Prevalence and trend of hypertension secondary data analysis from 2013 to 2020 of Mekelle zone, Tigray, Ethiopia, 2021

doi:10.21203/rs.3.rs-5047548/v1

Download PDF

comment

Prevalence and trend of hypertension secondary data analysis from 2013 to 2020 of Mekelle zone, Tigray, Ethiopia, 2021

https://doi.org/10.21203/rs.3.rs-5047548/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Introduction: Hypertension is a systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg that contributes to the burden of heart disease, stroke, kidney failure, and premature mortality and disability. There is limited evidence on the trend and magnitude of hypertension in Tigray, Ethiopia. Therefore, this study was designed to assess the magnitude and trend of hypertension among individuals visiting outpatient and inpatient units of health facilities in the Mekelle zone, Tigray, Ethiopia.

Methods: A descriptive cross-sectional study was conducted in the Mekelle zone, Tigray, Ethiopia from August 2^nd-4^th week, 2021. This study was done using secondary data from July 2013 to June 2020. The data was extracted from the health management information system and district health information software monthly report of Tigray Regional Health Bureau and analysis was done through Microsoft Excel 2020. Results were presented with texts, tables, graphs, and charts.

Result: Overall 53,386 outpatient cases, 4161 inpatient cases, and 135 deaths were reported during the seven-year reporting period due to hypertension. The overall prevalence of hypertension is 25/1000 with 28/1000 and 22/1000 in males and females respectively. Similarly, prevalence among ≥15 years was 44/1000 with 38/1000 in adult males and 50/1000 in adult females. The death rate was 6.8/1000 and 2.5/1000 among ≤15 years and adults. The trend of hypertension increased from 30/1000 (2013/14) to 43/1000 (2020) among adults ≥15 years.

Conclusion: The prevalence of hypertension in the Mekelle zone is higher among females and adults > 15 years old. Even though the magnitude of hypertension was higher in adults the death due to hypertension was higher among ≤15 years. This study also identified the increasing and decreasing trend of morbidity and mortality respectively. Public health officers and researchers should conduct further investigations to dig out the reason for the increased disease prevalence and its effects.

Hypertension

Prevalence of hypertension

Trend of hypertension

Mekelle

Tigray

Hypertension is a condition in which blood pressure (BP) of blood vessels is abnormally high, i.e., systolic blood pressure measurement equal to or greater than 140mmHg and diastolic blood pressure equal to or greater than 90mmHg (1). Hypertension (high blood pressure) is when the pressure in blood vessels is too high (140/90 mmHg or higher) on the average of two or more readings taken at each of two or more visits after initial screening. It is common but can be serious if not treated. Hypertension is one of the most common worldwide health problems, as it is estimated that over 20% of all adults across the world have hypertension. Developing countries are experiencing dramatic changes in health needs. The increasing prevalence of chronic diseases such as hypertension is creating a public health challenge (2).

Hypertension contributes to the burden of heart disease, stroke kidney failure, and premature mortality and disability. It disproportionately affects populations in low and middle-income countries with weak health systems. There are significant health and economic gains attached to early detection, adequate treatment, and good control of hypertension. Treating the complications of hypertension entails costly interventions such as cardiac bypass surgery, carotid artery surgery, and dialysis, draining individual and government budgets (3).

A large percentage of NCDs are preventable through the reduction of the four main shared behavioural risk factors: tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets (referred to as modifiable risk factors). These behavioural risk factors subsequently lead to more formidable biochemical risk factors, called intermediate risk factors including raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity (8).

In the first half of the twentieth century; high blood pressure was almost non-existent in African societies but currently, estimates show that in some settings in Africa, more than 40% of adults have hypertension (1). Although hypertension is a preventable and modifiable risk factor of CVD, the control and prevention of hypertension have not yet received due attention in many developing countries. Ethiopia is one of the lower-income countries that is affected by double burden disease. WHO 2011 report showed that 34% of all deaths in Ethiopia were due to NCDs, of which CVD contributes. Non-communicable diseases (NCDs) are the major causes of death in the world, accounting for around 36 million (63%) of the total deaths (57 million) that happened in 2008. Almost half (48%) of the NCD deaths were caused by cardiovascular disease (5).

The World Health Organization found around 62% of cardiovascular diseases (CVDs) and 49% of ischemic heart disease are attributable to raised BP globally (6). According to the global report on the epidemiology of HTN, CVDs are responsible for the largest proportion of non-communicable disease (NCD) deaths in the world (48%) and raised BP is one of the leading behavioural and physiological risk factors to which 13% of global deaths are attributed (16).

In Ethiopia, the finding of the pooled analysis showed that the overall prevalence of hypertension ranges from 7% – 37% with population-based studies from 9.3–30.3%, institution-based studies 7–37%, and hospital-based studies from 13.2–18.8% (17). The study conducted in Addis Ababa among civil servants of federal ministries in 2014 shows the overall prevalence was 27.3%. Hypertension was more prevalent among females (28.3%) than males (26.2%) (18).

An institution-based cross-sectional study conducted in Tigray shows hypertension was more prevalent among females and aged ≥ 15 years old adults. The trend of hypertension morbidity increased from 2011 to 2015 in OPD visits and IPD visits but the mortality trend decreased from 2011 (33/10,000) to 2015 (10/10,000) with an average fatality rate of 18/10,000 (23).

There is no strong surveillance system established regarding hypertension in Ethiopia. This plays a vital role in its high burden of hypertension morbidity and mortality. HTN is one of the important public health causes of non-communicable diseases. There is limited evidence on the trend and magnitude of hypertension morbidity and mortality documented in Tigray, Ethiopia except the one done from 2011–2015. The main aim of this study was to assess the prevalence and trend of hypertension among individuals visiting outpatient and inpatient units of health facilities in the Mekelle zone for various reasons. It will provide further information regarding the burden of hypertension and its risk factors to plan further interventions.

Study setting

The study was conducted in Mekelle city of Tigray Region, Northern Ethiopia from first week to third week of August 2021. Administratively, Mekelle is considered a Special Zone, which is divided into seven sub-cities. It is the economic, cultural, and political hub of northern Ethiopia. There were two private hospitals, three public hospitals, one referral hospital, and seven Woreda health offices reporting to Tigray Health Bureau HMIS and DHIS2. All health facilities were providing outpatient and inpatient services to hypertensive cases. It is located 783 Km from Addis Ababa, Ethiopia.

Study design

A descriptive cross-sectional study was conducted for HTN secondary data analysis.

Population

The population of the Mekelle zone from July 2013 to June 2020 was used for each corresponding year was considered as source population for the study. A study was conducted on all HTN morbidity and mortality cases reported from health facilities of Mekelle zone reported to the regional health bureau HMIS unit from July 2013 to June 2020.

Source of Data

Tigray Regional Health Bureau HMIS and DHIS2 reports are the sources of data. HMIS/DHIS2 is a system that allows for the collection, storage, compilation, transmission, analysis, and usage of health data that assist decision-makers and stakeholders manage and plan resources at every level of health service.

Operational definition

HTN case

is defined as any type of HTN case either with morbidity or mortality according to the national disease classification and reporting of HMIS except pregnancy-induced hypertension.

Reporting period

the reporting duration for hypertension was monthly. The annual report was starting from July to June.

Outpatient department patients

who visited the health institution due to hypertension or co-morbid with other diseases (hypertension and other diseases at the same time).

Inpatient department patients

who were admitted to the health institution due to hypertension or co-morbid with other diseases once.

Hypertension morbidity

Patients who have hypertension either alone or co-morbid with others like renal failure, stroke, etc.

Hypertension mortality

Death due to hypertension alone or co-morbid with other like stroke, or chronic renal failure.

Data Collection Method and Tool

Review of reports from Tigray health bureau HMIS and DHIS2 and exported into Excel data sheet.

Data management

Data from HMIS and DHIS2 was entered into Microsoft Excel 2020 and was checked for missing and incompleteness through repeated observation of the specific records from the Excel data sheet we communicated with the HMIS focal person about the missing values and they told us that all the spaces without value to consider as zero.

Data analysis and presentation

A simple description of secondary data was done through Excel and the analysis was done based on counts, proportions, and rates of HTN morbidity and mortality. The findings were presented using texts, tables, charts, and graphs.

Data dissemination and reporting

As soon as this study was finalized, written report soft copies were shared with Mekelle University School of Public Health Department of Epidemiology and Tigray Regional Health Bureau.

Ethical consideration

A letter of approval was written from the Mekelle University Department of Epidemiology to TRHB to practice field activities at the Mekelle field base and provide me with the necessary data. Therefore, I have used this data only for data analysis.

Distribution of Hypertension by person

Hypertension morbidity

Of the total cases, 32,583 (56.66%) are females while males account for 24,924(43.34%) (Table 1). Most (98.4%) of hypertension cases are 15 years old and above with an age-specific prevalence of 44/1000 (Fig. 2). Among admitted hypertensive patients 2365 (56.84%), and 1796(43.16%) are females and males respectively (Fig. 2). The overall prevalence of hypertension is 25/1000 with 28/1000 and 22/1000 in males and females respectively. Similarly, the overall prevalence among adults (≥ 15 years) was 44/1000 with 38/1000 in adult males and 50/1000 in adult females.

Table 1

Outpatient hypertension cases by age and sex of Mekelle zone from 2013 to 2020.
Year	Under 5 children		5–14 years		>=15 years		Total
Year	Male	Female	Male	Female	Male	Female
2013/14	3	5	37	19	1947	2308	4319
2014/15	6	2	23	28	2254	2983	5296
2015/16	6	28	68	48	3182	3653	6985
2016/17	54	13	41	32	3832	4410	8382
2017/18	62	44	20	127	4299	5940	10492
2018/19	0	6	11	3	3933	5790	9743
2019/20	11	8	11	14	3368	4757	8169
Total	142	106	211	271	22815	29841	53386

Hypertension mortality

Most of the deaths 77(57%) were males, and 58(43%) deaths were females during these reporting periods. Most of the deaths 130(96.3%) reported were 15 years and above followed by 3 deaths 5–14 years and 2 deaths under five years old. In addition, the average death rate was 6.8/1000 and 2.5/1000 among ≤ 15 years and ≥ 15 years individuals.

Distribution of hypertension by health facility

The report of hypertension was gained from 1 referral hospital, 5 general hospitals (2 private and 3 public), and 7 Woreda health offices and their contribution is as follows (Table 2). A total of 35,474 cases were reported from July 2013 to June 2018 from all health facilities which have regular reporting systems.

Table 2

HTN cases reported from public and private health facilities from July 2013 to June 2018.
Health facility name	Reporting period					Total
Health facility name	2013/14	2014/15	2015/16	2016/17	2017/18	Total
Ben Meskerem General Hospital	1725	125	279	443	211	2783
Ayder Referral Hospital	0	1908	3034	3412	3546	11900
Hewo Hospital	59	75	39	93	244	510
Kay Kalkidan General Hospital	0	19	89	106	90	304
Mekelle Hospital	1712	2079	2407	2324	2986	11508
Quiha Hospital	89	381	128	252	923	1773
Ayder Woreda Health Office	179	68	102	185	366	900
Hadent Woreda Health Office	228	358	434	682	631	2333
Haweliti Woreda Health Office	76	74	181	173	283	787
Qdemay Woyane Woreda Health Office	226	193	282	637	1157	2495
Quha Woreda Health Office	24	14	4	27	34	103
Semen Woreda Health Office	1	2	6	48	21	78
Total	4319	5296	6985	8382	10492	35474

Distribution of Hypertension by Time

A total of 57,547 cases and 135 deaths of HTN were reported during the last seven years period of time. Most hypertension cases (92.76%) were reported from the outpatient department in the period. More hypertension cases have visited health facilities in 2017/18 than other periods. A total of 4161 hypertension admissions were admitted to the reporting health facilities. Among these, only 109 patients were admitted in 2019 and 2020 with an average admission rate of 7.2% (Fig. 4). The trend of hypertension prevalence increased from 30/1000 (2013/14) to 59/1000 (2017/18) and decreased to 43/1000 (2020) among adults ≥ 15 years. Relatively death was high during 2013/14 and lower during 2019/20 (Fig. 3).

Overall, 57,547 hypertension cases are reported during the seven-year reporting period. Among these 53, 386 outpatients, 4161 inpatients and 135 deaths were reported during the seven-year reporting period. Overall adult prevalence of hypertension is 44/1000 with 38/1000 and 50/1000 in males and females respectively. In general, hypertension is more prevalent among persons aged 15 years and above, and females but death from hypertension is more prevalent among males, and ≤ 15 years old. Hypertension cases increased both in outpatient and inpatient admissions from 2013 to 2018 and declined in the two years after the peak period in 2017/18. Death from hypertension has decreased from 2013 to 2020 by nine times.

The overall prevalence of hypertension was 25/1000 which is lower than the findings of a community-based crossectional study done in Gondar (11). This might be due to differences in the age of the study population and the data source used. It is also lower than the findings of institutional-based crossectional studies in Ethiopia (18, 19, 21, 22). This is due to differences in the study population, the source of data used for analysis, and age differences among the study participants. This study's findings align with the findings of a systemic review in Ethiopia (17).

This study revealed that hypertension is more prevalent among females than males. This finding agrees with the community-based study conducted in Gondar (11), an institutional-based cross-sectional study in Addis Ababa and Tigray (18, 23) but it is opposite to the institutional-based crossectional study in Sidama (19, 22). The possible reasons for the difference may be the difference in the method of study design, the difference in sample size, the difference in selecting a method of data source, and the difference in sociodemographic and geographical characteristics. Hypertension is more prevalent among persons aged 15 years and above according to the study conducted on a trend of hypertension in Tigray (23). The findings of this study also reveal that hypertension was more prevalent in persons aged 15 years and above.

In the first five years duration, there was an increase in the morbidity of hypertension (from 4319 in 2013/14 to 10492 in 2017/18) but it decreased from 10,492 in 2017/18 to 8169 in 2019/20. However, the trend of death rate was decreased from 52.6/10,000 to 6/10,000 which is similar to the crossectional study conducted in Tigray (23) on the trend of hypertension morbidity and mortality from 2011 to 2015 but the average death rate is higher than the finding of a crossectional study conducted in Tigray (23). This is due to differences in study area and period because our study was localized only in the urban area and a longer duration but the study conducted on the trend of hypertension morbidity and mortality in Tigray was based on both urban and rural area hypertension data of four years. Even though there is an increase in outpatient visits, the admission rate decreased from 2013 (15.87%) to 2020 (1.17%) by 14 times. This might be due to improved quality of patient care service and health promotion services.

To conclude based on the findings of this study females are more at risk than males for hypertension and adults > 15 years old are at higher risk of hypertension. However, morbidity due to hypertension was higher in adults whereas mortality due to hypertension was higher among under 15 years old individuals.

The trend of HTN morbidity in the Mekelle Zone is increasing despite a slight decrease in cases in 2019 and 2020. Admission and death from hypertension have been decreasing starting from 2017/18. The trend of hypertension is becoming increasing and it can show us the overgrowing burden of hypertension. Researchers should conduct further studies to dig out the reason for the increased disease burden and its effects. Health workers should enhance and promote healthy lifestyles to control and reduce the burden of hypertension.

Since data is from secondary sources incompleteness and representativeness of the data were major limitations. Even though the location of the health facility is designated to a specific sub-city it was difficult to describe the distribution of hypertension by place because service utilisers do not gain health service only in the health facility in their administrative location; Instead, we have used distribution by health facility. In addition to this, data from the last two years of the study period was not aggregated by health facilities.

DHIS

Demographic health information software

HMIS

Health Management Information System

HTN

Hypertension

IPD

Inpatient department

NCD

Non–Communicable Disease

OPD

Outpatient department

RHB

Regional Health Bureau

WHO

World Health Organization.

Ethical approval:

Not applicable

Competing interests:

The authors declare that they have no competing interests

Funding:

There was no funding.

Author Contribution

The draft manuscript was done by TB: conception, design, data collection, analysis, writing, interpretation, and editing. DZ designed, edited and revised the draft manuscript; and the revision and editing of the manuscript by MY. All authors read and approved the final manuscript. (TB-Tsegay Berhane, DZ-Dawit Zenebe, MY-Mesfin Yimer).

Acknowledgement

We want to thank Mekelle University College of Health Science School of Public Health Department of Epidemiology, and the Tigray Regional Health Bureau PHEM Case team for their support and cooperation in conducting the study.

Data Availability

Dare available from the corresponding author on reasonable requests.

WHO. A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013. World Health Organization; 2013.
Iraq Ministry of Health. Hypertension prevention, diagnosis, and treatment. Primary care service delivery guideline; primary health care project, 2013.
WHO. A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013. World Health Organization; 2013.
WHO. World Health Statistics Monitoring Health for SDGs. World Health Organization; 2020.
WHO. World Health Organization Noncommunicable diseases: country profiles 2011. Geneva: WHO; 2011.
WHO. World Health Report 2013: Research for universal health coverage. World Health Organization; 2013.
Bekele A et al. Pattern and trend of medical admissions of patients of chronic non-communicable diseases in selected Hospitals in Addis Ababa, Ethiopia. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS), 2015. 13(1): pp. 34–48.
Ethiopia F. Health sector transformation plans I. Addis Ababa, 2015.
Gupta R, Gaur K, Ram CVS. Emerging trends in hypertension epidemiology in India. J Hum Hypertens. 2019;33(8):575–87.
WHO. Global Health Repository. Raised blood pressure: situation and trends. 2013.
Awoke A, et al. Prevalence and associated factors of hypertension among adults in Gondar, Northwest Ethiopia: a community-based cross-sectional study. BMC Cardiovasc Disord. 2012;12(1):1–6.
WHO. G., Global status report on noncommunicable diseases 2010. 2011.
Nshisso LD, et al. Prevalence of hypertension and diabetes among Ethiopian adults. Diabetes Metabolic Syndrome: Clin Res Reviews. 2012;6(1):36–41.
Mengistu MD. Pattern of blood pressure distribution and prevalence of hypertension and prehypertension among adults in Northern Ethiopia: disclosing the hidden burden. BMC Cardiovasc Disord. 2014;14(1):1–8.
Kibret KT, Mesfin YM. Prevalence of hypertension in Ethiopia: a systematic meta-analysis. Public Health Rev. 2015;36(1):1–12.
Dreisbach AW, Batuman V. Epidemiology of hypertension. Supplement to JAPI February 2013. 61: pp. 12–13.
Legese N, Tadiwos Y. Epidemiology of hypertension in Ethiopia: a systematic review. Integr blood Press control, 2020: pp. 135–43.
Angaw K, Dadi AF, Alene KA. Prevalence of hypertension among federal ministry civil servants in Addis Ababa, Ethiopia: a call for a workplace-screening program. BMC Cardiovasc Disord. 2015;15(1):1–6.
Badego B. Prevalence and Risk Factors of Hypertension among Civil Servants in Different Departments of Sidama Zone. Southern Ethiopia: HUCMHS; 2019.
Tiruneh SA, et al. Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS ONE. 2020;15(12):e0244642.
Asresahegn H, Tadesse F, Beyene E. Prevalence and associated factors of hypertension among adults in Ethiopia: a community-based cross-sectional study. BMC Res Notes. 2017;10(1):629.
Wolle SZ, Kebed SM, Alemu ZA. To determine the prevalence of hypertension and its lifestyle risk factors in Amhara Region of Debre Birehan Town among Zonal Civil Servants, Ethiopia. 2020.
Gerensea H, Teklay H. Trend of hypertension morbidity and mortality in Tigray Region from 2011 to 2015, Tigray, Ethiopia. BMC research notes, 2018. 11(1): pp. 1–5.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Prevalence and trend of hypertension secondary data analysis from 2013 to 2020 of Mekelle zone, Tigray, Ethiopia, 2021

Status:

Version 1

Abstract

Figures

Introduction

Methods

Study setting

Study design

Population

Source of Data

Operational definition

Data Collection Method and Tool

Data management

Data analysis and presentation

Data dissemination and reporting

Ethical consideration

Results

Distribution of Hypertension by person

Hypertension morbidity

Hypertension mortality

Distribution of hypertension by health facility

Distribution of Hypertension by Time

Discussion

Conclusion and Recommendation

Study limitations

Abbreviations

Declarations

Ethical approval:

Competing interests:

Funding:

Author Contribution

Acknowledgement

Data Availability

References

Additional Declarations

Status:

Version 1