Knowledge, attitudes and practices of hypertension in a community based cross sectional study done in Ward 14, Gwanda District, Matebeleland South, Zimbabwe

Background Hypertension is a significant contributor to cardiovascular and renal diseases. In poor communities there is lack of awareness, poor treatment and control. However, it can be controlled by lifestyle modifications. The aim of this study was to determine knowledge, attitudes and practices with regards to hypertension in a rural disadvantaged community in Matebeleland South province of Zimbabwe. Methods We conducted a descriptive cross-sectional survey. A pre-tested and validated interviewer administered questionnaire was used to collect demographic, awareness, treatment and control data among consenting hypertensive patients. Results 304 respondents were enrolled into the study, their mean age was 59 years and 65.4% were females. Adding salt on the table (59.8%) was a risk factor. There were strong community beliefs in managing hypertension with herbs (50.7%) and use of traditional medicines (14.5%). Knowledge on hypertension was poor with 43.8% of hypertensive patients having had a discussion with a health worker on hypertension and 64.8% believing the main case of hypertension is stress while 85.9% stated palpitations as a symptom of hypertension. Defaulter rate was high at 30.9% with 25% of those on medication not knowing whether their blood pressure control status. Odds ratio for good knowledge for secondary and tertiary education were 3.68 (95%CI: 1.61-8.41) and 7.52 (95%CI: 2.76-20.46) respectively compared to no formal education. Those that believed in herbal medicines and those that used traditional medicines were 53% (95%CI: 0.29-0.76) and 68% (95%CI: 0.29-0.76) less likely to have good knowledge compared to those who did not believe and use traditional medicines respectively. Conclusion Lack of education and poor socio-economic backgrounds were associated with poor knowledge on hypertension. Shortages of medication, poor health funding and weak health education platforms contributed to reduced awareness and control of hypertension in the community. Thus, community hypertension awareness, treatment and control needed to be upscaled.


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Hypertension (HT) is one of significant health challenges in low-and middle-income countries 61 (LMICs) that are experiencing epidemiological transition from communicable to non-62 communicable diseases [1][2][3]. Hypertension is prevalent in both high income and LMICs.

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Together with other cardiovascular diseases, these public health problems that are strongly 64 linked to urbanization, aging populations, westernized socio-economic sedentary lifestyles 65 promoting excessive salt and alcohol intake, smoking, obesity as well as lack of physical exercise 66 [4][5][6][7].

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Hypertension is the most common incidentally diagnosed chronic disease and various factors 68 affect diagnosis, treatment and control of HT. However, the most important barrier to diagnosis 69 is lack of knowledge and awareness on HT and its complications [8]. Almost half of hypertension-70 related deaths can be averted with compliance or adherence to antihypertensive treatment [9]. It 71 is therefore important to assess the patients' knowledge and awareness on HT because patient 72 education is a key component in the programs and interventions designed to control HT [10].

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Hypertension is a major risk factor for cerebro-vascular accidents as well as coronary heart 74 diseases, with two-thirds of all cerebro-vascular accidents being attributable to poor HT control 75 [11,12]. Cardiovascular diseases are the major cause of death globally, with an estimated 17.5 76 million deaths per year and 80% of the deaths are recorded in LMIC [5,9]. In African communities, 77 the challenges in managing HT lie in prevention, diagnosis and treatment [13]. There is a shortage 78 of national data on HT prevalence studies in Zimbabwe. A study that summarized HT prevalence 79 over a 14-year period from 1997 to 2010 estimated the pooled prevalence of HT in Zimbabwe at 5 80 30% [14]. In a hypertension study done in Bulawayo city, in southern Zimbabwe, the highest 81 prevalence of 38.4% was reported [15] while an average prevalence of 17.9% was recorded among 82 three provinces in another survey focusing on both urban and rural settings [16].

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Significant progress has been made in improving HT awareness, treatment and control among 84 patients living with hypertension (PLWHT). Efforts to control HT have included improving 85 public knowledge and awareness on the risks and complications of hypertension [10]. 199

Attitudes and practices on HT
200 Table 3 shows the attitudes and practices of respondents on the control of HT, their preferred 201 service providers and access areas for follow up.

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Regression analysis 220 Table 4 shows a logistic regression analysis of factors affecting knowledge on hypertension. Data 221 was recoded such that those who had scored six or more out of ten on knowledge and practice 222 scores were deemed to have good knowledge and good practice respectively whilst, a score of 223 three or more out of five was deemed good attitude towards HT treatment and control.
224 Table 4      307 Improved knowledge on hypertension should focus on primary prevention as this is cost effective 308 in low resource settings. Diet (83%) was singled out as the commonest risk factor in developing 309 HT, however 14% had no knowledge of risk factors for HT. Primary prevention reduces the 310 expenses on medical care and the resultant complications of high blood pressure. Awareness

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screening programs, skills training and capacity building of health workforce on how to deal with 312 hypertension and its associated risk factors including access to low cost antihypertensive 313 medicines are key for developing countries with limited resources [28]. It was noted that 65% of 314 those who took medication perceived that they had well controlled blood pressure however we 315 found out that their scale of measurement was based on experiencing or perceived 316 "complications" rather than blood pressure readings.

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In Zimbabwe there are limited national studies on hypertension prevalence while there is lack of 318 infrastructure to enable and support hypertension surveillance [14]. This was evident in that more 319 than 30% of respondents had last checked their blood pressure for more than 4 months while 320 some had lost track of when they had a BP checked. The local clinic was the only place where a 321 blood pressure machine was found however, sometimes the services would be unavailable to 322 various logistical reasons. This then calls for concerted efforts to prioritize service delivery, and 323 funding for HT consumables. Special priority and focus should be on the crafting policy and 324 research-based implementation of tailor-made service delivery packages to reduce hypertension 325 related morbidity and mortality [21].