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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020
AFRICA
13
Similarly, individuals’ knowledge of hypertension-related
consequences showed a trend toward improvement among
the intervention group (Table 3). Knowledge of possible
complications during delivery significantly increased among
respondents with intervention (TE, 3.3 pp;
p
<
0.01). Similarly,
a positive trend was seen in individuals’ knowledge of stroke
(increased from 19.6% at baseline to 22.4% at the end point),
heart failure (from 6.2 to 9.0%, respectively), aneurysm (from
3.8 to 4.1%, respectively) and death (from 43.7 to 52.3%,
respectively) with intervention; however, these changes were not
significant relative to the control. Individuals’ knowledge of
three or more consequences of hypertension increased two-fold
in the intervention group.
Despite these changes in knowledge surrounding hypertension,
the proportion of individuals screened for BP and diagnosed
with hypertension slightly decreased from baseline to the end
point in the intervention group (Table 4).
Discussion
Individuals’ natural awareness of hypertension may be limited
as the disease manifests asymptomatically and care may not be
sought until sudden, severe and irreversible consequences occur.
Little is known about the optimal method to rapidly educate the
general population of a low- to moderate-income developing
country about hypertension. The purpose of this 12-month
prospective study was to assess the impact of HHA intervention
on the status of awareness and knowledge of hypertension
among the rural Kenyan population.
General awareness of hypertension among survey respondents
was high (approximately 80 to 90%) at baseline; however,
the specific knowledge of risk factors and actions was poor,
indicating that information from primary sources, namely friends
and family, was not necessarily accurate. At baseline, less than
5% of respondents could correctly identify three or more known
risk factors for hypertension. Similarly, respondents appeared
to be largely unaware that smoking, alcohol consumption and
family history of heart disease were possible risk factors for
hypertension or associated CVD.
Within 12 months, HHA was successful in conveying
information about hypertension to individuals residing in the
intervention areas. This is demonstrated by the significant
increase in the percentage of respondents in the intervention
areas who reported healthcare providers as their primary source
of hypertension information compared with the control group.
In general, knowledge of hypertension showed a trend
toward improvement among the HHA intervention group. By
the end point, more individuals residing in the intervention
areas identified tobacco use as a risk factor for hypertension
and reducing alcohol consumption as a method for managing
hypertension. The observed improvement is of importance
because both alcohol and tobacco consumption have been
associated with the high prevalence of hypertension in Kenya.
9,10
According to the 2015 Kenya STEPwise survey, approximately
13.3% of survey respondents, aged 18–69 years, reported
current use of a tobacco product (manufactured or hand-rolled
cigarettes, pipes or shisha).
4
In addition, 19.3% of respondents
reported current alcohol use, with 12.7% consuming alcohol on
a daily basis and 12.7% reporting heavy episodic drinking (six or
more drinks on a single occasion).
4
Therefore it is believed that
improving individuals’ awareness of the association between
tobacco and alcohol use and hypertension may lead to the
adoption of a healthier lifestyle over time.
Table 3. Impact of Healthy Heart Africa on individuals’ knowledge of hypertension
Baseline
End point
Treatment
effect (SE),
percentage
point
Interven-
tion
(
n
=
432)
Control
(
n
=
406)
Interven-
tion
(
n
=
364)
Control
(
n
=
334)
Awareness of HTN,
a
%
91.0 79.1 94.9 96.7 –15.5 (3.4)**
Sources of HTN education, %
Television/radio/internet/
books/billboard/magazines/
newspapers
30.7 28.4 26.8 30.0 –7.7 (5.4)
Friends/family
60.1 56.8 44.1 68.7 –25.6 (6.2)**
Religious leader
1.3
2.1
2.4
4.1 –0.8 (3.3)
CHW/CHEW
5.7
1.0
4.6
2.5 –3.9 (4.2)
Community event
9.6
5.7
6.3
9.6 –7.9 (4.8)
Healthcare provider/facility 28.9 21.7 48.2 20.8 19.4 (8.1)*
School
1.8
2.3
8.7
2.9 2.9 (1.7)
Other
1.4
1.1
1.0
0.5 0.5 (0.6)
Individuals who correctly identified risk factors of HTN, %
Age
40.3
40.9
46.0
47.5
–0.8 (6.9)
Family history
7.4
5.6
6.5
1.7
0.1 (3.0)
High BMI/obesity/overweight 18.6
19.7
27.8
20.4
4.7 (7.7)
High salt intake
1.7
2.5
4.0
1.9
2.4 (1.5)
Low potassium intake
0.3
0.9
0.9
1.0
–0.4 (0.8)
Use of tobacco products
2.0
3.4
4.4
0.7
4.0 (1.7)*
High alcohol consumption
0.9
3.5
4.4
1.2
5.4 (2.6)
Pregnancy
7.9
5.3
12.1
6.3
1.6 (3.3)
Lack of physical activity
3.4
5.0
7.5
3.6
4.6 (2.6)
≥
3 risk factors for HTN
4.0
4.5
9.0
3.4
3.8 (2.4)
≥
5 risk factors for HTN
1.0
0.7
2.2
0.0
1.5 (1.0)
Individuals who correctly identified methods for reducing HTN, %
Reduce salt
9.4
11.9
15.4
17.5
1.0 (6.2)
Weight loss
7.2
8.6
9.5
8.7
–8.6 (9.8)
Medication
21.6
15.8
20.5
18.1
–2.6 (4.9)
Exercise
14.7
12.7
23.6
21.3
–7.4 (8.7)
Dietary changes
14.0
11.6
19.0
15.7
1.0 (6.9)
Reduce alcohol
2.0
5.3
8.3
1.6
8.4 (1.9)**
Stop use of chemical
contraceptives
1.9
1.1
1.0
1.1
–1.4 (1.0)
Reduce smoking
2.3
3.6
2.3
0.9
3.0 (1.8)
≥
3 methods for managing
HTN
3.2
6.5
10.1
7.7
3.7 (2.0)
≥
5 methods for managing
HTN
0.1
0.5
1.7
0.8
1.7 (1.6)
Individuals who correctly identified consequences of HTN, %
Death
43.7 38.8 52.3 68.1 –23.7 (9.9)*
Heart attack
19.2 10.0 16.4 10.4 –7.4 (6.8)
Stroke
19.6 17.7 22.4 13.4 8.0 (6.1)
Aneurysm
3.8
2.1
4.1
2.7 –2.1 (2.1)
Heart failure
6.2
4.5
9.0
6.0 0.1 (2.9)
Erectile dysfunction
0.6
0.5
1.7
3.8 –2.6 (1.8)
Loss of sight
1.8
1.9
4.5
3.7 1.2 (1.3)
Complications during deliv-
ery for pregnant women
0.4
2.2
1.8
0.7 3.3 (0.9)**
Increased risk of miscarriage 1.6
1.5
1.5
1.0 0.7 (1.6)
Renal disease
NA
b
NA
b
6.3
0.4 4.9 (2.6)
≥
3 consequences of HTN 5.0
4.3 11.2
8.5 0.3 (4.8)
≥
5 consequences of HTN 0.0
0.5
1.0
1.8 0.2 (1.3)
BMI: body mass index; CHEW: community health extension worker; CHW:
community healthcare worker; HTN: hypertension; NA: not available; SE: standard
error. *
p
<
0.05; **
p
<
0.01 vs control.
a
Defined as having heard of hypertension.
b
Data not captured.