Hypertension In Rural Community Research Articles

P140 PREVALENCE OF HYPERTENSION IN A RURAL COMMUNITY IN THE FEDERAL CAPITAL TERRITORY ABUJA (GBESSA) NORTH CENTRAL NIGERIA

Background: High Blood pressure, once rare, is rapidly becoming a major public health burden in sub-Saharan Africa. This has been attributed to acculturation of the populace who are rapidly adopting modern lifestyle changes. Aim This study aimed to describe the prevalence and identify risk factors for hypertension in rural community in the Federal capital territory in Nigeria. Methods A cross sectional survey of 491 households with 1,739 adults aged 18 years and above was carried out. Information about health and lifestyle was obtained from structured questionnaire interviews, followed by assessment of blood pressure (BP) and anthropometry. Results: There were 18.1% (95% confidence interval (CI), 16.0-20.6% participants with hypertension (defined as a systolic BP-140, diastolic BP-90mmHg or on antihypertensives medication). This prevalence of Hypertension was found to rise with age. Between the sexes males recorded a higher prevalence of 19.6% compared to 17.4%: females but this was not statistically ×2 P-value =0.34. Single and widowed subjects recorded high prevalence of 32.2% and 30.0% of Hypertension while students had low rate of 5.6%. The prevalence of Hypertension was 20.5% among farmers.Whereas, obesity (measured by WHR), alcohol intake, cigarette smoking, and family history of hypertension had no valid statistical evidence, chewing tobacco/ snuff, previously diagnosed diabetes mellitus or family history of diabetes showed statistically significant differences. Conclusion: This findings underscore the need for public health campaign at community levels to prevent increasing blood pressure and it's sequelae. This will involve campaigns to maintain the age- long tradition of exercise, avoidance of smoking, alcohol and weight maintenance.

STRATEGIES FOR THE PREVENTION AND CONTROL OF HYPERTENSION IN RURAL COMMUNITIES

Hypertension is a prevalent chronic condition that can lead to serious complications such as cardiovascular disease, stroke and kidney failure. The prevalence of hypertension is especially high in rural communities, where factors such as limited access to health care, lack of health information and socioeconomic conditions can contribute to a lack of control of the disease. Prevention and control strategies tailored to these communities are crucial to reducing the burden of hypertension and improving the overall health of the rural population. This brief explores effective strategies for the prevention and control of hypertension in rural communities, highlighting innovative approaches and associated challenges. The aim of this paper is to review and analyze strategies for the prevention and control of hypertension in rural communities. It aims to identify the main interventions that have proved effective, discuss approaches adapted to the needs and resources of rural communities, and address the challenges faced in implementing these strategies. This is a literature review, using qualitative and quantitative assumptions, using the PubMed, Scopus and Google Scholar databases. The health descriptors “Hypertension”, “Hypertension Management in Rural Areas”, “Telemedicine”, “Community Interventions” and “Rural Health Policies” were used to refine the research. The time frame covers the years 2018 to 2022. The focus is to promote a comprehensive understanding of best practices and areas that need more attention to improve the management of hypertension in rural contexts. Preventing and controlling hypertension in rural communities requires a multifaceted approach that takes into account the particularities of these areas, including barriers to accessing healthcare, resource limitations and specific cultural needs. Education is key to preventing hypertension. Awareness programs about risk factors, the importance of regular blood pressure monitoring and lifestyle changes can have a significant impact. Community initiatives such as workshops, lectures and local media campaigns can help raise awareness of hypertension and promote healthy habits. Improving access to healthcare is crucial for hypertension control in rural areas. This can include the implementation of mobile health units, telemedicine and partnerships with health organizations to provide regular medical services and blood pressure monitoring. Community screening programs and regular consultations can help identify and treat cases of hypertension early. Interventions that encourage a healthy diet, rich in fruit, vegetables and low in sodium, as well as regular physical activity, are essential for the prevention and control of hypertension. Nutritional education programs and the promotion of community physical activities, such as walking groups or sports, can be effective in promoting a healthy lifestyle. Thus, many people with hypertension also have other health conditions, such as diabetes or obesity. Integrated strategies that address hypertension alongside other health conditions can improve overall outcomes. This includes chronic disease management programs that provide support for managing multiple health conditions simultaneously. Involving the community in the planning and implementation of prevention and control strategies can increase the acceptance and effectiveness of interventions. Community groups, local leaders and non-governmental organizations can play an important role in promoting health programs and mobilizing resources. The effective implementation of hypertension control strategies in rural communities faces several challenges. Barriers can include a lack of adequate health infrastructure, a shortage of health professionals, limited access to medicines and treatments, and cultural factors that can affect the acceptance of interventions. In addition, logistical and financial difficulties can limit the ability to implement and maintain health programs in remote areas. Therefore, the approach to preventing and controlling hypertension in rural communities must be adapted to the specific needs and characteristics of these areas. Effective strategies include community education and awareness, improving access to health care, promoting a healthy lifestyle and integrated management of comorbidities. Involving the community and overcoming challenges related to infrastructure and resources are critical aspects for the success of these strategies. With a multifaceted and collaborative approach, it is possible to reduce the prevalence and impact of hypertension in rural communities, promoting better health and an improved quality of life for their inhabitants.

Effectiveness of a Patient-Family Carer Partnership Intervention on Blood Pressure Control for People with Hypertension in Rural Communities: A Randomised Controlled Trial

Objectives. To examine the effectiveness of a patient-family (carer) partnership intervention on the BP control, self-care and self-efficacy for hypertensive people, and dyadic-relationship quality, depressive and anxiety symptoms, and health-related quality of life for the family dyads (hypertensive people and family carers) in rural communities of mainland China. Design. A randomised controlled trial. Methods. A total of 110 family dyads were randomly recruited from village clinics and randomly allocated to the intervention group (n = 55) or control group (n = 55). Family dyads in the control group received usual care. In addition to the usual care, family dyads in the intervention group received the individual-based, five-session patient-family (carer) partnership intervention. The primary outcomes included SBP, DBP, and the proportion of people with normal controlled BP. EuroQol five-dimensional-five-level (EQ-5D-5L) was adopted to evaluate participants’ health-related quality of life. Data were collected at the baseline (T0), one-month (T1), and three-month postintervention (T2). Generalised estimating equation model was adopted to test the study hypotheses on all study outcomes. Results. Compared with the control group, hypertensive people in the intervention group had a greater reduction in SBP by 10.10 mmHg and DBP by 4.66 mmHg and a larger proportion of people with normal BP at T2, as well as statistically significant improvements at T1 and T2 in dyadic relationship, self-care, antihypertensive drug-titration rate, anxiety symptoms, and health-related quality of life. The intervention also had statistically significant positive effects on family carer’s dyadic relationship and health-related quality of life at T1 and T2. Conclusion. The patient-family (carer) partnership intervention has the potential to improve hypertensive people’s BP control and family dyad’s dyadic-relationship quality and mental health at short-to-medium term follow-ups. Implications for the Profession and/or Patient Care. This study provided evidence and direction to support healthcare providers in developing and implementing patient-family (carer) partnership intervention for hypertension care in rural areas. This trial is registered with ChiCTR1900027087.

Health-Seeking Behavior of Diabetic and Hypertensive Patients in Rural Communities of Ghana

Background: This study examined the health-seeking behaviors of patients with diabetes and hypertension in rural communities in Ghana. In Ghana, most studies on diabetes and hypertension are clinically oriented. However, medical-sociological truism suggests that attitudes towards health and illnesses, such as hypertension and diabetes, have a social-cultural perspective.
 Method: This study adopted a qualitative approach where twenty (20) participants who were either diabetic, hypertensive, or both were interviewed.
 Results: One of the study's significant findings was that diabetics/hypertensives use only orthodox hospitals to treat their conditions. Another finding was that the problems and challenges diabetics and hypertensives face include financial difficulties, social isolation, and stigmatization.
 Conclusion: Recommendations were made based on these findings. For instance, the registered traditional medicine practitioners should collaborate with the Ghana Health Service to intensify education on the importance of using certified traditional medicines in the treatment and management of diabetes and hypertension and provide customer-age-factor services at the various health facilities for persons with chronic diseases such as diabetics and hypertension.

Pulmonary Hypertension in Rural Minnesota

<h3>Purpose</h3> Pulmonary arterial hypertension (PAH) is a progressive disease with high morbidity and mortality. The purpose of this study is to describe the prevalence and natural history of pulmonary hypertension in rural communities. <h3>Methods</h3> Retrospective review of patients with suspected PH seen at an outreach cardiology practice in rural Minnesota between 1/1/2010 and the present. Patients were ≥18 years old, with echocardiography and right heart catheterization (RHC) procedures. All patients with mean pulmonary artery pressure > 20 mmHg on RHC were included. Patients were grouped into pulmonary arterial hypertension (PAH) or chronic thromboembolic PH (group 1), combined pre- and post-capillary PH (CPC-PH/fxoup 1*), and non-group 1 PH (groups 2, 3, and 5) using standard definitions. <h3>Results</h3> Of 272 patients, 61 patients had PAH, 48 patients had CPC-PH, and 163 patients had non-group 1 PH. Female sex was predictive of PAH (OR 2.37, 95% CI: 1.28, 4.37), as was higher RVSP on echo (OR 1.02, 95% CI: 1.01, 1.04). Moderate-severe left atrial enlargement on echo (OR 0.39, 95% CI: 0.21, 0.73), coronary artery disease (OR 0.50, 95% CI: 0.27, 0.91), and atrial fibrillation (OR 0.31, 95% CI: 0.16, 0.59) were predictive of non-group 1 PH. Patient mortality increased with age at diagnosis (<b>Figure 1</b>, p=0.002). Patient mortality was similar among group 1, CPC-PH, and non-group 1 PH. <h3>Conclusion</h3> PAH and CPC-PH patients have different baseline characteristics compared to non-group 1 PH patients yet have similar mortality. Age at diagnosis remains a critical factor in patient prognosis with higher mortality among older patients. Interestingly, males are overrepresented in this rural subset when compared to prior literature. Because rural patients often have difficulty accessing care and unique socioeconomic pressures, continued vigilant screening may result in more accurate diagnoses and improved patient morbidity and mortality.

Abstract 12325: Psychosocial Correlates of Hypertension Among Filipinos Living in Primarily Rural Areas of the Philippines

Introduction: Self-reported depression, anxiety, stress, and poor health-related quality of life (HRQoL) have all been linked to an elevated risk of hypertension (HTN), although indicators of psychosocial burden among Filipinos residing in rural parts of the Philippines are poorly defined. Methods: This cross-sectional study was conducted in the Philippines in 2017 and included a large representative sample of 1203 Filipinos (64.6 % female; 49.5 ± 17.7 years old; 16% widowed) seeking care from their barangay health clinics. Sociodemographic characteristics, health history, and psychosocial factors (depression, anxiety, stress, HRQoL) were assessed through a structured survey. In addition, height, weight, blood pressure, and waist circumference were measured. Multivariable-adjusted binary logistic regression was used to assess the independent predictors of hypertension. Results: HTN was observed in 42.5%, while depression, anxiety, stress, and overweight/obesity were noted in 20.6%, 39.0%, 82.1% and 29.4%, respectively. Women were more likely to be widowed and men married. No gender differences were noted in HTN, depression, or physical HRQoL, but women were more likely to be stressed and had higher anxiety and lower mental HRQoL than men. HTN was associated with higher depression and lower physical HRQoL. Significant positive correlates of HTN were being widowed and lower physical and mental HRQoL. Stress was the only correlate of HTN for men and lower physical and mental HRQoL for women. Conclusions: The results of this study are broadly consistent with prior studies from other East Asian countries. The study stresses the significance of reconsidering methods to assess both demographic and contextual characteristics in terms of psychological comorbidities in Filipinos, which could aid in identifying those at high risk for HTN. Future research should concentrate on raising knowledge of psychosocial factors and HTN in rural communities and designing interventions that target self-management of concomitant disorders. Decision-makers and policymakers must be aware of the rising trend and the socioeconomic and psychosocial drivers of HTN to limit its influence on cardiovascular disease morbidity and mortality.

Effects of a family dyadic partnership program for people with hypertension in a rural community: A pilot randomised controlled trial.

To evaluate the feasibility, acceptability and preliminary effectiveness of a theory-based patient-family carer partnership intervention for people with hypertension in a Chinese rural community. A pilot randomised controlled trial using pretest and post-test design. Rural China PARTICIPANTS: Forty-four hypertensive patients and their family carers (family dyads) were randomly recruited from a village clinic located in China between November 2019 and January 2020. Participants were randomised to either an intervention group receiving a five-session patient-family carer partnership intervention over 10weeks or a control group receiving usual care. The feasibility and acceptability of patient-family carer partnership intervention and the changes in patients' systolic blood pressure, diastolic blood pressure and percentage of normal controlled blood pressure. The patient-family carer partnership intervention was a feasible and acceptable program with high recruitment (81.5%) and completion rates (95.5%) and positive feedback from participants. Greater improvement in the percentage of normal controlled blood pressure was identified in the intervention group tested by the χ2 tests, with P=.03. Two-way ANOVA results indicated its interaction (Group×Time) effects on patients' systolic blood pressure (P<.001), diastolic blood pressure (P<.001), dyadic partnership quality (P=.002), self-care (P<.001), self-efficacy (P=.02), antihypertensive drug treatment rate (P=.02), prescription adjustment (P=.03), perceived anxiety (P<.001) and health-related quality of life (EuroQol five-dimensional five-level: P=.02; EuroQol visual analogue scale: P<.001); family carers' dyadic partnership quality (P=.002), perceived depression (P=.04) and health-related quality of life (P=.02) were significant. Our findings support the feasibility and acceptability of the patient-family carer partnership intervention and indicate benefits in improving patients' blood pressure control, dyadic relationship and psychological well-being of family dyads in rural area. Further research to test the longer-term effect in a large-sized population is recommended.

Knowledge, Attitudes, Practices and Blood Pressure Control of Hypertensive Patients at a South African Primary Health Care Centre

Hypertension is a serious global and South African public health problem. The high prevalence of uncontrolled hypertension is related to a patient’s lack of knowledge and healthy practices. The study aimed to assess the knowledge, attitudes and practices of hypertensive patients and their blood pressure control at a rural community health centre. This was a prospective cross-sectional study conducted on diagnosed cases of hypertension at the centre. Binary logistic regression analysis was conducted to determine the factors for the control of hypertension. Two hundred and ninety-seven known hypertensive patients were recruited, the majority of which were female. Eighty-eight percent were older than 45 years, and almost all had a monthly income of less than R3000 (USD 190). More than half controlled their blood pressure. It was found that 46% had poor knowledge, 64% had good attitudes and 60% were practising positively regarding the control of hypertension. Hypertensive patients attending the centre had poor knowledge but good attitudes and practices towards hypertension. The study revealed an urgent need for improved health promotion and educational efforts to increase the knowledge of hypertension in rural communities and to address poverty as a major obstacle to healthy lifestyle choices.

RISK FACTORS OF HYPERTENSION AMONG ADULTS IN A SEMI URBAN COMMUNITY IN SOUTH WEST NIGERIA

Recent studies have shown an increasing trend in the prevalence of hypertension in rural communities. This study aimed to investigate the prevalence of risks factors for hypertension among the residents of Likosi town, Sagamu local government area, Ogun state, Nigeria. A descriptive crosssectional design was used. 350 respondents aged from 20-80 years were recruited. Hypertension was defined as Systolic blood pressure (SBP) 140 and/or Diastolic blood pressure (DBP) 90. statistical analysis was performed using the SPSS package. The prevalence of hypertension was 23.3% (male 11.2% and female 12.1%). The mean age of the respondents was 37.5years. Mean systolic and diastolic BP were 124.25 ± 15.05mmHg and 83.45 ± 9.49mmHg, respectively. Higher odds of being hypertensive were found in 31-40 age group, The prevalence of the various classes of body mass index of the respondents were 18.5%, 45.1%, 15.1% and 24.3% for underweight, normal, overweight and obese respectively. Alcohol and tobacco use were found in 34.5% and 15.4% respectively. Hypertension was significantly associated with age groups 30-49 years (OR 2.258, 95% CI: 1.311 - 3.884),. Tobacco and alcohol consumption, overweight and obesity were also associated with hypertension

Hypertension prevalence, associated factors, treatment and control in rural Cameroon: a cross-sectional study

IntroductionSub-Saharan Africa is experiencing a surge in the burden of hypertension, and rural communities are increasingly affected by the epidemic.ObjectivesWe aimed to determine the prevalence of and factors associated with hypertension in rural communities of the Baham Health District (BHD), Cameroon. In addition, we sought to assess awareness, treatment and control rates of hypertension among community members.DesignA community-based cross-sectional study.SettingParticipants from five health areas in the BHD were recruited from August to October 2018.ParticipantsConsenting participants aged 18 years and above were included.ResultsWe included 526 participants in this study. The median age of the participants was 53.0 (IQR=35–65) years and 67.1% were female. The crude prevalence of hypertension was 40.9% (95% CI=36.7–45.1) with no gender disparity. The age-standardised prevalence of hypertension was 23.9% (95% CI=20.3–27.5). Five-year increase in age (adjusted OR (AOR)=1.34; 95% CI=1.23–1.44), family history of hypertension (AOR=2.22; 95% CI=1.37–3.60) and obesity (AOR=2.57; 95% CI=1.40–4.69) were associated with higher odds of hypertension after controlling for confounding. The rates of awareness, treatment and control of hypertension were 37.2% (95% CI=31.0–43.9), 20.9% (95% CI=16.0–26.9) and 22.2% (95% CI=12.2– 37.0), respectively.ConclusionThe high prevalence of hypertension in these rural communities is associated with contrastingly low awareness, treatment and control rates. Age, family history of hypertension and obesity are the major drivers of hypertension in this community. Veracious policies are needed to improve awareness, prevention, diagnosis, treatment and control of hypertension in these rural communities.

Disruption, changes, and adaptation: Experiences with chronic conditions in Mozambique, Nepal and Peru

ABSTRACTChronic conditions are an increasing problem in Low- and Middle-Income Countries (LMICs) yet, the challenges faced by low-income populations with these conditions in such countries are not well understood. Based on in-depth interviews with people affected by chronic conditions and their family members, this paper describes the experience of patients suffering from diabetes or hypertension in rural communities of Mozambique, Nepal, and Peru. We analysed our data using the concepts of disruption and adaptive strategies, finding that despite being very different countries, the implications in daily lives, interpersonal relationships, and family dynamics are similar, and that oftentimes such impact is defined along gender lines. We show that adjustments to living with a chronic disease are not always easy, particularly when they imply changes and reconfiguration of roles and responsibilities for which neither the individual nor their families are prepared. The study adds to the literature on the disruptive effects of chronic conditions and stresses the importance of contextualising disruptive experiences among disadvantaged populations within weak health systems. Our findings highlight the relevance of understanding the challenges of developing adaptive solutions to chronic care in resource-scarce contexts.

Hypertension in a rural community in South Africa: what they know, what they think they know and what they recommend

BackgroundHypertension is one of the most important risk factors for cardiovascular disease and has a high prevalence in South Africa and other low- and middle-income countries. However, awareness of hypertension has been reported to be low. Health programmes can increase awareness of hypertension and its causes, but hinge on the knowledge and perception of the targeted community. Therefore, this study investigated knowledge on and perceptions about hypertension of community members in a rural area in Limpopo, South Africa with the aim to increase awareness of hypertension and cardiovascular disease in the local population.MethodsUsing a mixed methods study approach, 451 participants of the Ndlovu Cohort Study, attending a follow-up visit between August 2017 and January 2018, completed a questionnaire on cardiovascular risk perception. A knowledge score was calculated for all participants. Sixty participants were invited to participate in six focus group discussions, of which 56 participated. Audio recordings were transcribed verbatim, transcripts coded, and thematic analysis of the data undertaken to obtain an understanding of knowledge and perception of hypertension in the community.ResultsMost members of the community seemed to have intermediate (74.3%) or good (14.0%) knowledge of hypertension based on the knowledge score, and only 11.8% of the population had poor knowledge. The risk factors of hypertension seemed to be well known in the community. Poverty was identified as a major vulnerability in this community limiting choices for healthy lifestyles such as nutritious foods, recreational physical activity and accessing health care timely. Participants proposed community-based activities as an effective way to reach out to community members for prevention and management of hypertension.ConclusionThis study highlights the need for improved health promotion efforts to increase knowledge of hypertension in rural communities, and to address poverty as a major obstacle to healthy life-style choices.

Prevalence and knowledge of hypertension among people living in rural communities in Ghana: a mixed method study.

Knowledge and understanding of hypertension and its associated health risks remain inadequate despite increasing trend of hypertension prevalence. This study was conducted to assess the prevalence, knowledge and perceptions of hypertension in rural communities in Ghana. A mixed method study involving 534 subjects was employed. Data was collected in six communities from May to December 2014 with structured questionnaires and interview guides. A logistic regression analysis was conducted to estimate the influence of the socio-demographic factors on knowledge of hypertension. Qualitative data was thematically analyzed. The mean systolic blood pressure (BP) was higher in men than women (127.42mmHg versus 124.42mmHg). The proportion of hypertensives was 21.4% and was higher among men in all age categories. Knowledge on some risk factors of hypertension was extremely low. Having formal education was associated with higher odds of knowledge of hypertension (Adjusted odds ratio [AOR]; 95% confidence interval [CI]=2.28; 1.25-4.16). Several misconceptions such as the use of agro-chemicals, fertilizers and excess vitamins were identified as causes of hypertension. This study demonstrates an increased prevalence of hypertension, knowledge gaps and misconceptions surrounding hypertension in rural communities in Ghana. This evidence is useful in streamlining interventional programmes aimed at improving knowledge and prevention of hypertension.

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Prevalence and risk factors of hypertension among women in a rural community of Maharashtra

Background: There are very few epidemiological studies on the prevalence of hypertension and its risk factors among women in the rural population. This cross-sectional study was carried out to determine the same in a rural community. This study was carried out in a rural population of Maharashtra in a rural field practice area of a Medical college with which the author is affiliated. The present study is thus a novel effort to measure the burden related to hypertension and related sociodemographic factors in a rural setting among women aged >30 years. Materials and Methods: A random sample of 220 women of 30 years and above were selected from a rural area. The study participants were selected using simple random sampling technique using lottery method. Numbers were allotted to every individual. All the women were then listed. This became the sampling frame. An individual was taken as the sampling unit. The pre-tested pro forma was used to collect the data by trained doctors. Results: Maximum participants in the study were from age group 30–39 years (33.6%), followed by 40–49 years (23.2%). Mean and standard deviation (SD) of age among study participants was found to be 47.7 ± 13.4 years. A total of 155 (70.5%) of the study participants used tobacco in one or the other smokeless form. About 29.5% of the study participants never used tobacco in the lifetime. The most common form of smokeless tobacco consumption was Mishri (71.6%) followed by tobacco which was used by 27% of the participants. Supari was also consumed by few of the participants. About 51.4% of the participants consumed >5 g (World Health Organization recommended level) of salt per day. All the participants consumed extra salt in the form of pickle/papad/table salt over and above that consumed in meals. About 8.2% of the study participants were found to be underweight while 21.2% were overweight. 3.2% of the study participants were in Grade I obesity and only one (0.4%) was in morbid obesity category. 70% of the study participants who had waist-hip ratio ≤ 0.85, whereas 30% of them had ratio > 0.85. Nearly 52% of the study participants gave a positive family history of hypertension among first-degree relatives. Only 22 (68.7%) of those participants diagnosed with hypertension were taking antihypertensive drugs and nearly half of these participants 12 (54.5%) were taking regular medication. 34.1% of participants had systolic blood pressure (BP) >140 than mmHg (isolated systolic hypertension) while 37.2% had diastolic BP >90 mmHg (isolated diastolic hypertension). The mean systolic BP calculated was 130 mmHg with SD 20.7 with 95% confidence interval (CI) of mean to be 127.5–132.8 mmHg, whereas diastolic BP was 83 mmHg with SD 11.1 with 95% CI of mean to be 81.7–84.6 mmHg. The overall prevalence of hypertension among the study participants was calculated to be 23.6% with 95% CI to be 18.2–26.8 mmHg. Conclusion: Prevalence of systolic hypertension in rural community was 34.1% and of diastolic hypertension 37.2% with an overall prevalence of 23.6%. Significant associations were found between the presence of hypertension and various sociodemographic variables using Chi-square test. Furthermore, there was a significant association between hypertension and consumption of smokeless tobacco, low physical activity level.

Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial

BackgroundHigh blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka.Methods/designThis study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training.The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed.Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will be interviewed.DiscussionThe study will provide evidence of the effectiveness and cost-effectiveness of MCI strategies for BP control compared to usual care in the rural public health infrastructure in South Asian countries. If shown to be successful, MCI may be a long-term sustainable strategy for tackling the rising rates of CVD in low resourced countries.Trial registrationClinicalTrials.gov, NCT02657746. Registered on 14 January 2016.

Factors related to intentional and unintentional medication nonadherence in elderly patients with hypertension in rural community.

PurposeWe assessed medication nonadherence, categorized as intentional or unintentional, and related factors in elderly patients with hypertension, correlating the data with measurement of blood pressure as the final target of medication adherence and other possible influencing factors, such as lifestyle.Patients and methodsSubjects were aged ≥65 years, resided in a rural area, and were taking antihypertensive drugs. The survey was conducted in July 2014. Participants were divided into the following three groups: “Adherence”, “Unintentional nonadherence”, and “Intentional nonadherence”. Individual cognitive components, such as necessity and concern as well as self-efficacy and other related factors, were compared according to adherence groups. The interrelationships between those factors and nonadherence were tested using structural equation modeling analysis.ResultsOf the 401 subjects, 182 (45.6%) were in the adherence group, 107 (26.7%) in the unintentional nonadherence group, and 112 (27.9%) in the intentional nonadherence group. Necessity and self-efficacy were found to have a significant direct influence on unintentional nonadherence behaviors (necessity β=−0.171, P=0.019; self-efficacy β=−0.433, P<0.001); concern was not statistically significant (β=−0.009, P=0.909). Necessity was found to have significant direct and indirect impact on intentional nonadherence (direct β=−0.275, P=0.002; indirect β=−0.113, P=0.036). Self-efficacy had no significant direct effect on intentional nonadherence though it had the only significant indirect effect on intentional nonadherence (direct β=−0.055, P=0.515; indirect β=−0.286, P<0.001). Concern had no significant influence on intentional or on unintentional nonadherence (direct β=0.132 0.132, P=0.151; indirect β=−0.006, P=0.909).ConclusionUnintentional nonadherence should be regularly monitored and managed because of its potential prognostic significance. Interventions addressing cognitive factors, such as beliefs about medicine or self-efficacy, are relatively difficult to implement, but are essential to improve medication adherence.

Hypertension in rural communities in Delta State, Nigeria: Prevalence, risk factors and barriers to health care.

IntroductionHypertension is a global health challenge and its prevalence is increasing rapidly amongst adults in many African countries. Some studies on the prevalence and risk factors of hypertension have been conducted in Nigeria, but none within Delta State. We assessed the prevalence of hypertension and associated risk factors amongst adults in three villages in the Ibusa community in Delta State, Nigeria.MethodHomesteads were randomly selected and all consenting adults (≥ 18 years of age) were recruited for this cross-sectional study (134 individuals: 48 men, 86 women). Sociodemographic data and anthropometric measurements (weight, height and abdominal circumference) were recorded. Diagnosis of hypertension was based on blood pressure ≥ 140/90 mmHg.ResultHypertension prevalence in this rural community was 44%. Results from one village (Ogboli: 82%) and ethnic group (Ibo: 50%) were significantly higher than in others in the same variable category. Multivariate logistic regression analysis suggested increasing age, increasing body mass index and high salt intake as prominent risk factors for hypertension. Lack of funds and equipment shortage in clinics were most often reported as barriers to health care.ConclusionA nutritional education programme to promote low-cholesterol and low-salt diets is recommended to specifically target people in higher-risk areas and of higher-risk ethnicity. Local barriers to accessing health care need to be addressed.

Awareness and Risk Factors Associated with Hypertension in Rural Community

High blood pressure is a major public health problem, because it is undetected and uncontrolled. Recent studies have shown that every known person with hypertension there are two persons with either undiagnosed hypertension or prehypertension. This study was conducted to identify the risk factors associated with hypertension and to study the awareness about hypertension. A community-based cross-sectional study among adults aged more than 20 years. A comprehensive pre tested pre structured questionnaire was used. Chi-square test was used as test of significance, co-efficient regression was calculated to check the correlation of variables. There was a strong association of prevalence of hypertension and people's lifestyles also. Smokers were tend to be more hypertensive than non-smokers and the same trend was found between alcoholics and non-alcoholics. In individuals with higher B.M.I., the prevalence of hypertension was also increasing; and those who were physically inactive not doing any exercise, (cycling, walking etc), the prevalence of hypertension was found to be high. Only 49% of the hypertensives were aware of their blood pressure status, and only 25% of them were being treated. There is a continued need for community based education programme for hypertensives, who are unaware of their diagnosis and incorporate such programme into the existing primary health care system.

Prevalence of Hypertension in Akwa Ibom State, South-South Nigeria: Rural versus Urban Communities Study.

Recent studies have shown an increasing trend in the prevalence of hypertension in rural communities compared to that of the urban communities. This study was therefore carried out to determine the prevalence of hypertension and its predictors (if any) in both urban and rural communities of Akwa Ibom State of Nigeria. Subjects and Method. This was a cross-sectional study of urban and rural communities of Akwa Ibom State for the prevalence of hypertension and its predictors. Two urban cities and two rural communities were randomly selected from the three senatorial districts of the state. Hypertension was defined based on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of Hypertension. Results. Nine hundred and seventy-eight (978) participants were recruited from rural areas and five hundred and ninety (590) from urban centers. The rural populace had higher systolic, diastolic, and mean arterial blood pressure than the urban populace (P < 0.001, < 0.002, < 0.001, resp.). The prevalence of hypertension was significantly higher in the rural populace than in the urban populace [44.3% (95% CI 41.1–47.4%) versus 28.6% (95% CI 24.9–32.3%)]. Age, BMI, and proteinuria were independent predictors of hypertension occurrence. Conclusion. There is an epidemiologic change in the prevalence of hypertension in the rural communities of Nigeria.