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

Abstract

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.

Keywords

hypertension prevalence blood pressure and Ethiopia

Background

Hypertension (HTN) is defined as higher than a diastolic blood pressure of 90 mmHg or systolic blood pressure of 140 mmHg in the general population (Program, 2004; van de Vijver et al., 2014). Around the world, HTN has grown to be a significant public health issue. It is estimated that a billion cases will occur worldwide, approximately 12.8% of all cases leading to death (Juma et al., 2019; Kearney et al., 2005). Non-communicable diseases (NCDs) are a growing global public health concern, particularly in developed nations (Hendriks et al., 2012). HTN is a global public health issue that is the third leading cause of death and the main source of morbidity (Adeyemo et al., 2013).

Modernization like sedentary lifestyles, excessive body weight, nutritional status, and other modifiable risk factors all contribute to an increase in the prevalence of HTN (Kearney et al., 2004). In 2000, there were about 25% of adults worldwide who had HTN, and by 2025, that number is expected to increase to 30% (Organization, 2014; Zekewos et al., 2019). HTN affects 27% of Canadians and 28% of Americans (Kaplan et al., 2010). In contrast, HTN is still one of the major causes of morbidity and mortality in Africa, where the national prevalence in people 25 to 65 aged ranges from 25% to 35% (Organization, 2002), 51% of stroke deaths and 45% of heart disease mortality among hospital patients are related to HTN (Asresahegn et al., 2017).

A previous study found that the prevalence of HTN in Ethiopia was 23.7% in urban areas and 19.6% nationwide (Kibret & Mesfin, 2015). The upsurge of HTN in the urban population may be explained by migration from rural to urban areas and lifestyle changes linked with civilization (Opie & Seedat, 2005). HTN is the leading cause of morbidity and mortality in the world, with males having a higher prevalence than females (Esam & Husain, 2012), older age, cigarette smoking, alcohol use, and obesity increasing HTN prevalence (Abdissa et al., 2015; Omar et al., 2020), lifestyle changes and physical inactivity (Forouzanfar et al., 2017). Prevention of HTN early detection, and control programs are crucial for minimizing HTN's impact on health and health-related problems (Badego et al., 2020; van de Vijver et al., 2014), sex, obesity, family history (Danaei et al., 2011), consuming foods high in salt and fat, eating insufficient amounts of fruits and vegetables (Widiyanto et al., 2021), overweight, consuming a diet low in calcium and potassium, drinking alcohol, experiencing psychosocial stress were associated with HTN (Gudina et al., 2013).

HTN is a significant risk factor for many chronic diseases, including coronary heart disease, stroke, heart failure, kidney disease, and others, in addition to being a major cause of death (Organization, 2014). Raised blood pressure is more prevalent than other biological and behavioral risk factors for NCDs, according to an Ethiopian study and a WHO report (Organization, 2014). Due to unplanned rapid urbanization of rural communities and population lifestyle changes in terms of nutrition and physical inactivity, the burden of disease has broadly been shifting from communicable diseases to NCDs in lower- and middle-income countries, including Ethiopia (van de Vijver et al., 2014). There have been numerous studies conducted worldwide and in Ethiopia at the institutional (hospital level but studies that focus on measuring blood pressure at the community level in Ethiopia (Stevens et al., 2012). The implementation of WHO recommendations are below par despite the rise in the burden and prevalence of HTN in emerging nations, including Ethiopia (Nyaaba et al., 2017). Since HTN is a silent killer for which the majority of hypertensive patients are unaware of their symptoms, community-based blood pressure screening is essential for early identification and for lowering mortality and morbidity. The mortality and morbidity linked to HTN are greatly reduced by studying the epidemiology of the disease. To the researchers’ knowledge, there is a limited study that concentrates on taking blood pressure in a community.

The current study aimed to determine the factors of HTN in a representative sample of adults in south Ethiopia using a community-based study.

Review of Literature

Many studies have shown that family history, race, genetics, old age, cigarette smoking, alcohol use, obesity, physical inactivity, excess salt, and dietary choices are modifiable and non-modifiable risk factors for HTN (Costa et al., 2007; Tesfaye, 2017). In general, the prevalence of HTN rises with age, and it is more prevalent in urban areas than in rural areas due to lifestyle changes (Kearney et al., 2005).

A cross-sectional, population-based study was conducted in Brazil in 2014, with 1,608 native indigenous people eligible for the study. The prevalence of HTN was 29.5%, and risk factors for HPN were among obese, diabetic, and older participants, who had a lower educational level and were alcohol consumption (Oliveira et al., 2014). A facility-based cross-sectional study in 2014 showed that in Bangladesh among 15.6% of HTN respondents associated variables increasing salt intake and heart disease (Ahmed et al., 2014). In cross-sectional household surveys in 2012 Sub-Sahara Africa, 9,857 non-pregnant individuals’ age and gender, BMI independently predicted blood pressure level in all study populations (Hendriks et al., 2012).

In the study conducted by Omar et al., 2020, a multistage sampling survey was undertaken in Gadarif to examine the prevalence of HTN, and older age and obesity were found to be direct predictors of HTN (Omar et al., 2020). A community-based cross-sectional study conducted by Wamala JF et al. in 2009 Uganda included 842 study participants. The following factors were discovered to be linked with HTN: alcoholism, being overweight, and obesity in female sex elderly (Wamala et al., 2009). A cross-sectional study conducted in Nairobi, Kenya using the cluster sampling approach showed that characteristics such as older age, higher overall, and central obesity are associated with the prevalence of HTN (Joshi et al., 2014a).

A community-based cross-sectional study conducted by Wamala JF et al. included 842 study participants. The following factors were discovered to be linked with HTN: alcoholism, being overweight, and obesity in female sex elderly (Roba et al., 2019). A community-based cross-sectional study was used with a sample size of 3,368 participants in 2017 in southern Ethiopia, and the results revealed that the prevalence of HTN was 18.92%, with associated factors such as old age, overweight, khat chewing, and low fruit consumption (Chuka et al., 2020).

Similar research has been conducted, and while not all aspects are addressed in a single study, age, sex, educational status, physical inactivity, alcohol consumption, and the presence of obesity are some of the predictors of HTN. As a result, the purpose of this study was to assess all factors of HTN and related variables.

Aim

The purpose of this study was to determine the prevalence and risk factors for HTN in adult populations in the Gurage zone of southwest Ethiopia.

Materials and Methods

Study Design and Period

A community-based cross-sectional study was conducted to assess the prevalence of HTN and its associated factors, from April 1 to June 30, 2022.

Research Questions

What is the community-wide prevalence of hypertension?

What are the community-level factors that affect hypertension?

Sample

Using a multi-stage formula and design effect of 2.0, the sample size was estimated using a single population proportion formula taken from a prior study in Gondar that found that proportion 27.9% of people had HTN (Abebe et al., 2015). The final estimated sample size was 680 after adding a 10% non-response rate.

A multistage cluster random sampling method was used at first, three administrative kebele. A systematic random sampling technique of K value every 10th household was employed to select study participants. The first HH was selected by the lottery method. The study includes 635 permanent residents (who lived in the area at least for 6 months) selected using a multistage random sampling technique. In the first stage, 3 out of 13 kebele 25% of the total area were selected by a simple random sampling technique. In the second stage, a total of 635 HHs were selected. In this process, samples were proportionally allocated to each selected kebele.

Inclusion and Exclusion Criteria

All ambulatory residents of the Gurage Zone were included in the study, but residents of that who were unable to communicate (unable to listen and talk), seriously ill, pregnant women, and children under the age of 18 were excluded.

Instruments for Data Collection

Data were collected using a structured and pre-tested interviewer-administered questionnaire. Data collection tools consisted of three-part questionnaires: The first part consists of demographic questions developed by investigators. The second part of the questionnaire includes clinical and behavior-related variables such as smoking. Participants’ height and weight were measured as part of the physical examination. Height and weight were measured by trained and experienced BSc nurses recruited as data collectors working in different sites. Height and weight were measured by a Standiometer and weighing scale (Tesfaye et al., 2019).

Central obesities were calculated as waist circumference divided by hip circumference and having WHR >1.00 in males and >0.85 in females was interpreted as elevated; whereas, a WHR ≤1.00 in males and ≤ 0.85 in females was considered normal (Chobanian et al., 2003). Data collectors were given two days of training on data collection techniques before starting data collection. The questionnaire has been adapted from World Health Organization WHO for NCD surveillance in developing countries (Tesfaye et al., 2019).

Statistical Analysis

The collected data was entered into Epi-data version 3.1 and exported to SPSS version 23, where it was cleaned, edited, coded, and exploratory data analysis was performed to check for missing values and influential outliers. To examine the relationship between outcome and independent variables, bivariate and multivariable logistic regression analyses were used. In the multivariable logistic regression analysis, those independent variables with a p-value less than .25 in bivariate analyses were included. The determinant variables were chosen using backward stepwise regression. 95% confidence intervals were used to show the level of strength. The statistical significance was determined by a P-value of < .05.

Results

Sample Characteristics

The study included 635 participants, with a response rate of 93.4%. Out of the total number of respondents, 402 (63.3%) were females, and the majority of the participants 596 (93.9%) were married. 313(49.3%) non-formal education, 247(38.9%) primary school, and 38(6%) secondary education status. The mean age of participants was 40.8 (SD ± 12.88) years and 340 (53.5%) were urban dwellers, being orthodox 216 (34.0%), 175 (27.6%), Muslim, and 186 (29.3%) protestant (Table 1).

Table 1.

Socio-Demographic and Economic Characteristics of Study Participants in the Gurage Zone, South, Ethiopia (n = 635) 2022.

Variable	Category	N	%
Sex	Male	233	36.7
Sex	Female	402	63.3
Age in years	18–29	132	20.8
	30–49	319	50.2
	>50	184	29.0
Religious	Orthodox	216	34.0
	Muslim	175	27.6
	Protestant	186	29.3
	Catholic	58	9.1
Marital status	Married	596	93.9
Marital status	Single	39	6.1
Residence	Rural	295	46.5
Residence	Urban	340	53.5
Educational status	Non-formal education	313	49.3
	Primary education	247	38.9
	Secondary education	38	6.0
	College and above	37	5.8
Monthly income ETB	<5,000	332	52,3
	5,000–10,000	94	14.8
	>10,001	209	32.9

Research Questions Results

The mean systolic and diastolic BP readings were 116 (±14.58 SD) mmHg and 72 (±10.93 SD) mmHg, respectively. The prevalence of HTN was slightly higher in females 57.1% than in males (Figure 1). The overall prevalence of high blood pressure among study participants was 140 (22.0; 95% CI: 19.1–25.4) (Figure 2).

Figure 1.

Prevalence of hypertension by sex (n = 635) 2022.

Figure 2.

Prevalence of hypertension in the Gurage zone, south Ethiopia (n = 635) 2022.

The results of associations were found to be significant in the bivariate logistic regression analysis at a p-value < .25. Therefore, a multivariable approach was applied to determine which factors were best explained out of all the independent variables, age, family history of HTN, animal fat consumption, do you check BP, smoking cigarettes, khat chewers, and knowledge of HTN. The odds of being hypertensive among participants aged 50 years and above were almost two times (AOR: 1.95; 95%CI: 1.13–3.36) as compared to those 18–29 years old, and those who had a family history of HTN were 2.65 times more likely to develop HTN than their counterpart [AOR: 2.65, 95% CI (1.29–5.45)], who eat animal fat 79% less likely to develop HTN than their counterparts [AOR: 0.21, 95% CI (0.08–0.52)].

Who had cigarette smokers were 4.00 times more likely to develop HTN than their counterparts [AOR: 4.06, 95% CI (2.24–7.36)] and who knew HTN were 2.69 times more likely to develop HTN than their counterparts [AOR: 2.69, 95% CI (1.61–4.49)] (Table 2).

Table 2.

Analysis of Multiple Variables Relating to Hypertension Among Residents of Gurage Zone South, Ethiopia (n = 635) in 2022.

Variable	Category	Blood pressure measurement				COR (95% CI)	AOR (95% CI)
		No HPN		HPN
		N	%	N	%
Age	18–29	108	21.8%	24	17.1%	1.00	1.00
	30–49	237	47.9%	82	58.6%	0.98(0.55–1.75)	1.04(0.53–2.07)
	>50	150	30.3%	34	24.3%	1.53(0.97–2.39)*	1.95(1.13–3.36)*
Level of education	Non-formal	16	3.2%	21	15.0%	1.00	1.00
	Primary education	240	48.5%	73	52.1%	7.0(2.36–20.77)*	6.59(1.88–23.07)
	Sec. education	207	41.8%	40	28.6%	1.62(0.65–4.03)	1.36(0.51–3.64)
	College and above	32	6.5%	6	4.3%	1.03(0.40–2.63)	0.80(0.29–2.23)
Family history of HPN	No	230	46.5%	90	64.3%	4.35(2.47–7.67)*	2.65(1.29–5.45)*
	Yes	87	17.6%	34	24.3%	4.35(2.28–8.31)*	2.80(1.27–6.20)
	I don't know	230	46.5%	90	64.3%	1.00	1.00
Animal fat consumption	No	65	13.1%	7	5.0%	1.00	1.00
	Usually	103	20.8%	6	4.3%	0.28(0.12–0.62)*	0.48(0.18–1.27)
	Always	327	66.1%	127	90.7%	0.15(0.06–0.35)*	0.21(0.08–0.52)*
Do you check your BP	Yes	158	31.9%	27	19.3%	0.51(0.32–0.81)*	0.17(0.09–0.31)
Do you check your BP	No	337	68.1%	113	80.7%	1.00	1.00
Smoke cigarette	Yes	66	13.3%	50	35.7%	0.361(2.34–5.56)*	4.06(2.24–7.36)*
Smoke cigarette	No	429	86.7%	90	64.3%	1.00	1.00
Khat chewers	Yes	162	32.7%	15	10.7%	.25(0.14–0.44)*	0.71(0.33–1.54)
Khat chewers	No	333	67.3%	125	89.3%	1.00	1.00
Knowledge of HPN	Good	263	53.1%	114	81.4%	3.87(2.44–6.13)*	2.69(1.61–4.49)*
Knowledge of HPN	Poor	232	46.9%	26	18.6%	1.00	1.00

Discussion

Ethiopia is a developing country that is undergoing major epidemiological and nutritional changes. As a result of this rapid change, HTN has emerged as one of the most pressing public health concerns. According to these findings, approximately 140 (22.0%) of the participants had HTN, with a range of 95% to 19.1%–25.4% (Pauletto et al., 1994).

This finding is consistent with studies conducted in Sidama at 24.5% (Badego et al., 2020), and Kenya at 22.8% (Joshi et al., 2014b). However, it was relatively higher than the result of the study done in Jimma at 13.2% (Gudina et al., 2013), Bedele town 16.9% (Bonsa et al., 2014), Arba Minch at 18.92% (Chuka et al., 2020), Uganda's 13.7% (Kayima et al., 2015), India at 17% (Bhadoria et al., 2014), and Bangladesh 15.6% (Ahmed et al., 2014). The differences in HTN prevalence between this study and others could be due to social and cultural differences, dietary and lifestyle factors, as well as the age range and research methods used.

On the contrary, The findings of this study appear to be lower than the result of the studies conducted in Felege Hiwot 27.3% (Belachew et al., 2018), Northwest Ethiopia 27.9% (Abebe et al., 2015), Rural Ethiopia 41.9% (Shukuri et al., 2019), Nigeria 32.5% (Ajayi et al., 2016), Cameroon 40.9% (Simo et al., 2020), Nepal 32.5% (Dhungana et al., 2016), and Urban Varanasi 32.9% (Singh et al., 2017). These differences might be due to variations in nutritional habits, living standards, and socio-economic levels of the population, coverage of the national health system, and knowledge of prevention and treatment strategies across the countries (Oluma et al., 2021).

The prevalence of HTN increased with age increase in the community. This is due to age increases blood pressure associated with elevated blood pressure due to loss of elasticity of blood vessels supported by Bedele Southwest, Ethiopia (Bonsa et al., 2014), Uganda (Wamala et al., 2009), and China (Gao et al., 2013). This might be related to the biological effect of increased vascular resistance as a result of arterial thickening in old age (Abebe et al., 2015; Hauser et al., 2012).

Family history of HTN, being overweight, and obesity were all found to be strongly related to HTN, which is supported by earlier studies in Gondar (Awoke et al., 2012), in south Asia (Tesfaye et al., 2007). Possible explanations include the fact that persons with a family history of HTN share the same genetic component and environmental factors, as well as the fact that families tend to share similar lifestyle choices and behaviors.

Animal fat consumption was also a major risk factor for HTN, with respondents who consumed animal product fat developing HTN more frequently than their counterparts. The finding of this study was consistent with a previous study in Addis Ababa (Abebe & Yallew, 2019). The possible reason for this was since diets containing animal fat source foods include saturated fats, which cause an excess of fat to accumulate in blood vessels, resulting in atherosclerosis (Ros & Mataix, 2006).

Cigarette smoking is associated with HTN similar to other studies conducted in different places of the world, including the Asian CARTA Consortium (Linneberg et al., 2015). The possible reason cigarette smoking induces sympathetic nervous system activation and oxidative stress, which leads to endothelial dysfunction, vascular injury, plague progression, and increased arterial stiffness, all of which lead to the development of HTN (Halperin et al., 2008; Kim et al., 2005).

Knowledge about HTN findings was consistent with those of prior studies in Metropolis-Ghana (Anowie & Darkwa, 2015). The findings of this study appear to support the pattern of low HTN knowledge among the populations studied in the previous studies, despite efforts to educate people about HTN (Marfo et al., 2014). This is because knowledgeable people are more careful and responsible when it comes to implementing preventive measures. Furthermore, knowledgeable people are aware of the method of prevention.

Strength and Limitation

Community-based studies are the most effective method for determining HTN prevalence. It contains other elements that have yet to be mentioned.

First, because the data is cross-sectional, the study cannot demonstrate a cause-and-effect relationship between HTN and associated risk variables. Second, behavioral data were acquired using an interviewer-administered structured questionnaire. As a result, recollection bias and social desirability bias cannot be ruled out.

Implication for Practice

Overall, the study's findings have significant implications for improving blood pressure screening and monitoring. A family history of the disease, animal fat consumption, cigarette smoking, and a lack of knowledge all had varying effects on HTN risk. The development and successful implementation of techniques for recognizing, changing, relieving, and managing the aforementioned factors at the personal and community levels could have significant implications for HTN prevention and management.

Conclusions

HTN was revealed to be widespread in this group, although lacking awareness of the disease and screening; older age-related HTN, a family history of the disease, animal fat intake, cigarette smoking, and a lack of knowledge about the disease are all risk factors for HTN. Therefore, to reduce the burden of HTN, healthcare practitioners should provide widespread health education, routine community screening, and support of recommended lifestyle changes.

Footnotes

Acknowledgment

The authors would like to thank the data collectors and Wolkite University for giving ethical clearance. The authors would like to thanks the study participants for their cooperation.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Institution Review Board Approval

Ethical clearance was obtained from Wolkite University College of medicine and health sciences’ ethical review board (ERB) with Reference of wku 351/03/14 and a permission letter was obtained from the Gurage zone health department and the corresponding kebele administrative offices. Informed consent was obtained from the respondents. All the necessary measures were taken to maintain and assure the confidentiality and benefits of the participants.

ORCID iDs

Mamo Solomon

Tadesse Tsehay Tarekegn

Shegaw Tesfa Mengist

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