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TITLE PAGE

EPIDEMIOLOGICAL SURVEY OF THE PREVALENCE OF HYPERTENSION IN A GIVEN POPULATION USING DATA ANALYSIS

BY

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EE/H2013/01430
DEPARTMENT OF ----
SCHOOL OF ---
INSTITUTE OF ---

DECEMBER,2018

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APPROVAL PAGE

This is to certify that the research work, "epidemiological survey of the prevalence of hypertension in a given population using data analysis" by ---, Reg. No. EE/H2007/01430 submitted in partial fulfillment of the requirement award of a Higher National Diploma on --- has been approved.

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Supervisor                                                  Head of Department.
Signature……………….                           Signature……………….        

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DEDICATION
This project is dedicated to Almighty God for his protection, kindness, strength over my life throughout the period and also to my --- for his financial support and moral care towards me.Also to my mentor --- for her academic advice she often gives to me. May Almighty God shield them from the peril of this world and bless their entire endeavour Amen.

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ACKNOWLEDGEMENT

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Hypertension is a leading cause of cardiovascular diseases and a growing public health problem in many developed and developing countries. However, population-based data to inform policy development are scarce in Nigeria. This nationally representative study aimed to determine population-based estimates of the prevalence and risk factors associated with hypertension in Nigeria. Hypertension is a major public health problem worldwide. Estimating the prevalence of disease in populations of Nigeria would be useful in developing intervention programs to control it and prevent its consequences.
The study was a church based cross sectional study involving 912 participants randomly selected from the three major zones in Anambra State. The age range of the participants was 17-79 years. Participants were administered with a well-structured questionnaire and their blood pressures (BP) as well as anthropometric measurements were taken using standard instruments. The study population (n = 912) consists, 476 (52.16%) females and 436 (47.81%) males; sampled randomly from Awka, Onitsha and Nnewi. The overall crude prevalence of hypertension in the study population were 22.81% and 42.54% respectively. The crude prevalence of hypertension in the three cities - Onitsha, Awka and Nnewi were 32.56%, 19.665 and 16.40% respectively. The prevalence of hypertension was significantly higher in Onitsha (P = 0.0001). The prevalence of hypertension in both sexes was not statistically different (male, 22.01% and female, 23.5% P = 0.587). Mean BMI, Systolic, and Diastolic BP for the study population was 25.43 ± 4.2, 120.7 ± 18.39 and 78.21 ± 12.57 respectively. Systolic and diastolic BP correlated with age and anthropometric measures such as waist circumference, BMI, Hip circumference, weight and height. The following factors were strongly associated with the prevalence of hypertension in our study population: Age (χ2 = 110.87, P = 0.000); Zone (χ2 = 25.19, P = 0.000); BMI (χ2 = 45.51, P = 0.000); Physical Activity(χ2 = 58.08, P = 0.000); Alcohol Consumption (χ2 = 32.27, P = 0.000); Smoking (χ2 = 7.892, P = 0.000); General Health status (χ2 = 46,62, P= 0.000); Consumption of fatty food (χ2 = 29.35, P = 0.000). A low percentage of the population, 9.76% reported previous diagnosis of high BP and 34.59% of 910 of the participants also reported previous BP diagnosis of any relative. Our result shows that the prevalence of hypertension  in this population was high and associated with some modifiable risk factors. In addition, poor detection, treatment and control of hypertension in this population were observed. This underscores the need for comprehensive evaluation of the prevalence of hypertension and other cardiovascular diseases in Nigeria.

ABBREVIATIONS AND THEIR MEANING

AOR	Adjusted Odds Ratio
BMI	Body Mass Index
CDC	Center for Disease Control
CHWs	Community Health Workers
CI	Confidence Interval
HDL	High Density Lipoproteins
HIV/AIDS	Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
HTN	Hypertension
LMIC	Low Middle Income Countries
MOH	Ministry of Health
NCDs	Non Communicable Diseases
NISR	National Institute of Statistics of Rwanda
PDA	Personal Digital Assistant
PPS	Probability Proportional to Size
RBC	Rwanda Biomedical Center
SD	Standard Deviation
WHO	World Health Organization

 TABLE OF CONTENTS
COVER PAGE
TITLE PAGE
APPROVAL PAGE
DEDICATION
ACKNOWELDGEMENT
ABSTRACT
CHAPTER ONE
INTRODUCTION
1.1      BACKGROUND OF THE PROJECT

1. PROBLEM STATEMENT
2. AIM/OBJECTIVE OF THE PROJECT
3. SIGNIFICANCE OF THE PROJECT
4. RESEARCH QUESTION
5. LIMITATION OF THE PROJECT
6. PROJECT ORGANISATION

CHAPTER TWO
2.0      LITERATURE REVIEW

1. OVERVIEW OF HYPERTENSION
2. SIGNS AND SYMPTOMS OF HYPERTENSION
3. HYPERTENSIVE CRISIS
4. CAUSES OF HYPERTENSION
5. HYPERTENSION MEASUREMENT TECHNIQUE

CHAPTER THREE
3.0      MATERIALS AND METHODS

1. STUDY AREA
2. STUDY DESIGN
3. POPULATION OF THE STUDY
4. SAMPLING METHOD
5. SAMPLE SIZE CALCULATION
6. DATA COLLECTION
7. ETHICAL CONSIDERATIONS

CHAPTER FOUR
RESULT ANALYSIS AND DISCUSSION

1. RESULT
2. DISCUSSION

CHAPTER FIVE

1. CONCLUSION
2. RECOMMENDATION
3. REFERENCES

CHAPTER ONE
1.0                                          INTRODUCTION
1.1                          BACKGROUND OF THE PROJECT
Hypertension is a major public health problem worldwide. The global prevalence of hypertension is on the increase. It was estimated in 2002 that 972 million people had hypertension with a prevalence rate of 26.4%. This figure have been projected to rise to 1.54 billion (prevalence of 29.4%) in 2025.[1],[2] It causes about 7.1 million deaths per year and 4.5% of the disease burden, which translates to 64 million disability-adjusted life years. [3] The relationship between blood pressure (BP) and risk of cardiovascular disease events is continuous, consistent, and independent of other risk factors. The higher the BP, the greater is the chance of heart attack, heart failure, stroke, and kidney diseases.[1] ,[3],[4] ,[5] Non-communicable diseases (NCDs) such as hypertension had been thought to be rare in rural Africa; however, it has been shown to be increasing in alarming proportion. According to the World Health Report 2001, NCDs accounted for 22% of the total deaths in the region in the year 2000; cardiovascular diseases alone accounted for 9.2% of the total deaths, killing even more than malaria. [3] ,[6] Although hypertension is usually asymptomatic, it may be associated with considerable morbidity and mortality.[5] Uncontrolled hypertension is associated with serious end-organ damage and complications, such as left ventricular hypertrophy, diastolic dysfunction, congestive heart failure, ischemic heart disease, stroke, and renal failure which have been established by various researchers in Nigeria.[3]

The cost of hypertension is alarming; it was estimated to be $30 billion in the United States in 1997 alone. Drug treatment covers nearly a third or $7 billion of the $22 billion in direct costs, which also includes the cost for hospitalizations and doctor visits.[9] The prevention and control of hypertension have not received due attention in many developing countries despite the fact that it is a modifiable risk factor for cardiovascular diseases. This could be attributed to one of the following factors; dearth of data on the prevalence and control levels of hypertension, which is sometimes perceived as nonexistence of the problem;[3] other priorities include HIV/AIDS, tuberculosis, cholera, and malaria.[8] There is paucity of data on hypertension prevalence in many populations of Nigeria. Thus, the burden of hypertension in these populations might be underestimated and might leave the illness undiagnosed and untreated.
This present study assesses the hypertension prevalence, risk factors, and information about diagnosis and treatment in three major populations in Anambra State.

1.2                                   PROBLEM STATEMENT
Hypertension is the most significant avoidable cause of morbidity and mortality, yet nationally representative adult data on Nigeria have not been available. The work asses the prevalence and determinants of hypertension, including sociodemographic variables, weight status, health behaviour, and psychosocial stress and support risk factors.

1.3                         AIM / OBJECTIVES OF THE STUDY
The main aim of this work is to analyze the Epidemiological survey of the prevalence of hypertension in a given population of Anambra state, Nigeria. This survey was carried out to assess the prevalence, awareness, treatment, detection and risk factors of hypertension in three major populations – Onitsha, Nnewi and Awka cities of Anambra State.

1.4                             SIGNIFICANCE OF THE STUDY
This study provides population-based estimates of the prevalence and risk factors associated with hypertension in Anambra state. The findings will serve as baseline for monitoring the changing pattern of hypertension and its risk factors, and inform development of appropriate policies, strategies, planning and targeting of preventive public health interventions.

1.5                                    RESEARCH QUESTION

1. What is the prevalence of hypertension in Nigeria?
2. Who is mostly affected by hypertension?
3. How is hypertension defined?

1.6                               LIMITATION OF THE STUDY
This study is limited to the study of the prevalence of hypertension population in Anambra state. In the study, Onitsha, Nnewi and Awka cities which of among the local government of the state is considered.

1.7                                                        PROJECT ORGANISATION
The work is organized as follows: chapter one discuses the introductory part of the work, chapter two presents the literature review of the study,  chapter three describes the methods applied, chapter four discusses the results of the work, chapter five summarizes the research outcomes and the recommendations.

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