|Year : 2013 | Volume
| Issue : 1 | Page : 1-4
The prevalence of hypertension and its modifiable risk factors among lecturers of a medical school in Port Harcourt, south-south Nigeria: Implications for control effort
Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
|Date of Acceptance||06-Oct-2011|
|Date of Web Publication||2-Feb-2013|
Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt
| Abstract|| |
Background: Hypertension and other noncommunicable diseases are currently responsible for at least 20% of all deaths in Nigeria, and constitute up to 60% of the patients admitted into the medical wards of most tertiary hospitals in Nigeria. Yet, the treatment outcomes for the diseases have remained very poor, prompting calls for better patient education. It has however been established that the effectiveness of patient education is linked to the healthy habits of the doctor. This study was conducted to find out the prevalence of hypertension and its modifiable risk factors among the lecturers of the University of Port Harcourt Medical School.
Materials and Methods: A descriptive cross-sectional study design was used, with the data collected using a modified form of the WHO STEPS instrument that consists of a questionnaire component and the measurement of body mass index (BMI) and blood pressure. The questionnaire was used to collect information on the sociodemographic characteristics of the respondents, the use of tobacco, the consumption of alcohol, the type of diet, and the amount and types of physical activities undertaken.
Results : A total of 75 lecturers participated fully in the study, out of an eligible total of 109. They were mostly males (65.33%), married (88.33%), and had an average age of 46.06 ± 9.62 years. The prevalence of hypertension was 21.33%; out of which 12 (75.00%) were already aware of their status, and were on appropriate therapy. Only 13 (17.33%) of the lecturers were of normal weight, 45 (60.00%) were overweight, while 17 (22.67%) were obese. Only 2 (2.67%) currently smoke, while most (94.67%) drank less than three standard units of alcohol in a day, mainly in social occasions.
Conclusion: The prevalence of hypertension among the lecturers in the medical school was lower than that in the general population, mainly due to their better health-seeking behavior and healthy lifestyle.
Keywords: Epidemiological transition, hypertension, medical lecturers, modifiable risk factors, Nigeria, Port Harcourt
|How to cite this article:|
Ordinioha B. The prevalence of hypertension and its modifiable risk factors among lecturers of a medical school in Port Harcourt, south-south Nigeria: Implications for control effort. Niger J Clin Pract 2013;16:1-4
|How to cite this URL:|
Ordinioha B. The prevalence of hypertension and its modifiable risk factors among lecturers of a medical school in Port Harcourt, south-south Nigeria: Implications for control effort. Niger J Clin Pract [serial online] 2013 [cited 2013 Dec 13];16:1-4. Available from: http://www.njcponline.com/text.asp?2013/16/1/1/106704
| Introduction|| |
More than 30 years ago, Omran had in a series of articles proposed the epidemiological transition theory.  In this theory, he predicted the displacement of infectious diseases by noncommunicable diseases, as major causes of morbidity and mortality, as a community or country develops. This theory has since been confirmed in most countries of the world, including Nigeria. ,,,,, Several community surveys indicate that the prevalence of hypertension in Nigeria has increased from 11.2% in the 1990s  to 27.9% in 2010 in a rural community in the Niger delta,  and 22.6% in 2009 among a suburban Christian community in south-west Nigeria.  Noncommunicable diseases are also currently responsible for at least 20% of all deaths in Nigeria,  and constitute up to 60% of the patients admitted into the medical wards of most tertiary hospitals in Nigeria. 
In spite of these increases, the treatment outcomes for the noncommunicable diseases, in even the best tertiary hospitals in Nigeria, have remained very poor. For instance, good hypertension control could only be achieved for just 24.2% of the patients seen in a clinic in Port Harcourt;  as much as 25.3% of all patients admitted into the medical ward of a hospital in Kano die,  while up to 45% of patients admitted for hypertension-related illness in Enugu are likely to die.  These gloomy statistics call for urgent action, especially as the WHO has projected a further 24% increase in the prevalence of noncommunicable diseases in Nigeria, in the next 10 years. 
The poor treatment outcome for noncommunicable diseases is however recognized globally, and has prompted the WHO to propose a paradigm shift in health care delivery, in favor of preventive and more proactive healthcare, through its innovative care for chronic condition (ICCC) framework.  This framework called for the education of patients and other members of the community, especially as the risk factors of the noncommunicable diseases are often lifestyle related.
Patient education by physicians and other members of the health team form an important part of this WHO recommendation. For example, the brief advice and counseling delivered by a physician or nurse practitioner, as part of routine primary care, can significantly reduce the amount of alcohol consumed by high-risk drinkers,  while a study in Lagos was able to achieve a 64% increase in hypertension control through the counseling of market women. 
The effectiveness of patient education efforts can however be adversely affected by the lifestyle of the attending physician. ,, Studies in the United States indicate that doctors who have healthy personal habits are more likely to discuss related preventive health behaviors with their patients; , while patients are more likely to believe and be motivated by the message given by a physician, if the physician discloses his/her own personal health habits. 
This study was conducted to determine the prevalence of hypertension and its modifiable risk factors among the lecturers of the University of Port Harcourt Medical School. Lecturers in a medical school were chosen for this study not only because they are the leaders of the health team in their respective specialties, but also because they are the teachers of the next generation of medical doctors. A study had found that the emphasis placed during medical education often influence the lifestyle and future practice of a doctor.  The findings of this study would therefore not only provide information on the effectiveness of the current management of chronic diseases in Nigeria, but can also assist in predicting the vigor with which future control efforts would be carried out.
| Materials and Methods|| |
A descriptive cross-sectional study design was used, while the medically qualified lecturers of the University of Port Harcourt medical school, who also hold the post of medical consultants in the University of Port Harcourt Teaching Hospital, were used as the study population. Both institutions are owned by the federal government of Nigeria, but primarily sited to take care of the educational and medical needs of the people of Rivers State, one of the States in the Niger delta region of Nigeria.
The study was designed to detect a 5% difference in prevalence of hypertension, with an alpha error of 5%, acceptable beta error of 20%, and a statistical power of 80%; while the estimated prevalence of hypertension in the study population was put at 27.9%.  Using the usual formula for sample size determination for studying proportions in populations of less than 10,000, the minimum required sample size was determined to be 75.
The subjects for the study were randomly chosen from a list of 109 lecturers, obtained from the two institutions, while the data were collected using a modified form of the WHO STEPS instrument for chronic disease risk factor surveillance, that consist of a questionnaire component and physical measurement. 
The questionnaire was structured, self-administered, and used to collect information on the sociodemographic characteristics of the respondents, the use of tobacco, the consumption of alcohol, the type of diet, the amount and types of physical activities undertaken by the respondents, and the history of raised blood pressure.
The physical measurements include the measurement of weight, height, and blood pressure. Weight was measured to the nearest 0.1 kg, using a portable weighing scale, while height was measured to the nearest 0.5 cm, using a stadiometer. The body mass index (BMI) for each of the subjects was then calculated from weight (in kilogram), divided by a square of the height (in meter); and classified as obese when the BMI was greater or equal to 30, overweight when the BMI was between 25.0 and 29.9, normal weight when the BMI was between 18.5 and 24.9, and underweight when the BMI was less than 18.5.
The blood pressure was measured in the sitting position, using a mercury sphygmomanometer with the appropriate size of cuff; and standard measures were taken to ensure accuracy. The systolic blood pressure was recorded at phase I Korotkoff sounds, while the diastolic blood pressure was recorded at phase V Korotkoff sounds. Three consecutive measurements were taken at an interval of at least three minutes, but only the second and third measurements were used in calculating the mean systolic and diastolic blood pressures that serve as the blood pressure of the subject. The subjects were said to be hypertensive according the WHO/ISH criteria, when their mean systolic blood pressure were greater than or equal to 140 mmHg, and/or when their mean diastolic blood pressure was greater or equal to 90 mmHg.
| Results|| |
A total of 100 lecturers were approached for the study, but only 75 responded to the questionnaire, and also made themselves available for the physical measurements. This gives a response rate of 75.00%. Of the 75 lecturers that were studied, 26 (34.67%) were female, while 49 (65.33%) were male, and had an average age of 46.06 ± 9.62 years. Most 64 (88.33%) of the lecturers were married, 6 (8.00%) were never married, 2 (2.67%) were divorced, while 3 (4.00%) were widowed.
The prevalence of hypertension among the lecturers was 21.33%, as a total of 16 of them, 12 males (75.00%), 4 females (25.00%) were found to be hypertensive. Out of the 16 lecturers that were found to be hypertensive, 12 (75.00%) were already aware of their status, and were already on drug therapy and reduced salt intake. Four (25.00%) of the hypertensive lecturers were also diabetic, and were on drugs and prescribed diet.
Only 13 (17.33%) of the lecturers were of normal weight, 45 (60.00%) were overweight, 17 (22.67%) were obese, while none was underweight. The lecturers ate an average of 6.34 ± 2.15 meals per week that were prepared outside their home; all of them went to work with their personal vehicle, while 51 (68.00%) regularly engage in some form of physical exercises, like jogging, brisk walking and aerobics.
Some 11 (14.67%) of the lecturers had previously smoked cigarette, but only 2 (2.67%) still smoke an average of six sticks of cigarette daily, mainly outside the hospital, and at home. All the lecturers had taken an alcoholic drink within the preceding 12 months, mainly in social occasions (92.00%), and less than three standard units (94.67%). Most 40 (53.33%) of the lecturers took an alcoholic drink monthly, 21 (28.00%) 2-3 times in a month, 11 (14.67%) drank alcohol weekly, while 3 (4.00%) took alcohol every day.
| Discussion|| |
The subjects of our study had an average age of 46.06 ± 9.62 years, and a prevalence of hypertension of 21.33%. This is much lower than the prevalence in the general population in the urban centers of Nigeria,  but consistent with the prevalence in the rural , and semiurban communities  of southern Nigeria that were mainly populated by farmers, fisherfolks, traders, and artisans. A 2003 study carried in urban Lagos  had recorded a prevalence of hypertension of 44.3%, while the prevalence in rural communities in Rivers State  and Edo State  were 27.9% and 20.2% respectively. The lower prevalence of hypertension recorded in our study might be due to the better health-seeking behavior of the medical lecturers,  especially as 75% of those that were found to be hypertensive were already aware of their condition, and had taken concrete steps to control the hypertension. This is much higher than the 18.5% awareness recorded in a rural community in Edo State. 
Also, the fact that only 2.67% of the lecturers were smokers, coupled with the finding that most of them drank less than three standard units of alcohol a day, might also be responsible for the lower prevalence of hypertension among the lecturers. The use of alcohol and the smoking of cigarette by the lecturers was much lower than that in the general population. The prevalence of smoking among the respondents of the Lagos study  was 9.9%, while close to half of them drank more than three units of alcohol daily. Also, a study conducted in a rural community close to the University of Port Harcourt medical school, recorded a 33% prevalence of harmful drinking among members of the community, with 12.73% of them classified as having alcohol dependence problem.  Studies have demonstrated a direct relationship between alcohol intake and the elevation of blood pressure,  while cigarette smoking is said to be responsible for at least 12% of all vascular diseases, including hypertension. 
The good health-seeking behavior of the subjects of our study and their healthy lifestyle are the essential ingredients required in every doctor, by the WHO's Innovative Care for Chronic Condition (ICCC) framework,  for the successful management of hypertension and other noncommunicable diseases. Healthy lifestyle particularly needs to be encouraged among doctors, especially as the prevalence of smoking among medical students is often similar to those of the general population, according to the Global Health Professions Student Survey (GHPSS).  It is also necessary to correct the impression in certain quarters that a doctor needs to drink alcohol and/or smoke cigarette to cope with the stress of medical practice.  The importance of ensuring that doctors have good health habits is reflected in the number of studies that show a positive relationship between physician's healthy habits and effective management of patients with noncommunicable diseases. , The desire to be a good role model for patients and children was one of the main reasons given by several health workers in the United States for quitting smoking.  Similar pressures should be exerted on doctors in Nigeria, even from medical school to achieve the same effect.
Our study also found that more than 80% of the subjects were either overweight or obese. This is much higher than the 39.6% found in the Lagos study,  and the 47.5% recorded in a rural community in Rivers State.  The weight problem of the subjects in our study was in spite of the fact that 68% of them regularly engaged in some form of physical exercise, but it is however not completely unexpected, considering the high socioeconomic status of the subjects, and the fact that they ate on a daily basis, an average of one meal that was not prepared at home. Although overweight and obesity are established risk factors for hypertension and other noncommunicable diseases,  weight control has been a contentious issue in Nigeria and other African countries where overweight is still being viewed as sign of affluence, while weight loss is often associated with HIV infection. 
However, the fact that 68% of the subjects in our study exercised regularly shows that they were well aware of their weight problem, and the health risks associated with it, in spite of the conflicting cultural reasons. This is higher than the proportion that regularly exercised in the Lagos study,  and can be viewed as a reflection of the greater relevant knowledge possessed by the subjects of our study. Studies have shown that there is a positive relationship between education and the body size dissatisfaction that often triggers actions aimed at weight control.  This further highlights the need to properly educate the general public to take action against the escalating obesity epidemic, especially as studies done in developed countries have linked weight problems to restricted knowledge, lower valuation of weight control, and cultural standards of physical attractiveness.  The importance of education and counseling has also been demonstrated in other aspects of the management of hypertension. Amira and Okubadejo  had found that 60% of the noncompliance to antihypertensive drug therapy was related to the attitudes and beliefs of the patients, which can be improved with education and counseling; while Busari et al were able to achieve a 64% increase in hypertension control through the counseling of market women. 
| Conclusion|| |
The prevalence of hypertension among the lecturers in the medical school was lower than that in the general population in the urban centers, but consistent with that in the rural communities of Nigeria. This can be attributed to the better health-seeking behavior of the lecturers, and their healthy lifestyle. These need to be encouraged among doctors, considering the positive relationship between the physician's personal health habits and the effective management of patients with noncommunicable diseases.
| References|| |
|1.||Omran AR. The epidemiologic transition: A theory of the epidemiology of population change. Milbank Mem Fund Q 1971;49:509-38. |
|2.||World Health Organization. The World Health Report: 2002: Reducing the Risks, Promoting Healthy Life. Geneva: World Health Organization; 2002. |
|3.||National Expert Committee on Non-communicable diseases in Nigeria. Final report of a national survey. Lagos: Federal Ministry of Health and Social Services; 1997. |
|4.||Wokoma FS, Alasia DD. Blood pressure pattern in Barako: a rural community in Rivers State, Nigeria. Niger Health J 2011;11:8-13. |
|5.||Adefuye BO, Adefuye PO, Oladapo OT, Familoni OB, Olurunga TO. Prevalence of hypertension and other cardiovascular risk factors in an African sub-urban religious community. Niger Med Pract 2009;55:4-8. |
|6.||WHO. Facing the facts: The impact of chronic disease in Nigeria. Geneva: WHO; 2005. Available from: http://www.who.int/chp/chronic_disease_report/ en/. [Last assessed on 2011 Mar 12]. |
|7.||Unachukwu CN, Agomuoh DI, Alasia DD. Pattern of non-communicable diseases among medical admissions in Port Harcourt, Nigeria. Niger J Clin Pract 2008;11:14-7. |
|8.||Akpa MR, Alasia DD, Emem-Chioma PC. An appraisal of hospital based blood pressure control in Port Harcourt, Nigeria. Niger Health J 2008;8:27-30. |
|9.||Sani MU, Mohammed AZ, Bapp A, Borodo MM. A three-year review of mortality patterns in the medical wards of Aminu Kano Teaching Hospital, Kano, Nigeria. National Postgrad Med J 2007:14:347-51. |
|10.||Arodiwe EB, Ike SO, Nwokediuko SC. Case fatality among hypertension-related admissions in Enugu, Nigeria. Niger J Clin Pract 2009;12:153-6. |
|11.||World Health Organization. Innovative care for chronic conditions: building blocks for action. Geneva: World Health Organization; 2002. |
|12.||Ockene JK, Adams A, Hurley TG, Wheeler EV, Hebert JR. Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: does it work? Arch Intern Med 1999;159:2198-205. |
|13.||Busari A, Olayemi S, Oreagba I, Alabidun A. Educational intervention as a strategy for improving blood pressure status of market women in Lagos, Nigeria. Internet J Health 2010;11. |
|14.||Frank E. STUDENT JAMA. Physician health and patient care. JAMA 2004;291:637. |
|15.||Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med 2000;9:287-90. |
|16.||Lewis CE, Clancy C, Leake B, Schwartz JS. The counseling practices of internists. Ann Intern Med 1991;114:54-8. |
|17.||Bonita R, de Courten M, Dwyer T, Jamrozik K, Winkelmann R. Surveillance of risk factors for noncommunicable diseases: The WHO STEP wise approach. Geneva: World Health Organization; 2002. Available from: http://www.who.int/chp/steps. [Last accessed on 2002]. |
|18.||Nigerian Heart Foundation, Federal Ministry of Health and Social Services. Health behavior monitor among Nigerian adult population. Lagos: Nigerian Heart Foundation; 2003. |
|19.||Omuemu VO, Okojie OH, Omuemu CE. Awareness of high blood pressure status, treatment and control in a rural community in Edo State. Niger J Clin Pract 2007;10:208-12. |
|20.||Amira CO, Okubadejo NU. Factors influencing non-compliance with antihypertensive drug therapy in Nigerians. Niger Postgrad Med J 2007;14:325-9. |
|21.||Brisibe SF, Ordinioha B. Socio-demographic characteristics of alcohol abusers in a rural Ijaw community in Bayelsa State, South-South Nigeria. Ann Afr Med 2011;10:97-102. |
|22.||Puddey IB, Beilin LJ, Vandongen R, Rouse IL, Rogers P. Evidence for a direct effect of alcohol consumption on blood pressure in normotensive men: A randomized controlled trial. Hypertension 1985;7:707-13. |
|23.||Warren CW, Sinha DN, Lee J, Lea V, Jones NR. Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008. BMC Public Health 2011;11:72. |
|24.||Kenna GA, Lewis DC. Risk factors for alcohol and other drug use by healthcare professionals. Subst Abuse Treat Prev Policy 2008;3:3. |
|25.||Nelson DE, Giovino GA, Emont SL, Brackbill R, Cameron LL, Peddicord J, et al. Trends in cigarette smoking among US physicians and nurses. JAMA 1994;271:1273-5. |
|26.||Ojofeitimi EO, Adeyeye AO, Fadiora AO, Kuyeyi AO, Faborode TG, Adegbenro CA, et al. Awareness of obesity and its health hazard among women in a university community. Pakistan Journal of Nutrition 2007; 6: 502 - 505.. |
|27.||Alwan H, Viswanathan B, Williams J, Paccaud F, Bovet P. Association between weight perception and socioeconomic status among adults in the Seychelles. BMC Public Health 2010;10:467. |
|28.||Sobal J, Stunkard AJ. Socioeconomic status and obesity: a review of the literature. Psychol Bull 1989;105:260-75. |