dr. mwebaza victor

1. KAMPALA INTERNATIONAL UNIVERSITY/ WESTERN CAMPUS P.O.BOX
71, ISHAKA BUSHENYI.
INCIDENCE AND FACTORS ASSOCIATED WITH HIGH BLOOD PRESSURE
AMONG SEEMINGLY NORMAL INDIVIDUALS BETWEEN 18- 55 YEARS OF
AGE AMONG RESIDENTS OF BUDUMBULI IN BUGEMBE MUNICIPALITY
IN JINJA DISTRICT.
SUBMITTED BY
MWEBAZA VICTOR BMS/9114/172/DU
A RESEARCH PROPOSAL SUBMITTED TO THE FACULTY OF CLINICAL
MEDICINE AND DENTISTRY OF KAMPALA INTERNATIONAL UNIVERSITY IN
PARTIAL FULFILMENT OFAWARD OF DEGREE IN BACHELOR OF MEDICINE
AND BACHELOR OF SURGERY.
6TH
/JANURAY/2023

2. i
DECLARATION
I MWEBAZA VICTOR, Hereby declare that this piece of work is a result of my effort
and all the authors whose work has been quoted in this text have been acknowledged. I
therefore confirm that this piece of work has never been submitted to any institution of
higher learning for award of any academic qualification.
Signature………………………………..
Date………………………………………..

3. ii
DEDICATION
To my mother NABUKEERA JENIFER a nurse at jinja regional referral hospital who
initiated my education and Uncle Merewoma Leo. Mary trinity kasuubo (my little baby
sister and best friend forever), Kyazikesulaina, Kisakye job, Mikisa prosper, Judith
kainembabazi, Esmo carol, and wandera victor okumu.
Not leaving out all Ghetto (slum) children and young people who despite the challenges
they face each day, still keep hopeful and dreaming big, working hard towards achieving
a better and bright future.
You have been my biggest inspiration and this is proof that all dreams are possible. From
the ghetto here am, a medical doctor.
Keep a positive dream no matter the challenge, remember you can come from ghetto and
be a president of the great nation.

4. iii
APPROVAL
This work will be submitted to the university examination board with approval from the
following supervisor;
Name of supervisor; Dr. Asad Muyinda (MBChB [MUK], MRCP [UK], FCP [ECSA]
Cardiologist and physician at Jinja Regional Referral Hospital)
Signature……………………………………………….......................................................

5. iv
ACKNOWLEDGEMENT
I WANT TO THANK THE FOLLOWING PEOPLE AND INSTITUTIONS:
1. My Heavenly Father for granting me the strength and courage to fulfill my dream
2. My mother Nabukeera Jennifer for her unconditional love and support in my
research.
3. My research supervisor Dr. Asad Muyinda for his support in my research.
4. My family for supporting me through this difficult period.
5. Dr. Akib Surat (Dep ED of KIU-TH) for the motherhood heart and kindness.
6. Dr. Okello Maxwell (DEAN FC M&D) standing with my class.
7. My supervisor; Dr. Asad Muyinda for his continuous motivation and help.
8. The Department of Health for granting me permission to perform my research.
9. Doctor Egesa Ivan for mentorship and encouragement.
10. People of budumbuli in bugembe municipality in jinja district
11. Ghetto people

6. v
ABBREVIATIONS
BMI……………………Body Mass Index
HT………………………Hypertension
BP………………………Blood pressure
WHO……………………World Health Organization
HIV……………………...Human immunodeficiency virus
AIDS…………………..Acquired immunodeficiency syndrome
MOH …………………. Ministry of Health
#

7. vi
TABLE OF CONTENTS
DECLARATION................................................................................................................. i
DEDICATION....................................................................................................................ii
APPROVAL ......................................................................................................................iii
ACKNOWLEDGEMENT................................................................................................. iv
ABBREVIATIONS ............................................................................................................ v
TABLE OF CONTENTS................................................................................................ v
Abstract.............................................................................................................................. ix
DEFINITION OF TERMS ................................................................................................. x
CHAPTER 1 ....................................................................................................................... 1
1.0 INTRODUCTION.................................................................................................. 1
1.2 STATEMENT OF THE PROBLEM........................................................................... 4
1.3.0 OBJECTIVE .......................................................................................................... 5
1.3.1 BROAD OBJECTIVE ........................................................................................... 5
1.3.2 SPECIFIC OBJECTIVES...................................................................................... 5
1.4 RESEARCH QUESTIONS ...................................................................................... 5
1.5 JUSTIFICATION OF THE STUDY. ....................................................................... 6
1.6.0 STUDY SCOPE..................................................................................................... 7
1.6.1 GEOGRAPHICAL SCOPE................................................................................... 7
1.6.2 CONTENT SCOPE ............................................................................................... 7
1.6.3 TIME SCOPE ........................................................................................................ 7
1.7 CONCEPTUAL FRAMEWORK............................................................................. 8
CHAPTER TWO ............................................................................................................ 8
LITERATURE REVIEW ............................................................................................... 9
2.0 INTRODUCTION.................................................................................................. 9
2.1 SOCIO-DEMOGRAPHIC FACTORS................................................................... 15
2.2 LIFE STYLE FACTORS........................................................................................ 18
2.3 HEALTH RELATED CONDITIONS ASSOCIATED WITH HIGH BLOOD
PRESSURE................................................................................................................... 21
CHAPTER THREE ...................................................................................................... 27
METHODOLOGY ....................................................................................................... 27
3.0 INTRODUCTION .................................................................................................. 27

8. vii
3.1 STUDY DESIGN.................................................................................................... 27
3.2 STUDY AREA ....................................................................................................... 28
3.3 STUDY POPULATION......................................................................................... 28
3.3.1 INCLUSION CRITERIA..................................................................................... 28
3.3.2 EXCLUSION CRITERIA ................................................................................... 28
3.4 SAMPLE SIZE DETERMINATION ..................................................................... 29
3.5 SAMPLING PROCEDURE ................................................................................... 29
3.7 DATA PROCESSING, ANALYSIS, AND PRESENTATION............................. 30
3.8 QUALITY CONTROL........................................................................................... 30
3.9 ETHICAL CONSIDERATION.............................................................................. 31
3.10 LIMITATIONS OF THE STUDY........................................................................ 31
CHAPTER FOUR......................................................................................................... 32
Results and Discussion ................................................................................................. 32
4.1.2 Socio-Demographic Characteristics of Study Participants in budumbuli village in
bugembe in jinja district................................................................................................ 33
4.1.3 Socio-Demographic Characteristics of Hypertensive and Non-Hypertensive
Group of Study Participants in Budumbuli Village in Bugembe Municipal Council-
Jinja district................................................................................................................... 34
4.1.4 Predictors of Hypertension in Budumbuli Village in Bugembe Municipal
Council- Jinja district.................................................................................................... 36
4.1.5 Hypertension Prevalence across Behavioral and Dietry Characteristics of
Respondents in Budumbuli Village in Bugembe Municipal Council- Jinja district..... 37
4.2 Discussion............................................................................................................... 39
CHAPTER FIVE .......................................................................................................... 46
Conclusion and.............................................................................................................. 46
Recommendations......................................................................................................... 46
REFERENCES ............................................................................................................. 50
APPENDIX 1................................................................................................................ 54
CONSENT FORM........................................................................................................ 54
APPENDIX II............................................................................................................... 55
SECTION 2................................................................................................................... 57
EXAMINATION.......................................................................................................... 57
SYSTEMIC EXAMINATION....................................................................................... 58
CVS EXAMINATION ..................................................................................................... 58
RESPIRATORY ............................................................................................................... 58
EXAMINATION.............................................................................................................. 58

9. viii
GIT EXAMINATION ...................................................................................................... 58
CNS EXAMINATION ..................................................................................................... 58
APPENDIX III.............................................................................................................. 59
APPENDIX IV.............................................................................................................. 60
APPENDIX V............................................................................................................... 61

10. ix
Abstract
Hypertension is a growing health problem in many countries including Uganda
and is increasing day by day. There is very little community based data available
in Uganda therefore, information regarding occurrence of hypertension in the general
population of the people of Budumbuli village in Bugembejinja district in Uganda is
desirable. There are many causes of hypertension but it is greatly influenced by
demographic characteristic such as gender, age, family history, alcohol, stress and many
other diseases. It is one of the most preventable risk factor for CVD, as we can detect it
easily and dietary and life style changes can be helpful to decrease the risk of associated
health complications. Although some studies are conducted in some areas of Budumbuli
village, less updated data available. I studied the prevalence of hypertension. The
objective of this study was to determine prevalence and factors associated with
hypertension. It was a community based cross-sectional study within Budumbuli. A well
tested questionnaire was administered. A total of 425 individuals participated in the
surveyof which 37.65% were men and 62.35% were women. The overall prevalence of
hypertension was (33.88%) male and female (63.89%). While 58.3% of the hypertensive
subjects were using anti-hypertensive medicine, Out of all subjects 39.29% had the
history of hypertension. Significant association was found between positive history of
hypertension and prevalence of hypertension (p= 0.00). If we consider the frequency of
eating processed meat its prevalence is much in subjects eating much meat. This
association was also statistically significant (p= 0.044).

11. x
DEFINITION OF TERMS
INCIDENCE: Refers to the number of cases of a disease that occur during a specified
period of time in a population at risk of developing the disease.
ASYMPTOMATIC INDIVIDUAL; Refers to an individual who has a disease condition
but is unaware because there no evidence manifestation.
CONSENT; Permission to perform a given task onto someone
PRE-TESTING; Refers to the use of the tools to be used in data collection prior to the
commencement of the renal process to ensure the tools are effective and efficient for data
collection.

12. 1
CHAPTER 1
1.0 INTRODUCTION
Hypertension is a condition in which arterial blood pressure is chronically elevated.
High blood pressure (hypertension) is considered when a blood pressure of
140/90mmHg or higher is recorded three or more consecutive times. (Newby DE, et
al 2010)
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a term
medical in which the blood pressure in the arteries is persistently elevated. High
blood pressure typically does not cause symptoms. Long-term high blood pressure,
however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial
fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and
dementia. Hypertension is an important public health challenge in both economically
developing and developed countries. Significant numbers of individuals with
hypertension are unaware of their condition and among those diagnosed with
hypertension treatment is frequently inadequate.(William A 1941) The risks
associated with a given blood pressure are dependent upon a combination of risk
factors in an individual such as age, sex, gender, weight, physical activity, family
history, Diabetes mellitus, and any pre existing vascular disease and its effective
management requires a holistic approach.(Newby DE et al 2010)
Hypertension is a silent danger because there are no typical symptoms sending out early
warning signals. On the contrary many people feel well and energetic despite high blood
pressure. There is only one way of finding out whether or not one’s blood pressure is
normal and that is to have it checked. Blood pressure measurements must be done at least
once a year.(Wolff H.P 1996)

13. 2
1.1 BACKGROUND
It is well known that high blood pressure can lead to hypertension which is a major risk
factor for overall mortality on the global scale. By changing the structure of arteries,
high(also known as raised or elevated) blood pressure increases the risk of stroke ,heart
disease and kidney failure, as well as other diseases. In 2009, the world Health
Organization (WHO) attributed13%of all deaths globally to high blood pressure making
it an area of prime importance for public health in both developing and developed
countries.(WHO 2009)
The modern history of hypertension begins with the understanding of the cardiovascular
system based on the work of physician William Harvey(1578-1657) who described the
circulation of blood in his book “De motucordis .The English clergyman Sephen hales
made the first published measurement of blood pressure in 1733(Kotchen TA et al
october 2011).The concept of hypertensive disease as a generalized circulatory disease
was taken up by Sir Clifford Allbutt, who termed the condition as hyperpiesia.(Shaw,
H.Batty (Harold Batty)1922).
However hypertension as a medical entity really came into being in 1896 with the
invention of a cuff-based sphygmomanometer by Scipione Riva-Rocci.(Postel-vinay,
1996)this made it possible to measure pressure in the clinic. Historically treatment of
what was called the “hard pulse disease” consisted in reducing the quantity of blood by
letting or the application of leeches(Esunge PM October 1991).In the late 19th
and early
to mid-20th
centuries, many therapies were used to treat hypertension (Society of
Actuaries committee on mortality 1960) but few were effective and these were not well
tolerated.
A number of theories about origin and development of hypertension, especially essential
hypertension, blossom repeatedly and are as varied as the wild flowers on a mountain
side and often as evanescent. Almost everyone of importance in the field has yielded to
the temptation, at least once, to offer an all, partly encompassing theory, only to be

14. 3
marred by the ever intrusive facts. Some of the theories among others suggested by some
scientists include the “Mosaic theory” suggested by Page(Page I H 1977)which stated
that essential hypertension will prove to be not a disease, but many different diseases of
different origin and development, all of which produce hypertension and its consequences
in a kind of mosaic of causes, some of which, may occur singly or together. However,
this theory does not account for such things as hereditary predisposition and the
interrelationships and dynamics of hypertensive disease. It also left 85% of the patients
with hypertension in the “essential” or of “unknown origin” category. Another theory
which was based on the work in man and animals (particularly the two kidney model, in
which one renal artery is constricted, versus one kidney model in which renal artery is
constricted and the artery ablated) suggested that essential hypertension is either due to
excessive retention of salt and water or to high production of Renin, Angiotensin and
aldosterone.(Laragh JH et al 1976 and Gavras H et al 1976).
The prevalence of hypertension has increased significantly over the past two to three
decades. There were approximately 20 million adults in Africa south of Sahara in 2000
and projections based on current epidemiological data suggest that this figure will rise to
150 million by 2025. Further there is evidence that indicates that related complications of
hypertension, and in particular stroke and heart failure are also becoming increasingly
more common in this region. These trends have been strongly linked with changes in
individual and societal lifestyle such as an increase in tobacco use, excessive alcohol
consumption, reduced physical activity and adoption of western diets that are high in salt,
refined sugar and unhealthy fats and oils.

15. 4
1.2 STATEMENT OF THE PROBLEM
Hypertension is the most common cardiovascular disorder affecting approximately 1
billion people globally and accounts for about 7.1 million deaths annually.(Brundtl and
G H1974)
.
Until recently, hypertension was given low priority in Africa and is now being reported in
many parts of Africa and is the most common cause of cardiovascular disease in the
continent. (Addo J et al 2007)
Recent studies conducted in Africa have revealed a prevalence ranging from 7.5% in
Sudan (Elbagir and Ahmed 1990 cited in Addo et al 2007, (Edwards R et al 2000)to as
high as 37.7% in Tanzania. (Bimenya G S, et al 2005). Anectodal data however suggests
that hypertension has increased over the years, and is increasingly becoming a public
health problem. A study conducted among Makerere University undergraduate students
revealed a systolic blood pressure of 11% and diastolic pressure of 18%,(G S Bimenya et
al)and another exploratory study conducted in Rukungiri district in 2005 among adults
attending out patients clinics revealed a hypertension prevalence of 23.7% (Wamala et
al29005 un published report ).Therefore given the relatively high incidence of
hypertension and the fact that its complications are fatal and cause ill health yet 9 out 10
people are unaware of their condition,(J hypertens et al 2011 Jun) there’s need to
design appropriate intervention strategies based on scientific evidence in form of
research. No published data exists on the incidence or prevalence of high blood pressure
among residents of rwemirokora in ishaka municipality and Bushenyi district as a whole.
This study therefore aims at investigating the incidence and risk factors associated with
high blood pressure in asymptomatic individuals in rwemirokora with a view of
designing appropriate interventions strategies.

16. 5
1.3.0 OBJECTIVE
1.3.1 BROAD OBJECTIVE
To establish the incidence and factors associated to high blood pressure in seemingly
normal individuals in budumbuli village
1.3.2SPECIFIC OBJECTIVES
o To determine the relationship between health related factors and high blood
pressure.
o The establish effect of lifestyle to development of high blood pressure
o To determine the social demographic factors associated with high blood pressure.
1.4 RESEARCH QUESTIONS
1. What is the relationship between health related factors and high blood pressure?
2. What is the effect of lifestyle to development of high blood pressure?
3. What socio-demographic factors increase the risk of high blood pressure?

17. 6
1.5 JUSTIFICATION OF THE STUDY.
Hypertension may be fatal and can cause ill health to those affected therefore there’s
urgent need to strengthen health services in responding effectively to large burden of
undetected hypertension.
The study will help to generate population –based data on the prevalence of high blood
pressure and related risk factors needed to inform planning and implementation of
effective prevention and control strategies in the country.
The study is important to me the researcher as it is an academic obligation for partial
fulfillment of the requirements for achieving the award of a bachelor’s degree in
medicine and surgery.

18. 7
1.6.0 STUDY SCOPE
1.6.1 GEOGRAPHICAL SCOPE
The study will carried out in Budumbuli village in Bugembe municipality within jinja
district. Jinja district is bordered by Wabulenga in the north, Kimaka in north west, Njeru
in the west, lake Victoria in the south and east then Bugembe in the northeast.
1.6.2 CONTENT SCOPE
The study will employ residents of Budumbuli village who are not aware of their blood
pressures ranging between 18 and 55 years of age
1.6.3 TIME SCOPE
The study will carried out from 12TH
of July to 17th
of Nov of 2022 starting from 8am to
6pm on weekends only.

19. 8
1.7 CONCEPTUAL FRAMEWORK
Independent variables
Dependent variables
SOURCE; Adapted from stone et al
CHAPTER TWO
Healthy related factors
HIV/AIDS
Diabetes
BMI
Social demographic factors
Age
Sex
Occupation
Lifestyle factors
Smoking
Alcoholism
Physical inactivity
High blood
pressure
Salt intake
Genetics
Outcome
-Increased risk
of developing
Hypertension
-Decreased risk
of developing
hypertension

20. 9
LITERATURE REVIEW
2.0 INTRODUCTION
The medical name for high blood pressure is hypertension (Buckman & Westcott,
2006:6).
Hypertension refers to a systolic (top) blood pressure reading higher than 140 mm Hg
and a diastolic (bottom) blood pressure reading that is higher than 90mmHg, after
several readings to make a diagnosis that the patient is hypertensive (Khan &
Beevers,2005:8,1105-1109).
The blood pressure consists of two numbers. The top number signifies the force of
contraction of the heart’s main section, the left ventricle, and the lower number
corresponds with the resistance to blood flow in the arteries (Sinatra, Roberts, James &
Zucker, 2007:9).
The term high blood pressure covers any blood pressure above 120/80 mm Hg, while
hypertension refers only to pressures of 140/90 mmHg and above (Casey & Benson,
2006:14-15).
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term
medical condition in which the blood pressure in the arteries is persistently elevated.
High blood pressure typically does not cause symptoms. Long-term high blood pressure,
however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial
fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.
High blood pressure is known as the “silent killer” due to the large damage caused to the
blood vessels (Tortora & Derrickson, 2006:798).

21. 10
Hypertension is given this name because of a person not having any noticeable
symptoms; a person can have high blood pressure for years without knowing it
(Kowalski, 2007:3).
Blood pressure is the amount of force applied by the blood on the inside of the arteries as
the blood is pumped throughout the circulatory system. Each time the heart muscle
contracts, blood is pressed against the walls of the arteries and is measured as systolic
blood pressure (top number). When the heart muscle relaxes between beats, the pressure
on the artery wall eases measured as diastolic blood pressure (bottom number)
(Kowalski, 2007:3).
Perry (2002:13) states that high blood pressure usually has no warning signs and
therefore people do not feel sick.
Kowalski (2007:24) on the other hand clarifies this by stating that regularheadache,
dizziness and nose bleeds are not symptoms. These symptoms can occur with severe
hypertension.
According to Buckman and Westcott (2006:6) many people think high blood pressure is a
mild condition, but if left untreated it can lead to a number of serious medical problems,
such as heart attack, heart failure, stroke and kidney damage.
The heart has to work harder to the effect of the forceful pulsation of blood caused by
hypertension and causing continuing damage to the arterial walls (Casey & Benson,
2006:10).
Buckman and Westcott (2006:10) state that great force is needed to pump blood out of
the heart and around the body. The walls react by thickening and losing their elasticity

22. 11

23. 12
and strength. Due to this effect, less blood can pass through, depriving surrounding
tissues of oxygen and nutrients. Therefore, it can cause the heart to become enlarged and
the arteries scarred and less elastic.
Akinboboye et al. (2002:17,381-382), confirm that hypertension is by far the most
common cardio-vascular disease followed by rheumatic heart disease and
cardiomiopathy, nonrheumatic heart diseases, coronary artery disease, pericardial
vascular disease and pulmonary heart disease.
Blood pressure is expressed by two measurements, the systolic and diastolic pressures,
which are the maximum and minimum pressures, respectively. For most adults, normal
blood pressure at rest is within the range of 100–130 millimeters mercury (mmHg)
systolic and 60–80 mmHg diastolic. For most adults, high blood pressure is present if the
resting blood pressure is persistently at or above 130/80 or 140/90 mmHg. Different
numbers apply to children. Ambulatory blood pressure monitoring over a 24-hour period
appears more accurate than office-based blood pressure measurement.
Lifestyle changes and medications can lower blood pressure and decrease the risk of
health complications. Lifestyle changes include weight loss, physical exercise, decreased
salt intake, reducing alcohol intake, and a healthy diet. If lifestyle changes are not
sufficient then blood pressure medications are used. Up to three medications can control
blood pressure in 90% of people. The treatment of moderately high arterial blood
pressure (defined as >160/100 mmHg) with medications is associated with an improved
life expectancy. The effect of treatment of blood pressure between 130/80 mmHg and
160/100 mmHg is less clear, with some reviews finding benefit and others finding
unclear benefit. High blood pressure affects between 16 and 37% of the population
globally. In 2010 hypertension was believed to have been a factor in 18% of all deaths
(9.4 million globally).
PATHOPHYSIOLOGY

24. 13
In most people with established essential hypertension, increased resistance to blood flow
(total peripheral resistance) accounts for the high pressure while cardiac output remains
normal.
Conway J (April 1984). "Hemodynamic aspects of essential hypertension in
humans".Physiological Reviews.64 (2): 617–60. doi:10.1152/physrev.1984.64.2.617.
PMID
There is evidence that some younger people with prehypertension or 'borderline
hypertension' have high cardiac output, an elevated heart rate and normal peripheral
resistance, termed hyperkinetic borderline hypertension.Palatini P, Julius S (June 2009).
"The role of cardiac autonomic function in hypertension and cardiovascular
disease".Current Hypertension Reports.11 (3): 199–205.
These individuals develop the typical features of established essential hypertension in
later life as their cardiac output falls and peripheral resistance rises with age. Whether
this pattern is typical of all people who ultimately develop hypertension is disputed. The
increased peripheral resistance in established hypertension is mainly attributable to
structural narrowing of small arteries and arterioles, although a reduction in the number
or density of capillaries may also contribute.
It is not clear whether or not vasoconstriction of arteriolar blood vessels plays a role in
hypertension. Hypertension is also associated with decreased peripheral venous
compliance which may increase venous return, increase cardiac preload and, ultimately,
cause diastolic dysfunction.
Pulse pressure (the difference between systolic and diastolic blood pressure) is frequently
increased in older people with hypertension. This can mean that systolic pressure is
abnormally high, but diastolic pressure may be normal or low, a condition termed
isolated systolic hypertension. The high pulse pressure in elderly people with

25. 14
hypertension or isolated systolic hypertension is explained by increased arterial stiffness,
which typically accompanies aging and may be exacerbated by high blood pressure.
Many mechanisms have been proposed to account for the rise in peripheral resistance in
hypertension. Most evidence implicates either disturbances in the kidneys' salt and water
handling (particularly abnormalities in the intrarenal renin–angiotensin system) or
abnormalities of the sympathetic nervous system. These mechanisms are not mutually
exclusive and it is likely that both contribute to some extent in most cases of essential
hypertension. It has also been suggested that endothelial dysfunction and vascular
inflammation may also contribute to increased peripheral resistance and vascular damage
in hypertension. Interleukin 17 has garnered interest for its role in increasing the
production of several other immune system chemical signals thought to be involved in
hypertension such as tumor necrosis factor alpha, interleukin 1, interleukin 6, and
interleukin 8.
Excessive sodium or insufficient potassium in the diet leads to excessive intracellular
sodium, which contracts vascular smooth muscle, restricting blood flow and so increases
blood pressure. Perez V, Chang ET (November 2014). "Sodium-to-potassium ratio and
blood pressure, hypertension, and related factors". Advances in Nutrition.5 (6): 712–41.

26. 15
2.1 SOCIO-DEMOGRAPHIC FACTORS
Sex where females are more likely to be hypertensive than men, (Wamala JF et al Sept.
2009).
Surveys done in numerous countries globally show that 26.6% of men and 26.1% of
women had hypertension and 29.2% were projected to have this condition by 2025
(tulame university school food public health and tropical medicine)The estimated number
of adults with hypertension (HT) in 2000 was 972 million (957-987 million), 333 million
(329-336) in economically developed countries and 639 million (625-654 Million) in
economically developing countries. The number of adults with hypertension in 2025 was
predicted to increase by about 60% to a total of 1.56 billion, (tulame university school of
public health and tropical medicine).
The WHO STEPS survey conducted between 2003 and2009 in 20 African countries
reported high rates of hypertension in most countries, particularly among men. The
prevalence ranges from 19.3% in Eritrea to 39.6% in Seychelles. The prevalence is for
adult population aged 18 years and above. In Africa hypertension is usually more
pronounced in males than females. However in a few countries there were higher levels
of prevalence in women than men such as Algeria 31.6% versus 25.7% in 2003,
Botswana 37.0% versus 28.8% in 2006 and Mali 25.8% versus 16.6% in 2007, for
women and men respectively(WHO 2009).
Other studies conducted in Africa reveal an overall prevalence of 5-20%, (Cooper R et
al 1997).
Most recent data such as those from Tanzania, Ghana, Nigeria, Egypt, South Africa
suggest hypertension prevalence (using partition value of 140/90mmHg) is on the rise in
Africa and commonly 20-25% in rural areas and over 30% in urban and semi urban areas,
(Edwards R et al 2000)

27. 16
A cross- sectional population- based survey in rural Uganda revealed that 2719 out of
4801 men(56.6%) and3959 out of the 5372 women (73,7%) who participated in the
survey, the prevalence of hypertension was 22.0%, (J hypertens et al Jun 2011).
Another study conducted among Makerere University undergraduate students in which
120 males and 63 females participated revealed that using systolic blood pressure 36% of
the sample population was normotensive while 53%were pre-hypertensive and 11% were
hypertensive. Using the diastolic pressure, 48% of the sample population was
normotensive, 34% was pre-hypertensive and 18% was hypertensive (G S Bimenya et al
dept. of pathology, faculty of medicine, Makerere University)
In 2009, females (17.3%) were more likely than males (16.4%) to report that they had
been diagnosed with hypertension (Figure 1).

28. 17
Bars in graph depict extent of correct, and imperfect, treatment and control across steps
of care cascade.
https://doi.org/10.1371/journal.pgph.0000386.g002

29. 18
2.2 LIFE STYLE FACTORS
They include alcohol use which is known to have a direct effect between high levels and
specific patterns of alcohol consumption and the rising risk of hypertension. Studies
conducted reveal that current alcohol users were approximately 1.6 more likely to be
hypertensive, while past alcohol users were 2.3 more likely to be hypertensive; all
compared to those who had never used alcohol. Accumulating scientific evidence
indicates that light to moderate alcohol consumption may significantly reduce the risk of
CVD and all-cause mortality.
(O’Keele JH, et al 2007, Ronksley PE et al 2011 and Carrao G et al 2000) In contrast,
excessive alcohol intake is toxic to both the heart and overall health.(O’Keele JH, et al
2007, Ronksley PE et al 2011 and Carrao G et al 2000)
.
Sodium intake in excess of the physiological needs i.e. (10-20mmol/day) also predisposes
one to high blood pressure,(Conlin PR 2007).
A high intake of sodium is common, inAfrica mostly from salt used to preserve food or to
make it tastier.Also salt is added to already prepared food by the consumer, as processed
food is rare. Decreased salt intake not only reduces blood pressure andrelated
cardiovascular risk but has other beneficial cardiovascular effects that are independentof
and additive to its effect on blood pressure.
Studies reveal that one’s residence either rural or urban is a risk to hypertension with a
risk of 30.2% in rural areas and 26.6% in urban areas,(Wamala JF,Karyabakako Z et al
September 2009)

30. 19
Physical activity is another factor known to reduce risk if hypertension and other
cardiovascular risks. it has been estimated that physical inactivity is responsible for 12%
of global burden of myocardial infarction (yusuf S, Hawken S et al 2004) .the American
college of sports medicine recommends at least 30 minutes of moderate –intensity
physical activity (such as walking briskly, mowing the lawn dancing, swimming) on most
of the days of the week

31. 20
TABLE 1; Risk factor analysis for hypertension
Characteristics -n- # Hypertension (%)
Alcohol use
Never used.
Present alcohol user Past
alcohol user
BMI(Kg/m2)
<25.0
25-29.9
e”30
Age group (years)
20-34
35-44
45-54
55-64
65-74
75+
All
Sex
Men
Women
Education level
No formal education
Primary
Secondary
Tertiary
Residence location
Urban
Rural
341
362
139
506
269
67
401
162
117
88
43
31
842
401
441
138
395
203
106
65
777
86 (25.2%)
105 (29.05)
61 (43.9%)
112 (22.1%)
96 (35.7%)
44 (65.7%)
90 (22.4%)
48 (29.6%)
40 (34.2%)
40 (45.5%)
20 (45.5%)
14 (45.2%)
252 (29.9%)
102 (25.4%)
150 (34.0%)
54 (39.1%)
100 (25.3%)
50 (24.6%)
48 (45.3%)
17 (26.2%)
235 (30.2%)
SOURCE; African Health Sciences vol9 No3 September 2

32. 21
2.3 HEALTH RELATED CONDITIONS ASSOCIATED WITH HIGH BLOOD
PRESSURE
Obesity
Obesity or overweight has been identified to be associated with hypertension, (WHO
1998). Excess body fat increases the risk of developing a range of health problems,
including high blood pressure, diabetes mellitus. (Wilson PW et al 1867-72 and
Chrostowska M et al 2011).
Romero-Corral et al, (Romero-Corral A et al 2006) undertook a meta-analysis to
determine the nature of the relationship between obesity and cardiovascular mortality.
Patients with severe obesity (BMI ≥ 35) had the greatest RR for cardiovascular mortality
(RR = 1.88) compared to people with a normal BMI (BMI = 20–24.9). However,
overweight patients (BMI = 25–29.9) had the lowest risk (RR = 0.88), and obese patients
(BMI > 30) had no increased risk (R = 0.97).
Body mass index greater than 25 puts an individual at risk of hypertension compared to
body mass index of 25 and lower. In Tanzania, Bovet et al (2002) found that body mass
index was strongly and independently associated with systolic and diastolic blood
pressure (1.01 mmHg with BP per 1kg/m2 increase in BMI), (Bovet P Ross AG,
Gervasoni JP et al 2002).
HIV/AIDS
Early studies suggested a link between a PI based ART and elevated BP. However other
studies conducted suggested a link between duration of ART and development of high
blood pressure. Prolonged ART defined as duration of 2 – 5 years was independently

33. 22
associated with development of hypertension where as those on ART below 2 years in
duration were not at risk
Heart failure
Smeltzer et al. (2010:825), defines heart failure as a condition of ventricular dysfunction.
It is a change in the pumping function of the heart accompanied by typical signs and
symptoms. Heart failure results when the heart is unable to produce an output of blood
necessary for the needs of the body, provided the venous return to the heart is enough
(Mani et al., 2009:81). Due to an overload of tissue perfusion, many patients experience
pulmonary and peripheral congestion (Smeltzer et al., 2010:825).
The effort of pumping out blood at high pressure, places the heart under enormous
pressure. With time, in order to cope with the strain, the heart enlarges (Buckman&
Westcott, 2006:26).
The heart muscle becomes weak due to a variety of causes, such as scarring from heart
attacks, stretching and enlargement from hypertension or other disease (Sinatra et al.,
2007:6)
. Patients with heart failure have a poor prognosis unless the cause is correctable. The
mortality rate of heart failure for the first year from 1
st
hospitalization is about 30 years
and older. In chronic heart failure, mortality depends on the severity of symptoms and
ventricular dysfunction and can range from 10 to 40% per year (Beers et al., 2006:658).
Signs of heart failure
o dyspnoea (breathlessness)
o tachypnoea (breathing rate more than 18 in men and more than 20 in
women)
o inspiratory basal crackles or crepitations on auscultation of the lungs
o fatigue
o ankle swelling with pitting oedema
o raised jugular venous pressure
o tachycardia

34. 23
o An enlarged liver which is often tender. (Department of Health, 2008:56).
Stroke
A stroke also called a cerebro-vascular accident is the onset of neurological dysfunction
resulting from the disruption of blood supply to the brain. The small blood clot travels
through the bloodstream and eventually blocks other vessels or the brain causing a
cerebro-vascular accident (Cassey& Benson, 2006:11).
Strokes can be ischemic (80%), resulting from thrombosis or embolism or hemorrhagic
(20%), resulting from vascular rupture (e.g. subarachnoid or intracerebral haemorrhage)
(Beers et al., 2006:1789).
There is a high occurrence of stroke incidence in young adults in specific communities
(Allen,2009:32,312).

35. 24
Strokes affect 500 000 people a year in the United States of America and represent the
third leading cause of death, after heart attacks and cancer (Tortora&Derrickson,
2006:517).
Untreated high blood pressure is the number one cause of stroke (Sinatra et al., 2007:8).
Stroke and high blood pressure are major causes of death and disability worldwide.
Although wide range stroke surveillance data for Africa are lacking, the available data
show that age-standardized mortality, case fatality and occurrence of disabling stroke in
Africa are the same as or higher than those measured in most high-income regions.
In Africa more than 90% of patients with haemorrhagic stroke and more than half with
ischemic stroke are found to have high blood pressure( Mensah,2008:n.p.).
After HIV/AIDS, heart attack, stroke and vascular disease have killed more South
Africans than any other disease (Kowalski, 2007:22).
Signs of a stroke
o sudden numbness or weakness of the face, arms, or leg, especially on one
side of the body
o sudden mental confusion
o sudden difficulty to speak or understanding speech
o sudden trouble in seeing in one or both eyes
o sudden trouble walking, dizziness, loss of balance or coordination
o A sudden, severe headache without any known cause (Perry, 2002:46).
Myocardial infarction (heart attack)
It is whereby the coronary artery narrows so much that blood is unable to get through the
heart, or if an artery is blocked by a clot lodged in the narrowed arteries. Part of the heart
is starved of blood and dies (Buckman & Westcott, 2006:28).
A complete obstruction to blood flow in a coronary artery may cause a myocardial
infarction (Tortora & Derrickson, 2006:708).
Tortora and Derrickson (2006:708) further explained that an infarction means the death
of an area of tissue because of interrupted blood supply.

36. 25
In the United States about 1, 5 million myocardial infarctions occurs annually. This leads
to the death of 400000 to 500000 people with about half of them dying before they reach
the hospital (Beers et al., 2006:635).
Signs of heart attack
o uncomfortable tightness or pain in the chest
o pain that radiate from the chest to the shoulders, arms (especially the left
arm) or neck
o dizziness, fainting, sweating, nausea or shortness of breath (Perry,
2002:450).
,
Renal failure
Renal failure is classified as either acute or chronic. Acute renal failure is a rapid
decrease in renal function over days and weeks, causing an accumulation of nitrogenous
products in the blood (Beers et al., 2006:1980).
Nettina (2006:771) further claims that acute renal failure is a syndrome of varying
causation which outcomes a sudden decline in renal function.
Hypertension damages the kidney arterioles causing them to thicken and consequently
narrows the lumen. The blood supply to the kidneys is thereby reduced and the kidneys
have to produce more rennin which causes the blood pressure to raise even more
(Tortora&Derrickson, 2006:798).

37. 26
Rennin is a hormone that is produced by the kidneys (Buckman& Westcott, 2006:11).
Signs of Kidney disease
o frequent need to urinate, especially at night
o difficulty urinating
o puffiness around the eyes and swelling of the hands and feet
o pain in the lower back
o An unpleasant taste and odor in the mouth (Perry, 2002:47).
Retinopathy
The part of the eyes that is mostly affected by high blood pressure is the retina. It is the
nerve layer at the back of the eye that senses light and sends visual images back to the
brain (Perry, 2002:47).
Tortora and Derrickson (2006:584) explain that the surface of the retina is the only place
in the body where blood vessels can be seen directly and examined for pathological
changes, such as hypertension and other illnesses. Most studies have shown a correlation
between blood pressure and retinopathy (Defronzo, Ferrannini, Keen &Zimmet,
2004:1198).
Extremely high blood pressure can cause hypertensive retinopathy that leads to blurry
vision and blindness (Buckman& Westcott, 2006:26).

38. 27
CHAPTER THREE
METHODOLOGY
3.0 INTRODUCTION
The study methodology describes the methods that may be used,study designs,sample
size determination,study population,and data collection tools.it also explains the sampling
methods, pre testing data and ethical consideration
3.1 STUDY DESIGN
The study will be a descriptive analytical study employing both quantitative and
qualitative approaches.

39. 28
3.2 STUDY AREA
The study will be carried out in Budumbuli village within Bugembe municipality in Jinja
district. The village has been chosen for the study as it is easily accessible and convenient
to me the researcher in terms of transport and time costs during data collection since it’s
my home area and also being at Jinja KIU study site light it made my work easy.
3.3 STUDY POPULATION
This will constitute both male and female residents between the ages of 18and 55 years
only
3.3.1 INCLUSION CRITERIA
Residents who consented and within the age ranges were allowed to participate in the
study.
3.3.2 EXCLUSION CRITERIA
Non consent, non Hypertensive and age below 18years

40. 29
3.4 SAMPLE SIZE DETERMINATION
Sample size was estimated using the Kish Leslie(1965) formula
n=Z2
P (1-P)
e2
Where n is estimated minimum sample size required.
P is the proportion of a characteristic in sample 23.7% (wamala et al., 2005)
Z is 1.96 (for 95% confidence interval)
e is the margin of error set at 5%
n=(1.96)2
*0.237(1-0.237)
(0.05)2
n=278
Minimal sample size was 278.
But due to enough time and willingness of the participants more than 425 participants
were involved.
3.5 SAMPLING PROCEDURE
Simple randomization was used

41. 30
3.6 DATA COLLECTION METHODS AND MANAGEMENT
Data was collected by taking respondents’ blood pressures using an automatic digital
blood pressure monitor. A stethoscope and weighing scale will be used to detect heart
sounds and measure weight respectively. An interview questionnaire with both closed
and open ended questions was used and it shall .It was administered in English
3.7 DATA PROCESSING, ANALYSIS, AND PRESENTATION
Obtained data was processed by categorization, tallying and with the help of a simple
electronic calculator. Quantitative was e analyzed using descriptive statistics such as
percentages, charts, tables, and charts among others.
3.8 QUALITY CONTROL
Improper positioning of the arm, poor assembly of the machine may result into errors.
Also batteries running low may generate errors. However to minimize errors, proper
positioning of the arm, proper assembly of the machine, and replacement of old with new
batteries was ensured.
The research assistants were trained prior to data collection to in order to minimize
errors.
Pre testing was done randomly among students of Kampala International University
western campus (KIU-WC) to ensure that tools are in good working condition and that
they are effective for data collection.
Individuals who were found to have high blood pressure had their blood pressure re-
measured.

42. 31
3.9 ETHICAL CONSIDERATION
The proposal was submitted to the Research Ethics Committee for approval before
proceeding for field work.
I also sought permission from relevant authorities the village chairperson. An informed
consent was obtained from the respondents after thorough explanation of the benefits
and aims the study.
3.10 LIMITATIONS OF THE STUDY
Some informational provided by the respondents may have been affected by recall bias

43. 32
CHAPTER FOUR
RESULTS AND DISCUSSION
4.1.1RESULTS
I studied 425 subjects (160 male and 265 female) between ages 18 to 55 years in
residents of Budumbuli village in Bugembe Jinja district.
More than 24.24 % of the subjects had secondary education, 45.18 % primary education
and 22.59 % graduated from universities respectively.
Mostly respondents were unemployed during survey and more than 27.53 % were
employed. Among 425 subjects 39.29 % had history of hypertension while there meaning
60.7 % mention that they did not have any hypertension history.
Blood pressure measurements was done in all participants to check hypertension. The
mean of systolic and diastolic BP results were 120.8 mm Hg and 79.6 mm Hg. Among all
respondents, 33.88 % were identified as hypertensive and 66.12 % were non
hypertensive.
Among hypertensive, there were 58.3% subjects who were using anti hypertensive
medication during data collection period. 41.41 % has normal BP on measurements.
During this study I observed an age wise dependent raise the prevalence of hypertension
in both male and female as with the minor prevalence in younger age wise groups and
major in high age groups.

44. 33
4.1.2 Socio-demographic characteristics of study participants in budumbuli village
in bugembe in jinja district.
Characteristic Freq (n) Percentage (%)
Sex Male 160 37.65
Female 265 62.35
Age 18-23 79 18.59
24-29 91 21.41
30-35 76 17.88
36-41 69 16.24
42-47 55 12.94
48-55 55 12.94
Marital status Married 373 87.76
Unmarried 47 11.06
Divorced 5 1.18
Job status Employed 117 27.53
Self employed 134 31.53
Un employed 174 40.94
Education status Uneducated 34 8
Primary 192 45.17
Secondary 103 24.24
Tertiary 96 22.59
Duration of stay in
community
≥10 years 23 5.41
11-29 years 104 24.47
30-49 years 86 20.24
≤50 years 212 49.88
.

45. 34
4.1.3 Socio-demographic characteristics of hypertensive and non-hypertensive
group of study participants in budumbuli village in bugembe municipal council-
jinja district
Characteristics Hypertensive Non-
hypertensive
Chi-square(×2) P-value
n % N %
Sex Male 52 36.11 108 38.43 0.219 0.64
Female 92 63.89 173
61.57
Age(yrs) 18-23 9 6.25 70 24.91
65.693
0
24-29 18 12.5 73
30-35 24 16.67 52 25.98
36-41 26 18.06 43
42-47 29 20.14 26 18.51
48-55 38 26.39 17 6.05
Duration of
stay In
community
≥10 yrs 2 1.39 21 7.47
57.69
0
11-29 yrs 12 8.33 92 32.74
30-40 yrs 23 15.97 63 22.42
≤50 yrs 107 74.31 105 37.37
Marital
status
Married 138 95.83 235 83.63
13.381
0.001
Unmarried 5 3.47 42 14.95
Divorced 1 0.69 4
1.42
Education Uneducated 29 20.14 5 1.78
67.293
0
Primary 79 54.86 113 10.21
Secondary 21 14.58 82 29.18

46. 35
Tertiary 15 10.42 81 28.18
Job status Employed 24 16.67 93 33.1 20.289 0
Self employed 41 93
Un employed 79 28.47
54.86
95 33.1
33.8

47. 36
4.1.4 Predictors of hypertension in budumbuli village in bugembe municipal
council- jinja district
Characteristics Subjects
(n)
Hypertensive OR 95%
C.I
P
value
(n) (%)
Sex Male 160 54 33.8 0.905 0.567 0.640
Female 265 92 34.7 1.0 1.373
Physician
activity
Yes 365 126 34.5 1.201 0.663 0.546
No 59 18 30.5 1.0 2.177
Family
history of
Hypertension
Yes 169 77 46.1 4.916 2.693 0.546
No 258 67 26.0 1.0 8.974
D.M status Diabetic 60 31 51.7 3.908 2.302 0.002
Non- diabetic 365 113 31.0 1.0 6.617
Tobacco
consumption
Yes 47 15 31.9 0.005 0.473 0.763
No 378 129 34.1 1.0 1.732
Fruit and
vegetation
consumption
Yes 369 133 36.0 2.305 1.153 0.016
No 56 11 19.6 1.0 4.609

48. 37
4.1.5 Hypertension prevalence across behavioral and dietary characteristics of
respondents in budumbuli village in bugembe municipal council- jinja district
Statement Options hypertensive Non-hypertensive
N % N %
Positive family
history of
hypertension
Yes 77 53.5 90 32
No 67 46.5 191 68
Positive family
history of Diabetes
Mellitus
Yes 39 27.1 60 21.4
No 105 72.9 221 78.6
DM Status Diabetic 31 21.5 29 10.3
Non diabetic 113 78.5 252 89.7
Smoking Yes 15 10.4 32 11.4
No 129 89.6 249 88.6
Doing physical
activity every day
Yes 126 87.5 239 85.1
No 18 12.5 42 14.9
Frequency of
eating oil and
fatty food
Not frequently 41 28.5 101 35.9
Frequently 92 63.9 157 55.9
Frequency of
eating deep
fries
Much frequently 11 7.6 23 8.2
Not frequently 41 28.5 84 29.9
Frequency of
Eating
processed meat
Frequently
Much frequently
More than once a
day
62
41
0
43.1
28.5
0
137
60
4
48.8
21.4
1.4

49. 38
About once a day
Once a week
Not at all
3
89
52
2.1
61.8
36.1
19
179
79
6.8
63.7
28.1

50. 39
4.2 DISCUSSION
From the Table at 4.1.2 shows the sociodemographic characteristics of respondents
such as age,
sex of hypertensive (n=144) and non-hypertensive (n=281) groups. The hyper-
tension prevalence was significantly higher in individuals more than 45 years than those
less than 45 years. There was significant difference in the two groups with respect to age.
It also showed the significant difference in hypertension prevalence in different education
classes. There was also the difference in hypertension the age wise distribution of
respondents. This showed that 18.59% were in age group of 18-23, 21.41% were in age
group of 24-29, 17.88% in age group of 30-35, 16.24% were in age group of 36-41,
12.94% were in the age group
of 42-47 and 12.94% were in the age of 48-55 the duration of stay in the community.
This showed that 5.41% of the subjects were living for _ 10 years in the community.
24.47% were living for 11-29 years, 20.24 % were living for 30-49 years and 49.88%
were living for more than 50 years.
87.76% of the subjects are married, 11.06% are unmarried
and 1.18% are divorced.
The educational status of the respondents. This showed that 8% of the subjects were
uneducated, 45.18% were primary
level, 24.21% were secondary level and 22.59% got tertiary level of education.
27.53% were employed, 31.53% were self employed and 40.94% were unemployed
during survey.
From Table 4.1.3 shows the predictors of hypertension.
The odds of developing hypertension was 4 times more among respondents who were
having family history of hypertension compared to those who were having not any family
history of hyper tension.
[OR] : 4.916, 95% confidence interval [CI] :(2.693, 8.974). The table also shows
That it’s also 3 times more among respondents who are diabetic as compared to
Non diabetic odd ratio [OR] : 3.908, 95% confidence interval [CI] : (2.302, 6.617).
The table also shows that there is less chances of developing hypertension among
subjects who use much fruits and vegetables and do some physical activity. This table

51. 40
shows that there is significant association between high blood pressure" and having
family history of Hypertension".
There were 146 subjects who were hypertensive and among those 77 respondents said
that they have family history of hypertension.
It is also statistically significant as p value is (0.00). It was also found in this table
that there is also association between DM status" and hypertension as a person
Having diabetes have more chances of having high blood pressure as compared to normal
person.
Studies showed that there is significant association between high blood pressure
and the use of tobacco.
The results of my studies showed not any proper association between tobacco
consumption and hypertension. This might be due to less use of tobacco among
the residents of budumbuli village.
This table also showed that there is less chances of HBP in the subjects who use
fruits and vegetables frequently and doing physical activity regularly.
This valley is well known for some popular fruits as apple, cherry, grapes, apricots, pears
etc. people mostly consume these fruits and mostly use vegetables for cooking.
This was also statistically significant as p value = (0.016). This table showed
that mostly subjects were doing some physical activity as out of 146 hypertensive
subjects 126 were doing physical activity.
From Table 4.1.4
shows the result that there are 167 (39.29 %) of respondents having
positive family history of hypertension and 99 (23.29 %) of subjects having positive
history of DM.
There were 60 (14.11 %) known DM patients. If we look at the table, there were
47 (11.05 %) of people are smokers and 365 (85.88 %) are doing some physical
activity

52. 41
Dietary Practice of Respondents
Approximately, 294 (69.17%) of the study participants eat processed meat at least once a
weak. While 92 % of the participants eat oil and fatty food frequently. Regarding to the
ratio of eating much deep fries 199 (46.82 %) consume mostly (frequently), and
101 (23.76 %) on much frequent basis.
Eating Oily and Fatty food
This table shows that among 146 hypertensive subjects 92 said that they consume oily
and fatty food frequently, and 11 said they consume oil much frequently.
If we consider the practices and level of awareness about the use of fat among
respondents, mostly knew that they must lower the consumption of oily and fatty
products. Their attitude towards the less use of fatty products was positive.
Eating Processed Meat and Meat products
This table shows that among 146 hypertensive subjects 89 subjects said that they were
using processed meat once a week and 52 subjects said that they were not using at all.
Like fatty food meat is also staple food of the people of budumbuli village
There is much use of meat and meat products among adults. This table shows the
significant association between hypertension and consumption of meat.
In general prevalence of hypertension in our study was (33.88% ) [144/425]
showed that there is increase in hypertension prevalence in budumbuli village which
might be due to change in deity habits, and other factors as much use of processed meat,
less physical activity and much consumption of salt.
A total of 425 adults aged 18-55 years from 170 households were studied. If we
considered the sex distribution of the respondents it was male (37.65 %) [160/425]and
female (62.35 %) [265/425]. In my studies there were more female respondents.
These findings are agree with the same findings in a survey conducted in mayuge district
in Uganda Busoga region in 2009. In this study patients practices were observed, in
which (61.8 %) respondents answered that they checked their blood pressure when they
fall ill.

53. 42
My research revealed that age and family history are associated with hypertension, as
aging reduces the elasticity of blood vessels leading to an increase in blood pressure"
There will be some other possible reasons as older people pay less
Attentions to take care of their health, or may be due to lack of Financial means
for their health care. Also, the accumulation of hypertension risk factors increase
along with the age of individuals. This study showed that 40% of the populations above
45 years have hypertension, the occurrences of hypertension and among
older in this study population was some what lower (23.26%). This increase in
hypertension with age is a well known fact.
Obesity is one of the major risk factor in developing hypertension, participants
with BMI > 25 are at higher risk as compared to those having BMI less than 25.
This fact is supported by many other studies and they have reported a strong
connection between BMI and hypertension.
If we consider the previous studies, it is found that High HBP is common, complex and
phylogenetic disease whose phenotype is the result of multiple interactions between
genes and the environment".
If I link this with my studies, these environmental aspects might be linked to dietary
habits of an individual and his cultural aspects which could explain the connection
between the family history and the hypertension. As my study strongly showed this
association.
The study has provided information on the subject of hypertension its prevalence
and related factors of hypertension among adults living in budumbuli village It has
demonstrated (33.88%) prevalence of hypertensions.
My present study depict that having family history of hypertension, being aged, having
much weight, diabetes mellitus, and obesity was significantly associated with
hypertension.
In my studies, the individuals with positive family history were more likely to

54. 43
be hypertensive, this could be explained by the fact that genetic factors accounted for one
third to one half of the risk of hypertension. Blood relatives tend to have many of the
same genes that can predispose a person to high blood pressure, heart diseases or stroke"
If we consider the on the whole prevalence of hypertension, it is significantly elevated
to fact that people have changed dietary habits and life style modification. This
high prevalence in the area has found to be serious public health implications as
there are much chances of risk of cardiovascular disease.
Research reveals that the life style modifications are one of important determinants of our
physical health is an helpful tool to manage and maintain HBP.
If we consider physical activity, most of the respondents said that they were doing
physical activity daily and understood that exercise plays positive role in hypertension
control. Our findings are agreed by other studies and its proved that physical activity
plays significant role in medicine free management of hypertension. In
this study majority of the respondents also agreed that consumption of fruits and
vegetables also plays an important role in controlling HBP.
Consumption of extra table salt, in addition to what has already been included
in the dish is associated with HBP and stroke and this has been proven by clinical
studies".
The current study showed that there is low proportion of hypertension among
those with control salt intake being hypertensive, this could also be explained by
the fact that might be the hypertensive respondents were using less salt under
medical advice.
Studies found that marital status was also associated with hypertension. If we
consider a single individual, he might be expose to stress more because of low
socialization while married individuals, are more secure .
If we consider the diet there is less control over diet in married individuals, as
prefer to eat processed food meals out door. These kind of meals are saltier also
faultier and contain more spices and broths"
In this study it was observed that hypertension was more common in over weight

55. 44
adults as compared to normal weight adults. Obesity as been identified as the
most important risk factor for developing hypertension. Several epidemiological
studies have reported the significance association between obesity and hypertension".
Thus weigh lose has been proved a powerful mean of preventing hypertension.
There must be further improvement in high blood pressure related knowledge.
This will lead to better and improved sustainable health outcome. If we consider
the attitude towards high blood pressure, this study found that mostly respondents as both
non hypertensive and hypertensive. Moreover, this showed positive attitude towards
predictions of HBP. All the participants agreed that intake of vegetables and fruits,
regular checkup of blood pressure and discussion with physician can help in controlling
HBP.
People with high level of education are usually more concern about health matters so
adopt healthy life style, health diet, exercise, quit smoking and weight control.
While with low education are not much conscious about health related issues
and tend to be less informative.
It is identified that the majority of individuals
suffering from high blood pressure are not suffering from particular symptoms until
complications arise results in sudden deaths due to heart attacks and also results in severe
disabilities such as stroke as well as heart failure.
This study found that Diabetes was also associated with increase in hypertension. The
coexistence of diabetes and hypertension might be due to common risk factors as
smoking, unhealthy diet, physical inactivity.
In this study most of study participants were never examined for blood pressure.
I observed that many participants are even unaware of their hypertension status.
This may lead to hidden epidemic in particular population.
However, the use of preventive measures and positive activities, awareness regarding
HBP are most effective ways of controlling hypertension. This is because of the fact that
control of high blood pressure depends upon individual's attitude and practices, which
may include firstly, life style changed, as physical activity, health weight, healthy diet
and avoiding the use of tobacco and alcohol as well as close monitoring after diagnosis.
This study has a number of advantages including being a community based study this can
truly describe the general population as compared to several other studies that have
reports from hospital based studies. Hypertension is always a tough medical condition
among non-communicable diseases of a certain population. We can overcome HTN by
rising public awareness and knowledge about risks and related factors of HBP.

56. 45

57. 46
CHAPTER FIVE
Conclusion and
Recommendations
5.1 Conclusion
Hypertension a major public health problem is directly responsible for cardiovascular
deaths in most parts of the world.
The risk factors which lead to hypertension are altered life style, less attention to health
care related practices, much consumption of processed food, and some other factors as
use of oily and fatty food, much consumption of salt, stress etc. So accurate estimates of
hypertension is necessary to plan accurate and effective control measures.
The present study was done in this direction to estimate the increase in occurrence of
hypertension and to examine its risk factors and practices in budumbuli village.
This study was undertaken by selecting 425 subjects in the
cross sectional study conducted in July 2022 to November 2022.
All the subjects were personally contacted in their houses, interviewed using
questionnaire. The data was obtained from subjects of 18 years to 55 years.
There BP readings were recorded and average of last two was considered as
final reading.
Male comprised about 37.65% and female comprised about 62.35% of the study.
If we look at the educated profile, majority of respondents consist of primary
and secondary levels. Most of the participants were female and mostly living in the
community for more than 30 years. The results show that the prevalence of
Hypertension was steady with increase in age. In this study most of the subjects
were agriculturists.
There are many causes of hypertension and it is much influenced by demographic
characteristics such as age, gender, social status, obesity, family history of hypertension,
alcohol use, tobacco use, stress and many other factor.

58. 47
My study found that the prevalence of hypertension has direct relation with family
history of hypertension, obesity, physical inactivity and tobacco use.
If we consider the attitude and knowledge regarding hypertension, the respondents
showed the positive response. Mostly have knowledge predictors as regular checkup,
exercise and less use of processed meat are helpful to control blood pressure.
These results found that the subjects with more knowledge and had positive attitude than
subjects having less awareness. During survey when practices were elevated, it was found
that mostly check their blood pressure when fall ill.
There is considerable increase over time and future so there is need
for good quality study, which specially focusing the management and treatment of
hypertension in bugembe area at large in jinja district.
The study concluded that there was increase in prevalence of hypertension in budumbuli
village in bugembe in jinja district The prevalence was 33.8% which was alarming with
its associated risk factors.
o _ When practices were elevated regarding the risk factors and life style
modifications, it was found that mostly subjects control the use of salt, much oil
and use their medicines regularly.
o _ The findings of this study indicated that hypertension has become important
health problem among adults in budumbuli village in bugembe. There are certain risk
factors as
 consumption of processed meat,
 meal with fats,
 less vegetable and fruits consumption and
 less physical activity were related with increase in HBP.
Hypertension and majority of its risk factors are preventable as through
Screening programs. These programs should be arranged at community
level and its risk factors are need to be find out.
o _ This study found that prevalence of hypertension increased with increase image
as majority of hypertensive patients are above 65 years old. This study showed
that 40% of the population above 45 years is hypertensive. This increase in
hypertension with the age is a well known factor.

59. 48
o _ Our results suggests to create awareness about HBP among the people, as the
manifestation of hypertension depends on life style factors, life dietary and other
factors.
o
Health care sessions are needed to overcome this emerging health problem.
These studies suggest the existence of much awareness about high blood pressure in
educated people as compared to low educated or uneducated.

60. 49
5.2 Recommendations
1. Population screening for high blood pressure is the most effective method for
diagnosis and managing hypertension. so screening by private organizations
should be encouraged.
2. There must be health education as part of formal education in every country
which should focus on weight lose, restrictions on smoking, restriction on alcohol
intake, increase physical activity and restriction on dietary salt intake.
3. There must be specialized channels of communication, and youth at their colleges
and universities should provide unique opportunities to promote the adaptation of
health life style.
4. The programme for weight loses, proper exercise, life style modification, and
control over blood pressure should be introduced at community level.
5. More research work in the area of primary prevention of high blood pressure
should be encouraged. There must be development of hypertension related
programs which can be implemented in general population.
6. It is recommended that, there must be programs at community level which will
convince people to quitting smoking.
7. Stress which is also a contributing factor of hobbies hypertension can be Managed
by active hobbies such as gardening, walking, good aerobic exercise.
8. Public education plays an important role for the successful national campaign to
manage hypertension.
9. As the prevalence of hypertension increasing and becoming a global problem so it
is necessary that routine health screening should be under taken by health services
of various countries.

61. 50
REFERENCES
Newby DE, Grubb NR, Bradburry, “Cardiovascular disease” In Nicki R, Colledge,
Brian R. Walker, Stuart H.Ralstones(eds), Davidson’s principles &practice of medicine
21st
edition pg606 Churchill Livingstone 2010
William A. The blood pressure of Africans. East Afr.Med.J 1941; 18:109-117
Wolff H.P: Speaking of high blood pressure, Sterling Publishers Pvt Ltd 1996; p33-65.
World Health Organization, Global health risk: mortality and burden of disease
attributable to selected major risks. Geneva Switzerland; 2009.
Kotchen TA (October, 2011) “historical trends and milestones in hypertension research; a
model of the process of translational research” Hypertension 58(4) 522-38
Page I H; Some regulatory mechanisms of Reno -vascular and essential arterial
hypertension.in hypertension edited by Genest J, KolwE,Kuchel O, Newyork, McGraw-
Hill 1977 page 576.
Laragh JH, Baer L, Brunner HR, Buhler FR, Sealey JE, Vaughan ED Jr:The renin-
angiotensin-aldosterone system in pathogenesis and management of hypertensive
vascular disease. In hypertension manual edited by Laragh JH, Newyork,York medical
books,1976, pg313.
Gavras H, Ribeiro AB, Gavras I, Brunner HR: Reciprocal relation between renin
dependency and sodium dependency in essential hypertension. N Engl J med 295:1278,
1976
Golden burden of hypertension (dept of epidemiology, Tulame university school of
public health and tropical medicine

62. 51
Cooper R, Rotimi C, Atama S, etal.The prevalence of hypertension in seven populations
of west Africa. AM J public health 1997; 87:160-8.
Edwards R, Unwin N, Mugusi F, Whiting D, Rashid S,et al. Hypertension prevalence
&care in an urban rural area of Tanzania. J hypertens 2000; 18:145-152.
J hypertens 2011 Jun; 29(6):1061-8: Maher D, Wasswa L, Baisley K, karabarinde, Unwin
N.
G.S Bimenya, Byarugaba, S. Kalungi, J. Mayito, K.Mugabe, R. Makabayi,
E. Ayebare, H.wanzira,M. Muhame.(Dept of pathology, faculty of medine,makerere
university)
Brundtland G H from the world health organistion.Reducing factors to heath promoting
healthy life: Jama 2002; 288:1974.
AddoJ, Smeeth L, Leon DA hypertension in sub-Saharan Africa; a systematic review.
Hypertension 2007; 50; 1012-1018.
Edwards R, Unwin, N, Mugusi F, Whiting D, Rashid S, et al. Hypertension prevalence
& care in an urban and rural Tanzaniahypertens 2000;18:145-152
Bimenya G S, Byarugaba W, Kalungi S, Mayito J, Mugabe K, et al blood pressure
profiles among makerere university undergraduate students.Afri Health Sci 2005;5;99-
106
J hypertens 2011 Jun; 29(60:1061-8; Maher D, Wasswa L, Baisley K, Karabarinde,
Unwin N.

63. 52
African Health Sciences vol.9 No3 Sept.2009. (Wamala JF, Karyabakabo Z, Ndungutse
D, Guwatudde D)
O’Keele JH, Bybee KA, LawieCJ.Alcohol and cardiovascular health;theazor- doubled
edged sword. Journal of American college of cardiology 2007; 50:1009-14
Ronksley PE, Brien SE, Turner BJ, MukamalKJ,GhaliWA.Association of alcohol
consumption with select6ed cardiovascular outcomes,A systematic review amd meta-
analysis.BMJ 2011:342:d671.
Carrao G, Rubbiati L, Bagnardi V, Zambon A, pokolamenk.Alcoholand coronary heart
disease. A meta-analysis, Addiction 2000; 95:1505-23
Wilson PW, D’Agostino RB, Sulivani L, Parise H, Kannel WB, Overweight and obesity
as determinant of cardiovascular risk. The Framingham experience:Archieves of
international medicine 2002:162:1867-72
Chrostowska M, Szyndler A, Paczwa P, Nawewiczki,impact of abdominal obesity on
frequency of hypertension and cardiovascular disease in Poland.results from the
IDEA(international day for evaluation of abdominal obesity).Blood pressure
2011;20:145-52
J O I, Ahn Y, Lee J, Shin KR,Lee HK, et al.prevalence awareness, treatment, control
and risk factors of hypertension.
WHO (1998) Health expectancy is more important than life expectancy –message from
WHO Director General on the World health report 1998.Geneva, Switzerland; World
Health Organization v-vi
J hypertens 2011 Jun: 29(6):1061-8. Wasswa L, Maher D, Baisley k, Karabarinde A,
Unwin N.

64. 53
Conlin PR, Eat your fruits and vegetables but hold the salt. Circulation 2007; 116:1530-
31
Bovet P, Ross AG, Gervasoni JP, Mkamba M, Mtasiwa DM, et al distribution of blood
pressure, body mass index and smoking habits in urban population of Dar-el-
salam.Tanzania and associations with socioeconomic status.Int.J Epidemiology
2002:31:240-247.
African Health Sciences Vol.9 No3 September 2009 (Wamala JF, Karyabakabo Z,
Ndungutse D, Guwatudde D)
Garriguet, Didier. 2007. “Sodium consumption at all ages.” Health Reports.Vol. 18, no.
2.May.Statistics Canada Catalogue no. 82-003. p. 47–52.
http://www.statcan.gc.ca/pub/82-003-x/2006004/article/sodium/9608-eng.pdf (accessed
May 10, 2010)

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APPENDIX 1
CONSENT FORM
CONSENT
The study is being conducted to assess the levels of blood pressure and any other related
conditions among residents or budumbuli villagebugembe municipalityjinja district. The
purpose is to gather information that will help in designing appropriate interventions.
All information obtained will be treated with utmost confidentiality and no identities shall
be revealed either during the process of data collection or thereafter.
You are free to decline to take part in the research or withdraw from taking part in the
study.
This will not penalize you in any way.
Signed……………………………………………………………………………… (If yes)
Date………………………………………………………………………………………..

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APPENDIX II
QUESTIONNAIRE
A QUESTIONNAIRE TO ASSESS THE INCIDENCE AND RISK FACTORS
ASSOCIATED WITH HIGH BLOOD PRESSURE IN SEEMINGLY NORMAL
INDIVIDUALS
. SECTION 1
Questionnaire number……………….
A. Demographic data
I. Age
II. Sex Male
Female
III. Tribe
B. Past medical history.
 Have you ever suffered from any of these conditions?
(i)Heart disease Yes
No
(ii) Kidney (renal disease) Yes
No
(iii) Chronic cough yes
No

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(iv)Diabetes mellitus Yes
No
(v) Other specify………………………………………………………………..
C. Drug history
 Are you currently on any medication yes
No
 If yes specify…………………………………………………………
D. Social history
o Do you;
DRINK ALCOHOL YES NO
If yes specify……………………………………………………………..
SMOKING YES NO
 Any other drugs……………………………………..
 Do you indulge in regular exercises yes
No
E. Family history

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 Is there any member of your family linage with or who has ever had a
chronic illness such as?
DIABETES MELLITUS YES
NO
HYPERTENSION YES
NO
HIV/AIDS YES
NO
SECTION 2
EXAMINATION
Weight………………….kg
Height ……………………m
BMI (wgt/h2
)…………………………….………..kgm-2
Random Blood Sugar……………………………………mg/dl
VITALS
PULSE RATE ………………………………………………B/M
BLOOD PRESSURE ……………………………………….mmHg
RESP RATE……………….…………………………………BPM
TEMP…………………………………………………………degrees C

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SYSTEMIC EXAMINATION
CVS
EXAMINATION
RESPIRATORY
EXAMINATION
GIT
EXAMINATION
CNS
EXAMINATION

70. 59
APPENDIX III
RESEARCH BUDGET
ITEM QUANTITY UNIT COST TOTAL
Supervisor 1 50000 50000=
Pens 5 500 2500=
Ream of paper 1 15000 15000=
Research assistants 3 20000 30000=
Pencils 5 200 1000=
Rulers 2 2000 4000=
Ream of ruled papers 1 15000 15000=
Photocopying 20 5OO 10000=
Printing 70 150 50000=
Binding 4 2000 8000=
Digital blood pressure
machine
1 150000 150000=
Weighing scale 1 150000 150000=
Glucometers 2 80000 160000/=
GRAND TOTAL 116 485350/= 645,500/=

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APPENDIX IV
WORK PLAN
TASKS PERSON RESPONSIBILITY DATES
Finalize proposal Researcher 17th
/NOV/2022
Submission of the proposal Researcher 29th
/OCT/2022
Preparation of the data collection
tools and mobilize all the required
resources
Researcher 9th
/JULY/2022
Train research assistants Researcher
Obtaining permission to collect
data from authorities and collect
data
Researcher
Pre-test tools Researcher
Data collection Researcher 12th
/JULY/2022 to
17th
/NOVEMBER/2022
Data cleaning, analysis and
presentation
Researcher
Report writing Researcher 19th
/NOVEMBER/2022
Submission of the study report Researcher By end of 6TH
/JANURAY/ 2023

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APPENDIX V
A MAP OF JINJA DISTRICT SHOWING THE NEIGHOERING AREAS
S