PREVALENCE, AWARENESS AND RISK FACTORS OF
HYPERTENSION AMONG MARKET TRADERS IN MBARARA CITY,
SOUTHWESTERN UGANDA.
NABIRYE AFUSA
2018/BSP/085/PS
NAMPIJJA RITAH
2018/BSP/049/PS
NINSIIMA PATIENCE
2018/BSP/055/PS
NJAKA SADIC
2018/BSP/081/PS
ZIRIMENYA JOEL
2018/BSP/074/PS
A RESEARCH DISSERTATION SUBMITTED TO THE DEPARTMENT OF
PHYSIOTHERAPY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
AWARD OF BACHELOR OF SCIENCE IN PHYSIOTHERAPY AT MBARARA
UNIVERSITY OF SCIENCE AND TECHNOLOGY.
SUPERVISOR: DR ARUBAKU WILFRED
NOVEMBER 2022
ABSTRACT
Background: Hypertension, a silent killer, is the principal causes of mortality and morbidity
globally, and approximately 1.4 billion people worldwide are living with it. It is highly prevalent
in developing countries. Data about its prevalence, risk factors and awareness is crucial to curbing
its implications in a low resource setting like Uganda.
Purpose: To find out the prevalence, risk factors, and awareness of hypertension among market
traders in Mbarara City in southwestern Uganda.
Methodology: A descriptive cross-sectional study with a stratified proportionate random sampling
design was carried out among market traders in 4 markets in Mbarara, a city in southwestern
Uganda. A modified HELM guided questionnaire on 357 study participants aged >25 years was
used together with a height board, automatic blood pressure machines and weighing scales.
Results: The prevalence of hypertension was 32.5%. Females contributed 26.3% and males 6.2%.
The mean systolic and diastolic blood pressure were 142.11 and 83.45 mmHg, respectively. Out
of the total 116 hypertensive participants, 93.4% (109/116) were newly diagnosed. On average,
the participants were overweight (BMI: 29.56). The majority of the participants were found to be
physically inactive.
Conclusion: A third of the study participants were hypertensive and half were pre-hypertensive.
Awareness about hypertension status was low. Low levels of physical activity and obesity were
the prevalent risk factors of hypertension.
Key words: Blood pressure, hypertension, body mass index, physical activity, noncommunicable diseases, risk factors, awareness, prevalence
1
TABLE OF CONTENTS
ACKNOWLEDGEMENT
vi
DECLARATION
vii
ABBREVIATIONS
viii
OPERATIONAL DEFINITIONS
ix
CHAPTER 1: INTRODUCTION
1
1.0 Introduction
1
1.1 Background
1
1.2 Research study questions
3
1.3 General research objective
3
1.4 Specific research objectives
3
1.5 Problem statement
4
1.6 Justification for the research study
5
1.7 Significance of the study
6
1.8 Conceptual framework
7
CHAPTER 2: LITERATURE REVIEW
8
2.0 Introduction
8
2.1 The burden of hypertension
8
2.2 Awareness about hypertension
10
2.3 Risk factors of hypertension
10
2.4 Outcomes of hypertension
11
CHAPTER 3: METHODOLOGY
12
3.0 Introduction
12
2
3.1 Study design
12
3.2 Study setting
12
3.3 Study population
12
3.4 Sample size estimation
13
3.5 Sampling
13
3.6 Inclusion criteria
13
3.7 Exclusion criteria
13
3.8 Data collection procedure
13
3.9 Data entry and analysis
14
3.10 Ethical considerations
14
3.11 Quality assurance
15
CHAPTER 4: RESULTS
16
4.0 Introduction
16
4.1 Demographics
16
Table 4.1.0 Demographics of the market traders
17
4.2 Lifestyle and health status characteristics of the participants
17
Table 4.2.0 Lifestyle and health status characteristics of the traders
19
Table 4.3.0 BMI and blood pressure grades according to gender and age categorization
21
4.4 Awareness about hypertension
22
CHAPTER 5: DISCUSSION OF RESULTS
23
5.1 Prevalence of hypertension
23
5.2 Awareness about hypertension
24
5.3 Risk factors of hypertension
24
3
CHAPTER 6: RECOMMENDATIONS, LIMITATIONS, SUMMARY OF FINDINGS
AND CONCLUSION
27
6.0 Introduction
27
6.1 Recommendations
27
6.2 Limitations
28
6.3 Summary of findings
28
6.4 Conclusion
28
REFERENCES
29
APPENDICES
41
Appendix 1: Consent form
41
Appendix 2: Questionnaire
45
Appendix 3: Time frame
51
Appendix 4: Budget
52
Appendix 5: Approval letter
53
4
ACKNOWLEDGEMENT
To begin with, we thank God, who enabled us to get this far with our research study and made it a
success. We also want to thank our wonderful parents for their unending financial support in
meeting the research's financial needs.
With a lot of enthusiasm, we thank the Department of Physiotherapy, Mbarara University of
Science and Technology, for equipping us with special knowledge and skills that have enabled us
to successfully complete our research study.
We also thank our dear supervisor, Dr. Arubaku Wilfred for his upper hand and tireless efforts in
always reviewing our work and pointing out areas for improvement.
We also pass a vote of thanks to Niyonsenga Jean Damascene and Nuwahereza Amon, who are
lecturers in the Department of Physiotherapy, and Nabbosa Maria, a Principal Physiotherapist at
Mbarara Regional Referral Hospital, for assisting us with material for our research study.
In addition, we appreciate Ms. Turyakira Eleanor, a senior statistician in the Department of
Community Health, for her unending support in making us get more familiar with STATA, a data
analysis software.
Finally, a special thanks to each and every member of our research group for the great idea we
came up with and the unity and enthusiasm exhibited all throughout our research study.
5
DECLARATION
We hereby declare that this work that we have presented for the attainment of the Bachelor of
Science in Physiotherapy at Mbarara University of Science and Technology is our own work and
it has never been presented to any other institution/university for another award whatsoever.
All resources used have been well acknowledged with complete references.
Researcher
Registration number
Signature
1. ZIRIMENYA JOEL
2018/BSP/074/PS
_______________
2. NABIRYE AFUSA
2018/BSP/085/PS
_______________
3. NAMPIJJA RITAH
2018/BSP/049/PS
_______________
4. NJAKA SADIC
2018/BSP/081/PS
_______________
5. NINSIIMA PATIENCE
2018/BSP/055/PS
________________
SUPERVISOR
SIGNATURE
DATE
DR WILFRED ARUBAKU
______________
_______________
6
ABBREVIATIONS
BMI: Body Mass Index
CVD: Cardiovascular Disease
DBP: Diastolic Blood Pressure
LMICs: Low-and Middle-Income Countries
NCDs: Non-Communicable Diseases
SBP: Systolic Blood Pressure
WHO: World Health Organization
7
OPERATIONAL DEFINITIONS
BLOOD PRESSURE: The pressure exerted by blood within the arterial system of the body and
is measured in mmHg (Walker et al., 1990).
SYSTOLIC BLOOD PRESSURE: The maximal pressure in the arterial system generated during
the contraction of the ventricles (Walker et al., 1990).
DIASTOLIC BLOOD PRESSURE: The minimal pressure within the arterial system of the body
when the ventricles are relaxing (Walker et al., 1990).
HYPERTENSION: When a person’s systolic blood pressure (SBP) is greater or equal to 140
mmHg or when the diastolic blood pressure is greater or equal to 90 mmHg or when one is on
antihypertensive medication (Burnier and Egan, 2019).
PHYSICAL ACTIVITY: Any movement of the body executed by skeletal muscles that requires
energy expenditure (WHO, 2022).
PHYSICAL EXERCISE: A form of physical activity that is organized and involves repetitions
with the main goal of enhancing and sustaining physical fitness (Caspersen et al., 1985).
OVERWEIGHT OR OBESE: An abnormally increased deposition of fat in the body which may
negatively affect someone’s health (OO et al., 2020).
BODY MASS INDEX (BMI): An indicator of a person's thinness or fatness using their weight
and height. It is usually used to show whether a person’s weight is normal for their height. It
therefore categorizes individuals as: obese, overweight, normal or underweight (Carr and
Friedman, 2005).
8
BMI is graded as below according to the National Heart, Lung and Blood Institute:
Category
BMI range (Kg/m2)
Underweight
<18.5
Normal
18.5-24.9
Overweight
25-29.9
Obese
>or=30
Classification of Blood pressure according to the joint national committee on prevention,
detection, evaluation and treatment of high blood pressure as seen in the table below (Maiyaki and
Garbati, 2014).
BP CLASSIFICATION
SYSTOLIC
BLOOD DIASTOLIC
PRESSURE
PRESSURE
Normal
<120
<80
Prehypertension
120-139
80-89
Stage 1 hypertension
140-159
90-99
Stage 2 hypertension
>or =160
>or =100
Stage 3 hypertension
>or =180
>or =110
9
BLOOD
CHAPTER 1: INTRODUCTION
1.0 Introduction
This chapter presents the background of the study, the problem statement, study objectives, study
questions as well as justification and significance of the study.
1.1 Background
Economically developing countries are undergoing an epidemiological transition from
communicable diseases to non-communicable diseases (Maiyaki and Garbati, 2014). Noncommunicable diseases (NCDs), as reported by the World Health Organization (WHO), are the
major cause of death worldwide, with 41 million people dying annually, approximately 71% of
the overall deaths in the whole world. The four main non-communicable killers include
cardiovascular diseases, cancers, respiratory diseases, and diabetes, which are responsible for 17·9
million, 9·0 million, 3·9 million, and 1·6 million deaths each year, respectively. These together
account for more than 80% of all premature NCD deaths (Budreviciute et al., 2020).
Over the past 20 years, a drastic rise in the incidence of non-infectious diseases in Sub-Saharan
Africa has been fueled by a high incidence of cardiovascular risk factors. For example, physical
inactivity, obesity, air pollution, hyperlipidemia, unhealthy diets, hypertension and diabetes have
been noted (Melaku et al., 2016).
Hypertension is the predominant risk factor for NCDs globally, thus a major precipitant for
mortality and morbidity yet its control is not routinely emphasized (Lim et al., 2012, Kaddumukasa
et al., 2017, Rahman et al., 2018). If hypertension is not controlled it will lead to catastrophic
outcomes which include: renal failure, stroke, cardiac failure and myocardial infarction among
other NCDs (Guwatudde et al., 2015).
1
Hypertension is commonly found in populations greater than 25 years of age, with a prevalence of
40% (Campbell and Zhang, 2018). Additionally, the proportion of the population’s understanding
of hypertension, its treatment, and control is low in low and middle-income countries despite the
increasing prevalence (Bosu, 2015, Mills et al., 2020). In comparison to other continents, Africa
faces the greatest burden of hypertension, which is the main adjustable risk factor for NCDs with
the greatest incidence, prevalence, and case fatality of NCDs (Owolabi et al., 2016). A study in
2013 estimated that the number of adults with hypertension in Sub-Saharan Africa would have
exceeded 125 million by 2025 (Kotwani et al., 2013).
Hypertension, like other NCDs, is becoming increasingly common in Uganda. Results from the
Uganda national NCDs risk factor survey carried out in 2015, where 3906 participants were
recruited, showed that 1033 of the participants had hypertension. The prevalence of hypertension
from this survey in urban areas and rural areas was 28.9% and 25.8%, respectively, and these
numbers might have increased (Guwatudde et al., 2015)
A study done in Mbarara City, Kakoba division, southwestern Uganda about sedentary lifestyle
and hypertension in the peri-urban areas, which included 310 participants, concluded that 69.7%
of the participants were newly diagnosed with hypertension (Twinamasiko et al., 2018).
Therefore, studies on awareness, risk factors, and prevalence of hypertension in Uganda are still
scarce, and this study will seek to find out the awareness, prevalence, and risk factors of
hypertension among market traders in Mbarara City in southwestern Uganda.
2
1.2 Research study questions
I.
What is the awareness of hypertension among market traders in Mbarara, a city in
southwestern Uganda?
II.
What is the prevalence of hypertension among market traders in Mbarara, a city in
southwestern Uganda?
III.
What are the risk factors for hypertension among market traders in Mbarara, a city in
southwestern Uganda?
1.3 General research objective
To establish the awareness of hypertension, its prevalence and risk factors among market traders
in Mbarara City, southwestern Uganda.
1.4 Specific research objectives
I.
To establish awareness about hypertension among market traders in Mbarara, a city in
southwestern Uganda.
II.
To determine the prevalence of hypertension among market traders in Mbarara, a city in
southwestern Uganda.
III.
To establish the risk factors of hypertension among market traders in Mbarara, a city in
southwestern Uganda.
3
1.5 Problem statement
Hypertension is one of the major modifiable predisposing factors for NCDs globally, thus a major
precipitant for mortality and morbidity, yet its control is not routinely emphasized (Lim et al.,
2012, Kaddumukasa et al., 2017, Rahman et al., 2018). In addition, hypertension is a main risk
factor for preventable death (Castro-Porras et al., 2021). According to the World Health
Organization, approximately 1.4 billion people worldwide are hypertensive, and a high prevalence
has been observed in Africa, mostly in low and middle-income countries, with approximately 46%
of adults who are aged 25 years of age and above having hypertension (Ibrahim and Damasceno,
2012).
Many studies have indicated a rise in the prevalence of hypertension amongst market traders. A
study in 3 markets in Lagos, Nigeria among 391 participants found that 46.6% with hypertension
were unaware of their hypertensive status (Achonu et al., 2022). One in the market of Dantokpa in
Benin among 255 women market traders showed that 34% were hypertensive and of these, 14%
were newly screened (Ibrahim et al., 2020). A study in Maiduguri, Borno state in a regional market
in Nigeria among 411 market traders showed that 102 were hypertensive and of these, 25% had
undiagnosed hypertension (1 in every 4 market traders) (Vincent-Onabajo et al., 2017).
The effect of hypertension on the heart and blood vessels has been shown to induce heart attacks,
heart failure, strokes, kidney damage and deaths (Kaplan, 2010, Fuchs and Whelton, 2020).
Predisposing factors to hypertension include: age, sedentary lifestyle, high BMI, alcoholism,
tobacco smoking and diet (Guwatudde et al., 2015, Asemu et al., 2021).
4
Lack of awareness of unrecognized hypertension poses greater risk to the individual, predisposing
them to the occurrence of many NCDs (Nwoha et al., 2022). The low levels of awareness about
hypertension reported in Africa is a major threat to public health since the population in this area
is increasing and, therefore, there will be significantly large populations not aware of the increased
risk of complications associated with hypertension in years to come (de-Graft Aikins et al., 2010).
The prevalence of hypertension and awareness data is very important in understanding the extent
of the problem, recognizing groups at risk for hypertension and examining the outcomes of
interventions in policy and practice (van de Vijver et al., 2014).
Various studies have characterized market traders with a sedentary lifestyle, obesity, and old age
with low levels of awareness about hypertension, which are the major predisposing factors to
hypertension (Fatiu et al., 2011, Ulasi et al., 2011, Awosan et al., 2014, Oparah et al., 2021).
In Uganda, data about hypertension among market traders is still limited and therefore less
attention is paid to market traders in regard to their increasing predisposition to hypertension. This
could lead to increased prevalence and complications of the disease in this population, increased
hospital admissions, overwhelming the hospital systems in Uganda.
1.6 Justification for the research study
There are increasing numbers of patient admissions in most hospitals in Uganda for NCD related
cases for example a four-year retrospective study done at Mulago Hospital reported that majority
of patients (72%) had NCDs as the primary reason for admission (Kalyesubula et al., 2019) yet the
major risk factor, hypertension, has been given less attention to identify its prevalence, risk factors,
and level of awareness among people (Chang et al., 2019).
5
According to the WHO, cardiovascular diseases have been predicted to account for about a quarter
of deaths worldwide by 2030 (Gabert et al., 2017). There is a need to control these numbers.
From recent studies, it has been suggested that people have little knowledge about hypertension
and its risk factors, leading to their failure to get hypertension screening and health education about
it.
There is still limited data about the prevalence, awareness and predisposing factors for
hypertension in Uganda; to be specific, the data among market traders, yet they are more at risk,
thus triggering the study.
1.7 Significance of the study
This research study would inform the health policy makers about the prevalence and the most
common risk factors of hypertension in the study population so that more health promotion
projects aimed at increasing awareness of people about changing some of their lifestyles could be
carried out.
The study would benefit the researchers in identifying the awareness gap in the study population
and to estimate the extent to which the communities need to be reached out to in order to make
them more responsible for their health and hence reduce the prevalence of hypertension.
Data regarding the prevalence, awareness, and control of hypertension in different settings is
crucial to provide a criterion for not only monitoring but also notifying the development of new
strategies for improving hypertension control by the ministry of health.
6
This study would emphasize the prioritization of preventive initiatives and screening for
hypertension in public health education and media campaigns by health policy makers so that it
could be detected and treated earlier to prevent the occurrence of particular NCDs.
1.8 Conceptual framework
Social Demographic
factors; age, sex, marital
status, education
background
Awareness
afe
Health complications
Awareness about
hypertension.
Awareness about
blood pressure
status.
Prevalence
of HTN
Obesity
Lifestyle

Physical
inactivity
 Tobacco
Smoking
 Alcoholism
 Diet
 Too much
salt intake
7
Heart disease
Stroke
Kidney disease
Respiratory
disease
Death
among others
CHAPTER 2: LITERATURE REVIEW
2.0 Introduction
This chapter points out literature of other studies in relation to this study and constitutes the
following; burden of hypertension, awareness about hypertension, risk factors and outcomes of
hypertension.
2.1 The burden of hypertension
Hypertension is the leading cause and risk factor of cardiovascular diseases (Ostchega et al., 2020)
and premature mortality and morbidity worldwide (Vincent-Onabajo et al., 2017). Mills et al.
(2020) reported that previous studies had estimated a 31.1% prevalence of hypertension among
adults in 2010 which was approximately 1.13 billion people worldwide. Additionally, the
hypertension prevalence in low-income countries was higher with 31.5%, which was
approximately 1.04 billion people, in comparison to higher-income countries with 28.5%, which
approximated 349 million people (Mills et al., 2020). Recent reports by WHO as of August 2021,
reported a 33% prevalence of hypertension among adult population worldwide.
A study by Ostchega et al.; (2020) among adult Americans suggested the hypertension prevalence
to be higher as people age, with a 22.4% prevalence found among those aged 18–39, 54.5% among
those aged 40–59, and 74.5% among those aged 60 and over (Ostchega et al., 2020).
Several studies and predictions from various systematic reviews also show significant increases in
hypertension prevalence in both village and town populations in Africa over time (Bosu et al.,
2017, Bakilo et al., 2021). A study in 2013 estimated that the number of adults with hypertension
in Sub-Saharan Africa would have exceeded 125 million by 2025 (Kotwani et al., 2013).
8
Hypertension is increasingly prevalent in Uganda (Green et al., 2020) yet there is insufficient data
about it in the country and the continent of Africa as a whole. Twinamasiko et al., (2018) theorized
that since hypertension is asymptomatic, many of the affected people may not be aware of their
status (Twinamasiko et al., 2018).
According to the Uganda National Non-Communicable Diseases Risk Factor Survey, a high
prevalence of hypertension (26.4%) was reported among adults in central Uganda, with only 7.7%
being aware that they had hypertension (Musinguzi and Nuwaha, 2013, Kaddumukasa et al., 2017,
Guwatudde et al., 2015).
A high prevalence of hypertension is seen more among the elderly, males, obese people, those
with a family history of hypertension, the physically inactive, and those on a diet with fewer
vegetables and more additional salt consumption (Helelo et al., 2014).
Several studies have reported a significant prevalence of hypertension among traders. A study
amongst Jos market traders in Nigeria reported a 26.6% prevalence of hypertension (Daboer et al.,
2021), another study carried out among traders in Sokoto central market observed a 29.1%
prevalence of hypertension (Awosan et al., 2014) while a community based study among workers
in Enugu state Nigeria observed a 32.8% hypertension prevalence (Ulasi et al., 2011).
2.2 Awareness about hypertension
The prevalence of hypertension and pre-hypertension is often underreported due to its silent nature
(Rahman et al., 2017, Aldiab et al., 2018). Despite the surging prevalence of hypertension, the
levels of hypertension awareness are generally low in low- and middle-income countries which
increases the financial burden of these countries (Mills et al., 2020). The WHO-SAGE population
9
survey carried out in South Africa among 1847 participants concluded that 43% (802 participants)
were hypertensive, yet 58% of the hypertensive were unaware of the condition (Ware et al., 2019).
In south-western Uganda, a study done in peri-urban areas of Mbarara showed that 69.7% of the
hypertensive were unaware (Twinamasiko et al., 2018).
When the population is aware of hypertension, it reduces its exposure to the modifiable risk factors,
which will in turn reduce the incidence of hypertension, hence limiting the occurrence of CVDlike strokes in the population (Mokdad et al., 2018).
2.3 Risk factors of hypertension
It is suggested that living a sedentary lifestyle is linked to hypertension and, therefore, physically
inactive populations should be focused on if we are to produce a greater effect in terms of reducing
the NCD burden (Twinamasiko et al., 2018). Others include: Excess salt intake, alcoholism,
cigarette smoking, individual’s sex, age, dietary habits, BMI>25Kg/m2 (Landi et al., 2018), family
history and marital status (Asresahegn et al., 2017, Omorogiuwa et al., 2021).
A study by Mouhtadi et al.; (2018) found that the aged were 2.7 times more susceptible to suffering
from hypertension, with males being 2.4 times more vulnerable to suffering from the condition
than females. Being obese increased one’s risk of getting hypertension in both males and females
as compared to those who had a normal body weight. Smokers had a higher prevalence of 59.3%
than non-smokers with 40.7%. Likewise, varying education levels also pose a risk to hypertension
where 48% of participants without a university degree had hypertension while 24% of participants
with a university degree had hypertension (Mouhtadi et al., 2018).
10
However, Akinremi et al.; (2020) reported that cardiovascular diseases like hypertension are
increasingly affecting more of the younger and high-stress populations like single parents, women,
and those responsible for their family’s welfare decisions (Akinremi, 2020).
A cross-sectional study in northeast China concluded that there was a positive correlation between
a reduced sleep period and hypertension among people aged 18–44 years (Chang et al., 2022).
2.4 Outcomes of hypertension
Diseases like atrial fibrillation, heart valve diseases, dementia, aortic syndromes, heart failure,
chronic kidney disease, among others, have been attributed to increased blood pressure as
demonstrated by various cohort studies (Akinremi, 2020). In addition, increased blood pressure
has been linked to increased risks of coronary heart disease and stroke. The severe organ damage
due to hypertension also contributes to its deadly nature (Vincent-Onabajo et al., 2017).
11
CHAPTER 3: METHODOLOGY
3.0 Introduction
This chapter includes; the study design, study setting, study population, sample size estimation,
sampling, inclusion and exclusion criteria, data collection procedure, data entry and analysis,
ethical considerations and quality assurance.
3.1 Study design
A descriptive cross-sectional study design utilizing quantitative methods among market traders in
Mbarara City, southwestern Uganda was used.
3.2 Study setting
This study was conducted in the markets of Mbarara City in southwestern Uganda. Mbarara City
has six divisions which include: Kamukuzi, Nyamitanga, Biharwe, Kakiika, Nyakayojo, and
Kakoba. Each division has at least one main market, making a total of eight main markets in
Mbarara City. These include: Koranorya, Mbarara central market, Kizungu, Lugazi, Rwebikoona,
Ruti, Makahn Singh, and Kakooba markets. There are a number of market traders in Mbarara City,
estimated to be 5000 in the 8 major markets stated. There were both men and women, most of
whom were over 25 years of age, selling different items. These traders included: boutique owners,
retail shop traders, grocery sellers, clothing, cutlery sellers, charcoal sellers, and many more.
3.3 Study population
The target population of the study was market traders operating in different markets in Mbarara
City. The study was carried out in four markets, which were randomly selected from the eight
major markets. The selected markets included: Rwebikoona, Makahn Singh, Central Market, and
Koranorya.
12
3.4 Sample size estimation
To estimate the sample size, a Raosoft online calculator was used to compute the sample size of
the target population using a margin of error at 5%, a confidence level of 95%, a target population
size of approximately 5000 and a response distribution of 50%. The sample size was 357 study
participants (Hazra and Gogtay, 2016). Sample allocation was done for each market due to the
different number of traders in the different markets, where Central market was allocated 110,
Koranorya 110, Rwebikoona 55 and Makahn Singh 82 participants.
3.5 Sampling
Each market population was divided into two strata, female and male, and then male and female
participants were recruited conveniently.
3.6 Inclusion criteria
Market traders aged 25 and above were recruited; traders who had been operating in the market
for over 6 months trading, spending at least 4 hours a day and more than 4 days per week working
in the market were also recruited (Odugbemi et al., 2012).
3.7 Exclusion criteria
Pregnant women at the time of data collection were not recruited into the study in order to eliminate
pregnancy-induced hypertension.
3.8 Data collection procedure
Consent forms were given to each participant in the study for them to consent, and then researcherguided questionnaires (Modified version of HELM scale) both English and Runyankole versions
with close-ended questions were used to examine the awareness of participants about hypertension
and lifestyle of the market traders. Each questionnaire had an identification number for each
13
participant and space for demographic data. A height board was used to measure the height of each
participant, and values were noted on paper in meters (cm). A calibrated weighing scale was used
to measure the weight of each study participant, and values were noted on paper in kilograms
(Kgs). Using weight and height values obtained for each study participant, BMI values were
calculated using an online BMI calculator and values were noted on paper in Kg/m2. Two
automatic blood pressure machines were used to measure the current blood pressure of each
participant after allowing 5 minutes for each participant to relax. Then 3 blood pressure
measurements were taken, each at an interval of 1 minute from the other, and the average blood
pressure value was the mean of the last two blood pressure values, for both systolic and diastolic
blood pressures in (mmHg).
3.9 Data entry and analysis
Values and text data were entered into Microsoft Excel software program. The researchers then
copied the raw data from the Microsoft Excel program and pasted it into the Stata software
program. The latter was used to generate frequency distribution tables for categorical data and to
calculate mean values for continuous variables.
3.10 Ethical considerations
The proposal was presented for approval to the Faculty of Medicine Research Committee of
Mbarara University of Science and Technology (MUST) for approval. Permission was sought from
the chairperson of each market for the study to be conducted. There was voluntary participation in
the study, and prior informed consent was given by each participant. The participants retained their
right to decline participating or responding to any question without any repercussions for being
intimidated by the researchers. For data confidentiality, the researchers used unique identification
numbers for each participant and kept consent forms separate from the questionnaires under lock
14
and key. In the dissemination of the researchers’ findings, the identification of each participant
remained anonymous.
3.11 Quality assurance
To ensure that instruments for data collection like the automatic blood pressure machines,
weighing scales and height boards were in good working condition, they were first tested on the
researchers to ensure that each researcher knew how to accurately take blood pressure, height, and
weight. An approved questionnaire was used.
15
CHAPTER 4: RESULTS
4.0 Introduction
This chapter presents results of a study conducted among market traders from four markets in
Mbarara City, southwestern Uganda, about the prevalence, awareness, and risk factors of
hypertension among market traders. It includes the demographics of the study participants,
lifestyle and health characteristics, BMI and blood pressure grades according to gender and age
categorization and awareness about hypertension.
4.1 Demographics of the market traders
In this study, a total of 357 subjects were enrolled, with 263(73.67%) being females and
94(26.33%) males. The mean age was 41.6 ± 11.04 years.
Overall, the majority of the subjects were females, 73.7% (263/357) and males constituted the
smallest percentage, 26.3% (94/357). The marital status showed that 71.2% (254/357) of the
participants were married, 11.2% (40/357) were divorced, 10.4% (37/357) were widowed, and
7.35% (26/357) were single.
Looking at the educational level, we found that the majority, 51.82% (185/357), went to primary,
41.2% (147/357) went to secondary, 4.2% (15/357) were degree holders, 1.7% (6/357) were
diploma holders, and 1.12% (4/357) received no formal education as seen in table 4.1.0 below;
16
Table 4.1.0 Demographics of the market traders
Freq
.
Percent.
Site
Central
Koranorya
Makahn Singh
Rwebikoona
Total
110
110
82
55
357
30.81
30.81
22.97
15.41
100
30.81
61.62
84.59
100
Sex
Female
Male
263
94
73.67
26.33
73.67
100
Marital status
Married
Divorced
Widowed
Single
254
40
37
26
71.15
11.2
10.36
7.28
82.35
11.2
92.71
100
Level of education
Degree
Diploma
Primary
Secondary
No formal education
15
6
185
147
4
4.2
1.68
51.82
41.18
1.12
4.2
5.88
57.7
98.88
100
Parameters
Cum
.
4.2 Lifestyle and health status characteristics of the participants
The mean BMI of the study participants was 29.56 ±6.17 Kg/m2. The body mass index of the
participants was distributed as follows; 43.7% (157/357) were obese, 31.9% (114/357) were
overweight, 23.3% (83/357) had normal BMI, and 1.1% (4/357) were underweight. Furthermore,
66.7% (238/357) of the market traders sit for more than 4 hours daily.
17
There were participants with normal blood pressure (<120mmHg systolic and <80mmHg
diastolic), pre-hypertensive (120-139mmHg systolic and 80-89mmHg diastolic), hypertensivegrade 1(140-159mmHg systolic and 90-99mmHg), hypertensive-grade 2 (160-179mmHg systolic
and 100-109mmHg diastolic) and hypertensive-grade 3(> or =180mmHg systolic and > or
=110mmHg diastolic).
The mean systolic blood pressure and diastolic blood pressure were 134.46 ± 18.68 mmHg and
83.45±12.26 mmHg, respectively. Of those who were hypertensive, 93.4% (109/116) were newly
diagnosed. Overall, 44.6% (160/357) were pre-hypertensive and 32.5% (116/357) participants
were hypertensive, where 21.9% (78/357) had grade 1 hypertension, 7.8% (28/357) grade 2
hypertension, and 2.8% (10/357) grade 3 hypertension. 22.7% (81/357) had normal blood pressure.
The results of the study show that the majority of participants 52.7% (188/357) use a motorbike
from home to their place of work, 36.4% (137/357) walk, 5.0% (18/357) use a vehicle, 2.5%
(9/357) use a bicycle, and 1.4% (5/357) walk and use a motorbike.
Overall, 98.3% (351/357) of the participants do not smoke cigarettes, with only 1.7% (6/357) of
them being current smokers. In addition, 72.8% (260/357) of the participants do not drink any
form of alcohol, with 27.17% (97/357) of those who drink alcohol as seen in table 4.2.0 below.
18
Table 4.2.0 Lifestyle and health status characteristics of the traders
Freq
.
Percent
.
Cum
.
Class of BMI
Normal
Obese
Overweight
Underweight
83
156
114
4
23.25
43.7
31.93
1.12
23.25
66.95
98.88
100
Grade of BP
Grade 1 HTN
Grade 2 HTN
Grade 3 HTN
Normal
Pre-HTN
78
28
10
81
160
21.85
7.84
2.8
22.69
44.62
21.85
29.69
32.49
55.18
100
Mode of transport
Bicycle
9
Motorbike
188
Vehicle
18
Walk
137
Walk, motorbike 5
2.52
52.66
5.04
36.38
1.4
2.52
55.18
60.22
98.6
100
Physical
exercise
Football, jog
Jog
Don't do
1
7
349
0.28
1.96
97.7
0.28
2.24
100
Smoke cigarette
Yes
No
6
351
1.68
98.32
1.68
100
Drink alcohol
Yes
No
97
260
27.17
72.83
27.17
100
Sitting time
<4hrs
>4hrs
119
238
33.33
66.67
33.33
100
Parameter
19
Overall, for the participants who were hypertensive, females contributed 26.3% (94/357) and
males contributed 6.2% (22/357). For those with grade 1 hypertension, females contributed 16.8%
(60/357) and males contributed 5.0% (18/357). Among those with grade 2 hypertension, females
contributed 7.3% (26/357) and males 0.6% (2/357). For grade 3 hypertension, males contributed
0.6% (2/357) and females 2.2% (8/357). Females contributed 16.8% (60/357) and males 5.9%
(21/357) to normal blood pressure. Overall, females contributed 30.5% (109/357) and males 14.3%
(51/357) to the pre-hypertensive.
For overall BMI, males contributed 11.8% (42/357) and females 11.5% (41/357) for normal BMI.
For the obese, females contributed 39.2% (140/357) and males 4.5% (16/357. For those who were
overweight, females contributed 22.7% (81/357) and males 9.2% (33/357), and for underweight,
males contributed 0.8% (3/357) and females 0.3% (1/357).
Of those who were hypertensive, 18.2% (65/357) were aged between 35 and 50 years, 10.1%
(36/357) were above 50 years of age, and 4.2% (15/357) were below 35 years. Of those with prehypertension, 21.1% (75/357) were between 35 and 50 years old, 17.4% (62/357) were below 35
years old, and 6.4% (23/357) were above 50 years old. 11.8% (42/357) of those with normal blood
pressure were between the ages of 35 and 50, 8.96% (32/357) were under the age of 35, and 1.96%
(7/357) were over the age of 50.
Of those who were obese, 24.7% (88/357) were between 35 and 50 years old, 10.4% (37/357) were
below 35 years old, and 8.7% (31/357) were above 50 years old. For the overweight, 16.8%
(60/357) were between 35 and 50 years old, 8.7% (31/357) were below 35 years old, and 6.4%
(23/357) were above 50 years old. For underweight, 0.6% (2/357) were below 35 years of age and
the same percentage of 0.3% (1/357) were between 35-50 years and above 50 years of age. Those
20
below 35 years and between 35 -50 years of age had the same percentage of normal BMI of 10.1%
(36/357) as shown in table 4.3.0 below:
Table 4.3.0 BMI and blood pressure grades according to gender and age categorization
Grade of Blood pressure
Gender
Age
Gender
Age
Parameter
Male No (%)
Female No
(%)
<35 years
35-50 years
>50 years
Normal
21(5.88)
Pre-HTN
51(14.29)
Grade 1
18(5.04)
Grade 2
2(0.56)
Grade 3
2(0.56)
60(16.81)
109(30.53)
60(16.81)
26(7.28)
8(2.24)
32(8.96)
42(11.76)
7(1.96)
62(17.37)
75(21.01)
23(6.44)
14(3.92)
41(11.48)
23(6.44)
1(0.28)
18(5.04)
9(2.52)
0(0.00)
6(1.68)
4(1.12)
Grade of BMI
Over
Obese
weight
33(9.24)
16(4.48)
Parameter
Normal
Male No (%)
Female No
(%)
<35 years
35-50 years
>50 years
42(11.76)
Under
weight
3(0.84)
41(11.48)
1(0.28)
81(22.69)
140(39.22)
36(10.08)
36(10.08)
11(3.08)
2(0.56)
1(0.28)
1(0.28)
31(8.68)
60(16.81)
23(6.44)
37(10.36)
88(24.65)
31(8.68)
21
4.4 Awareness about hypertension
In this study, 94.96% (339/357) didn’t know the range for normal blood pressure, 74.79%
(267/357) of the participants knew that hypertension would cause premature death, stroke, visual
disturbance and heart disease. 54.9% (196/357) didn’t know that hypertension causes kidney
disease.
61.90% (221/357) of the participants didn’t know that smoking tobacco, excessive alcohol
consumption, and eating red meat would cause hypertension. 76.47% (273/357) were aware that
excessive salt and fat consumption, physical inactivity, and stress can all lead to hypertension.
61.63% (220/357) of the participants knew that hypertension is not just a result of aging and that
treatment is necessary and that both treatment and change in lifestyle are important in controlling
high blood pressure. Overall, participants’ awareness about risk factors of hypertension was good.
22
CHAPTER 5: DISCUSSION OF RESULTS
5.0 Introduction
This chapter relates the results above to the findings of other studies and gives probable
explanations for the prevalence, awareness and risk factors of hypertension found among the
Mbarara City market traders.
5.1 Prevalence of hypertension
The results highlighted a remarkable prevalence of both pre-hypertension and hypertension of
44.62% (160/357) and 32.5% (116/357), respectively, among our study population. This
prevalence was higher than a 26.5% HTN prevalence reported in a Ugandan national noncommunicable disease risk factor survey done in 2015 (Wesonga et al., 2016). This could be
accounted for by the fact that, on average, the market traders are overweight and most of them are
physically inactive. Females contributed a higher percentage of those who were pre-hypertensive
and hypertensive because, overall, females constituted a higher proportion of the total population
compared to males, which is in agreement with other similar studies done in Sub-Saharan Africa.
Another study among 255 market women traders in Dantokpa, Benin, reported a 34% prevalence
of hypertension among those traders (Ibrahim et al., 2020). A study among 391 participants in 3
markets in Lagos, Nigeria, reported that 30.9% of the traders were hypertensive (Achonu et al.,
2022). However, a community-based study in a market population in Enugu, Nigeria reported that
42.2% of the traders were hypertensive, a percentage higher than this study’s prevalence (Ulasi et
al., 2011). Participants between 35 and 50 years of age had the highest prevalence of hypertension
at 18.2% compared to other age categories. This could be explained by the fact that this was the
age category which contributed the greatest percentage of traders who were overweight or obese.
23
A similar study among people aged 35 to 60 years old found a prevalence of hypertension of 20.5%
which was similar to our findings (Mayega et al., 2012)
5.2 Awareness about hypertension
Overall, 97.2% (347/357) were not aware of their blood pressure status. Of those who were
hypertensive, 93.4% didn’t know their blood pressure status. This could be explained by the fact
that very few individuals consulted medical personnel about their blood pressure status. This is
comparable to a lower 53.4% of those who did not know their blood pressure status in a descriptive
study which was carried out in three markets in Lagos (Achonu et al., 2022).
54.9% had ever consulted a health worker about their blood pressure status. However, this was
earlier in life when either they were pregnant or during the management of other illnesses.
Many participants knew the consequences of hypertension because many of them had had a
relative with hypertension who was suffering from one of the effects of the condition.
5.3 Risk factors of hypertension
A large percentage of study participants were found to be overweight or obese (75%), which is
way greater than a study done in Ondo state, Nigeria among market traders in Owo, which reported
that 39.9% of the traders were overweight or obese (Bolajoko et al., 2020) and another study done
in Port Harcourt, Nigeria among market traders with a percentage of those overweight or obese at
44% (Wordu and Akusu, 2018). The same study had a different distribution of the overweight or
obese individuals in terms of sex, where males were found to be more obese (33.0%) than females
(29%), which contradicts the results of this study, yet the number of participants was almost the
same (Wordu and Akusu, 2018). These findings may be attributed to a sedentary lifestyle adopted
24
by market traders due to the nature of their job that requires them to sit most of the time unless
they have customers (Odugbemi et al., 2012). BMI is closely associated with gender and ethnicity,
according to a study conducted among market traders in the Fiji Islands, which discovered that
obesity was more prevalent in women (58%) than in men (Ratumaiyale et al., 2020). Current
research has established a close correlation between high BMI and marital status. A systematic
review of changes in weight-related outcomes, diet, and physical activity among the cohabiting
and married concluded that being married resulted in a higher BMI and reduced levels of physical
activity, which could explain why most participants in the current study who were married were
also overweight or obese (Werneck et al., 2020).
A correlation between hypertension and obesity has already been established by various studies
(Leggio et al., 2017, Jiang et al., 2016) and therefore, the implication of this finding is that
individuals who are overweight or obese have a higher chance of suffering from a range of healthrelated issues, hypertension inclusive.
Very few participants in our study population were found to smoke cigarettes, and a significant
percentage of market traders were found to be alcoholic (27.1%). This is comparable with slightly
higher values in other studies (Wordu and Akusu, 2018). Another study of 200 participants in
mammy markets in Sokoto, Nigeria found a prevalence of alcoholism in market traders of 75%,
which was higher than in our study. Alcoholism has been positively correlated with the occurrence
of hypertension and other cardiovascular diseases in many research studies (Odugbemi et al.,
2012).
This study found out that most of the market traders are physically inactive, with 97.7% of market
traders not involving themselves in any form of physical exercise. According to this study, some
25
of the physical exercises included: jogging, walking, football and cycling for at least 30 mins
(Odugbemi et al., 2012). Also, most of the market traders sit for more than 4 hours a day and use
their motorcycles as a means of transport to and from work. These results correlate with a 92%
prevalence of physical inactivity which was found in an urban market in Lagos, Nigeria
(Odugbemi et al., 2012). A higher prevalence of physical inactivity was found in this study as
compared to a study among traders in Calabar metropolis, Nigeria which found a 58.3% prevalence
of physical inactivity (Ukweh et al., 2021). Based on the nature of the traders’ daily work, the
higher levels of physical inactivity found was not surprising because they spend most of their time
seated in their stalls; that is, from 8am to 7pm with little or minimal chance of breaks since failure
to remain consistently available in their stalls could lead to the loss of potential customers or buyers
since customers’ visits are not predictable.
26
CHAPTER 6: RECOMMENDATION, LIMITATIONS, SUMMARY OF FINDINGS AND
CONCLUSION.
6.0 Introduction
This chapter explores the various limitations `encountered by the researchers throughout the
research process, the various recommendations to all the stakeholders, a summary of the findings
and a conclusion.
6.1 Recommendations
To the market executive committee
According to the findings, market traders were not aware about the causes of hypertension thus we
recommend the market executive to organize health promotion sessions in which they invite health
workers to expand more on hypertension, its prevention, control and management.
To the researchers
Since this study didn’t involve following up participants, we recommend other researchers to carry
out a similar study in which participants are followed up for at least three days.
To the local government
This study found a high prevalence of market traders who were newly diagnosed with
hypertension. The researchers therefore recommend the local government to make announcements
over different media platforms to remind all market traders to do blood pressure check-up at least
every month.
27
6.2 Limitations of the study
This research study had certain limitations which included limited literature about our target
population (market traders).
The study design didn’t allow the researcher to follow up the participants thus limiting them from
getting the real number of participants who were hypertensive because to confirm that a person is
hypertension, he/she must be followed up for a minimum of 3 days.
6.3 Summary of the findings
The study found a high prevalence of pre-hypertension and hypertension among the participants
of 42.6% and 32.5% respectively. Most of the participants were not aware about the risk factors
of hypertension. The most prevalent risk factors of hypertension were being overweight and
physically inactive.
6.4 Conclusion
The high prevalence of pre-hypertension and hypertension found among the participants marks
market traders as a special at-risk group for hypertension. This is a major public health challenge.
The high prevalence of hypertension and pre-hypertension in this group may be explained in part
by their sedentary lifestyle and overweight. This subpopulation needs special attention including
intensive health education in hypertension prevention and management. Large scale population
screening for hypertension is warranted and adequate blood pressure control is imperative to
mitigate the mortality and morbidity associated with hypertension. About half of the population
were obese. It is time to emphasize weight management to avoid the looming pandemic of obesity.
28
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APPENDICES
Appendix 1: Consent form
MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY
INSTITUTIONAL REVIEW COMMITTEE
P.O. Box 1410, Mbarara, Uganda
Tel: +256-4854-33795 Fax: + 256 4854 20782
Email: irc@must.ac.ugmustirb@gmail.com
Website: www.must.ac.ug
Study title
AWARENESS, PREVALENCE AND RISK FACTORS OF HYPERTENSION AMONG
MARKET TRADERS IN MBARARA, A CITY IN SOUTHWESTERN UGANDA
Dear respondent, you are kindly requested to participate in a study which will investigate about
awareness, prevalence and risk factors of hypertension among market traders in Mbarara city. You
are free to ask the investigators any question about what you do not understand concerning the
study which will be promptly answered.
Purpose of the study
During the study process, the researchers’ main aim will be to assess the current awareness about
hypertension, its prevalence and risk related factors among market traders in Mbarara city.
Following your assent, a questionnaire written in English/ Runyakole will be administered to you
containing questions that will cover social demographics except the name, other questions related
41
to your current awareness about hypertension and about your lifestyles to get a clue about some of
those lifestyles that might redispose you to getting hypertension. Your blood pressure, height and
weight will be measured to help us know your blood pressure status, and the risk factors for
hypertension.
What you need to know about this study
As you are being requested to participate in the study, this consent letter explains the research
study and your part in the study. Please read it carefully, take as much time as you need for proper
understanding of the information in it. Please note that you are a volunteer and thus you can choose
to take part or not and you remain with the right to quit at any time as your will. There will be no
penalty if you decide not to participate or quite the study.
Why are you being requested to participate
The researchers do believe that you are equipped with the information required to fulfill the aims
of their study.
Discomforts / fears
You will experience some minimal discomforts during blood pressure measurements and the
information provided will be confidentially handled.
Benefits of the study
Being the first study to be conducted at Mbarara University of science and technology, the findings
could act as a foundation for further research. This study will be used by policy makers of Mbarara
city to develop policies that will provide favorable working conditions for market traders. Will
also be used to create awareness about hypertension, identify the prevalence of hypertension and
42
the risk factors for hypertension among market traders in Mbarara city. You will also be able to
know your current blood pressure status at the end of the research study.
Incentives / rewards for participating
There will be no incentives or payment given but your co-operation is of value to the researcher.
Risks
There will be a risk of disclosure of abnormal results. This will be dealt with by referral to other
health care providers for further management
Confidentiality
You can be assured that the researchers will not use your name on a questionnaire or anywhere
and the information you provide will not be shared with anyone unless you permit the researchers
to do so. Thus, you will be interviewed individually in a place free from interference, and the
response you will provide to the researchers will be coded and the data capturing tools will be kept
under lock and key.
Researchers
1. ZIRIMENYA JOEL (0757884715/0773078515)
2. NAMPIJJA RITAH (0756859523)
3. NINSIIMA PATIENCE (0759453859)
4. NABIRYE AFUSA (0754567010)
5. NJAKA SADIC (0757017259)
43
What your signature / thumb print means on this consent form
Your signature on this consent form means that you have been informed about the study to be
conducted, purpose, procedure, discomforts, confidentiality, benefits of the study and you have
been given a chance to ask any question before your sign and you have voluntarily agreed to
participate in the study.
Initials of participant __________________ Signature/ thumbprint of participant________
Date___________
44
Appendix 2: Questionnaire
RESEARCH STUDY QUESTIONNAIRE
AWARENESS, PREVALENCE AND RISK FACTORS OF HYPERTENSION AMONG
MARKET TRADERS IN MBARARA CITY IN SOUTH WESTERN UGANDA
Identification number of participant: _____
Demographic and social factors:
1. Age:
2. Sex: Marital status:
Single
Married
Divorced
Level of education
45
AWARENESS ABOUT
4. Have you ever consulted your
HYPERTENSION/ HIGH BLOOD
health worker about your blood
PRESSURE
pressure status?
Yes
1. When somebody’s blood pressure
Never
is 115/75, it is
5. Rate your confidence in detecting
High
hypertension/high blood pressure
Low
Very confident
Normal
Confident
Do not know
Not confident. I will need more
2. If someone’s blood pressure is
guidance.
160/100, it is---?
6. Do you know of anyone who has
High
high blood pressure?
Low
Yes
Normal
No
Do not know
7. High
3. When someone has high blood
blood
pressure
if
left
untreated, can cause a person to
pressure, it usually lasts for?
have a stroke
A few years
Yes
5-10 years
No
The rest of their life
Do not know
Do not know
46
8. Increased blood pressure can cause
No
heart diseases such as heart attack
Do not know
if left untreated
13. Eating much salt usually makes
Yes
blood pressure
No
Go up
I don’t know
Go down
9. Increased blood pressure can cause
Stay the same
premature death if left untreated
Do not know
Yes
14. Smoking a packet of cigarettes per
No
day will not affect a person risk of
I don’t know
hypertension
10. Increased blood pressure can cause
Yes
kidney failure if left untreated
No
Yes
Do not know
No
15. A person with high blood pressure
I don’t know
should eat less fat
11. Increased blood pressure can cause
Yes
visual disturbances if left untreated
No
Yes
Do not know
No
16. A person with high blood pressure
I don’t know
should eat fruits and vegetables
12. High blood pressure can be cure?
frequently
Yes
Yes
47
Know
Yes
Do not know
No
I don’t know
17. Moderate to vigorous exercise 30
minutes/day 3-5 times a week
22. Stress does not cause hypertension
lowers blood pressure
Yes
Yes
No
No
I don’t know
Do not know
23. Physical inactivity can cause
18. Do you know your current blood
hypertension
pressure status?
Yes
Yes
No
No
I don’t know
19. If Yes, are you:
Normal
Hypertension is a result of aging, so
Hypertensive
treatment is unnecessary
20 When did you last test for your
Yes
blood pressure?
No
One year ago
I don’t know
More than a year ago
19. If the medication for increased
Never
blood pressure can control blood
21. Excessive alcohol consumption does
pressure, there no need to change
not cause hypertension
lifestyle
48
Yes
Red meat
No
White meat
I don’t know
I don’t know
20. If individuals with increased blood
LIFESTYLE OF MARKET
pressure change their lifestyle, they
ATTENDANTS
don’t need treatment
1. How long do you stay seated in a
Yes
day?
No
Less than
I don’t know
Most of the times
21. Drugs for increased blood pressure
must be taken every day
2. What means of transport do you
Yes
use?
No
Walk
I don’t know
Bicycle
22. Individuals with increased blood
Motor bike
pressure
must
take
their
Vehicle
medication only when they feel ill
3. Do you do physical exercises?
Yes
Yes
No
no
I don’t know
4. If yes, which physical exercises do
23. The
best
type
of
meat
for
you engage in and how long per
individuals with increased blood
session
pressure is
Jogging
49
Walking
More than 5
Foot ball
7. Do you drink alcohol?
Others
Yes
5. Do you smoke cigarettes?
No
Yes
8. If yes how many bottles do you take
No
in a week?
6. If yes how many sticks a day?
<5
1
5-10
2-5
>10
50
Appendix 3: Time frame
YEAR
2021
MONTHS OF THE J
YEAR
2022
A S O N D J
F
M A
M
J
J
A
S
O
N
U U E C O E
A E
A
P
A
U
U
U
E
C
O
L
N B
R
R
Y
N
L
G
P
T
V
G P T
V C
Y
PROPOSAL
WRITING
ETHICAL
APPROVAL
DATA
COLLECTION
DATA ENTRY AND
ANALYSIS
REPORT WRITING
DISSEMINATION
OF RESULTS
RESEARCH BOOK
SUBMISSION
51
T
Appendix 4: Budget
ITEM
NO OF ITEMS
TOTAL AMOUNT
Consent forms
360
80000
Questionnaire(both
for 360
220000
english and runyakole)
Transport
Five people@40000
200000
printing and binding (final)
200000
Miscillaneous
100000
TOTAL AMOUNT
710,000
52
Appendix 5: Approval letter
53