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

Hypertension is a major modifiable risk factor for cardiovascular disease (CVD) and leading cause of premature mortality worldwide.^1,2 It 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.³ It 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.^4,5,6 The World Health Organization has reported that hypertension is responsible for 62% of cases of cerebrovascular disease and 49% of cases of ischemic heart disease.⁷ Physical 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.¹⁰ If 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.¹¹ Body 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.¹² Appropriate lifestyle modification practices, usually called nonpharmacological approaches, are the cornerstone of the prevention and control approach for hypertension in people with low socioeconomic status.¹³ Therefore, the main objective of this study was to assess lifestyle modification practices and associated factors among hypertensive patients having follow-up at a hospital.

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.

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.¹⁴ As 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.¹⁵ The 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.¹⁵ The 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

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.