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Prevalence and correlates of hypertension: a cross-sectional study among rural populations in sub-Saharan Africa

Journal of Human Hypertension volume 24, pages 786–795 (2010)Cite this article

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Abstract

Substantial evidence suggests an increasing burden of hypertension (HTN) in urban sub-Saharan Africa (SSA). However, data on HTN prevalence in rural SSA are sparse. In a cross-sectional study, we investigated magnitude and correlates of HTN in rural SSA. Study participants (N=1485), 18 years and above, were selected using a stratified random sampling technique from three villages (in Malawi, Rwanda and Tanzania) that participated in the Millennium Villages Project. Information on socio-demographic characteristics, risk factors and blood pressure measures was collected using standardized protocols. Prevalence of HTN and pre-HTN were 22 and 44%, respectively. Older age (P<0.001), higher body mass index (BMI) (P=0.07), television ownership (P=0.01) and less work-related vigorous physical activity (P=0.02) were associated with higher prevalence of HTN and higher blood pressure measures (all P<0.05). Frequent meat and fat intake were associated with higher HTN prevalence (trend P=0.02 and 0.07, respectively). Frequent fruit and vegetable intake was significantly associated with lower blood pressure measures (all P<0.05). HTN and pre-HTN are common in rural SSA. Modifiable risk factors (such as BMI, dietary intake and physical activity) are associated with HTN prevalence in this population, indicating potential opportunities for prevention measures.

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Acknowledgements

We thank Drs Daniel Levy and Frank Sacks for their helpful insights in the design and analysis of this study. We are also indebted to Dr Ranvir Dhillon and to the MVP field teams of Tanzania, Rwanda and Malawi for their help with data collection. We thank Dr Freeman Changamire for additional statistical help. We are grateful for the wealth index and nutrition guidance we received from Drs Jyotsna Puri and Jessica Fanzo, respectively. Finally, we are indebted to the Sarnoff Cardiovascular Research Foundation and the Harvard Medical Office of Enrichment Programs for funding Sarah Stewart de Ramirez's time to carry out this research.

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Authors and Affiliations

  1. Department of Emergency Medicine, The Johns Hopkins University, Baltimore, MD, USA

    S Stewart de Ramirez

  2. Harvard Medical School, Boston, MA, USA

    S Stewart de Ramirez, M Ramirez & W Willett

  3. Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA

    S Stewart de Ramirez, D A Enquobahrie & W Willett

  4. Millennium Villages Project, Earth Institute, Columbia University, New York, NY, USA

    S Stewart de Ramirez, S Ehrlich Sachs & W Willett

  5. Millennium Villages Project, Tanzania Field Office, Tabora, Tanzania, Africa

    G Nyadzi & D Mjungu

  6. Millennium Villages Project, Malawi Field Office,

    F Magombo

  7. Mwandama, Malawi, Africa

    F Magombo

  8. Department of Orthopedic Surgery, Union Memorial Hospital, Baltimore, MD, USA

    M Ramirez

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  1. S Stewart de Ramirez
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Corresponding author

Correspondence to S Stewart de Ramirez.

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Competing interests

The Sarnoff Cardiovascular Research Foundation and the Harvard Medical Office of Enrichment Programs funded Dr Sarah Stewart de Ramirez's time to carry out this research. The funders had no role in study design, data collection and analysis, preparation of paper or decision to publish the paper. All authors report no conflict of interest.

Appendix A

Appendix A

Food group assignments

Fruits and vegetables

 Cooked bananas

 Cowpeas

 Beans

 Green grams

 Pumpkin

 Cowpea leaves

 Pumpkin leaves

 Cabbage

 Sukuma Wiki (kale)

 Kasava leaves

 Bean leaves

 Sweet potato leaves

 Mgagani

 Spinach

 Mrenda

 Mixed vegetables

 Mchicha

 Carrots as a whole

 Lettuce salad

 Green pepper

 Onion

 Mushrooms

 Avocado (whole)

 Avocado (part of dish)

 Ripe banana (large)

 Ripe banana (small)

 Mango

 Tomato

 Grapes

 Pumpkin

 Orange

 Lemon

 Pawpaw

 Pineapples

 Plums

 Tangerines

 Peaches

 Pears

 Melon

 Papaya

 Passion fruit

 Guava

Fish

 Fish as main dish

 Fish as part of mixed dish

Fats

 Elianto oil

 Groundnut oil

 Other vegetable oil

 Palm oil

 Cotton oil

Meat

 Beef as main dish

 Beef as part of a mixed dish

 Pork as main dish

 Pork as part of a mixed dish

 Goat as a main dish

 Goat as part of a mixed dish

 Sheep as a main dish

 Sheep as part of a mixed dish

 Veal as a main dish

 Veal as part of a mixed dish

 Other meat

 Chicken large piece

 Chicken small piece

 Duck

 Bird (pigeon, quail)

 Wild game (rabbit, and so on)

Carbohydrates

 Maize meal ugali

 Mixed grain ugali

 Maize (boiled or roasted)

 Sorghum ugali

 Millet ugali

 Rice

 Nyoyo (maiz+beans)

 Wheat chapatti

 Irish potatoes

 Boiled casava

 Sweet potatoes

 Kasava ugali

 Bread

 Samosa

 Mandazi

 Sconsi

 Vitumbua

 Sugar

 Sugar cane

 Maize meal porridge

 Mixed grain porridge

 Mixed grain porridge (with milk)

 Soda

Dairy

 Glass of milk

 Milk in food or drink

 Sour milk

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de Ramirez, S., Enquobahrie, D., Nyadzi, G. et al. Prevalence and correlates of hypertension: a cross-sectional study among rural populations in sub-Saharan Africa. J Hum Hypertens 24, 786–795 (2010). https://doi.org/10.1038/jhh.2010.14

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