ABSTRACT

High blood pressure continues to be a global public health issue and attention needs to be given to primary preventive measures especially among health practitioners who are a channel to the entire population. Modifiable risk factors for hypertension include overweight and obesity, low consumption of fruits/vegetables, physical inactivity, occupational stress, smoking and excess alcohol consumption. The prevalence of hypertension among health workers in other countries outside and within Africa ranges between 10%-33% while Kenya is between 18.4-32.6% among various community populations but there is no specific data on the prevalence of hypertension among health workers in Uasin Gishu County. This study aimed at determining blood pressure and its associated risk factors among staff at Uasin Gishu level 5 Hospital, Uasin-Gishu County. A cross-sectional analytical study was conducted on a convenient sample of 136 respondents at Uasin Gishu hospital since it is the largest hospital in Uasin Gishu County. Pretested and validated tools were used. A structured questionnaire was used to collect data on socio-demographic characteristics and behavioural factors. 24-hour dietary recall and dietary diversity score were used to collect data on dietary practices. Data on physical activity levels of respondents was collected using the Global physical activity questionnaire. Anthropometric parameters namely weight, height and waist hip ratio were used to determine the nutritional status which was described using World Health Organization classification on Body Mass Index (BMI) and waist hip ratio (WHR). 24hr dietary recall data were analyzed using Nutri-survey. Demographic and socio-economic factors, behavioural factors, occupational stress, dietary practices, nutritional status and physical activity level were analyzed using descriptive statistics. Pearson correlation test was used to determine the relationship between variables, chi- square for the association. A p-value of <0.05 was used as a criterion for statistical significance. The mean age of the hospital staff was 36.96±9.96 years. Prevalence of high blood pressure was 22.6% with the most prevalent risk factors being central obesity (66.9%), BMI above 24.9kg/m2 (63.4%), occupational stress (23%) and physical inactivity at 14%. High dietary cholesterol intake of 219mg which is above RDI of 200mg was observed in female respondents. A Majority (80.1%) had medium dietary diversity score. Dietary intake of key micronutrients such as potassium, calcium in women and vitamin C in males were below the recommended dietary intake. Gender was associated with BMI (p-value = 0.007) and physical activity level (p-value = < 0.001). Factors related to BP were BMI (p-value= 0.011), WHR (p-value= 0.002), age (p-value = < 0.001), education (p-value= 0.016) and household size (p-value= 0.004). Socio-demographic and nutritional status of Uasin Gishu hospital staff influenced their BP levels. Based on findings from this study, respondents should be informed on their nutritional status and blood pressure levels and its associated risk factors. County health administration may find the results from this study useful to help come up with interventions to curb risk factors among their staff. Ministry of Health and other relevant stakeholders such as Kenya Cardiac Society, International Society of hypertension and MoH involved in the prevention and management of hypertension may find this information useful for guiding policy and meeting global targets and goals.

CHAPTER ONE: INTRODUCTION

            Background to the Study

High blood pressure is a condition in which long term force of the blood against blood vessels is high enough to eventually cause health problems such as heart diseases. According to World Health Organization, WHO standards and Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure, JNC (VII), high blood pressure refers to blood pressure above 140/90 mmHg on repeated diagnosis (WHO 2013). Hypertension is termed as a silent killer because it often has no warning signs or symptoms at the early stage and many people do not know that they have it. It is a key risk factor for cardiovascular diseases (CVDs) (Farag et al., 2014).

Globally CVDs accounts for approximately 17 million deaths yearly and about 80% of these deaths occur mainly in low and middle-income countries (Alwan, 2011). High blood pressure (HBP), which affects a billion people worldwide, is the leading cause of heart attacks and stroke. Researchers have estimated that 9 million people die every  year due to raised blood pressure (WHO, 2013). Hypertension is responsible for at least 45% of death due to heart disease (Slim, Vos, Flaxman, Danaei & Shibuya, 2012). As per the year 2013, the prevalence of hypertension was highest in the African region with 46% of adults aged 25 and above being hypertensive, while America had the lowest prevalence of 35% among the continents (WHO, 2013). According to Mohamed et al., (2018), his study findings of a national survey reported a prevalence of high blood pressure at 24.5% among adult’s population in Kenya.

An effective high blood pressure management program should be diverse and requires the participation of patients, families, communities and health care delivery systems. This includes awareness to patients and health care providers, appropriate lifestyle modifications, access to care, evidence based-treatment, high level of medication adherence and adequate follow-up (Roger et al., 2011). The modifiable risk factors for hypertension include raised cholesterol levels in the body, obesity, less than 5 servings of fruits and vegetables per day, insufficient physical activity, smoking and high alcohol consumption and occupational stress (Banyangiriki & Phillips, 2013).

In regard to non-communicable diseases risk factors, Steps Survey Kenya (2015) reported that 91.8% of adults with raised blood pressure are not on medication, 5% were on medication and not in control while 3% were on medication and their pressure was controlled. Those found in stage 2 and emergency crisis with medication are at 23.8% and those with more than three risk factors for hypertension are at 25.9%, 25.3% and 26.5% in both sexes, in males and females respectively indicating vulnerability to hypertension by both sexes.

Problem Statement

Hypertension was declared a global public health issue by the World Health organization on the world health day in 2013, (WHO, 2013) and there is a need for attention since the increase is alarming. A recent national survey shows that the prevalence of HBP was 24.5% among adults in Kenya while data from recent studies indicated that prevalence of HBP ranges from 18.4-32.6% among various communities in Kenya (Mohamed et al., 2018). According to Kenya Demographic Health survey

(2014), 9% of women and 3% of men reported that they had been informed by the health provider that they were hypertensive and that 11.6% of the urban population had high blood pressure compared to 7.8% of the rural population. These percentages generally increase with age, education and wealth status. Better control of hypertension and its associated risk factors is expected among hospital staff considering the proximity to health care delivery. A study by Egbi, Rotifa, & Jumbo (2015) reported that crude adjusted prevalence of hypertension is at 21.3% while age-adjusted prevalence is at 23.8% among hospital employees in Nigeria.

Hypertension is the major cause of disease burden in both developed and developing regions with 64 million disability adjusted life years (DALY) which affect individual productivity and effectiveness. It leads to early retirement and reduced health workforce that generally affect the economy of the country (Farag et al., 2014). Even though many health workers may be knowledgeable on the control and early diagnosis of hypertension, compelling demands at job, workload and lack of signs and symptoms of hypertension could be barriers toward achieving the recommended levels of blood pressure (Mitwalli et al., 2013).

Hypertension is attributed to risk factors such as; consumption of food containing a lot of salt, sugars and fats with an increase in age, as well as not eating enough fruits and vegetables, harmful levels of alcohol use, physical inactivity, obesity, high social- economic status, gender and occupational stress (Bosu, 2016; Salaudeen et al., 2014; Egbi et al., 2015). A study by Cavagioni & Pierin (2012) among health professional in

Brazil found that among hypertensive victims of behavioural risk factors; 20.1% were smokers, 47% were alcoholic while 64% had a sedentary lifestyle.

Kenya has shown increased rates of mortality due to cardiovascular diseases (KDHS 2014), although measuring blood pressure has become a standard operating procedure  in Kenya before any treatment and proximity of health services. Existing research conducted on blood pressure are on a general population in Kenya and other  populations but no specific data in Uasin-Gishu county and little is concluded on blood pressure and its associated risk factors especially among the hospital workers in Uasin Gishu County. Therefore, to address this gap, this study was carried out to assess blood pressure and associated risk factors of staff in Uasin Gishu level 5 hospital, Uasin-Gishu County.

Purpose of the Study

The purpose of this study was to determine blood pressure and its associated risk factors among staff at Uasin Gishu level 5 hospital, Uasin-Gishu County.

Objectives

The objectives of this study were to:

1. Establish the socio-economic and demographic characteristics of staff at Uasin Gishu level 5 hospital.
   1. Determine the dietary practices of Uasin Gishu level 5 hospital staff.

• Assess the nutritional status (BMI and waist-hip ratio) of Uasin Gishu level 5 hospital staff.

• Establish the level of physical activity of Uasin Gishu level 5 hospital staff.

• Assess the occupational stress levels of Uasin Gishu level 5 hospital staff.

• Establish the blood pressure levels among Uasin Gishu level 5 hospital staff.

• Determine the relationship among socio-demographic characteristics, nutritional status, dietary practices, physical activity level, and occupational stress with blood pressure levels among Uasin Gishu hospital staff.

Hypotheses

Ho _1:    There is no significant relationship between socio-economic and demographic factors and blood pressure levels of Uasin Gishu hospital staff.

Ho _2:    There is no significant relationship between occupational stress and blood pressure levels of Uasin Gishu hospital staff

Ho₃:     There is no significant relationship between dietary practices and blood pressure levels of Uasin Gishu hospital staff.

Ho₄:     There is no significant relationship between nutritional status and blood pressure levels of Uasin Gishu hospital staff.

Ho₅: There is no significant relationship between physical activity level and blood pressure levels of Uasin Gishu hospital staff.

Significance of the Study

This study has provided information on the risk factors associated with high blood pressure to the participants and the Ministry of Health. These findings informed participants on adjustments they needed to make with regards to the risk factors. The

results informed the Ministry of Health and Uasin Gishu level 5 hospital management in particular on interventions necessary to curb the risk factors and help improve the health of their workers. Finally, the study has added literature in the area of hypertension risk factors among health workers and provided information on which further research can be based.

Delimitation of the Study

Since the study was conducted in one county, generalizing to the other counties and the country as a whole may not give the true picture of the situation. This could be due to differences in dietary practices and geographical area that affect both dietary practices and the level of physical activity.