Prevalence, awareness and factors associated with hypertension among adults in rural south-western Uganda: a cross-sectional study

Background

Hypertension is the leading cause of preventable deaths globally, yet there have been inconsistent reports on its burden and risk factors in rural Sub-Saharan Africa. This study aimed to assess the prevalence, awareness, and risk factors associated with hypertension among adults in a rural community in southwestern Uganda.

Methods

A baseline survey was conducted as part of an ongoing implementation science cohort study in Ngango, a rural parish in the Mbarara district of southwestern Uganda. The study included adults aged 18-79 years from eleven villages. Research assistants and community health workers visited homes to enroll consenting adults. Data collection involved administering the WHO STEPS questionnaire, which gathered demographic information, behavioral characteristics, and lifestyle data, including tobacco and alcohol use, salt intake, fruit and vegetable consumption, and physical activity. Participants were also asked about prior blood pressure (BP) measurements. BP readings were taken three times, two minutes apart, along with anthropometric measurements. Hypertension was defined as BP ≥140/90 mmHg, based on the average of the last two readings, or self-reported use of antihypertensive medication. The primary outcome was the prevalence and factors associated with hypertension, assessed using logistic regression. Secondary outcomes included hypertension awareness and the proportion of participants with controlled hypertension.

Results

A total of 953 adults were enrolled. The median age was 43 years, with most participants being female (61.5%). Hypertension prevalence was 27.3% (260/953). Among those with hypertension, 61.5% were unaware, 27.7% were on treatment, and 65.3% had controlled BP. Despite 66.8% of participants reporting physical activity, 63.7% were overweight. Factors associated with hypertension were age > 40 years (OR 2.26, 95% CI 1.53-3.33; p <0.001), consuming <3 servings of fruit or vegetables per week (OR 1.62, 95% CI 1.11-2.35, p = 0.012), overweight (OR 1.57, 95% CI 1.05-2.34, p = 0.028), and obesity (OR 2.73, 95% CI 1.80-4.15, p <0.001).

Conclusion

The prevalence of hypertension in rural southwestern Uganda is high, despite a relatively young and physically active population, indicating the need for targeted interventions.

Key Points

• More than 1 in 4 adults in rural Uganda have hypertension, despite high levels of physical activity (67%)

• Hypertension awareness and control rates remain below the global targets

• Our data shows that interventions targeting modifiable risk factors are urgently needed to reduce rural hypertension burden.