The prevalence and socio-demographic correlates of hypertension among women (15–49 years) in Lesotho: a descriptive analysis

BMC Public Health, Volume 22, No. 1, Year 2022

Interpretation

Background: Hypertensive disorders are among the leading conditions for severe maternal morbidity across all regions and have a major impact on health care costs. This study aimed to identify the prevalence and its associated socio-demographic correlates of hypertension among women of the reproductive ages in Lesotho. Methods: The study used the Lesotho Demographic and Health Survey (2014 LDHS) data set. A total of 3353 women of childbearing age (15–49 years) whose blood pressure was measured were used for analysis. The blood pressure readings were categorized according to the JNC7 cut-offs. The dependent variable of this study is hypertension. Both bivariate and binary logistic regressions were performed to determine socio-demographic correlates of hypertension. Results: Results from this study revealed that one out of every five respondents of the study had hypertension compared to 23% who were in the prehypertension stage. The situation adds to the overall future risk of hypertension. About 30% percent who were at the hypertension stage were either living with a partner or widowed. The odds of being hypertensive were significantly 9.78 times higher among women aged 45–49 years [CI: 6.38–15.00]. Other factors associated with hypertension among women of the reproductive ages were “living with a partner” [OR 3.55:95% CI: 1.76–7.16], widowed [OR 2.61:95% CI: 1.89–3.60], and residing in the Maseru district [OR 2.12: 95% CI: 1.49–3.03]. Conclusion: Chances of being diagnosed with high blood pressure increased with an increase with the age of the respondents. Age was found to be the most definite positive significant socio-demographic correlate of hypertension among women in Lesotho. To control hypertension, primary prevention strategies should target the identified high-risk -older age groups, the ever-married as well as prehypertensive women. This is a secondary data analysis of cross-sectional data of the 2014 Lesotho Demographic and Health Survey (LDHS). These are women of childbearing age (15–49 years) who had ever given birth in the five years preceding the 2014 LDHS. The total unweighted female population in the LDHS was 6,621. In determining the variable of interest, respondents were asked whether they were ever diagnosed with high blood pressure by a doctor or a nurse [10]. Blood pressure readings were taken from 3353 who were included in the final analysis. About fifteen percent (705) respondents were ever diagnosed with high blood pressure. The individual female dataset for the 2014 LDHS was used for this study and the data were extracted and processed using Stata version 14. In this study, hypertension is the outcome variable, which was defined using the WHO classification and categorized using the JNC7 cut-offs. The categorization was done with the use of blood pressure records of women taken from the 2014 Lesotho Demographic and Health Survey [11]. This variable is derived from the survey question of “Ever been diagnosed with high blood pressure by a doctor or a nurse?”. If the response is “yes”, then the inclusion criteria which was used was for those whose hypertension levels were 140 + mmHg (systolic) or 90 + mmHg (diastolic) or above. The outcome variable was categorized as hypertension stage 1, that is, those with SBP ≥ 140 (mmHg) or DBP of ≥ 90 (mmHg), then Hypertension stage 2, as those with SBP ≥ 160 (mmHg) or DBP SBP ≥ 100 (mmHg) [12]. The independent variables of the study were socio-demographic characteristics such as age, marital status, place of residence, region/district, religion, level of education and occupation. Cross-tabulations, bivariate and logistic regression analyses were done. At the bivariate level, the percentage distribution of the study sample was presented by the selected socio-demographic characteristics of the women. The correlation was tested using the Pearson correlation coefficient. Binary logistic regression was used to determine socio-demographic correlates of hypertension among women aged 15–49 years in Lesotho. A p-value of < 0.05 was considered statistically significant. All analyses were carried out using version 14 of the STATA software. The Lesotho DHS can be downloaded from the website and is free to use by researchers for further analysis. In order to access the data from DHS MEASURE, a written request was submitted to the DHS MACRO, and permission was granted to use the data for this survey.

AI Digest

Study Justification:

– Hypertensive disorders are a leading cause of severe maternal morbidity and have a significant impact on healthcare costs.
– Understanding the prevalence and socio-demographic correlates of hypertension among women of reproductive age in Lesotho is crucial for developing effective prevention and control strategies.

Study Highlights:

– The study used data from the 2014 Lesotho Demographic and Health Survey.
– A total of 3,353 women aged 15-49 years were included in the analysis.
– The study found that one in five respondents had hypertension, and an additional 23% were in the prehypertension stage.
– Age was the most significant socio-demographic correlate of hypertension, with women aged 45-49 having significantly higher odds of being hypertensive.
– Other factors associated with hypertension included living with a partner, being widowed, and residing in the Maseru district.

Study Recommendations:

– Primary prevention strategies should target high-risk groups, including older age groups, ever-married women, and prehypertensive women.
– Healthcare providers should prioritize blood pressure screening and management for women in these high-risk groups.
– Public health interventions should focus on raising awareness about hypertension and promoting healthy lifestyle behaviors to prevent and control hypertension among women.

Key Role Players:

– Ministry of Health: Responsible for implementing and coordinating hypertension prevention and control programs.
– Healthcare Providers: Involved in screening, diagnosing, and managing hypertension among women.
– Community Health Workers: Play a crucial role in raising awareness, conducting health education, and promoting healthy behaviors.
– Non-Governmental Organizations: Can support the implementation of prevention and control programs, provide resources, and advocate for policy changes.

Cost Items for Planning Recommendations:

– Training and Capacity Building: Budget for training healthcare providers and community health workers on hypertension screening and management.
– Awareness Campaigns: Allocate funds for public health campaigns to raise awareness about hypertension and promote healthy lifestyle behaviors.
– Screening and Diagnostic Tools: Budget for blood pressure monitors and other necessary equipment for screening and diagnosing hypertension.
– Medications and Treatment: Include funds for providing antihypertensive medications and ongoing treatment for women diagnosed with hypertension.
– Monitoring and Evaluation: Allocate resources for monitoring and evaluating the effectiveness of prevention and control programs.
Please note that the cost items provided are general suggestions and may vary depending on the specific context and resources available in Lesotho.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used a large sample size (3353 women) and analyzed data from the 2014 Lesotho Demographic and Health Survey. The study employed both bivariate and binary logistic regressions to determine socio-demographic correlates of hypertension. The results showed a significant association between age, marital status, and place of residence with hypertension among women in Lesotho. However, the study is limited to cross-sectional data, which may not establish causality. To improve the strength of the evidence, future research could consider longitudinal studies to establish temporal relationships and explore potential confounding factors. Additionally, conducting further analyses to assess the validity and reliability of the hypertension measurements would enhance the robustness of the findings.

Abstract

This is a secondary data analysis of cross-sectional data of the 2014 Lesotho Demographic and Health Survey (LDHS). These are women of childbearing age (15–49 years) who had ever given birth in the five years preceding the 2014 LDHS. The total unweighted female population in the LDHS was 6,621. In determining the variable of interest, respondents were asked whether they were ever diagnosed with high blood pressure by a doctor or a nurse [10]. Blood pressure readings were taken from 3353 who were included in the final analysis. About fifteen percent (705) respondents were ever diagnosed with high blood pressure. The individual female dataset for the 2014 LDHS was used for this study and the data were extracted and processed using Stata version 14. In this study, hypertension is the outcome variable, which was defined using the WHO classification and categorized using the JNC7 cut-offs. The categorization was done with the use of blood pressure records of women taken from the 2014 Lesotho Demographic and Health Survey [11]. This variable is derived from the survey question of “Ever been diagnosed with high blood pressure by a doctor or a nurse?”. If the response is “yes”, then the inclusion criteria which was used was for those whose hypertension levels were 140 + mmHg (systolic) or 90 + mmHg (diastolic) or above. The outcome variable was categorized as hypertension stage 1, that is, those with SBP ≥ 140 (mmHg) or DBP of ≥ 90 (mmHg), then Hypertension stage 2, as those with SBP ≥ 160 (mmHg) or DBP SBP ≥ 100 (mmHg) [12]. The independent variables of the study were socio-demographic characteristics such as age, marital status, place of residence, region/district, religion, level of education and occupation. Cross-tabulations, bivariate and logistic regression analyses were done. At the bivariate level, the percentage distribution of the study sample was presented by the selected socio-demographic characteristics of the women. The correlation was tested using the Pearson correlation coefficient. Binary logistic regression was used to determine socio-demographic correlates of hypertension among women aged 15–49 years in Lesotho. A p-value of < 0.05 was considered statistically significant. All analyses were carried out using version 14 of the STATA software. The Lesotho DHS can be downloaded from the website and is free to use by researchers for further analysis. In order to access the data from DHS MEASURE, a written request was submitted to the DHS MACRO, and permission was granted to use the data for this survey.

Materials

N/A

Innovations

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

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and resources on maternal health, including hypertension management. These apps can offer educational materials, appointment reminders, and access to healthcare professionals through telemedicine.

2. Community Health Workers: Train and deploy community health workers to provide education and support to pregnant women and new mothers, including information on hypertension prevention and management. These workers can conduct home visits, organize support groups, and refer women to healthcare facilities when necessary.

3. Telemedicine Services: Establish telemedicine services that allow pregnant women and new mothers to consult with healthcare professionals remotely. This can help overcome geographical barriers and improve access to timely and quality care, especially for women living in rural areas.

4. Maternal Health Clinics: Set up specialized maternal health clinics that focus on hypertension prevention, screening, and management. These clinics can provide comprehensive care, including regular blood pressure monitoring, medication management, and lifestyle counseling.

5. Health Education Campaigns: Launch targeted health education campaigns to raise awareness about the importance of maternal health and the risks associated with hypertension. These campaigns can use various channels, such as radio, television, and community events, to reach a wide audience and promote behavior change.

6. Integration of Services: Integrate maternal health services with existing healthcare facilities, such as primary care clinics and antenatal care centers. This can ensure that women receive comprehensive care that includes hypertension screening and management alongside other essential maternal health services.

7. Task Shifting: Train and empower non-specialist healthcare providers, such as nurses and midwives, to screen for and manage hypertension in pregnant women. This can help alleviate the burden on specialized healthcare professionals and improve access to timely care.

8. Public-Private Partnerships: Foster collaborations between the public and private sectors to improve access to maternal health services. This can involve leveraging private healthcare providers and facilities to expand service coverage and reduce wait times.

It is important to note that the implementation of these innovations should be tailored to the specific context and needs of Lesotho, taking into account factors such as resource availability, infrastructure, and cultural considerations.

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:

Develop a targeted intervention program to address hypertension among women of reproductive age in Lesotho. This program should focus on primary prevention strategies and target high-risk groups, such as older age groups, ever-married women, and prehypertensive women. The program should include regular blood pressure screenings, education on healthy lifestyle choices, and access to affordable and effective hypertension treatment options. Additionally, partnerships can be formed with healthcare providers and community organizations to ensure widespread access to these interventions. By addressing hypertension among women of reproductive age, this innovation can help reduce the prevalence of maternal morbidity and improve overall maternal health outcomes in Lesotho.

AI Innovations Methodology

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

1. Strengthening Primary Healthcare: Enhance the capacity of primary healthcare facilities to provide comprehensive maternal health services, including prenatal care, skilled birth attendance, and postnatal care. This can be achieved by training healthcare providers, ensuring the availability of essential equipment and supplies, and improving infrastructure.

2. Community-Based Interventions: Implement community-based interventions to raise awareness about maternal health and promote early detection and management of hypertension. This can involve community health workers conducting home visits, organizing health education sessions, and facilitating access to healthcare services.

3. Telemedicine and Mobile Health: Utilize telemedicine and mobile health technologies to provide remote consultations, monitoring, and support for pregnant women with hypertension. This can help overcome geographical barriers and improve access to specialized care, especially in rural areas.

4. Task Shifting and Training: Expand the role of midwives and other healthcare professionals in managing hypertension during pregnancy. This can be achieved through task shifting, where certain responsibilities are delegated to lower-level healthcare providers after appropriate training and supervision.

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

1. Data Collection: Collect baseline data on key indicators related to maternal health access, such as the number of women receiving prenatal care, skilled birth attendance, and postnatal care, as well as the prevalence of hypertension among pregnant women.

2. Intervention Design: Develop a simulation model that incorporates the potential recommendations mentioned above. This model should consider factors such as population size, geographical distribution, healthcare infrastructure, and resource availability.

3. Parameter Estimation: Estimate the parameters required for the simulation model, such as the effectiveness of each recommendation in improving access to maternal health, based on available evidence from similar interventions or expert opinions.

4. Simulation Execution: Run the simulation model using the estimated parameters to project the potential impact of the recommendations on maternal health access. This can include estimating the increase in the number of women receiving prenatal care, skilled birth attendance, and postnatal care, as well as the reduction in the prevalence of hypertension among pregnant women.

5. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the simulation results by varying key parameters within plausible ranges. This can help identify the most influential factors and potential uncertainties in the simulation model.

6. Interpretation and Reporting: Analyze the simulation results and interpret the findings in terms of the potential impact on improving access to maternal health. Present the results in a clear and concise manner, highlighting the key findings and implications for policy and practice.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data in Lesotho. Additionally, involving relevant stakeholders, such as policymakers, healthcare providers, and community members, in the simulation process can help ensure the relevance and feasibility of the recommendations.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1186/s12889-022-12960-0

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Sexual and Reproductive Health, Social Determinants

Study Countries:

Lesotho

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female