A cross sectional study on Blood Pressure level among Non-pregnant Tanzanian Women in the Child-bearing Age

Description

Abstract:

Problem: The prevalence of non-communicable diseases (NCDs) is rising fast worldwide following urbanization with changing lifestyle, growing economies and ageing. The phenomena particularly hit low and middle-income (LMIC) countries where 80% of NCD related deaths occur, and where the transition seems to be occurring with a speed and magnitude far beyond what has been seen in countries of the western world. Cardio-vascular disease (CVD) constitutes the major subgroup of NCDs. Its link to genetics and risk factors has been studied in details, though less in LMIC. Studies indicate, however, that far from all cases can be explained by heritage and “common risk factors”. The impact of reduced foetal growth coupled with exposure to a nutrient abundant environment later in life is hypothesized to play a major role.
Aim: To estimate the blood pressure (BP) profile and hypertension prevalence among non-pregnant women in the childbearing age in rural Tanzania as baseline for future research in the role of foetal  programming for the development of NCDs in later life.
Study population and methods: Cross-sectional screening of 579 non-pregnant women aged 18-40 years in rural villages of Korogwe and Handeni districts, Tanzania from July-December 2014 as part of FOETALforNCD, a study currently undertaken in Tanzania with support from the Danish Strategic Research Council. Standard operating procedures were developed based on international guidelines. Eligible women were screened for BP level and factors possibly associated with hypertension and metabolic disease, including anthropometric indices. Interviews collected data on socio-economic status, medical history and hypertension related symptoms. Suspected infection with malaria and HIV/AIDS was confirmed by blood test. Women with screening BP ≥140/90 mmHg were invited for follow-up measurement to confirm hypertension. Associations between risk of hypertension and the included covariates were estimated using logistic regression analyses.
Results: The mean BP level was 118/76 mmHg. The overall prevalence of hypertension was 9.6% and significantly higher in subjects with increasing values of all anthropometric measurements analyzed. Hypertension was statistically significantly associated with age, some socio-economic indicators, including water source and one symptom of potential CVD, i.e. palpitations. Water source appeared to be the most important predictor of hypertension, with OR 11.22 [3.52-35.74] for use of private tap/well and 2.30 [0.98-5.37] for use of river/stream/pond/pool compared to use of public tap/well in the multiple analyses. This variable was an important proxy for urbanization. Age was associated with OR 0.27 [0.10-0.67] for women aged 18-29 years compared to 30-40 years old women in the multiple analyses. Although measurements including BMI, waist circumference and mid upper arm circumference appeared to be predictors of hypertension in the crude analysis, these effects became statistically insignificant in the adjusted model.
Conclusions: In this rural area of Tanzania a high proportion of women aged 18-40 years presented with hypertension while their exposure to well-known risk factors was low. Rapid epidemiological transition was confirmed by the higher level of hypertension, overweight and educational level compared to previous generations. Further research in hypertension prevalence and its risk factors in relation to urbanization and foetal programming is needed to prevent an upcoming NCD epidemic also in this population.