Prevalence of Uncontrolled Hypertension and Associated Factors among Hypertensive Patients Attending Medical Outpatient Clinic, Thika Level 5 Hospital, Kiambu County, Kenya

Abstract

Hypertension is a public health concern, which accounts for high morbidity and mortality globally every year. High hypertension burden is reported in Middle- and Low-income Countries (LMICs) due to an increase in hypertension risk factors in populations with 33% prevalence rates in Africa including 26.6% prevalence rate in Kenya. In many communities in the world, less than half of all hypertensive patients have controlled blood pressure despite well-established approaches to diagnosis and treatment, leading to inadequate achievements in hypertension management. The main objective of this study was to determine the prevalence of uncontrolled hypertension and associated factors among hypertensive patients attending Medical Outpatient Clinic, Thika Level 5 Hospital (TL5H) Kiambu County Kenya. The specific objectives were to determine the proportion of patients with uncontrolled hypertension, their socio demographics, socioeconomics, lifestyle and the types of antihypertensive drugs prescribed to the patients. This was a hospital based cross-sectional study. Questionnaires were administered to a total of 394 patients who were selected by systematic random sampling to participate in the study at an interval of 2, whereas all 6 health professionals were purposively selected as Key Informants to give in-depth knowledge of hypertension management. Four Focused Group Discussions composed of 35 patients (17 Males and 18 Females) were used to solicit data for providing context to the quantitative data. Quantitative data were coded, checked and analysed using STATA 14 and Qualitative data was thematically organised using NVIVO. The study showed that 48% of the study participants had uncontrolled hypertension at the time of the study. Bivariate analyses showed Significant association between uncontrolled hypertension and level of education (χ2= 10.21 (3); p= 0.017), source of finance for drugs (χ2=9.01 (1); p=0.011), BMI (χ2= 10.78 (2); p=0.005). Salt intake (χ2= 3.11 (1); p= 0.078.) at 90% Confident interval. Multivariable analyses revealed the independent predictors of uncontrolled hypertension include level of education primary COR 2.16[1.084-4.304], secondary school education COR 2.21[1.072-4.55], post-secondary education COR 0.822[0.293-2.312]. Patients who maintained their BMI COR0.275[0.131-0.575] and those who reduced their BMI COR 0.767 [0.475-1.240]. Source of finance for drugs NHIF COR 0.667[0.209-2.128] Out of pocket COR 1.213[0.392-3.760] and salt intake COR 0.6[0.350-1.028]. The study concluded that BMI, level of education, source of finance for drugs and salt intake were predictors of uncontrolled hypertension and these are supported by insights from KIIs and FGDs. Following the findings, the study recommends: community health promotion activities to increase awareness of how to modify these significant factors to reduce hypertension. Findings from this research within a county referral hospital context is critical and will guide the policy makers on the appropriate measures to take so as to reduce hypertension burden in Kiambu county and Kenya.