Hypertension and its associated factors in Hosanna town, Southern Ethiopia: community based cross-sectional study
Asfaw et al. BMC Res Notes
Hypertension and its associated factors in Hosanna town, Southern Ethiopia: community based cross-sectional study
Likawunt Samuel Asfaw 0
Samuel Yohannes Ayanto 2
Fiseha Laemengo Gurmamo 1
0 Department of Nursing, Hosanna College of Health Sciences , Post Box 159, Hosanna , Ethiopia
1 Hosanna College of Health Sciences , Hosanna , Ethiopia
2 Department of Midwifery, Hosanna College of Health Sciences , Hosanna , Ethiopia
Objectives: This study was conducted to determine the prevalence of hypertension and its associated factors among residents of Hosanna town in Hadiya Zone. Results: The overall prevalence of hypertension was 30% among the study participants. Out of the study participants who were identified as being hypertensive, only 24.6% knew their hypertensive status. The odds of being hypertensive is significantly higher among males when compared to females (adjusted odds ratio (AOR) 1.9, confidence interval (CI) 1.14-3.23) and married participants as compared to their unmarried counterparts (AOR 4.1; CI 1.10-16.18). High prevalence and increased risks for hypertension were noted among the study participants in the study area. The experiences of aerobic physical activities were reported only in 22.9% of the study participants. These evidences may suggest the need for urgent interventions.
Cardio-vascular disorders; Hypertension; Non-communicable diseases; Obesity
Hypertension is persistent elevation of BP above this
normal range [
] and is classified into different groups based
on causes and degree of severity [
Hypertension has become major public health problem
of human being globally. It is estimated to cause 1 billion
deaths, which is about 12.8% of all deaths worldwide [
]. In Africa 46% of its adult population had
hypertension, which is the highest for regions in the world [
Similarly, the figure for sub-Saharan Africa was 47.5% [
Ethiopia shares similar profile like most sub-Saharan
African countries. Findings of World Health
Organization on prevalence of hypertension showed that 35.2% of
the community in Ethiopia has high likelihood of being
]. To a large extent hypertension is
associated with environmental, rapid urbanization and life style
]. There are controversial opinions on the
association between hypertension and gender. In
prevalence study in rural Bareilly there was no significant
difference between males and females [
]. However, in
most global and Ethiopian studies hypertension is more
prevalent among males than females [
tobacco smoking and harmful alcohol use are
significantly associated with hypertension [
]. Majority of
previous studies done in Ethiopia were based on
hospital records and reported contradicting opinions.
Therefore, the aim of this study was to assess the prevalence
and associated factors of hypertension in a community
Study design and setting
The study was conducted in Hosanna town, the capital
of Hadiya Zone, located at a distance of 232 km
southwest of Addis Ababa, the capital of Ethiopia. There were
16,707 Households in the town. Community based
crosssectional study was carried out among residents of the
town, in May 2014 [
Sample size and sampling technique
The desired sample size for our study was estimated by
taking prevalence of hypertension (35.2%) from
previous study [
], 95% confidence level, 5% margin of error
and design effect of 1.5. Consequently, the final sample
size was determined to be 525 participants. The sample
size was calculated using the formula;
Z α2 2P(1 − P)
The final sample size was proportionally allocated to
sub-administrative units of the town. Sampling frame
was created for each sub-unit and randomly
generated numbers were used to select the households.
Simple random sampling technique was used to select the
households from each unit. From each of the selected
households, one participant satisfying inclusion criteria
was selected by lottery method.
Inclusion and exclusion criteria
Individuals below the age of 25 years, those above the
age of 64 years, pregnant mothers and disabled
people were excluded from the study. The primary reason
for excluding pregnant women and individuals above
the age of 64 is that they are most at risk for
hypertension and their inclusion could preclude generalization.
Contrarily, young people below the age of 25 years are
at low risk for hypertension and disabled people were
not eligible for exercise related inquiries relevant for
our research which might affect the true finding in the
Data collection instrument and measurement
The WHO STEPS instrument and global physical
activity questionnaire (GPAQ) were modified and used [
]. The tool has three major parts: socio-demographic
characteristics, behavioral profile and physical
measurements. The modified instrument was translated into the
local language, Amharic. Data were collected through
interviewer administered and physical body
measurement techniques using structured questionnaire.
Two days training was provided for data collectors and
supervisors regarding research ethics, data collection
procedures and contents of the instrument to increase
the quality of our data. Supportive supervision was
carried out by the supervisors on a daily basis during the
data collection period. The completed questionnaire had
been checked daily for its completeness and consistency.
The blood pressure was measured after the
participant had rested for at least 5 min. Two measurements at
10 min interval were taken from right arm by a mercury
sphygmomanometer. The mean value of the two
measurements was recorded as a BP for each participant.
Height was measured using fixed height measuring
board in upright position with participant’s heel,
shoulder and buttock touching the vertical board behind. The
measurement value was recorded to the nearest
millimeter. Weight was measured using calibrated weight scale
where participants being in light clothing and barefooted.
Its reading was taken to the nearest 0.1 kg. Waist
circumference measurement was taken at midpoint between
lower measure margin of the last plain rib and top of iliac
crest using non elastic tape meter. Each participant was
told to take little deep, natural breath before taking the
measurement. The measurement was taken at the end of
normal expiration, when the lungs are at their residual
Data analysis techniques
The collected data were cleaned and entered to Epi-Data
version 3.2, and exported to STATA version 12.0 for
analysis. Descriptive statistics and multivariable logistic
regression were used to analyze the data. Candidate
variables with P value < 0.2 in Bivariable model were entered
to multivariable model to adjust for predictors. The 95%
CI for the corresponding Odds Ratio (OR) was used to
assess the degree of associations at (P < 0.05) to declare
Variables and definitions
The participant was regarded as hypertensive when an
average SBP ≥ 140 mmHg, and/or DBP ≥ 90 mmHg was
recorded and/or the participant is currently on
The body mass index (BMI) was interpreted according
to WHO classification as underweight (BMI < 18.5 kg/
m2), normal (BMI 18.5–24.9 kg/m2), overweight (BMI
25.0–30.0 kg/m2) and obese (BMI > 30.0 kg/m2).
Men having waist circumference greater than 94 cm
were identified as having increased risk for hypertension
and metabolic complications whereas men having waist
circumference greater than 102 cm were identified as
having substantially increased risk for hypertension and
Women having waist circumference greater than 80 cm
were identified as having increased risk for hypertension
and metabolic complications whereas women having
waist circumference greater than 88 cm were identified
as having substantially increased risk for hypertension
and metabolic complications.
A total of 524 participants were involved in the study
which gives response rate of 99.8%. The majority (52.9%)
of study participants were males. The mean age of the
study participants was 35.4 ± 7.7 SD years.
Majority (38.5%) of participants were government employee.
Nearly half (48.8%) of the study participants were College
or University graduates. The average monthly income of
the study participants was 72.31 ± 916.33 USD. The
average number of individuals per household was nearly 6
(Table 1). One hundred twenty-two (23.3%) participants
reported their experience of alcohol consumption on
daily basis and 77 (14.7%) participants were smokers.
The mean systolic and diastolic BP reading for the
study participants were 118.37 ± 13.42 (SD) mmHg and
74.24 ± 11.18 (SD) mmHg respectively. The prevalence
of hypertension among the study participants was 30%
(CI 26.0–33.8%) out of which only 39 (24.6%) knew their
hypertensive status (Fig. 1).
The mean BMI of the study participants was
23.79 ± 2.60 kg/m2 (SD). Fifty-four (10.3%) participants
were overweight and 28 (5.3%) were obese.
The mean waist circumference of men was
86.9 ± 4.9 cm (SD). The vast majority (84.1%) of men had
waist circumference measurement of ≤ 94 cm whereas 36
(12.9%) of them had > 94 cm. Few, 3.0%, of male
participants had > 102 cm waist circumference measurement.
The findings indicate that 12.9% men had increased risk
for hypertension and metabolic complications.
The mean waist circumference for women was
83.6 ± 8.35 SD cm. One hundred four (42.1%) women
had waist circumference measurement of < 80 cm. Nearly
one out of three (29.1%); women have waist
circumference measurement of > 80 cm. On the other hand, 71
(28.7%) of women had waist circumference measurement
of > 88 cm. This finding represents that more than half of
women had higher Waist circumference measurements.
Twenty-nine percent of women had increased risk for
hypertension and metabolic complications and 28.7%
of women had substantially increased risk for
hypertension and metabolic complications. Overall, 37.2% (15.8%
men and 61.1% women) participants were identified as
having increased risk for hypertension and metabolic
Fifty-seven (10.9%) and 108 (20.6%) of the study
participants undertake vigorous and moderate-intensity
physical activities respectively. Only 22.9% of the participants
reported the experience of aerobic physical activities. The
average estimated time spent without movement among
the study participants was 10.25 ± 3.1 (SD) hours.
Factors associated with hypertension
The presence or absence of significant association
between independent and outcome variables was
determined. Accordingly, sex, marital status and aerobic
physical activities were significantly associated with
hypertension. The odds of hypertension was 1.92 times
higher among men as compared to females (AOR 1.92;
CI 1.14–3.23). The likelihood of hypertension was
significantly higher among married participants when
compared to unmarried ones (AOR 4.1; CI 1.0–16.18).
Participants who did not undertake aerobic physical
activities had three times more likely to develop
hypertension as compared to participants who did (AOR 3.0;
CI 1.1–6.5) (Table 2).
The overall prevalence of hypertension in this study was
30.0%. This is comparable with report from Addis Ababa
]. But higher than reported for Jimma town
], Gondar town (28.3%) [
] and Sidama Zone
]. However, the prevalence of hypertension in
our study was lower than the national average (35.2%) [
and Africa sub-regional prevalence (47.5%) [
national average was higher because it used health
facility reports in its estimation, which might have not
represented the true magnitude in the general public. This
difference could be explained by differences in life style
factors including diet, exercise and the use of different
substances, etc. Among hypertensive participants, those
participants who are aware of their hypertensive status
were 24.6%, which matches with other study findings [
]. This might indicate low awareness and screening
practices for hypertension in the community.
The prevalence of hypertension was significantly higher
among men participants than females. In contrast,
previous study reports showed that the variation in
occurrence of hypertension between the two sexes was not
statistically significant [
]. Conversely, the higher rate
of hypertension among men in our study was
congruent with previous study reports [
7, 9, 14, 16
]. More likely,
this difference could be explained as large number of men
engage in risky behaviors such as excess alcohol
consumption, smoking tobacco products, and ka’hat
chewing that predispose to hypertension when compared to
females. However, the controversy between reports on
association between sex and hypertension warrant
The prevalence of hypertension was found to be higher
among higher age groups in previous studies [
In our study age was obtained subjectively which might
not be participants’ exact age due to absence of birth
certificates in majority of the cases. Although the risk of
hypertension increased with advancing age because of
biological reasons, substance use in younger age groups
balanced the prevalence of hypertension across all age
groups. These facts could also, more likely, explain the
importance of hypertension at any age.
In our study, marital status is significantly associated
with hypertension and married participants were more
likely to develop hypertension when compared to their
unmarried counterparts. Community-based study in
Jazan region of Saudi Arabia also reported the presence
of association between marital status and hypertension
]. This could be explained in such a way that married
couples are vulnerable to and face disputes from different
life dimensions. These stressful life conditions they may
face could increase the risk of hypertension among them.
High prevalence of hypertension was noted among the
study participants. Only few participants were aware of
their hypertensive status. The community is at increased
risk for hypertension and metabolic complications.
Women had substantially increased risk for hypertension
when compared to males. Sex, marital status and limited
exercise were significantly associated with hypertension.
Increased prevalence of hypertension and its associated
factors imply the need for urgent intervention by
designing strategies to increase public awareness on risks,
preventive measures and screening behaviors.
This study is cross-sectional; therefore, we cannot ascribe
causality to any of the associated factors. Moreover,
prevalence may not be representative as some severe cases
may die soon after they develop the disease.
BMI: body mass index; CI: confidence interval; CVD: cardiovascular disorders;
DALY: disability adjusted life year; EDHS: ethiopia demographic and health
survey; GPAQ: global physical activity questionnaire; HBP: high blood pressure;
HSDP: health sector development; MMHG: millimeter mercury; NCD:
noncommunicable diseases; PA: physical activity; SBP: systolic blood pressure; SSA:
sub-Saharan Africa; WC: waist circumference; WHO: World Health Organization.
LSA conceived and designed the study idea, developed proposal, organized
the data collection tool, created data entry template, interpreted findings and
wrote the manuscript. SYA edited the proposal and approved the manuscript.
FLG edited the proposal and approved the manuscript. All authors read and
approved the final manuscript.
The authors would like to thank Hosanna College of Health Sciences Research
and community service. We are also grateful to Hosanna town residents, data
collectors and Hosanna town health office for their cooperation during the
entire process of data collection.
The authors declare that they have no competing interests.
Availability of data and materials
Data will be obtained from the corresponding author whenever required.
Consent for publication
Ethical approval and consent to participate
This study was approved by institutional review board of Hosanna College of
Health Sciences. Informed verbal consent was obtained from all study
participants before data collection after explaining the objectives of the research.
In this research we obtained informed verbal consent from the research
participants because all the data sought was associated purely with
information rather than human samples or did not put participants on experiment,
which needs national ethical approval in our context. We obtained ethical
clearance for the research to be conducted in this way. This is the reason why
we obtained informed verbal consent than written.
Hosanna College of Health Sciences funded the study. The funder had no role
in study design, data collection and analysis, decision to publish, or
preparation of the manuscript.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
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