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Nursing Thesis and Dissertations

2020-07

Undiagnosed Hypertension and

Associated Factors Among Bank
Workers In Bahir Dar City, Northwest
Ethiopia, 2020

Mekdes, Dejenie

http://ir.bdu.edu.et/handle/123456789/13439
Downloaded from DSpace Repository, DSpace Institution's institutional repository
 BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

UNDIAGNOSED HYPERTENSION AND ASSOCIATED FACTORS

AMONG BANK WORKERS IN BAHIR DAR CITY, NORTHWEST
ETHIOPIA, 2020

BY

MEKDES DEJENIE (BSc N)

JULY, 2020

BAHIR DAR, ETHIOPIA

 BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

UNDIAGNOSED HYPERTENSION AND ASSOCIATED FACTORS

AMONG BANK WORKERS IN BAHIR DAR CITY, NORTHWEST
ETHIOPIA, 2020
A THESIS RESEARCH TO BE SUBMITTED TO BAHIR DAR UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCINCES SCHOOL OF HEALTH
SCIENCES DEPARTMENT OF ADULT HEALTH NURSING FOR THE
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR DEGREE OF
MASTERS OF SCIENCE IN ADULT HEALTH NURSING, NORTH WEST
ETHIOPIA

By: MEKDES DEJENIE (BSc Nurse)

Advisors:

1. Mr. SITOTAW KERIE (BSc, MSc in adult health nursing, Assistant professor)

2. Ms. KIDIST REBA (BSc, MSc in adult health nursing, Assistant professor)

JULY, 2020

© 2020 Mekdes Dejenie BAHIR DAR, ETHIOPIA

DECLARATION
This is to certify that the thesis entitled “Undiagnosed Hypertension and associated factors
among bank workers in Bahir Dar city”, submitted in partial fulfillment of the requirements
for Master of Adult Health Nursing in college of medicine and health sciences, school of health
sciences, department of Adult Health Nursing, Bahir Dar University, is a record of original work
carried out by me and has never been submitted to this or any other institution to get any other
degree or certificates. The assistance and help I received during the course of this investigation
have been duly acknowledged.

Name of the candidate Date Signature

______________ ___________ ______________

ADVISOR’S APPROVAL FORM

BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

APPROVAL OF THESIS FOR DEFENSE

I hereby certify that I have supervised, read, and evaluated this thesis titled “Undiagnosed
Hypertension and associated factors among bank workers in Bahir Dar city” by Mekdes
Dejenie prepared under my guidance. I recommend the thesis be submitted for oral defense.

_____________________ ________________ _____________

Advisor‟s name Signature Date

_____________________ ________________ _____________

Co-Advisor‟s name Signature Date

_____________________ _______________ ____________

Department Head Signature Date
EXAMINERS' APPROVAL FORM

BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

APPROVAL OF THESIS FOR DEFENSE RESULT

As members of the board of examiners, we examined this thesis entitled “Undiagnosed
Hypertension and associated factors among bank workers in Bahir Dar city” by Mekdes
Dejenie. We hereby certify that the thesis/dissertation is accepted for fulfilling the requirements
for the award of the degree of “Masters in Adult Health Nursing”.

BOARD OF EXAMINERS

_____________________ ________________ _____________

External examiner‟s name Signature Date

_____________________ ________________ _____________

Internal examiner‟s name Signature Date

_____________________ ________________ _____________

Chair person‟s name Signature Date

ACKNOWLEDGEMENTS
Firstly, I am very grateful to my sponsor, Amhara Regional Health Burro for granting me this
great opportunity in post graduate study. Secondly, I would like to acknowledge Bahir Dar
University, college of medicine and health sciences department of Adult health nursing for
giving me this opportunity to conduct my research. Thirdly, I wish to express my sincere
gratitude to my advisers M/r Sitotaw Kerie and M/s Kidist Reba for their tireless guidance and
constructive comments that led to successful accomplishment of this thesis.
I would like to thank Bahir Dar City banks which gave as some information about number of
workers. I would like to thank data collectors and supervisor for their valuable data collections
and supervision. Finally, my special thanks go to the study participants for their commitment in
administering to their questionnaires and to be measured for the screening.

i
ABSTRACT
Background: Hypertension is defined as two or more readings of systolic blood pressure
measurement of 130 mm Hg or higher or diastolic blood pressure measurement of 80 mm Hg or
higher. Undiagnosed hypertension is defined as individuals who were hypertensive but did not
report having been told by a doctor that they have hypertension.
Objective: This study aimed to assess the prevalence of undiagnosed hypertension and
associated factors among bank workers in Bahir Dar city, Northwest Ethiopia 2020
Method: An institutional based cross-sectional study conducted in Bahir Dar city administration
banks from February 24 to March 24 2020. Simple random sampling technique was used to
select the study subjects. The data was collected through self-administered structured
questionnaire and physical measurement. Logistic regression applied to assess the association
between dependent and explanatory variables. The association interpreted using the odds ratio
and 95% confidence interval. P-values less than or equal to 0.05 were considered statistically
significant.
Result- The prevalence of undiagnosed hypertension among bank workers was 24.8% with (95%
CI 21.1 - 28.5). Age group 35-44 (AOR = 2.560, 95% CI: 1.603 - 4.088), being male (AOR =
3.606, 95% CI: 1.844 - 7.051), having moderate knowledge (AOR = 3.805, 95% CI: 2.285 -
6.338), having poor knowledge (AOR = 6.189, 95% CI: 3.069 - 12.479) and being physically in
active (AOR = 2.914, 95% CI: 1.256 - 6.762) were significantly associated with undiagnosed
hypertension.
Conclusion- This study demonstrated the proportion of undiagnosed hypertension among bank
workers is high. Age group of 35-44 years, being male, having moderate and poor knowledge
and being physically inactive was significantly associated with undiagnosed hypertension.
Therefore, there is an urgent need to create health awareness, frequent health screening and
implementation of effective interventions targeting hypertension among this vulnerable group.
Key words- Undiagnosed Hypertension, factors, bank workers, Bahir Dar, Ethiopia

ii
LIST OF ABRIVATIONS AND ACRONYMS
AOR Adjusted Odds Ratio

BMI Body Mass Index

BP Blood Pressure

BSC Bachelor Science

CI Confidence Interval

COR Crud Odds Ratio

DBP Diastolic Blood Pressure

ESC European Society of Cardiology

ESH European Society of Hypertension

HPN Hypertension

MmHg Millimeters of Mercury

MSc Master of Science

OR Odds Ratio

SBP Systolic Blood Pressure

SPSS Statistical Package for Social Science Research

US United States

WHO World Health Organization

iii
TABLE OF CONTENT
CONTENTS PAGES
ACKNOWLEDGEMENTS ............................................................................................................. i
ABSTRACT .................................................................................................................................... ii
LIST OF ABRIVATIONS AND ACRONYMS............................................................................ iii
TABLE OF CONTENT ................................................................................................................. iv
LIST OF TABLES ......................................................................................................................... vi
LIST OF FIGURES ...................................................................................................................... vii
1. INTRODUCTION ...................................................................................................................... 1
1.1 BACK GROUND .................................................................................................................. 1
1.2 STETMENT OF THE PROBLEM ....................................................................................... 3
1.3. SIGNIFICANCE OF THE STUDY ..................................................................................... 5
2. LITRATURE REVIEW .............................................................................................................. 6
3. CONCEPTUAL FRAMEWORK ............................................................................................. 10
4. OBJECTIVES ........................................................................................................................... 11
5. METHODS AND MATERIALS .............................................................................................. 12
5.1 Study area and period .......................................................................................................... 12
5.2 Study design ........................................................................................................................ 12
5.3 Source of population ........................................................................................................... 12
5.4 Study population ................................................................................................................. 12
5.5 Eligibility criteria ................................................................................................................ 12
5.6 Sample size determination .................................................................................................. 13
5.7 Sampling Procedure ............................................................................................................ 14
5.8 Study Variables ................................................................................................................... 16
5.9 Operational definitions ........................................................................................................ 16
5.10 Data collection procedure.................................................................................................. 17
5.11 Data processing and analysis............................................................................................. 18
5.12 Data quality control ........................................................................................................... 19
5.13 Ethical consideration ......................................................................................................... 19
6. DISSEMINATION OF RESULTS ........................................................................................... 20
7. RESULT ................................................................................................................................... 21

iv
 7.1 Descriptive statistics ............................................................................................................ 21
7.2 Factors associated with undiagnosed hypertension ............................................................. 25
8. DISCUSSION ........................................................................................................................... 27
9. STRENGTH AND LIMITATION OF THE STUDY .............................................................. 29
10. CONCLUSION AND RECOMMENDATION ...................................................................... 30
11. REFERENCES ....................................................................................................................... 31
12. ANNEXS ................................................................................................................................ 38
Annex A: Structured questionnaires of English version ........................................................... 38
Annex B: መጠይቅ በአማርኛ ........................................................................................................... 48

v
LIST OF TABLES
Table 1: Sample size calculation for different factors associated with undiagnosed hypertension
....................................................................................................................................................... 14
Table 2: Socio-demographic characteristics of bank workers in Bahir Dar city, Northwest,
Ethiopia, 2020 (n=513) ................................................................................................................. 21
Table 3: Behavioral characteristics of bank workers in Bahir Dar city, Northwest, Ethiopia, 2020
(n=513).......................................................................................................................................... 23
Table 4: The bivariable and multivariable logistic regression analysis for factors associated with
undiagnosed hypertension among bank workers in Bahir Dar city, 2020 .................................... 25

vi
LIST OF FIGURES
Figure 1: This conceptual framework adapted from different literatures .................................... 10
Figure 2: Schematic representation of sampling procedure ......................................................... 15
Figure 3: Hypertension knowledge status of bank workers in Bahir Dar city, Northwest,
Ethiopia, 2020 (n=513) ................................................................................................................. 22
Figure 4: History of chronic illnesses among bank workers in Bahir Dar city, Northwest,
Ethiopia, 2020 (n=513). ................................................................................................................ 24
Figure 5: Body mass index status of bank workers in Bahir Dar city, Northwest, Ethiopia, 2020
(n=513).......................................................................................................................................... 24

vii
1. INTRODUCTION
1.1 BACK GROUND
The new Hypertension Guideline changes the definition of hypertension, which is now
considered to be any systolic BP measurement of 130 mm Hg or higher or any diastolic BP
measurement of 80 mm Hg or higher. Hypertension was previously defined as a systolic BP of
140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher. With the updated guideline,
measurements of 140/90 mm Hg or higher are considered stage 2 hypertension (1).
Blood pressure level is classified as normal; systolic blood pressure <120 and Diastolic Blood
Pressure <80 mm Hg, Elevated; systolic blood pressure 120-129 mm Hg and Diastolic Blood
Pressure <80 mm Hg, Hypertension: stage 1; systolic blood pressure 130-139 mm Hg or
Diastolic Blood Pressure 80-89 mm Hg and Hypertension: stage 2; systolic blood pressure ≥140
mm Hg or Diastolic Blood Pressure ≥90 mm Hg (1).
Individuals who were hypertensive but did not report having been told by a doctor that they have
hypertension classified as undiagnosed hypertension (2).
There are three general types of hypertension. Essential or primary hypertension occurs when the
condition has no known cause. This form of hypertension cannot be cured, but it can be
controlled. More than 90% of individuals with hypertension have essential hypertension. Genetic
factor may play an important role in the development of essential hypertension. When
hypertension is caused by another condition or disease process, it is called secondary
hypertension. Fewer than 10% of patients have secondary hypertension; where either a co-
morbid disease or drug is responsible for elevating BP. In most of these cases renal dysfunction
resulting from sever chronic kidney disease or renovascular disease is the most common
secondary cause (3).
Hypertension has a variety of causes. Blood pressure generally tends to rise with age.
Hypertension can also be caused by other medical conditions, such as thyroid disease or chronic
kidney disease. Hypertension may also be a side effect of certain medications, such as over-the-
counter cold medications and oral contraceptives and other hormone drugs. Age, sex, weight,
alcohol consumption, geographic variation, smoking, salt consumption and genetic
predisposition are the common determinants of hypertension (3).
Most hypertensive people have no symptoms at all. There is a common misconception that
people with hypertension always experience symptoms, but the reality is that most hypertensive

1
people have no symptoms at all. Sometimes hypertension causes symptoms such as headache,
shortness of breath, dizziness, chest pain, palpitations of the heart and nose bleeds. It can be
dangerous to ignore such symptoms, but neither can they be relied upon to signify hypertension
(4).
Hypertension puts strain on the heart, leading to hypertensive heart disease and coronary artery
disease if not treated. Hypertension is also a major risk factor for stroke, aneurysms of the
arteries and peripheral arterial disease and is a cause of chronic kidney disease. Millions of
people with hypertension are seen by health care providers each year, but many remain
undiagnosed essentially “hiding in plain sight” within clinical settings. Hypertension is generally
symptom less, but increases the risk of various other cardiovascular diseases like stroke, heart
attack and non-cardiovascular diseases like renal damage, end stage of renal failure (3, 5, 6).
Measuring blood pressure is the only way to diagnose hypertension, as most people with raised
blood pressure have no symptoms. Blood pressure measurement and control is particularly
important in adults who have had a prior heart attack or stroke, diabetes, chronic kidney disease,
obese, use tobacco and have a family history of heart attack or stroke (7).
The prevention and control of hypertension is complex, and demands multi-stakeholder
collaboration, including governments, civil society, academia and the food and beverage
industry. Because of weak health systems the number of peoples with hypertension who are
undiagnosed, untreated and uncontrolled are higher in low and middle income countries
compared to high-income countries (4).

2
1.2 STETMENT OF THE PROBLEM
One billion people are affected by hypertension worldwide, and this figure is predicted to
increase to 1.5 billion by 2025. Nearly one-half of this population are unaware of their condition
(8). Worldwide, 7·6 million premature deaths were attributed to high blood pressure.
Hypertension accounts for an estimated 54 percent of all strokes and 47 percent of all ischemic
heart disease globally (9).
High blood pressure (HTN) is a prevalent condition affecting millions of adults, unfortunately
millions more unaware, undiagnosed and untreated they are hiding in plain sight (10).
Hypertension rarely causes symptoms in the early stages and many people go undiagnosed (4).
In 2007, approximately 50% of people worldwide were living with undiagnosed hypertension
(11).
One out of three adults has hypertension and that more than 50% of them are unaware of this
condition (12). The burden of undiagnosed hypertension based on age group showed that , 67
percent of 18 to 24 year-olds remained undiagnosed compared to 54 percent of people 60 and
older, 65 percent of 25 to 31 year olds were undiagnosed and 59 percent of 32 to 39 year-olds
were still living with undiagnosed high blood pressure (13). There was a general increasing trend
in prevalence with age, from 6.0% in the 18-19 years age group, reaching a peak of 28.7%
among the 65-69 years age group. Besides this, the prevalence of undiagnosed hypertension
significantly higher in the rural areas 20.7% compared to urban areas 16.1% and also higher in
males 18.6% compared to females 15.6% (14).
Undiagnosed Hypertension is important risk factor for development of chronic kidney disease,
cardiovascular disease and all-cause mortality (15). Millions of United Kingdom adults could be
suffering from undiagnosed high blood pressure (BP), increasing the risk of heart disease or
stroke kidney problem and target organ damage (16-19).
In Sub Saharan Africa Undiagnosed Hypertension has resulted in significant health and
economic burdens, a large proportion of the population with hypertension remains undiagnosed,
untreated, or inadequately treated, contributing to the rising burden of cardiovascular disease.
Poor access to health information and services and low socio-economic status are contribute
substantially to the high prevalence of undiagnosed hypertension in the region (20).

3
In Ethiopia the magnitude of undiagnosed hypertension is found to be 15.6%. The prevalence of
undiagnosed raised blood pressure is high in Ethiopia and only very small percentage of people
had been aware of their high blood pressure (21).
Different studies in different areas indicates that young and older age (above 65 years old), lower
socio-economic status, alcohol drinkers, being underweight, absence of associated cardiovascular
co morbidities, no familial hypertension history and primary educated individuals having higher
likelihood to have undiagnosed hypertension. Besides this undiagnosed hypertension is more
common in men and people with less access to health care (22-27).
Generally many studies have assessed the prevalence and associated factors of undiagnosed
hypertension in different countries with various findings. As far as my knowledge concern in
Ethiopia there are few studies conducted regarding the prevalence of undiagnosed hypertension
and its associated factors. The bank employees had a high prevalence of hypertension and they
must be considered an occupational risk group (28). Therefore conducting this study is very
important to assess the prevalence of undiagnosed hypertension and to identify associated factors
among bank workers in Bahir Dar city.

4
1.3. SIGNIFICANCE OF THE STUDY
The results of this study will contribute in designing appropriate intervention strategies, help
policy makers, non-Governmental organizations, Bahir Dar city administration and Amhara
regional health bureau work on undiagnosed hypertension. Furthermore this research identifies
hypertensive employees early and facilitates the provision of proper care, thereby helping to
reduce the risk of undiagnosed hypertension. Finally, the result of this study will be used as base
line information for further researchers to conduct similar study in different areas of Ethiopia.

5
2. LITRATURE REVIEW
2.1 Prevalence of Undiagnosed Hypertension
Different study designs conducted in different areas with varying findings, a cross sectional
study in different areas, in the local Community of Byblos Lebanon among 260 participants, in
India among 365 participants and in Western Indian among 3629 participants the prevalence of
undiagnosed hypertension found to be 16.9%, 10.1% and 26% respectively (23, 29, 30).
Different Studies in Nigeria in different period of time among 178 and 107 health care workers
(HCW) the prevalence of undiagnosed hypertension found to be 35.1% and 26.2% respectively
(31, 32). Besides this, another studies in different area of Nigeria among 411 male and female
traders at the „Monday Market‟ and among 441 university workers the prevalence of
undiagnosed hypertension found to be 25% and 36.1% respectively (33, 34).
A cross-sectional study in a cohort of males in the Central Province of Sri Lanka shows that from
a total of 2462 male participants the prevalence rate of undiagnosed HTN is found to be 31.7%
(35). Additionally a study in Ireland and United States of America shows that from the total of
8,504 respondents the prevalence of undiagnosed hypertension is found to be 41.2% in Ireland
and 19.7% in United States of America (36). Besides this a study in Iran at the emergency
department from 346 patients the prevalence of undiagnosed HTN found to be 4.8% (37).
The two community based studies in Sudan in different sample size indicates that from 1099 and
500 study participants the prevalence of undiagnosed hypertension found to be 38.2% and 49.4%
respectively (38, 39).
Another study in a rural area of West Bengal shows that from a total of 166 study subjects,
undiagnosed hypertension found to be 24.1% (40). Besides this a study in Bangladeshi
among1685 participants the prevalence of undiagnosed hypertension found to be 59.9% (27).
The predicted prevalence of undiagnosed hypertension among US adults during 2013‐2015
ranged from 4.1% to 6.5% among adults, from 5.0% to 8.3% among men and from 3.3% to 4.8%
among women (41). In urban and rural adults in Ghana from urban 162 (46.3%) and rural 188
the prevalence of Undiagnosed hypertension is high but similar in both urban (18.5%) and rural
(18.4%) settings (42). A study in Finland from 462 apparently healthy cardiovascular risk
subjects the prevalence of undiagnosed hypertension found to be 24% (43).
In Ethiopia different studies in different area, in Hosanna town among 627 adults, in Addis
Ababa gulele Sub-City among 422 participants and in Hawassa town among 390 adult dwellers

6
the prevalence of undiagnosed hypertension found to be 10.2%, 13.25% and 12.3% respectively
(44-46).
2.2 Associated Factors of undiagnosed hypertension
2.2.1 Socio demographic factors:- A number of socio demographic factors have been
reported to have significant association with undiagnosed Hypertension by different studies. Age
is one of the factors reported by different studies to be associated with Undiagnosed
Hypertension.
A study in the local Community of Byblos, Lebanon and Central Province of Sri Lanka indicates
that there is a significant relation between age with undiagnosed hypertension (23, 35).
A study in Malaysia indicates that Elderly age found to have higher likelihood of having
undiagnosed hypertension. Another study in north central Nigeria indicates that age greater than
42 years is a significant correlate of undiagnosed hypertension (22, 31).
Additionally in North Western Nigeria among health care workers of some selected hospitals and
among traders at a regional market and also in Sudan among rural community and in a Rural
Area of West Bengal among adults similarly age were significantly associated with undiagnosed
Hypertension (32, 33, 38, 40).
In Ethiopia a study in Hosanna and Addis Ababa age also associated with undiagnosed
hypertension (44, 45). Where as a study in Bangladeshi indicates that age group from 50-64 or
above were at lower risk of undiagnosed hypertension (27).
Sex is another factor reported to have an association with undiagnosed hypertension. A study in
Karachi indicates that women had a higher rate of getting their BP checked than men (47).
Besides this a study in north west of Iran indicates that males were significantly more likely to
have undiagnosed hypertension than females (48). Another study in Bangladeshi indicates that
females are at lower risk of undiagnosed hypertension (27).
The other factor reported to be associated with undiagnosed hypertension is marital status. A
study in Nigeria and Addis Ababa indicates that undiagnosed hypertension is significantly
associated with marital status (33, 45).
Educational status is another important factor of undiagnosed hypertension. Different studies in
Sudan indicates that there is a significant associations between undiagnosed hypertension and
illiteracy (38, 39). Besides this another study in Malaysians indicates that lower educated
respondents are have higher likelihood of having undiagnosed hypertension (22).

7
2.2.2 Clinical related factors: - Surprisingly, those who are underweight are more likely to
have undiagnosed hypertension. Due to the false belief that hypertension strikes only those who
are overweight or obese (49). A study in Sri Lanka on relationship between body mass index
and hypertension among 195 subjects shows that High BP was recorded in 12 (14.28%) in the
normal weight group (50). Another cross sectional survey in Italy indicates that among normal
BMI participants, the prevalence of hypertension found to be 45% (51). Besides this a study in
China on association between Undiagnosed Hypertension and Health Factors among Middle-
Aged and Elderly Populations, the study indicates that underweight in body mass were
associated with undiagnosed hypertension (2). And also a nationwide survey on Inequalities in
the prevalence of undiagnosed hypertension among Bangladeshi adults indicates that individuals
with underweight were more likely to have undiagnosed hypertension (27). A study in Western
India, in Nigeria, in the Central Province of Sri Lanka, in Sudan and in Hosanna obesity was
associated with undiagnosed hypertension (30, 33, 35, 38, 44).
A study in Sudan indicates that there is a significant associations between undiagnosed
hypertension and diabetes mellitus (38). Besides this a study in North of Iran indicates that from
a total of 703 study participants 31% of the people with undiagnosed diabetes also had
undiagnosed hypertension (52). A study in the Local Community of Byblos, Lebanon indicates
that absence of associated cardiovascular co morbidities having higher likelihood to have
undiagnosed hypertension (23). Additionally a study on health-related determinants of
undiagnosed arterial hypertension, the result showed that there is association between
undiagnosed hypertension with no cardiovascular diseases and no familial hypertension history
(26). Whereas a study in north western Nigeria indicates that there is no significant association
between family history of hypertension and undiagnosed hypertension (32).
2.2.3 Behavioral related factors:- Behavioral factors also contribute to the prevalence of
undiagnosed hypertension. A studies in Malaysia, Local Community of Byblos Lebanon, rural
area of West Bengal and in Hosanna town indicates that undiagnosed hypertension is
significantly associated with alcohol consumption and smoking (22, 23, 40, 44). And also a study
in Rural Rwanda alcohol consumption were found to be significantly associated undiagnosed
hypertension but smoking were not found to be risk factors of undiagnosed hypertension.
Whereas according to a study in central province of Sri Lanka alcohol consumption and smoking
were not significantly associated with undiagnosed hypertension (11, 35).

8
Dietary practice also another risk factors of undiagnosed hypertension. A study conducted in
Addis Ababa reviled that prevalence of undiagnosed hypertension by respondents who did not
consume fruits and/or vegetables in a typical week were three times more likely than those
respondents who consume fruits and/or vegetables for greater than five days in a typical week
(45). Another behavioral factor associated with undiagnosed hypertension was performing
regular physical activity. A study conducted in Hawassa revealed that being physical inactive
was associated with undiagnosed hypertension (46).
2.2.4 Hypertension knowledge related factors: - Knowledge towards hypertension has
great influence on hypertension screening or control. A study in rural Rwanda showed that from
a total of 155 study participants, 41.9% had undiagnosed hypertension. More than 98% of
respondents either did not know or knew wrong information about hypertension, and only 3%
know they should have regular checkups with physicians. Besides this another study in Cracow
indicates that there is an association between knowledge about hypertension and blood pressure
screening (53, 54).

9
3. CONCEPTUAL FRAMEWORK
This conceptual framework below shows a relationship between socio demographic
characteristics, hypertension knowledge, Behavioral characteristics, History of chronic illnesses
and body mass index related factors with undiagnosed hypertension.

Socio demographic factors:-

- Age, Sex, Marital status and
Educational statues

Behavioral
Clinical related factors
Characteristics:-
Undiagnosed - Body mass index
- Alcohol drinking
- Family history of HPN
- Cigarette smoking
Hypertension
- History of DM
- Dietary habits
- History of CVD
- Physical exercise

Knowledge towards:-
- Good knowledge
- Moderate knowledge
- Poor knowledge

Figure 1: This conceptual framework adapted from different literatures

10
4. OBJECTIVES
4.1 General objective
 This study aimed that to assess undiagnosed hypertension and associated factors among
bank workers in Bahir Dar city, Northwest, Ethiopia, 2020
4.2 Specific objectives

 To determine the prevalence of undiagnosed hypertension among bank workers in Bahir

Dar city.
 To identify associated factors of undiagnosed hypertension among bank workers in Bahir
Dar city.

11
5. METHODS AND MATERIALS
5.1 Study area and period
5.1.1 Study area

A facility based cross-sectional study was conducted from February 24 to March 24, 2020 in the
bank workers in Bahir Dar city administration, Northwest Ethiopia. The city is located 565 km
northwest of Addis Abeba at the exit of the abbey from Lake Tana at an altitude of 1,800 meters
(5,900 ft) above sea level. Bahir Dar is the capital city of Amhara regional state found in west
gojam, comprises of the total population 750,991. From the total population 89.72% of the
population was Ethiopian Orthodox Christian, 8.47% was Muslim and 1.62% was Protestants
(55). The city has 2 governmental banks with 624 workers and 16 private banks with 995
workers.

5.1.2 Study period

 The study was conducted from February 24/2020 to March 24/2020.

5.2 Study design

 Institutional based cross sectional.

5.3 Source of population

 All bank workers in Bahir Dar city.

5.4 Study population

 All bank workers those who are working in the selected banks and those who were
available during the data collection period.

5.5 Eligibility criteria

5.5.1 Inclusion criteria

 Bank workers who have no previous diagnosis of hypertension and/or use of anti-
hypertensive medications were included in the study.
5.5.2 Exclusion criteria
 Female bank workers who are pregnant at the time of the study and Janitors were
excluded in the study.

12
5.6 Sample size determination
The sample size determination for first objective was calculated based on the prevalence of
undiagnosed hypertension among Residents (13.25%) which was taken from the study conducted
in Addis ababa, Gulele Sub-City in 2018 (45), within 5% marginal error and 95% confidence
interval of certainty (alpha = 0.05). Based on this assumption the actual sample size for the study
was calculated as below. Finally adding 10% non response rate and with design effect of 2. The
sample size was determined by using single population proportion formula:

n= za/22 p (1-p)

d2

Where: n = the required sample size

α = level of significance (0.05)

Z = the standard normal distribution with 95% CI (1.96)

P = prevalence of undiagnosed hypertension (13.25%)

d = margin of error (+5%) around P

 n= (1.96)2 0.1325(1-0.1325)/ (0.05)2 =177

 Adding 10% non response rate and with design effect of 2
 177*10= 195 then use design effect 195×2 = 390
 The total sample size= 390
For the second objective sample size was determined by using double population proportion
formula and two key factors were taken from the previous literature (44). According to the
following assumptions sample size was computed by Epi info version 7.2 software.

13
Table 1: Sample size calculation for different factors associated with undiagnosed hypertension
S.no Associated Assumptions The final
factors sample size
1 BMI (body mass Power = 80%, Ratio =1:1, Outcome in unexposed 524
index) group = 12.52%, AOR = 2.7, Outcome in exposed
group = 27.9% and adding 10% non response rate
and with design effect of 2.
2 Alcohol drinking Power = 80%, Ratio =1:1, Outcome in unexposed 338
group = 20.37%, AOR = 2.9, Outcome in exposed
group = 42.6% and adding 10% non response rate
and with design effect of 2.

Thus the required sample size of this study was determined by taking the maximum sample size
from the second objective (524). Therefore 524 bank workers were included in this study.

5.7 Sampling Procedure

Simple random sampling technique was used to select the study subjects. Bahir Dar city have 18
main district banks with a total of 1,697 workers. Firstly, nine out of 18 banks was selected by
using lottery method (which is 50% of the total banks) with a total of 916 workers. Then the
sample size was proportionally allocated. To allocate the sample size proportionally first the total
sample size was divided by the total population of all selected banks that means 524/916 = 0.57,
then the total population of each selected bank was multiplied by 0.57. To select the study
subjects from each selected bank, first the list of all selected bank workers was obtained from
each selected bank. Secondly each member was numbered or assigned in a sequential number.
Finally a total of 524 bank workers were selected by using random generator soft ware.

14
 Total 18 banks in Bahir Dar
city with a total of 1,697
workers

1. Commercial bank of Ethiopia (CBE) 10. Lion international bank (LIB)

2. Development bank of Ethiopia (DBE) 11. Zemen bank (ZB)
3. Awash international bank (AIB) 12. Oromia international bank (OIB)
4. Dashen bank (DB) 13. Berhan international bank (BIB)
5. Bank of Abyssinia (BOA) 14. Bunna international bank (BIB)
6. Wegagen bank (WB) 15. Abay international bank (AIB)
7. United bank (UB) 16. Addis international bank (AIB)
8. Nib international bank (NIB) 17. Debub international bank (DIB)
9. Cooperative bank of oromia (CBO) 18. Enat bank (EB)

Select 9 banks by using lottery method

DBE Abay IB Bank of Dashen Bunna United B Wogage Awash BIB

Abyssinia Bank IB n Bank IB
N=77 N=100 N=150 N=80
N=180 N=120 N=50 N=47 N=112

N=61 Population Proportion to size

3

n=44 n=57 n=103 n=68 n=29 n=86 n=27 n=64 n=46

Select a total of 524 bank workers from the total of 916

N= Total workers in the bank n= proportionally allocated sample size

Figure 2: Schematic representation of sampling procedure

15
5.8 Study Variables
5.8.1 Dependent variable

 Undiagnosed hypertension

5.8.2 Independent Variables

 Socio demographic variables

 Age, Sex, Religion, Marital status, Educational level, Job description and working
experience
 Knowledge towards hypertension
 Good, moderate and poor knowledge
 Behavioral characteristics
 Alcohol drinking, Cigarette smoking, Chat chewing, Dietary habits and Physical exercise
 Clinical related factors
 Family history of hypertension, History of diabetes mellitus, History of cardio vascular
problem, History of kidney problem and Body mass index

5.9 Operational definitions

Hypertension:- Two or more readings of systolic blood pressure measurement of 130 mm Hg or
higher or diastolic blood pressure measurement of 80 mm Hg or higher (1).
Undiagnosed Hypertension:- Individuals who were hypertensive but did not report having been
told by a doctor that they have hypertension (2).
Family history of hypertension:- Hypertension status among blood relatives (Father, Mother
and Grandfather and grandmother) (56).
Regular physical exercise:- Individual performing physical exercise at least 30 min of moderate
intensity dynamic aerobic exercise (walking, jogging, cycling or swimming) on 5–7 days/week
(57).
Risky alcohol drinking:- drinking of alcohol for women: greater than 7 drinks a week or 4 or
more drinks on any single occasion; Men: greater than 14 drinks a week or 5 or more drinks on
any single occasion (58).
Smoker:- Smoke cigarettes every day or some days (59).
Regular chat chewer:- Individuals who reported chat use for one or more days per week (59)

16
Low consumption of fruits:- Consumed <5 servings of fruits per day. (1serving=one orange/
apple/banana/peach/mango/grapes etc) (46).
Low consumption of vegetables:- Consumed <5 servings of vegetables per day. (1 serving=
three tablespoons of cooked vegetables) (46).
Knowledge:- The scores were classified into 3 levels (60).
1. Good knowledge: Knowledge score 80% and above
2. Moderate knowledge: Knowledge score between 60 and 79%
3. Poor knowledge: Knowledge score below 60%
Body mass index:- Body mass index is a statistical index using a person's weight and height to
provide an estimate of body fat in males and females of any age (61). WHO Classification of
BMI (62):-
1. Underweight - BMI less than 18.5 kg/m2
2. Normal weight - BMI between 18.5 - 24.9 kg/m2
3. Overweight - BMI between 25 - 29.9 kg/m2
4. Obesity - BMI 30 kg/m2 and above

5.10 Data collection procedure

Data was collected through self-administered structured questionnaires and physical
measurements of weight, height and blood pressure. The questionnaire is adapted from previous
similar studies and the WHO STEPS wise approach guidelines on NCD risk factor surveillance
questionnaire (53, 60, 63-73). It contains information about socio demographic characteristics,
behavioral characteristics, history of chronic illnesses, hypertension related knowledge questions.
And also, it contains weight, height and blood pressure measurements. For this purpose four BSc
nurse was recruited. Three nurses for data collection purpose and one nurse for supervision.
BP was measured based on 2017 Guideline for the Prevention, Detection, Evaluation and
Management of High Blood Pressure in Adults (74). Auscultatory method of BP measurement
was used. Two measurements were taken with a minimum of 15 minutes apart using left arm
consistently and the average of two BP measurements was used to determine the status of the
participant.
Firstly they were requested to avoid caffeine for 30 minutes prior to measurement. Participants
were seated quietly for 5 minutes in a chair with feet on the floor and right arm was bared and
supported at heart level. A standard sphygmomanometer and a standard stethoscope were used to
17
ensure accuracy. For manual determinations, palpated radial pulse obliteration pressure was used
to estimate systolic blood pressure (SBP), the cuff was inflated 20-30 mmHg above this level for
the auscultatory determinations; the cuff deflation rate for auscultatory readings was 2 mmHg
per second. SBP was recorded at the point at which the first of two Korotkoff sounds was heard
(onset of phase 1), and the disappearance of Korotkoff sound (onset of phase 5) was used to
define Diastolic Blood Pressure (DBP).
Weight was measured, in kilograms using a portable weighing scale with the subjects standing,
arms hanging naturally at the sides, without footwear material that may increase the body weight
of the participant. Height was measured, in meters, using a standiometer, to the crown of the
head, the subject standing without any footwear or headgear and looking straight ahead.
Then body mass index was calculated by using the formula (weight in Kg/ height in m2) and
classified based on the WHO classification (62).

5.11 Data processing and analysis

Each questionnaire was checked for completeness and missed values and then manually cleaned
up on such indications before living the study area. Data was coded and entered in to Epi Info
version 3.1. Data was cross checked for consistency and accuracy, after data clearing exported to
SPSS version 23 for statistical analysis. Descriptive statistics like frequency distribution,
percentages, tables, graphs and figures was employed to describe socio demographic, history of
chronic illnesses, body mass index, behavioral and knowledge variables. An association between
independent variables and dependent variables was analyzed first by using bivariable analysis to
identify factors eligible for multivariable analysis. All factors with a p-value < 0.2 at 95% CI in
the bivariable logistic regression analysis were included in the multivariable analysis. A
backward binary logistic regression model was used to identify factors associated with
undiagnosed hypertension.
Both Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with 95 % confidence interval
(CI) were used to show an association between undiagnosed hypertension and selected variables.
Variables having p-value ≤ 0.05 in the final model were assumed significant determinants.
Model fitness test was evaluated by the Hosmer and lemeshow goodness of fit test.

18
5.12 Data quality control
The data collection instrument was developed in English by investigator and translated to
Amharic and later back translated to English by language expert to ensure accuracy and desired
results. To evaluate the completeness, consistency and the applicability of the instruments one
week prior to the main field work, a pre-test was done among 52 bank workers in Debre Tabor
town. After conducting the pre test, data ambiguous or unclear questions was rephrased to make
it more understandable.
The weighing scales was checked and adjusted at zero level between each measurement and the
instrument was calibrated daily by known object. Height was measured by using standard non-
stretchable measuring tape. And also Blood pressure was measured by using a standard mercury
sphygmomanometer, with appropriate cuff size based on the basis of the circumference of the
participant‟s arm and participants who drank caffeine were made stay for 30 min before BP
measurement to ensure consistency and desired results. Multiple BP reading was obtained and all
the measurements were done in the study area. Data collectors were trained for two days before
actual data collection about data collection techniques and measurement procedures. Close
supervision was done by supervisor and principal investigator throughout the data collection
time.

5.13 Ethical consideration

Ethical clearance was obtained from ethical review committee of Bahir Dar University, College
of Medicine and Health Sciences and then formal letter was written by the department of adult
health nursing to the selected banks. During data collection time the aim of the study was
explained to study subjects. And also written informed consent was obtained from study
participants.
Data was collected unlinked anonymously, without any personal identifiers. Confidentiality of
the information was assured throughout the data collection process. There was no invasive
procedure performed to conduct this study, instead measuring of physical composition was
performed in addition to self administer questionnaires. This really consumed their time and to
some extent disturbed their participants. Participants with abnormal BP were advised regarding
appropriate medical care.

19
6. DISSEMINATION OF RESULTS
The finding of the research will be submitted to Bahir Dar University College of medicine and
health sciences department of adult health nursing, Bahir Dar city Administration, Amhara
regional health burro, Bahir Dar city banks and other responsible bodies. The result will be
presented at Bahir Dar University and in different seminars, meetings and workshops. Finally,
the findings will be published.

20
7. RESULT

7.1 Descriptive statistics

7.1.1 Socio-demographic characteristics of the study subjects
From 524 respondents, 513 respondents were complete the study with a 97.9% response rate. Of
the respondents 284 (55.4%) were age ranged from 20 to 34 years, with a mean age of 34.1 years
(SD±6.6), 394 (76.8%) were males, 293 (57.1%) were educated at degree, 309 (60.2%) were
married and 484 (94.3%) were Orthodox Christianity followers and 370 (72.1%) (Table 2).
Table 2: Socio-demographic characteristics of bank workers in Bahir Dar city, Northwest,
Ethiopia, 2020 (n=513)

Variables Frequency Percentage (%)

Age 20-34 284 55.4
35-44 217 42.3
≥45 12 2.3
Sex Male 394 76.8
Female 119 23.2
Marital status Single 194 37.8
Married 309 60.2
Divorced 10 1.9
Educational level High school 36 7
Diploma 40 7.8
Graduate 293 57.1
Post graduate 144 28.1
Job description Manager 38 7.4
Officer 380 74.1
Clerical 21 4.1
Guard 74 14.4
Working experience ≤ 10 years 370 72.1
>10 years 143 27.9

21
7.1.2 Knowledge of study participants about hypertension

Regarding the hypertension knowledge level, the majority 235(45.8%) of respondents had good
knowledge (figure 3).

11.30%

Good knowledge
45.80%
Moderate knowledge
Poor knowledge
42.90%

Figure 3: Hypertension knowledge status of bank workers in Bahir Dar city, Northwest,
Ethiopia, 2020 (n=513)

7.1.3 Behavioral characteristics of the study subjects

All study participants didn‟t smoke cigarette. Among study subjects eleven (2.1%) of
respondents were chewing chat, six (1.2%) and five (1%) of respondents were chewing chat
daily and weekends respectively. Three hundred thirty seven (65.7%) of respondents were drink
alcohol, two hundred ninety eight (58.1%) of respondents were eat fruits, four hundred seven
(79.3%) of respondents were eat vegetables and one hundred nineteen (23.2%) of respondents
were perform physical exercise (Table 3).

22
Table 3: Behavioral characteristics of bank workers in Bahir Dar city, Northwest, Ethiopia, 2020
(n=513).

Variables Frequency (N) Percentage (%)

Alcohol drinking Yes 337 65.7
No 176 34.3
Drinking amount Less than 1 drink 52 10.1
1-3 drinks 169 32.9
4-6 drinks 116 22.6
Eating fruits Yes 298 58.1
No 215 41.9
Frequency of eating fruit Daily 57 11.1
1-4 days/week 241 47
Serving of fruits 1-4 servings 262 51.1
≥5 servings 36 7
Eating vegetables Yes 407 79.3
No 106 20.7
Frequency of eating vegetable Daily 45 8.8
1-4 days/week 362 70.6
Serving of vegetables 1-4 servings 372 72.5
≥5 servings 35 6.8
Performing P/E Yes 119 23.2
No 394 76.8
Exercise frequency <5 days/week 43 8.4
≥5 days/week 76 14.8
Exercise duration <30 minutes 47 9.2
≥30 minutes 72 14

23
7.1.4 Clinical related characteristics

7.1.4.1 History of chronic illnesses

All study participants do not have history of cardiovascular disease, sixty five (12.7%) of
respondents have family history of hypertension, eleven (2.1%) of respondents have history of
diabetes mellitus and seven (1.4%) of respondents have history of kidney problem (Figure 4).
120
97.9 % 98.6 %
100
83 %
80
Percent

60
Yes
40
No
20 12.7 %
2.1 % 1.4 %
0
Family history of HPTN History of DM History of kidney problem
History of chronic illnesses

Figure 4: History of chronic illnesses among bank workers in Bahir Dar city, Northwest,
Ethiopia, 2020 (n=513).
7.1.4.2 Body mass index status
Regarding body mass index the majority 381(74.3%) of respondents have normal body mass
index (Figure 5).

80 74.3 %
70
60
50
Percent

40
30
18.5 %
20
10 4.7 % 2.5 %
0
Under Wt Normal Wt Over Wt Obese
Body mass index category

Figure 5: Body mass index status of bank workers in Bahir Dar city, Northwest, Ethiopia, 2020
(n=513).
24
7.1.5 Prevalence of undiagnosed hypertension

Blood pressure of the respondents was taken two times with a minimum of 15 minutes interval
and the average value was recorded. Out of 513 participants 127 (24.8%) was hypertensive with
(95% CI 21.1-28.5).

7.2 Factors associated with undiagnosed hypertension

All independent variables were analyzed in the bivariable analysis. Of all variables age, sex,
marital status, educational level, job description, hypertension knowledge, consuming
vegetables, performing regular physical exercise and body mass index were included in the
multivariable analysis, since they had P-value below 0.2. In the multivariable logistic regression
analysis age, sex, hypertension knowledge and performing regular physical exercise were
significantly associated with undiagnosed hypertension (P-values < 0.05).
Accordingly, respondents with age group of 35-44 were 2.56 times more likely to have
undiagnosed hypertension as compared with age group of 20-34 (AOR=2.560, 95% CI: 1.603-
4.088), males were 3.6 times more likely to have undiagnosed hypertension as compared with
females (AOR= 3.606, 95% CI: 1.844-7.051). Respondents those who had moderate knowledge
about hypertension 3.8 times more likely to have undiagnosed hypertension as compared with
those who had good knowledge with (AOR= 3.805, 95% CI: 2.285-6.338). And also respondents
those who had poor knowledge about hypertension 6.1 times more likely to have undiagnosed
hypertension as compared with those who had good knowledge with (AOR= 6.189, 95% CI:
3.069-12.479). The finding of this study also showed that bank workers those who had not
perform regular physical exercise 2.9 times more likely to have undiagnosed hypertension than
their counterpart with (AOR 2.914, 95% CI: 1.256-6.762) (Table 4).
Table 4: The bivariable and multivariable logistic regression analysis for factors associated with
undiagnosed hypertension among bank workers in Bahir Dar city, 2020

25
Variables Undiagnosed Hypertension
Yes No COR (95% CI) AOR (95% CI)
Age 20-34 48 (9.6) 236 (46) 1 1
35-44 74 (14.6) 143 (27.9) 2.544 (1.674-3.866)** 2.560 (1.603-4.088)**
≥45 5 (0.6) 7 (1.4) 3.512 (1.070-11.531)* 2.326 (0.627-8.634)
Sex Male 115 (22.4) 279 (54.4) 3.675 (1.948-6.935)**
3.606 (1.844-7.051)**
Female 12 (2.3) 107 (20.9) 1 1
Marital Single 39 (7.6) 155 (30.2) 0.252 (0.069-0.913) 0.465 (0.101-2.135)
status Married 83 (16.4) 226 (44.1) 0.367 (0.104-1.301) 0.538 (0.125-2.317)
Divorced 5 (0.8) 5 (1.0) 1 1
Educational H/school 6 (1.2) 30 (5.8) 0.502 (0.195-1.297) 0.346 (0.085-1.403)
level Diploma 6 (1.2) 34 (6.6) 0.443 (0.173-1.135) 0.544 (0.151-1.960)
Graduate 74 (14.4) 219 (42.7) 0.849 (0.543-1.328) 1.009 (0.584-1.745)
MSc 41 (8.0) 103 (20.1) 1 1
Job Manager 16 (3.1) 22 (4.3) 2.861 (1.213-6.746)* 2.032 (0.779-5.304)
description Officer 90 (18.5) 290 (55.4) 1.221 (0.661-2.256) 1.190 (0.598-2.369)
Clerical 6 (0.2) 15 (4.1) 1.573 (0.522-4.743) 2.292 (0.622-8.438)
Guard 15 (2.9) 59 (11.) 1 1
Knowledge Good 31 (6.0) 204 (39.8) 1 1
level Moderate 71 (13.8) 149 (29) 3.136 (1.956-5.026)** 3.805 (2.285-6.338)**
Poor 25 (4.9) 33 (6.4) 4.985 (2.622-9478)** 6.189 (3.069-12.479)**
Consuming Not consume 33 (6.4) 73 (14.2) 2.712 (0.966-7.614) 2.003 (0.645-6.216)
vegetables Low 89 (17.5) 283 (55.2) 1.887 (0.711-5.009) 1.559 (0.535-4.543)
Normal 5 (0.8) 30 (5.8) 1 1
Performing Yes 7 (1.4) 65 (12.7) 1 1
regular P/E No 120 (23.4) 321 (62.6) 3.471 (1.548-7.783)* 2.914 (1.256-6.762)*
BMI Under Wt 5 (0.6) 19 (4.1) 1 1
Normal Wt 94 (18.7) 287 (55.6) 1.245 (0.452-3.425) 0.710 (0.235-2.147)
Over Wt 22 (5.1) 73 (13.5) 1.145 (0.383-3.421) 0.780 (0.235-2.589)
Obese 6 (0.4) 7 (2.1) 3.257 (0.749-14.159) 1.272 (0.249-6.501)
*= P-value < 0.05, **= P-value <0.01

26
8. DISCUSSION
This study tried to assess the magnitude and factors associated with undiagnosed hypertension
among bank workers in Bahir Dar city.
The finding of this study showed that the magnitude of undiagnosed hypertension among bank
workers was found to be 24.8% with (95% CI 21.1-28.5). This finding is consistent with those of
studies done in Western Indian (26%), in Nigeria (25%), in a rural area of West Bengal (24.1%),
in Finland 24%, (30, 33, 40, 43).
However, this finding is higher than that of studies done in the Byblos Lebanon (16.9%), in India
(10.1%), in United States of America (19.7%), in Iran (4.8%), in Ghana (18.5%), in Hosanna
(10.2%), in Addis Ababa (13.25%) and Hawassa (12.3%) (23, 29, 37, 38, 43-46). This
discrepancy may be due to study subject differences. A job of bank employees is both sedentary
in nature and experience varying levels of mental stress to reduce the possibility of manual error
and are thus more prone for chronic diseases like hypertension (75). Besides this the new
Hypertension Guideline changes the definition of hypertension, which is now considered to be
any systolic BP measurement of 130 mm Hg or higher or any diastolic BP measurement of 80
mm Hg or higher (1). This new definition of hypertension contributes to increase the prevalence
of undiagnosed hypertension in the current study.
The prevalence of undiagnosed hypertension in this study was lower than that of studies
conducted in Bangladeshi (59.9%), in Nigeria (36.1%), in Central Province of Sri Lanka
(31.7%), in Ireland (41.2%), in Sudan (38.2%) and (39.4%) (27, 34-36, 38, 39). This discrepancy
may be due to the study subject and socio demographic differences, the current study was
conducted in the banking staff and the mean age of the respondents was 34.1±6.6. Whereas the
previous study conducted in Bangladeshi the study subjects was patients and age greater than 35
years (27), in Nigeria the mean age of the participants was 40±8.5 (34), in Ireland the
participants age was 50+ (36) and in Central Province of Sri Lanka the study subjects was only
males (35).
In the current study age, sex, hypertension knowledge and regular physical exercise were found
to be significantly associated with undiagnosed hypertension.
In our study age was statistically associated with undiagnosed hypertension. Respondents with
age group of 35-44 were 2.56 times more likely to have undiagnosed hypertension as compared
with age group of 20-34. This finding was supported by study done in Malaysia, in north central

27
Nigeria, in Sudan, in Hosanna and in Addis Ababa old age were observed to be significantly
associated with undiagnosed hypertension (22, 31, 38, 44, 45). It is known, increasing arterial
stiffness with increasing age, which will contribute to high prevalence of hypertension in the
older age group (76).
The current study showed that there is an association between sex and undiagnosed hypertension.
Male participants were three point six times more likely to have undiagnosed hypertension as
compared with females. This finding was supported by the previous studies conducted in
Bangladeshi and North West of Iran (27, 48). The American journal of hypertension indicates
that women had a higher rate of getting their BP checked than men (77). And also, Men have
greater increases in blood pressure compared with women (47). The possible reasons may be due
to females getting frequent health services like family planning, antenatal care, delivery and
immunization and have to visit health professionals. Nonetheless, this creates an opportunity to
get diagnosed with some typical health screening, including hypertension. So, females were
likely to have lower risks of being undiagnosed for hypertension. And also, it may be due to the
presence of coexisting risk factors in males like alcohol drinking.
In the current study respondent‟s knowledge was significantly associated with undiagnosed
hypertension. This finding was supported by the study conducted in rural Rwanda and Cracow
(53, 54). Respondents those who had moderate knowledge three point eight times more likely to
have undiagnosed hypertension as compared with those who had good knowledge. And also,
respondents those who had poor knowledge were six point one times more likely to have
undiagnosed hypertension as compared with those who had good knowledge. The possible
reason may be due to the respondents with greater hypertension knowledge have better healthy
life style and health-seeking behavior regarding to hypertension.
The current study also revealed that there is an association between undiagnosed hypertension
and regular physical exercise. Respondents who did not perform regular physical exercise were
two point one times more likely to have undiagnosed hypertension than those respondents who
perform regular physical exercise. This finding was supported by the previous study conducted
in Hawassa (46). It is known, physical exercise lowers blood pressure by reducing blood vessel
stiffness (78). The possible barriers in performing regular physical exercise among bank workers
may be due to the shortage of spare time or lack of desire or not convinced of the benefits.

28
9. STRENGTH AND LIMITATION OF THE STUDY
9.1 Strength of the study
 During the study time, health education was given by investigator for each of the study
participants about the benefits of regular blood pressure checkup and the risk of
undiagnosed hypertension.
9.2 Limitations of the study
 The study was conducted in an institution and this limits the generalizability of the
finding to the whole population.
 There was no pregnancy test for female participants and early pregnancy that cannot be
noticed by participants and data collectors was difficult to differentiate.
 Community-based research on undiagnosed hypertension and associated factors should
also be carried out as a comparison with the results of this institutional-based study.

29
10. CONCLUSION AND RECOMMENDATION
10.1 Conclusion
Undiagnosed hypertension was high in this study; this result showed that many bank workers
could have hypertension without being aware of it. Age group of 35-44 years, being male,
having moderate and poor knowledge and also being physically inactive were significantly
associated with undiagnosed hypertension.
10.2 Recommendation

 Recommendation to Amahra Regional Health bureau:-Better to Mobilize different

media to create proper health awareness about hypertension screening.
 Recommendation to policy maker:- Should continuously conduct periodically survey
for screening and early detection, treatment and control for hypertensive case in the
working place.
 Recommendation to Bahir Dar city administration:- Should work collaboratively
with nearby health facilities and health care professionals by arranging health education
program to improve hypertension knowledge status among bank workers.
 Recommendation to Bank workers:- Should check your blood pressure nearby health
institution at least one or two times within a week and do regular physical exercise at
least for 20-30 minutes per day.

30
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65. Hazar Kanj1 AK, Mikhael Kossaify2 and Antoine Kossaify3 Predictors of Undiagnosed
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12. ANNEXS

Annex A: Structured questionnaires of English version

BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

Section I. Information sheet

1. Name of the study area _________

2. Questionnaire identification no _______

Good morning/afternoon? My name is I am data collector for the research

conducted by Bahir Dar University College of medicine and health Science Msc adult health
nursing student. Before we go to our discussion, I will request you to listen carefully to, what I
am going to read to you about the purpose and general condition of the study, and you will tell
me whether you agree or disagree to be administer the questioner at the end. The purpose of this
questionnaire gathers information to assess the prevalence of undiagnosed hypertension and
associated factors among bank workers in Bahir Dar city.
I have identified you as a study participant hoping that you would be willing to help me by
providing some information. The questionnaire contains socio-demographic characteristics,
behavioral characteristics, history of chronic illnesses, knowledge towards hypertension, weight,
height and blood pressure measurement. All information you provide will be kept confidential. I
will not include any identifiers, such as your name or exact address. Only honest answers would
contribute to the improvement of health planning, your role in the success of the research is
important and I appreciate your contribution to the research.
Would this be okay for you?

A. Yes B. No

38
2. Section II. Consent form
I the undersigned have been informed about the purpose of this particular research project. I have
been informed that I am going to respond to this question by answering what I know concerning
the issue. I have been informed that the information I give will be used only for the purpose of
this study and my identity as well as the information I give will be treated confidentially. I have
also been informed that I can refuse to participate in the study or not to respond to questions if I
am not interested. Furthermore I have been informed that I can stop Responding to the questions
at any time in the process. Based on the above information I agree to participate in this research
voluntarily.

Signature: _________

Date: ______________

If respondent agrees to be administer the questioner

Code __________

Date of data collection--------------------------

Name of data collector--------------------------signature--------------------

Name of supervisor------------------------------signature--------------------

Instruction
Dear participant please read each questions and answer carefully. It is important that you answer
every question. For each questions there are alternative choices please circle the choice that best
describes you and for questions that do not have choices please write your answer on the space
provided given under the response category.

39
3. Section III. Questionnaires
Structured questionnaires to assess the prevalence of undiagnosed hypertension and associated
factors among bank workers in Bahir Dar city, 2020 G.C.

Data collector full name-----------------------------sign--------------- Date------------------

Instruction:- I request you kindly to go through each question and encircle your answer.
Part I. Socio demographic characteristics
No Variable Response
101 Age in year
-------------- years old
102 Sex 1. Male
2. Female
103 Marital status 1. Never married
2. Married
3. Divorced
4. Widowed
104 Religion 1. Orthodox Christian
2. Muslim
3. Catholic
4. Protestant
5. Other specify---------------
105 Educational level?
--------------------
106 Your job description in this bank? --------------------
107 Working experience?

-------------------Months/Years
Part II. Knowledge towards Hypertension
A. Knowledge towards the causation of Hypertension

40
201 Eating diet rich in salt can cause 1. Yes
Hypertension. 2. No
3. Don‟t know
202 Being overweight can cause Hypertension. 1. Yes
2. No
3. Don‟t know
203 Anxiety or anger can cause Hypertension. 1. Yes
2. No
3. Don‟t know
204 Too much drinking of alcohol can cause 1. Yes
Hypertension. 2. No
3. Don‟t know
205 Smoking cigarette can cause Hypertension. 1. Yes
2. No
3. Don‟t know
206 Hypertension will occur genetically. 1. Yes
2. No
3. Don‟t know
B. knowledge towards the signs and symptoms of Hypertension
207 Headache is the symptoms of 1. Yes
Hypertension. 2. No
3. Don‟t know
208 Dizziness is the symptoms of 1. Yes
Hypertension. 2. No
3. Don‟t know
209 Shortness of breath is the symptoms of 1. Yes
Hypertension. 2. No
3. Don‟t know
210 Palpitation is the sign and symptoms of 1. Yes
Hypertension. 2. No

41
 3. Don‟t know

C. Knowledge towards prevention of Hypertension

211 Exercising regularly could prevent 1. Yes
Hypertension. 2. No
3. Don‟t know
212 Monitoring of blood pressure is very 1. Yes
important in order to prevent high blood 2. No
pressure. 3. Don‟t know
213 Reducing stress level could prevent 1. Yes
Hypertension. 2. No
3. Don‟t know
214 Eating fruits and vegetables could prevent 1. Yes
Hypertension. 2. No
3. Don‟t know
215 Reducing the amount of salt intake could 1. Yes
prevent Hypertension. 2. No
3. Don‟t know
D. Knowledge towards complication of Hypertension
216 Hypertension con cause heart diseases, if 1. Yes
left untreated. 2. No
3. Don‟t know
217 Hypertension can cause visual impairment, 1. Yes
if left untreated. 2. No
3. Don‟t know
218 Hypertension can cause Stroke, if left 1. Yes
untreated. 2. No
3. Don‟t know
219 Hypertension can cause kidney failure, if 1. Yes
left untreated. 2. No

42
 3. Don‟t know

220 Hypertension can cause premature death, if 1. Yes

left untreated. 2. No
3. Don‟t know
E. Knowledge towards Hypertension treatment methods
221 Herbal medications used to control 1. Yes
hypertension. 2. No
3. Don‟t know
222 Chemical drugs used to control 1. Yes
hypertension. 2. No
3. Don‟t know
223 Taking healthy diet used to control 1. Yes
hypertension. 2. No
3. Don‟t know
224 Minimizing stress used to control 1. Yes
hypertension. 2. No
3. Don‟t know
225 Smoking and alcohol cessation used to 1. Yes
control hypertension. 2. No
3. Don‟t know
226 Performing regular exercise used to control 1. Yes
hypertension. 2. No
3. Don‟t know
Part III. Behavioral characteristics
A. Cigarette smoking
301 Do you smoke cigarettes? 1. Yes
2. No

Note: If your answer is No for question number 301 go to question number 303

43
302 How frequently do you smoke? 1. Daily
2. Once /wk
3. 2 -3 days/wk
4. 4-5 days/wks
5. Other specify----------------

303 During the time of smoking how many 1. 1 or less cigarette

cigarettes do you smoke? 2. 2-5 cigarettes
3. 6-10 cigarettes
4. 11 and more cigarettes
B. Khat chewing
304 Do you have a habit of Khat chewing? 1. Yes
2. No
Note: If your answer is No for question number 304 go to question number 306
305 How frequently do you chewing the khat? 1. Daily
2. Most week days
3. Weekends only
4. On occasions
C. Alcohol drinking
306 Do you drink alcohol? 1. Yes
2. No
Note: If your answer is No for question number 306 go to question number 309
307 How often do you take alcoholic drinks? 1. Daily
2. 5-6 days per week
3. 1-4 days per week
4. 1-3 days per week
5. Other specify---------------
308 On average, how much do you usually 1. Less than one drink
drink alcohol? (one portion of alcohol is 2. One to three drinks
having at least 1 glass of wine, 1 bottle of 3. Four to six drinks
beer, a 50g of ouzo) 4. Seven or more drinks

44
D. Dietary history

309 Do you eat fruits? 1. Yes

2. No
Note: If your answer is No for question number 309 go to question number 312
310 In a typical week, on how many days do 1. Daily
you eat fruit? 2. 1- 4 days per week
311 How many servings of fruits do you eat on 1. 1- 4 serving of fruits
one of those days? (1 serving= one orange/ 2. 5 or more servings of fruits
apple/banana/peach/mango/grapes etc).
312 Do you eat vegetables? 1. Yes
2. No
Note: If your answer is No for question number 312 go to question number 315
313 In a typical week, on how many days do 1. Daily
you eat vegetables? 2. 1- 4 days per week
314 How many servings of vegetables do you 1. 1- 4 serving of vegetables
eat on one of those days? (1 serving= three 2. 5 or more servings of vegetables
tablespoons of cooked vegetables)
E. Physical activity

315 Do you perform regular physical exercise? 1. Yes

2. No
Note: If your answer is No for question number 315 go to question number 401
316 What type of exercise do you perform? 1. Walking
2. Jogging
3. Cycling
4. Swimming
317 How often do you exercise? 1. < 5 days per week
2. ≥ 5 days per week
318 For how many minutes do you exercise per 1. <30 minutes
session? 2. ≥30 minutes

45
Part IV. History of chronic illness
401 Do you have family history of 1. Yes
hypertension? 2. No
3. I don‟t know
Note: If your answer is No or Don’t know for question number 401 go to question number 403
402 Who is your family? 1. Father
2. Mother
3. Grand father
4. Grand mother
403 Have you ever been told by a doctor that 1. Yes
you have diabetes mellitus? 2. No
404 Have you ever been told by a doctor that 1. Yes
you have cardiovascular problem? 2. No
405 Have you ever been told by a doctor that 1. Yes
you have kidney problem? 2. No

Part V. Body Mass Index and Blood Pressure level

A. Height and Weight
501 Weight
--------------------------kg
502 Height
--------------------------Meter
503 BMI level
-------------------------kg/m2
B. Blood Pressure level
504 First blood pressure measurement
Systolic--------------mmHg

Diastolic------------ mmHg
505 Second blood pressure
Systolic--------------mmHg

46
 Diastolic-------------mmHg
506 Average blood pressure
Systolic--------------mmHg

Diastolic-------------mmHg

WE THANK YOU FOR THE FULL COOPRERATION!

SUPPERVISOR NAME------------------------- SIGNATURE--------------DATE----------------

47
Annex B: መጠይቅ በአማርኛ

ባህርዳር ዩኒቨርሲቲ

ህክምናና ጤናሣይንስ ኮሌጅ

የአዋቂዎች ጤና ነርሲንግ ትምህርት ክፍል

ክፍሌ አንዴ :- የመረጃ መስጫ ቅጽ

1. መረጃ የሚሰበሰብበት ቦታ------------------

2. የመጠየቂያ መሇያ ቁጥር--------------------

እንዯምን አዯሩ/ዋለ ስሜ ÃvLM uባህርዲር ዩኒቨርሲቲ በነርሲንግ ትምህርት ክፍሌ

አስተባባሪነት ¾Te}`e Ç=Ó] }T]ª ሇምታዯርገዉ ጥናት S[Í እየሰበሰብኩ እገኛሇሁ፡፡ ሇዚህም S[Í
እንዱተባበሩኝ በትህትና እጠይቃሇሁ፡፡ ወዯ S[Í ከመግባታችን በፊት ስሇጥናቱ አሊማ ስሇማነብልት በጥሞና
እንዱያዲምጡኝ እጠይቃሇሁ፡፡ በመጨረሻም በጥናቱ ሇመሳተፍ መስማማትዎን ወይም አሇመስማማትዎን ይነግሩኛሌ፡፡
የዚህ ጥናት አሊማ ስሊሌተመረመረ የዯም ግፊት ስርጭት እና ተዛማጅ ችግሮች KTØ“ƒ ’¨<:: ÃI” ›LT
KTd"ƒ ¾`c- ÁM}qÖu }dƒö u×U ›eðLÑ>’¨<::
በዚI SÖÃp LÃ የስነሕዝብ እና ማህበራዊ ሁኔታ ፣ ስሇ አኗኗር ሁኔታ ፣ ካሁን በፊት ስሇታዎቁ በሽታዎች ፣
eKÅUÓòƒ እዉቅነ ጥያቄዎችን ¾Á² c=J” u}ÚT]U የቁመት ፣ የክብዯት እንዱሁም የዯም ግፊት መጠን
ሌኬታን የያዘ ነዉ:: ULi- uõèU T>eØ^©’~ ¾}Öuk ’¨<:: eS-U J’ ›É^h- u²=I
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ÁeÅe}—M ¾T>K<ƒ” ULi dÃJ” ƒ¡¡K—¨<”“ `c- ÁS’<uƒ” ULi u=cÖ<
Áሌተመረመረ የዯም ግፊት ስርጭት ከተዛማጅ ችግሮች Ò` ÁL†¨<” l`˜ƒ ¾uKÖ KS[ǃ እና
K¨Åòƒ Ø“ƒ KT>ያ>Å[Ñ< ¾}KÁ¿ ›"Lƒ eKT>ÖpS< KT>Å[ÓM” ƒww` ምስጋና‹”
Ÿõ ÁK ’¨<::
SÖÃl” KSS<Lƒ ðnÅ— ’­ƒ?

G. ›¨ K. ›ÃÅKG<U

48
ክፍሌ ሁሇት ፡- የፍቃዯኝነት መጠየቂያ ቅጽ

ከታች ፊርማዬን ያኖርኩት እኔ የጥናቱ አሊማ የተነገረኝ ሲሆን ሇምሰጠዉ ጥያቄ የማዉቀዉን ሇመመሇስ እንዯምችሌ፡
እኔ የምሰጠዉ መረጃ ሇዚህ ጥናት አገሌግልት ብቻ የሚዉሌ ሲሆን ስሜና የምሰጠዉ መረጃ በሚስጥር
እንዯሚጠበቅ ተነግሮኛሌ፡፡ በተጨማሪም ፍሊጎት ከላሇኝ በጥናቱ ያሇመሳተፍ እና ጥያቄዉን በምሞሊበት ወቅት
አsርጨ መተዉ እንዯምችሌ ተነግሮኛሌ በዚህ መሰረት ጥናቱ ሊይ ሇመሳተፍ ፈቃዯኛ ሇመሆኔ በፍሪማዬ
አረጋግጣሇሁ፡፡

ቀን -------------------

ፊርማ ---------------

SÖÃl” KSS<Lƒ ፈቃዯኛ ከሆኑ

¾ØÁo SKÁ--------------------

k”----------------------

¾S[Í cwdu=¬ eU-------------------------------------ò`T---------------k”---------------

¾c<ø`zò` eU-----------------------------------------ò`T----------------k”---------------

መመሪያ

ተሳታፊወች እባከወን ጥያoወችን አንብበዉ መሌስ ይሆናሌ የሚለትን መርጠዉ ያክብቡ ምክያቱም የያንዲንደ መሌስ
ጠቀሜታ ስሊሇዉ ሇእያንዲንደ ጥያo አማራጮች ተዘርዝረዋሌ ከዝርዝሩ ዉስጥ የሚስማማዎት መሌስ ከሇሇ እባከዎን ባድ
ቦታዉ ሊይ የራስዎትን መሌስ ይፃፉ፡፡

49
ክፍሌ ሶስት ፡- መጠይቆች

በባህርዲር ከተማ ባንክ ቤቶች ሊይ በሚሰሩ ሰራተኞች ሊይ ያሌተመረመረ የዯም ግፊት ያሇዉን የስርጭት መጠን እና
ተዛማጅ ችግሮችን ሇመሇየት የቀረበ መጠይቅ 2012 ዓ.ም

ጥናትና ምርምሩን የሚያካሂዯው ሰው ሙለ ስም: ----------------------------------ፊርማ------------ቀን-----------

መመሪያ ፡-ጥያቄዎቹን አንብበዉ ከተረደ በኋሊ መሌስዎን ያክብቡ

ክፍሌ 1. የስነ ሕዝብ እና ማህበራዊ ጉዲዮች

ተራ ጥያቄ አማራጭ መሌስ

ቁጥር

101 እዴሜ

-----------አመት

102 ፆታ 1. ወንዴ

2. ሴት

103 የጋብቻ ሁኔታ 1. ያሊገባ /ያሊገባች

2. ያገባ/ያገባች

3. የፈታ/የፈታች

4. የሞተችበት/የሞተባት

104 ሐይማኖት 1. ኦርቶድክስ ክርስቲያን

2. ሙስሉም

3. ካቶሉክ

4. ፕሮቴስታንት

5. ላሊ ካሇ ይጥቀሱ-----------------

105 የትምህርት ዯረጃ

--------------------------

50
106 በዚህ ባንክ ቤት ውስጥ ያሇዎት የስራ ዴርሻ ምንዴን

ነዉ? -------------------------

107 የአገሌግልት ዘመን

-----------------------ዓመት

ክፍሌ 2. ስሇዯም ግፊት ያሇዎት እዉቅና

ሀ. የዯም ግፊትን ስሇሚያመጡ ነገሮች ያሇዎት እዉቅና

201 ጨዉ የበዛበት ምግብ መመገብ ሇዯምግፊት ያጋሌጣሌ፡፡ 1. ያጋሌጣሌ

2. አያጋሌጥም

3. አሊዉቅም

202 ከሌክ በሊይ የሆነ ዉፍረት ሇዯም ግፊት ያጋሌጣሌ፡፡ 1. ያጋሌጣሌ

2. አያጋሌጥም

3. አሊዉቅም

203 ከሌክ በሊይ የሆነ ጭንቀት ወይም ብስጭት ሇዯም ግፊት 1. ያጋሌጣሌ

ያጋሌጣሌ፡፡ 2. አያጋሌጥም

3. አሊዉቅም

204 ከሌክ በሊይ የሆነ አሌኮሌ መጠጣት ሇዯም ግፊት 1. ያጋሌጣሌ

ያጋሌጣሌ፡፡ 2. አያጋሌጥም

3. አሊዉቅም

205 ሲጋራ ማጨስ ሇዯም ግፊት ያጋሌጣሌ፡፡ 1. ያጋሌጣሌ

2. አያጋሌጥም

3. አሊዉቅም

206 የዯም ግፊት በዘር ይተሊሇፋሌ፡፡ 1. ይተሊሇፋሌ

2. አይተሊሇፍም

3. አሊዉቅም

51
ሇ. የዯም ግፊት በሽታ ስሇሚያሳያቸዉ ስሜቶች እና ምሌክቶች ያሇዎት እዉቅና

207 የራስ ምታት አንደ የዯም ግፊት በሽታ ስሜት ነዉ፡፡ 1. ነዉ

2. አይዯሇም

3. አሊዉቅም

208 ራስ ማዞር አንደ የዯም ግፊት በሽታ ስሜት ነዉ፡፡ 1. ነዉ

2. አይዯሇም

3. አሊዉቅም

209 የትንፋሽ ማጠር አንደ የዯም ግፊት በሽታ ስሜት እና 1. ነዉ

ምሌክት ነዉ፡፡ 2. አይዯሇም

3. አሊዉቅም

210 ፈጣን የሌብ ምት አንደ የዯም ግፊት በሽታ ስሜት እና 1. ነዉ

ምሌክት ነዉ፡፡ 2. አይዯሇም

3. አሊዉቅም

ሐ. ስሇ ዯም ግፊት መከሊከያ ዘዳዎች ያሇዎት እዉቅና

211 ተከታታይ የሆነ የአካሌ ብቃት እንቅስቃሴ ማዴረግ የዯም 1. ይከሊከሊሌ

ግፊትን ይከሊከሊሌ፡፡ 2. አይከሊከሌም

3. አሊዉቅም

212 የዯም ግፊት ምርመራ ማዴረግ ከፍተኛ የሆነ 1. ይጠቅማሌ

የዯምግፊትን ሇመከሊከሌ ይጠቅማሌ፡፡ 2. አይጠቅምም

3. አሊዉቅም

213 ጭንቀትን መቀነስ የዯም ግፊትን ይከሊከሊሌ፡፡ 1. ይከሊከሊሌ

2. አይከሊከሌም

3. አሊዉቅም

214 አትክሌት እና ፍራፍሬ አዘዉትሮ መመገብ የዯም ግፊትን 1. ይከሊከሊሌ

ይካሇከሊሌ፡፡ 2. አይከሊከሌም

52
 3. አሊዉቅም

215 ጨዉ የበዛበት ምግብ አሇመመገብ የዯም ግፊትን 1. ይከሊከሊሌ

ይከሊከሊሌ፡፡ 2. አይከሊከሌም

3. አሊዉቅም

መ. የዯም ግፊት ስሇሚያመጣዉ የጎንዮሽ ጉዲት ያሇዎት እዉቅና

216 የዯም ግፊት ካሌታከመ የሌብ በሽታ ያመጣሌ፡፡ 1. ያመጣሌ

2. አያመጣም

3. አሊዉቅም

217 የዯም ግፊት ካሌታከመ የእይታ ችግር ያመጣሌ፡፡ 1. ያመጣሌ

2. አያመጣም

3. አሊዉቅም

218 የዯም ግፊት ካሌታከመ የአንጎሌ ጥቃት ያመጣሌ፡፡ 1. ያመጣሌ

2. አያመጣም

3. አሊዉቅም

219 የዯም ግፊት ካሌታከመ የኩሊሉት ስራ ማቆም ያመጣሌ፡፡ 1. ያመጣሌ

2. አያመጣም

3. አሊዉቅም

220 የዯም ግፊት ካሌታከመ ሞት ያመጣሌ፡፡ 1. ያመጣሌ

2. አያመጣም

3. አሊዉቅም

ሠ. ስሇ ዯም ግፊት የህክምና ዘዳዎች ያሇዎት እዉቅና

221 የባህሌ መዴሀኒት መዉሰዴ የዯም ግፊትን ሇመቆጣጠር 1. ይጠቅማሌ

ይጠቅማሌ:: 2. አይጠቅምም

3. አሊዉቅም

222 የኬሚካሌ መዴሀኒት መዉሰዴ የዯም ግፊትን 1. ይጠቅማሌ

53
 ሇመቆጣጠር ይጠቅማሌ:: 2. አይጠቅምም

3. አሊዉቅም

223 ጤናማ የሆነ ምግብ መመገብ የዯም ግፊትን ሇመቆጣጠር 1. ይጠቅማሌ

ይጠቅማሌ፡፡ 2. አይጠቅምም

3. አሊዉቅም

224 ጭንቀትን መቀነስ የዯም ግፊትን ሇመቆጣጠር 1. ይጠቅማሌ

ይጠቅማሌ፡፡ 2. አይጠቅምም

3. አሊዉቅም

225 ሲጋራ እና አሌኮሌ ማቆም የዯም ግፊትን ሇመቆጣጠር 1. ይጠቅማሌ

ይጠቅማሌ፡፡ 2. አይጠቅምም

3. አሊዉቅም

226 ተከታታይ የሆነ የአካሌ ብቃት እንቅስቃሴ ማዴረግ የዯም 1. ይጠቅማሌ

ግፊትን ሇመቆጣጠር ይጠቅማሌ፡፡ 2. አይጠቅምም

3. አሊዉቅም

ክፍሌ 3. የአኗኗር ዘይቤ

ሀ. ሲጋራ ማጨስ

301 ሲጋራ ያጨሳለ? 1. አዎ

2. አሊጨስም

መመሪያ፡ ሇጥያቄ ቁጥር 301 መሌሰወ አሊጨስም ከሆነ ወዯ ጥያቄ ቁጥር 304 ይቀጥለ

302 በየስንት ጊዜው ያጨሳለ? 1. በየቀኑ

2. በሳምንት አንዴ ጊዜ

3. በሳምንት ከ 2-3 ቀን

4. በሳምንት ከ 4-5 ቀን

5. ላሊ ካሇ ይጥቀሱ-----------------

54
303 በሚያጨሱበት ሰአት ምን ያህሌ ሲጋራ ያጨሳለ? 1. 1 እና ከዚያ በታች
2. ከ 2-5 ሲጋራ
3. ከ 6-10 ሲጋራ
4. 11 እና ከዚያ በሊይ
ሇ. ጫት መቃም
304 ጫት የመቃም ሌምዴ አሇዎት? 1. አዎ

2. የሇኝም

መመሪያ፡ ሇጥያቄ ቁጥር 304 መሌስወ የሇኝም ከሆነ ወዯ ጥያቄ ቁጥር 306 ይቀጥለ

305 በየስንት ጊዜው ይቅማለ? 1. በየቀኑ

2. አብዛኛዉን የሳምንት ቀናት
3. በየሳምንቱ
4. አሌፎ አሌፎ
ሐ. የአሌኮሌ መጠጥ

306 የአሌኮሌ መጠጥ ይጠጣለ? 1. አዎ

2. አሌጠጣም

መመሪያ፡ ሇጥያቄ ቁጥር 306 መሌስወ አሌጠጣም ከሆነ ወዯ ጥያቄ ቁጥር 309 ይቀጥለ

307 በየስንት ጊዜው ይጠጣለ? 1. በየቀኑ

2. በሳምንት ከ 5-6 ቀን

3. በሳምንት ከ 1-4 ቀን

4. በሳምንት ከ 1-3 ቀን

5. ላሊ ካሇ ይጥቀሱ-----------------

308 በአማካይ ምን ያህሌ ይጠጣለ? መገሇጫ፡- አንዴ መጠን 1. አንዴ መጠን

የሚባሇዉ ቢያንስ 1ብርጭቆ ወይን፣ 1ጠርሙስ ቢራ፣
2. ከ1-3 መጠን
ወይም 50 ሲሲ ኡዞ፣ ጂን የመሳሰለ አሌኮልች ማሇት
3. ከ 4-6 መጠን
ነዉ፡፡
4. ከ7 መጠን በሊይ

መ. የአመጋገብ ታሪክ

55
309 ፍራፍሬ ይመገባለ? 1. አዎ
2. አሌመገብም
መመሪያ፡ ሇጥያቄ ቁጥር 309 መሌስወ አሌመገብም ከሆነ ወዯ ጥያቄ ቁጥር 312 ይቀጥለ
310 በሳምንት ምን ያህሌ ቀን ይመገባለ? 1. በየቀኑ

2. በሳምንት ከ 1-4 ቀን

311 በሚመገቡበት ሰአት ስንት የፍራፍሬ አይነት ይመገባለ? 1. ከ1- 4 የፍራፍሬ አይነት
( አንዴ የፍራፍሬ አይነት= አንዴ ብርቱካን/አፕሌ/ሙዝ/ 2. 5 እና ከዚያ በሊይ የፍራፍሬ አይነት
ዎይን/ኮክ እና የመሳሰለት).
312 አትክሌት ይመገባለ? 1. አዎ
2. አሌመገብም
መመሪያ፡ ሇጥያቄ ቁጥር 312 መሌስወ አሌመገብም ከሆነ ወዯ ጥያቄ ቁጥር 315 ይቀጥለ
313 በሳምንት ምን ያህሌ ቀን ይመገባለ? 1. በየቀኑ

2. በሳምንት ከ 1-4 ቀን

314 በሚመገቡበት ሰአት ስንት የአትክሌት አይነት ይመገባለ? 1. ከ1- 4 የአትክሌት አይነት
(አንዴ የአትክሌት አይነት=ሶስት የሾርባ ማንኪያ 2. 5 እና ከዚያ በሊይ የአትክሌት አይነት
የተዘጋጁ አትክሌቶች).
ሠ. የአካሌ ብቃት ዕንቅስቃሴ

315 የአካሌ ብቃት እንቅስቃሴ ያዯርጋለ? 1. አዎ

2. አሊዯርግም

መመሪያ፡ ሇጥያቄ ቁጥር 315 መሌስወ አሊዯርግም ከሆነ ወዯ ጥያቄ ቁጥር 401 ይቀጥለ

316 ምን አይነት እንቅስቃሴ ያዯርጋለ? 1. እርምጃ

2. ሶምሶማ

3. ብስክላት መንዲት

4. ዉሀ ዋና

317 በየስንት ጊዜዉ እንቅስቃሴ ያዯርጋለ? 1. በሳምንት ከአምስት ቀን በታች

2. በሳምንት አምስት ቀን እና ከጊዜ በሊይ

318 በሚንቀሳቀሱበት ጊዜ ሇምን ያህሌ ዯቂቃ ይንቀሳቀሳለ? 1. ከ30 ዯቂቃ በታች

56
 2. 30 ዯቂቃ እና ከዚያ በሊይ

ክፍሌ 4. ካሁን በፊት የታዎቁ በሽታዎች

401 የዯም ግፉት በሽታ በቤተሰብዎ አሇበወት? 1. አዎ

2. የሇብኝም

3. አሊዉቅም

መመሪያ፡ ሇጥያቄ ቁጥር 401 መሌስወ የሇብኝም ወይም አሊዉቅም ከሆነ ወዯ ጥያቄ ቁጥር 403 ይቀጥለ

402 ቤተሰብዎት ማን ነዉ? 1. አባት

2. እናት

3. ወንዴ አያት

4. ሴት አያት

403 እርሰዎ በህክምና የተረጋገጠ የስኳር በሽታ አሇብዎት? 1. አዎ

2. የሇብኝም

404 እርሰዎ በህክምና የተረጋገጠ የሌብ በሽታ አሇብዎት? 3. አዎ

4. የሇብኝም

405 እርሰዎ በህክምና የተረጋገጠ የኩሊሉት በሽታ አሇብዎት? 5. አዎ

6. የሇብኝም

ክፍሌ 5. የሰዉነት አቋም መጠን እና የዯም ግፊት መጠን ሌኬታ

ሀ. የክብዯት እና የቁመት መጠን

501 ክብዯት

-----------------------ኪል ግራም

502 ቁመት

------------------------ሜትር

503 የሰዉነት አቋም መጠን

------------------------ኪ.ግ/ሜ2

57
ሇ. የዯም ግፊት መጠን

504 የመጀመሪያው የዯም ግፊት መጠን

ሲስቶሉክ---------ሚሉ ሜትር ሜርኩር

ዱያስቶሉክ--------ሚሉ ሜትር ሜርኩር

505 ሁሇተኛ የዯም ግፊት መጠን

ሲስቶሉክ---------ሚሉ ሜትር ሜርኩር

ዱያስቶሉክ--------ሚሉ ሜትር ሜርኩር

506 አማካኝ የዯም ግፊት መጠን

ሲስቶሉክ---------ሚሉ ሜትር ሜርኩር

ዱያስቶሉክ--------ሚሉ ሜትር ሜርኩር

ሊዯረጉሌኝ ሙለ ተሳትፎ በጣም አመሰግናሇሁ

መጠየቁ በትክክሌ መሞሊቱን የተከታተሇው ሰው ስም ---------------------------------ፊ ር ማ -------ቀን ---------

58