KENYA MEDICAL TRAINING COLLEGE
A STUDY TO DETERMINE FACTORS CONTRIBUTING TO THE INCREASED
PREVALENCE OF HYPERTENSION IN MATAYOS SUB-COUNTY HOSPITAL.
BY:
DOLPHINE BANCHIRI MACHUKI
COLLEGE NO:D/CM/15018/001
SUBMITTED TO THE DEPARTMENT OF CLICAL MEDICINE AND SURGERY
IN THE PARTIAL FULFILMENT FOR AWARD OF DIPLOMA IN CLINICAL
MEDICINE AND SURGERY.
KENYA MEDICAL TRAINING COLLEGE
P.O.BOX 1594
KISUMU.
DECLARATION
i
I here by declare that this is my original work.It has not been presented in any other institution
for academic progress or any other purpose.
RESEARCHER:DOLPHINE BANCHIRI MACHUKI
COLLEGE NO:D/CM/15018/001
PERSONAL CONTACT:0719756867
SIGNATURE……………………………….
DATE…………………………
ii
Contents
DECLARATION
ii
DEDICATION
iv
ACKNOWLEDGMENT
v
ABBREVIATIONS
vi
OPERATIONAL DEFINITIONS
vii
ABSTRACT
viii
CHAPTER ONE
1
1.0 Introduction
1
1.1 PROBLEM STATEMENT
3
1.2 STUDY JUSTIFICATION
4
1.3 RESEARCH QUESTIONS
5
1.4 OBJECTIVES
6
1.4.1 BROAD OBJECTIVES
6
1.4.2 SPECIFIC OBJECTIVES
6
CHAPTER TWO
7
2.0 LITERATURE REVIEW
7
2.1INTRODUCTION
7
2.2 GRADING OF HYPERTENSION
7
2.3PATHOPHYSILOGY
7
2.4CLASSIFICATION.
8
2.4.1 Primary HTN
8
2.4.2Secondary HTN
9
2.4.3 Pregnancy HTN
9
2.5 HYPERTENSIVEURGENCIES
10
2.6 HYPERTENSIVE EMERGENCIES
10
2.7 HYPERTENSIVE CRISIS
10
2.8CLINICAL PRESENTATION
10
2.9 DIAGNOSIS
10
2.9.1Goals of evaluation
10
2.9.2 History
11
iii
2.9.3 Physical examination
11
2.9.4 Investigations
11
2.10 MANAGEMENT OF HYPERTENSION
11
2.10.1 lifestyle modification
11
2.10.2 Drug therapy
11
3.2 STUDY DESIGN
13
3.3 STUDY POPULATION
13
3.4 INCLUSION AND EXCLUSION CRITERIA
13
3.4.1 Inclusion criteria
13
3.5.1 Dependent variables
13
3.5.2 Independent variable
14
3.6 SAMPLING PROCEDURE
14
3.7 DATA COLLECTION PROCEDURE
14
3.8 DATA COLLECTION TOOL
14
3.9 PRE TESTING
14
3.10SAMPLE SIZE DETERMINATION
14
3.1.1DATA ANALYSIS AND PRESENTANTION
15
3.1.2ETHICAL CONSIDERATIONS
15
3.1.3STUDY LIMITATION
15
REFERENCE
16
APPENDIX I: WORKPLAN
17
APENDIX II: BUDGET
18
APENDIX III:QUESTIONAIRE
19
iv
DEDICATION
I dedicate the research to my father James and my mother Josephine,my brother,sisters and
friends who tirelessly dedicated their prayers and support for my well being in college.
Special thanks to them who assisted me financially throughout my educational background.
May God bless them all abundantly.
v
LIST OF TABLES
Table 1.0 Age of respondents.
Table 1.1 Gender of respondents.
Table 1.2 Occupation of respondents.
Table 1.3 Common complaints that respondents present with.
Table 1.4 Effects of hypertension to hypertensive patients.
Table 1.5 Association of hypertension to lifestyle.
Table 1.6 Benefits of hypertensive patients on complying to drugs.
Table 1.7 Commonly used hypertensive drugs in Matayos health centre.
Table 1.8 Places where hypertensive patients obtain their drugs.
LIST OF FIGURES
Figure 1.0 Gender of respondents.
Figure 1.1 Occupation of respondents.
Figure 1.2Level of education of respondents.
Figure 1.3 Marital status of the respondents.
Figure 1.4 Association of hypertension to lifestyle.
Figure 1.5 Commonly used hypertensive drugs in matayos health centre.
vi
ACKNOWLEDGMENT
My sincere gratitude goes to all those who have contributed to the success of this study in a
special way, I would like to thank my supervisors for their untiring guidance through my study,
like wise my thanks goes to all staff of matayos who contributed in many ways. Thanks to my
family members and friends for their financial support. My God bless you abundantly.
My greatest thanks to the almighty God for his gift of life, knowledge and energy to carry out
my study.Appreciation to my supervisor Mr.Barmao,other lecturers and my classmates for their
moral support.
vii
CERTIFICATION
The undersigned duly certify that he has read and recommended to KMTC Kisumu for the
approval of this research study in partial fulfillment for the award of diploma in clinical
medicine and surgery.
SUPERVISOR: ………………………………..
SIGNATURE: ……………………………………….
DATE : …………………………………………..
viii
ABBREVIATIONS
HTN: Hypertension
BP:Blood pressure
HBP:High blood pressure
WHO: World Health Organization
NGO’S:Non-governmental organization
MHC:Matayos Health centre
SBP: Systolic blood pressure
DBP: Diastolic blood pressure
%: Percentage
MAP: Mean arterial pressure
HIV: Human immunodeficiency virus
AIDS: Acquired immune deficiency syndrome
JNC: Joint national committee
ix
OPERATIONAL DEFINITIONS
Hypertension: Elevation of arterial blood pressure above the normal range expected in a
particular age group.
Patient:A person who receives treatment from a doctor or other medically educated
person.
Prevalence: The number of cases of
a disease that are present in a particular
population at a given time.
Morbidity: This is illness or disease.
Mortality:Becoming susceptible to death.
Cardiac output: The amount of blood the heart pumps through the circulatory system in
a minute.
Peripheral resistance: It’s the resistance of the arteries to blood flow.
Respondent:A person who responds or participates in research involving questionnaire.
x
ABSTRACT
A prospective study about hypertension which is elevated blood pressure where systolic
pressure is more than 120mmHg and diastolic pressure more than 80mmHg.
The aims were:
To determine the attitude and belief of hypertension.
To determine the knowledge people have to hypertension.
To determine the risk factors of hypertension.
Simple random sampling method was used to collect data and people interviewed
through questionnaires of open-ended and closed questions.
The study design was a descriptive cross sectional study.The tools that were used to
collect data include papers,rubbers,pens,pencils and scientific calculators.
xi
xii
CHAPTER ONE
1.0 Introduction
Hypertension is a high blood pressure affecting people of all ages but generally
associated with middle aged people and elderly. Lifestyle is significant contributor to
high BP and one can inherit from parents and grandparents but diet, tobacco use, stress
and Lack of exercise is the leading cause (2016)
Blood pressure is necessary for blood to flow around the body ensuring organs receive
oxygen andnutrients. Heart and kidney are important organs that help in control of BP.
Blood vessels throughout the body are innervated or touched by these autonomic or
sympathetic nerve cells. The activity of sympathetic nerve cell causes vessels to
constrict which generates BP {Professor Julian Paton} (year 2016).
HTN is a condition that does not cause symptoms but long term HBP is a major risk
factor for coronary artery disease, stroke, heart failure, peripheral vascular disease,
vision loss, and chronic kidney disease. HBP is classified as primary<essential>HTN or
secondary HBP.primary HBP is due to non specific lifestyle and genetic factors and
occurs about 90-95%causes. Life style factors are excess salt intake, excess body
weight, smoking and alcohol .secondary BP is due to an identifiable cause such as
chronic kidney disease, narrowing of the arteries and endocrine disorder or use of birth
control pills and occurs in 5-10% cases{Wikipedia Google}(year 2016)
HBP is a trait as opposed to a specific and represents a quantitative rather than a
qualitative deviation from the normal. The cardiovascular risks associated with a given
BP are dependent upon the combination of risk factors in an individual such as age ,
gender, weight , physical activity smoking family history, serum cholesterol , diabetes
mellitus and pre existing vascular disease .effective management of hypertension
requires a holistic approach based on the identification of those at highest
cardiovascular risk and use of multifactorial intervention targeting BP and all modifiable
cardiovascular risk factors (Davidson’s 2010).
Measurement of BP is from both arms at the branchial pulse which is palpated first, the
blood pressure machine is called a sphygmomanometer tied above the cuff a with the
1
patient lying down or the patient seated and relaxed. Ensure that no tight clothing
constricting the upper arm. Both diastolic pressure and systolic pressure of right and
left arm are to be recorded correctly<Hutchison 2012>hypertension is classified into
different categories for easy administration of drugs that are antihypertensive only
given to hypertensive sufferers. The drugs are administered according to the state of
the patient.<pharmacology 2008>
Hypertension tend to be familiar and likely to be consequence of interaction between
environmental and genetic factors.edo Thomas akpan studied about factors affecting
compliance to hypertension treatment among hypertensive patients on Praslin island in
south Africa.Copper R Rotimi C studied about factors contributing to increased
prevalence of hypertension in population of west African origin in India.
This study was carried out in matayos health centre because of the increased
prevalence of hypertension and no studies have been seen about hypertension in that
area and it’s to identify the major contributing factors to increased prevalence of
hypertension.
2
1.1 PROBLEM STATEMENT
Hypertension is the single most important cause of cardiovascular disorders morbidity
and mortality in the world.
The prevalence of HBP is highest in Africa 30% for both sexes and lowest in the WHO
region of the Americans 18% for both sexes. Hypertension is slightly frequent in men
those of low socioeconomic status and prevalence increase with age.
Hypertension is common in high, medium and low income countries and is associated
with failure to thrive, seizures, irritability lack of energy and difficulty in breathing in
neonates and young infant’s .in older infants and children HTN further causes headache
fatigue blurred vision nose bleeds and facial paralysis. The prevalence of hypertension
vary from region to region though in the world for adults of 20 years and above in the
year 2000 was 26.4%that is 972million people<Kearney ET at 2005>
HIV/AIDS and immunosupressed patients are at high risk of developing HTN at younger
age than in general population <Ramos 2000>. Factors affecting drug treatment and
lifestyle modification compliance in hypertension may result n uncontrolled
hypertension and consequent complication in non compliant hypertensive sufferers
3
(pasty alderman and Weiss 2003).
In matayos hypetension was a problem to many people since most people and most
frequently men like smoking and taking alcohol and eating fatty meals that have a lot of
salt and hypertensive patients being non compliant to drugs because of their attitude to
the drugs that they have many effects hence lead to complications.
1.2 STUDY JUSTIFICATION
The benefit of the study is:

To understand the knowledge , awareness and attitude to hypertension

To know the important factors in achieving blood pressure control

To assist in choosing the appropriate nursing tools for promoting health
Increased development of the country like having many NGO’s will help establish
enough health centers which will be helpful in managing hypertensive patients.
I shared the information about factors contributing to increased prevalence of
hypertension with the community of Matayos through discussion to provide
4
new
knowledge to them.
1.3 RESEARCH QUESTIONS
I.
What are the factors contributing to increased prevalence of
hypertension?
II.
How do people view and understand about hypertension?
III.
What are the causes of hypertension?
IV.
How do people understand hypertension?
V.
Who are at risk of contracting hypertension?
5
1.4 OBJECTIVES
1.4.1 BROAD OBJECTIVES
To determine factors contributing to increased prevalence of hypertension
1.4.2 SPECIFIC OBJECTIVES

To determine the attitude and belief of people to hypertension
6

To determine patients knowledge and practice about hypertension

To determine the cause of hypertension

To determine the people at risk of contracting hypertension.
CHAPTER TWO
2.0 LITERATURE REVIEW
There are various views pertaining hypertension.This chapter explains further about the
broad and specific objectives.
7
2.1INTRODUCTION
Different terms are defined below;
Blood pressure is a measure of the force that the circulating blood exerts against the
arterial wall. Hypertension is elevated blood pressure than normal, systolic BP more
than 139mmHg and diastolic BP more than 89mmHg. SBP is the maximal pressure that
occurs during ventricular contraction while DBP is pressure during ventricular filling,
arterial pressure is maintained but a lower level.[Harrisons 2012]
2.2 GRADING OF HYPERTENSION
The optimal pressure is SBP upto 120mmHg and DBP up to 80mmHg.
The normal pressure is SBP up to 130mmHg and diastolic BP up to 85mmHg.
The high normal pressure is SBP up to 130-139mmHg and DBP up to 85-89mmHg.
Grade 1: (Mild) SBP 140-159mmHg and DBP 90-99mmHg.
Grade 2: (Moderate)SBP 160-179mmHg and DBP 100-109mmHg.
Grade 3: (Severe) SBP>180mmHg and DBP>110mmHg.
Isolated systolic HTN.
Grade 1: Systolic BP 140-159mmHg and DBP<90mmHg.
Grade 2: Systolic BP>160mmHg and DBP <90mmHg.
(Davidson 2010)
2.3PATHOPHYSILOGY
Cardiac output and peripheral resistant are the determinants of arterial pressure.
Cardiac output is determined by stroke volume and heart rate.Stroke volume is related
to myocardial contractility and to the size of vascular compartment. Peripheral
resistance is determined by functional and anatomic changes in small arteries and
arterioles.Vascular volume is the primary determinant of arteriole pressure. The initial
elevation of BP in response to vascular volume expansion is related to an increase of
cardiac output however,peripheral resistance increases and cardiac output reverts to
normal.When sodium chloride intake exceeds the capacity of the kidney to excrete
sodium, vascular volume initially expands and cardiac output increases.A higher arterial
pressure may be required to achieve sodium balance that is the pressure natriuresis
8
phenomenon. High BP leads to increased afterload and damage of the functional and
structural vascular component of the heart,kidney ,eyes,brain and other organs ( Glies et
al 2005)
2.4CLASSIFICATION.
Hypertension is classified into :
I.Primary hypertension
II. Secondary hypertension
III.Pregnancy HTN
2.4.1 Primary HTN
Primary HTN is also known as essential or idiopathic HTN. Its mos common and
constitutes 95% of cases. The cause is unknown (Ganong 2003) several lifestyle related
risk factors are thought to contribute to HTN which include :
Weight gain and obesity- a sedentary lifestyle and weight gain are associated with HTN.
Weight gain appears to be a main determinant of rise in BP that is commonly seen with
aging.(Wolk ,Shamsuzzaman and Somers 2003)
Effects of dietary salt- consumption of large quantities of dietary salt is associated with
High BP . Researchers reported that lowering of dietary sodium intake level was
associated with lowering of BP.(Mac Gregor 2003).
Cigarette smoking- The presence of nicotine in cigarette leads to the release of nor
adrenaline from adrenergic fibers thus persistent stimulation of the sympathetic
nervous system through habitual smoking is responsible for sustained elevation of BP
and an increased risk of cardiovascular disease in smokers(Kaplan 2005)
Alcohol consumption- Excess consumption of alcohol is arisk factor in the development
of HTN . The study by Wang 2006 reveled that alcohol consumers at the time of study
were 1.22 times more likely than non consumers to develop HTN.
Stress- Persistent stress leads to the release of certain hormones notably adrenaline
and cortisol resulting in a sustained elevation of BP [Gianavos,Jennings, Sheu
Derbyshire and Mathews2007]
Age- HTN is more prevalent in adults over the age of 25 years than in young
persons.Wang 2006 demonstrated that the incidence of HTN among respondents of
65years and older was about 38% higher than among adults between 45 and 54 years.
9
2.4.2Secondary HTN
It is arterial HTN with a specific cause identified. These patients should not be ignored
for atleast two reasons:
Correlation of the cause may cure their HTN.
Secondary forms of the disease may provide insight into the etiology of essential HTN.
It constitutes about 5% of cases . The following are known causes:
Sleep apnea syndrome.
Drugs like contraceptive pills and anti inflammatory pills.
Chronic renal disease
Primary aldosteronism.
Renal vascular disease.
Steroid therapy.
Cushing syndrome.
Pheachromocytoma .
Coarctation of the aorta
Thyroid and parathyroid disease
[Kannel 2004]
2.4.3 Pregnancy HTN
Gestational HTN- BP >140/90mmHg for the 1st time in pregnancy without
proteinuria[obstetric 2006]
Superimposed pre-eclampsia or eclampsia-The occurrence of a new onset of
proteinuria in women with chronic HTN [Obstetric 2006]
Chronic HTN- A known HTN before pregnancy or HTN diagnosed for the 1st time befire
20weeks of pregnancy[Obstetrics2003]
Pre-eclampsia- A multisystem disorder of unknown etiology
characterized by
development of HTN to the extent of BP level of 140/90mmHg or more with proteinuria
after the 20th week in a previously normotensive and non proteinuric woman.
Eclampsia-This is pre-eclampsia complicated grandmal seizures that is generally tonic
clonic convulsions and coma.Vary widely from country to country.More commonly in
primigravidae and 5 times more common in twin than in single pregnancy.[Obstetrics
10
2006].
2.5 HYPERTENSIVE URGENCIES
Severe elevated BP in the upper range grade II HTN without progressive end or target
organ dysfunction. Highly elevated BP without severe headache, shortness of breath or
chest pain. Usually due to under controlled HTN [Professor Misbah 2003]
2.6 HYPERTENSIVE EMERGENCIES
Also called malignant HTN. This is severely elevated BP >180/120mmHg with acute
impairment of target organs that can result in irreversible organ damage.The BP is
slowly lowered over a period of minutes to hours with an antihypertensive argent.Signs
and
symptoms
are
;retinal
headache,vomiting,cerebral
hemorrhage
hemorrhage,kigney
,increased
damage
intracranial
leading
to
pressure,
hematuria
proteinuria and acute renal failure.The causes are; discontinuation of antihypertensive
medication,glomerulonephritis,head trauma,autonomic hyperactivity and collagen
vascular disease.The morbidity and mortality depend on the extent of end organ
dysfunction at the time of presentation.[Brewster LM 2006]
2.7 HYPERTENSIVE CRISIS
Hypertensive crisis is a sudden or sustained diastolic BP>120mmHg with
papilloedema,progressive decrease in renal function an evidence of neurogenic
dysfunction .It may present as hypertensive urgency or emergency. The BP should be
controlled within one hour to prevent permanent damage and hypertensive
emergencies.Rapid decrease of BP should be avoided to reduce the risk of cerebral
hypoperfusion.[Bel Marra Health 2005]
2.8CLINICAL PRESENTATION
HTN is rarely accompanied by symptoms but some people seek medical attention with
complains of: Headache at the back of the head and in the morning ,Fatigue and
confusion, vision problems, chest pain, difficulty in breathing, irregular heart beat and
blood in urine.[James Beckerman ,MD,FACC 2016]
2.9 DIAGNOSIS
A good diagnosis is made from a detailed history,proper examination and investigations.
2.9.1Goals of evaluation
To determine the extent of target organ damage.
11
To assess patients overall cardiovascular risk status.
To rule out identifiable and curable causes of HTN.
2.9.2 History
Search for factors that help determine the presence of precipitating and aggreviating
factors, the natural cause of blood pressure,the extent of target organ damage and the
presence of other risks for cardiovascular disease.
2.9.3 Physical examination
To evaluate for signs of end organ damage like retinopathy and for evidence of a cause
of secondary hypertension.Check for the presence of changes in the optic fundus.
2.9.4 Investigations
Complete blood count.
Urinalysis.
Urea,creatinine and electrolytes.
Lipid and renal profile.
Electrocardiogram/echocardiography.
Chest x-ray.
[Davidson 2010]
2.10 MANAGEMENT OF HYPERTENSION
2.10.1 lifestyle modification
Relief of stress.
Regular exercises.
Weight reduction.
Dietary management-encourage patients to reduce salt intake.
Control of other risk factors contributing to development of arteriosclerosis.
2.10.2 Drug therapy
Antihypertensive drugs are used and they are:
Angiotensin converting enzyme inhibitors.
Angiotensin receptor blockers.
Beta blockers like carvedilol and labetalol.
Diuretics like hydrochlorothiazide.
Antiadrenergic agents like methyldopa.
12
Vasodilators like hydralazine.
Calcium channel blockers like verapamil.
[JNC 7]
13
CHAPTER THREE
3.0METHODOLOGY
3.1 STUDY AREA
Busia county covers an area of /26/3km2.It has a population of 149085.It borders
Kakamega district to the east,Bungoma and teso to the north,Uganda to the west and
lake Victoria to the south.Matayos is a settlement in the Busia district in the western
province .It is a small township of about 2000 inhabitants among Busia-Kisumu highway.
TOPOGRAPHY AND CLIMATE
The landscape is mostly steep ridged and semiarid region experiencing long rains
between march to june and short rains between October to december .The main water
sources are dams,rivers and streams.
ECONOMIC ACTIVITY
Majority of the population are subsistent farmers who mainly grow cassava, wheat,
yellow maize, sweet potatoes, sorghum, finger millet and beans in small pieces of
land.They raise livestock on small scale mainly cattle which are drought resistant
animals for ploughing purposes,some goats,sheep and usually some free range chicken.
3.2 STUDY DESIGN
A descriptive cross sectional study design.It involves collection of data so as to answer
the research questions.Interviewing respondents by use of questionnaires to record
different information.
3.3 STUDY POPULATION
Respondents who visit the Matayos subdistrict hospital.
3.4 INCLUSION AND EXCLUSION CRITERIA
3.4.1 Inclusion criteria
All patients visiting MHC and have been suffering from hypertension both nearly
detected and those who had HTN before and are on medication.
3.4.2 Exclusion criteria
Patients attending MHC but do not suffer from HTN.Those who decline their consent.
3.5VARIABLES
3.5.1 Dependent variables
14
Hypertensive patients depend on drugs.
3.5.2 Independent variable
In hypertension men are more affected than female.
3.6 SAMPLING PROCEDURE
All clinics in MHC were my sampling unit.Respondents were drawn from each
clinic to avoid discrimination and biasness. simple random sampling method
was used.
3.7 DATA COLLECTION PROCEDURE
Open ended and close ended questions were used in a questionnaire to the
target population to meet the research objectives, answer research questions
and evaluate knowledge and attitude of people to hypertension.
3.8 DATA COLLECTION TOOL
Collection of data through interviewing and questionnaire by use of papers,pens,pencils
and rubbers.
3.9 PRE TESTING
A sample of 20 attendants of Kondele health centre were interviewed.
3.10SAMPLE SIZE DETERMINATION
The researcher targets 50 patients attending MHC to arrive at desired sample size ,the
following formula by Fisher et al [2002] was used.
N=Z2PQ/D2
Where
N=The desired sample size if the target population is greater than 1000
Z=A standard numerical deviation at required confidence level.The standard normal [zscore] deviation given as 1.96 for 95% confidence level.
P=Population of target population.This is unknown as it was estimated at 50%
Q=Statistical notation for 1-op[1-0.5=0.5]
D=Degree of accuracy required and set at 0.05
N=[1.96]2×[0.5]2/[0.05]2
=3.8416×0.25/0.0025
15
=384
If the study population was less than 10000
Nf=n/1+n/N
Nf=Is the desired sample size of finite population in the desired sample size in which
population is calculated above 384
N=finite study population at 100
I=a constant for correction
Nf=384
1+384=79.3384
=79 respondents
Due to limited time and resources,the researcher used 50 respondents.
3.1.1DATA ANALYSIS AND PRESENTANTION
Data was analyzed manually,calculated by use of scientific calculators and
recorded.Descriptive method of data presentation was used to analyze demographic
data. The data was presented in form of tables , pie charts and graphs.
3.1.2ETHICAL CONSIDERATIONS
The research proposal was presented to the department of clinical medicine and
surgery for evaluation and approval.Copies were kept in the head of department for
reference for those who will conduct the same study.The researcher
seeked for
permission from the department of clinical medicine and surgery and the incharge of
Matayos health centre to conduct the study.The people were to choose whether to
participate or not after being informed the benefits and reasons of carrying out the
study.
The researcher observed the respondent’s confidentiality and privacy.
3.1.3STUDY LIMITATION
 Lack of enough funds and time in data collection.
 Language barrier
 Harsh environmental conditions
16
 Uncooperative respondent.
CHAPTER FOUR
4.0 STUDY FINDING
Chapter four presents and discusses the results of the study.The objectives were to
determine factors contributing to increased prevalence of hypertension and to
determine the attitude and belief of people to hypertension.Data was coded and
analysed using piecharts, tables and graphs.
TABLE 1.0 AGE OF RESPONDENTS.
PARAMETER
FREQUENCY
PERCENTAGE
10-30
4
8%
31-55
7
14%
56-75
28
56%
Above 75
11
22%
TOTAL
50
100%
Majority of respondents were 28[56%] within the age of 56-75years.
TABLE 1.1 GENDER OF RESPONDENTS.
SEX
FREQUENCY
PERCENTAGE
Male
34
68%
Female
16
32%
TOTAL
50
100%
FIGURE 1.1 GENDER OF RESPONDENTS.
17
40
35
30
25
20
15
10
5
0
MALE
FEMALE
18
The male were mostly affected with hypertension with a high percentage of 68% while
female had a percentage of 32%.
TABLE 1.2 OCCUPATION OF RESPONDENTS.
PARAMETER
FREQUENCY
PERCENTAGE
UNEMPLOYED
14
28%
EMPLOYED
13
26%
BUSINESS
23
46%
TOTAL
50
100%
FIGURE1.1OCCUPATIONOFRESPONDENTS.
25
20
15
FREQUENCY
PERCENTAGE
Column1
10
5
0
UNEMPLOYED
EMPLOYED
BUSINESS
Majority of the respondents were doing a business 23[46%].
TABLE 1.3 COMMON COMPLAINTS THAT RESPONDENTS PRESENT WITH.
COMPLAINT
FREQUENCY
PERCENTAGE
19
HEADACHE
19
38%
CHEST PAIN
7
14%
ABDOMINAL PAIN
8
16%
VISION PROBLEMS
16
32%
TOTAL
50
100%
Majority of respondents complained of headache 19[38%] followed by vision problems
16[32%].Complaints of chest pain and abdominal pain were fewer.
FIGURE 1.2 LEVEL OF EDUCATION OF RESPONDENTS.
FREQUENCY
NONFORMAL
PRIMARY
SECONDARY
COLLEGE
Many of the respondents were secondary school drop outs 20[40%] primary were
15[30%] non-formal 5[10%] and college or university were 10[20%].
FIGURE 1.3 MARITAL STATUS OF RESPONDENTS.
20
FREQUENCY
SINGLE
DIVORCED/SEPARATED
MARRIED
WIDOW/WIDOWER
The pie chart above explains about marital status of the respondents where majority
were married 20[40%],15[30%] were widows and widowers,10[20%] were divorced or
separated 5[10%] were single.
TABLE 1.4 EFFECTS OF HYPERTENSION IN HYPERTENSIVE PATIENTS.
EFFECT
FREQUENCY
PERCENTAGE
INSTANT DEATH
17
34%
DISABILITY
11
22%
STIGMATIZATION
14
28%
DISCRIMINATION
8
16%
TOTAL
50
100%
Majority of respondents complained of family and friends instant death 17[34%]
TABLE 1.5 ASSOCIATION OF HYPERTENSION TO LIFESTYLE.
PARAMETER
FREQUENCY
PERCENTAGE
Alcohol consumption
6
12%
21
Cigarrate smoking
9
18%
Exercise
3
6%
Excess dietary salt
15
30%
Fatty feeds
17
34%
TOTAL
50
100%
FIGURE 1.4 ASSOCIATION OF HYPERTENSION TO LIFESTYLE.
20
18
16
14
12
Column1
PERCENTAGE
FREQUENCY
10
8
6
4
2
0
Alcohol consumption
Exercise
Fatty feeds
The table and figure above explains how lifestyle affects hypertensive patients.Mostly
respondents complained of fatty feeds affecting high percentage 17[34%] followed by
excess dietary
salt intake 15[30%]Exercise helped few respondents to reduce
symptoms3[6%]Few respondents were taking alcohol 6[12%] as well as smoking 9[18%].
TABLE 1.6 BENEFITS OF HYPERTENSIVE PATIENTS COMPLYING TO DRUGS.
PARAMETER
FREQUENCY
PERCENTAGE
Increase quality of life
13
26%
Blood pressure kept under 14
28%
22
control
Increase chance of survival
13
26%
Decrease complication and 10
20%
financial burden
TOTAL
50
100%
Many respondents thought that drugs kept their blood pressure under control 14[28%]
others thought drugs increases their quality of life as well as chance of survival each
13[26%].Few respondents thought that drugs decrease complications and financial
burden10[20%].
TABLE 1.7 COMMONLY USED HYPERTENSIVE DRUGS IN MATAYOS HEALTH CENTRE.
PARAMETER
FREQUENCY
PERCENTAGE
Nifedipine
21
42%
HCTZ
14
28%
Propranolol
7
14%
Torsemide
7
14%
Chlothalidone
1
2%
TOTAL
50
100%
FIGURE 1.5 COMMONLY USED HYPERTENSIVE DRUGS IN MATAYOS HEALTH CENTRE.
23
25
20
15
Column1
PERCENTAGE
FREQUENCY
10
5
0
Nifedipine
HCTZ
Propranolol
Torsemide
Chlothalidone
The table and figure above reveals that many of the respondents used nifedipine
21[42%] and less respondents used chlothalidone 1[2%].
TABLE 1.8 PLACES WHERE HYPERTENSIVE PATIENTS OBTAIN THEIR DRUGS.
PARAMETER
FREQUENCY
PERCENTAGE
Local chemist
6
12%
Pharmacy
16
32%
Given by friend
2
4%
Hospital
26
52%
TOTAL
50
100%
FIGURE 1.6 PLACES WHERE HYPERTENSIVE PATIENTS OBTAIN THEIR DRUGS.
24
LOCAL CHEMIST
PHARMACY
GIVEN BY FRIEND
HOSPITAL
The table and figure above illustrates that many respondents obtained drugs from
hospital 26[52%] and the fewer were given by their friends 2[4%].
CHAPTER FIVE
5.0 DISCUSSION AND INTERPRETATION.
The study was carried out in matayos health centre.The study revealed that majority of
the respondents were between the age of 56-75years[56%]The findings revealed that
male were commonly affected with hypertension at 68% because of their lifestyle of
smoking and consuming much alcohol.The study revealed that most respondents were
dependant on their own business and they included 23[46%].According to the
study,many respondents were secondary school drop outs 20[40%].The respondents
25
commonly presented with complaints of headache 19[38%]The findings also explained
that respondents complained of being affected commonly due to taking fatty feeds
17[34%] which is not recommended.Few patients did exercises 3[6%] to reduce
symptoms.The study reveals that majority of respondents complained of family and
friends instant death 17[34%].Respondents were compliant to drugs because of the
benefit of keeping blood pressure under control 14[28%] and the most common drug
used was nifedipine 21[42%] where majority of the respondents obtained their drugs
from the hospital 26[52%].
The study finding showed that their was adequate awareness of hypertension by clients
attending hypertension clinic.The respondents were educated by health care provider
who was providing services to them during the clinic visiting time and health talks
conducted by community health workers.Due to the knowledge provided the clients
were compliant to both medication and lifestyle regime and according to Zen et al 2002,
self report was a reliable method of assessing medication compliance.According to
Vitolins 2000, recalling adherent behavior over a short period was more reliable than
assessing compliance over a longer period of time.The study revealed that patients who
attended the clinic with their blood pressure high in almost every visit were noncompliant to drugs because of their side effects and this concurs with Benson and
Britten 2003, findings.The study reveals that majority of the respondents were
attending the clinic appointment as they were scheduled.The respondents had positive
perceptions and indicated that they had confidence in their doctors.
CHAPTER SIX
6.0 CONCLUSION AND RECCOMMENDATION.
6.1 CONCLUSION
The following conclusive remarks were made after analysis of the research finding:
26

Hypertension was high in clients who were attending hypertension clinic in MHC
and common in people of age 56-75years.

Male were mostly affected than female.

Majority of respondents presented with complaints of headache and vision
problems.

Many respondents of Matayos were affected with hypertension because of fatty
feed diet.

Most patients took their medication to keep their blood pressure under control.

Many respondents preferred of obtaining drugs from the hospital.
6.2 RECCOMMENDATION
The doctors and clinicians should educate the patients about the disease and how
severe and dangerous it is.They should also impart knowledge to them about the
causes,management and consequences of non-adherence.
The government should come up with mechanisms and subsidize the cost of
hypertension medication to improve adherence and quality of life of people.
Client follow-up programmes should be intensified in all hypertensive clinics.
Health education campaigns concerning hypertension ought to be delivered through
different means to target patients and community at large.
REFERENCE

Bertram G Katzung,MD,PhD,San Francisco 2011 clinical pharmacology 12th
27
edition

Benson and Pernolis handbook of obstetrics and gynaecology 2001 10th edition

Dan L. Longo,MD,Dennis L. Kasper MD 2012 Harrison’s principle of internal
medicine 18th edition

Jitender P Vij.M Triphati 2008 essential of pharmacology medicine 6th edition

Margaret Crouch 2009 WHO clinical management and referral guidelines volume
III Kenya

Nicki R. colledge,Brian R.Walker,Stuart H.Ralston 2010 Davidson’s principle and
practice of medicine 21st edition

Susan Jeffrey 2003 hypertension guidelines joint national committee 7 and 8

William M. Drake 2012 Hutchison’s clinical methods 23rd edition
APPENDIX I: WORKPLAN
ACTIVITY
DURATION
28
Selection of research topic
5 days
Proposal writing
60 days
Pretesting
10 days
Data collection
60 days
Data analysis
15 days
Research writing
15 days
Typing and printing
5 days
Research presentation
15 days
Submission of dissertation
5 days
TOTAL
190 days
29
APENDIX II: BUDGET
ITEMS
QUANTITY
AMOUNT[Ksh]
Research file
1
60
Foolscaps
1 Rim
500
Pens
4
80
Ruler
1
30
Rubber
1
30
Pencils
2
30
Typing and printing
1 booklet
2000
Binding
200
Duplicating
2 booklets
500
Photocopying
50 copies
500
Questionnaire
20 copies
2300
Other expenses
5000
TOTAL
11230
30
APENDIX III:QUESTIONAIRE
A QUESTIONAIRE ON FACTORS CONTRIBUTING TO THE INCRESED PREVELENCE OF
HYPERTENSION IN MATAYOS
TARGET GROUP:Male and female attending MHC
Dear respondent;
Your contribution is considered important to this study.You are kindly requested to
answer this questions in good faith based on your knowledge.Your participation is
confidential and voluntary as your cooperation is required for the success of this study.
INSTRUCTIONS.
Tick in the boxes provided correctly and only one response is required in each question
Do not write your name anywhere.
SECTION A: DEMOGRAPHIC DATA
1 Age
10-30
[ ]
31-55
[ ]
56-75
[ ]
Above 75
[ ]
2 Gender
Male
[ ]
31
Female
[ ]
3 marital status
Single
[ ]
Divorced/Separated [ ]
Married
[ ]
Widow/wdower
[
4 The highest level of education
Non formal
[ ]
Primary
[ ]
Secondary
[ ]
Colledge/university [ ]
Others specify…………………………………………………..
5 Occupation
Unemployed
[ ]
Employed
[ ]
Business
[ ]
Others specify………………………………………………………
6 Religion
Christian
[ ]
Muslim
[ ]
Hindu
[ ]
Others specify…………………………………………………………
SECTION B: KNOWLEDGE
1 Have you ever heard of hypertension?
Yes
[ ]
32
No
[ ]
If yes,from whom………………………………………………………….
2 What do you understand by the term hypertension?
Increased blood pressure
[ ]
Decreased blood pressure
[ ]
Breathing difficulty
[ ]
Swelling of legs and arms
[ ]
Others specify………………………………………………………………………….
3 What complaints does one present with in hypertension?
Headache
[ ]
Chest pain
[ ]
Stomach pain
[ ]
Vision problems
[ ]
Others specify……………………………………………………………………………
4Can hypertension lead to the following?
Disability
[ ]
Instant death
[ ]
Stigmatization
[ ]
Discrimination
[ ]
Others specify……………………………………………………………………………
5 How do you view your life being at risk as a result of hypertension?
Increasing daily
[ ]
Decreasing daily
[ ]
Disrupts family life
[ ]
Becoming burden to the family
[ ]
33
Career being affected
[ ]
SECTION C: PRACRICE
1Have you ever heard or used hypertensive drugs?
Yes
[ ]
No
[ ]
If yes,which one do you prefer and
wh
y
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…………………………………………………………………………………………………………………………………………………………
2 Where do you buy your drugs?
Local chemist
[ ]
Pharmacy
[ ]
Given in the hospital
[ ]
From your friend
[ ]
Others specify ………………………………………………………………………………
34
3 What should avoid if hypertensive?
Alcohol consumption
[ ]
Cigarette smoking
[ ]
Eating a balanced diet
[ ]
Others specify ………………………………………………………………………………
4 What do you do to maintain your blood pressure?
Excess dietary salt intake
[ ]
Exercise
[ ]
Maintain fatty feeds
[ ]
Others specify……………………………………………………………………………….
5 What drugs do you use?
Nifedipine
[ ]
Propranolol
[ ]
Torsemide
[ ]
Chlothalidone
[ ]
Others specify…………………………………………………………………………………..
6 What are the benefits of complying to drugs?
Increasing quality of life
[ ]
Blood pressure kept under control
[ ]
Increased chance of survival
[ ]
Reduced complications and financial burden [ ]
SECTION D: ATTITUDE
35
1 Do your family members take good care of you?
Strongly agree
[ ]
Agree
[ ]
Disagree
[ ]
Strongly disagree
[ ]
2 Do you think hypertension is commonly associated with the poor than the rich?
Strongly agree
[ ]
Agree
[ ]
Disagree
[ ]
Strongly disagree
[ ]
3 Do you think hypertension is associated with diabetes?
Strongly agree
[ ]
Agree
[ ]
Disagree
[ ]
Strongly disagree
[ ]
4 Does hypertension affect HIV patients mostly?
Strongly agree
[ ]
Agree
[ ]
Disagree
[ ]
Strongly disagree
[ ]
5 Do you think hypertension can be cured?
Strongly agree
[ ]
Agree
[ ]
Disagree
[ ]
Strongly disagree
[ ]
36
37