Lifestyle modification practices and associated factors among hypertensive patients at Gambella Hospital Southwest Ethiopia; 2019

Tilhun Triku Jimlo, Eiss Negr Gemechu, Admsu Bely Gizw

aDepartment of Publice Health, Gambella Refugee Camp Southwest Ethiopia, Gambella, SNNP 74, Ethiopia

bDepartment of Public Health, Faculty of Public Health and Medical Science, Metu University, Mettu, Oromiya 318, Ethiopia

cSchool of Nursing, Institute of Health, Jimma University, Jimma 378, Ethiopia

Abstract: Background: Hypertension is one of the leading causes of death in developed and developing countries that need urgent strategies to implement interventions. Appropriate lifestyle modification practices are the corner stone of the prevention and control.Objective: To assess lifestyle modification practices and associated factors among hypertensive patients.Methods: A facility-based cross-sectional study was conducted among hypertensive patients from 1 April to 30 April 2019. Simple random sampling was used to select the study subjects. Data were entered to EpiData 3.1 and exported to Statistical Package for Social Sciences, version 25.0, for analysis. A binary logistic regression analysis was performed to determine predictors of lifestyle modifications among hypertensive patients.Results: The findings of this study revealed that the level of lifestyle modification practice was 79 (39.5%). This finding is very low, and it has a significant effect on the management of hypertensive disorders and hypertension-related acute and chronic complications. Ethnicity, family history of hypertension, and knowledge about hypertension were identified as predictors of lifestyle modification practice.Conclusions: In this study, lifestyle modification practice is low (about 40%), but scientifically, almost all hypertensive patients on follow-up should practice lifestyle modification modalities.

Keywords: hypertension ? life style ? life style modification ? life style modification practice

1. Introduction

Hypertension is a major modifiable risk factor for cardiovascular disease (CVD) and leading cause of premature mortality worldwide.1,2It is a major health problem throughout the world, with high morbidity and mortality rates. Globally, the disease affects over 1 billion people; further, 7 million of them die each year as a consequence of severe complications and lack of adequate control.3It is a major health problem in developed countries and is now becoming an increasing important cause of morbidity and mortality in developing countries. It is estimated to cause 7.5 million deaths worldwide and about 12.8% of the total annual deaths in sub-Saharan Africa.4-6The World Health Organization has reported that hypertension is responsible for 62% of cases of cerebrovascular disease and 49% of cases of ischemic heart disease.7Physical inactivity causes 9% of premature mortality or ＞5.3 million of the 57 million deaths that occurred worldwide.8,9

In Africa, obesity and sodium intake are risk factors for hypertension. In 2012, about 3.3 million deaths, or 5.9% of all global deaths, were attributable to alcohol consumption.10If inactivity were decreased by 10%, ＞533,000 deaths can be averted. Furthermore, if inactivity is decreased by 25%, ＞1.3 million deaths can be prevented.11Body mass index (BMI) is positively and independently associated with morbidity and mortality from hypertension. Primary prevention mainly focuses on lifestyle modification practices, such as weight reduction, moderation of alcohol consumption, adoption of eating fruits and vegetables, and doing regular physical exercises.12Appropriate lifestyle modification practices, usually called nonpharmacological approaches, are the cornerstone of the prevention and control approach for hypertension in people with low socioeconomic status.13Therefore, the main objective of this study was to assess lifestyle modification practices and associated factors among hypertensive patients having follow-up at a hospital.

2. Methods

An institutional-based cross-sectional study was conducted in public health facilities from 23 May 2019 up to 22 June 2019. All sampled hypertensive patients who had follow-up during the study period were included in the study, and those who were severely ill and not able to communicate were excluded from the study.

A total of 200 hypertensive patients were identified as candidates for this study by using the standard formula for a single population. Simple random sampling method was used to select the study participants, and the data were collected by face-to-face interviews using structured questionnaires and chart reviews. Three diploma nurses were recruited as data collectors, and 1 MSc nurse supervised the data collection process. Data were analyzed using Statistical Package for Social Sciences (SPSS), version 25.0. Variables with (P-value ≤ 0.25) on bivariate analysis were included in the multivariable logistic regression analysis. The results are presented in the form of tables, figures, and text using frequency and summary statistics, such as mean, standard deviation, and percentage. The degree of association between the independent and dependent variables was interpreted using odds ratio with 95% confidence interval.

3. Results

3.1. Sociodemographic characteristics of study subjects

A total of 200 adult patients on hypertensive followup were involved in the study, with a response rate of 100%. Regarding sociodemographic characteristics, the majority of the respondents, i.e., 182 (91%), were ＜64 years old, 114 of them were males (57%), 146 were married (73.0%), 122 had formal education (61.0%), and 89 were government employees (44.5%) (Table 1).

Table 1. Sociodemographic characteristics of hypertensive patients

3.2. Lifetyle modification practice

Forty (21%) of the patients had basic knowledge about hypertension, 4 (2%) of the patients were on treatment for ＞10 years, 26 (13%) of the patients heard information from media, and 12 (6%) of the patients with comorbidity practiced good lifestyle modifications (Table 2).

Overall, only about 40% of hypertensive patients were practicing the recommended lifestyle modification, and the remaining 60% of the study participants were not practicing those recommended practices (Figure 1).

3.3. Knowledge about lifestyle modification

Among the total study participants, only about 40% had good lifestyle modification practice, and only one third of them were knowledgeable about hypertension and lifestyle modification practice to prevent it (Table 3). According to the eating patterns obtained using respondent interviews, 140 (70%) participants applied the recommended low-salt diet. Physical activity for 30 min/d was applied by only 32 (16%) of the patients, 171 (85.5%) ceased smoking, and 88 (44%) of them still continued consumption of alcohol (Figure 2).

Table 2. Lifestyle modification practices among hypertensive patients.

Figure 1. Overall level of lifestyle modification practices and level of knowledge about hypertension and associated factors among hypertensive patients.

Figure 2. Overall level of knowledge about lifestyle modification practice and level of knowledge about hypertension and associated factors among hypertensive patients.

Table 3. Knowledge about lifestyle modification practice among hypertensive patients.

3.4. Factors affecting lifestyle modification practice among hypertensive patients

Multivariable logistic regression analysis was carried out to identify the independent variables on lifestyle modification. Accordingly, from the result of the multivariable analysis, ethnicity, family history of hypertension, knowledge about hypertension, and physical exercise were identified as independent predictors of lifestyle modification practice among hypertensive patients at Gambella Hospital, Southwest Ethiopia. The study showed that patients from Amhara by ethnicity were 76% more likely to practice lifestyle modifications [adjusted odds ratio (AOR): 0.761; 95% confidence interval (CI): (0.611, 0.949)] when compared with Oromo ethnic groups. Patients with a family history of hypertension were 16 times more likely to practice lifestyle modification [AOR: 15.9; 95% CI: (6.7, 38.05)] when compared with those with no family history of hypertension. The study also revealed that patients having basic knowledge about hypertension were 2.5 times more likely to practice life modifications [AOR: 2.54; 95% CI: (0.428, 0.69)] when compared with poorly knowledgeable patients about hypertension. Patients who performed regular physical exercise practice were 30% more likely to practice lifestyle modifications (AOR: 0.285; 95% CI: (0.094, 0.865)] compared with those who did not perform regular physical exercise (Table 4).

Table 4. Factors associated with lifestyle modification practice among hypertensive patients.

Table 4. Continued

4. Discussion

This study assessed lifestyle modification practice levels and identified the factors affecting lifestyle modification practice among hypertensive patients who have regular follow-up at the hypertensive clinic. The findings of this study also revealed that the level of lifestyle modification practice was 79 (39.5%). This finding shows that the level is very low and can be considered as poor lifestyle modification practice. This level is less compared with the results of a study done in Turkey in which 74% hypertensive patients comply with the recommended lifestyle modification practice.14As Ethiopia is among one of the developing countries in sub-Saharan Africa, the difference might be due to the level of knowledge and access to health information among patients. The finding is slightly better than the outcome of a study done at Wolaita, where only 27.3% of the study participants comply with the recommended lifestyle modification practice.15The inconsistency might be due to the increased level of awareness among the health care professionals to recommend the lifestyle modification practice modalities and among the study participants.15

In this study, ethnicity is found to be a significant predictor of lifestyle modification practice among the study participants. The finding in this study showed that those participants who belonged to the Amhara ethnic group practiced lifestyle modifications as compared with the remainder of the group. The finding is not consistent with different studies. This might be due to differences related to access to information about hypertension and the varied cultural and religious practices. Specially, the majority of Amhara ethnic groups in Ethiopia are Christian Orthodox religious followers, who fast and refrain themselves throughout their life from fat and fat products.

The study findings indicated that 69 (34.5%) participants had basic knowledge about hypertension and lifestyle modification practice, which was lower compared with the results of a study done at Jimma, which revealed that 67.7% of patients had basic knowledge about hypertension.15The main reason for the inconsistency might be due to differences in the level of awareness among the study participants at each study area and also probably due to differences in the quality of key messages delivered by health care providers working at each study area. Regular physical exercise has positive outcomes for the improvement of hypertensive disorders before and after initiation of antihypertensive medication. In this study, very few participants 32 (16%) performed regular physical exercise as one of the lifestyle modification modalities. The finding is consistent with a study done at Wolaita Sodo and significantly poorer than the result of a study done in China and slightly better than a study done in Saudi Arabia.5,15,16

5. Conclusions

This study showed that lifestyle modification practice among hypertensive patients was 40%, which is too low when compared with similar studies that were conducted in Ethiopia and different countries. Ethnicity, family history of hypertension, and having good knowledge about hypertension were found to be independent predictors of lifestyle modification practice among hypertensive patients. The majority of the patients diagnosed with hypertension are at high risk and should implement the recommended lifestyle modification practices to reduce the chance of developing complications and death related to hypertension. Secondly, the Regional Health Office has to work hard on creating awareness among health care professionals to recommend appropriate lifestyle modification practice modalities. Lastly, but not the least, health workers should provide advice and support to all hypertensive patients regardless of other indicated treatments and encourage patients to achieve and maintain lifestyle practices.

Acknowledgments

We would like to express our deepest gratitude to Metu University Public Health and Medical Science College. Our appreciation also goes to our data collectors, supervisors, and study participants for their valuable contribution to the completion of this study.

Acknowledgement

Ebisa Negara and Tilahun Tariku contributed to the study conception and design; Ebisa Negara supervised the study; Tilahun Tariku conducted data analysis; Admasu Belay was involved in data collection and contributed to data analysis; Ebisa Negara and Admasu Belay critically revised the manuscript. Finally, all authors read and approved the final draft manuscript.

Ethical approval

Ethical issues are not involved in this paper.

Conflicts of interest

The authors have each completed the International Committee of Medical Journal Editors Form for uniform Disclosure of Potential Conflicts of Interest. No authors have any potential conflict of interest to

disclose.