagnosed hypertension, broader health systems issues including barriers to access to health care may be contributing to inequalities.
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Affiliation(s)
- Mrigesh Bhatia
- grid.13063.370000 0001 0789 5319London School of Economics, London, WC2A 2AE UK
| | - Priyanka Dixit
- grid.419871.20000 0004 1937 0757Tata Institute of Social Sciences, Mumbai, India
| | | | - Laxmi Kant Dwivedi
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
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Diendéré J, Kaboré J, Bosu WK, Somé JW, Garanet F, Ouédraogo PV, Savadogo AA, Millogo A, Zeba AN. A comparison of unhealthy lifestyle practices among adults with hypertension aware and unaware of their hypertensive status: results from the 2013 WHO STEPS survey in Burkina Faso. BMC Public Health 2022; 22:1601. [PMID: 35999516 PMCID: PMC9396908 DOI: 10.1186/s12889-022-14026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We compared the prevalence of unhealthy lifestyle factors between the hypertensive adults who were aware and unaware of their hypertensive status and assessed the factors associated with being aware of one's hypertension among adults in Burkina Faso. METHODS We conducted a secondary analysis of data from the World Health Organization Stepwise approach to surveillance survey conducted in 2013 in Burkina Faso. Lifestyle factors analysed were fruits and vegetables (FV) consumption, tooth cleaning, alcohol and tobacco use, body mass index and physical activity. RESULTS Among 774 adults living with hypertension, 84.9% (95% CI: 82.2-87.3) were unaware of their hypertensive status. The frequencies of unhealthy lifestyle practices in those aware vs. unaware were respectively: 92.3% vs. 96.3%, p = 0.07 for not eating, at least, five FV servings daily; 63.2% vs. 70.5%, p = 0.12 for not cleaning the teeth at least twice a day; 35.9% vs. 42.3%, p = 0.19 for tobacco and/or alcohol use; 53.9% vs. 25.4%, p = 0.0001 for overweight/obesity and 17.1% vs, 10.3%, p = 0.04 for physical inactivity. In logistic regression analysis, older age, primary or higher education, being overweight/obese [adjusted odds ratio (aOR) = 3.2; p < 0.0001], intake of adequate FV servings daily (aOR = 2.9; p = 0.023) and non-use of alcohol and tobacco (aOR = 0.6; p = 0.028) were associated with being aware of one's hypertensive status. CONCLUSION Undiagnosed hypertension was very high among Burkinabè adults living with hypertension. Those aware of their hypertension diagnosis did not necessarily practise healthier lifestyles than those not previously aware of their hypertension. Current control programmes should aim to improve hypertension awareness and promote risk reduction behaviour.
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Affiliation(s)
- Jeoffray Diendéré
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso.
| | - Jean Kaboré
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - William Kofi Bosu
- Department of Public Health and Research, West African Health Organisation (WAHO), Bobo-Dioulasso, Burkina Faso
| | - Jérome Winbetouréfâ Somé
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Franck Garanet
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS) Unité de Kaya, Kaya, Burkina Faso
| | | | - Abdoul Aziz Savadogo
- Université Nazi Boni/Institut Supérieur des Sciences de la Santé (INSSA), Bobo-Dioulasso, Burkina Faso
| | - Athanase Millogo
- Université Joseph Ki-Zerbo/Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Augustin Nawidimbasba Zeba
- Centre National de la Recherche Scientifique et Technologique (CNRST)/Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
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Ibrahim AA, Manaf MRA, Ismail NH. The Determinants of Undiagnosed Hypertension among Urban Community of Kuala Lumpur, Malaysia. Iran J Public Health 2022; 51:1323-1330. [PMID: 36447985 PMCID: PMC9659544 DOI: 10.18502/ijph.v51i6.9677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/11/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND The prevalence of undiagnosed hypertension in Malaysia is 17.2%, which is higher compared to the known case of hypertension (13.1%) reported in 2015. For every two people diagnosed with hypertension, there will be three persons with undiagnosed hypertension; the trend has not changed since 2011. This study aimed to determine the determinants of undiagnosed hypertension among urban community of Kuala Lumpur, Malaysia. METHODS This was a cross-sectional study conducted among 206 participants in Kuala Lumpur, Malaysia from the ongoing Prospective Urban Rural Epidemiology (PURE) project. The samples with complete variable data were taken from the second year of follow-up, starting Jan 2014 till Dec 2015, through convenience sampling. Data were analyzed using descriptive analysis, simple logistic regression, and multivariable logistic regression. RESULTS Multivariable logistic regression showed that only four determinants were associated with undiagnosed hypertension which were the age group of 35 to 49 yr old (aOR: 5.9, 95% CI: 1.8; 19.1), secondary education level (aOR: 2.3, 95% CI: 1.1; 4.6), normal BMI (aOR: 5.1, 95% CI: 1.5; 16.6), and non-diabetes mellitus (aOR: 5.5, 95% CI: 2.5; 12.0). CONCLUSION The determinants of undiagnosed hypertension in this study showed that low-risk groups of hypertension were highly underdiagnosed. The low-risk group of hypertension was easily approached at their working place. Thus, routine health screening and awareness campaigns should be emphasized substantially at the working place to detect undiagnosed hypertension. Early detection will be beneficial as early management can be initiated to prevent further complications.
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Morey BN, Valencia C, Lee S. Correlates of Undiagnosed Hypertension Among Chinese and Korean American Immigrants. J Community Health 2022; 47:425-436. [PMID: 35103847 PMCID: PMC8805138 DOI: 10.1007/s10900-022-01069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/24/2022]
Abstract
Asian Americans are more likely to be unaware that they have hypertension compared to non-Hispanic white Americans, despite having higher risk of hypertension at lower body-mass indices. Furthermore, immigrants are more likely than their United States (U.S.)-born counterparts to have undiagnosed hypertension, placing them at greater risk of subsequent morbidity and mortality. This study examines the social determinants of undiagnosed hypertension among Asian American immigrants. Using a study of foreign-born Chinese and Korean Americans between the ages of 50-75 years-old recruited from physicians' clinics in the Baltimore-Washington DC Metropolitan Area (n = 355), we used blood pressure readings measured by trained staff members, self-reported diagnosis by a medical professional, and self-reported hypertension medication use to determine hypertension status-whether patients were non-hypertensive, had diagnosed hypertension, or had undiagnosed hypertension. Using multinomial logistic regression, we examined how demographic, socioeconomic, and immigration-related factors were associated with hypertension status. Results indicated that older age, male gender, Korean subgroup, and marital status were associated with having diagnosed hypertension compared to being non-hypertensive. Lack of health insurance was the strongest predictor of having undiagnosed hypertension compared to being non-hypertensive. Acculturation variables had no strong associations with hypertension status. We then explored correlates of health insurance status for Chinese and Korean American immigrants. Those without health insurance were more likely to have lower income and to be not currently employed. Our findings point to the importance of increasing health insurance access for Asian American immigrant groups to ensure that hypertension is not left undiagnosed and untreated.
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Affiliation(s)
- Brittany N Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA.
| | - Connie Valencia
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
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Haider MR, Gupta RD. Inequalities in Undiagnosed Hypertension Among Adult Population in Bangladesh: Evidence from a Nationally Representative Survey. High Blood Press Cardiovasc Prev 2021; 29:57-64. [PMID: 34757583 DOI: 10.1007/s40292-021-00488-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Bangladesh has experienced a rising trend in hypertension in recent years and women are suffering from this non-communicable disease more than men. About one-fifth of the adult population is suffering from hypertension and almost three-fifth of them are undiagnosed. AIM This study aims to assess the prevalence and determinants of undiagnosed hypertension and to examine the extent of socioeconomic inequalities in undiagnosed hypertension among adult Bangladeshi population (≥ 18 years). METHODS This study used nationally representative Bangladesh Demographic and Health Survey 2017-18 data. Undiagnosed hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg and was never told by the health professionals to lower/control blood pressure. Multiple logistic regression analysis was performed to assess factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index. RESULTS Out of total 3196 hypertensive adults, half (50.1%) were undiagnosed. In the adjusted model, older age, overweight/obesity, female gender, richest wealth quintiles had lower odds of being undiagnosed. Overall concentration index showed that poor patients were disproportionately affected by undiagnosed hypertension (Concentration Index: - 0.103, Standard Error (SE) of Concentration Index: 0.024; P value < 0.001). The poor(Q1)-to-rich(Q5) ratio of 1.3 also demonstrates that poorest hypertensive Bangladeshi adults have higher prevalence of undiagnosed hypertension than their richest counterparts. CONCLUSION Awareness building program should be targeted towards adults belong to poor wealth quintiles for checking blood pressure regularly. Hypertension should be diagnosed and treated to prevent further complications.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Wright Hall 301B, 100 Foster Rd, Athens, GA, 30602, USA.
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
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Haider MR, Das Gupta R. Inequalities in undiagnosed hypertension among adult Nepalese population: Evidence from a nationally representative survey. Int J Cardiol Hypertens 2020; 5:100026. [PMID: 33447755 PMCID: PMC7803054 DOI: 10.1016/j.ijchy.2020.100026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION With one in every five adults suffering from hypertension and three-fifth of these patients undiagnosed, Nepal faces an enormous problem of undiagnosed hypertension. This study aims to assess the prevalence and determinants of undiagnosed hypertension in Nepal and to examine the extent of socioeconomic inequalities in undiagnosed hypertension in Nepal. METHODS This study used the nationally representative Nepal Demographic and Health Survey 2016 data. Undiagnosed hypertension was defined having systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mmHg and being told two or more times by health professionals to lower/control blood pressure. Multiple logistic regression analysis was used for identifying determinants associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (CI). RESULTS The study results show that out of total 2831 hypertensive patients, 1611 (56.9%) were undiagnosed. In the adjusted model, older age, overweight/obesity, higher wealth quintiles had less odds of being undiagnosed. Male gender and residing in Province 7 had higher odds of being undiagnosed. Overall CI showed that poor patients were disproportionately affected by undiagnosed hypertension (CI: 0.21, Standard Error (SE) of CI: 0.03). The poor (Q1)-to-rich (Q5) ratio was 1.57 showed again that poorest patients in Nepal had higher prevalence of undiagnosed hypertension than richest patients. CONCLUSION Poor patients are disproportionately affected by undiagnosed hypertension in Nepal. Awareness should be created specially among the poor wealth quintiles regarding checking blood pressure regularly. Innovative implementation strategies required to be developed to detect undiagnosed case and provide treatment accordingly.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Grover Center W333, 1 Ohio University Drive, Athens, OH, 45701, USA
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
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Hanna DR, Walker RJ, Smalls BL, Campbell JA, Dawson AZ, Egede LE. Prevalence and correlates of diagnosed and undiagnosed hypertension in the indigenous Kuna population of Panamá. BMC Public Health 2019; 19:843. [PMID: 31253116 PMCID: PMC6599360 DOI: 10.1186/s12889-019-7211-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To determine the prevalence of hypertension and investigate sociodemographic correlates in an indigenous Kuna community living on the San Blas islands of Panama. METHODS Data was collected from adults using a paper-based survey using a cross sectional study design. Blood pressure was measured, and hypertension defined at two cut-points: 130/80 mmHg and 140/90 mmHg. Individuals with undiagnosed hypertension had a blood pressure measurement that indicated hypertension, however, the individual had not been told by a doctor they had hypertension. Whereas individuals with diagnosed hypertension had been told by a healthcare provider that they had hypertension. Univariate tests compared diagnosed and undiagnosed hypertension by sociodemographic categories and logistic regression models tested individual correlates adjusting for all sociodemographic factors. RESULTS Two hundred and eleven adult indigenous Kuna participated in the study. Overall prevalence of hypertension was 6.2% (95%CI:3.32-10.30) as defined by 140/90 mmHg, and 16.6% (95%CI:11.83-22.31) as defined by 130/80 mmHg. Hypertension was significantly higher in men (31.6, 95% CI:19.90-45.24, compared to 11.0, 95% CI:6.56-17.09). Individuals with low income were 3 times more likely to be hypertensive (OR = 3.13, 95% CI:1.02-9.60) and 3.5 times more likely to have undiagnosed hypertension (OR = 3.42, 95% CI:1.01-11.52); while those with moderate income were 6 times more likely to be hypertensive (OR = 7.37, 95% CI:1.76-30.90) compared to those who were poor. CONCLUSION The prevalence of diagnosed and undiagnosed hypertension is higher in men and those with higher income. Investigating these factors remains vitally important in helping improve the health of the Kuna through targeted interventions to address chronic disease.
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Affiliation(s)
- Daniel R Hanna
- College of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brittany L Smalls
- Center for Health Services Research, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA. .,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
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Ahmed S, Tariqujjaman M, Rahman MA, Hasan MZ, Hasan MM. Inequalities in the prevalence of undiagnosed hypertension among Bangladeshi adults: evidence from a nationwide survey. Int J Equity Health 2019; 18:33. [PMID: 30770739 PMCID: PMC6377713 DOI: 10.1186/s12939-019-0930-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/28/2019] [Indexed: 11/28/2022] Open
Abstract
Background In recent years, developing countries like Bangladesh are facing a higher burden of non-communicable diseases such as hypertension as a result of demographic transition. Prevalence of hypertension is often studied in this setting. However, evidence on undiagnosed hypertension is not widely available in the existing literature. Therefore, the current study focuses on inequalities in the prevalence of undiagnosed hypertension in Bangladesh. Methods A total of 8835 participants aged 35+ years were included in this study using nationally representative Bangladesh Demographic and Health Survey 2011 (BDHS). In the survey, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of these participants were measured three times with approximately 10 minutes of an interval between each measurement. Any respondent with either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was considered as patient with hypertension as per the guidelines from American Heart Association. Among the participants, undiagnosed hypertension was defined as having SBP > =140 mmHg or DBP > =90 mmHg and never taking prescribed medicine or being told by health professionals to lower/control blood pressure. Multiple logistic regression analysis was applied for identifying factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (C). Results We found 978 (59.9% of the total) were undiagnosed among 1685 hypertensive patients studied. Regression analysis showed individuals with being underweight, having poor socioeconomic conditions, and lower educational qualifications were more likely to have undiagnosed hypertension. A similar association between undiagnosed hypertension and socioeconomic quintiles was observed using concentration index (C = − 0.07). On the other hand, individuals from higher age group (50–64 or above), female sex, and Sylhet region were at lower risk of undiagnosed hypertension. Conclusions This study showed that a large proportion of the cases with hypertension are remained undiagnosed in Bangladesh, especially among the poor and low educated population. Screening and awareness building initiatives on hypertension should be taken for this group of population to reduce the burden of undiagnosed hypertension.
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Affiliation(s)
- Sayem Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh. .,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, 171 77, Sweden. .,Department of Tropical Disease Biology, Liverpool School of Tropical Medicine (LSTM), Liverpool, L3 5QA, UK.
| | - Md Tariqujjaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Md Arafat Rahman
- Department of Economics, Faculty of Business and Economics, Macquarie University, Sydney, NSW, 2109, Australia
| | - Md Zahid Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, 4068, Queensland, Australia
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Oyeyemi AY, Usman MA, Oyeyemi AL, Jaiyeola OA. Casual blood pressure of adolescents attending public secondary schools in Maiduguri, Nigeria. Clin Hypertens 2015; 21:16. [PMID: 26893926 PMCID: PMC4750820 DOI: 10.1186/s40885-015-0026-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 06/10/2015] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Although evidence exists that adolescents' hypertension could lead to adults' hypertension, it is a general belief that measures for early detection and treatment of this condition is seldom undertaken especially in medically underserved communities such as Maiduguri, Northeastern Nigeria. This study investigated the prevalence of undiagnosed hypertension among adolescents in Maiduguri, Nigeria, and explored the association between undiagnosed hypertension and adolescents' physical characteristics and parental socio-demographic factors. METHODS Participants' physical characteristics were assessed, and information on their socio-demographics including parental socioeconomic status were obtained. Blood pressures and heart rates of the participants were also measured three times at 5-10-min period. RESULTS The prevalence of undiagnosed hypertension among the students was 13.2 %, and overwhelming majority (82.4 %) of the hypertensive students were in the prehypertensive stage, while 17.6 % were in the stage 1 classification of hypertension. Higher prevalence of undiagnosed hypertension was observed for the females compared to the male adolescents (X (2) = 15.49, p = 0.001), and presence of undiagnosed hypertension is positively but tenuously linked to age (r = 0.11, p = 0.01), body mass index (r = 0.10, p = 0.01), and parental income (r = 0.26, p = 0.02) of the students. DISCUSSION This study suggests that any effective programs designed to mitigate undiagnosed hypertension among adolescents in this city should include strategies that address possible barriers to physical activity and exercise among female adolescents in the society.
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Affiliation(s)
- Adetoyeje Y. Oyeyemi
- />Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, P.M.B 1069, Maiduguri, Nigeria
| | - Muhammad A. Usman
- />Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, P.M.B 1069, Maiduguri, Nigeria
| | - Adewale L. Oyeyemi
- />Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, P.M.B 1069, Maiduguri, Nigeria
| | - Olabode A. Jaiyeola
- />Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
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