|Year : 2014 | Volume
| Issue : 1 | Page : 23-28
Awareness, practices, and prevalence of hypertension among rural Nigerian women
Samuel O. Azubuike1, Rahab Kurmi2
1 Community Health Unit, School of Health Sciences, National Open University of Nigeria, 14/16 Ahmadu Bellow Way, Victoria Island, Lagos, Nigeria
2 Primary Health Care Department, Sanga Local Government, Kaduna State, Nigeria, Nigeria
|Date of Web Publication||4-Jun-2014|
Samuel O. Azubuike
Community Health Unit, School of Health Sciences, National Open University of Nigeria, 14/16 Ahmadu Bellow Way, Victoria Island, Lagos
Source of Support: None, Conflict of Interest: None
Background: High blood pressure is on the rise globally, affecting more women than men in many developing countries. It is the leading cause of mortality worldwide, and hospitalization in sub-Saharan Africa. Many known risk factors to hypertension, though prevalent in Nigeria, are controllable. Prevention, however, is difficult where there is poor awareness, attitude, and practices. Objectives: The study aims at determining the level of knowledge of hypertension and its associated factors, attitudes, practices, and prevalence among rural Nigerian women. Materials and Methods: Cross-sectional design was used to study 252 subjects in Sanga Local Government Area. Subject selection was by purposive and stratified sampling techniques. Data were collected using self-administered, semi-structured questionnaire after informed consents were obtained both verbally and in writing. Data were analyzed using SPSS statistical package. Level of significant was taken at 0.05. Results: Prevalence of hypertension was 24.2%. Average level of risk factor awareness was 65.4% with excessive salt intake (77.4%) being the most recognized. Asymptomatic nature of hypertension was recognized by 61.5% of the respondents, while 44.4% only knew the standard method for hypertension detection. While 17.5% strongly believed that hypertension can be managed effectively with drugs, it was only 9.1% that strongly disagreed that it could be caused by evil spirits. The average number of those with good preventive life style practices was 61.3%. Knowledge was associated with several factors and seems to affect practices (P < 0.05). Conclusion: Fair but inadequate level of knowledge and attitudes affected by several factors, as well as moderately high prevalence was recorded.
Keywords: Awareness, hypertension, practice, prevalence, women
|How to cite this article:|
Azubuike SO, Kurmi R. Awareness, practices, and prevalence of hypertension among rural Nigerian women. Arch Med Health Sci 2014;2:23-8
| Introduction|| |
The prevalence of hypertension is on the rise globally.  Among adults aged 25 and over, it was around 40% in 2008 amounting to 1 billion people [resulting in estimated 7.5 million deaths (12.8% annual deaths) and 57 million DALYs.  Overall estimate for Nigeria was 42.8% (far higher than 25% in an indigenous study.)  Raised blood pressure is a major risk factor to coronary heart disease, hemorrhagic stroke, visual impairment etc. ,
Hypertension is the most common chronic disease in developed and underdeveloped countries. ,, Hypertension, though controllable by various mean ,, yet the prevalence remains high in Nigeria, especially among women  due to ignorance, poverty, and non-compliance. ,
| Materials and Methods|| |
The study was carried out in Sanga local government area of Kaduna State and involved women aged 15-60 years attending post-natal clinic. Most times, people in this part of the world do not see much reason why they should spend their time to fill questionnaires, seeing it as not having much bearing to their wellbeing. Immunization clinic, therefore, provides an opportunity to explore their loyalty and patience towards clinic procedures to engage them in the study. Cross-sectional study design was used to study 252 subjects selected for the study. Sample size was computed based on confidence interval of 95% and absolute precision of 0.05. Purposive and Stratified sampling were used to select 13 health facilities from 5 wards based on their population strength and strategic location. The questionnaires were evenly distributed to people sitting at different positions of the halls at the health facilities, and whosoever received it and was willing was encouraged to fill it. Simple random sampling could not be used since the subjects were at the facilities primarily for immunization and could not afford too much time for other events such as research. Informed consents of the local government health authorities were obtained in writing while those of the focal persons and subjects were obtained orally.
The measuring instrument was a semi-structured questionnaire containing 20 questions designed to measure the knowledge, attitude, practices, and prevalence. Questions with 3 options Yes, No, or None response were used to determine presence or absence of a particular knowledge or practice of interest based on option ticked by the respondent, while attitude was measured using a 4-scale options (agree, strongly agree, disagree, and strongly disagree). The questionnaires were developed based on those used in several published works in reputable journals. They were self-administered to the respondents, after which they were collected at the spot. However, assistants were given to those who could not effectively handle the questionnaire on their own. Data generated from the study were analyzed using statistical package for social science students (SPSS) version 16. Test of associations employed Chi-square statistical tool with level of significance taken at 0.05.
| Results|| |
[Table 1] shows that greater number of those studied were within the age range of 35-54 (50.2%), followed by 15-34 yrs (11.9%). The dominant occupation was civil service (34.9%) with married people (64.7%) being more represented. Their levels of education indicate that primary education (33.7%) was higher in number followed by tertiary education (29.4%), then secondary education (26.6%). Ninzons (21%), followed by the Aboros (20.2%), were the dominant tribes with Christianity (62.7%) being the dominant religion compared to Islam (32.1%). Most of them (40.5%) have up to 5 children.
[Table 2] shows that about 203 (80.6%) have heard about hypertension, while about 155 (36.1%) knew that hypertension most times presents asymptomatically. It was, however, only 140 (55.6%) that knew that hypertension could lead to other complications. The prevalence of hypertension among the subjects was 61 (24.2%). Knowledge of hypertension was significantly associated with family history (P = 0.002). Basic exposure to hypertension information was significantly associated with knowledge of its asymptomatic presentation (P = 0.001). Knowledge that hypertension could lead to other complications was significantly associated with level of education and occupation (P = 0.001) respectively). Prevalence of hypertension was significantly associated with age (P = 0.016) and family history of the condition (P = 0.001).
[Table 3] shows that the most prevalent risk factor known to the subjects was excessive salt intake [195 (77.4%)], followed by family history of hypertension [185 (73.4%)]. The least was alcohol intake [120 (47.6%)]. Best practices in relation to risk factors were found for irregular consumption of alcohol [213 (84.5%)], followed by non-tobacco use/smoking [213 (84.5%)]. Regular exercise was 144 (57.1%), regular checking of blood pressure was 108 (42.9%), while weight reduction practice was 108 (42.8%). Mean level of risk factor knowledge was 164.7 (65.4%) compared to practice [154.9 (61.3%)]. Significant associations were noted between knowledge of some risk factors and positive practices towards them (P < 0.05) as indicated in [Table 2].
[Table 4] indicates that a total 190 (75.4%) tends to indicate a good tendency for apositive attitude towards the use of drugs in the management of hypertension, though this seems to be strong in only 44 (17.5%) of the respondents. It was not, however, significantly associated with level of education (P = 0.806, χ2 = 5.315) nor basic exposure to information (χ2 = 0.242, P = 0.971). Positive perception towards etiology of hypertension seems to be harbored by a total of 139 (55.1%), of which only 23 (9.1%) have a strong positive perception. It was not, however, significantly associated with the level of education (P = 0.344, χ2 = .084) nor basic exposure to hypertension information (χ2 = 2.075, P = 0.722).
|Table 4: Perceptions about Hypertension (Management and Cause of Hypertension) |
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| Discussion|| |
The sociodemographic table shows that greater number of those studied were within the age range of 35-54 (50.2%), followed by 15-34 yrs (11.9%)This may be attributed to the tendency to delay marriage or pregnancy that is usually associated with increasing civilization and industrialization. The dominant occupation was civil service (34.9%) with married people (64.7%) being more represented. These may indicate a good presence of governmental institution in the area as well as the fact that the populations were women attending post-natal clinic who are more likely to be married. Their levels of education indicate that primary education (33.7%) was higher in number followed by tertiary education (29.4%), then secondary education (26.6%). This suggests that a good number of them were enlightened and further justified a higher proportion of civil servants among the study population. Ninzons (21%), followed by the Aboros (20.2%), were the dominant tribes with Christianity (62.7%) being the dominant religion compared to Islam (32.1%). This was probably a reflection of strong presence of Christianity in southern Kaduna. Most of them (40.5%) have up to 5 children. Generally, women in Northern Nigeria tend to have more children than their Southern counterparts.
According to [Table 2], most of the subjects [203 (80.6%)] have heard about hypertension, while about 44 (17.5%) had no information at all. This suggests that some people or places within the locality were yet to have basic exposure to information on hypertension. This underscores the need for more efforts on awareness creation. This does not, however, remove the fact that substantial number (80.6%) knew about the problem. Similar good levels of basic exposure to hypertension information have been reported in several previous studies among both hypertensive and non-hypertensive patients, ,,,, especially women.  Exposure to hypertension knowledge was significantly associated with family history of hypertension (P = 0.002), but not with education (P = 0.118) or occupation (P = 0.183). Those with family history of hypertension seem to pay more attention to information related to hypertension. About 155 (61.5%) knew that hypertension most times presents asymptomatically. Awareness of the asymptomatic nature of the condition could affect attitude toward screening and early health-seeking behavior. This knowledge was significantly associated with basic exposure to information on hypertension (P = 0.001). The result was relatively high compared to 10% reported by Iyalomhe and Iyalomhe in 2010 in a suburban community of Nigeria.  However, the dominant populations of that study were farmers compared to civil servants in this study. Low knowledge of the asymptomatic presentation of hypertension has also been reported in some other studies. ,, Knowledge that hypertension could lead to other complications was seen among 140 (55.6%). This knowledge was significantly associated with level of education (P = 0.001) and occupation (P = 0.001). Similar associations have been found in other studies.  Knowledge of complications associated with hypertension could facilitate positive attitude towards compliance to treatment and early detection. The finding (55.6%) in this study is moderately high compared to the result of other studies ],[, but lower than those of other studies,  possibly due to differences in location and study population.
The prevalence of hypertension among the subjects was 61 (24.2%), and seems to be significantly associated with age (P = 0.016) and family history (P = 0.0001). Similar associations have been reported. , The prevalence was 14.63% among those aged 15-34 years, 18.09% among those aged 35-54 years, and 36.58% among those aged 55 yrs and above. Hypertension generally seems to be more prevalent as a population grows older and could be transmitted from one generation to another.  The prevalence in this study, however, seems to be lower than WHO 2008 estimate (44%), but tends to be closer to 25% cited by a Nigerian study in 2010,  and 23.9% cited in Saudi study in 2011.  The WHO study, however, had a wider scope than the population used in this study.
[Table 2] shows that the most prevalent risk factor known to the subjects was excessive salt intake [195 (77.4)], followed by family history of hypertension [185 (73.4%)]. The least was alcohol intake [120 (47.6)]. Good awareness of salt as a risk factor has been widely reported. ,, Poor knowledge of alcohol as risk factor has also been reported.  However, on an average, knowledge of risk factors (65.4%) seems to be moderately high compared to reports of previous studies. , This might be due to increasing global awareness of hypertension. Best practices in relation to risk factors indicated were irregular consumption of alcohol [213 (84.5%)], followed by non-tobacco use/smoking [213(84.5%)]. Regular exercise was 144 (57.1%), regular checking of blood pressure was 108 (42.9%), which was lower than that of a 2010 study,  though higher in another study done in 1998,  while weight reduction practice was 108 (42.8%). When knowledge of alcohol as a risk factor (47.6%) is compared with practice level (84.5%), it seems obvious that the good practice level noticed might not have been geared towards an attempt to control hypertension but possibly towards other related variables. Similar disparity could also be seen in knowledge and practice towards tobacco use (54.4%, 84.5%), suggesting that good level of practice cannot be traced alone to the knowledge of tobacco as a risk factor. Knowledge of alcohol as a risk factor did not significantly affect non-use of it (P = 6.98). However, increasing the awareness of tobacco use as a risk factor could significantly affect refrain from it (P = 0.017). Mean level of risk factor knowledge was 164.7 (65.4%) compared to practice [(154.9 (61.3%)]. Knowledge of stress as a risk factor seems to encourage regular physical exercise (P = 0.025), while knowledge of the asymptomatic nature of hypertension seems to encourage regular blood pressure monitoring (P = 0.001).
Strong positive attitude towards the use of drugs in the management of hypertension was seen only in 44 (17.5%) of the respondents while strong positive perception towards etiology of hypertension seems to be harbored by only 23 (9.1%) who strongly disagreed with the opinion that hypertension could be caused by evil spirits or charms. Previous study in Nigeria  reported that about 40% felt that hypertension was caused by malevolent spirits. This may indicate the influence of superstition on health perception of Nigerians. These attitudes seems not to be affected by the respondents levels of education (P = 0.806 and 0.344 respectively) nor basic exposure to hypertension information (P = 0.971 and 0.722 respectively). Proper perception is critical for appropriate health-seeking behavior and compliance to drug regimen.
[Figure 1] shows that the greatest source of information was hospital (44.05%), followed by women organization meeting (15.48%), ahead of television and radio (9.52%). These suggest avenues that could provide opportunities for creation of awareness on issues related to hypertension. The role of hospitals, print and electronic media has been noted in an indigenous study.  However, the role of women organization meetings seems not to have been well reported.
|Figure 1: Source of information: Figure 1 shows that the greatest source of information was hospital (44.05%), followed by women organization meeting (15.48%), ahead of television and radio (9.52%)|
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[Figure 2] shows that the most effective way of detecting hypertension according to the respondent was measurement of blood pressure (44.44%) followed by excessive headache (23.41%), feeling of internal heat (15.06%), then feeling of dizziness. This knowledge was significantly associated with level of education (P = 0.001). It seems that education increases opportunity for exposure to vital information related to hypertension.
|Figure 2: Respondents' knowledge of the best way to detect hypertension: Figure 2 shows that the most effective way of detecting hypertension according to the respondent was measurement of blood pressure (44.44%) followed by excessive headache (23.41%), feeling of internal heat (15.06%), then feeling of dizziness. This knowledge was significantly associated with level of education (P = 0.001, χ2 = 33.66)|
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Knowledge of blood pressure measurement as the best way of detecting hypertension in this study was very low compared to the report of Iyalomhes in Auchi, Nigeria,  probably because the subjects of that study were hypertensive patients. The findings here indicate the preponderance to late presentation to treatment since hypertension most times is asymptomatic. Such poor knowledge could also affect precautionary measures since they are most likely to view themselves as healthy in the absence of symptoms. It has been reported that lack of awareness of asymptomatic presentation of hypertension affect positive attitude towards screening.  The study, however, has some limitation. The experience of women attending post-natal clinic may not fully reflect the experience of all women in the locality who were not attending. For example, women aged above 65 yrs who may carry substantial risk of hypertension were not included since they are less likely to be seen in post-natal clinic. Moreover, the study could not apply simple random sampling, which may have been less biased than the method applied. Despite these, the study forms a very strong basis for future investigation.
| Conclusion|| |
The study suggests a moderately high prevalence of hypertension. While most of the respondents have basic exposure to hypertension information, there still remain some who have information at all. Level of knowledge seems to decrease at varying levels in relation to specific factors associated with hypertension. Attitudes to management and etiology of hypertension tend to be generally very low. Level of practice generally seems to be lower than level of knowledge; however, evidence exists that it improves as knowledge improves.
| References|| |
|1.||Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005;365:217-23. |
|2.||Alwan A. Global Status Report on non communicable disease 2010. Geneva: World Health Organisation; 2011. |
|3.||Iyalomhe GB, Iyalomhe SI. Hypertension related knowledge attitudes and lifestyle practices among hypertensive patients in suburban Nigerian community. J Public Health Epidemiol 2010;2:71-7. |
|4.||World cancer research fund/American institute for cancer research. Policy and action for Cancer Prevention: Food, nutrition and physical activity: A global perspective. Washinton, DC: WCRF-AICR; 2009. |
|5.||Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. British Hypertension Society guidelines for hypertension management 2004 (BH5-IV): Summary. BMJ 2004;328:634-40. |
|6.||Sabouhi F, Babaee S, Naji H, Zadi AH. Knowledge, Awareness, Attitudes and Practice about Hypertension in Hypertensive patients referring to Public Health Care centre in Khoor and Biabanak 2009. Iran J Nurs Midwifery Res 2011;16:35-41. |
|7.||Odutola TA, Amu VE. Multiple drug therapy of essential hypertension - Is it necessary'? Niger Q J Hosp Med 1997;7:332-4. |
|8.||Abdullahi AA, Amzat J. Knowledge of hypertension among the staff of University of Ibadan, Nigeria. J Public Health Epidemiol 2011;3:204-9. |
|9.||Collins R, Peto R, MacMahon S, Hebert B, Fiebach NH, Eberlein KA, et al. Blood pressure, stroke, and coronary heart disease, II: Short-term reductions in blood pressure: Overview of randomised drug trials in their epidemiological context. Lancet 1990;335:827-38. |
|10.||Aubert L, Bovet P, Gervasoni JP, Rwevogora A, Waeber B, Paccaud F. Knowledge, Attitude and Practices of h hypertension in a Country in Epidemiological Transition. Hypertension 1998;31:1136-45. |
|11.||Kadiri S. A Bottle of beer per day brings Hypertension Closer'. In: Abdullahi, and Amzat, J. Knowledge of Hypertension among the Staff of University of Ibadan, Nigeria. J Public Health Epidemiol 2011;3:204-9. |
|12.||Wang PS, Bohn RL, Knight E. Non-compliance with antihypertensive medications: The impact of depressive symptoms and psychosocial factors. J Gen Intern Med 2002;17:504-11. |
|13.||Oke DA, Bandele EO. Misconceptions of hypertension. J Natl Med Assoc 2004;96:1221-4. |
|14.||Addo J, Amoah AG, Koram KA. The changing patterns of hypertension in Ghana: A study of four rural communities in the Ga district. Ethn Dis 2006;16:894-9. |
|15.||Demaio AR, Otgontuya D, de Courten M, Bygbjerg IC, Enkhtuya P, Meyrowitssch DW, et al. Hypertension and Hypertension-related disease in Mongolia; Findings of a national Knowledge attitudes and practices Study. BMC Public Health 2013;13:194. |
|16.||Kusuma YS, Gupta SK, Pandav CS. Knowledge and Perceptions about hypertension among Settled Migrants in Delhi, India. CVD Prev Control 2009;14:119-29. |
|17.||Oliveria SA, Chen RS, McCarthy BD, Davis CC, Hill MN. Hypertension Knowledge, awareness, and attitudes in a hypertensive population. Gen Intern Med 2005;20:219-25. |
|18.||Guo F, He D, Zhang W, Walton RG. Trends in Prevalence, awareness, Management and Control of Hypertension among United States adults, 1999-2010. J Am Coll Cardiol 2012;60:599-606. |
|19.||Familoni BO, Ogun SA, Aina AO. Knowledge and awareness of hypertension among Patients with systemic hypertension. J Natl Med Assoc 2004;1996:620-4. |
|20.||Katibi IA, Olarinoye JK, Kuranga SA. Knowledge and Practice of hypertensive patients as seen in tertiary hospital in the middle belt of Nigeria. Niger J Clin Pract 2010;13:159-62. |
|21.||Jaddoh HY, Bateila AM, Ajlouni KM, Hum J. Prevalence, Awareness and Management of Hypertension in a recently urbanised Community, Eastern Jordan. Hypertension 2000;14:497-501. |
|22.||Saeed AA, Al-Hamdan NA, Bahnassy AA, Abdalla AM, Abbas MA, Abuzaid LZ. Prevalence, Awareness, Treatment and Control of Hypertension among Saudi Adult Population: A National Survey. Int J Hypertens 2011;2011:174135. |
|23.||Centre for Disease Control and Prevention. High Blood Pressure. Available from: http://www.cdc.gov/bloodpressure/heredity.htm [Last accessed on 2013 Oct 13]. |
|24.||Cielecka-Piontek J, Styszynski A, Wieczorowska-Tobis K. Knowledge of Risk Factors for Hypertension in the Elderly. New Medicine 1/2004, s. 2-4. Available from: http://www.czytelniamedyczna.pl/1000 [Last accessed on 2013 Oct 13]. |
|25.||Mlunde L. Knowledge, Attitude and Practices towards risk factors for hypertension in Kinondoni Municipality. Daressalaam. DMSJ 2007;14:59-62. |
|26.||Viera AJ, Cohen LW, Mitchel MC, Sloane P. High blood pressure Knowledge among Primary Care Patients with Known Hypertension. A North Carolina Family Medicine Research Network. J Am Board Fam Med 2008;21:300-8. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]