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Background: Hypertension is one of the leading causes of cardiovascular morbidities in Ghana and represents a major public health concern. There is dearth of information on the rural-urban disparity in hypertension among women in Ghana. Therefore, this study aimed at examining the rural-urban variation in hypertension among women in Ghana. Methods: We extracted data from the women’s file of the 2014 Ghana Demographic and Health Survey. The sample included 9333 women aged 15–49 with complete data on hypertension. The analysis was done using Pearson Chi-square and binary logistic regression at 95% confidence interval. The results of the binary logistic regression were presented as Odds Ratios (ORs) and Adjusted Odds Ratios (AORs). Statistical significance was set at p < 0.05. Results: Hypertension prevalence among urban and rural residents were 9.5% and 5.1% respectively. Rural women had lower odds of hypertension [OR = 0.59; 95% CI = 0.52, 0.67] compared to urban women, however, this was insignificant in the adjusted model [aOR = 0.84; 95% CI = 0.70, 1.00]. The propensity to be hypertensive was lower for women aged 15–19 [aOR = 0.07; 95% CI = 0.05, 0.11]. The poorest were less likely to be hypertensive [aOR = 0.63; 95% CI = 0.45, 0.89]. Single women were also less probable to have hypertension [aOR = 0.66; 95% CI = 0.46, 0.97]. Conclusions: Women from urban and rural areas shed similar chance to be hypertensive in Ghana. Therefore, the health sector needs to target women from both areas of residence (rural/urban) when designing their programmes that are intended to modify women’s lifestyle in order to reduce their risks of hypertension. Other categories of women that need to be prioritised to avert hypertension are those who are heading towards the end of their reproductive age, richest women and the divorced.
In this study, we used data from the 2014 GDHS. Since the inception of the GDHS, it is only the 2014 edition that assessed hypertension status of Ghanaian women. The GDHS is a five-year interval nationally representative survey mostly carried out by the Demographic and Health Surveys (DHS) Program, Ghana Statistical Service and Ghana Health Service [25]. The survey seeks to collect, analyse, and circulate representative and reliable data on core health indicators in over 90 countries including Ghana. These core healthcare indicators comprise adult health and lifestyle including hypertensive status, nutrition as well as maternal and child health. In 2014, the survey recruited 9396 women within the 15–49 age group. The survey made use of an updated frame prepared for the 2010 Population and Housing Census (PHC) and had a response rate of 97%. We included 9333 women in the present study because this sample had complete information for the analysis. The sample was derived through a two-stage sampling approach aimed at permitting estimation of core indicators throughout the then 10 administrative regions. The first stage involved the selection of sample points or clusters made up of enumeration areas (EAs) whereas the second stage constituted a sampling of households following systematic sampling. Between January and March 2014, household listing was conducted for this purpose. Approximately 30 households were identified per cluster. This resulted in 427 clusters (with 216 from urban and 211 from rural settings) and 12,831 households throughout the country [25]. The sample excluded institutional and nomadic persons such as those in hotels and prisons. The data was deemed suitable for the study because it is nationally representative and the first of its kind to investigate the hypertensive status of women in their reproductive age at the national level. We had access to the dataset from the website of Measure DHS and is freely available through https://dhsprogram.com/data/available-datasets.cfm. Hypertensive status (measured by blood pressure) of Ghanaian women aged 15–49 was the dependent variable for the study. During the 2014 DHS, blood pressure was monitored and measured on three occasions following the UA-767F/FAC (A&D Medical) blood pressure with at least 10 min interval [25]. In determining hypertensive status, an average of the second and third measurements were computed, and this conforms to calibration by other studies on hypertension that are underpinned by the DHS datasets [16, 26, 27]. Following the Joint National Committee Seven (JNC7) guideline, hypertension was conceptualised as an average systolic blood pressure of ≥140 mmHg and/or an average diastolic blood pressure of ≥90 mmHg. Hypertensive women were coded as 1 whilst non-hypertensive women were coded otherwise ‘0’. The main explanatory variable was place of residence (rural or urban), in line with the categorisation of the DHS survey. The choice of this explanatory variable emerged from its statistically significant association with hypertension with dominance among the urban population [18, 28, 29] whilst some evidence also documents high inclination toward rural residents [9]. There was, therefore, the need to interrogate and identify the situation in Ghana. We included some socio-demographic characteristics of the women; age, wealth quintile, marital status, occupation, salted fish consumption, region and tobacco use (comprising cigarette, tobacco, and snuff). We included salted fish consumption because some evidence indicates an association between hypertension and salt intake [30, 31]. Behavioural factors such tobacco use and some related lifestyles have been documented as precursors to hypertension [32–34]. The following variables were recoded to suit the analysis; marital status was recoded as “single = 0”, “married = 1”, “cohabiting = 2”, “widowed = 3”, “divorced = 4” and “separated=5; occupation recoded into “not working=0” “agriculture = 1″ “manual = 2″ and “service = 1″; salted fish consumption into “No = 0″ and “Yes = 1.” In our analysis, we calculated the proportion of women with hypertension by place of residence (rural or urban) as shown in Fig. 1. We also computed the proportion of hypertension by the socio-demographic variables as shown in Table 1, and also explored which of them had a significant association with hypertension. Out of the ten variables tested (see Table Table1),1), six were significant and were used in our inferential analysis (residence, age, wealth, marital status, occupation, and region). To ensure that there is no multicollinearity between the explanatory variables, tests for multicollinearity was conducted and it was revealed that the socio-demographic variables are not highly correlated [mean VIF = 1.42, maximum = 2.31, minimum = 1.02]. Due to the dichotomous nature of our dependent variable, binary logistic regression analysis was conducted where odds ratios (ORs) and adjusted odds ratios (aORs) with their respective 95% confidence intervals (95% CI) were reported (Table 2). Model 1 focused on the bivariate analysis between residence and hypertension whilst Model 2 presents a multivariable model adjusting for the effect of the significant socio-demographic variables. The results were weighted in order to achieve proportionality at the national level and the entire analysis was conducted using Stata version 13. Rural/urban distribution of hypertension among women Socio-demographic characteristics and hypertension among Ghanaian women (n = 9333) Source: 2014 GDHS Binary logistic regression results on residential status and hypertension in Ghana Exponentiated coefficients; 95% confidence intervals in brackets, OR = Odd Ratio, aOR = Adjusted Odds Ratio, * p < 0.05, ** p < 0.01, *** p < 0.001, 1 = Reference categorys Source: 2014 GDHS DHS reports that informed consent was sought from all the women prior to their participation in the survey. The DHS sought ethical approval from the Ethics Committee of ORC Macro Inc. and that of Ghana Health Service. Authors of this manuscript were not directly involved in the data collection processes but rather obtained access by applying to the DHS (via https://dhsprogram.com/data/available-datasets.cfm) in order to obtain access.
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