KNOWLEDGE OF RISK FACTORS AND PREVENTIVE MEASURES OF HYPERTENSION AMONG CHILD BEARING MOTHERS. C.C. Igbokwe and A. N.Odo

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1 KNOWLEDGE OF RISK FACTORS AND PREVENTIVE MEASURES OF HYPERTENSION AMONG CHILD BEARING MOTHERS C.C. Igbokwe and A. N.Odo Department of Health and Physical Education, University of Nigeria, Nsukka Abstract The purpose of the study was to elicit the knowledge of risk factors and preventive measures of hypertension among Child Bearing Mothers (CBMs) in Udenu Local Government Area of Enugu State, Nigeria. The study adopted the descriptive research design. Specifically, three objectives with three corresponding research questions and two hypotheses were formulated to guide the study. The multi-staged sampling procedure using simple random sampling techniques of balloting without replacement was used to select 246 CBMs in Udenu LGA. Data were collected using researchers self-developed questionnaire and data collected were analyzed using percentages to answer the research questions. Chi-square statistics was used to verify the null hypothesis at.05 level of significance. The result showed that majority of CBMs in Udenu LGA do not have enough knowledge of risk factors of hypertension, CBMs in Udenu LGA had moderate knowledge of preventive measures of hypertension and that educational qualification had influence on the knowledge of risk factors and preventive measures of hypertension possessed by CBMs in Udenu LGA. Based on the above findings, the researchers recommended among other things that ante-natal and infant clinic health-talk should be given adequate attention in all health facilities. Keywords: Hypertension, knowledge, risk factors, preventive measures Introduction Hypertension is one of the non-communicable diseases that is very common and constitutes a major risk factor for cardiovascular diseases (CVD). Hypertension has been identified as a major cause of morbidity and mortality globally including sub- Saharan Africa (Ekwunife and Aguwa, 2011). The report further stated that the burden of noncommunicable diseases (NCDs) such as hypertension is increasing in epidemic proportions in Africa. In Nigeria, hypertension seems to be the most common cardiovascular condition or disease. According to Oboh (2012), it is estimated that over 41 million Nigerians are hypertensive. It went further to state that this figure is expected to increase over time, hence the need for a renewed effort and an urgent action to tackle the scourge. Obinna (2011) stated that about 20 to 25 percent of Nigerian population has hypertension. Hypertension affects both male and 115 female, and the risk of developing it increases as one gets older. Hypertension, according to the British Medical Association (20002) is the persistently raised blood pressure exceeding about 140mmHg (systolic) and 90mmHg (diastolic) at rest. Okoye (2006) stated that hypertension is an elevation in the blood pressure above 140/90mmttg. Hypertension which is also called high blood pressure (HBP) and silent killer can be defined as a medical condition in which the blood pressure is elevated up to 140/90mmttg based on at least two readings and on separate occasions in an adult. High blood pressure is a common condition in which the force of the blood against the arterial walls is high enough that eventually causes health problems, such as heart diseases. Hypertension is called silent killer because most times, those that have hypertension do not experience initial warning signs before the worst happens. This implies that one s blood pressure may rise up to a critical level

2 without the person realizing he or she is seriously sick. Unfortunately one may have stroke (which is one of the complications of hypertension) before knowing that he or she is hypertensive. According to Marks (2012), hypertension is designated as either essential (primary) hypertension or secondary hypertension. Hypertension is said to be of primary origin when there is no obvious cause of it. This type accounts for about 95 percent of cases of hypertension (Okoye, 2006). While hypertension is said to be of secondary origin when there is an already existing health problem that leads to hypertension as its complication. Some health problems that may lead to hypertension include kidney problems, adrenal gland tumors, certain defects in the blood vessels, certain medications such as birth control pills, cocain, amphetamines among others (Obinna, 2011). Though greater percentage of hypertension is believed to have no obvious cause, there are some identified risk factors. Mayo (2012) stated that high blood pressure has many risk factors which include age, race, family history, being overweight or obese, physical inactive, tobacco use, too much salt in the diet, two little potassium and vitamin D in the diet, too much intake of alcohol, stress and certain chronic conditions. The risk of high blood pressure increases as one gets old and more common in men during early middle age. Women are more likely to develop high blood pressure after menopause, though may still occur before menopause. Mayo further stated that high blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. High blood pressure runs in family. According to Haines (2011), heredity plays a part in ones hypertension risk. The report stated further that if one has family members with high blood pressure, that means the person is more prone to the condition. Also, the more one weighs, the more blood the person needs to supply oxygen and nutrients to the tissues. As the volume of blood circulating through the blood vessels increases, so does the pressure on the artery walls. Too much intake of salt (sodium) makes the body to retain fluid, which increases blood pressure. While lack of or too little intake of potassium leads to the accumulation of sodium in he blood which invariable increase the blood pressure. Potassium helps to balance the amount of sodium in the cells (Mayo, 2012). 116 Weber (2007) opined that there are many things which contribute to an individual s risk of developing high blood pressure. They include; age, ethnicity, gender, family history, smoking, activity level/exercise, diet, stress, medications and street drugs, kidney problems, and other medical problems like hormonal imbalance, certain anatomic abnormalities and tumors can cause secondary hypertension. Pregnancy has also been identified to contribute to hypertension. Hypertension during pregnancy, leads to a condition called pre-eclampsia and eclampsia (toxemia in pregnancy) (Marks, 2012). Diabetes is another risk factor to hypertension. If one has diabetes, the risk of developing hypertension is doubled (Haines, 2011). This may be the reason why many elderly diabetics are at the same time hypertensive. Some of these risk factor of high blood pressure can be prevented especially if one has the knowledge or is aware that he or she is at risk of developing high blood pressure. Preventive measures of high blood pressure entails avoiding those known and avoidable or preventable risk factors like; smoking, low intake of potassium and vitamin D, high intake of salt (sodium), overweight, physical inactivity, medications, stress, among others. Obinna (2011) opined that life style changes can help one control and prevent high blood pressure. According to the report, this can be achieved through eating healthy foods by applying the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low fat dairy foods, plenty of potassium, less saturated fats and total fats, decreased salt intake; maintain a healthy weight; increased physical activity; limit alcohol intake; avoid smoking; manage stress, monitor your blood pressure at home; and practice relaxation or slow, deep breathing. Adopting a healthy lifestyle is very essential in the prevention of high blood pressure. McCoy (2012) identified 10 healthy habits that will keep blood pressure down. The healthy habits include, eating balance diet, reducing salt intake, maintaining a healthy weight, exercise regularly, limit alcohol intake, stop smoking to limit artery damage, monitor your blood pressure at home, manage stress, practice relaxation techniques and take blood pressure medications. McCoy further stated that though stress can cause temporary increase in high blood pressure, scientists are still unsure how stress affects blood

3 pressure. Evidence suggests however, that stress can lead to overeating, smoking, drinking and blood pressure-raising activities. This implies that one should pay attention to his or her stress levels and avoid unnecessarily stressful activities and events. Regular exercise reduces stress as it improves the health of the heart. This not withstanding, people need to know the type of exercise that suits his or her health. Hypertension being a disease that is very common needs to be given adequate attention, especially as it concerns dissemination of information about the risk factors and preventive measures. Knowledge according to Hornby (2010) is the information, understanding and skills that you gain through education or experience. Knowledge means awareness or possession of information, facts, ideas or truths. The magnitude of deaths as a result of hypertension in Nigeria has become such that needs very urgent attention to avoid an imminent epidemic of cardiovascular diseases in the country (Obinina 2011). The urgent attention needed to fight Hypertension in this country will definitely base on awareness creation. People need adequate knowledge of the disease, its risk factors and preventive measures. Many people die of cardiovascular diseases resulting from hypertension due to the fact that they were not aware that they had hypertension or that they are at risk of having hypertension. As earlier mentioned, pregnancy is a risk factor of hypertension. Therefore, women of child bearing age should have enough knowledge of hypertension. Child-bearing Mothers (CBMs), are mothers within the ages of years. These mothers supposed to possess good knowledge of risk factors and preventive measures of hypertension to enable them prevent the disease before, during and after pregnancy. The problem being observed is that many CMBs are ignorant of their being at risk of hypertension. As a result of this, many of them develop hypertension during pregnancy and consequently pre-eclampsia and or eclampsia (toxemia in pregnancy). This paper therefore, seeks to elicit the knowledge of risk factors and preventive measures of hypertension among child-bearing mothers in Udenu LGA. Udenu LGA is one of the seventeen LGAs in Enugu State, precisely in Enugu-North senatorial Zone. It is made up of urban and rural settings with CBMs 117 found in every community. With the upsurge of modern life-styles like eating habits, physical inactivity, cigarette smoking, among others, many people including CBMs are at risk of hypertension and at the same time, lack knowledge of the disease. Moreover, no study on the knowledge of risk factors and preventive measures of hypertension among CBMs in Udenu LGA exist to the knowledge of the researchers. In order to fill this gap, this study was deemed necessary. Methods The study adopted descriptive survey research design. Nworgu (2006) asserted that a descriptive survey research design is one which aims at collecting data on, and describing in a systematic manner, the characteristics, features or facts about a given population According to (Ohen, Manion and Morrison (2011), descriptive survey research sets out to describe and to interpret what is; gathers data at a particular point in time with the intention of describing the nature of existing conditions, or identifying standards against which existing conditions can be compared, or determining the relationships that exist between specific events. Therefore, this design was deemed appropriate for the present study. The population of the study comprised 2,460 CBMs accessing health services in the thirty-three government primary health facilities in Udenu LGA of Enugu State. The multi- stage sampling procedure using simple random sampling technique of balloting without replacement was used to select 246 CBMs being the sample size for the study. This represents 10 percent of the population for the study. Nwana (1990) asserted that 10 percent of the population serves as a good sample, if the population runs in few thousand. The instrument used for data collection was investigators developed questionnaire in line with the research questions. The instrument was validated by three experts in Health and Physical Education Department, University of Nigeria, Nsukka. The reliability of the instrument was established and a reliable index of 0.80 was obtained using sperman s rank order correlation formular. The instruments were distributed to the respondents during ante-natal and infant-welfare clinic with the

4 help of the health officers in-charge of the facilities. The instruments were collected on the spot and a total number of 238 completed questionnaires were retrieved. The data generated were analyzed using frequencies and percentages. The null hypotheses were tested using chi-square (X 2 ) statistics at. 05 level of significance. Results The results are hereby presented. Table 1: Knowledge of Some Risk Factors of Hypertension (N= 238) Items F % Age Family history Stress Alcohol Over weight Some diets Cigarette Table 1 shows that majority of the respondents do not have enough knowledge of risk factors of hypertension as evidenced by low responses to age 98(41 2%), family history 105(44.1%), some diets 50(21.0%) and cigarette 110(46.2%). The table however, shows that majority of the respondents 228 (95.8%) indicated that stress is a risk factor to hypertension. Table 2: Preventive Measures of Hypertension (N = 238) Items F % Adopting healthy life style Maintaining a healthy weight Avoid smoking Manage stress Monitor your blood pressure regularly

5 Table 2 shows that majority 228(95.8%) and 230 (96.6%) had good knowledge of preventive measures of hypertension to include, stress management and regular monitoring of blood pressure respectively. The table also shows that majority of the respondents were moderately aware that adopting healthy life style, maintaining a healthy weight and avoiding smoking are preventive measures of hypertension. Table 3. Influence of Education on the Knowledge of Risk Factors of Hypertension. (N = 238) Items No formal Education Primary Education Secondary Education Tertiary Education F % F % F % F % Age Family history Stress Alcohol Overweight Certain diets Cigarette smoking Table 3 shows that education has influence on the respondents knowledge of risk factors of hypertension. The table shows that highest responses on the risk factors of hypertension were among respondents with tertiary education as follow; age 48(16.0%) certain diets 20(8.4%) and cigarette smoking 50(21.0%), while respondents with no formal education had highest response 88(36.9%) on stress as a risk factor to hypertension. Table 4: Influence of Education on the Knowledge of Preventive Measures of Hypertension. No formal education Primary education Secondary education Tertiary education Items F % F % F % F % Adopting a healthy life style Maintaining a health weight Avoid smoking Manage stress

6 Regular monitoring of blood pressure Table 4 shows that education has influence on the respondents knowledge of preventive measures of hypertension. The highest responses on preventive measures of hypertension were among respondents with tertiary education, as follows; adopting healthy life style 37(15.5%) maintaining a healthy weight 38 (16.0%), avoiding smoking 50(21.0%) and regular monitoring of blood pressure 70(29%). The table also shows that respondents with no formal education 88(36.9%) had highest response on managing stress as preventive measure to hypertension. Table 5: Summary of Chi-square (X 2 ) Analysis in the Knowledge of Risk Factors of Hypertension based on Level of Education (N = 238) Variable n calx 2 tabx 2 df P decision Level of Education Not accepted Result in table 5 shows that the calculated chi-square (calx 2 ) value of is greater than the table chisquare (tabx 2 ) value of at df 18. This implies that the null hypothesis of no significant difference in the knowledge of risk factors of hypertension based on their level of education was not accepted. Table 6: Summary of chi-square (X 2 ) Analysis in the knowledge of preventive measures of hypertension based on their level of education. (N=238) Variable n calx 2 tabx 2 df P decision Level of Education Not accepted Result in table 6 shows that the calculated chi-square (calx 2 ) value of is greater than the table chisquare (tabx 2 ) value of at df 12. The implication is that the null hypothesis of no significant difference in the knowledge of preventive measures of hypertension based on their level of education was not accepted. Discussion much thinking (i.e. mental stress), stress has been identified by many literature assertions as one of the risk factors of hypertension. Mayo (2012) stated that high blood pressure has many risk factors which include stress, age, alcohol, race, family history, salty diets, among others. Similarly, Weber (2007) also stated that stress is among many other things that contribute to hypertension. The findings in table 2 showed that majority of the The findings of the study in table 1 showed that respondents indicated high knowledge of preventive majority of the respondents were not aware that measures of hypertension to include stress alcohols, over weight, certain diets, age among others management and monitoring of blood pressure. The are risk factors of hypertension. However, majority findings also showed moderate knowledge of of the respondents showed high knowledge of stress adopting healthy life style, avoiding smoking and as a risk factor of hypertension. These findings were maintaining a healthy weight as preventive measures expected due to the social and cultural belief within of hypertension. These support their belief that the LGA, that hypertension is being caused by too mental stress causes hypertension. These findings 120

7 were not surprising but in line with McCoy (2012) which identified healthy habits or life style, managing stress, avoiding smoking, maintaining healthy weight among others as preventive measures of hypertension. Similarly Obinna (2011) stated hat life style changes, maintaining a healthy weight, regular monitoring of blood pressure, increased physical activity, decrease salt intake are among the preventive measures of hypertension. Findings in Tables 3 and 4 showed that education had influence on the knowledge of risk factors and preventive measures of hypertension possessed by CBMs in Udenu LGA. The tables showed that respondents with tertiary education indicated highest knowledge of risk factors and preventive measures of hypertension while respondents with no formal education showed the least knowledge of risk factors and preventive measure measures of hypertension. These findings were expected and in line with Agu (2007) which stated that women empowerment is the capacity of women to increase their self-reliant strategies through the inducement of education. Women s access to higher level of education enhances their capacity to participate in their health care or health promotion. Similarly, WHO (2007) identified illiteracy, among other as non-medial contributory factor to maternal and neonatal deaths. This implies that with higher education of childbearing mothers, hypertension and other preventable pregnancy-related diseases will be curtailed to a large extent. The chi-square analysis in Table 5 and 6 were not accepted as the tables showed that there were significant difference in the knowledge of risk factors and preventive measures of hypertension possessed by CBMs in Udenu LGA based on their level of education. This invariably implies these women were not well educated. Majority of the respondents do not have tertiary education. These findings were not surprising but in support of some literature assertions. Ajayi (2011) stated that Nigerian women s access to education especially higher education is still being constrained as a result of differences in gender roles which are culturally constituted. World Bank (2011) asserted that education is the key to women empowerment. UNFPA(2012) opined that higher levels of women s education are strongly associated with both lower infant and material mortality and lower fertility as well as with higher levels of education and economic opportunities for their children. Conclusion Based on the results and discussion of the study, the following conclusions were made; 1. Majority of CBMs in Udenu LGA do not have enough knowledge of risk factors of hypertension. 2. CBMs in Udenu LGA had moderate knowledge of preventive measures of hypertension. 3. Educational qualification had influence on the knowledge of risk factors and preventive measures of hypertension possessed by CBMs in Udenu LGA. Recommendations 1. Ante-natal and infant clinic health-talk should be given adequate attention in all health facilities. 2. The public should be educated on the importance of periodic blood pressure check. 3. Pregnant and CBMs should check their blood pressure regularly. 4. Girl-child education up to tertiary level should be made compulsory. References Agu, S. (2007). Gender equality, education and women empowerment: the Nigerian challenge. Retrieved 13 th August, 2012 from Ajayi, O. (2011). Women emancipation: attainable task in Nigeria. Retrieved 13 th August, 2012 from www. tribute.com.ng/. British Medical Association, (2002). Illustrated Medical Dictionary. London Dorling Kindersley Ltd. Ekwunife, O.I & Aguwa, C.N (2001).A Meta Analysis of Prevalence of rate of Hypertension in Nigerian Population. 122

8 Retrieved on 9 th August 2012 from org/phe. Haines, C. (2012). 6 Hypertension risk factors. Retrieved 10 th August, 2012 from com/ hypertension/preventing/-- Marks, J.W. (2012). High blood pressure: signs, symptoms, causes, treatment. Retrieved on 9 th August, 2012 from htt://www. medicinenet.com /high-blood-pressrue/artide htm. Mayor, C.S(2012). High blood pressure (hypertension) risk factors. Retrieved 9 th August, 2012 from McCoy, K. (2012). 10 health habits hat will keep your blood pressure down. Retrieved 13 th August, 2012 from health.com/hypertension. Okoye, R. C. (2006). The mystery of silent killers. Port Harcourt: Save a life foundation Publication. UNFPA, (2012). Empowering women: Promoting gender equality. Retrieved 19 th August, 2012 from htm. Weber, C. (2007). Top 10 high blood pressure risk factors. Retrieved 10 th August, 2012 from com/od/understanding your risk. WHO (2007). Why gender and health. Retrieved 13 th August, from project.org/ document. World Bank (2011). Promote gender equality and empower women. Retrieved 13 th August, 2012 from org/mdgs.gender.html. 123