Prevalence and Associated Factors of Hypertension among Women in Southern Ghana: Evidence from 2014 GDHS

International Journal of Hypertension, Volume 2022, Year 2022

Interprétation

Background. Hypertension, coupled with prehypertension and other hazards such as high blood pressure, is responsible for 8·5 million deaths from stroke, ischaemic heart disease, other vascular diseases, and renal disease worldwide. Hypertension is the fifth commonest cause of outpatient morbidity in Ghana. Some evidence have illustrated geographical variation in hypertension and it seems to have a heavy toll on women in southern Ghana compared to the north. This study seeks to determine the prevalence and associatedfactors of hypertension among women in southern Ghana using the most recent demographic and health survey (DHS) data set. Materials and Methods. This study used data of 5,662 women from the current DHS data from Ghana that was conducted in 2014. Data were extracted from the women’s file of the 2014 Ghana DHS. The outcome variable of this current study was hypertension and it was measured by blood pressure, according to guidelines of the Joint National Committee Seven (JNC7). Multivariable binary logistic regression analyses were performed to establish the factors associated with hypertension at the individual and community levels. Results. Prevalence of hypertension among women in southern Ghana was 16%. Women aged 40-44 years (aOR = 8.04, CI = 4.88-13.25) and 45-49 years (aOR = 13.20, CI = 7.96-21.89] had the highest odds of hypertension relative to women aged 15-19 years. Women with two births (aOR = 1.45, CI = 1.01-2.07) and those with three births (aOR = 1.47, CI = 1.01-2.15) had a higher likelihood of being hypertensive. Greater Accra women had higher odds (aOR = 1.35, CI = 1.02-1.79) of being hypertensive relative to the reference category, women from the Western region. Women of Guan ethnicity had a lesser likelihood (aOR = 0.54, CI = 0.29-0.98) of being hypertensive. Women who engaged in agriculture had the least likelihood (aOR = 0.72, CI = 0.52-0.99) of being classified hypertensive compared to unemployed women. Conclusion. This study has revealed the prevalence of hypertension among women in southern Ghana. The associated factors include age, parity, region, and occupation. As a result, existing interventions need to be appraised in the light of these factors. Of essence is the need for Ghana Health Service to implement wide-embracing health promotion initiatives that accommodate the nutritional, exercise, and lifestyle needs of women in southern Ghana. Having more children is associated with higher propensity of hypertension and consequently, women need to limit childbearing to reduce their chances of being hypertensive. It will also be advisable for women in the Greater Accra region to have frequent hypertension screening, as women in the region exhibited higher hypertension prospects. The study was implemented in southern Ghana. Our study was based on 2014 Ghana Demographic and Health Survey (GDHS); and it is worth noting that prior to 2018 Ghana had ten administrative regions [9]. As stated by the Ghana Statistical Service, six out of the ten regions constitute southern Ghana and these are Western, Central, Greater Accra, Ashanti, Eastern, and Volta region as illustrated in green in Figure 1. One key distinction between southern and northern Ghana manifest in skeweness in development towards the south [10]. Southern Ghana. This study used current DHS data of Ghana which was conducted in 2014 [11]. Specifically, data was pulled from the women’s files of the DHS data set. DHS are national surveys in respective countries carried out approximately every five years in over 90 low- and middle-income countries in the world [12]. DHS concentrates on maternal and child health issues, including physical activity, non-communicable diseases, sexually transmitted infections, fertility, tobacco use, health insurance, and alcohol consumption. The survey categorically provides data to monitor the demographic and health profiles of included countries [12]. The sample for the present study consisted of women whose blood pressure were taken (aged 15–49 years) and had complete cases on all variables of interest (N = 5, 662). The DHS program permitted us access to the dataset after the evaluation of our concept note. The datasetis freely available and accessible to the public at https://www.measuredhs.com/. The outcome variable of this study was hypertension, measured by blood pressure. For 2014 DHS, blood pressure was monitored and measured thrice and these followed the UA-767F/FAC (A & D Medical) blood pressure computation with a minimum of 10 minutes interval [10]. Hypertension status was determined by computing the average of the second and third measurements. It was in line with the calibration by similar empirical studies on hypertension that relied on DHS datasets [13]. Guided by the guidelines of the Joint National Committee Seven (JNC7), hypertension was computed as the average systolic blood pressure of ≥140 mmHg and/or an average diastolic blood pressure of ≥90 mmHg. Consequently, a hypertensive woman was identified as 1, and non-hypertensive women were identified otherwise “0.” Eleven explanatory variables were examined in the study. The selection of these variables was based on conceptual relevance and their significant association with the outcome variable based on findings from previous studies [14–17]. A number of studies have followed this approach [18, 19]. All variables were grouped into personal and community level variables based on the orderly nature of the dataset. The variables were determined based on their availability in the dataset, practical significance, and theoretical relevance for hypertension. The individual level explanatory variables were wealth status, age, marital status, education, parity, occupation, and the consumption of salted fish in the last 24 hours. Age was recorded as 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, and 45–49 years. Wealth status was categorized into poorest, poorer, middle, richer, and richest. Education was classified into four categories: no education, primary education, secondary education, and higher education. Occupation was identified unemployed, professional/clerical, sales/services, agricultural worker, and manual worker. Consumption of salted fish in the last 24 hours was coded as Yes and No. Four variables were selected at the community level. These are region, place of residence, ethnicity, and religion. The region was coded as Eastern, Western, Greater Accra, Central Volta, and Ashanti, since the study was limited to the Southern part of Ghana. Ethnicity was coded Ga/Dangme, Akan, Ewe, Guan, Mole-Dagbani, Gurma, Grusi, Mande, and others. Religion was identified as Islam, Christianity, and others. Place of residence was identified as urban and rural. Data were extracted, cleaned, and analyzed using Stata software version 13.0. Percentage was used to summarize the prevalence of hypertension among respondents. Cross-tabulation was adopted to examine the distribution of hypertension across explanatory variables. Results of cross-tabulation were displayed using percentages with their corresponding confidence intervals. Subsequently, multivariable binary logistic regression analysis was used to determine the factors related with hypertension. Three (3) models were built to examine the factors associated with hypertension. The first model (Model I) consisted of only individual-level variables. Model II was built to contain community-level variables, whilst in Model III, all explanatory variables were combined to examine their association with hypertension. Results of the study were presented using adjusted odds ratio (aOR) with their respective 95% confidence intervals. The women’s sample weights (v005/1,000,000) were utilized to achieve unbiased estimates, and the Stata survey command “svy” was used to correct for the data’s complex sampling structure in the chi-square test and regression analyses, as recommended by DHS. We evaluated the fitness of all models with Akaike’s information criterion (AIC) and Bayesian information criterion (BIC). The presence of multicollinearity between independent variables was checked before fitting these models. The variance inflation factor (VIF) test revealed the absence of high multicollinearity between variables (Mean VIF = 3.01). This study included participation of human subjects; however, the authors of this manuscript were not directly involved in data collection processes. According to the final report of 2014 GDHS, the survey protocol, including biomarker collection, was reviewed and approved by the Ghana Health Service’ Ethical Review Committee and the Institutional Review Board of ICF International [10]. For every research participant, either written or verbal consent was obtained.

Résumé de l’IA

Study Justification:

– Hypertension is a major global health issue, responsible for millions of deaths worldwide.
– The prevalence and factors associated with hypertension among women in southern Ghana are not well understood.
– This study aims to fill this knowledge gap and provide valuable insights for public health interventions.

Highlights:

– Prevalence of hypertension among women in southern Ghana was found to be 16%.
– Factors associated with hypertension include age, parity, region, and occupation.
– Women aged 40-44 and 45-49 had the highest odds of hypertension.
– Women with two or three births had a higher likelihood of being hypertensive.
– Greater Accra women had higher odds of hypertension compared to women from the Western region.
– Women of Guan ethnicity had a lesser likelihood of being hypertensive.
– Women engaged in agriculture had the least likelihood of being hypertensive compared to unemployed women.

Recommendations:

– Implement wide-embracing health promotion initiatives that accommodate the nutritional, exercise, and lifestyle needs of women in southern Ghana.
– Encourage women to limit childbearing to reduce their chances of developing hypertension.
– Advise women in the Greater Accra region to have frequent hypertension screening.

Key Role Players:

– Ghana Health Service: Responsible for implementing health promotion initiatives and hypertension screening programs.
– Ministry of Health: Provides policy guidance and support for public health interventions.
– Community Health Workers: Involved in delivering health promotion messages and conducting hypertension screenings.
– Non-Governmental Organizations: Collaborate with government agencies to implement health programs and raise awareness.

Cost Items for Planning Recommendations:

– Health promotion materials: Printing and distribution of educational materials on nutrition, exercise, and lifestyle.
– Training and capacity building: Workshops and training programs for healthcare providers and community health workers.
– Screening equipment: Purchase and maintenance of blood pressure monitoring devices.
– Outreach programs: Costs associated with organizing and conducting community outreach programs.
– Monitoring and evaluation: Budget for monitoring and evaluating the effectiveness of interventions.
Please note that the cost items provided are general categories and the actual costs would depend on the specific context and scale of the interventions.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides specific details about the study design, data source, and statistical analysis. However, it lacks information on sample size calculation and potential limitations of the study. To improve the evidence, the authors could include a discussion on the representativeness of the sample and potential biases in the data collection process. Additionally, they could provide information on the statistical power of the study and any potential confounding factors that were controlled for in the analysis.

Abstrait

The study was implemented in southern Ghana. Our study was based on 2014 Ghana Demographic and Health Survey (GDHS); and it is worth noting that prior to 2018 Ghana had ten administrative regions [9]. As stated by the Ghana Statistical Service, six out of the ten regions constitute southern Ghana and these are Western, Central, Greater Accra, Ashanti, Eastern, and Volta region as illustrated in green in Figure 1. One key distinction between southern and northern Ghana manifest in skeweness in development towards the south [10]. Southern Ghana. This study used current DHS data of Ghana which was conducted in 2014 [11]. Specifically, data was pulled from the women’s files of the DHS data set. DHS are national surveys in respective countries carried out approximately every five years in over 90 low- and middle-income countries in the world [12]. DHS concentrates on maternal and child health issues, including physical activity, non-communicable diseases, sexually transmitted infections, fertility, tobacco use, health insurance, and alcohol consumption. The survey categorically provides data to monitor the demographic and health profiles of included countries [12]. The sample for the present study consisted of women whose blood pressure were taken (aged 15–49 years) and had complete cases on all variables of interest (N = 5, 662). The DHS program permitted us access to the dataset after the evaluation of our concept note. The datasetis freely available and accessible to the public at https://www.measuredhs.com/. The outcome variable of this study was hypertension, measured by blood pressure. For 2014 DHS, blood pressure was monitored and measured thrice and these followed the UA-767F/FAC (A & D Medical) blood pressure computation with a minimum of 10 minutes interval [10]. Hypertension status was determined by computing the average of the second and third measurements. It was in line with the calibration by similar empirical studies on hypertension that relied on DHS datasets [13]. Guided by the guidelines of the Joint National Committee Seven (JNC7), hypertension was computed as the average systolic blood pressure of ≥140 mmHg and/or an average diastolic blood pressure of ≥90 mmHg. Consequently, a hypertensive woman was identified as 1, and non-hypertensive women were identified otherwise “0.” Eleven explanatory variables were examined in the study. The selection of these variables was based on conceptual relevance and their significant association with the outcome variable based on findings from previous studies [14–17]. A number of studies have followed this approach [18, 19]. All variables were grouped into personal and community level variables based on the orderly nature of the dataset. The variables were determined based on their availability in the dataset, practical significance, and theoretical relevance for hypertension. The individual level explanatory variables were wealth status, age, marital status, education, parity, occupation, and the consumption of salted fish in the last 24 hours. Age was recorded as 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, and 45–49 years. Wealth status was categorized into poorest, poorer, middle, richer, and richest. Education was classified into four categories: no education, primary education, secondary education, and higher education. Occupation was identified unemployed, professional/clerical, sales/services, agricultural worker, and manual worker. Consumption of salted fish in the last 24 hours was coded as Yes and No. Four variables were selected at the community level. These are region, place of residence, ethnicity, and religion. The region was coded as Eastern, Western, Greater Accra, Central Volta, and Ashanti, since the study was limited to the Southern part of Ghana. Ethnicity was coded Ga/Dangme, Akan, Ewe, Guan, Mole-Dagbani, Gurma, Grusi, Mande, and others. Religion was identified as Islam, Christianity, and others. Place of residence was identified as urban and rural. Data were extracted, cleaned, and analyzed using Stata software version 13.0. Percentage was used to summarize the prevalence of hypertension among respondents. Cross-tabulation was adopted to examine the distribution of hypertension across explanatory variables. Results of cross-tabulation were displayed using percentages with their corresponding confidence intervals. Subsequently, multivariable binary logistic regression analysis was used to determine the factors related with hypertension. Three (3) models were built to examine the factors associated with hypertension. The first model (Model I) consisted of only individual-level variables. Model II was built to contain community-level variables, whilst in Model III, all explanatory variables were combined to examine their association with hypertension. Results of the study were presented using adjusted odds ratio (aOR) with their respective 95% confidence intervals. The women’s sample weights (v005/1,000,000) were utilized to achieve unbiased estimates, and the Stata survey command “svy” was used to correct for the data’s complex sampling structure in the chi-square test and regression analyses, as recommended by DHS. We evaluated the fitness of all models with Akaike’s information criterion (AIC) and Bayesian information criterion (BIC). The presence of multicollinearity between independent variables was checked before fitting these models. The variance inflation factor (VIF) test revealed the absence of high multicollinearity between variables (Mean VIF = 3.01). This study included participation of human subjects; however, the authors of this manuscript were not directly involved in data collection processes. According to the final report of 2014 GDHS, the survey protocol, including biomarker collection, was reviewed and approved by the Ghana Health Service’ Ethical Review Committee and the Institutional Review Board of ICF International [10]. For every research participant, either written or verbal consent was obtained.

Matériaux

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health in southern Ghana:

1. Mobile Health (mHealth) Solutions: Develop mobile applications or SMS-based platforms that provide pregnant women with information on prenatal care, nutrition, and hypertension management. These platforms can also send reminders for antenatal visits and medication adherence.

2. Telemedicine Services: Implement telemedicine services that allow pregnant women in remote areas to consult with healthcare professionals through video calls or phone consultations. This can help overcome geographical barriers and provide timely advice and support.

3. Community Health Workers: Train and deploy community health workers to provide education and support to pregnant women in their communities. These workers can conduct regular check-ups, monitor blood pressure, and provide guidance on healthy lifestyles and pregnancy care.

4. Maternal Health Clinics: Establish specialized maternal health clinics in areas with high prevalence of hypertension among women. These clinics can offer comprehensive prenatal care, including regular blood pressure monitoring, early detection of complications, and appropriate management.

5. Health Promotion Campaigns: Launch targeted health promotion campaigns to raise awareness about the risks of hypertension during pregnancy and the importance of regular check-ups. These campaigns can use various media channels, community events, and educational materials to reach a wide audience.

6. Collaborative Partnerships: Foster collaborations between healthcare providers, government agencies, non-profit organizations, and community leaders to improve access to maternal health services. This can involve sharing resources, coordinating efforts, and implementing joint initiatives to address the specific needs of pregnant women in southern Ghana.

It is important to note that these recommendations are based on the information provided and may need to be further evaluated and adapted to the specific context and resources available in southern Ghana.

AI Innovations Description

Based on the information provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Implement targeted health promotion initiatives: Based on the study’s findings, it is recommended to implement wide-embracing health promotion initiatives that accommodate the nutritional, exercise, and lifestyle needs of women in southern Ghana. These initiatives should focus on raising awareness about hypertension, its risk factors, and prevention strategies among women in the region.

2. Provide regular hypertension screening: Women in the Greater Accra region exhibited higher prospects of hypertension. Therefore, it is advisable to establish regular hypertension screening programs specifically targeting women in this region. These screenings can be conducted at healthcare facilities, community centers, or through mobile clinics to ensure accessibility for all women.

3. Encourage family planning and limit childbearing: The study found that having more children is associated with a higher propensity for hypertension. To reduce the chances of women being hypertensive, it is important to promote family planning services and educate women about the benefits of limiting childbearing. This can be done through community outreach programs, educational campaigns, and the integration of family planning services into existing maternal health programs.

4. Strengthen healthcare infrastructure and services: To improve access to maternal health, it is crucial to strengthen healthcare infrastructure and services in southern Ghana. This includes ensuring the availability of well-equipped healthcare facilities, trained healthcare professionals, and essential maternal health services such as antenatal care, skilled birth attendance, and postnatal care. Investments should be made to improve the quality and accessibility of healthcare services in the region.

5. Collaborate with community leaders and stakeholders: Engaging community leaders, stakeholders, and local organizations is essential for the success of any innovation aimed at improving access to maternal health. Collaborative efforts can help raise awareness, mobilize resources, and ensure the sustainability of initiatives. Partnerships with community leaders, women’s groups, NGOs, and government agencies should be established to support and implement the recommended interventions.

By implementing these recommendations, it is expected that access to maternal health will be improved, leading to better health outcomes for women in southern Ghana.

AI Innovations Methodology

To improve access to maternal health in southern Ghana, here are some potential recommendations:

1. Increase awareness and education: Implement health promotion initiatives that focus on educating women about the importance of maternal health, including the risks of hypertension. This can be done through community outreach programs, workshops, and media campaigns.

2. Improve healthcare infrastructure: Invest in improving healthcare facilities in southern Ghana, particularly in rural areas where access to maternal health services may be limited. This includes ensuring the availability of skilled healthcare professionals, necessary medical equipment, and adequate facilities for prenatal and postnatal care.

3. Strengthen community-based healthcare: Establish and support community-based healthcare programs that provide maternal health services closer to where women live. This can include training community health workers to provide basic prenatal care, health education, and referrals to higher-level healthcare facilities when needed.

4. Enhance transportation services: Address transportation challenges by improving access to reliable and affordable transportation options for pregnant women, especially in remote areas. This can involve partnering with local transportation providers or implementing transportation subsidies for pregnant women.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations, such as the number of women receiving prenatal care, the percentage of women with controlled blood pressure, or the reduction in maternal mortality rates.

2. Collect baseline data: Gather data on the current state of maternal health in southern Ghana, including the prevalence of hypertension among women, the availability of healthcare facilities, and the utilization of maternal health services.

3. Develop a simulation model: Create a simulation model that incorporates the recommendations and their potential impact on the defined indicators. This model should consider factors such as population demographics, healthcare infrastructure, and the effectiveness of the interventions.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to assess the potential impact of the recommendations. This can involve adjusting variables such as the coverage of health promotion initiatives, the number of healthcare facilities, or the accessibility of transportation services.

5. Analyze results: Analyze the simulation results to determine the projected impact of the recommendations on improving access to maternal health. This can include quantifying changes in the defined indicators and assessing the cost-effectiveness of the interventions.

6. Refine and validate the model: Continuously refine and validate the simulation model by incorporating new data and feedback from stakeholders. This ensures that the model accurately represents the complex dynamics of maternal health in southern Ghana.

By using this methodology, policymakers and healthcare providers can gain insights into the potential impact of different recommendations and make informed decisions on how to improve access to maternal health in southern Ghana.

Auteur

Dima Health

Identifiers:

DOI: 10.1155/2022/9700160

ISSN: 20900384

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Social Determinants, Substance Abuse

Study Countries:

Ghana

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory, Phenomenological Study

Study Approach:

Quantitative

Participants Gender:

Female

Partagez ceci :