Abstract
Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants. A mixed methods approach was used; 203 adults completed surveys including demographics, anthropometric measures, blood pressure (BP), physicial activity, diet, and salt intake at five health check stations. Two focus groups were conducted with rural and urban community members to better understand their perspectives on hypertension. The prevalence of hypertension was 32.8% for survey participants. A further 24.6% had pre-hypertension. The mean total weight of salt added to food was nearly double the WHO recommendation with women adding significantly more salt to food than men. Significant differences in waist circumference were observed between men and women with men at low risk and women at substantialy high risk. In focus groups, participants cited westernized diets, lack of physical activity, stress, psychological factors, and urbanization as causative factors for hypertension. Participants lacked understanding of BP medications, healthy lifestyles, adherence to treatment, and ongoing monitoring. Focus group participants mentioned challenges in obtaining treatment for hypertension and desired to be active contributors in creating solutions. They recommended that government priorize hypertension initiatives that increase access to health education to reduce risk, enhance early detection, and support lifestyle changes and medication adherence. Our findings suggest that policy-makers need to engage communities more effectively to develop successful public health strategies to prevent, detect, and manage hypertension in Western Province, Zambia, particularly in rural areas.
Highlights
The prevalence of Non-Communicable Diseases (NCDs), such as hypertension (HTN), in Sub-Saharan Africa (SSA) is a major public health concern (Thorogood, Myles, Hundt, & Tollman, 2007; van de Vijver et al, 2013; Yach, Hawkes, Gould, & Hofman, 2004)
Our findings suggest that policy-makers need to engage communities more effectively to develop successful public health strategies to prevent, detect, and manage hypertension in Western Province, Zambia, in rural areas
HTN rates ranging from 19% to as high as 40% were found in countries that participated in the World Health Organization (WHO)-STEPS surveys (2003-2009)
Summary
The prevalence of Non-Communicable Diseases (NCDs), such as hypertension (HTN), in Sub-Saharan Africa (SSA) is a major public health concern (Thorogood, Myles, Hundt, & Tollman, 2007; van de Vijver et al, 2013; Yach, Hawkes, Gould, & Hofman, 2004). The potential effects of uncontrolled HTN may place a further burden on Zambia’s already strained health system. A HTN rate of 32% was found in a study conducted in another urban area of Zambia (Siziya, Rudatsikira, Babaniyi, Songolo, Mulenga, & Muula, 2012). Age was a significant factor associated with HTN where increased age was correlated with higher rates of HTN (Dewhurst et al, 2013; Goma et al, 2011; Mulenga et al, 2013; Siziya et al, 2012; van de Vijver et al, 2013). No significant difference was found in HTN rates between males and females in other reports and studies (Mulenga et al, 2013; Siziya et al, 2012; van de Vijver et al, 2013). HTN was associated with tobacco use (Goma et al, 2011; Mulenga et al, 2013; van de Vijver et al, 2013), frequent alcohol use, lack of physical activity, (Goma et al, 2011; van de Vijver et al, 2013), high sodium intake (van de Vijver et al, 2013), low fruit and vegetable consumption (van de Vijver et al, 2013), increased BMI (Goma et al, 2011; Mulenga et al, 2013; Siziya et al, 2012; van de Vijver et al, 2013), increased heart rate (Mulenga et al, 2013), high cholesterol, and impaired glucose levels (Goma et al, 2011)
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