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CARDIAC HEALTH: HYPERTENSION RATE IN RURAL AREAS IN GHANA

TABLE OF CONTENT
? Acknowledgement 2
? Abstract 2
? Introduction 3-4
? Methodology 4
? Results 5-11
? Discussion 12-15
? Conclusion 15-16
? References 17

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ACKNOWLEDGEMENT
My profound gratitude goes the Almighty God and secondly to Dr. Akwasi Anyanful who stood in as my facilitator when my facilitator was on sabbatical leave. Special thanks to Dr. Sebastian Eliason, module coordinator for Community-Based Experience and Services who gave me the permission to make use of the data collected during our community service in Ayeboafo for this particular study.

ABSTRACT
A study done to rule out the fact that hypertension is rare in rural areas but becoming a major public health problem. A purposive study design was used with a sample size of 55 made up of 7 men and 48 females present at the durbar. Study was done in Ayeboafo in the Eastern Region of Ghana.
Methodology: Blood pressures of individuals present at durbar grounds were taken and other demographics obtained from interviewing the respondent. Results show a mean blood pressure of 128/74mmHg which is within the prehypertension range. 40.8% of people were in the high normal (prehypertension) state, 36.4% in the normal range and 21.8% in the hypertension range which is quite higher than Ghana Demographic and Health Survey report which is 16% for urban dwellers, 10% and 9% for women and men respectively in the rural areas.
Conclusion: findings of the study clearly outline that the rate of hypertension is increasing in the rural areas. Measures for treatment and management as well as education on hypertension should be made available in these areas to prevent high blood pressure from becoming a public health burden.
INTRODUCTION
According to the World Health Organization, hypertension, also known as high or raised blood pressure, is defined as a condition in which the blood vessels have persistently raised pressure. Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure the harder the heart has to pump. Measurement of blood pressure is done by the use of a stethoscope and a sphygmomanometer. The current definition of hypertension is when the systolic pressure is 140 or above in mmHg or diastolic pressure is 90 or more in mmHg or both.
According to WHO, more than one quarter of the world’s adult population had hypertension in the year 2000 and has been projected to increase to 1.56 billion which is 60% in 2025. Further classification by WHO for hypertension were as follows: 140-159mmHg systolic pressure and 90-99mmHg diastolic pressure is stage one hypertension, 160-179mmHg systolic and 100-109mmHg diastolic is stage 2 and 180mmHg and above with diastolic 110mmHg and above is severe and is termed hypertension crisis.
Hypertension has been noted to be one of the leading causes of cardiovascular diseases and premature mortality in the world, it has been nicknamed ‘the silent killer’ since it exhibits no symptoms in patients that have it. Hypertension, which was considered to be rare in the most African countries particularly within the rural areas is now peaking up. Recent studies show that blood pressure levels and hypertension rates in Ghana are among the highest in Africa. Further studies also show that many with the condition are not aware.
The prevalence may be due to rapid changes to lifestyle habits, diet in relation to modernization and urbanization of these rural areas hence reducing level of physical activity. Risk factors associated with hypertension include age, sex, occupation, obesity, family history, alcohol consumption, level of education and many others.
The main objective of this study is to pinpoint the fact that hypertension in the rural areas is no longer extremely rare but rates are increasing than expected irrespective of the fact that people in the rural areas engage in more physical activity.
METHODOLOGY.
As part of the Community-Based Experience and Service in Ayeboafo, a village which is part of Akyemansa district in the Eastern region of Ghana, a health screening exercise for vital signs was done as community service which was done after the exit durbar on the March 21, 2018. Parameter taken from data for analysis for the purpose of this study was blood pressure. The people of Ayeboafo present at the exit durbar were 55. Each member present went through blood pressure check during the screening. Demographics like sex, marital status, educational level as well as occupation were collectively gathered during the administration of questionnaires.
Research design Purposive
Sample size 55
Method Interview, blood pressure measurement
Tool Questionnaires, sphygmomanometer, stethoscope
Data analysis SPSS version 23, Microsoft Excel 2013

RESULTS
DEMOGRAPHICS.
N=55 MALE: 7 FEMALE: 48

Figure 2: A bar chart showing the ages of residents who attended the screening. N= 55 Minimum: 18years Maximum: 80years

Figure 3: A bar chart showing the marital status of the people. N=55

Figure 4: A bar chart indicating the educational level of the people. Compared with GDHS report 2014. N=55

Figure 5: A pie chart indicating the occupation of the people. Compared with GDHS 2014 report

BLOOD PRESSURE READINGS

Figure 6: A bar chart indicating the systolic blood pressure. N=55

SYSTOLIC BLOOD PRESSURE
MODE 130
MEDIAN 130
MEAN 127.7

Figure 7: A bar chart showing the diastolic pressure. Compared with CDC and GDHS report. N=55

DIASTOLIC BP
MODE 70
MEDIAN 75
MEAN 73.9

Figure 8: A bar chart indicating the blood pressure. Compared with CDC and GDHS report. N=55

BP CHECKED
MODE 100/70
MEDIAN 130/80
MEAN 128/74

DISCUSSION
Beginning with the demographics, out of the 55 people present at the durbar, 7 were men representing a percentage of 12.7% and females, 48 representing a percentage of 87.3%. The percentage for male present appears to be seven times that of females and this was as a result of the low turnout of males for the durbar due to their farming activities scheduled at the time the data was collected. Data was collected from individuals within the age ranges of 18years to 80years. The age group that turned out most was the 40-49 years accounting for 30.9%, followed by ages 20-29years with a percentage of 25.5% and the least being ages 50-59 and 80-89 both with percentages 3.6%. For marital status, majority of the people were married having a percentage of 76.4%, followed by the widowed representing 10.9% with the least being cohabited, 3.6%. With respect to their educational level, the highest level of education appears to be the JHS and this is represented by 49.1% which is close to the percentage of Ghana Demographics and Health Survey (GDHS) which is 52.4% for women in eastern region where Ayeboafo is found, and about 45% of these female do not continue their education due to lack of funding and sometimes marriage. About 18.2% were never educated with the tertiary level predominantly reached by the men present with a percentage of 10.9%. Moving on to the last aspect of the demographics which is their occupation, according to the study, 67% were farmers, 14% were civil servants basically teachers,11% were petty traders with 4% others having no job. These percentages especially for the farmers is slightly higher than the Ghana demographic and health survey report which was 46.1% for women in rural areas who were into farming, accounting for age ranges 15-49years, which in this particular research, age ranges were from 18-80years. However, percentage for petty trading was lower than GDHS report which is 34.9%. It must also be noted that, sample size for the research is not the actual representation of the whole population hence accounting for the margins in percentages presented by GDHS report.
Blood Pressure Measurement
According to Blood Pressure UK, ranges of blood pressure were defined as follows:
• Systolic blood pressure less than or equal to 90 and diastolic pressure less than or equal to 60 means low blood pressure.
• Systolic pressure greater than 90 and less than 120 with diastolic pressure greater than 60 but less than 80 means normal blood pressure.
• Systolic pressure 120 but less than 140 with diastolic pressure 80 but less than 90 means prehypertension
• Systolic pressure 140 and above with diastolic pressure of 90 and above means hypertensive.
These ranges are in line with Centre for Disease Control and Prevention (CDC) standards.
Taking a closer look at the graph illustrating the systolic pressure, about 45.5% of the people are within the prehypertension range, that means they are at higher risk of developing hypertension with time if measures for lowering blood pressure are not taken into consideration, followed by 32.7% within the normal range and about 21.8% being hypertensive. According to Addo et al. in his study of the prevalence of hypertension in rural Ghana specifically rural Accra stated that hypertension in the rural areas was no longer rare. In his study 25.4% were hypertensive, comparative to this study was a slight difference of 3.6%. This is actually higher comparing it to study made by GDHS which states that the percentage of hypertension is 16% in urban men and women both as well as 10% and 9% in both women and men in rural areas respectively. The percentage obtained in this particular study was quite higher and this could be explained by several factors noted in observation as well as counselling sessions after screening such as high alcohol consumption due to their palm plantation farming which also include palm wine tapping, poor healthy lifestyle and well as ignorance of the risk factors of hypertension. The mode and median systolic pressure were both 130mmHg with average systolic pressure computed as 127.7mmHg which is within the prehypertension category which gives an indication that hypertension is no longer becoming a rare condition in the rural area.
For the diastolic pressure, more than half the sample size were in the normal range specifically 56.4% followed by about 21.8% in the prehypertension category, 12.7% with a lower diastolic pressure and the least being a hypertensive diastolic pressure about 9.1%. A mode of 70mmHg, median of 75mmHg and a mean of 73.9mmHg were obtained for the diastolic pressures giving an indication that their diastolic pressures were within the normal ranges.
Looking at the combination of both systolic and diastolic pressure, graph and results slightly changed as compared to the individual as a result of some patients having a normal systolic pressure and a lower diastolic pressure hence affecting the interpretation like in cases with patients having blood pressures of 91/57mmHg and 96/57mmHg. In some cases of the prehypertension and hypertensive stage, some patients recorded a blood pressure of 130/90mmHg which if looking at the systolic is in the prehypertension category but for diastolic is in the hypertensive category. Blood pressure was hence classified as high normal or prehypertension, hence accounting for slight changes. The highest blood pressure recorded was 185/85mmHg which according to GDHS report and WHO is a stage 3 hypertension or severely elevated blood pressure. The mode blood pressure was 100/70mmHg which is within the normal blood pressure range, median being 130/80mmHg which is high normal or prehypertension and mean 128/74mmHg which according to CDC is prehypertension but according to WHO is above the optimal or is normal. In percentages, about 40% were prehypertensive, 36.4% in the normal range, 21.8% hypertensive and only 1.8% representing those with low blood pressure. These values when compared with GDHS report tends to be higher indicating that the rate of hypertension is increasing in the rural areas.

CONCLUSION
From the findings of the study, it is now clear that hypertension rates in the rural certain is no longer rare but peaking up in Ghana. Though no conclusive statistical analysis were made to correlate the rate of hypertension to their age, occupation, sex, lifestyle, alcohol consumption and educational level, qualitative analysis done during the screening session indicated that some of the hypertensive patients were not even aware of their condition whereas others who were aware could not seek the right treatment due to some financial constraint to seek health care.
Recommendation:
Healthier lifestyle habits should be adopted. There should be mass education on the risk factors leading to hypertension as well as its effect on our health on the whole most especially in rural areas. People of Ayeboafo community must be mindful of the amount of alcohol intake as part of adopting a healthy way of life. More screening and counselling sessions should be done at the CHPS centers to make monitoring of blood pressures as easy as possible.

REFERENCES
Agyemang, C. (2006). Rural and urban differences in blood pressure and hypertension in Ghana, West Africa. Public health, 120(6), 525-533.
Addo, J., Amoah, A. G., ; Koram, K. A. (2006). The changing patterns of hypertension in Ghana: a study of four rural communities in the Ga District. Ethnicity ; disease, 16(4), 894-899.
Ghana Demographic and Health Survey (2014) report. Retrieved on April 23, 2018
Center for Disease Control and Prevention: Measuring Blood Pressure. Available at https://www.cdc.gov retrieved on April 23, 2018.

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