Prevalence of Hypertension and Associated Risk Factors in Galkayo, Puntland- Somalia

doi:10.21203/rs.3.rs-4716277/v1

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Research Article

Prevalence of Hypertension and Associated Risk Factors in Galkayo, Puntland- Somalia

https://doi.org/10.21203/rs.3.rs-4716277/v1

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Background

Hypertension is a significant global public health concern, yet research on its prevalence and associated risk factors in understudied regions in Somalia like Galkayo is very limited. This study aimed to investigate the prevalence of hypertension and its determinants among patients attending the Galkayo Medical Center (GMC).

Methods

A cross-sectional study was conducted from June to August 2023 at GMC. Participants (N = 382) were selected using systematic sampling and completed a questionnaire assessing demographics, clinical history, and lifestyle factors. Blood pressure measurements were obtained to confirm hypertension diagnosis. Data were analyzed using descriptive statistics, binary logistic regression, and multiple logistic regression.

Results

The study found a prevalence of 13.6% among participants. Older age, unemployment, and comorbidities are significantly associated with hypertension (p < 0.05). Multiple logistic regression identified younger age, employment status, and comorbidity as independent predictors of hypertension.

Conclusion

These findings underscore a considerable burden of hypertension among GMC Hospital attendees in Galkayo, Somalia. Efforts to address modifiable risk factors and enhance access to hypertension management services are crucial to mitigating the impact of this chronic condition on public health in the region. This study contributes valuable insights into the epidemiology of hypertension in a previously understudied area, informing targeted interventions to improve health outcomes and reduce the burden of hypertension in Galkayo and similar settings.

Hypertension

high blood pressure

risk factors

cardiovascular diseases

Galkacyo

Somalia

Hypertension, commonly referred to as high blood pressure (HTN), is a widespread health concern globally, with its prevalence steadily increasing over the years. It has been recognized as a major risk factor for cardiovascular diseases. Approximately 54% of cerebral stroke and 47% of myocardial infarction cases occur due to hypertension[1]. Globally, approximately one-third of people with hypertension remain undiagnosed, and of those diagnosed, about half are not taking antihypertensive medication[2]. The World Health Organization has estimated that globally, hypertension directly or indirectly causes the deaths of at least nine million people every year. Over the past 25 years, the number of hypertensive patients and related morbidity and mortality have significantly increased [3]. It has been predicted that by 2025, one out of every three persons will be hypertensive [4].

In recent decades, low- and middle-income countries (LMICs), including developing nations in sub-Saharan Africa, have been witnessing a significant increase in high blood pressure; yet, in LMICs, only 1 in 3 hypertensives are aware of their hypertension status, and only ≈ 8% have their blood pressure controlled [5]. This rising burden contributes to massive economic hardships for patients and families and increases costs to the health system, which already faces challenges such as low physician-to-patient ratios and lack of access to medicines [5, 6]. Despite available cost-effective lifestyle and medical interventions that could control hypertension and prevent morbidity and mortality, the African region still bears poor rates of detection, treatment, and control [7, 8].

Somalia, a country in SSA, suffers from a dysfunctional public healthcare system due to long-term instability and armed conflicts. Limited public healthcare facilities have created space for private healthcare systems, often inaccessible due to high costs, hindering the diagnosis and treatment of chronic diseases [9, 10]. Nationwide statistics on hypertension in Somalia remain elusive, with limited information from international organizations. Despite the global significance of hypertension, its true magnitude and associated risk factors in Somalia remain shrouded in obscurity. Existing data is fragmented and sparse, painting an incomplete picture of this silent threat [11, 12]. This lack of clarity impedes the development of effective prevention, diagnosis, and management strategies, leaving individuals vulnerable to the devastating consequences of uncontrolled hypertension. Understanding the sociodemographic and behavioral factors associated with hypertension is crucial for effective prevention and management strategies. This study explored the sociodemographic characteristics, behavioral patterns, medication adherence, and complications associated with hypertension. Hence, this study delves into the uncharted territory of hypertension in Galkacyo, Somalia. By exploring its prevalence and associated risk factors, we aim to generate crucial insights that can inform the development of effective interventions and ultimately mitigate the burden of this debilitating disease. With this knowledge, we hope to illuminate a path toward a healthier future for the people of Galkacyo particular, and the people of Somalia in General, and empower them to face the challenges of hypertension with resilience and hope.

2.1. Study Design and Setting

This research adopted a cross-sectional design to assess the prevalence and risk factors associated with hypertension in Galkayo, Somalia. This design allows for a snapshot of hypertension prevalence and associated factors at a specific point in time. The study was conducted at the Galkayo Medical Center (GMC) between June and August 2023, providing insights into the hypertensive burden within this understudied region.

2.2. Participant Selection and Recruitment

Participants were selected among patients seeking medical care at GMC during the specified period. Utilizing a systematic sampling technique, every third adult (≥ 18 years) presenting for medical consultation was enrolled. Exclusion criteria included acute medical emergencies, cognitive impairments hindering informed consent, pregnancy, and participation in other ongoing studies. This approach yielded a final sample size of 382 participants, ensuring adequate representation and statistical power.

2.3. Data Collection

Data collection involved a comprehensive questionnaire translated into Somali and culturally adapted for relevance. The questionnaire encompassed three domains: demographics (age, gender, marital status, education, occupation), clinical history (existing chronic diseases, hypertension diagnosis), and lifestyle factors (physical activity, smoking, alcohol consumption). Additionally, blood pressure measurements were obtained using a sphygmomanometer, with hypertension confirmed based on established criteria.

2.4. Data Analysis

Descriptive statistics summarized demographic characteristics, clinical history, and lifestyle habits. Binary logistic regression identified factors significantly associated with hypertension, followed by a multiple logistic regression model to assess independent effects while controlling for confounders. Statistical analyses were performed using SPSS software version 25.0, with significance set at α = 0.05. Odds ratios with 95% confidence intervals quantified the strength and direction of associations.

2.5. Ethical Considerations

The study adhered to the Helsinki Declaration and obtained approval from the Institutional Review Board of Somalia National University (IRB reference number: SNU/SPHR/0148/2023). Informed consent was obtained from all participants, ensuring confidentiality and ethical conduct throughout the research process.

3.1. Sociodemographic Characteristics

The study included 382 participants, with a predominance of female participants (63.9%). The mean age of the study participants was 35.1 years, with a considerable proportion (34.8%) falling within the 18 to 25 age group, and a smaller representation (11.3%) aged above 55. A significant proportion of participants had limited educational attainment, with 42.7% unable to read and write. Among 63.1% of participants, unemployment was prevalent, while the majority (63.1%) were married (Table 1).

Table 1

Sociodemographic characteristics of the study participants of patients attending Galkacyo Medical Center (GMC) hospital, Galkacyo, Puntland, Somalia, 2023 (n = 382)
Variable	Category	Frequency	Percent
Age	> 26	133	34.8
	26–35	100	26.2
	36–45	65	17.0
	46–55	41	10.7
	> 55	43	11.3
Sex	Female	244	63.9
Sex	Male	138	36.1
Educational status	Elementary	54	14.1
	Secondary	64	16.8
	University	101	26.4
	Unlearned	163	42.7
Employment status	Employed	125	32.7
	Retired	13	3.4
	Unemployed	244	63.9
Marital Status	Divorced	2	.5
	Married	241	63.1
	Single	130	34.0
	Widowed	9	2.4
	Total	382	100.0

3.2. Behavioral, medications, and complications associated with hypertension

A notable finding was the lack of exercise among two-thirds (63.4%) of participants and the presence of substance use in 7.1% of the participants. Among hypertension patients, a substantial portion (64.4%) did not adhere to anti-hypertensive medications (Table 2).

Table 2

Behavioral, medications, and complications characteristics Patients attending Galkacyo Medical Center (GMC) hospital, Galkacyo, Puntland, Somalia, 2023 (n = 382)
Variables	Category	Frequency	Percent
Physical activity	exercise	140	36.6
Physical activity	No exercise	242	63.4
HTN status	None	330	86.4
	Chronic	33	8.6
	Undiagnosed	19	5.0
HTN control status	None	349	91.4
	Controlled	18	4.7
	Uncontrolled	15	3.9
Complication status	None	377	98.7
Complication status	Complications	5	1.3
	Total	382	100.0
Anti-HTN users (n = 52)	None	31	64.4
Anti-HTN users (n = 52)	Yes	21	5.5
Comorbidity with HTN	None	365	95.5
Comorbidity with HTN	Comorbidity	17	4.5
Substance users’ status	None	355	92.9
Substance users’ status	Yes	27	7.1
Total		382	100

The overall prevalence of hypertension was 13.6% (95% CI; 10.2, 17.3), with more than one-third (36%) of hypertensive individuals being undiagnosed (Fig. 1). Furthermore, among chronic hypertensive patients, 28.84% had uncontrolled hypertension

3.3. Factors Associated with Hypertension

The multivariate logistic regression analysis revealed independent associations between hypertension, age, employment status, and comorbidity. Participants aged 46 to 55 were nearly ten times more likely to have hypertension (AOR = 9.69 95% CI (2.22–42.23), while those above 55 years were sixteen times more likely compared to individuals below 26 years (AOR = 16.23, 95% CI (3.91–67.20).

Additionally, unemployed individuals were nearly three times more likely to have hypertension (AOR = 2.80, 95% CI 1.04–7.56), and participants with comorbidity had a ninefold increased likelihood of hypertension compared to those without comorbidity (AOR = 8.83 95% CI 2.50-31.17) (Table 3).

Table 3

Factors Associated with hypertension among patients attending Galkacyo Medical Center (GMC) hospital, Galkacyo, Puntland, Somalia, 2023 (n = 382)
Variables	Category	HTN		COR (95% CI)	AOR (95%CI)	P-value
Variables	Category	No	Yes	COR (95% CI)	AOR (95%CI)	P-value
Age	Below 26 (Ref)	127(38.5%)	6(11.5%)	1	1	.000
	26–35	95(28.8%)	5(9.6%)	1.11(0.33–3.76)	1.268(5.36–0.75)	.747
	36–45	59(17.9%)	6(11.5%)	2.15(0.66–6.96)	2.47(11.60 − 0.25)	.253
	46–55	27(8.2%)	14(26.9%)	10.96(3.87–31.13)	9.69(2.22–42.23)	.003
	Above 55	22(6.7%)	21(49.4%)	20.20(7.33–55.59	16.23(3.91–67.20)	.000
Educational status	Secondary and above (Ref)	153(46.4%)	12(23.1%)	1	1	.849
	Elementary	48(14.5%)	6(11.5%)	1.59(0.57–4.47)	0.860(0.23–3.24)	.824
	Unlearned	129(39.1%)	34(65.4%)	3.36(1.67–6.76)	0.72(0.23–2.25)	.576
Employment Status	Employed (Ref)	113(34.3%)	12(23.1%)	1	1
Employment Status	Unemployed	216(65.7%)	40(76.9%)	1.74(0.88–3.46)	2.80(1.04–7.56)	.043
Marital status	Married (Ref)	131(39.7%)	10(19.2%)	1	1
Marital status	Single	199(60.3%)	42(80.8%)	2.77(1.24–5.70)	1.36(0.48–3.90)	.562
Life style	Good (Ref)	310(93.9%)	45(86.5%)	1	1
Life style	Poor	20(6.1%)	7(13.5%)	2.41(0.96–6.03)	3.12(0.89–10.88)	.075
Comorbidity	None (Ref)	324(98.2%)	41(78.8%)	1	1
Comorbidity	Comorbidity	6(1.8%)	11(21.2%)	14.49(5.09-41-25)	8.83(2.50-31.17)	.001

The findings of this study shed light on the prevalence, risk factors, and management challenges of hypertension in Galkacyo, Somalia, offering valuable insights into a unexplored aspect of public health in the region.

The study reveals a prevalence rate of 13.6% among the participants, indicating a significant burden of hypertension in Galkacyo Somalia. This figure is consistent with global trends showing an increasing prevalence of hypertension, especially in low- and middle-income countries [13]. Alarmingly, more than one-third of hypertensive individuals were unaware of their condition, reflecting a substantial gap in hypertension awareness and diagnosis. Furthermore, a considerable proportion of diagnosed hypertensive patients had uncontrolled hypertension, suggesting challenges in effective management and treatment adherence [5].

The study identifies several sociodemographic factors associated with hypertension. Age emerged as a significant predictor, with older individuals being at a higher risk, consistent with established literature on age-related hypertension. Unemployment also shows a strong association, indicating potential socioeconomic determinants of hypertension in the study population [14]. The study highlights the influence of educational attainment on hypertension, with a notable proportion of participants having limited or no formal education. Lack of exercise and substance use also featured prominently among the study population, underscoring the role of lifestyle factors in hypertension prevalence [15].

The study reveals suboptimal medication adherence among hypertensive individuals, with a majority failing to adhere to anti-hypertensive medications. This finding underscores the importance of addressing barriers to treatment adherence, such as medication cost, accessibility, and patient education [16].

The multivariate logistic regression analysis reveals age, employment status, and comorbidity as significant independent predictors of hypertension. These findings underscore the multifaceted etiology of hypertension, influenced by a combination of individual-level factors and broader sociodemographic determinants. Moreover, these results align with findings from comparable studies conducted in diverse geographic regions. This consistency suggests a universal pattern in the factors contributing to hypertension prevalence across various populations. One possible explanation for this convergence may be the shared influence of lifestyle, environmental, and genetic factors on hypertension risk across different cultural and geographical contexts [17, 18].

The study acknowledges limitations such as its cross-sectional design and reliance on self-reported data, which may introduce bias. Future research should explore longitudinal trends in hypertension prevalence and delve deeper into the sociocultural factors influencing health behaviors and outcomes in the study population.

This study provides valuable insights into the epidemiology of hypertension in Galkacyo, Somalia, highlighting the need for comprehensive public health interventions to address the growing burden of this condition. By understanding the complex interplay of sociodemographic, behavioral, and clinical factors associated with hypertension, policymakers, and healthcare providers can develop targeted strategies to improve hypertension awareness, diagnosis, and management, ultimately reducing the morbidity and mortality associated with this silent but significant health threat.

Conflict of interest

The authors declare that they have no competing interests

Ethics approval

The Ethical approval was obtained from IRB of Somalia National University (IRB reference number: SNU/SPHR/0148/2023)

Human Ethics and Consent to Participate

Consent to participate was obtained from all study participants

Author contributions

AAA, KAB, and SMM, Conceived and designed the study; performed study protocols; analyzed and interpreted the data; developed materials, and data analysis tools; reviewed the paper, and wrote the paper.

AAA, SMM, AMG, KAB: Analyzed and interpreted the data; developed materials, and data analysis tools; reviewed paper, wrote the paper.

AAA, SMM, AMG, KAB: Analyzed and interpreted the data, and analysis tools, reviewed the paper, and wrote the paper.

AAA, SMM, KAB: Contributed materials, data analysis tools; reviewed the paper, wrote the paper.

AA and SM proposed this research article and collected the data. AA and KB organized the data in the computer, did the analysis, and interpretation, and wrote the manuscript. AM supervised data collection, and data analysis, revised the manuscript for scientific content, and checked the language. All authors read and approved the final manuscript.

Funding

Funding is not applicable for this study.

Data availability

The data used and analyzed in this study is available from this manuscript.

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No competing interests reported.

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You are reading this latest preprint version

Prevalence of Hypertension and Associated Risk Factors in Galkayo, Puntland- Somalia

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

1. BACKGROUND

2. METHODOLOGY

2.1. Study Design and Setting

2.2. Participant Selection and Recruitment

2.3. Data Collection

2.4. Data Analysis

2.5. Ethical Considerations

3. RESULTS

3.1. Sociodemographic Characteristics

3.2. Behavioral, medications, and complications associated with hypertension

3.3. Factors Associated with Hypertension

4. Discussion

5. Conclusion and recommendations

Declarations

References

Additional Declarations

Status:

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