Prevalence of hypertension among federal ministry civil servants in Addis Ababa, Ethiopia: a call for a workplace-screening program

Co-occurrence of hypertension and type 2 diabetes: prevalence and associated factors among Haramaya University employees in Eastern Ethiopia

Background

Both hypertension (HTN) and diabetes are public health concerns in low- and middle-income countries, particularly in sub-Saharan African countries. The co-occurrence of HTN and diabetes is associated with an increased risk of mortality, morbidity, and reduced productivity in the working force. In Ethiopia, there is limited evidence on the co-occurrence of HTN and type 2 diabetes (T2DM). Therefore, this study was conducted to assess the co-occurrence of HTN and T2DM and their associated factors among Haramaya University employees in Eastern Ethiopia.

Methods

A cross-sectional survey was conducted among 1,200 employees at Haramaya University using a simple random sampling technique from December 2018 to February 2019. Demographic and behavioral factors were collected on a semi-structured questionnaire, followed by measurement of anthropometry and blood pressure. Blood glucose and lipid profile measurements were performed by collecting 6 ml of venous blood samples after 8 h of overnight fasting. Data were entered into EpiData 3.1 version and analyzed using Stata 16 software. Bivariable and multivariable logistic regressions were applied to observe the association between independent variables with co-occurrence of HPN and T2DM using odds ratio, 95% confidence interval (CI), and p-values of ≤ 0.05 were considered statistically significant.

Results

The prevalence of HTN and T2DM was 27.3 and 7.4%, respectively. The co-occurrence of HTN and T2DM was 3.8%. The study found that being older (AOR = 3.97; 95 % CI: 1.80-8.74), khat chewing (AOR = 2.76; 95 % CI: 1.23-6.18), body mass index ≥ 25 kg/m² (AOR = 5.11; 95 % CI: 2.06-12.66), and sedentary behavior ≥8 h per day (AOR = 6.44; 95 % CI: 2.89-14.34) were statistically associated with co-occurrence of HTN and T2DM. On the other hand, consuming fruits and vegetables (AOR = 0.10; 95 % CI: 0.04-0.22) and a higher level of education (AOR = 0.39; 95% CI: 0.17-0.89) were negatively statistically associated with the co-occurrence of HTN and T2DM.

Conclusion

The co-occurrence of HTN and T2DM was prevalent among the study participants. This may create a substantial load on the healthcare system as an end result of increased demand for healthcare services. Therefore, rigorous efforts are needed to develop strategies for screening employees to tackle the alarming increase in HTN and T2DM in university employees.

Prevalence and risk factors of hypertension among public servants in Ejisu-Juaben municipality, Ghana

OBJECTIVES

We determined the prevalence and risk factors of hypertension among public servants of Ejisu Juaben municipality.

RESULTS

The overall prevalence of hypertension was 29.3% (95%CI:22.5-36.1%) and only 8.6% of the participants were aware of their hypertensive status. Respondents who were > 40 years were twice as likely to develop hypertension compared to those who were ≤ 40 years [adjusted odds ratio (AOR) = 2.37, 95% confidence interval (CI) 1.05-5.32]. Those who were married were 2.54 times more likely to be hypertensive compared with those unmarried [AOR = 2.54, 95%CI: 1.06-6.08]. Compared to health workers, Judicial and Security service workers were almost five times more likely to be hypertensive [AOR = 4.77, 95%CI: 1.20-18.96]. Being overweight [AOR = 2.25, 95%CI: 1.06-6.41] and obese [AOR = 4.80, 95%CI: 1.82-12.91] was associated with increased odds of hypertension. The prevalence of hypertension among the participants in this study is high. Employee wellness programs are needed at workplaces and the Ghana Health Service must adopt targeted intervention programs such as regular screening for non-communicable diseases and promotion of physical activities at the workplace.

Blood Pressure Examination Habit and Its Determinants Among Civil Servants in Arba Minch Town: A Cross-Sectional Study - Using Hurdle Poisson Regression Model

Background

Hypertension is a common non-communicable disease detected through blood pressure measurement that makes periodic health examinations crucial for the detection, prevention, and timely treatment.

Objective

To assess the frequency of blood pressure examination and its determinant among civil servants in Arba Minch Town, south Ethiopia.

Methods

From February to March 2020 an organization-based cross-sectional study design was employed among civil servants in Arba Minch town. Data were collected from 580 randomly selected civil servants using a well-structured questionnaire. Hurdle Poisson regression model was conducted to identify determinants of frequency of blood pressure examination using R version 4.0.2.

Results

A total of 407 (70.2%) civil servants had never examined their blood pressure within a year before the study time. The mean frequency of blood pressure examination was 0.71 with a standard deviation of 1.46. The hurdle Poisson regression analysis indicates age above 40 years (IRR = 6.11, p < 0.001), elevated blood pressure (IRR = 1.48, p < 0.001), no family history of hypertension (IRR = 0.59, p < 0.001) had significant effects on the expected number of non-zero counts blood pressure examination. And education status (OR; 2.39, p < 0.05), poor knowledge about hypertension, not getting advice from health professionals (OR = 8.93, p < 0.001), and age above 40 years had significant effects on not taking blood pressure examination.

Conclusion

The frequency of blood pressure examinations among civil servants was found to be low. This study reveals age, elevated blood pressure, family history of hypertension, getting advice, and knowledge on hypertension were found to be determinants of the frequency of blood pressure examination. Thus, concerned health authorities and medical workers should work on these factors to prevent and detect hypertension among apparently healthy civil servants.

High burden of hypertension amongst adult population in rural districts of Northwest Ethiopia: A call for community based intervention

BACKGROUND

Hypertension is a serious public health issue in Ethiopia, but there is a paucity of evidence in the country's rural areas. The aim of this study was to determine the prevalence of hypertension and its risk factors among adults in rural districts in northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from June to October 2020. The 1177 study participants were chosen using a multistage sampling procedure. A face-to-face interview was conducted using an adapted version of the WHO STEPwise approach questionnaire. Blood pressure was measured three times using an aneroid sphygmomanometer, and the mean of the last two readings were used for the analysis. Data was entered using Epidata and analyzed using STATA-16. Multivariable logistic regression was used to identify risk factors associated with hypertension.

RESULTS

Of the total participants, 218 (18.5%) were found to be hypertensive. The prevalence of hypertension consistently increases with age. Hypertension was positively and significantly associated with female sex ((adjusted odd ratio (AOR) = 2.30, 95% CI: 1.53, 3.45)), age group 45-54 years (AOR = 4.63, 95% CI: 1.01, 21.37), 55-64 years (AOR = 14.40, 95% CI: 3.07, 67.63), ≥65 years (AOR = 19.37, 95% CI: 4.03, 93.09), having history of alcohol consumption (AOR = 3.25, 95% CI: 1.17, 9.02), used much amount of salt (AOR = 2.37, 95% CI: 1.53, 3.60) and too much amount of salt (AOR = 3.78, 95% CI: 1.85, 7.72), sleeping for a short duration (AOR = 2.05, 95%CI: 1.30, 3.24), and having family history of hypertension (AOR = 2.12, 95% CI; 1.32, 3.39).

CONCLUSIONS

Hypertension was significantly high among the rural population we studied and is emerging as a public health problem. Female sex, advanced age, ever used alcohol, excessive salt intake, insufficient sleep, and a family history of hypertension were factors that were positively and significantly associated with hypertension. We recommend local health authorities integrate promotion of hypertension health education, lifestyle modification intervention on salt and alcohol reduction, and hypertension detection, particularly for the female and elderly population, at the health post level to avert the problem.

Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia

Background

Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients’ risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).

Methods

A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants’ risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.

Results

Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18–82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43–18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36–14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants’ CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.

Conclusion

Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients’ CVD risk perception to reduce adverse CVD events.

High rates of undiagnosed and uncontrolled hypertension upon a screening campaign in rural Rwanda: a cross-sectional study

Background

Hypertension remains the major risk factor for cardiovascular diseases (CVDs) worldwide with a prevalence and mortality in low- and middle-income countries (LMICs) among the highest. The early detection of hypertension risk factors is a crucial pillar for CVD prevention.

Design and method

This cross-sectional study included 4284 subjects, mean age 46 ± 16SD, 56.4% females and mean BMI 26.6 ± 3.7 SD. Data were collected through a screening campaign in rural area of Kirehe District, Eastern of Rwanda, with the objective to characterize and examine the prevalence of elevated blood pressure (BP) and other CVD risk factors. An adapted tool from the World Health Organization STEPwise Approach was used for data collection. Elevated BP was defined as ≥ 140/90 mm/Hg and elevated blood glucose as blood glucose ≥ 100 mg/dL after a 6-h fast.

Results

Of the sampled population, 21.2% (n = 910) had an elevated BP at screening; BP was elevated among individuals not previously known to have HTN in 18.7% (n = 752). Among individuals with a prior diagnosis of HTN, 62.2% (n = 158 of 254) BP was uncontrolled. Age, weight, smoking, alcohol history and waist circumference were associated with BP in both univariate analyses and multivariate analysis.

Conclusion

High rates of elevated BP identified through a health screening campaign in this Rwandan district were surprising given the rural characteristics of the district and relatively low population age. These data highlight the need to implement an adequate strategy for the prevention, diagnosis, and control of HTN that includes rural areas of Rwanda as part of a multicomponent strategy for CVD prevention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02606-9.

Addressing the Impact of Noncommunicable Diseases and Injuries (NCDIs) in Ethiopia: Findings and Recommendations from the Ethiopia NCDI Commission

BACKGROUND

Noncommunicable diseases and injuries (NCDIs) are the leading causes of premature mortality globally. Ethiopia is experiencing a rapid increase in NCDI burden. The Ethiopia NCDI Commission aimed to determine the burden of NCDIs, prioritize health sector interventions for NCDIs and estimate the cost and available fiscal-space for NCDI interventions.

METHODS

We retrieved data on NCDI disease burden and concomitant risk factors from the Global Burden of Disease (GBD) Study, complemented by systematic review of published literature from Ethiopia. Cost-effective interventions were identified through a structured priority-setting process and costed using the One Health tool. We conducted fiscal-space analysis to identify an affordable package of NCDI services in Ethiopia.

RESULTS

We find that there is a large and diverse NCDI disease burden and their risk factors such as hypertension and diabetes (these conditions are NCDIs themselves and could be risk factors to other NCDIs), including less common but more severe NCDIs such as rheumatic heart disease and cancers in women. Mental, neurological, chronic respiratory and surgical conditions also contribute to a substantial proportion of NCDI disease burden in Ethiopia. Among an initial list of 235 interventions, the commission recommended 90 top-priority NCDI interventions (including essential surgery) for implementation. The additional annual cost for scaling up of these interventions was estimated at US$550m (about US$4.7 per capita).

CONCLUSIONS

A targeted investment in cost-effective interventions could result in substantial reduction in premature mortality and may be within the projected fiscal space of Ethiopia. Innovative financing mechanisms, multi-sectoral governance, regional implementation, and an integrated service delivery approach mainly using primary health care are required to achieve these goals.

Metabolic risk factors for non-communicable diseases in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Non-communicable diseases (NCDs) are causing a new and yetsignificant health challenge in low-income countries. In Ethiopia, although 39% of deaths are NCD related, the health system remains underprepared, highlighting the clear need for evidence on risk factor distributions to inform resource planning and the health response. Therefore, this review investigates prevalence distributions and sex and age variations of metabolic risk factors among Ethiopian adults.

RESEARCH DESIGN AND METHODS

This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published until 6 January 2021 were searched from PubMed, Scopus, ProQuest and Web of Science databases, reference lists of selected studies and grey literature. Studies reporting prevalence of metabolic risk factors: overweight/obesity, hypertension, impaired glucose homoeostasis and metabolic syndrome among Ethiopian adults were eligible for this systematic review and meta-analysis. Two authors independently extracted data and used the Joanna Briggs Institute tool for quality appraisal. The random effects model was used to conduct meta-analysis using Stata V.16. Subgroup analyses examined prevalence differences by region, study year, sample size and settings.

RESULTS

From 6087 records, 74 studies including 104 382 participants were included. Most showed high prevalence of metabolic risk factors. Meta-analysis revealed pooled prevalence of metabolic risk factors from 12% to 24% with the highest prevalence observed for overweight/obesity (23.9%, 95% CI 19.9% to 28.0%) and hypertension (21.1%, 95% CI 18.7% to 23.5%), followed by metabolic syndrome (14.7%, 95% CI 9.8% to 19.6%) and impaired glucose tolerance (12.4%, 95% CI 8.7% to 16.1%). The prevalence of overweight/obesity was higher in women. All metabolic risk factors were higher among people aged above 45 years.

CONCLUSIONS

A signficant proportion of Ethiopian adults have at least one metabolic risk factor for NCDs. Despite heterogeneity of studies limiting the certainty of evidence, the result suggests the need for coordinated effort among policymakers, healthcare providers, non-governmental stakeholders and the community to implement appropriate preventive measures to reduce these factors.

Prevalence of and risk factors for hypertension in Ethiopia: A systematic review and meta-analysis

BACKGROUND

A number of epidemiological studies were performed to know the prevalence of and the risk factors for hypertension. However, these studies reported inconsistent results. As a result, this systematic review and meta-analysis were planned to generate representative data on the prevalence of and risk factors for hypertension among the Ethiopian adult population.

METHODS

Five electronic databases, namely, PubMed, Science Direct, Google Scholar, Hinari, and African Journals Online, were searched for studies published in English from 1 January 2010 to 31 August 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa scale were used for data extraction and quality assessment for this review. Stata version 14 statistical software was used for the analysis, and due to high heterogeneity a random effects model was used for meta-analysis at 95% confidence interval (CI).

RESULTS

In this review, 35 observational studies were included. The pooled prevalence of hypertension in Ethiopia was 20.63% (95% CI [18.70, 22.55]) with the I 2 value of 96.1%. Older age (≥40 years) (adjusted odds ratio [AOR]: 3.46 [95% CI: 2.67, 4.49]), urban residence (AOR: 1.47 [95% CI: 1.28, 1.70]), educational status less than grade 12 (AOR: 1.67 [95% CI: 1.38, 2.01]), family history of hypertension (AOR: 4.33 [95% CI: 2.95, 6.34]), diabetes mellitus (DM) (AOR: 5.18 [95% CI: 3.01, 8.88]), body mass index (BMI) ≥25 (AOR: 3.79 [95% CI: 2.61, 5.50]), central obesity (AOR: 1.91 [95% CI: 1.09, 3.36]), and alcohol consumption (AOR: 1.72 [95% CI: 1.26, 2.34]) were the identified risk factors for hypertension.

CONCLUSION

The pooled prevalence of hypertension is relatively higher as compared to the previous reports in Ethiopia. Older age, urban residence, lower educational coverage, family history of hypertension, DM, BMI ≥25, alcohol consumption, and central obesity were the risk factors for hypertension. The governments and stakeholders should design an appropriate strategy to prevent and control the disease in the Ethiopian population.

Prevalence of Hypertension and Associated Factors Among Public Servants in North Wollo Zone, Amhara Region, Ethiopia, 2020

Background

The leading preventable risk factor for premature death and disability worldwide is hypertension. Globally, 31.1% of adults (1.39 billion people) have hypertension and 9.4 million deaths are recorded annually, accounting for 13% of overall mortality.

Objective

The objective of this study is to assess the prevalence of hypertension and associated factors among public servants in North Wollo Zone, Amhara Region, Ethiopia.

Materials and Methods

An institutional-based cross-sectional study was conducted among 627 public servants. To classify candidate variables for multivariable logistic regression, a binary logistic regression model was applied. In order to analyze factors associated with hypertension among participants, all variables with a P-value<0.2 were entered into the multivariable logistic regression model. In order to determine statistical significance, a p value of less than 0.05 was taken. The assumptions of Chi square and multi-collinearity were verified. For model fitness, the Hosmer–Lemeshow goodness-of-fit was checked.

Results

The total hypertension rate was 27.6% (95% CI: 24.1–31.3). The prevalence was higher in males 129 (32.5%) than in females 444 (19.1%). History of diabetes mellitus (AOR= 9.64, 95% CI: 3.20–29.30), age >35 years (AOR= 2.94, 95% CI: 1.91–4.51) and body mass index 25kg/m² and above (AOR= 3.44, 95% CI: 2.21–5.34) have been found to be separately associated with hypertension.

Conclusion and Recommendation

Among public servants in the study setting (study area), hypertension has become a major public health issue. Half of the newly reported cases is hypertensive. The conclusion of this study calls for a more holistic approach to hypertension in terms of hypertension prevention, screening, and proper management.

Survival Time to Development of Hypertension and Its Predictors among a Cohort of Diabetic Patients in Health Facilities of Gurage Zone: A Retrospective Follow-Up Study

Background

It is expected that around 50% of individuals with diabetes mellitus will develop hypertension in the course of medical follow-up. However, with strict medical follow-up and adherence to medical advice the incidence of hypertension can be highly reduced and the time to occurrence can be delayed. Therefore, this paper aimed to measure the time to development of hypertension and identify its predictors among a 10-year cohort of diabetic patients who have medical follow-up in health facilities of Gurage Zone.

Methods

An institution-based retrospective cohort study was conducted in diabetic follow-up clinics of Gurage Zone by reviewing 540 consecutively selected records among the records enrolled from January 1, 2010 to December 31, 2019. The outcome variable was incidence rate and survival time to the occurrences of hypertension (a systolic blood pressure at or above 140 mmHg and/or a diastolic blood pressure at or above 90 mm Hg and known hypertensive cases taken from adults’ age ≥18 years) among admitted diabetic patients (fasting blood sugar ≥126 mg/dL or random blood sugar ≥200 mg/dL). Data were collected using a standardized checklist by trained professionals by reviewing records of all clients ever enrolled. Data were cleaned and entered by Epi info version 7 and analyzed by STATA. A Cox-proportional hazard regression model was built to identify predictors of development of hypertension.

Results

A total of 540 clients were followed for different periods with a median follow-up period of 2.3 years which gives 3,200 person-years of observation. Two hundred and seventy-six (51.1%) participants were males and the mean age of was 52.2 (+11.7) years. Three hundred (55.6%) participants were urban dwellers. The overall incidence density rate (IDR) of hypertension in the cohort was 48.6 cases per 1,000 persons-year. Older ages adjusted hazard ratio (AHR)=4.0 (95% CI=2.26–7.82), body mass index (BMI) >25 kg/m² AHR=2.3 (95% CI=1.06–3.68), Type II diabetes mellitus (DM) AHR=2.0 (95% CI=1.16–3.04), presence of comorbidity AHR=2.9 (95% CI=1.74–4.58), and poor drug adherence AHR=2.5 (95% CI=1.45–4.65) predicted the development of hypertension.

Conclusion

The risk of occurrences of hypertension among diabetic patients was high at the early periods and the risk was less at the late diabetic periods and the incidence density rate of hypertension among diabetic patients was high. In addition, age, BMI, type of DM, comorbidity, and drug adherence were independent predictors of occurrences of hypertension. Therefore, intervention to further reduce its occurrence has to focus on drug adherence and prevention of infection.

The Prevalence of Hypertension and Associated Risk Factors among Secondary School Teachers in Bahir Dar City Administration, Northwest Ethiopia

Background

Hypertension is one of the noncommunicable cardiovascular diseases (CVDs), and its prevalence is rising in middle- and low-income countries. It is not given enough attention in the developing countries like Ethiopia. Not enough data and studies about hypertension are available in Ethiopia. This study aimed to determine the prevalence of hypertension and its associated risk factors among secondary school teachers in Bahir Dar city administration.

Methods

An institutional-based cross-sectional survey was conducted among secondary school teachers in Bahir Dar. Two hundred twenty-two randomly selected teachers were interviewed, and data related to the demographic, behavioral, health, and dietary characteristics of the individuals were recorded. Blood pressure data were taken. Logistic regression analysis had been used to assess independent risk factors for hypertension. p-values of less than 0.05 were considered statistically significant.

Results

The overall prevalence of hypertension in the study was 29.28%. Age 41 to 50 (AOR: 2.506; 95% CI: 1.103–5.694; and p=0.028), having self-reported diabetes mellitus (AOR: 8.595; 95% CI: 2.795–26.424; and p < 0.0001), having a family history of hypertension (AOR: 3.387; 95% CI: 1.579–7.285; and p=0.002), khat chewing (AOR: 5.426; 95% CI: 1.811–16.256; and p=0.003), physical inactivity (AOR: 5.212; 95% CI: 1.974–13.763; and p=0.001), and presence of self-reported repeated stress (AOR: 3.027; 95% CI: 1.404–6.527; and p=0.005) were the risk factors associated with hypertension.

Conclusions

Different intervention measures with a particular emphasis on prevention by introducing lifestyle modifications are highly recommended to mitigate and control hypertension.

Prevalence of Hypertension and Its Associated Factors Among Adults in Areka Town, Wolaita Zone, Southern Ethiopia

Background

Hypertension is an emerging public health problem in many low- and middle-income countries including Ethiopia. However, there are limited studies and data are scarce in these countries, particularly in Ethiopia. Thus, the aim of this study was to assess the prevalence of hypertension and its associated factors in this study area.

Methods

A community-based cross-sectional study was conducted in Areka town. Multi-stage sampling technique was used to select 581 adults. Information on socio-demographic data, behavioral and dietary habits, and family history of hypertension were collected using face-to-face interview. Measurements of weight, height, and blood pressure were taken using digital weighing scale, Stadio-meter, and digital sphygmomanometer respectively. Data were entered and cleaned in Epi-Data version 3.1, and exported to SPSS version 20 for analysis. Binary logistic regressions were done and odds ratios with 95% confidence intervals were calculated to identify associated factors.

Results

The overall prevalence of hypertension among the study participants was 19.1% (95% CI: 15.9-22.4). Out of these, more than half (57.3%) of the cases were newly screened for hypertension. In a multivariate logistic regression analysis; history of perceived childhood obesity (AOR:2.8 (95% CI:1.6,5.1)), age 55 years and above (AOR=8.90, 95% CI: 3.77-21.02), family history of hypertension (AOR= 2.57, 95% CI: 1.17-5.64), fatty meat intake (AOR=1.96, 95% CI: 1.05-3.65), eating vegetables less than two days per week (AOR=2.81, 95% CI: 1.24-6.37) and being obese (AOR=11.59, 95% CI: 4.7-27.62) were associated factors of developing hypertension.

Conclusion

The study revealed that the prevalence was found to be high among adults indicating the hidden burden of the problem in the area. Therefore, the health systems need to develop strategies for community-based screening, strategies that focus on life cycle-based approach because childhood and adolescence are crucial times for the prevention of NCDs including hypertension. Health education on eating behavior and life style modifications to maintain normal body weight are recommended.

Adherence to antihypertensive medications and associated factors among hypertensive patients in Ethiopia: Systematic review and meta-analysis

The foundation of controlling hypertension is adherence to antihypertensive medication adherence. This systematic review and meta-analysis aimed to assess the magnitude and associated factors of adherence to antihypertensive medication among adult hypertensive patients in Ethiopia. A comprehensible bibliographic searching was conducted from PubMed, EMBASE, Scopus, and Web of Science core collection. All published and unpublished studies that had been accessible before 31 May 2020, and written in English were eligible. Joanna Briggs Institute assessment tool was used to evaluate the quality of the findings of the included studies. Stata software 16.0 was used to analyze the data. Study-specific estimates were pooled to determine the overall prevalence estimate across studies using a random-effects meta-analysis model. Publication bias and heterogeneity were checked. Fourteen studies with a total of 4938 hypertensive patients were included in the final systematic review and meta-analysis. The pooled prevalence of medication adherence among hypertensive patients in Ethiopia was 65.41% (95% confidence interval: 58.91-71.91). Sub-group analysis shown that the pooled prevalence of medication adherence was the highest (69.07%, 95% confidence interval: 57.83-80.31, I ² = 93.51) among studies using questionnaire technique whereas the lowest in Morisky Medication Adherence Scale eight-items (60.66%, 95% confidence interval: 48.92-72.40, I ² = 97.16). Moreover, medication adherence was associated with the presence of comorbidities (pooled odds ratio = 0.23, 95% confidence interval: 0.07-0.38, p = 0.030, I ² = 54.9%) and knowledge about the disease and its management (pooled odds ratio = 2.98, 95% confidence interval: 1.72-4.24, p = 0.04, I ² = 55.55%) but not with place of residence (pooled odds ratio = 1.22, 95% confidence interval: 0.51-1.93, p = 0.00, I ² = 76.9%). Despite a lack of uniformity among included studies, adherence to antihypertensive medication among the hypertensive population in Ethiopia was moderate. The presence of comorbidities and/or complications reduced the odds of adherence whereas having good knowledge about the disease increased chance of medication adherence among hypertensive patients.

PASCAR and WHF Cardiovascular Diseases Scorecard project

Data collected for the World Heart Federation's Scorecard project regarding the current state of cardiovascular disease prevention, control and management, along with related non-communicable diseases in Ethiopia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the accompanying infographic. Information was collected using open-source data sets from the World Bank, the World Health Organization, the Institute for Health Metrics and Evaluation, the International Diabetes Federation and relevant government publications.

Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis

Introduction

Hypertension is a major public health problem globally and it is a leading cause of death and disability in developing countries. This review aims to estimate the pooled prevalence of hypertension and its determinants in Ethiopia.

Methods

A systematic literature search was conducted at the electronic databases (PubMed, Hinari, and Google Scholar) to locate potential studies. Heterogeneity between studies checked using Cochrane Q test statistics and I² test statistics and small study effect were checked using Egger’s statistical test at 5% significance level. Sensitivity analysis was checked. A random-effects model was employed to estimate the pooled prevalence of hypertension and its determinants in Ethiopia.

Results

In this review, 38 studies that are conducted in Ethiopia and fulfilled the inclusion criteria with a total number of 51,427 study participants were reviewed. The overall pooled prevalence of hypertension in the country was 21.81% (95% CI: 19.20–24.42, I² = 98.35%). The result of the review also showed that the point of prevalence was higher among males (23.21%) than females (19.62%). When we see the pervasiveness of hypertension from provincial perspective; the highest prevalence of hypertension was observed in Addis Ababa (25.35%) and the lowest was in Tigray region (15.36%). In meta-regression analysis as the mean age increases by one year, the likelihood of developing hypertension increases by a factor of 0.58 times (β = 0.58, 95% CI: 0.31–0.86, R² = 36.67). Male sex (OR = 1.29, 95% CI: 1.03–1.61, I² = 81.35%), age > 35 years (OR = 3.59, 95% CI: 2.57–5.02, I² = 93.48%), overweight and/or obese (OR = 3.34, 95% CI: 2.12–5.26, I² = 95.41%), khat chewing (OR = 1.42, 95% CI: I² = 62%), alcohol consumption (OR = 1.50, 95% CI: 1.21–1.85, I² = 64%), family history of hypertension (OR = 2.56, 95% CI: 1.64–3.99, I² = 83.28%), and family history of diabetes mellitus (OR = 3.69, 95% CI: 1.85–7.59, I² = 89.9%) are significantly associated with hypertension.

Conclusion

Hypertension is becoming a major public health problem in Ethiopia. Nearly two out of ten individuals who are older than 18 years living with hypertension. Sex, age, overweight and/or obese, khat chewing, alcohol consumption, and family history of hypertension and diabetes mellitus are statistically significant determinant factors for hypertension in Ethiopia. Primary attention should be given for behavioral risk factors to tackle the alarming increase of hypertension in Ethiopia.

Prevalence of Hypertension and Its Associated Factors Among Gimbi Town Residents, Ethiopia: A Community-Based Cross-Sectional Study

Background

Globally, sixty-two percent of cerebrovascular disease and forty-nine percent of ischemic heart disease are attributable to increased blood pressure. Half of the patients with stroke and heart disease were due to hypertension.

Objective

This study aimed to identify prevalence of hypertension and its associated factors in Gimbi town, Ethiopia.

Methods

We conducted a community-based cross-sectional study from May to June 2017 on 471 participants in Gimbi town, western Ethiopia. A systematic sampling method was used to recruit study participants. Data collectors used structured questionnaires to gather data through face to face interview. The standardized procedure followed to measure blood pressure and anthropometric measurements by trained extension health workers. We entered data into Epi-data and exported to SPSS version 20.00 for analysis. Variables having a P-value less than or equal to 0.05 were declared as statistically significant in multivariable analysis.

Results

Four hundred seventy-one participants were included with a response rate of 98.85%, and 248 (52.6%) were female. The prevalence of isolated systolic and diastolic hypertension was 9.55% and 9.3%, respectively. Of 157 (33.5%) hypertensive participants, 117 (24.8%) were newly diagnosed. Age 35–55 [AOR: 2.335 95% CI (1.360–4.009)], ≥55 [(AOR: 3.566 95% CI (1.288–9.876))], occupation, government employee [(AOR: 3.072 95% CI (1.458–6.474))], merchants [(AOR: 3.177 95% CI (1.290–7.824))], ever alcohol drinker [(AOR: 2.333 95% CI (1.320–4.122))], and family history of hypertension [(AOR: 6.642 95% CI (4.068–10.843))] were found to be predictor variables for hypertension.

Conclusion

The findings of this study indicated a hidden high prevalence of hypertension indicating the need for stakeholders’ collaboration to design and implement a mobile blood pressure screening programs at the community level.

Self-care practice and associated factors among hypertensive patients in public health facilities in Harar Town, Eastern Ethiopia: A cross-sectional study

Background:

Self-care practice is the activity that a hypertensive patient undertakes intending to improve their health. Poor self-care practice leads to uncontrolled hypertension. Therefore, strategies designed to prevent and control hypertension-related death, disability, and morbidity should consider the level of the patient’s self-care practice and risk factors. This study assessed self-care practice and associated factors among hypertensive patients in public health facilities of Harar Town in eastern Ethiopia.

Method:

An institution-based cross-sectional study was conducted among 398 randomly selected hypertensive patients from 25 March 2019 to 16 April 2019. Pretested structured questionnaires adapted from validated tools were used to collect data from participants using electronic Open Data Kit software through face-to-face exit interview. Data were analyzed by SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with self-care practice. Adjusted odds ratio with 95% confidence interval was used to report association and the significance was declared at p-value < 0.05.

Results:

Level of good self-care practice was 29.9% (95% confidence interval: 25.3% and 34.7%). Age ⩾ 60 years (adjusted odds ratio = 3.4, 95% confidence interval: 1.2 and 9.3), formal education (adjusted odds ratio = 2.3, 95% confidence interval: 1.3 and 4.2), absence of comorbidities (adjusted odds ratio = 1.8, 95% confidence interval: 1.1 and 3.1), adequate knowledge about hypertension (adjusted odds ratio = 4.7, 95% confidence interval: 2.5 and 8.8), good social support (adjusted odds ratio = 2.7, 95% confidence interval: 1.6 and 4.7), and being khat abstainer (adjusted odds ratio = 1.9, 95% confidence interval: 1.1 and 3.5) were significantly associated with good self-care practice.

Conclusion:

The prevalence of good self-care practice was low. In this study, good self-care practice was significantly associated with age, formal education, comorbidities, knowledge about hypertension, social support, and current khat chewing condition. Regular check-up and follow-up of patients’ compliance with self-management protocol, and more emphasis should be given to identify factors that potentially impeding patients’ adherence to hypertension self-management protocol.

Epidemiology of Hypertension in Ethiopia: A Systematic Review

Background

Hypertension is one of the leading causes of disease in the world. This study is a systematic review paper, intended to provide compressive evidence on the prevalence, distribution, determinants, and burden of hypertension in Ethiopia.

Methods

A quantitative epidemiological literature review was conducted by searching different articles in different databases, including PubMed, Cochrane, and Google scholar. The search involved population-based, hospital-based, and institution-based studies on hypertension conducted in Ethiopia. All data were extracted independently by two reviewers using data collection formats. Finally, this review included 22 studies.

Results

Different studies reported varied prevalence of hypertension because of the differences in participant's mean ages, source population, and study settings. Population-based studies revealed the prevalence of hypertension to be 9.3-30.3%, institution-based studies revealed 7-37%, whereas hospital-based studies revealed 13.2-18.8%. In studies included in this review, about 37-78% of hypertensive patients were not aware of their blood pressure condition. There was a high prevalence of hypertension in urban residents, and different factors were associated with hypertension, including being overweight, family history of hypertension, age, sex, diabetes mellitus, alcohol intake, physical inactivity, and obesity.

Conclusion and Recommendation

Hypertension was substantially prevalent in Ethiopia, which calls for the implementation of timely and appropriate strategies for the prevention and control of the disease.

Prevalence of Hypertension and Associated Factors among the Outpatient Department in Akaki Kality Subcity Health Centers, Addis Ababa, Ethiopia

Background

Fatalities from hypertension in East Africa are increasing, even though they decreased in western industrial regions. Older age, being female, illiterate, smoking, physical inactivity, and high waist circumferences are major risk factors for the development of hypertension. The prevalence of hypertension among Federal Ministry Civil servants in Addis Ababa, Ethiopia, has found to be high; which is an indication for institution-based hypertension-screening programs.

Objective

Prevalence of hypertension and associated factors among the outpatient department in Akaki Kality Subcity Health Centers, Addis Ababa, Ethiopia. Methodology. Facility-based cross-sectional study was carried out on systematically sampled 401 out-department patients whose age was greater than or equal to 18 years in four government health centers in Addis Ababa. Data collection took place from March 10, 2018, to April 06 2018. Binary logistic regression analysis was carried out to identify predictors of hypertension.

Results

Patients had a mean age of 41.17 years (95% CI: 39.77–42.57). The prevalence of hypertension was 14% (95% CI: 13.653–14.347), and 30 (53.57%) were males. Alcohol drinkers were 11.844 times more likely to be hypertensive as compared to non-alcohol drinkers (AOR = 11.844, 95% CI: 3.596–39.014). Cigarette smokers were 16.511 times more likely to be hypertensive as compared to non-cigarette smokers (AOR = 16.511, 95% CI: 4.775–57.084). Khat chewers were 6.964 times more likely to be hypertensive as compared to non-khat chewers (AOR = 6.964, 95% CI: 1.773–26.889).

Conclusion

The prevalence of patients with hypertension was 14%. Alcohol drinking, cigarette smoking, khat chewing, body mass index ≥25 kg/m², and age ≥44 years old are major determinants identified by this study. Hence, appropriate management of patients focusing on the relevant associated factors would be of great benefit in controlling hypertension.

Prevalence and risk factors of hypertension among civil servants in Sidama Zone, south Ethiopia

INTRODUCTION

Hypertension is the leading cause of death and disability in adult populations globally. Its prevalence is increasing rapidly in Ethiopia. Studies conducted to date address different population categories. However, there is lack of data on the prevalence and risk factors of hypertension among civil servants working in various sectors and levels.

OBJECTIVE

To assess the prevalence and risk factors of hypertension among civil servants in Sidama Zone, south Ethiopia.

METHODS AND MATERIALS

An institution-based cross-sectional study was conducted from March 1-30, 2019 on a sample of 546 civil servants selected randomly from different departments of Sidama Zone Administration. Data were collected using structured, face-to-face interviewer-administered questionnaire and standard physical measurements. The data were entered using Epi Data 3.1 and analyzed using SPSS version 20. Multivariable logistic regression analysis was used to identify factors associated with hypertension. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were computed to assess the presence and strength of associations.

RESULTS

A total of 546 civil servants responded resulting in a response rate of 94.9%. The prevalence of hypertension was 24.5% [95% CI: 23.3% - 25.6%]. The identified risk factors of hypertension were male sex (AOR 4.31[95% CI: 1.84-10.09]), moderate current alcohol consumption (AOR: 4.85; [95% CI: 1.73-13.61]), current khat chewing (AOR 2.97[95% CI: 1.38-6.40]), old age (AOR: 4.41[95% CI: 1.19-16.26]), being obese (AOR 5.94 [95% CI: 1.26-27.86]) and central obesity (AOR 3.57 [95% CI: 1.80-7.07]).

CONCLUSIONS

One in four civil servants are hypertensive. Different demographic, behavioral and metabolic factors increase the odds of hypertension among civil servants. Prevention and control of hypertension shall involve promotion of healthy lifestyles such as weight management, regular physical activity and quitting or cutting down on harmful use of substances such as alcohol and khat.

The Prevalence and Associated Factors of Hypertension among Adults in Southern Ethiopia

Background

Hypertension is a growing public health problem in many developing countries including Ethiopia. Determining the prevalence of hypertension and identifying the associated factors is crucial.

Objective

To assess the prevalence of hypertension and associated factors, among adult population of Arba Minch town, Gamo Zone, Southern Nations, Nationalities and Peoples Region, Ethiopia.

Methods

A cross-sectional study design was conducted from December 1 to 30, 2017 among adults. Study participants were selected using a multistage systematic sampling method. Data were collected by face-to-face interview after getting written informed consent by using a structured questionnaire. Additionally, weight, height, and blood pressure of participants were measured following standard procedures. Data were entered into a computer using EPI INFO 7 and exported into SPSS version 20 for analysis. Bivariate and multivariable analyses were performed to explore the association between hypertension and associated factors. Multivariable logistic regressions were fitted to control the effect of confounders.

Results

A total of 784 study participants were included in this study. The overall prevalence of hypertension in Arba Minch Town was 35.2%, (95% CI: 32.4%, 38.4%). Nearly 90% of hypertensive patients were screened for the first time. Age ≥55 years [AOR = 7.74; 95% CI: 2.19, 27.23], income level which is greater than 2501 Ethiopian Birr [AOR = 9.5; 95% CI: 4.5, 20.20], working hour less than seven hours per day [AOR = 12.5; 95% CI: 4.3, 36.1], and chewing “khat” [AOR = 11.06: 95% CI: 4.3, 27.7] were the independently associated factors with hypertension.

Conclusion

The prevalence of hypertension is found to be high. Increasing awareness on control use of “khat,” increasing physical activity, and strengthening community-based periodic screening programs of high-risk populations are recommended.

Impact of dietary patterns, individual and workplace characteristics on blood pressure status among civil servants in Bida and Wushishi communities of Niger State, Nigeria

The global burden estimate of hypertension is alarming and results in several million deaths annually. A high incidence of sudden deaths from cardiovascular diseases in the civil workforce in Nigeria is often reported. However, the associations between Dietary Patterns (DPs), individual, and workplace characteristics of hypertension among this workforce have not been fully explored. This study aimed to identify DP in the Bida and Wushishi Communities of Niger State and establish its relationship with hypertension along with other individual and workplace characteristics. Factor analysis was used to establish DP, Chi-square test to identify their relationships with hypertension, and logistic regression to determine the predictor risk factors. The prevalence of hypertension was 43.7%; mean weight, height, and body fat were: 72.8±15 kg, 166±8.9 mm and 30.4%, respectively. Three DPs: “Efficient Diet,” “Local diet,” and “Energy Boost Diet” were identified. The factor loading scores for these factors were divided into quintiles Q1–Q5; none of them had a significant effect on hypertension status. Conversely, increase in age, the Ministry, Department, and Agency (MDA) of employment, frequency of eating in restaurants, and obesity were identified as significant risk factors. After adjusting for confounders (age, body mass index, MDA, and eating habits), a high score (Q5) in “efficient diet pattern” was significantly related to a lower likelihood of hypertension than a low score (Q1). The prevalence of hypertension among the participants was relatively very high. An increase in age and working in educational sector were risk factors associated with hypertension. Therefore, it is recommended that civil servants engage in frequent exercise and undergo regular medical checkups, especially as they get older. These findings highlight the need for large-scale assessment of the impact of variables considered in this study on hypertension, among the civil workforce across Niger state and Nigeria.

Prevalence of hypertension and its associated factors among adults in Debre Markos Town, Northwest Ethiopia: community based cross-sectional study

Objective

To assess the prevalence and associated factors of hypertension among adults in Debre Markos town, Northwest Ethiopia. A community based cross sectional study design was employed. Systematic random sampling was used to select 456 study participants. Analysis was performed using SPSS version 20. Binary logistic regression was fitted to show the association between dependent variable and independent variables.

Result

A total of 57 (12.5%) individuals had hypertension in Debre Markos town. Being female [AOR 3.78, 95% CI 1.56, 9.147], consuming animal source fat [AOR 6.28, 95% CI 2.63, 14.99], family history of hypertension [AOR 4.88, 95% CI 1.99, 12.015], age greater than 50 years [AOR 3.31, 95% CI 1.00, 10.99], body mass index ≥ 25 kg/m² [AOR 4.70, 95% CI 1.99, 11.06], excess salt consumption [AOR 6.49, 95% CI 2.83,14.89] and alcohol consumers [AOR 3.19, 95% CI 1.13, 8.99] were found to be statistically significant factors associated with hypertension. The prevalence of hypertension in Debre Markos town is still a public health problem. Being female sex, consuming animal source fat, family history of hypertension, excess salt consumption age greater than 50 years and body mass index > 25 kg/m² were significant factors of hypertension. Therefore, health sectors should take actions to tackle these modifiable risk factors.

Prevalence of Hypertension and Associated Factors in Dire Dawa City, Eastern Ethiopia: A Community-Based Cross-Sectional Study

Background

Hypertension is a major cardiovascular risk factor that is linked with fatal complications and is an overwhelming global challenge. Primary prevention is a key to control hypertension with identification of major risk factors. This study was aimed at assessing the prevalence and factors associated with hypertension.

Methods

Community-based cross-sectional study was conducted among 903 adults aged 25 to 64 years in Dire Dawa City, East Ethiopia. Data were collected using World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) for non-communicable disease (NCD) standard survey tool. Multivariate logistic regression models were used to identify relative effects of distal, proximal, and immediate risk factors of hypertension, and all statistical tests were declared significantly at P-value<0.05.

Results

The average SBP and DBP were 124.98±17.18 mmHg and 78.92±10.13 mmHg, respectively. The prevalence of hypertension was 24.43% (95% CI: 21.57, 27.28). Majority (51.64%) of adults were not aware of their elevated blood pressure status. hypertension was significantly associated with the age group 30-44 (aOR 3.61, 95% CI: 2.0, 6.55), 45-54 (aOR 5.36, 95% CI: 2.62, 10.91), and 55-64 (aOR 9.38, 95% CI: 4.73, 18.59), being unemployed (aOR 1.68, 95%CI: 1.03, 2.77), ever smoking (aOR 1.89, 95% CI: 1.04, 2.23), having abdominal obesity (aOR 1.72, 95% CI: 1.13, 2.64), and BMI≥25 kg/m² (aOR 1.48, 95%CI: 1.01, 2.15).

Conclusion

Moderately high prevalence of hypertension was observed among adults in study setting demonstrating a major public health problem. Majority of adults with hypertension in study setting were not aware of their elevated BP status highlighting the burden of the hidden morbidity and subsequent complications. Community level intervention and routine assessment of sociodemographic, behavioral, and biophysiological risk factors, screening, and diagnosis of NCDs should be institutionalized to address the occult burden.

Hypertension and Diabetes Mellitus among Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia

Background

The burden of noncommunicable disease (NCD) in Africa is on a remarkable rise exacerbating the poor public health status affected by the existing but yet unsolved communicable disease. In Ethiopia, there is a paucity of evidence regarding prevalence and risk factors to NCD.

Objective

This study sought to determine the prevalence of risk factors of NCDs, prevalence of DM and HTN, and risk factors associated with diabetes mellitus (DM) and hypertension (HTN).

Method

This is an institution based cross-sectional study conducted on a sample of 411 clients attending a university-based comprehensive specialized hospital in Southern Ethiopia. The data was collected by using a pretested interviewer-administered questionnaire and observational checklist. Frequency, proportions, bivariate and multivariate logistic regression analysis was conducted using SPSS software version 20.

Result

We identified 64.2% of the clients had at least one of the risk factors to the NCDs. One-third (33.3%) had physical inactivity, whereas 20.2% had a BMI of ≥ 25%. The prevalence of DM and HTN was 12.2% and 10.5%, respectively. The multivariate analysis demonstrated that age ≥ 60 years, physical inactivity, higher BMI, and cigarette smoking were risk factors for at least one of the NCDs.

Conclusion

The prevalence of DM and prevalence of HTN were high. The magnitudes of risk factors to NCDs among the study population were substantial. Higher BMI, physical inactivity, low fruit and vegetable consumption, alcohol use, khat chewing, and cigarette smoking were among the prevailing risk factors identified.

Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis

The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6–15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6–16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.

Magnitude and risk factors for hypertension among public servants in Tigray, Ethiopia: A cross-sectional study

BACKGROUND

Hypertension is a globally recognized threat to social and economic development with premature morbidity and mortality. In middle and low-income countries hypertension appears to be increasing. However, sufficient data on this silent-killer is not available in Ethiopia. Therefore, this study examined the magnitude and risk factors for hypertension among public servants in Tigray, Ethiopia.

METHODS

We used a cross-sectional survey from May-June 2016 among 1525 public servants in Tigray region. Field workers collected data using a pre-tested, standardized questionnaire. A multivariate logistic regression analysis conducted to identify risk factors for hypertension. Statistical significance was declared using a p-value<0.05 and 95% of confidence interval (CI) for an adjusted odds ratio (AOR).

RESULTS

The overall prevalence of hypertension was 16% (95% CI: 13.10-21.9) and the proportion of awareness (96.7%), treatment (31.3%) and control of hypertension (40.1%) among employees. Being male [AOR = 2.06, 95%CI:1.49, 2.84], ages groups of 30-49 years [AOR = 2.21, 95%CI:1.25, 3.89] and >50years [AOR = 3.61, 95% CI:1.93, 6.69], Body Mass Index(BMI); underweight [AOR = 0.40, 95% CI; 0.20, 0.78], overweight [AOR = 1.70, 95%CI; 1.22, 2.33] and obesity [AOR = 3.20, 95% CI; 1.78, 5.78] were determinants for hypertension.

CONCLUSION

The prevalence of hypertension is relatively high in Mekelle city compared with previous reports. This study revealed that male sex, age-group, and BMI were evidenced as risk factors for hypertension. Policy makers need to consider sector wise integrating prevention and control of hypertension. Skilled based information, education and communication strategies should be designed and implemented to avoid unhealthy lifestyles, investing in workforces to eliminate the modifiable risk factors for non-communicable diseases and promote healthy practices.

Burden of NCDs in SNNP region, Ethiopia: a retrospective study

Background

Non-communicable diseases (NCDs) are medical conditions or diseases that are non-transmissible. As NCDs are becoming one of major public health problem, providing local description of diseases and injuries is key to health decision- making and planning processes. So, this study aimed to describe caseload of NCDs in Southern Nations Nationalities and People’s Region, Ethiopia.

Methods

A facility based retrospective study was conducted in February 2015 in SNNPR, Ethiopia. A total of 22,320 records of three years retrieved from 23 health facilities using systematic sampling. Data were entered in to Epi-Info 3.5.3 and descriptive analysis was carried out using SPSS version 20.

Results

From 22,320 records reviewed, 6633 (29.7%) clients visited health facilities due to Non-Communicable Diseases (NCDs). Majority (37.2%) of NCD cases were in productive age groups (20–35 year). Near to half (43%) of NCD cases were from rural and 45.8% were females. Digestive disorder (26.7%), cardiovascular diseases (18.8%) and Diabetes Mellitus (13.1%) were the most prevalent types of NCDs.

Conclusion

Health facilities are burdened with significant proportion of clients with NCDs. Young population accounts large share and NCDs are becoming public health problem of urban and rural area within a health care system that focus on communicable diseases. There is a need to strengthen the health system to work towards NCDs, and investigate risk factors associated with NCDs at individual level.

Non-communicable disease risk factor profile among public employees in a regional city in northern Ethiopia

The burden of non-communicable diseases (NCDs) is increasing in Ethiopia. This study aims to describe the prevalence of NCD risk factors of public employees in a regional city in northern Ethiopia. We conducted a cross-sectional epidemiological study targeting men and women aged 25-64 years employed by public offices in Mekelle. The prevalence was age-standardized to the Ethiopian 2007 population. Among the 1380 subjects (823 men and 557 women), 68.7% had less than 1 serving of fruits and vegetables per day, 41.0% were physically inactive, and 57.3% observed religious fast. The age-standardised prevalence of abdominal obesity was 29.3% in men and 58.5% in women, but that of metabolic syndrome was comparable between men (39.2%) and women (39.0%). The prevalence of diabetes was underestimated if only fasting blood glucose (FBG) was used for the diagnosis compared to combination of FBG and glycated haemoglobin (HbA1c) (6.7% in men and 3.8% in women vs. 12.1% in men and 5.6% in women). More than a quarter (26.1%) of men and 8.7% of women had estimated 10-year risk of cardiovascular disease of 10% or more. This study revealed the high prevalence of NCD metabolic risk factors among the urban public employees in the highland of Ethiopia.

A series of N-of-1 trials to assess the therapeutic interchangeability of two enalapril formulations in the treatment of hypertension in Addis Ababa, Ethiopia: study protocol for a randomized controlled trial

BACKGROUND

Hypertension is one of the leading causes of morbidity and mortality in Ethiopia. Treatment usually involves lifelong medication use. Enalapril is a common drug for the treatment of hypertension in Ethiopia. However, the drug is expensive and, therefore, there is limited capacity for people to afford the treatment. Locally produced Enalapril is a cost-effective solution to treat the disease. However, as local medicines regulation does not include bioequivalence tests on locally produced drugs, physicians and patients need assurance about the effectiveness and safety of local generics. Evidence on therapeutic equivalence is needed on these untested local drugs.

METHODS

This is a hospital-based, randomized, partially blinded, three-cycle crossover trial in single patients, comparing a locally produced version of enalapril with enalapril imported from Europe. Patients involved in this trial are not blinded, as there is no local facility to produce relatively small numbers of placebos or encapsulated drugs. To ensure blinding of study investigators and data analysts, study medications are prepared by an independent pharmacy unit using opaque medication packaging. The importance of maintaining blinding is also part of patient pre-trial education. Each N-of-1 trial will consist of three successive 14-day treatment pairs, each pair comprising 7 days of 5-20 mg local and 7 days of 5-20 mg imported enalapril taken once daily in the morning. The primary outcome will be the average difference in systolic blood pressure as measured by home blood pressure measurements.

DISCUSSION

The number of locally produced products, such as enalapril, being approved without proof of bioequivalence is dramatically increasing. By bridging the information gap on bioequivalence, the trial will give rigorous evidence on therapeutic equivalence of locally produced enalapril in the treatment of hypertension. If there is no difference, the hypothesized result, then patients can take the local medicine with confidence. This trial will also will determine whether aggregated N-of-1 studies are feasible to evaluate untested generic drugs in resource-limited countries where bioequivalence testing centers are unavailable.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Clinical Trial Registry, ID: ACTRN12616001088437p . Registered on 12 August 2016.

Adherence to prescribed antihypertensive medications and associated factors for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia

OBJECTIVES

The study was aimed at assessing adherence to prescribed antihypertensive medications and its associated factors.

METHODOLOGY

Institutional-based cross-sectional study was conducted in four public hospitals which were selected by lottery method. Systematic random sampling was used to select the study subjects. Data were checked, cleaned, and entered into Epidata software version 3.1 and were imported to SPSS version 21 software for analysis. The results of the descriptive statistics were expressed as percentages and frequencies. Associations between independent variables and dependent variable were analyzed using bivariate and multivariate analysis. The study was conducted from February 15 to April 15, 2016.

RESULTS

The study included 404 respondents with 97% response rate. 210 (52%) were male and mean age was 54 ± 10.77 years. The respondents' adherence to antihypertensive medications was 66.8%. The medication-related adherences were found to be better in females, patients who had comorbidities and have been knowledgeable about the disease and was poor among young adult respondents.

CONCLUSION

This study found out a 66.8% adherence to prescribed antihypertensive medications. This figures show that medication adherence (MA) rates are low. The factors impeding or enhancing the outcome variable was thoroughly analyzed. Sex, age, number of types of medications, and knowledge were associated with MA. Educational sessions that especially focus on MA and ongoing support for patients should be designed. Studies which assess all the components of self-management should be conducted for comparison among different subgroups.

Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia

INTRODUCTION

One of the most prevalent noncommunicable diseases is hypertension (HTN). The availability of effective antihypertensive medications does not result in the expected outcomes in terms of controlling blood pressure. The rationale for these and other findings of uncontrolled HTN points toward poor adherence. The most neglected causes of uncontrolled HTN are unhealthy lifestyles. Few studies have been conducted to show the gap and magnitude of self-management adherence.

OBJECTIVE

This study aimed to assess adherence to recommended lifestyle modifications of hypertensive patients undergoing follow-up at chronic follow-up units of public health hospitals in Addis Ababa, Ethiopia, 2016.

METHODS

Institutional-based cross-sectional study was conducted in four public health hospitals which were selected by drawing lots. Systematic random sampling was used to select study subjects. The results of the descriptive statistics were expressed as percentages and frequencies. Associations between lifestyle modification and independent variables were ana-lyzed using bivariate and multivariate logistic regression analysis. The study was conducted from February 15, 2016 to April 15, 2016.

RESULTS

The study included 404 respondents with a 97% response rate; 210 (52%) were male and the mean age was 54.00±10.77 years. The respondents' adherence to lifestyle modifications was 23%. The lifestyle adherence was found to be better in females, patients who had comorbidities, and had been knowledgeable about the disease and was poor among young adult respondents.

CONCLUSION

The rates of adherence to lifestyle changes were generally found to be low. Educational sessions that especially focus on lifestyle modifications and ongoing support for patients should be designed and studies which assess all the components of self-management should be conducted for comparison among different subgroups.

Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.