Epidemiology and awareness of hypertension in a rural Ugandan community: a cross-sectional study

Prashant Kotwani, Dalsone Kwarisiima, Tamara D Clark, Jane Kabami, Elvin H Geng, Vivek Jain, Gabriel Chamie, Maya L Petersen, Harsha Thirumurthy, Moses R Kamya, Edwin D Charlebois, Diane V Havlir, SEARCH Collaboration, Prashant Kotwani, Dalsone Kwarisiima, Tamara D Clark, Jane Kabami, Elvin H Geng, Vivek Jain, Gabriel Chamie, Maya L Petersen, Harsha Thirumurthy, Moses R Kamya, Edwin D Charlebois, Diane V Havlir, SEARCH Collaboration

Abstract

Background: Hypertension is one of the largest causes of preventable morbidity and mortality worldwide. There are few population-based studies on hypertension epidemiology to guide public health strategies in sub-Saharan Africa. Using a community-based strategy that integrated screening for HIV and non-communicable diseases, we determined the prevalence, awareness, treatment rates, and sociodemographic factors associated with hypertension in rural Uganda.

Methods: A household census was performed to enumerate the population in Kakyerere parish in Mbarara district, Uganda. A multi-disease community-based screening campaign for hypertension, diabetes, and HIV was then conducted. During the campaign, all adults received a blood pressure (BP) measurement and completed a survey examining sociodemographic factors. Hypertension was defined as elevated BP (≥ 140/≥ 90 mmHg) on the lowest of three BP measurements or current use of antihypertensives. Prevalence was calculated and standardized to age distribution. Sociodemographic factors associated with hypertension were evaluated using a log-link Poisson regression model with robust standard errors.

Results: Community participation in the screening campaign was 65%, including 1245 women and 1007 men. The prevalence of hypertension was 14.6%; awareness of diagnosis (38.1%) and current receipt of treatment (20.6%) were both low. Age-standardized to the WHO world standard population, hypertension prevalence was 19.8%, which is comparable to 21.6% in the US and 18.4% in the UK. Sociodemographic factors associated with hypertension included increasing age, male gender, overweight, obesity, diabetes, alcohol consumption, and family history. Prevalence of modifiable factors was high: 28.3% women were overweight/obese and 24.1% men consumed ≥ 10 alcoholic drinks per month.

Conclusions: We found a substantial burden of hypertension in rural Uganda. Awareness and treatment of hypertension is low in this region. Enhanced community-based education and prevention efforts tailored to addressing modifiable factors are needed.

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