Physical, behavioral and sociodemographic determinants of hypertension among the adult population in Nekemte town, western Ethiopia: community based study
- 147 Downloads
Hypertension is a growing public health problem in many developing countries. However, there is an insufficiency of scientific evidence on the prevalence of hypertension (HTN) at a community level in the study area. The aim of the study was exploring the prevalence and associated factors of hypertension among adults in Nekemte town, Ethiopia. A community-based cross-sectional study was conducted on 711 adults who were selected by the multistage sampling procedure. Height, weight, blood pressure and waist circumference were measured with standard procedures. Data were analyzed by statistical package for social sciences (SPSS) version 20, and multiple logistic regression model was used to determine the independent risk factors for hypertension.
The overall prevalence of hypertension was 34.9% among the adult population. Of them, only 52.7% know their status, and 22.4% were on antihypertensive medication. The prevalence of hypertension was higher among the older aged; AOR 5.85 (95% CI 1.74–20), Obese and over-weighted; (AOR 1.71 (95% CI 1.09–2.67)), Khat chewers in the past year; AOR 2.44 (95% CI 1.05–5.68), and with higher formal education (college and above); AOR 2.75 (95% CI 1.26–6.03) than their respective counterparts. Community-level prevention and treatment of hypertension should get due attention.
KeywordsHypertension Nekemte Ethiopia
disability-adjusted life years
congested heart disease
World Health Organization
body mass index
WHO defines hypertension as systolic blood pressure ≥ 140 mmHg or a diastolic blood pressure ≥ 90 mmHg or prior diagnosis of hypertension and taking antihypertensive drugs [1, 2, 3]. About 80–90% of hypertension is primary hypertension and has no known cause. Secondary hypertension takes a share of 5–20% of hypertension cases and has different causative factors that could be preventable .
Hypertension is a leading risk factor of mortality, followed by tobacco use and diabetes mellitus (DM). It is the fifth cause of Disability-adjusted life years (DALYs) lost globally . Hypertension doubles the risk of CVD: coronary heart disease (CHD), congestive heart failure (CHF), ischemic stroke and hemorrhagic stroke, renal failure and Peripheral arterial disease (PAD). Systolic blood pressure causes 51% and 45% of deaths due to stroke and ischemic heart disease respectively [1, 2, 3].
Hypertension has been thought of as a disease of affluence. But, now its distribution is increasing in Africa than in Europe and America . The global average of the prevalence of hypertension is about 40%. Its distribution is different in different regions, being highest in Africa; 46% . The prevalence of undiagnosed, untreated, and uncontrolled hypertension; and the risk of hypertension-related morbidities are higher in developing countries than the high-income countries [2, 4, 5].
Morbidity and mortality caused by chronic illnesses are increasing in developing countries; shifting from communicable diseases to non-communicable diseases [6, 7]. According to the world health (WHO) report, 67% of mortality in low and middle-income countries was attributed to non-communicable diseases of which CVD shares 48% . Hypertension is the leading cause of CVD and related mortality in Africa in the coming few years. The WHO survey in 20 African countries shows that the prevalence of hypertension is 19.3 to 39.6% [6, 7]. Evidence shows an increase in hypertension and related complications in Ethiopia [8, 9, 10].
The distribution of hypertension can be affected by different modifiable and non-modifiable factors: family history of hypertension, age, lifestyle and environmental factors [11, 12, 13, 14, 15]. Another behavioral factor, which became rampant in Ethiopia and could be related to hypertension is frequent chewing of khat. According to research done in Addis Ababa, Current daily smoking and regular khat chewing were significantly associated with elevated mean diastolic blood pressure . Psychological factors such as anxiety, depression, and anger contribute to the development of hypertension [16, 17, 18, 19]. This study intended to determine the prevalence of hypertension; and the physical, behavioral and sociodemographic determinants of hypertension among adult populations in the study area.
Study setting and design
The study participants were identified by a multistage sampling technique.
Dependent variable The Prevalence of hypertension.
Independent variable Age, Sex, Ethnicity, marital status, educational status, family Income, accessibility of Screening program, alcohol consumption, smoking, chewing khat, diet, physical exercise, and psychological stress.
Data collection procedure
Data were collected by 5 health extension workers and supervised by experienced BSc nurses after 1-day training. Data were obtained on hypertension status, socio-demographic characteristics and behavioral factors by interview and measurement as appropriate. Weight, height, waist circumference, and blood pressure were taken by Physical measurement. Weight and height were measured on the participant’s standing position without a shoe. Height was recorded to the nearest 0.5 cm, and weight was measured to the nearest 100 g with a digital weight scale. BMI was calculated as weight in kilograms divided by height in meters squared [weight (kg)/(height (m))2]. Waist circumference was measured at the midway between the level of the iliac crest and lowest margin of the rib by a non-elastic tape measure. Blood pressure was measured in a sitting position with supported back, and a mercury sphygmomanometer and a stethoscope were used to measure the BP. The accuracy of the mercury sphygmomanometer was checked on the upper curve of the meniscus of the mercury column. It should be fixed at 0 mmHg, free of dirt, and rises and falls freely during cuff inflation and deflation. Standard procedure was used to measure BP: stereoscope placed 2–3 cm above ante-cubital fossa and the bladder encircled at least 2/3rd of the arm. The participants took rest for at least 5 min before measurement. They did not drink coffee, smoke cigarette and engaged in strenuous exercise within an hour of BP measurement. The measurement was done in both arms at sitting position with back supported and the larger one was taken. Two consecutive measurements of BP were taken 2 min apart from the participants, and the average reading was used for analysis [20, 21].
Data processing and analysis
Data were cleaned and entered into a computer and analyzed using SPSS Windows Version 20. Descriptive analysis was done using numbers and percentages. The presence of a statistical association between dependent and independent variables was assessed. Multiple Logistic regression analysis was done to assess independent risk factors for hypertension.
Socio-demographic and socio-economic characteristics of respondents
Sociodemographic characteristics of respondents in Nekemte town, western Ethiopia, Dec. 2015 (n = 705)
Frequency (in N)
Percentage (in %)
Age groups (year)
No formal education
College and above
Prevalence of hypertension
The mean systolic and diastolic BP readings were 119.8 (± 1.2) and 81.9 (± 0.9) mmHg, respectively. The overall prevalence of hypertension was 34.9% (± 3.6% CI 31.3–38.5). About 37% (36.9%) of males and 33% of females were hypertensive. Only 53.3% of respondents had BP measurement before. Out of hypertensive respondents; only 52.7% knew as their BP is raised and only 22.4% were on anti-hypertensive medications.
Descriptions of behavioral, physical and nutritional factors
Only 1.4% of the respondents have ever smoked cigarettes, 13.9% had regular alcohol drinking habits, and 6.2% had cat chewing habits. On dietary behavior, most of the respondents (83.6%) had a habit of high Salt consumption. Only 3.2% and 5.3% of the respondents had a habit of adequate intake of vegetables and fruit respectively. As to physical exercise; 18% of them were engaged in rigorous physical activity, 52.2% of them were engaged in moderate activities and 29.8% were not involved in either of these activities. As to the BMI, 62.6%, 16.7%, 11.2%, and 9.5% were in the normal range, underweight, overweight and obese respectively. About 21.6% of the obese had central obesity.
Risk factors associated with hypertension
Multiple logistic regression analysis of factors associated with hypertension among respondents in Nekemte town, western Ethiopia, Dec. 2015 (n = 705)
COR (95% CI)
AOR (95% CI)
Age group (year)
3.12 (2.1, 4.63)
2.6 (1.49, 4.57)
8.47 (3.33, 21.28)
5.85 (1.72, 20)
0.63 (0.45, 0.9)
0.48 (0.22, 1.05)
3.14 (1.69, 5.83)
1.71 (1.09, 2.67)
2.1 (1.46, 3.03)
1.46 (0.93, 2.28)
0.85 (0.48, 1.5)
1.82 (1.13, 2.95)
1.11 (0.57, 2.14)
Alcohol intake ever
1.72 (1.11, 2.64)
0.94 (0.5, 1.78)
Chewed Khat past year
2.38 (1.28, 4.39)
2.44 (1.05, 5.68)
Monthly income (ETB)
1.89 (1.27, 2.79)
4.12 (1.93, 8.77)
0.97 (0.48, 2.01)
No formal education
3.96 (2.13, 7.36)
1.63 (0.72, 3.69)
5.52 (3.19, 9.61)
2.38 (1.11, 5.09)
College and above
6.88 (3.8, 12.47)
2.75 (1.26, 6.03)
Self-report of DM
2.25 (1.02, 4.95)
1.75 (0.625, 4.88)
Family history of HTN
1.40 (1.02, 1.92)
1.34 (0.88, 2.03)
This study has revealed that about a third of the adult population in the town were hypertensive. This is comparable with the WHO estimate of the prevalence of hypertension in Ethiopia which is 31%. The result is higher than a similar study done in the Northern part of the country; (28%) and it is comparable with the study done elsewhere [8, 9, 10, 22]. The finding is higher compared to surveys in Eritrea (16%), and Ghana (29.4%) [23, 24]. However, this study showed a lower prevalence of hypertension compared with the WHO estimate of the prevalence of hypertension in Africa, which is 46% . The variation can be explained by; variability in different age groups, the prevalence in different proven risk factors, the difference in the definition of hypertension and genetic differences.
In this study; age, BMI, educational status and Khat chewing had a positive association with the prevalence of hypertension. With regards to sex, similar to studies done in Gondar, Addis Ababa, Durame and Bedele towns of Ethiopia, it didn’t show any association [8, 9, 10]. The prevalence of hypertension was higher in overweight and obese (44.3%) than those of normal (33.6%) and underweight (20.3%). This is consistent with other studies [8, 9, 10]. In this study, chewing Khat in the past 1 year (54.5%) had an association with hypertension. This is similar to the study done in Addis Ababa but did not show any association with a study done in Bedele [10, 15].
The prevalence of hypertension was found to be high among adults older than 18 years in Nekemte town. Older age, higher educational status, overweight/obesity, and Khat chewing were associated with a high prevalence of Hypertension. Community-based health promotion and screening programs should be strengthened and further researches with biochemical data should be done to control the impacts.
There could be a recall bias on responses to behaviors. Hiding of socially unacceptable behaviors like alcohol intake; cigarette smoking and Khat chewing may underestimation of the finding. This study did not include the biochemical factors of hypertension.
We extend appreciation to the Wollega university department of public health, for allowing us to conduct this research. We are also thankful to the Nekemte town administration for the support in the collection of data. Above all, the respondents deserve appreciation for their cooperation.
All of the authors participated in the preparation of this manuscript. The final version of the manuscript was read by all authors and approved for the publication process. GTG generated the research question, developed the proposal, supervised the data collection process, analyzed data and prepared the research report. MCC was the senior advisor of the research proposal development and data analysis process. EMR was co-advisor of the research proposal development and data analysis process. All authors read and approved the final manuscript.
The source of funds for this study was the authors.
Ethics approval and consent to participate
Ethical clearance was obtained from Wollega University ethical clearance committee before data collection. Written informed consent was obtained from all participants for participation in this research.
Consent for publication
The authors declare that they have no competing interests.
- 1.Longo D, Kasper D. Harrison’s principles of internal medicine, vol. 2. 18th ed. 2011. https://freemecal.com/harrisons-principles-of-internal-medicine-18th-edition-pdf.
- 2.Mathers C, Stevens G, Mascarenhas M. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009.Google Scholar
- 4.van de Vijver S, Akinyi H, Oti S, Kyobutungi C. The impact of non-communicable diseases (NCDs) and neglected tropical diseases (NTDs) on development in Africa. In: AU conference of ministers of health (camh6) sixth ordinary session, 22–26 April 2013, Addis Ababa, Ethiopia.Google Scholar
- 5.World Health Organization. A global brief on hypertension: silent killer, a global public health crisis. Geneva: WHO; 2013. https://www.who.int/cardiovascular_diseases/publications/global_brief_hypertension/en/.
- 7.Addo J, Smeeth L, Leon DA. Hypertension in sub saharan Africa: a systematic review. Hypertension. 2007. https://doi.org/10.1161/HYPERTENSIONAHA.107.093336.CrossRefPubMedGoogle Scholar
- 13.World Health Organization. Global health observatory data repository. http://apps.who.int/gho/data/view.main. Accessed 11 Feb 2013.
- 15.Tesfaye F, et al. Association of smoking and Khat use with high blood pressure among adults in Addis Ababa, Ethiopia. 2006. http://www.cdc.gov/pcd/issues/2008/jul/07_0137.htm.
- 20.Bonita R, de Courten M, Dwyer T, Jamrozik K, Winkelmann R. Surveillance of risk factors for noncommunicable diseases: the WHO STEP wise approach. Geneva, Switzerland: World Health Organization; 2002. http://www.sciepub.com/reference/35088.
- 21.Pickering TG, et al. Recommendations for blood pressure measurement in humans and experimental animals. Circulation. 2005. https://doi.org/10.1161/01.HYP.0000150859.47929.8e.CrossRefPubMedGoogle Scholar
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.