Annals of African Medicine Vol. 14, No. 1; 2015
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Original Article
Website: www.annalsafrmed.org DOI: 10.4103/1596-3519.148709 PMID: *****
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Prevalence of hypertension and its correlates among employees of a tertiary hospital in Yenagoa, Nigeria Oghenekaro Godwin Egbi1,2, Stella Rotifa3, Johnbull Jumbo1,2 Departments of Medicine, 1Niger Delta University, Okolobiri, Bayelsa State, 2Federal Medical Centre, Yenagoa, Bayelsa State, 3Department of Community Medicine, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria
Correspondence to: Dr. Oghenekaro Godwin Egbi, Dialysis Unit, Federal Medical Centre, P. M. B 502, Yenagoa, Bayelsa State, Nigeria. E‑mail: [email protected]
Abstract Background: Hypertension (HTN) is a common medical problem with increasing prevalence and dire consequences. Considering the relative proximity of hospital workers to health care delivery, one may expect a better control of HTN and associated risk factors in this population. The objective of the current study was to determine the prevalence of HTN and risk factors among hospital employees in a Nigerian tertiary hospital. Materials and Methods: All employees of the Federal Medical Center, Yenagoa (Bayelsa State, Nigeria) were invited for a HTN screening exercise on the world kidney day on March 14, 2013. A total of 231 participants completed this cross-sectional study. Data was obtained with a pre-tested interviewer-administered structured questionnaire while blood pressure was taken with an Accoson sphygmomanometer. Anthropometry was done using standardized protocols. Urine and blood were analyzed for glucose. HTN was defined as blood pressure >140/90 or prior diagnosis or use of antihypertensives. Data was entered, stored and analyzed with Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20. Results: The crude and age-adjusted prevalence of HTN among the hospital employee was 21.3% and 23.8% respectively. Age, marital status, educational level, body mass index, waist circumference (WC) and waist hip ratio showed significant association with HTN in the univariate analysis. However, in multivariate regression analysis, only older age and abnormal WC predicted HTN. Conclusion: The prevalence of HTN among the hospital employees compared with reports in other population and was predicted by advancing age and abnormal WC. The study underscores the need for introduction of HTN screening programs among hospital employees especially staff that are older with truncal obesity. Keywords: Bayelsa, correlates, employees, hypertension, prevalence
Résumé Contexte: L'hypertension (HTN) est un problème médical commun avec l'augmentation de la prévalence et les conséquences désastreuses. Compte tenu de la proximité relative des travailleurs de l'hôpital à la prestation des soins de santé, on peut attendre un meilleur contrôle de HTN et facteurs de risque dans cette population. L'objectif de cette étude était de déterminer la prévalence de HTN et facteurs de risque chez les employés de l'hôpital dans un hôpital tertiaire nigérian . Matériaux et Méthodes: tous les employés du centre médical fédéral, Yenagoa (Etat de Bayelsa, Nigeria) ont été invités pour un HTN dépistage exercice sur la journée mondiale du rein le 14 mars 2013. Un total de 231 participants ont complété cette étude transversale. Données ont été obtenues avec un questionnaire structuré pré-testée intervieweur, tandis que la pression artérielle a été prise avec un sphygmomanomètre Accoson. L'anthropométrie a été fait à l'aide de protocoles standardisés. Sang et urine ont été analysés pour le glucose. HTN a été défini comme sang pression
Vol. 14, January-March, 2015
Annals of African Medicine
Egbi, et al.: Hypertension among hospital employees >140/90 ou diagnostic préalable ou utilisation des antihypertenseurs. Données a été entrées, stockées et analysées avec Logiciel de statistiques pour les Sciences sociales (SPSS Inc., Chicago, IL, USA) version 20. Résultats: La prévalence brute et ajusté selon l'âge du HTN chez l'hôpital employé était de 21,3 % et 23,8 % respectivement. Âge, état matrimonial, niveau d'instruction, indice de masse corporelle, tour de taille (WC) et taille hip ratio a montré l'association significative avec HTN dans l'analyse univariée. Toutefois, dans l'analyse de régression multivariée, seulement plus âgés et WC anormale prédit HTN . Conclusion: La prévalence de HTN parmi les employés de l'hôpital par rapport aux rapports dans d'autres populations et a été prédite par l'âge et WC anormale. L'étude met en évidence la nécessité d'introduire des HTN parmi les employés de l'hôpital en particulier du personnel qui sont plus âgé avec obésité abdominale, les programmes de dépistage. Page | 9
Mots-clés: Bcorrélats, employés, hypertension, ayelsa, prévalence
Introduction Hypertension (HTN) is a common medical problem of increasing magnitude and disturbing consequences. In Nigeria like in most other countries in sub‑Saharan Africa, it is considered a major contributor to morbidity and mortality.[1] The overall prevalence of HTN in Nigeria ranges from 8% to 64%[1] depending on the study target population, type of measurement and cut‑off value used for defining HTN. It has been projected that by 2025, about 75% of the world’s hypertensive population will be in developing countries. [2] Although, it is commonly asymptomatic, the damage it does to arteries and organs can lead to significant morbidity. HTN is a major risk factor for stroke, heart failure and kidney disease making it a key priority for prevention, early detection and control. Risk factors for HTN include increasing age,[3] obesity,[4] sedentary lifestyle,[5] family history of HTN,[6] diet,[7] alcohol,[8] and tobacco use.[9] Patient education by physicians and other members of the heath team about lifestyle modifications plays an important role in the control of HTN.[10] The effectiveness of patient education may be enhanced by a healthy lifestyle of the attending health care worker. For example, the predictors study [11] highlighted how physicians who drank less alcohol, smoked tobacco and engaged in healthier habits were more likely to have higher success rates in patient management. Similarly, the nurses’ body size study[12] indicated that patients showed more confidence in health education when being given by a normal weight nurse than when being delivered by an overweight nurse. Considering the health‑related knowledge at the disposal of the hospital workers and their proximity to health care delivery, the assumption will be that the control of HTN and its modifiable risk factors would be relatively high. An earlier study done among civil servants working in the Bayelsa State, South‑South Nigeria had put the prevalence of HTN at 27.8%.[13] Similarly, in Port Harcourt, a Annals of African Medicine
nearby town in Rivers State, Onwuchekwa et al. have reported prevalence of 32.0% among civil servants and 30.0% among professionals including engineers, lawyers and accountants.[14] Furthermore in Port Harcourt, Ordinioha et al. revealed prevalence of 21.3% among lecturers.[15] In Benin City, Nigeria, prevalence of 17.7% was reported among bankers.[16] However, there are only scanty reports on the prevalence of HTN among hospital workers in Nigeria. The lecturers in Ordinioha’s series were however also medical consultants in the University Teaching Hospital.[15] A few reports exist on the prevalence of HTN among hospital employees outside Nigeria. For instance, some Brazilian studies reported prevalence rates of 26%[17] and 36%[18] among physicians and female nurses respectively. Against this background, the aim of this study was to determine the prevalence of HTN and associated risk factors among hospital workers in a tertiary hospital in Bayelsa State, Nigeria.
Materials and Methods Study design The study was cross‑sectional and observational in design. It was carried out in the Federal Medical Center, Yenagoa. The hospital is the largest hospital in Bayelsa State with a total bed capacity of about 200 and an average annual in‑patient load of 10,000. It serves as a referral center to other smaller hospitals in the state as well as hospitals in neighboring states such as Delta, Rivers, Edo and Akwa‑Ibom. The hospital has a total of about 815 full time employees which includes various cadres of doctors, nurses, laboratory staff, pharmacists, technicians and administrative staff. A minimum acceptable sample size of 246 was determined using Daniel’s sample size formula with finite population correction,[19] HTN prevalence of 27.8% (from Egbi’s report),[13] with a precision of 5.0%, 95% confidence interval (CI) set at 1.96 and an allowable error of 10%. Vol. 14, January-March, 2015
Egbi, et al.: Hypertension among hospital employees
All employees of the hospital were invited for a HTN screening program through a circular sent from the office of the head of administration to the respective heads of departments several days before the event. Sensitization banners were also placed at strategic positions in the hospital. The screening exercise took place as part of the event to commemorate the world kidney day on March 14, 2013. Page | 10
Non‑probability consecutive sampling was used in recruitment of participants. Individuals
Access this article online Quick Response Code:
Original Article
Website: www.annalsafrmed.org DOI: 10.4103/1596-3519.148709 PMID: *****
Page | 8
Prevalence of hypertension and its correlates among employees of a tertiary hospital in Yenagoa, Nigeria Oghenekaro Godwin Egbi1,2, Stella Rotifa3, Johnbull Jumbo1,2 Departments of Medicine, 1Niger Delta University, Okolobiri, Bayelsa State, 2Federal Medical Centre, Yenagoa, Bayelsa State, 3Department of Community Medicine, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria
Correspondence to: Dr. Oghenekaro Godwin Egbi, Dialysis Unit, Federal Medical Centre, P. M. B 502, Yenagoa, Bayelsa State, Nigeria. E‑mail: [email protected]
Abstract Background: Hypertension (HTN) is a common medical problem with increasing prevalence and dire consequences. Considering the relative proximity of hospital workers to health care delivery, one may expect a better control of HTN and associated risk factors in this population. The objective of the current study was to determine the prevalence of HTN and risk factors among hospital employees in a Nigerian tertiary hospital. Materials and Methods: All employees of the Federal Medical Center, Yenagoa (Bayelsa State, Nigeria) were invited for a HTN screening exercise on the world kidney day on March 14, 2013. A total of 231 participants completed this cross-sectional study. Data was obtained with a pre-tested interviewer-administered structured questionnaire while blood pressure was taken with an Accoson sphygmomanometer. Anthropometry was done using standardized protocols. Urine and blood were analyzed for glucose. HTN was defined as blood pressure >140/90 or prior diagnosis or use of antihypertensives. Data was entered, stored and analyzed with Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20. Results: The crude and age-adjusted prevalence of HTN among the hospital employee was 21.3% and 23.8% respectively. Age, marital status, educational level, body mass index, waist circumference (WC) and waist hip ratio showed significant association with HTN in the univariate analysis. However, in multivariate regression analysis, only older age and abnormal WC predicted HTN. Conclusion: The prevalence of HTN among the hospital employees compared with reports in other population and was predicted by advancing age and abnormal WC. The study underscores the need for introduction of HTN screening programs among hospital employees especially staff that are older with truncal obesity. Keywords: Bayelsa, correlates, employees, hypertension, prevalence
Résumé Contexte: L'hypertension (HTN) est un problème médical commun avec l'augmentation de la prévalence et les conséquences désastreuses. Compte tenu de la proximité relative des travailleurs de l'hôpital à la prestation des soins de santé, on peut attendre un meilleur contrôle de HTN et facteurs de risque dans cette population. L'objectif de cette étude était de déterminer la prévalence de HTN et facteurs de risque chez les employés de l'hôpital dans un hôpital tertiaire nigérian . Matériaux et Méthodes: tous les employés du centre médical fédéral, Yenagoa (Etat de Bayelsa, Nigeria) ont été invités pour un HTN dépistage exercice sur la journée mondiale du rein le 14 mars 2013. Un total de 231 participants ont complété cette étude transversale. Données ont été obtenues avec un questionnaire structuré pré-testée intervieweur, tandis que la pression artérielle a été prise avec un sphygmomanomètre Accoson. L'anthropométrie a été fait à l'aide de protocoles standardisés. Sang et urine ont été analysés pour le glucose. HTN a été défini comme sang pression
Vol. 14, January-March, 2015
Annals of African Medicine
Egbi, et al.: Hypertension among hospital employees >140/90 ou diagnostic préalable ou utilisation des antihypertenseurs. Données a été entrées, stockées et analysées avec Logiciel de statistiques pour les Sciences sociales (SPSS Inc., Chicago, IL, USA) version 20. Résultats: La prévalence brute et ajusté selon l'âge du HTN chez l'hôpital employé était de 21,3 % et 23,8 % respectivement. Âge, état matrimonial, niveau d'instruction, indice de masse corporelle, tour de taille (WC) et taille hip ratio a montré l'association significative avec HTN dans l'analyse univariée. Toutefois, dans l'analyse de régression multivariée, seulement plus âgés et WC anormale prédit HTN . Conclusion: La prévalence de HTN parmi les employés de l'hôpital par rapport aux rapports dans d'autres populations et a été prédite par l'âge et WC anormale. L'étude met en évidence la nécessité d'introduire des HTN parmi les employés de l'hôpital en particulier du personnel qui sont plus âgé avec obésité abdominale, les programmes de dépistage. Page | 9
Mots-clés: Bcorrélats, employés, hypertension, ayelsa, prévalence
Introduction Hypertension (HTN) is a common medical problem of increasing magnitude and disturbing consequences. In Nigeria like in most other countries in sub‑Saharan Africa, it is considered a major contributor to morbidity and mortality.[1] The overall prevalence of HTN in Nigeria ranges from 8% to 64%[1] depending on the study target population, type of measurement and cut‑off value used for defining HTN. It has been projected that by 2025, about 75% of the world’s hypertensive population will be in developing countries. [2] Although, it is commonly asymptomatic, the damage it does to arteries and organs can lead to significant morbidity. HTN is a major risk factor for stroke, heart failure and kidney disease making it a key priority for prevention, early detection and control. Risk factors for HTN include increasing age,[3] obesity,[4] sedentary lifestyle,[5] family history of HTN,[6] diet,[7] alcohol,[8] and tobacco use.[9] Patient education by physicians and other members of the heath team about lifestyle modifications plays an important role in the control of HTN.[10] The effectiveness of patient education may be enhanced by a healthy lifestyle of the attending health care worker. For example, the predictors study [11] highlighted how physicians who drank less alcohol, smoked tobacco and engaged in healthier habits were more likely to have higher success rates in patient management. Similarly, the nurses’ body size study[12] indicated that patients showed more confidence in health education when being given by a normal weight nurse than when being delivered by an overweight nurse. Considering the health‑related knowledge at the disposal of the hospital workers and their proximity to health care delivery, the assumption will be that the control of HTN and its modifiable risk factors would be relatively high. An earlier study done among civil servants working in the Bayelsa State, South‑South Nigeria had put the prevalence of HTN at 27.8%.[13] Similarly, in Port Harcourt, a Annals of African Medicine
nearby town in Rivers State, Onwuchekwa et al. have reported prevalence of 32.0% among civil servants and 30.0% among professionals including engineers, lawyers and accountants.[14] Furthermore in Port Harcourt, Ordinioha et al. revealed prevalence of 21.3% among lecturers.[15] In Benin City, Nigeria, prevalence of 17.7% was reported among bankers.[16] However, there are only scanty reports on the prevalence of HTN among hospital workers in Nigeria. The lecturers in Ordinioha’s series were however also medical consultants in the University Teaching Hospital.[15] A few reports exist on the prevalence of HTN among hospital employees outside Nigeria. For instance, some Brazilian studies reported prevalence rates of 26%[17] and 36%[18] among physicians and female nurses respectively. Against this background, the aim of this study was to determine the prevalence of HTN and associated risk factors among hospital workers in a tertiary hospital in Bayelsa State, Nigeria.
Materials and Methods Study design The study was cross‑sectional and observational in design. It was carried out in the Federal Medical Center, Yenagoa. The hospital is the largest hospital in Bayelsa State with a total bed capacity of about 200 and an average annual in‑patient load of 10,000. It serves as a referral center to other smaller hospitals in the state as well as hospitals in neighboring states such as Delta, Rivers, Edo and Akwa‑Ibom. The hospital has a total of about 815 full time employees which includes various cadres of doctors, nurses, laboratory staff, pharmacists, technicians and administrative staff. A minimum acceptable sample size of 246 was determined using Daniel’s sample size formula with finite population correction,[19] HTN prevalence of 27.8% (from Egbi’s report),[13] with a precision of 5.0%, 95% confidence interval (CI) set at 1.96 and an allowable error of 10%. Vol. 14, January-March, 2015
Egbi, et al.: Hypertension among hospital employees
All employees of the hospital were invited for a HTN screening program through a circular sent from the office of the head of administration to the respective heads of departments several days before the event. Sensitization banners were also placed at strategic positions in the hospital. The screening exercise took place as part of the event to commemorate the world kidney day on March 14, 2013. Page | 10
Non‑probability consecutive sampling was used in recruitment of participants. Individuals
