Professional Documents
Culture Documents
Undiagnosed Hyperternsion
Undiagnosed Hyperternsion
1
DECLARATION
i
ACKNOWLEDGEMENT
We would like to gratefully acknowledge the Community Based Education Services
(COBES) department and the COBES IV coordinator Dr.C.Nyamwange for their
facilitation and guidance. We offer sincere gratitude to our supervisors Dr. Kimaiyo and
Prof. Wakhisi for their technical input. Our appreciation also goes to the Eldoret
municipal council and the women traders at the Eldoret municipal market for their
cooperation during our study.
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TABLE OF CONTENTS
Contents
................................................................................................................................................................ 1
DECLARATION .......................................................................................................................................... i
ACKNOWLEDGEMENT ............................................................................................................................. ii
ABBREVIATIONS..................................................................................................................................... vi
ABSTRACT .............................................................................................................................................viii
INTRODUCTION................................................................................................................................... 1
BACKGROUND ................................................................................................................................. 1
JUSTIFICATION ................................................................................................................................ 1
HYPOTHESIS .................................................................................................................................... 2
RESEARCH QUESTION...................................................................................................................... 2
BROAD OBJECTIVE........................................................................................................................... 2
METHODOLOGY .................................................................................................................................. 6
SAMPLING ....................................................................................................................................... 7
ELIGIBILITY ...................................................................................................................................... 7
MEASUREMENT .............................................................................................................................. 9
IMPLEMENTATION .......................................................................................................................... 9
CHAPTER 5 ............................................................................................................................................ 11
RESULTS ............................................................................................................................................ 11
Age ................................................................................................................................................ 11
Income .......................................................................................................................................... 13
Sources of information.................................................................................................................. 14
Awareness..................................................................................................................................... 16
iv
CHAPTER SIX.......................................................................................................................................... 19
DISCUSSION....................................................................................................................................... 19
CONCLUSION ..................................................................................................................................... 21
RECOMENDATIONS ........................................................................................................................... 22
APPENDIX .......................................................................................................................................... 23
REFERENCES .......................................................................................................................................... 24
QUESTIONNAIRE ............................................................................................................................ 26
v
ABBREVIATIONS
NCDs- Non–communicable diseases
UN-United Nations
vi
DEFINITION OF TERMS
Hypertension - a sustained systolic blood pressure of greater than 140mmHg and a
sustained diastolic blood pressure of greater than 90mmHg
vii
ABSTRACT
Introduction:
Hypertension is a chronic medical condition in which systemic blood pressure levels are
elevated. It remains typically Asymptomatic until when very severe. It may cause long
term damage to vital organs such as the brain and kidneys.
Study Justification:
Worldwide, action is being taken to deal with the problem; however the local situation
in Africa and Kenya is difficult to tackle because of insufficient information on how
widespread it is across the social classes. Market women represent a social class that is
‘neglected’ in terms of routine healthcare checkups. They also do not have adequate
information on the problem
We chose Eldoret municipal market because it is near the school bearing in mind that
we will make several visits during the study
The information we get will help the government in developing policies, intervention
programs and increase awareness in the society.
Broad objective:
To find out the prevalence, level of information and contributing factors towards
undiagnosed hypertension among market women in the municipal market in Eldoret
Kenya.
Specific objectives:
2. To define the demographics, diet and body mass index (BMI) among market
women in the municipal market in Eldoret Kenya.
3. To find out the level of information on hypertension among market women in the
municipal market in Eldoret Kenya.
4. To find out any other chronic illnesses associated with hypertension in the
municipal market in Eldoret Kenya.
viii
Methodology:
The study population is the market women in the municipal market in Eldoret Kenya.
Our sample size calculated using the fisher’s formula came to 337. Our sampling
technique is systematic random sampling. Interviewer administered questioners will be
used
Data presentation:
Conclusion:
The data and results obtained will be useful in developing intervention programs, as
well as giving a better picture on the situation of hypertension in Kenya.
ix
CHAPTER ONE
INTRODUCTION
BACKGROUND
Hypertension is a chronic medical condition in which the systemic arterial blood
pressure is elevated. It constitutes a sustained systolic blood pressure of greater than
140mmHg and a sustained diastolic blood pressure of greater than 90mmHg.
Hypertension is the most common cardiovascular disease. In a survey carried out in
2000, hypertension was found in 28% of American adults. According to a Framingham
study of blood pressure trends in middle-aged and older individuals, approximately 90%
of Caucasian Americans will develop hypertension in their lifetime. The prevalence
varies with age, race, education, and many other variables. Sustained arterial
hypertension damages blood vessels in kidney, heart, and brain and leads to an
increased incidence of renal failure, coronary disease, cardiac failure, and stroke.
In Africa, hypertension remains one of the major diseases that has not received the
attention it needs. Many people may not be aware that they are hypertensive and
usually discover it during routine medical checkups such as the antenatal clinic for
pregnant women.
JUSTIFICATION
Hypertension is the most common cardiovascular disease worldwide. It is a serious non
communicable chronic illness that has not seemingly received the attention it deserves.
It typically remains asymptomatic until late in its course when its related complications
are severe. The international community has started taking steps to deal with
hypertension based on various studies that have established the prevalence and the
morbidity of the problem. Studies on hypertension are currently being carried out in
various African countries. However, the local situation in Kenya is difficult to deal with
because there is little information on how widespread it is across the various classes in
the society.
In Kenya, its mainly the high class population that get frequent blood pressure checkups
as the majority are well informed .In contrast, the low class population is less informed
on the issue and are therefore at a higher risk of suffering from undiagnosed
1
hypertension. The market women belong to this class and to our knowledge no other
study on hypertension has been done among market women locally.
We chose Eldoret market because of its convenience in terms of distance from the
school bearing in mind that we will be making several visits in the course of our study.
We believe that our study will aid the government and other stakeholders in the health
sectors in coming up with policies and intervention programs.
HYPOTHESIS
Majority of market women in the municipal market in Eldoret have undiagnosed
hypertension.
RESEARCH QUESTION
What is the prevalence, level of information and contributing factors towards
undiagnosed hypertension among market women in the municipal market in Eldoret
Kenya?
BROAD OBJECTIVE
To find out the prevalence, level of information and contributing factors towards
undiagnosed hypertension among market women in the municipal market in Eldoret
Kenya.
SPECIFIC OBJECTIVES
2. To define the demographics, diet and body mass index BMI among market
women in the municipal market in Eldoret Kenya.
3. To find out the level of information on hypertension among market women in the
municipal market in Eldoret Kenya.
4. To find out any other chronic illnesses associated with hypertension in the
municipal market in Eldoret Kenya.
2
CHAPTER TWO
LITERATURE REVIEW
According to WHO, hypertension is a highly prevalent cardiovascular risk factor
worldwide because of increasing longevity and the prevalence of contributing risk
factors such as obesity. Hypertension, however, remains inadequately managed
everywhere. UN summit on chronic non-communicable diseases in September 2011 NY-
the 2011 world health assembly held in May 2011 issued a declaration noting that NCDs
(cancers, chronic lung diseases, diabetes and cardiovascular diseases) pose one of the
greatest challenges to health and development, contributing to more than 60% of
deaths worldwide1. The last summit of its kind was on HIV/AIDS issue in 2001, indicating
a shift of focus from communicable to non-communicable diseases. The aim of the
summit, among other things is to push governments to prioritize NCDs within their
national health plans and to strengthen health systems to effectively cater for NCDs and
other health needs including communicable diseases and child and maternal care2.
In a study done in the UAE to determine the correlation between hypertension and
income distribution, case control studies matched for age, sex, nationality and
education. Hypertension was found to be significantly higher in low income groups
(35.2% versus 24.9%). Mean SBP in low income group was 130.2 versus 128.0 among
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the controls. It was also found that smoking and alcohol consumption were higher
among the low income groups5. A study on cross national comparisons of time trends in
overweight inequality in Kenya, Cameroon, Guinea, and Haiti found increases in levels of
overweight among low income groups. Impact of income on the profile of cardiovascular
risk factors among hypertensives done in Nigeria however found that dyslipidemia and
high CVD risk were found in over 71% of those profiled regardless of their levels of
income6. These findings pose a great challenge to management of patients considering
that access to healthcare among low income earners in Sub Saharan Africa is
considerably low, even with government subsidies.
Hypertension has materialized as the most prevalent risk factor for heart failure,
coronary artery disease, and stroke in economically emerging countries. This is
according to a study by M. J. Maseko et al (2010)7. In contrast to the approximately 34-
35% of all hypertensives and 55% of treated hypertensives that are controlled to target
BP levels in economically developed countries, by comparison, in economically emerging
countries such as South Africa, only 14% of all hypertensives and 33–44% of treated
hypertensives in primary-care settings are controlled to target BP. The major barrier to
BP control in economically emerging countries is lack of treatment. Although a lack of
treatment accounts for inappropriate BP control in economically emerging
communities, the decision to treat hypertension with drug therapy should be based on
global cardiovascular risk scores, rather than on the presence of hypertension per se. In
this regard, it is acknowledged that there is little evidence to support the use of drug
therapy in people who have BP values between 140 and 159/90 and 99 mmHg and a
‘low or moderate added’ risk.
4
Gender, smoking, fasting capillary glucose, blood pressures and age are potential
determinants of overall death due to hypertension and other cardiovascular disorders in
rural Cameroon. This is according to a research done in rural Cameroon by A. P. Kegne
et al in 19989. Another study, dietary, social and environmental determinants of obesity
in Kenyan women10, established that urbanization was a major risk factor for obesity
since obesity was most prevalent in women in this group. It is a well-established fact
that obesity, plus other variables that go hand in hand, is a major contributor to the
development of hypertension.
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CHAPTER THREE
METHODOLOGY
STUDY AREA
The study area is Eldoret Municipal Market. It is located in the Central Business District
in Eldoret town offOloo Street. Eldoret is in Uasin-Gishu County in Rift-Valley province
Western Kenya. Eldoret has an altitude of 2100 meters above sea level.
STUDY DESIGN
A descriptive cross sectional study method was employed in this study.
STUDY POPULATION
The study targeted the regular women traders at the Eldoret Municipal Market .The
approximate study population was about 1500 persons
SAMPLE SIZE
The sample size was calculated using the Fisher’s formula
n=Z2PQ/d2
Q is 1-P
6
Therefore,
n= [(1.96)2X 0.326X(1-0.326
(0.05)2
n=325
SAMPLING
The sampling method employed was systematic random sampling
ELIGIBILITY
Inclusion criteria were; women aged 18 years and above and regular tradersat the
market who consented to participate in the study.
Exclusion criteria included: age below 18 years, shoppers and visitors to the market,
pregnant women and those who were already diagnosed with hypertension.
BIAS MINIMIZATION
To reduce bias researcher administered questionnaires were used.
Researcher recall bias was minimized by immediately recording data obtained. The
questionnaires was structured to help the respondentsremain relevant to the study
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CHAPTER FOUR
STUDY EXECUTION
PILOT STUDY
This study was carried out at the Huruma municipal market to establish the
appropriateness and accuracy of data collection tools and methods. It also helped in
pre-testing the questionnaire therefore improving the quality of the main study.
MAIN STUDY
The main study was carried out at the municipal market in Eldoret in the month of
august 2012.
STUDY PROCEDURE
COMMUNITY ENTRY
The research team began the main study by holding a preliminary meeting with the
mayor and the market authorities, from whom they received a written consent to
undertake a study within their area of jurisdiction. The market authorities also issued
the researchers with a mobilizer, who mobilized the market women. The mobilizer
however did not participate in the actual study.
The subjects then made an informed decision and gave written consent.
8
MEASUREMENT
Blood pressure measurement using an automated BP machine, Omron series,
was done by the researchers.
Weight and height measurement for BMI was done using a weighing scale and a
height meter.
DATA COLLECTION
Data collection forms were used to collect data.
IMPLEMENTATION
Blood pressure:
Screening for blood pressure was done by the researchers within the market center,
using a non - invasive method as follows:
Participant was required to rest for at least five minutes. Blood pressure was then
obtained in a stable sitting position in the right arm which was supported on a table.
Appropriately sized cuffs were used and the blood pressure was measured when the
right arm was properly positioned at the mid-chest level.
After the first BP measurement, two more BP readings to be obtained, each after five
minutes interval of rest.
9
BMI= weight (kg)/height (m) 2
Questionnaires
Interviewer administered questionnaires were used.
STUDY OUTCOMES
Variables of interest are blood pressure and body mass index. Subjects were categorized
according to the following predefined BP categories:
The standard BMI ranges for adults is as shown in the table below
BMI Weight
18.5-24.9 Normal
25.0-29.9 Overweight
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CHAPTER 5
RESULTS
Age
Majority of the women (70%) interviewed were above 40 years of age. Of the 325
women interviewed, 80 of them were aged between 40 and 44 years of age. This
represents 24% of the total population sampled. This age group was followed in number
by the 45 to 49 year old group at 18% then the 30 to 34 year old age group. These are
women who are likely to be at risk of suffering from hypertension and other NCDs.
20-24 5 1.5
25-29 18 5.5
30-34 45 13.8
35-39 31 9.5
40-44 80 24.6
45-49 56 17.2
50-54 40 12.3
55-59 22 6.7
60-64 28 8.6
Figure 1.table showing the age distribution of the respondents
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Level of Education
More than half (53%) of these women had only attained primary level of education.
Only 37% had gone up to secondary level of education while 9% had no formal
education. None of the women interviewed had attained tertiary level of education. This
is again reflected in terms of knowledge concerning hypertension and its causes and
means of prevention as will be later expounded.
Marital Status
A large of no of the respondents at 47% were married, followed by the single women at
21%.The least being the divorced at 2%
Marital status
18%
21%
single
married
12%
divorced
separated
2% widowed
47%
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Income
A majority (42%) of the women reported making between 5000 and 9000 shillings per
month. This was however quite variable, with some reportedly making less than 5000
shillings per month.
Other sources of income stated were spouses’ income for those married although
almost 100% of them could not tell how much their spouses were making.
140
120
100
80
60
40
20
No of mrkt
0
Hypertension was found to be more frequent among the women with low income levels
and the frequency was reducing with increasing income. There was however a slight rise
13
in frequency in women with higher income levels of more than 20000
100
80
60
%
40
20
0
Normotensive
hypertensives
Income
Figure 4.line graph showing the interrelationship between income levels and hypertension.
Sources of information
27.10% of those who were aware of hypertension got the information from health
personnel. 67.80% got to know about hypertension from their friends while the rest
(5.10%) learned about it from the media.
sources of information
5.10%
27.10%
media
figure 5 pie chart showing the sources of information on hypertension for the respondent
14
Age and hypertension
Normal Hypertension
20-24 5 0
25-29 18 0
30-34 40 5
35-39 21 10
40-44 55 25
45-49 26 31
50-54 31 9
55-59 7 15
60-64 18 10
120%
100%
80%
60%
normol
40% HTN
20%
0%
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
AGE
15
Awareness.
Of the total population interviewed, 81% were not aware of the causes and prevention
of hypertension. Most of those who were aware cited stress as the most common cause
of hypertension. Few cited obesity and other diseases like diabetes as causes of
hypertension
DIABETES MELLITUS 12 7
HEART DISEASE 4 2
RENAL DISEASE 1 1
TOTAL 16 10 9.5%
16
BMI/hypertension
Of the 325 women sampled, 47 % were overweight, 38% were obese, leaving only 15%
of women at the market who were either of normal weight or underweight. Of those
who are underweight (8) none were hypertensive. 12.5% (42) of the women had normal
BMIs. Among those who are overweight (152), 55 have hypertension, Obese women
(123); 47 are hypertensive.
The graph below shows that hypertension prevalence increases with increasing BMI.
120
100
80
% 60
Normotensive
40 Hypertensives
20
0
underwt Normal overwt obese
BMI
17
Relationship between diagnosedand undiagnosed hypertension
Out of the 325 women sampled, 105 had hypertension. Thisrepresents 32.3% of the
total. Of the hypertensive women, 16%, were found to be diagnosed and on follow up.
84% of the hypertensives were found to have undiagnosed hypertension.
16%
Diagnosed
Undiagnosed
84%
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CHAPTER SIX
DISCUSSION
Increasing age is a known risk factor for hypertension. The National Institute of Aging
reports that more than 50% of people aged >60 years are hypertensive13, however, age
by itself is not considered an independent risk factor for hypertension. 36% of the
women above 60 we sampled were hypertensive. This lower number could be a result
of the difference in terms of diet and activity for this as compared to younger age
groups. There was generally an increasing incidence of hypertension with increasing age
though, with 36% of women between 40 and 44 being hypertensive while of those
between 55 and 59, 68% were hypertensive.
Current (2012) WHO statistics report that 1 in every 6 adults is obese. The rising
incidence of obesity increases the number of hypertensive individuals. A study done by
Margaret M. H. et al in 2000 to establish the relationship between fat distribution and
obesity and hypertension found that the prevalence of hypertension increased with
increased BMI, Weight to height ratio and waist circumference14. Although this increase
in prevalence was found in both whites and African Americans, the incidence of both
obesity and hypertension was higher among African Americans.
A study conducted among market men and women in Ibadan city in Nigeria15 by Sanusi
Ajani et al found that Among the men, (43%) were non overweight, and non obese,
while (42%) were overweight and (14%) were obese. Among the females, (42%) were
obese, (28%) were overweight and (29%) were within normal weight range. Among
obese men 64% were hypertensive, while 26% obese women, had hypertension. This
closely relates to our findings on market women where we found that 38% of the obese
women were hypertensive.
19
A study done in Kenya in 2008 by Ann Hum et al on obesity found the prevalence of
overweight to be 40% among the urban population and 15% among the rural
population. The prevalence of obesity was at 16% and 5% for the urban vs. rural
population respectively. From this study, 44% of the urban population is of normal BMI
or underweight, however we found only 15% of these market women being either of
normal BMI or underweight16. This difference could be because while the 2008 study
sampled both men and women, our study sampled women only. Also, 70% of the
women we sampled were above 40 years of age- these are women more likely to be
obese than the younger population.
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CHAPTER SEVEN
CONCLUSION
70% of the women were over forty years of age hence were at risk of hypertension since
prevalence of hypertension increased with age.
Income made by the majority of the women(42%) was between five thousand and nine
thousand Kenyan shillings.some made less than five thousand shillings. Hypertension
was found to be higher in those with lower income
47% of the women were found to be overweight while 38% were obese. Of those found
to be overweight, 36% were hypertensive, while 38% of the obese were hypertensive.
81% of the women sampled were unaware of the causes and means of prevention of
hypertension.
10% of the hypertensives had other chronic illnesses associated with hypertension
including diabetes mellitus, heart disease and renal disease. Diabetes mellitus was the
most common diseas associated with hypertension.
21
CHAPTER EIGHT
RECOMENDATIONS
To the government
1. The government policies are majorly focused on infectious disease, but with current
global trends and lifestyle changes, the burden has shifted towards non infectious
diseases so should the government.
1. The health facilities should provide provision for free regular screening of
Hypertension
2. The Health facilities should provide Education to the patients on risks, causes,
prevention and management detailing both pharmacological and non pharmacological
interventions
To the Community
1. To embrace proper lifestyle that minimize the risk of developing hypertension like
weight reduction, reducing salt intake, exercising.
2. To undertake the initiative of regular screening especially the high risk groups to
ensure early detection and hence management to prevent development of
complications like strokes, organ failures like renal, that are life threatening.
22
APPENDIX
STUDY BUDGET
23
REFERENCES
25
QUESTIONNAIRE
A :Demographic data:
1. Age of participant
2. Marital status
a. Single
b. Married
c. Divorced
d. Separated
e. Widowed
3. Level of education
a. None
b. Primary
c. Secondary
d. Tertiary
4. Spouse’s occupation
6. Number of children
8. Place of residence
26
9. Average income per month
B. NUTRITIONAL INFORMATION
2. Source(s) of information
a. Media
b. Health personnel
c. Others
D. HEALTH STATUS
27
PATIENT REFERRAL FORM
DATE.................................. TIME.............................
PROVISIONAL DIAGNOSIS.........................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
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CONSENT FORM
CONSENT FORM
Respondent,
I consent to give information required for this study which has been fully explained to me by the
researcher(s).I understand the full implication of taking part in the study. All the information I
give will be true to the best of my knowledge and will be given out of my free will.
SIGNATURE……………………………
DATE……………………………………
Ninakubali kwamba watafiti wamenieleza habari ambayo inahitajika katika utafiti huu,na
ninaelewa umuhimu wake, na ninakubali kutoa habari ya kweli na kwa hiari yangu mwenyewe.
SAHIHI………………………………….
TAREHE…………………………………
Researcher
I……………………………………………have explained the purpose of the study to the
respondent and that the respondent understands all the information that is required from him/her.
He/she also understands the implication of taking part in the study.
SIGNATURE………………………………
DATE………………………………………..
29