Geographic differences in the prevalence of hypertension in Uganda: Results of a national epidemiological study.

Abstract

BACKGROUND:Hypertension accounts for more than 212 million global disability-adjusted life-years, and more than 15 million in sub-Saharan Africa. Identifying factors underlying the escalating burden of hypertension in sub-Saharan Africa may inform delivery of targeted public health interventions. METHODS:As part of the cross-sectional nationally representative Uganda National Asthma Survey conducted in 2016, we measured blood pressure (BP) in the general population across five regions of Uganda. We defined hypertension as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or on-going use of medications for the purpose of lowering BP among adults (≥18 years of age); pre-hypertension as systolic BP between 120 and 140 mmHg and/or diastolic BP bteween 80 and 90 mmHg among adolescents and adults (≥12 years of age). FINDINGS:Of 3416 participants who met inclusion criteria, 38.9% were male, and mean age ± SD was 33.8 ± 16.9 years. The age- and sex-adjusted prevalence of hypertension was 31.5% (95% confidence interval [CI] 30.2 to 32.8). The adjusted prevalence of hypertension was highest in the Central Region (34.3%; 95% CI 32.6 to 36.0), and it was comparable to that in the West and East Regions. However, compared with the Central Region, hypertension was significantly less prevalent in the North (22.0%; 95 CI 19.4 to 24.6) and West Nile Regions (24.1%; 95% CI 22.0 to 26.3). Adjustment for demographic characteristics (occupation, monthly income, and educational attainment) of participants did not account for the significantly lower prevalence of hypertension in the North and West Nile Regions. The prevalence of pre-hypertension was 38.8% (95% CI 37.7 to 39.8), and it was highly prevalent among young adults (21-40 years of age: 42.8%; 95% CI 41.2-44.5%) in all regions. CONCLUSIONS:Hypertension is starkly prevalent in Uganda, and numerous more people, including young adults are at increased risk. The burden of hypertension is highest in the Central, Western, and Eastern regions of the country; demographic characteristics did not fully account for the disparate regional burden of hypertension. Future studies should explore the potential additional impact of epidemiological shifts, including diet and lifestyle changes, on the development of hypertension.

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Published Version (Please cite this version)

10.1371/journal.pone.0201001

Publication Info

Lunyera, Joseph, Bruce Kirenga, John W Stanifer, Samuel Kasozi, Thys van der Molen, Wenceslaus Katagira, Moses R Kamya, Robert Kalyesubula, et al. (2018). Geographic differences in the prevalence of hypertension in Uganda: Results of a national epidemiological study. PloS one, 13(8). p. e0201001. 10.1371/journal.pone.0201001 Retrieved from https://hdl.handle.net/10161/18545.

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Scholars@Duke

Lunyera

Joseph Lunyera

Medical Instructor in the Department of Medicine

I am a clinical epidemiologist with a life-long desire to advance our understanding of etiologic mechanisms of kidney disease, and to advocate for policies that promote the highest quality care for individuals with kidney disease. Specifically, I am interested in delineating mechanisms by which exposures in the social environment perpetuate disparate adverse kidney outcomes such as chronic kidney disease and acute kidney injury.

Stanifer

John W. Stanifer

Adjunct Assistant Professor of Medicine

John W. Stanifer, MD, MSc-GH, is a nephrologist and clinical researcher with a focus on using translational and trans-disciplinary methods to uncover mechanisms of global health disparities in kidney disease. John completed his residency training in internal medicine and global health at Duke, completing the Master of Science in Global Health program in 2014. He also completed his sub-specialty training in nephrology at Duke, and during that time, he also completed a fellowship in clinical research at the Duke Clinical Research Institute, where he served as chief fellow in 2016-2017.

He has investigated the epidemiology of chronic kidney disease in Tanzania, where he started and led the CKD-AFRIKA study. This mixed-method study not only was among the first to explore community-based prevalence, risk factors and consequences of chronic kidney disease in sub-Saharan Africa, but it also investigated several cultural and social topics around the use of traditional medicines among individuals living with kidney disease.

More recently, he has also turned his attention to local health disparities. Since 2015, he has been co-leading, with Dr. Cherry Beasley, the KIDNEY NC Study, a mixed-methods study investigating determinants of kidney disease among ethnic and racial minorities in Robeson County, North Carolina, home of the Lumbee Indian tribe. In addition to a Bass Connections team, he and Dr. Beasley have led two Student Research Training programs that included several Duke students working in Robeson County each summer. He is mentored by Drs. L. Ebony Boulware and Myles Wolf.


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