SCHOOL OF MEDICINE

UNDIAGNOSED HYPERTERNSION AMONG MARKET WOMEN IN THE MUNICIPAL

MARKET IN ELDORET KENYA.

1
 DECLARATION

We confirm that this is our original work.

NAME REG.NO. SIGNATURE

1. Phoebe waswa MED/1032/08 ---------------------

2. Angela Wainaina MED/41/08 ----------------------

3. PraxidesPessa MED/37/08 ----------------------

4. Kogos Lawrence MED/65/09 ----------------------

Under the supervision of:

SUPERVISOR SIGNATURE DATE

1. Dr Sylvester kimaiyo ------------------- --------------------

2. Prof. Johnston Wakhisi ………………………. ……………………….

i
 ACKNOWLEDGEMENT
We would like to gratefully acknowledge the Community Based Education Services
(COBES) department and the COBES IV coordinator Dr.C.Nyamwange for their
facilitation and guidance. We offer sincere gratitude to our supervisors Dr. Kimaiyo and
Prof. Wakhisi for their technical input. Our appreciation also goes to the Eldoret
municipal council and the women traders at the Eldoret municipal market for their
cooperation during our study.

ii
 TABLE OF CONTENTS

Contents
................................................................................................................................................................ 1

DECLARATION .......................................................................................................................................... i

ACKNOWLEDGEMENT ............................................................................................................................. ii

TABLE OF CONTENTS.............................................................................................................................. iii

Contents ................................................................................................................................................ iii

ABBREVIATIONS..................................................................................................................................... vi

DEFINITION OF TERMS .......................................................................................................................... vii

ABSTRACT .............................................................................................................................................viii

CHAPTER ONE ......................................................................................................................................... 1

INTRODUCTION................................................................................................................................... 1

BACKGROUND ................................................................................................................................. 1

JUSTIFICATION ................................................................................................................................ 1

HYPOTHESIS .................................................................................................................................... 2

RESEARCH QUESTION...................................................................................................................... 2

BROAD OBJECTIVE........................................................................................................................... 2

SPECIFIC OBJECTIVES ....................................................................................................................... 2

CHAPTER TWO ........................................................................................................................................ 3

LITERATURE REVIEW ........................................................................................................................... 3

CHAPTER THREE ...................................................................................................................................... 6

METHODOLOGY .................................................................................................................................. 6

STUDY AREA .................................................................................................................................... 6

STUDY DESIGN ................................................................................................................................ 6

STUDY POPULATION ....................................................................................................................... 6

iii
 SAMPLE SIZE.................................................................................................................................... 6

SAMPLING ....................................................................................................................................... 7

ELIGIBILITY ...................................................................................................................................... 7

BIAS MINIMIZATION ....................................................................................................................... 7

CHAPTER FOUR ....................................................................................................................................... 8

STUDY EXECUTION .............................................................................................................................. 8

PILOT STUDY ................................................................................................................................... 8

MAIN STUDY ................................................................................................................................... 8

STUDY PROCEDURE ............................................................................................................................. 8

COMMUNITY ENTRY ....................................................................................................................... 8

CONSENTING AND RECRUITMENT OF PARTICIPANTS ..................................................................... 8

MEASUREMENT .............................................................................................................................. 9

DATA COLLECTION .......................................................................................................................... 9

IMPLEMENTATION .......................................................................................................................... 9

STUDY OUTCOMES ........................................................................................................................ 10

CHAPTER 5 ............................................................................................................................................ 11

RESULTS ............................................................................................................................................ 11

Age ................................................................................................................................................ 11

Level of Education ......................................................................................................................... 12

Income .......................................................................................................................................... 13

Sources of information.................................................................................................................. 14

Age and hypertension ................................................................................................................... 15

Awareness..................................................................................................................................... 16

Chronic diseases associated with hypertension ............................................................................ 16

Relationship between diagnosed and undiagnosed hypertension .................................................. 18

iv
CHAPTER SIX.......................................................................................................................................... 19

DISCUSSION....................................................................................................................................... 19

CHAPTER SEVEN .................................................................................................................................... 21

CONCLUSION ..................................................................................................................................... 21

CHAPTER EIGHT ..................................................................................................................................... 22

RECOMENDATIONS ........................................................................................................................... 22

APPENDIX .......................................................................................................................................... 23

STUDY BUDGET .............................................................................................................................. 23

REFERENCES .......................................................................................................................................... 24

QUESTIONNAIRE ............................................................................................................................ 26

v
 ABBREVIATIONS
NCDs- Non–communicable diseases

B.P – blood pressure

BMI- Body mass Index

SBP-Systolic Blood Pressure

UAE-United Arab Emirates

UN-United Nations

HIV/AIDS-Human Immunodeficiency Virus/Aquired Immunodeficiency Syndrome

vi
 DEFINITION OF TERMS
Hypertension - a sustained systolic blood pressure of greater than 140mmHg and a
sustained diastolic blood pressure of greater than 90mmHg

vii
 ABSTRACT
Introduction:

Hypertension is a chronic medical condition in which systemic blood pressure levels are
elevated. It remains typically Asymptomatic until when very severe. It may cause long
term damage to vital organs such as the brain and kidneys.

Study Justification:

Worldwide, action is being taken to deal with the problem; however the local situation
in Africa and Kenya is difficult to tackle because of insufficient information on how
widespread it is across the social classes. Market women represent a social class that is
‘neglected’ in terms of routine healthcare checkups. They also do not have adequate
information on the problem

We chose Eldoret municipal market because it is near the school bearing in mind that
we will make several visits during the study

The information we get will help the government in developing policies, intervention
programs and increase awareness in the society.

Broad objective:

To find out the prevalence, level of information and contributing factors towards
undiagnosed hypertension among market women in the municipal market in Eldoret
Kenya.

Specific objectives:

1. To establish the prevalence of undiagnosed hypertension among market women

in the Eldoret municipal market in Kenya.

2. To define the demographics, diet and body mass index (BMI) among market
women in the municipal market in Eldoret Kenya.

3. To find out the level of information on hypertension among market women in the
municipal market in Eldoret Kenya.

4. To find out any other chronic illnesses associated with hypertension in the
municipal market in Eldoret Kenya.
viii
Methodology:

The study population is the market women in the municipal market in Eldoret Kenya.
Our sample size calculated using the fisher’s formula came to 337. Our sampling
technique is systematic random sampling. Interviewer administered questioners will be
used

Data presentation:

Presentation will be through power point, reports and journals.

Conclusion:

The data and results obtained will be useful in developing intervention programs, as
well as giving a better picture on the situation of hypertension in Kenya.

ix
 CHAPTER ONE

INTRODUCTION

BACKGROUND
Hypertension is a chronic medical condition in which the systemic arterial blood
pressure is elevated. It constitutes a sustained systolic blood pressure of greater than
140mmHg and a sustained diastolic blood pressure of greater than 90mmHg.
Hypertension is the most common cardiovascular disease. In a survey carried out in
2000, hypertension was found in 28% of American adults. According to a Framingham
study of blood pressure trends in middle-aged and older individuals, approximately 90%
of Caucasian Americans will develop hypertension in their lifetime. The prevalence
varies with age, race, education, and many other variables. Sustained arterial
hypertension damages blood vessels in kidney, heart, and brain and leads to an
increased incidence of renal failure, coronary disease, cardiac failure, and stroke.

In Africa, hypertension remains one of the major diseases that has not received the
attention it needs. Many people may not be aware that they are hypertensive and
usually discover it during routine medical checkups such as the antenatal clinic for
pregnant women.

JUSTIFICATION
Hypertension is the most common cardiovascular disease worldwide. It is a serious non
communicable chronic illness that has not seemingly received the attention it deserves.
It typically remains asymptomatic until late in its course when its related complications
are severe. The international community has started taking steps to deal with
hypertension based on various studies that have established the prevalence and the
morbidity of the problem. Studies on hypertension are currently being carried out in
various African countries. However, the local situation in Kenya is difficult to deal with
because there is little information on how widespread it is across the various classes in
the society.

In Kenya, its mainly the high class population that get frequent blood pressure checkups
as the majority are well informed .In contrast, the low class population is less informed
on the issue and are therefore at a higher risk of suffering from undiagnosed

1
hypertension. The market women belong to this class and to our knowledge no other
study on hypertension has been done among market women locally.

We chose Eldoret market because of its convenience in terms of distance from the
school bearing in mind that we will be making several visits in the course of our study.
We believe that our study will aid the government and other stakeholders in the health
sectors in coming up with policies and intervention programs.

HYPOTHESIS
Majority of market women in the municipal market in Eldoret have undiagnosed
hypertension.

RESEARCH QUESTION
What is the prevalence, level of information and contributing factors towards
undiagnosed hypertension among market women in the municipal market in Eldoret
Kenya?

BROAD OBJECTIVE
To find out the prevalence, level of information and contributing factors towards
undiagnosed hypertension among market women in the municipal market in Eldoret
Kenya.

SPECIFIC OBJECTIVES

1. To establish the prevalence of untreated hypertension among market women in

the municipal market in Eldoret Kenya.

2. To define the demographics, diet and body mass index BMI among market
women in the municipal market in Eldoret Kenya.

3. To find out the level of information on hypertension among market women in the
municipal market in Eldoret Kenya.

4. To find out any other chronic illnesses associated with hypertension in the
municipal market in Eldoret Kenya.

2
 CHAPTER TWO

LITERATURE REVIEW
According to WHO, hypertension is a highly prevalent cardiovascular risk factor
worldwide because of increasing longevity and the prevalence of contributing risk
factors such as obesity. Hypertension, however, remains inadequately managed
everywhere. UN summit on chronic non-communicable diseases in September 2011 NY-
the 2011 world health assembly held in May 2011 issued a declaration noting that NCDs
(cancers, chronic lung diseases, diabetes and cardiovascular diseases) pose one of the
greatest challenges to health and development, contributing to more than 60% of
deaths worldwide1. The last summit of its kind was on HIV/AIDS issue in 2001, indicating
a shift of focus from communicable to non-communicable diseases. The aim of the
summit, among other things is to push governments to prioritize NCDs within their
national health plans and to strengthen health systems to effectively cater for NCDs and
other health needs including communicable diseases and child and maternal care2.

Hypertension is a "neglected disease," according to a report released by the Institute of

Medicine3. Despite high blood pressure being the cause of death in 1 of 6 US adults, and
the greatest single risk factor for deaths from cardiovascular disease, millions of
Americans are developing, living with, and dying from hypertension. The decade from
1995 to 2005 saw a 25% increase in the death rate from high blood pressure.

In a studybyWhelton P. K.et al4done between 1988-1993 with results from national

surveys, a strikingly similar relationship between age and (especially) systolic blood
pressure was identified, with a progressive and steep increase in blood pressure
throughout adult life. In the US and Egypt, approximately 25% of adults had
hypertension (systole >140mmhg), while in China it was around 14%. In the US, 25%
were unaware of their diagnosis, and only 55% were on treatment. In Egypt and China,
only 8% and <5% of adults respectively were being treated for hypertension. This study
indicates that hypertension is highly prevalent, poorly treated and an escalating health
challenge in economically developing countries.

In a study done in the UAE to determine the correlation between hypertension and
income distribution, case control studies matched for age, sex, nationality and
education. Hypertension was found to be significantly higher in low income groups
(35.2% versus 24.9%). Mean SBP in low income group was 130.2 versus 128.0 among
3
the controls. It was also found that smoking and alcohol consumption were higher
among the low income groups5. A study on cross national comparisons of time trends in
overweight inequality in Kenya, Cameroon, Guinea, and Haiti found increases in levels of
overweight among low income groups. Impact of income on the profile of cardiovascular
risk factors among hypertensives done in Nigeria however found that dyslipidemia and
high CVD risk were found in over 71% of those profiled regardless of their levels of
income6. These findings pose a great challenge to management of patients considering
that access to healthcare among low income earners in Sub Saharan Africa is
considerably low, even with government subsidies.

Hypertension has materialized as the most prevalent risk factor for heart failure,
coronary artery disease, and stroke in economically emerging countries. This is
according to a study by M. J. Maseko et al (2010)7. In contrast to the approximately 34-
35% of all hypertensives and 55% of treated hypertensives that are controlled to target
BP levels in economically developed countries, by comparison, in economically emerging
countries such as South Africa, only 14% of all hypertensives and 33–44% of treated
hypertensives in primary-care settings are controlled to target BP. The major barrier to
BP control in economically emerging countries is lack of treatment. Although a lack of
treatment accounts for inappropriate BP control in economically emerging
communities, the decision to treat hypertension with drug therapy should be based on
global cardiovascular risk scores, rather than on the presence of hypertension per se. In
this regard, it is acknowledged that there is little evidence to support the use of drug
therapy in people who have BP values between 140 and 159/90 and 99 mmHg and a
‘low or moderate added’ risk.

In an analysis of population based studies on hypertension published between January

1975 and May 2006, less than 40% of people with blood pressure above the defined
normal range had been previously detected as hypertensive. Of those previously
diagnosed with hypertension, less than 30% were on drug treatment in most countries.
Prevalence of hypertension in all studies that covered both rural and urban areas was
higher in urban as compared to rural areas8.

4
Gender, smoking, fasting capillary glucose, blood pressures and age are potential
determinants of overall death due to hypertension and other cardiovascular disorders in
rural Cameroon. This is according to a research done in rural Cameroon by A. P. Kegne
et al in 19989. Another study, dietary, social and environmental determinants of obesity
in Kenyan women10, established that urbanization was a major risk factor for obesity
since obesity was most prevalent in women in this group. It is a well-established fact
that obesity, plus other variables that go hand in hand, is a major contributor to the
development of hypertension.

Actionable information on the prevalence, awareness, detection and management of

high blood pressure in Kenya is scarce. Relevant articles published within the last 10
years reporting on the epidemiology of hypertension among urban dwellers include one
study done in Mombasa old town among subjects aged 18 years and older found age
adjusted prevalence of hypertension to be 32.6%(+/- 2.2)11. Another study done in
Nakuru found the prevalence among adults aged 50 years and older to be 50.1%, of
whom only 15% were on treatment12.

Hypertension is an important public health challenge worldwide. Information on the

burden of disease from hypertension is important in developing effective prevention
and control strategies. An up to date and comprehensive assessment of the evidence
concerning hypertension in Sub-Saharan Africa is lacking8.

5
 CHAPTER THREE

METHODOLOGY

STUDY AREA
The study area is Eldoret Municipal Market. It is located in the Central Business District
in Eldoret town offOloo Street. Eldoret is in Uasin-Gishu County in Rift-Valley province
Western Kenya. Eldoret has an altitude of 2100 meters above sea level.

STUDY DESIGN
A descriptive cross sectional study method was employed in this study.

STUDY POPULATION
The study targeted the regular women traders at the Eldoret Municipal Market .The
approximate study population was about 1500 persons

SAMPLE SIZE
The sample size was calculated using the Fisher’s formula

n=Z2PQ/d2

n is the sample size

Z is the standard score associatedwith 95% level of confidence=1.96

P is the prevalence of 32.6 %based on a study on hypertension done in old Mombasa

town which is the closest available reference point in relation to our research.

Q is 1-P

d is the amount of discrepancy tolerated=0.05

6
Therefore,

n= [(1.96)2X 0.326X(1-0.326

(0.05)2

n=325

SAMPLING
The sampling method employed was systematic random sampling

ELIGIBILITY
Inclusion criteria were; women aged 18 years and above and regular tradersat the
market who consented to participate in the study.

Exclusion criteria included: age below 18 years, shoppers and visitors to the market,
pregnant women and those who were already diagnosed with hypertension.

BIAS MINIMIZATION
To reduce bias researcher administered questionnaires were used.

Researcher recall bias was minimized by immediately recording data obtained. The
questionnaires was structured to help the respondentsremain relevant to the study

7
 CHAPTER FOUR

STUDY EXECUTION

PILOT STUDY
This study was carried out at the Huruma municipal market to establish the
appropriateness and accuracy of data collection tools and methods. It also helped in
pre-testing the questionnaire therefore improving the quality of the main study.

MAIN STUDY
The main study was carried out at the municipal market in Eldoret in the month of
august 2012.

STUDY PROCEDURE

COMMUNITY ENTRY
The research team began the main study by holding a preliminary meeting with the
mayor and the market authorities, from whom they received a written consent to
undertake a study within their area of jurisdiction. The market authorities also issued
the researchers with a mobilizer, who mobilized the market women. The mobilizer
however did not participate in the actual study.

CONSENTING AND RECRUITMENT OF PARTICIPANTS

This exercise was carried out within the market center. Only the subjects who fulfill the
inclusion criteria were enrolled. The purpose, benefits and procedures to be carried out
in the study were explained to the participants in a language they understood.

The subjects then made an informed decision and gave written consent.

8
MEASUREMENT
 Blood pressure measurement using an automated BP machine, Omron series,
was done by the researchers.
 Weight and height measurement for BMI was done using a weighing scale and a
height meter.

DATA COLLECTION
Data collection forms were used to collect data.

IMPLEMENTATION

Blood pressure:
Screening for blood pressure was done by the researchers within the market center,
using a non - invasive method as follows:

Participant was required to rest for at least five minutes. Blood pressure was then
obtained in a stable sitting position in the right arm which was supported on a table.
Appropriately sized cuffs were used and the blood pressure was measured when the
right arm was properly positioned at the mid-chest level.

After the first BP measurement, two more BP readings to be obtained, each after five
minutes interval of rest.

Body mass index (BMI)

The participants had their weights and heights measured using a weighing scale and a
height board respectively .Their BMI was then recorded and calculated using the
standard procedure as follows:

9
BMI= weight (kg)/height (m) 2

Questionnaires
Interviewer administered questionnaires were used.

STUDY OUTCOMES
Variables of interest are blood pressure and body mass index. Subjects were categorized
according to the following predefined BP categories:

Normal BP: SBP/DBP≤120/80 mmHg

Pre hypertension: BP/DBP 121-139/81-89 mmHg.

Stage 1 hypertension: SBP≥140-159 or DBP ≥90-99 mmHg.

Stage 2 hypertension: SBP≥160 or DBP≥100 mmHg

The standard BMI ranges for adults is as shown in the table below

BMI Weight

Below 18.5 Underweight

18.5-24.9 Normal

25.0-29.9 Overweight

30 and above Obese

10
 CHAPTER 5

RESULTS

Age
Majority of the women (70%) interviewed were above 40 years of age. Of the 325
women interviewed, 80 of them were aged between 40 and 44 years of age. This
represents 24% of the total population sampled. This age group was followed in number
by the 45 to 49 year old group at 18% then the 30 to 34 year old age group. These are
women who are likely to be at risk of suffering from hypertension and other NCDs.

Age groups Total No %

20-24 5 1.5

25-29 18 5.5

30-34 45 13.8

35-39 31 9.5

40-44 80 24.6

45-49 56 17.2

50-54 40 12.3

55-59 22 6.7

60-64 28 8.6
Figure 1.table showing the age distribution of the respondents

11
Level of Education
More than half (53%) of these women had only attained primary level of education.
Only 37% had gone up to secondary level of education while 9% had no formal
education. None of the women interviewed had attained tertiary level of education. This
is again reflected in terms of knowledge concerning hypertension and its causes and
means of prevention as will be later expounded.

Marital Status

A large of no of the respondents at 47% were married, followed by the single women at
21%.The least being the divorced at 2%

Marital status

18%
21%

single
married
12%
divorced
separated

2% widowed

47%

Figure 2.pie chart showing the marital status of the respondent

12
Income
A majority (42%) of the women reported making between 5000 and 9000 shillings per
month. This was however quite variable, with some reportedly making less than 5000
shillings per month.

Other sources of income stated were spouses’ income for those married although
almost 100% of them could not tell how much their spouses were making.

140
120
100
80
60
40
20
No of mrkt
0

Figure 3 bar graph showing the level of income of the respondents

Hypertension was found to be more frequent among the women with low income levels
and the frequency was reducing with increasing income. There was however a slight rise

13
in frequency in women with higher income levels of more than 20000

100
80
60
%

40
20
0
Normotensive
hypertensives

Income

Figure 4.line graph showing the interrelationship between income levels and hypertension.

Sources of information
27.10% of those who were aware of hypertension got the information from health
personnel. 67.80% got to know about hypertension from their friends while the rest
(5.10%) learned about it from the media.

sources of information
5.10%

27.10%
media

67.80% health personnel

others

figure 5 pie chart showing the sources of information on hypertension for the respondent

14
Age and hypertension

Normal Hypertension
20-24 5 0
25-29 18 0
30-34 40 5
35-39 21 10
40-44 55 25
45-49 26 31
50-54 31 9
55-59 7 15

60-64 18 10

TOTAL 220 105

Figure 6 table showing age and hypertension

120%

100%

80%

60%
normol

40% HTN

20%

0%
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
AGE

Figure 7 line graph showing relationship between age and hypertension

15
Awareness.
Of the total population interviewed, 81% were not aware of the causes and prevention
of hypertension. Most of those who were aware cited stress as the most common cause
of hypertension. Few cited obesity and other diseases like diabetes as causes of
hypertension

Chronic diseases associated with hypertension

Of the total number of hypertensives (105), 10 which is 9.5% had chronic diseases
associated with hypertension

disease number No with HTN

DIABETES MELLITUS 12 7

HEART DISEASE 4 2

RENAL DISEASE 1 1

TOTAL 16 10 9.5%

Figure8 table showing chronic diseases associated with hypertension

16
BMI/hypertension

Of the 325 women sampled, 47 % were overweight, 38% were obese, leaving only 15%
of women at the market who were either of normal weight or underweight. Of those
who are underweight (8) none were hypertensive. 12.5% (42) of the women had normal
BMIs. Among those who are overweight (152), 55 have hypertension, Obese women
(123); 47 are hypertensive.

The graph below shows that hypertension prevalence increases with increasing BMI.

120

100

80

% 60
Normotensive
40 Hypertensives

20

0
underwt Normal overwt obese
BMI

Figure 9: graph showing the relationship between BMI and hypertension

17
Relationship between diagnosedand undiagnosed hypertension
Out of the 325 women sampled, 105 had hypertension. Thisrepresents 32.3% of the
total. Of the hypertensive women, 16%, were found to be diagnosed and on follow up.
84% of the hypertensives were found to have undiagnosed hypertension.

16%

Diagnosed
Undiagnosed

84%

figure 10 pie chart showing diagnosed and undiagnosed hypertension

18
 CHAPTER SIX
DISCUSSION
Increasing age is a known risk factor for hypertension. The National Institute of Aging
reports that more than 50% of people aged >60 years are hypertensive13, however, age
by itself is not considered an independent risk factor for hypertension. 36% of the
women above 60 we sampled were hypertensive. This lower number could be a result
of the difference in terms of diet and activity for this as compared to younger age
groups. There was generally an increasing incidence of hypertension with increasing age
though, with 36% of women between 40 and 44 being hypertensive while of those
between 55 and 59, 68% were hypertensive.

Awareness and level of education. In a study on hypertension in India in 2011, it was

found that while about 57% of urban women were aware of hypertension, only 25% of
the rural populace was aware18. The difference in knowledge could have been as a
result of the different levels of education between the two groups of women sampled.
In our study only 19% of those sampled were aware of hypertension in terms of causes
and prevention. Among these, only 37% had attained secondary level of education. The
low level of education could be one of the factors that contributed to the low awareness
of hypertension, despite this being a common ailment among the adult population.

Current (2012) WHO statistics report that 1 in every 6 adults is obese. The rising
incidence of obesity increases the number of hypertensive individuals. A study done by
Margaret M. H. et al in 2000 to establish the relationship between fat distribution and
obesity and hypertension found that the prevalence of hypertension increased with
increased BMI, Weight to height ratio and waist circumference14. Although this increase
in prevalence was found in both whites and African Americans, the incidence of both
obesity and hypertension was higher among African Americans.

A study conducted among market men and women in Ibadan city in Nigeria15 by Sanusi
Ajani et al found that Among the men, (43%) were non overweight, and non obese,
while (42%) were overweight and (14%) were obese. Among the females, (42%) were
obese, (28%) were overweight and (29%) were within normal weight range. Among
obese men 64% were hypertensive, while 26% obese women, had hypertension. This
closely relates to our findings on market women where we found that 38% of the obese
women were hypertensive.

19
A study done in Kenya in 2008 by Ann Hum et al on obesity found the prevalence of
overweight to be 40% among the urban population and 15% among the rural
population. The prevalence of obesity was at 16% and 5% for the urban vs. rural
population respectively. From this study, 44% of the urban population is of normal BMI
or underweight, however we found only 15% of these market women being either of
normal BMI or underweight16. This difference could be because while the 2008 study
sampled both men and women, our study sampled women only. Also, 70% of the
women we sampled were above 40 years of age- these are women more likely to be
obese than the younger population.

According to the American Heart Association Journal, hypertension is actually more

prevalent among (post menopausal) women, contrary to popular belief. In an extensive
study done in India in 2011 it was found the prevalence of hypertension among women
was 32% and 48% among rural and urban women respectively. Our study sampled urban
market women and found a prevalence of 32% which is a bit lower than the Indian study
done, but was at par with their findings of the rural populace17.

Undiagnosed hypertension. A study conducted by Ireland Institute of Health on

undiagnosed hypertension found the prevalence to be 12%, but ranged from 3% among
adults 18-44 years to 23% among those >45 years old.This result greatly differs with our
findings of 84% which is an extremely high figure on prevalence of undiagnosed
hypertension.

20
 CHAPTER SEVEN
CONCLUSION

Prevalence of undiagnosed hypertension among women in Eldoret municipal market

was 27%. Out of the 325 women sampled,32% were found to be hypertensive . 84% of
the total hypertensive patients were undiagnosed representing 27% of the total
population.

70% of the women were over forty years of age hence were at risk of hypertension since
prevalence of hypertension increased with age.

Majority(53%) of the women attained primary level education,9% had no formal

education and none had tertiary level education
Most (47%) were married with the least percentage being divorced at 2%.

Income made by the majority of the women(42%) was between five thousand and nine
thousand Kenyan shillings.some made less than five thousand shillings. Hypertension
was found to be higher in those with lower income

47% of the women were found to be overweight while 38% were obese. Of those found
to be overweight, 36% were hypertensive, while 38% of the obese were hypertensive.

81% of the women sampled were unaware of the causes and means of prevention of
hypertension.

10% of the hypertensives had other chronic illnesses associated with hypertension
including diabetes mellitus, heart disease and renal disease. Diabetes mellitus was the
most common diseas associated with hypertension.

21
 CHAPTER EIGHT
RECOMENDATIONS
To the government

1. The government policies are majorly focused on infectious disease, but with current
global trends and lifestyle changes, the burden has shifted towards non infectious
diseases so should the government.

2. Thegovernment should develop programmers that are aimed at providing education

on hypertension to the public.

3. Encourage further local research on hypertension especially in the low socio

economic status by recruiting people to the job or funding institutions or/and
individuals.

To the Health facilities

1. The health facilities should provide provision for free regular screening of
Hypertension

2. The Health facilities should provide Education to the patients on risks, causes,
prevention and management detailing both pharmacological and non pharmacological
interventions

To the Community

1. To embrace proper lifestyle that minimize the risk of developing hypertension like
weight reduction, reducing salt intake, exercising.

2. To undertake the initiative of regular screening especially the high risk groups to
ensure early detection and hence management to prevent development of
complications like strokes, organ failures like renal, that are life threatening.

22
 APPENDIX

STUDY BUDGET

Shown is the budgetary allocation for the study:

ITEM QUANTITY UNIT COST@ TOTAL COST

KSHS KSHS
1 Pens 8 25 200
2 Pencils 4 40 160
3 Sharpeners 4 25 100
4 Rulers 4 30 120
5 Erasers 4 25 100
6 Stapler 1 500 500
7 Staple pins 2 packets 100 200
8 Folders and files 8 100 800
9 Re-writable CD 8 250 2000
10 Notebooks 4 50 200
11 Calculator 1 1500 1500
12 Lunch 16 300(4 days) 4800
13 Mineral Water 16 100(4days) 1600
14 Airtime 4 1000 4000
15 Field notebooks 4 100 400
16 Foolscaps 4 reams 500 2000
17 Flash disks 1 1000 1000
18 Printing paper 8 reams 500 4000
19 Transport taxi 8 500 4000
20 Miscellaneous costs 2500
21 Typing and printing costs 8000
22 Internet Search 4000
23 Contingencies 5000
TOTAL 46226

23
 REFERENCES

1. UN Summit on non-communicable diseases. European Society for Medical

Oncology Feb 2011
2. WHO/ high level meeting on non-communicable
diseases.www.who.int/../un_ncd_summit2011
3. Medscape Medical News February 22, 2010
4. Whelton P. K. et al. Prevalence, awareness, treatment and control of
hypertension in North America, North Africa, and Asia. Journal of hypertension.
2004 Jan 22(1):11-9
5. Sabri s, Bener A, Eapen V, Azhar AA, Abdishakure A, Singh J. Correlation between
hypertension and income distribution among United Arab Emirates population.
2005
6. Karaye KM, Okeahialam BN, Wali SS. Impact of income on the profile of
cardiovascular risk factors among hypertensives in Nigeria. PubMed 2005.
7. M. J. Maseko et al. Global cardiovascular risk profiles of untreated hypertensives
in an urban, developing community in Africa; Cardiovascular Journal of Africa.
2010
8. Juliet Addo, Liam Smeeth, David A. Leon. Global health systematic review on
hypertension in Sub – Saharan Africa. American Heart Association Journal. Sep
2007 50(6):1012-8
9. A. P Kegne et al. Classical cardiovascular risk factors and all-cause mortality in
rural Cameroon. QJM International Journal of Medicine Mar 2009 102:209-215
10. Nelia P. Steyn et al. Dietary, social and environmental determinants of obesity in
Kenyan women. Scandinavian Journal of Public Health. Jun 2009;39:88-97
11. Jenson A., Omar A. L., Omar M. A., Risjad A.S., Khoshnood K. Assessment of blood
pressure control in a district of Mombasa, Kenya. Global Health 2010 Sep
12. Mathenge W., Foster A., Kuper H. Urbanization, ethnicity and cardiovascular risk
in a population in transition in Nakuru, Kenya: a population based survey. BMC
public Health 2010
24
13. Burt, VL, Whelton, P, Roccella, EJ, et al. Prevalence of hypertension in the US
adult population. Results from the Third National Health and Nutrition
Examination Survey, 1988-1991. Hypertension 1995; 25:305.
14. Margaret, MH et al. Relationship between fat distribution and obesity and
hypertension. J Hypertens 2007; 25:1105.
15. Sanusiajani et al. obesity and hypertension Seven Countries Study Research
Group. N Engl J Med 2000; 342:1.
16. Ann, HM, Christensen, DL, et al. Obesity and regional fat distribution in Kenyan
populations: impact of ethnicity and urbanization, 2008; 232-49.A
17. Kshirsagar AV, Carpenter M, Bang H, et al. Hypertension among urban versus
rural women in India. Am J Med 2006; 119:133.

25
 QUESTIONNAIRE
A :Demographic data:

1. Age of participant

2. Marital status
a. Single
b. Married
c. Divorced
d. Separated
e. Widowed

3. Level of education
a. None
b. Primary
c. Secondary
d. Tertiary

4. Spouse’s occupation

5. Spouses level of education.

a. None
b. Primary
c. Secondary
d. Tertiary

6. Number of children

7. Number of other dependants

8. Place of residence

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 9. Average income per month

10. Spouses average income per month

11. Any other source of income

B. NUTRITIONAL INFORMATION

1. 24 hour diet recall

2. Common foods eaten

a. Proteins
b. Carbohydrates
c. Vegetables and fruits
C. HEALTH INFORMATION

1. Do you know about hypertension?

a. Causes
b. Prevention

2. Source(s) of information
a. Media
b. Health personnel
c. Others

3. Have you ever been screened for hypertension

a. When
b. How often

D. HEALTH STATUS

1. Do you have any chronic illnesses

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 PATIENT REFERRAL FORM

DATE.................................. TIME.............................

NAME OF REFERRING PERSON.................................................................................................

NAME OF PATIENT......................................................................... D.O.B.............................

PROVISIONAL DIAGNOSIS.........................................................................................................

REASON FOR REFERRAL............................................................................................................

..................................................................................................................................................

..................................................................................................................................................

..................................................................................................................................................

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 CONSENT FORM
CONSENT FORM
Respondent,
I consent to give information required for this study which has been fully explained to me by the
researcher(s).I understand the full implication of taking part in the study. All the information I
give will be true to the best of my knowledge and will be given out of my free will.

SIGNATURE……………………………

DATE……………………………………

Ninakubali kwamba watafiti wamenieleza habari ambayo inahitajika katika utafiti huu,na
ninaelewa umuhimu wake, na ninakubali kutoa habari ya kweli na kwa hiari yangu mwenyewe.

SAHIHI………………………………….

TAREHE…………………………………

Researcher
I……………………………………………have explained the purpose of the study to the
respondent and that the respondent understands all the information that is required from him/her.
He/she also understands the implication of taking part in the study.

SIGNATURE………………………………

DATE………………………………………..

29