Hypertension Awareness, Treatment and Control at Vubachikwe Mine, Gwanda,
Zimbabwe, 2013
Pugie Tawanda Chimberengwa
Dissertation Submitted in Partial Fulfillment of
Master in Public Health Degree
University of Zimbabwe
Faculty of Health Sciences
Department of Community Medicine
University of Zimbabwe
Harare
August 2013
Declaration
I certify that this dissertation is my original work and submitted for the Master in Public
Health Programme. It has not been submitted in part or in full to any university and/or any publication.
Student:
Signature______Date______
Pugie Tawanda Chimberengwa
I, having supervised and read this dissertation, I am satisfied that this is the original work of the author in whose name it is being presented. I confirm that the work has been completed satisfactorily for presentation in the examination.
Academic Supervisors:
Signature______Date______
Mr. N.T. Gombe
Signature______Date______
Professor M. Tshimanga
Chairman:
Signature______Date______
Professor S. Rusakaniko
ii
ABSTRACT
Background: In July 2012, according to the chronic disease register Vubachikwe mine had at least 1 in every 10 workers suffering from hypertension. However about 30 workers had defaulted hypertensive treatment that is offered free at the mine clinic. The management was concerned about lost to shift hours and high costs of medical care due to hypertension related illness among employees. Therefore we set out to evaluate the prevalence of hypertension and the reasons why employees defaulted treatment. Methods: An analytic cross sectional study was done at Vubachikwe mine. Systematic sampling was used. An interviewer administered questionnaire adopted and modified from the WHO STEPwise survey was used to capture; demographic data, risk factors and awareness of hypertension. Biophysical measurements; weight, height, random blood sugar and blood pressure were measured. Results: Ninety three percent of employees were aware of their blood pressure. The prevalence of hypertension was 27.2% while males were 6 times more likely to develop hypertension compared to females. Awareness of hypertension increased with age, (p<0.05). Thirty five percent of hypertensives were non-compliant to treatment and 70% of hypertensives had well controlled blood pressure. Earning more than US$600 per month was significantly associated with being diagnosed of hypertension compared to those that earn below US$300 (POR 1.5; 95% CI, 0.46-0.93). ). However, heavy manual workers were less likely to be diagnosed of hypertension [POR 0.19 (0.042-0.852) 95% CI] and they also earned less than US$300 per month. Family history of blood pressure was associated with being diagnosed with hypertension (POR 9.03; 95%CI, 4.49-18.21 Conclusion: This study showed that the prevalence of hypertension is higher in males and increases with age. The factors associated with hypertension include a positive family history and earning a salary above US$600 which is associated with a sedentary lifestyle. Heavy manual workers who earned less than US$300 were less likely to be diagnosed of hypertension. Based on the study findings, the mine management has instituted interventions targeted at health educating workers on hypertension and defaulters will be traced, given psychosocial support and encouraged to comply with medication.
Key words: Hypertension, Vubachikwe mine, awareness, blood pressure control.
iii
ACKNOWLEDGMENTS
This project came to being through selfless and dedicated works of various individuals and organizations who tirelessly gave their maximum input. Mere words of acknowledgement will not suffice to express how thankful I am.
Firstly, to Mr. N.T. Gombe, my academic supervisor; thank you for the dedication, the tracking comments, reminders and the encouragement. You have been a source of inspiration even when the flesh was weak and the spirits were low. You would remind me how good I can be! To the rest of my supervisors at the Health Studies Office, Dr Takundwa and Mr. H.
Ndondo; I thank you for the guidance given over the years. To Professor M. Tshimanga, the experiment of public health training a doctor from a provincial hospital seems to be feasible.
I would also want to acknowledge the Centre for Disease Control and Prevention (CDC)
Atlanta for the support throughout the FETP course
To my field supervisor, Dr N. Masuka, thank you for enduring the pain of teaching and leading the way. I would like to thank all my fellow Zim-FETP colleagues present and past for the positive criticisms that we shared.
I would also want to express sincere gratitude to Forbes and Thompson, Vubachikwe Mine
Management, special mention to Mr. T.R. Chittenden, Mr. B. Chiwandire and Mr. C. Mhere.
You allowed this study to be held in your premises and offered adequate funding for the study, I thank you.
iv
To Sisters S. Nkala, M. Nyoni and the team at the Vubachikwe mine industrial clinic; thank you ladies and gentleman for your support. To all the employees at the mine and especially the study participants, I thank you so much because without you this would not have been possible.
Finally, I also want to extend special thanks to my family for enduring long periods of divided attention from me. To my wife, Roseweeter and children Tinotenda and Olivia, thank you for the support rendered through this arduous time.
Lord, I thank you for this opportunity to advance in education and understanding while making a positive difference to this call in the ministry of healing.
Thank you.
Pugie Tawanda Chimberengwa
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TABLE OF CONTENTS
Declaration ...... ii ABSTRACT ...... iii ACKNOWLEDGMENTS ...... iv TABLE OF CONTENTS ...... vi LIST OF TABLES ...... ix LIST OF FIGURES ...... xi LIST OF APPENDICES ...... xii LIST OF ABBREVIATIONS ...... xiii 1 CHAPTER 1 ...... 1 1.1 Background Information ...... 1
1.3 Problem Statement ...... 4
1.4 Justification ...... 5
1.5 Research Questions...... 6
2 CHAPTER 2 ...... 7 2.1 Broad Objective ...... 7
2.2 Hypothesis ...... 7
3 CHAPTER 3: ...... 8 3.1 Introduction ...... 8
3.2 Conceptual framework ...... 20
4 CHAPTER 4: ...... 21 4.1 Introduction ...... 21
4.2 Eligibility Criteria ...... 23
4.4 Sample Size and Sampling Procedures ...... 24
4.5 Operational Definitions ...... 25
vi
4.6 Study Variables...... 29
4.6.1 Outcome variables; ...... 29
4.6.2 Independent variables ...... 29
4.7 Data collection ...... 30
4.8 Data analysis ...... 30
4.9 Pre-testing of methods and data collection tools ...... 31
4.10 Permission to Proceed ...... 31
4.11 Ethical Considerations ...... 31
5 CHAPTER 5: ...... 32 5.1 Socio-demographic characteristics ...... 32
5.2 Awareness of Hypertension ...... 33
5.4 Hypertension diagnosis and report ever taking medication ...... 39
5.5 Blood pressure control ...... 40
5.6 Distribution of blood pressure ...... 41
5.7 Factors associated with hypertension ...... 42
5.8 Alcohol and smoking use ...... 44
5.9 Body Mass Indices (BMI ...... 46
5.10 Co-morbidities ...... 47
5.11 Knowledge on hypertension ...... 48
5.12 Risk factors for developing high blood pressure ...... 50
5.13 Possible reasons for defaulting blood pressure treatment ...... 51
6 CHAPTER 6: ...... 53
vii
6.1 Discussion ...... 53
6.2 Study Limitations ...... 57
7 CHAPTER 7 ...... 58 7.1 Conclusion ...... 58
7.2 Recommendations ...... 58
REFRENCES ...... 61 APPENDICES ...... 65 Appendix 1 English Questionnaire ...... 65
Appendix 2 Ndebele Questionnaire ...... 71
Appendix 3 Shona Questionnaire ...... 77
Appendix 4 English Consent ...... 83
Appendix 5 Ndebele Consent ...... 87
Appendix 6 Tsamba Yemvumo ...... 90
Appendix 7 Medical Research Council of Zimbabwe Approval ...... 95
viii
LIST OF TABLES
Table 1; classification of hypertension by diastolic and systolic measurements ...... 25
Table 2; grading of body mass index (BMI) ...... 27
Table 3; Independent variables for hypertension awareness, treatment and control ...... 29
Table 4; Socio-demographic characteristics of Vubachikwe mine employees, hypertension awareness treatment and control study, 2013 ...... 32
Table 5; Awareness of hypertension among Vubachikwe Mine Employees, hypertension awareness, treatment and control study, 2013 ...... 35
Table 6; Frequency of taking medication among Vubachikwe mine employees that ever took antihypertensive treatment, 2013 ...... 36
Table 7; Compliance Patterns among Age Groups in Patients Who Have Ever Taken Anti- hypertensive Medication, Vubachikwe Mine, 2013 ...... 38
Table 8; Blood pressure control among employees that have ever taken antihypertensive treatment; Hypertension, awareness, treatment and control study, Vubachikwe mine 2013 .. 40
Table 9; Socio-demographic factors associated with hypertension among Vubachikwe mine employees, 2013 ...... 42
Table 10; Lifestyle, family and disease related factors associated with hypertension among
Vubachikwe mine employees; Hypertension awareness, treatment and control study, 2013 . 43
Table 11; Knowledge on hypertension among Vubachikwe Mine employees; Hypertension awareness, treatment and control, 2013 ...... 48
Table 12; Risk factors for developing high blood pressure; Hypertension awareness, treatment and control, Vubachikwe mine, 2013 ...... 50
Table 13; Possible reasons for defaulting blood pressure tablets as reported by the employees; Hypertension awareness, treatment and control study, Vubachikwe Mine, 2013 51
ix
Table 14; Actual reported reasons for defaulting anti-hypertensive therapy among employees taking blood pressure medication; Hypertension awareness, treatment and control,
Vubachikwe Mine, 2013 ...... 52
x
LIST OF FIGURES
Figure 1; Conceptual framework, modifiable and non-modifiable risk factors associated with
Hypertension...... 20
Figure 2; Map of Gwanda district showing Vubachikwe Mine. (source OCHA Maps and
Graphics Zimbabwe)37 ...... 22
Figure 3; Awareness of Hypertension among Vubachikwe Mine Employees (aggregated by age); Hypertension awareness, treatment and control study, 2013 ...... 34
Figure 4; Compliance with medication among Vubachikwe mine employees who are aware of
Hypertension, 2013 ...... 37
Figure 5; Comparison of Vubachikwe mine employees aware of hypertension diagnosis and ever taking medication for hypertension, 2013...... 39
Figure 6; Distribution of systolic blood pressure (SBP) and Diastolic blood pressures (DBP) in hypertensive employees at Vubachikwe mine, 2013 ...... 41
Figure 7; Use of alcohol and smoking by Vubachikwe Mine Employees,2013...... 44
Figure 8; Frequency of alcohol use among employees that reported ever consuming alcohol at Vubachikwe Mine; Hypertension awareness, treatment and control study, 2013 ...... 45
Figure 9; Body Mass Indices (BMI) for Vubachikwe Mine employees; Hypertension awareness, treatment and control study, 2013 ...... 46
Figure 10; Random Blood Sugar Levels among mine employees; Hypertension awareness, treatment and control study, Vubachikwe Mine, 2013 ...... 47
Figure 11; Signs and symptoms of hypertension as reported by Vubachikwe Mine employees;
Hypertension awareness, treatment and control study, 2013 ...... 49
xi
LIST OF APPENDICES
Appendix 1 English Questionnaire ...... Error! Bookmark not defined.
Appendix 2 Ndebele Questionnaire ...... Error! Bookmark not defined.
Appendix 3 Shona Questionnaire ...... Error! Bookmark not defined.
Appendix 4 English Consent ...... Error! Bookmark not defined.
Appendix 5 Ndebele Consent ...... Error! Bookmark not defined.
Appendix 6 Tsamba Yemvumo ...... Error! Bookmark not defined.
Appendix 7 Medical Research Council of Zimbabwe Approval ...... Error!
Bookmark not defined.
xii
LIST OF ABBREVIATIONS
AIDS Acquired Immune Deficiency Syndrome
AOR Adjusted Odds Ratio
BMI Body Mass Index
BP Blood Pressure
CDC Centre for Disease Control and Prevention
CI Confidence Interval
CVA Cerebro-vascular Accident
CVD Cardio-vascular Disease
DBP Diastolic Blood Pressure
DMO District Medical Officer
HIV Human Immune-deficiency Virus
NCD Non-Communicable Diseases
NHANES National Health and Nutrition Examination Survey
NSSA National Social Security Authority
PMD Provincial Medical Director
POR Prevalence Odds Ratio
RBS Random Blood Sugar
SBP Systolic Blood Pressure
WHO World Health Organization
WHR Waist Hip Ratio
xiii
1 CHAPTER 1
1.1 Background Information
Vubachikwe mine is situated 12 km North-West of Gwanda town, which is the provincial capital of Matabeleland South Province. It is a gold mine employing about 1 100 workers.
The population dynamics being that there is a diversity of people of different ethnicities. The people in the area are pre-dominantly Ndebele speaking though one finds Shona, Sotho and
Venda speaking workers including migrant workers from Malawi and Zambia. There is also a dynamic migration mix of people from both urban and rural origins depending on their level of engagement. Beliefs and faiths are also varied in the population as they also have an impact in the employee health seeking behaviors.
These diverse community members habitating at the mine are offered accommodation in the mine compound which houses the majority of junior employees while senior employees stay in Gwanda town. There are social amenities within the mine compound such as schools, shops, recreational bars, soccer stadium among other recreational facilities for the employees and their dependents.
The management of the mine has set up an industrial clinic equipped with two full time nurses, ancillary staff and a visiting supervising doctor who runs a weekly clinic and attends to emergencies whenever they arise. Employees attending the clinic are routinely screened for hypertension, have their weight and temperatures recorded every time before they are [1]
seen by the nurse or doctor. When a diagnosis of hypertension is made, the employees (and dependents) are given medication for free, thus the full cost of healthcare is being borne by the employer.
On initial employment a through medical examination is done by the medical officer who will authorize the employee to work in a mining environment, subsequently the employee gets a certificate of fitness from the National Social Security Authority (NSSA) medical bureau which is renewed periodically. A register of these medical examinations is kept at the mine and is updated regularly.
1.2 Epidemiology of Hypertension: The Burden.
Hypertension is a worldwide epidemic whose epidemiology has been well studied in western countries.5 Approximately 1 billion people are hypertensive, accounting for an estimated 7.1 million deaths per year worldwide. Hypertension prevalence is increasing with increase in prevalence of risk factors such as obesity, physical inactivity, and unhealthy diet.7
Cardiovascular disease is the main cause of death in virtually all industrialized countries and limited information from developing countries suggests a similar trend.7
Data on hypertension globally, shows that more than a quarter of the world’s adult population, approximately 1 billion people had hypertension in 2000.14 This is projected to increase by about 1.56 billion in 2025, with the population burden being greater in developing countries.14 In 2005, global deaths from NCDs were five times more than those arising from HIV and AIDS.14
[2]
Blood pressure tends to rise as people get older and thus everyone’s risk for hypertension increases with age regardless of ancestry and gender.1,7 In many countries, 50% of the population older than 60 years have hypertension.5 Prevalence is higher in men than in women before 60 years of age, but equal after this age.7 According to Centres for Disease
Control and Prevention (CDC) in 2012, over half of all Americans with hypertension do not have their high blood pressure under control.2
Globally, black adults have the highest rates of hypertension, with an increasing prevalence.5
Compared to hypertensive white persons, hypertensive black individuals had a higher rate of sequlae from hypertensive complications.5 Based on NHANES data; prevalence is highest in black women, who also develop hypertension at a younger age than other groups.
There are no clear documented studies done for Sub-Saharan Africa though indication from dotted studies done in the region point to a growing epidemic of high blood pressure. Non- communicable diseases (NCDs), including hypertension, are emerging as a major public health problem in Zimbabwe.12 The major known risk factors for NCDs, that are amenable to preventive measures are smoking, obesity, high alcohol consumption, unhealthy diet, physical inactivity, unsafe environments and stress.8
Historical information shows that hypertension prevalence has been on the increase dating back to the eighties. Data analyzed from peripheral hospitals in Zimbabwe showed steep rise in prevalence of hypertension between 1993 and 1998.13 This was accompanied with a rise in the prevalence of cerebrovascular accidents and Zimbabwe’s case fatality rate due to hypertension rose from 2.8% in 1990 to 8% in 1997.13
[3]
In 2004, hypertension accounted for 41% of all outpatients visits for chronic conditions, while, cardiovascular accidents (CVAs), were the fourth leading cause of mortality in adults.3
The prevalence of hypertension among the healthy population of Zimbabwe is as high as 34% among the adult population. More so, the risk factors of hypertension are also increasing; diabetes was about 7%, physical inactivity was 97%, tobacco consumption 54.1% and alcohol consumption was 74.6% according to the NCDs Risk factors Surveillance study of
2005.3, 12 Hypertension accounts for 50% of all cardio-vascular diseases and its complications including strokes in Zimabwe.12 Strokes are responsible for a significant portion of disabilities and attendances at medical rehabilitation units.12
1.3 Problem Statement
Vubachikwe mine safety and wellness clinic is recording increasing numbers of hypertensive patients over the past five years. In July 2012, the chronic disease register indicated that 125 employees out of 1,100 were on medication for hypertension. Anecdotally, this translates to about at least 1 in every 10 workers suffering from hypertension. According to pre- employment medical examination records for the year 2011 the prevalence of hypertension is estimated at about 1 in 30 workers for new employees. In the year 2011, 7 mine workers experienced varying degrees of cardiovascular accidents.
Worrisomely about 30 workers in 2011 defaulted treatment while medication is offered free of charge. The employees have daily access to free medical care at the industrial clinic and specialist care as and when necessary with all medical costs catered for by the employer. The mine is recording lost shift time hours to hypertension but not much is being done on
[4]
improving and prioritizing awareness and screening for hypertension and its co-morbid diseases.
1.4 Justification
Zimbabwe like several other developing African countries is being faced by increasing prevalence rates of NCDs in addition to existing high rates of communicable diseases.8 The mission of the Ministry of Health and Child Welfare in Zimbabwe encompasses; promotion of healthy lifestyles and improvement of well being of individuals and communities, by creating the environments which will prevent diseases and alleviate the burden from NCDs through appropriate measures.8
In Zimbabwean society, hypertension, once rare, is rapidly becoming a major public health problem. The increasing prevalence of hypertension is well known and reflected in the increasing stroke and cardiovascular disease mortality. At the same time the emerging data also show that hypertension awareness, treatment, and control are unacceptably low.
In a mining community, there are special groups of people with special health needs. Some are immigrant workers; others migrated from rural or urban areas to the mine seeking employment. They are generally heavy manual workers, lowly educated and are not highly remunerated. Information on factors associated with awareness, treatment, and control of hypertension is very scarce at the mine, while studies on hypertension (in these special groups of the population) in the country are limited.
[5]
The study findings will be used by the mine management to craft regulations that will improve the management, control and care of employees with high blood pressure. In addition to the few studies done on hypertension in Zimbabwe, this study will add to the knowledge base of the practitioners in the country while also assisting the health workers, managers and employees at the mine to improve understanding on aspects relating to hypertension.
1.5 Research Questions
1. What is the prevalence of hypertension and its associated factors at Vubachikwe
mine?
2. Why do employees default antihypertensive treatment yet it is being given free of
charge?
[6]
2 CHAPTER 2
Objectives and Hypothesis 2.1 Broad Objective
To determine the factors associated with awareness, treatment and control of
hypertension at Vubachikwe Mine, Gwanda district.
2.1.1 Specific Objectives
1. To determine socio-demographic factors associated with hypertension.
2. To determine environmental factors associated with developing hypertension.
3. To determine the prevalence of hypertension among Vubachikwe mine employees
4. To determine proportion of hypertensive workers on treatment.
5. To determine proportion of hypertensive patients who have well controlled blood
pressure
6. To determine awareness of hypertension among employees.
7. To determine reasons for employees defaulting hypertensive treatment
2.2 Hypothesis
H0: there is no association between type of work performed at the mine and developing hypertension
H1: there is an association between type of work performed at the mine and contracting hypertension
[7]
3 CHAPTER 3:
Literature Review
3.1 Introduction
3.1.1 Definitions for Hypertension
Blood pressure is the force the blood creates against the artery walls as it circulates throughout the body.1 Every time the human heart beats; it pumps blood to the whole body through the arteries.2 Hypertension, also referred to as high blood pressure is a condition in which the arteries have persistently elevated blood pressure through constant pumping of blood with excessive force.1, 2, 3
Blood pressure is written as two numbers; systolic (numerator) represents the pressure in blood vessels during the heart beat while the diastolic (denominator) represents the pressure in the vessels when the heart rests in-between beats.1 The normal level for blood pressure is below 120/80. Systemic hypertension is a disease characterized by a sustained elevation of arterial blood pressure. In adult human beings the disease develops when the systolic blood pressure is sustained above 140mmHg and/or the diastolic blood pressure is above
90mmHg.3,4 Blood pressure between 120/80 and 139/89 is called pre-hypertension.2
Hypertension is classified as either primary (essential) and secondary hypertension.1,2,5,6 In 85 to 95% of cases, depending on setting the cause of hypertension is unknown and this is called
[8]
essential hypertension.1,2,5,6 It is postulated that primary hypertension is as a result of genetic and environmental causes.5 There are multiple etiologies to secondary hypertension such as example renal, endocrine, vascular, tumors and medicines.2,5,6 Secondary hypertension accounts for 5 to 15% of the burden of the disease.1,6 Hypertensive emergencies are most often precipitated by inadequate medication or poor compliance.5
3.1.2 Risk factors for hypertension
Risk factors for hypertension are classified as modifiable and non-modifiable.4, 5, 6, 7
Behavior and lifestyle-related factors can put people at a higher risk for developing high blood pressure. This includes eating too much salt, not eating enough potassium (from fruits and vegetables), being overweight, not getting enough exercise, as well as drinking too much alcohol and smoking.1 The risk for high blood pressure is higher when heredity is combined with unhealthy lifestyle choices.1 Hypertension is the most important modifiable risk factor for coronary heart disease, stroke, congestive heart failure, end-stage renal disease and peripheral vascular disease.
3.1.3 Symptoms and Complication of Hypertension
High blood pressure is called the "silent killer" because it often has no warning signs or symptoms, and many people do not realize they have it.1, 2, 7 The only way to detect high blood pressure is to have it measured regularly by a doctor or a health professional with a device called a sphygmomanometer.2 Hypertension could give rise to early-morning headache, nosebleed, irregular heartbeats and buzzing in the ears.1
Symptoms of severe hypertension include tiredness, nausea, vomiting, confusion, anxiety, chest pain and muscle tremors.1About 33% of people actually do not know that they have
[9]
high blood pressure, and this ignorance can last for years.2 High blood pressure can cause serious damage to health. It can harden the arteries, decreasing the flow of blood and oxygen to the heart, eyes and other vital organs. This can lead to damaged organs, such as renal failure, aneurysm, heart failure, stroke, or heart attack.1, 2, 3
3.1.4 Management of hypertension.
High blood pressure is largely preventable by adopting lifestyle modifications. Lifestyle changes include; reducing and managing mental stress; eating a healthy diet consisting of lots of fresh fruits and vegetables; limiting intake of sodium by reducing the amount of salt added to food; limiting the intake of food high in saturated fats.1, 2 Maintaining a healthy weight, avoiding being overweight, engaging in physical activity, not using tobacco and limiting alcohol use have been found to reduce the risk of hypertension and its associated complications. Treatment of high blood pressure and managing other medical conditions such as diabetes and high cholesterol helps in reducing complications. About 60% of people who have diabetes also have high blood pressure.1, 2
History taking by the clinician should include: family history of hypertension, diabetes, dyslipidaemia, coronary heart disease, stroke, or renal disease.3 Duration and previous levels of high blood pressure and medicines used including other associated illnesses such as heart failure, peripheral vascular disease, renal disease, cerebrovascular disease which are symptoms suggestive of secondary causes of hypertension be checked need to be checked.
Lifestyle factors including dietary intake of fat, sodium and alcohol, quantification of smoking and physical activity.3 Personal, psychosocial and environmental factors may also be contributory factors to hypertension.3
[10]
Treating hypertension is associated with a reduction in cardiovascular complications.
Medical options to treat hypertension include several classes of medicines. The aims of treatment are to maintain normal blood pressure, control all associated modifiable risk factors
(for example smoking, obesity, and dyslipidaemia) and to treat end organ damage if present.2,3 Angiotensin Converting Enzyme (ACE) inhibitors, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators are the primary medicines used in treatment. These medications may be used alone or in combination. In addition, some of these medicines are preferred to others depending on the characteristics of the patient needs.2
The prevalence of hypertension in many developing countries, particularly urban societies, is already as high as those seen in developed countries.7 Data from National Health and
Nutrition Examination Survey (NHANES) in the United States 2006-2008 found that in the population aged 20 years or older showed that 33.6% of US adults 20 years of age have hypertension, resulting in an estimated 74.5 million US adults with hypertension.5 NHANES
2005-2006 showed that 29% of US adults 18 years of age and older were hypertensive, 28% were pre-hypertensive, and 7% of hypertensive adults were unaware that they had hypertension.5 Of those with high blood pressure (BP), 78% were aware they were hypertensive, 68% were being treated with antihypertensive agents, and more than 64% of treated individuals had controlled hypertension.5
NCDs are largely preventable or treatable as the rule of thirds does apply; one third preventable, one third curable and one third incurable.8 The major known risk factors for
NCDs are amenable to preventive measures. These include; smoking, obesity, high alcohol
[11]
consumption, unhealthy diet, physical inactivity, unsafe environments and stress. Thus the general public is exposed to a number of risk factors associated with NCDs.8, 12
Hypertension in sub-Saharan Africa is a widespread problem of immense economic importance. It is highly prevalent in urban areas, frequently under diagnosed and the severity of its complications is noted.15Poverty may be a contributory factor while health seeking behaviors are not uniform in the region. Therefore, establishing factors associated with awareness and management is an essential starting point in preventing and combating the increasing burden of morbidity and mortality from hypertension and its co-morbid conditions.14
In Zimbabwe the prevalence of hypertension has been on the increase as evidenced by an increase in prevalence of lifestyle related diseases.8,12,16 Clinical studies suggests there is a high prevalence of hypertension and its complications in Zimbabwe.16 A study by Mufunda et.al (2000) showed hypertension prevalence of 41% and 26% in women and men respectively in urban Marondera.17 This has been strongly associated with higher body mass indices in women as compared to men. As the body mass index in women rises above 25 kg/m2, systolic blood pressure rises sharply. This trend has also been noted in a study done in
Mashonaland Province by Banda et al in 2008.18
In a STEPwise survey done in Zimbabwe, they reported hypertension prevalence of more than 27%, diabetes mellitus 10%, alcohol use of more than 70% and tobacco use at more than
33%.12In 2005 Zimbabwe reported diabetes prevalence of 1.8% in men and 1.6% in women.
For those patients suffering from diabetes, hypertension and obesity prevalence rates were
[12]
much higher in women than men and the majority of the people were not aware of their conditions.8, 12
In Ghana they reported that old age was independently associated with higher awareness of hypertension while being overweight was independently associated with pharmacological treatment of hypertension.14The older age groups, females, overweight and obese people were more likely to be receiving medication for their hypertension.14In a recent survey done in
Zimbabwe by Mungati et.al (2012), they found out that 41.3%of hypertensive patients had co-morbid conditions with HIV (10.7%) and diabetes mellitus (12.1%). Complications of hypertension noted included congestive cardiac failure, stroke and visual defects.19
Emerging data, mostly from the industrialized nations, indicate that factors such as gender, geographical setting, and body sizes are associated with hypertension awareness, treatment and control.14It is unclear, however, whether these factors are applicable in very poor resource settings. Several studies attest to rural versus urban differences in BP levels throughout sub-Saharan Africa. The prevalence of hypertension in rural studies undertaken in the 1970s to the 1990s has generally been low: 4.1% in Ghana, 5.9% in Nigeria, 10.7% in
Lesotho and9.4% in the rural Zulu.15
In a study done in Kenya they concluded that, the migration of people from traditional rural areas to the urban settings of Nairobi was associated with an increase of blood pressure. A sedentary lifestyle in the urban setting including lack of exercise may have been contributory to higher body weights, pulse rates, and urinary sodium-potassium ratios than did those who remained in the rural areas.15Higher pulse rates noted in study participants may suggest that
[13]
there is increased autonomic nervous system activity that would contribute to the higher
BPlevels.15
In a study done in Eritrea, the prevalence of hypertension was different in urban and rural environments.20 The prevalence of hypertension was higher in urban settings (16.5%) than in rural settings (14.5%). However, this difference was not significant(p=0.26).20 In these patients,80% of the newly diagnosed hypertensive cases were not aware of their condition.20
In another study done in southern Africa, the Xhosa and San tribes living in the desert as hunters and gatherers subsisting on game and wild vegetation had their blood pressure levels relatively flat with age.15
In a study among factory workers, hypertension emerged as the most common cardiovascular disease (CVD) risk factor with a prevalence of 22% using a cut-off level of 140 and/or 90 mmHg or 14% using a higher cut-off level of 160 and/or 95 mmHg.12 Hypertension was significantly associated with several socio-demographic and biochemical variables in men, but only varied with age in women.12 Using body mass index, 60% of women were overweight compared to 16% of men. Obesity was found in 15% ofwomen.12
In a study done in Marondera, Zimbabwe, the age-adjusted prevalence of hypertension were
30% for women and 21% for men.17The average body mass index (BMI) was 26.3 kg/m2 for women and 21.4 kg/m2for men. The prevalence of hypertension had a steep association with age and in women ranged from 15% (25–34 years) to 63% (55 years and over) and in men from 9% to 47%.17 In both men and women the levels of hypertension and systolic blood pressure (SBP) were strongly positively associated with BMI, although the relationship
[14]
appeared to plateau in women with a BMI greater than 25 kg/m2. At a given BMI, men and women had similar SBPs and prevalence of hypertension.17
In Tanzania, in a study done on urban inhabitants of Dar-es-Salaam, socio-economic status was inversely related to high blood pressure and smoking, whereas increasing affluence was linked to increasedobesity.15 Thus it is postulated that African urbanization is associated with inevitable stress, dietary changes, and acculturation.15 In a study done by Mungati et.al
(2012) rural-urban differences were noted with those in urban areas being at a higher risk of hypertension, more obese with higher centrally obese.19
In a study done in South Africa by Stockwell et.al (1994), older, more obese and black employees were significantly more aware of their high blood pressure.21 On treatment outcomes, the older and more obese employees and those with more physician visits were significantly more likely to be treated for their high blood pressure.21 In this study; gender, education, and race were not independently associated with a failure to be aware or to enter treatment.21
Increasing obesity is associated with increasing blood pressure levels in West African and
American blacks.15In the South African Demographic and Health survey of 1998, the incidence of obesity in blacks was 30% in females and 8% in males. Abdominal obesity was particularly common in females and a corresponding higher incidence of hypertension was noted. The more urbanized the South African communities were, the higher the rate of obesity and the less prudent their diets became.15 It is presumed therefore that the lower male hypertension prevalence relates to the much higher rate of heavy manual labour.15
[15]
In a study done in Eritrea, the effect of BMI was greater in males than in females, especially in the over 45 year age groups. Among lean people, there was no significant effect of BMI on
BP while in normal BMI women over 45 years, there was a significant correlation between all forms of blood pressure and BMI (p=0.05), but this significance disappears for those women below 45 years.20 In Ethiopia, females were more likely to have been detected, be on treatment, and have hypertension controlled compared with males.22A one-year follow-up of newly diagnosed hypertensive patients showed that despite referral, 62.9% had uncontrolled hypertension and 26.8% claimed to be unaware of their hypertension.22
In Eritrea the prevalence of hypertension in the general population was 16%.20 The prevalence of hypertension steadily increased with age in both sexes. Contrary to other studies, the overall prevalence was slightly higher in males (16.88%) than in females
(15.28%). However, below the age of 44 years, the prevalence was higher in males, and above that age group, the prevalence became higher in females.20
In a study done in Ghana, the overall prevalence of hypertension was 29.4%. Among these hypertensives, 34% were aware, 28% were receiving treatment, and only 6.2% had adequately controlled blood pressure below 140/90mmHg.14 In this study the prevalence of hypertension was higher in those above 35 years, those with no formal education, overweight and obese people, landowners, and alcohol users.14 Among hypertensives; older age groups, females, those with no formal education, and traders were more likely to be aware of their hypertensiondiagnosis.14 Interestingly in this study, among hypertensive patients, blood pressure was adequately controlled more among current smokers and the younger age groups.14
[16]
In a study done among employees in Bulawayo City, the prevalence of hypertension was
38.4% and it was higher in females than males while the prevalence of undiagnosed hypertension was 14.2%.23 Hypertensive patients who were on treatment amounted to 80% while 39% of them had well controlled BP.23 Independent risk factors for hypertension were being aged 40 years or older, being obese, current tobacco smoking, family history of hypertension and being married.23
In a recent study done in Concession by Mungate et.al (2012) they found out that 41.4% of respondents were hypertensive but not on treatment. Twenty two percent of those on treatment had controlled hypertension with preponderance towards women.19 Women and those staying in urban areas had higher mean blood pressure values. Knowledge was poor among respondents with 70.6% believing that stress was the major cause of hypertension while 23% and 26.5% did not know of any cause or complications of hypertension respectively. About 28.9% and 27.9% were overweight and obese respectively with women being more affected than men. Risk factors for hypertension identified in this study were: age above 60years and obesity.19
In a study done by Adoo et.al (2007) hypertension detection ranged between 11% in all participants in rural Cameroon and 47% in females in South Africa, treatment between 10% in urban Cameroon and 32% in Ghana, and control between 0.4% and 16.8%.22In a study done in the USA on awareness, treatment and control of hypertension, less than one-third of the sample had controlled blood pressure, almost half had hypertension and hypertension awareness and treatment were inadequate.24
[17]
In a clinical study done in Zimbabwe by Matenga et.al (1997), of the 100 consecutive cases of stroke studied, 53% were hypertensives, 50% of whom had defaulted treatment while the other 50% were newly diagnosed.25 In another study of hypertension awareness in communities with different levels of socio-economic development, only 26% of hypertensives were aware of their elevated blood pressure status.25Recreational physical activity was less than 4% making the population a very sedentary one and prone to overweight and obesity which was reported to be 15%.12
In a study done in Zimbabwe, potential relations between blood pressure and age, BMI, Na/K ratio, alcohol, tobacco and time in rural areas and to compare the relationship of BMI and hypertension in Zimbabwe to the pattern observed among study participants.17Sodium restriction in black Zimbabweans did not increase plasma renin values in hypertensives but elevated the value in controls. Among the explanations include; abnormalities of sodium handling, such as excessive sodium renal re-absorption, and genetic abnormalities in the renin-angiotensin system or related genes. With regard to angiotensinogen, levels in Nigeria are substantially lower than those in the US black population, but these differences chiefly reflect obesity, sex and age.15
Non biomedical beliefs appear to be relatively common among blacks with hypertension. A study conducted blacks in South Africa with hypertension during routine ambulatory clinic visits found that 38% believed that hypertension could be cured, 38% believed that taking antihypertensive medication lifelong was not necessary, and 23% thought that antihypertensive medications needed to be taken only when experiencing symptoms.26
Clearly, these beliefs could negatively influence the likelihood that blacks with hypertension will seek treatment and, once prescribed, adherence to treatment over the long term. [18]
In Zimbabwe, cigarette smoking was entirely in males(30%) while only a small proportion of women drank alcohol (6.5%) compared to 64% in men.12 Generally the prevalence of physical inactivity during normal working hours was high (50%) in all the age groups. Of note is the fact that Matabeleland South province reported the highest prevalence of physical inactivity during normal working hours (above70%) in all age groups as compared to other provinces. The distribution of physical inactivity was not significantly different among females and males in all the provinces.12
Given the high cost of hypertension medication relative to income, increasing awareness and simple preventive measures such as promotion of physical activity, normalizing body weight and reduction of salt intake, present the best hope for reducing the impact of hypertension on morbidity and mortality.14 Patients should be advised not to drink alcohol as there is evidence that an 85% decrease in intake among drinkers consuming moderate amounts of alcohol results in a reduction of 5/3 mm Hg in hypertensives and 4/1 mm Hg in normotensives.3
[19]
3.2 Conceptual framework
Lifestyle related Socio-demographic factors factors
Level of education Excess alcohol consumption Age Smoking cigarettes
Sex Occupation
Level of activity/ exercise Income
Obesity High blood pressure Place of (Hypertension) residence Diabetes
mellitus
Genetic predisposition Adherence to medication Renal disease
Family history Health seeking behavior HIV/AIDS
Perceptions & beliefs Co-morbidity/ disease Environmental/genetic factors related factors Knowledge & education
Figure 1; Conceptual framework, modifiable and non-modifiable risk factors associated with
Hypertension.
[20]
4 CHAPTER 4:
Methods and Materials
4.1 Introduction
This chapter will describe the research methods used in this study. It will look at study design, study setting, study population, sample size and sampling plan. The research instruments, study variables, data capturing and analysis and ethical considerations will also be covered.
4.1.1 Study type; An analytic cross sectional study was carried out.
4.1.2 Study setting; Vubachikwe Mine, Gwanda district, Matabeleland South Province,
Zimbabwe.
[21]
Vubachikwe Mine
Figure 2; Map of Gwanda district showing Vubachikwe Mine. (source OCHA Maps and
Graphics Zimbabwe)37
[22]
4.1.3 Study population; Employees at Vubachikwe Mine.
4.2 Eligibility Criteria
4.2.1 Inclusion Criteria
Permanent employees who had worked for more than 6 months at the mine, (manual
workers are treated as a contract worker before they complete six months of work in a
mining environment) were recruited into the study. They should be above 18 years of age
consenting to participating in the study.
4.2.2 Exclusion criteria
All those not consenting to the study were excluded and those that are below the age of 18 years from birth. Contracted and temporary workers by virtue of them not being permanent workers were excluded from the study. All those not reporting on duty (leave or suspension) were not included as it was going to be difficult to trace them for the study.
All pregnant female employees were excluded since physical measurement would be difficult to interpret and compare with non pregnant females and male counterparts.
4.3 Data collection techniques
Interviewer administered questionnaires were used to collect information on; Age, Sex, Level of Education, Occupation, Salt Intake, Alcohol use, Level of Activity. Medical records were reviewed to verify; duration of treatment, treatment regimen, co-morbidity, concurrent use of other medicines. Direct biophysical measurements were done for blood pressure, blood sugar, weight and height including body mass index.
[23]
4.4 Sample Size and Sampling Procedures
4.4.1 Sampling frame; the employment register
4.4.2 Sample size
Using the formula n =Z2pq/Δ2
Where n = sample size
Z= standard error risk
p = prevalence of hypertension (proportion of people with hypertension)
q = 1-p (proportion of people without hypertension)
Δ = absolute precision
Assuming 95% confidence interval (z=1.96), prevalence of hypertension (p) of 15% (in
Matabeleland South 2011 prevalence ranging between 12-18%, as reported in DHIS) 27 an absolute precision of 5% a total number of 195 participants were selected for the study.
Adjusting for 10% non response/refusal rate, I set out to interview 216 participants.
4.4.3 Sampling
Systematic sampling was conducted where the employment register was used as a sampling frame. All the employees who were attending were assigned numbers, 1, 2, 3, 4… up to the last employee. The total number of available employees (n=1150) in the employment register was divided by 216 (the sample size) to get 5; the interval of selection (k). The first participant was selected from the first interval by the lottery method. The subsequent participants were selected by adding 5 the interval to the selected participant. This was done until all 216 participants were selected.
[24]
4.5 Operational Definitions
4.5.1 Hypertension
Hypertension was defined as systolic blood pressure (SBP) of 140 mmHg or higher and/or diastolic blood pressure (DBP) of 90mmHg or higher in a patient not taking anti-hypertension medication or a participant taking anti-hypertension medication.5,12,25,28
Table 1; classification of hypertension by diastolic and systolic measurements
Classification Systolic value Diastolic value
Pre-hypertension 120-139 80-89
Hypertension stage 1 140-159 90-99
Hypertension stage 2 >/=160 >/=100
Prehypertension is when a patient is at risk for progression to hypertension and that lifestyle modifications are important preventive strategies.
Severe hypertension is defined by a blood pressure above 180/120 mm Hg without symptoms or end-organ damage.
Hypertensive emergency is defined as a blood pressure above 180/120 mm Hg with the presence of end-organ damage. In these conditions, the BP should be lowered aggressively over minutes to hours.
[25]
Acute end-organ damage may include the following; hypertensive encephalopathy, cerebral vascular accident, subarachnoid hemorrhage, myocardial infarction, pulmonary edema, unstable angina pectoris, acute renal failure, retinopathy and eclampsia among others.
4.5.2 Awareness of hypertension
Knowing or remembering (self-reporting) that the individual had previously been diagnosed of hypertension or had been told that their blood pressure was raised by a health care worker
(even without remembering the actual values of systolic and diastolic blood pressure).
4.5.3 Treatment of hypertension
Treatment of hypertension was defined as having received prescribed antihypertensive medication within the past two weeks at the time of the interview.
4.5.4 Blood pressure control
Good blood pressure control was defined as a SBP of less than 140mmHg and a DBP of less than 90mmHg in a participant taking anti-hypertension medication.
Poor blood pressure control was defined as a SBP which is more or equal to 140mmHg and/or DBP which is more or equal to 90mmHg in a patient being treated for hypertension
4.5.5 Measurement of blood pressure
After the interview, the study participant was allowed to rest (relax) for at least 5 minutes.
Using appropriate cuff sizes, two blood pressure measurements were taken five minutes apart in a sitting position and a mean was computed. The blood pressure was measured on the left upper arm positioned at the same level with the level of the heart. To minimize measurement and inter-observer variability, digital BP machine was used and all blood pressure measurements were done by the Public Health Officer. Hypertension awareness was disaggregated by age into categories; 20-30, 30-40, 40-50, 50-60 and 60+ years. [26]
4.5.6 Body Mass Index
Body mass index (BMI) was used as a measure of obesity and was calculated as follows: weight in kg/height in square meters. Height was measured to the nearest 0.1metres in the standing position using a portable height board, and weight was determined to the nearest
0.01 kg on a digital scale. Refer to the table below for classification of BMI.12, 28, 29
Table 2; grading of body mass index (BMI)
Category of relative weight BMI
Underweight <18.5
Normal 18.5-24
Grade 1 overweight 25.0-29.9
Grade 2 overweight 30.0-39.9
Obesity >40
4.5.7 Other Measured Variables
Co-morbidity is defined by quantifying the number of the following diseases that were present in the current clinical history: diabetes mellitus, heart disease, HIV disease, cerebrovascular disease and chronic kidney disease.
Frequency of taking antihypertensive medication was to be determined using the question;
“Currently, are you regularly taking antihypertensive medication as prescribed to control
BP?” and will be measured with a nominal scale (1 = always regularly taking; 2 = intermittently or as needed;3 = not taking).
Sodium intake was estimated by whether the participant adds additional salt to prepared food.
[27]
Heavy alcohol drinking was measured using amount taken per day and the frequency thereof in a week.
Frequency and amount of physical activity
Physical inactivity was assessed in three categories, at work, during transportation and at leisure time. Physical inactivity at work was defined in three categories, firstly as work involving mostly sitting or standing with walking for no more than 10 minutes at a time, secondly work that does not involve vigorous activities like heavy lifting, digging or construction work for at least 10 minutes at a time and thirdly in term of number of days per week one does vigorous activities as part of one’s work. While physical inactivity on transportation was defined by walking or cycling for no more than 10 minutes continuously to get to and from places.
On leisure it was defined as recreation or sport or leisure time which involve mostly sitting, reclining or standing with no physical activity lasting more than 10 minutes at a time and whether during leisure time one does not do any vigorous activities like running, or strenuous sports, weight lifting for at least 10 minutes at a time.
Stress was measured using the question “How much stress do you feel in your normal life?” and was scored on a 4-point Likert scale (from 1 = very severe to 4 = hardly ever).29
Diabetes screening; a random blood sugar will be done on all patients. A participant with a random blood sugar of at least 11.1mmol/L or more will be classified as diabetic and further management recommended. RBS were done using SD CHeCK GOLD BLOOD GLUCOSE
TEST MONITOR and STRIPS. Those with RBS between 7mmol/L and 11mmol/L were classified as suspected diabetics and recommended for a fasting blood sugar (FBS) to confirm or exclude diabetes.
[28]
4.6 Study Variables
4.6.1 Outcome variables; Prevalence of hypertension, blood pressure control, awareness
on hypertension
4.6.2 Independent variables
Table 3; Independent variables for hypertension awareness, treatment and control
Variable Definition Data collection* Socio-demographic Age Number of years at last birthday Questionnaire Sex Gender Observe Income Average family income Questionnaire Place of residence Place where the participant lives Questionnaire Lifestyle related factors Diet Fruit and vegetable consumption Questionnaire Alcohol consumption -Quantity and frequency of drinking Questionnaire alcohol
Cigarette smoking - Quantity and frequency of smoking Questionnaire
Physical activity - Physical activities done at work, home Questionnaire and during leisure time - Time spent doing physical activities
Family-related factors Family history of Sibling or parent with hypertension Questionnaire hypertension Family history of Sibling or parent who develop Questionnaire hypertension complications of hypertension complications Co-morbidity Obesity Presence and grade of obesity (BMI) Measurements
Diabetes mellitus Presence of diabetes Questionnaire
[29]
Medication Complications of Heart failure, kidney disease or stroke as a Questionnaire/ hypertension result of hypertension medical records
4.7 Data collection
An interviewer administered questionnaire which was adopted from the WHO STEPwise survey (adapted to suit Vubachikwe mine employees) was administered. The questionnaire was translated into Ndebele and Shona so that the study participants were being communicated with using a language they were comfortable with.
Measurements and recording of weight, height, waist and hip circumference, random blood sugar and blood pressure were described above. Clinic records including participant hospital records were reviewed for patients’ history, adherence, compliance and control of hypertension.
4.8 Data analysis
Epi info version 3.5.3 (January 2011) was used to capture and analyse data. It was used to; generate frequencies, means, and proportions of variables; calculate prevalence odds ratio
(POR), 95% confidence intervals (CI); conduct multivariate analysis using logistic regression to identify independent factors associated with awareness, treatment and control of hypertension. Graphs were generated using Epi Info. The Chi square test was used to compare variables represented by proportions such as study subjects with hypertension aware of their condition, receiving treatment and whose BP was controlled.
[30]
4.9 Pre-testing of methods and data collection tools
Tools were pre-tested at Blanket Mine Industrial clinic which is located 2km away from
Vubachikwe Mine. The following were checked for; willingness of respondents to answer questions; acceptability and validity of questions; feasibility of administering data collection tools; optimal time for conducting the interviews and appropriateness of sampling procedure.
Modifications of the collection tools were done appropriately before data collection.
4.10 Permission to Proceed
Permission was sought and obtained from the Provincial Medical Director (Matabeleland
South), the District Medical Officer (Gwanda), the Mine Manager (Vubachikwe Mine),
Health Studies Office University of Zimbabwe - Joint Parirenyatwa Ethical Review Board and the Medical Research Council of Zimbabwe.
4.11 Ethical Considerations
Written and informed consent was sought and obtained from all study participants. A sample of the consent form which we used is attached below (annex 2). Confidentiality was assured and maintained throughout the study. Names of participants were not captured on questionnaires. Anonymity of study participants was guaranteed by appropriately coding variables that led to no identification of individual respondents. Questionnaires were secured and locked up in lockable steel cabinet.
Untreated and inappropriately managed hypertensives were referred for appropriate care and free medical consultations were offered to study participants who needed it. Undiagnosed medical conditions that were discovered among study participants were given medical advice.
[31]
5 CHAPTER 5:
Results
In this survey we managed to enroll 213 out of 216 employees translating to a 98.6% recruitment rate.
5.1 Socio-demographic characteristics
Table 4; Socio-demographic characteristics of Vubachikwe mine employees, hypertension awareness treatment and control study, 2013
Male Female Total
n=196 % n=17 % n=213 % Age <30 33 16.8 2 11.8 35 16.4 30-40 41 20.9 6 35.3 47 22.1 40-50 47 24 7 41.2 54 25.4 50-60 65 33.2 2 11.8 67 31.5 >60 10 5.1 0 0 10 4.7 Educational level None 6 3.1 0 0 6 2.8 Primary 68 34.7 5 29.4 73 34.3 Secondary 107 54.5 10 58.8 117 54.9 Tertiary 15 7.7 2 11.8 17 8 Ethnic origin Ndebele 76 38.8 7 41.2 83 38.97 Shona 68 34.7 6 35.3 74 34.74 Chawa 20 10.2 2 11.8 22 10.33 Sotho 12 6.1 2 11.8 14 6.57 Tonga 6 3.1 0 0 6 2.82 Kalanga 4 2 0 0 4 1.88 Coloured/Caucasian 4 2 0 0 4 1.88
Other (Nambiya, Yawe, 6 3.1 0 0 6 2.82 Shangaan, Venda)
[32]
Ninety two percent of respondents were males. Most males (33.2%) were aged between 50-
60 years. The 60+ age group was least populated as it had only 5.1% of males and no women.
89.2% of the respondents were married, 6.6% were single, while 2.3% and 1.9% were divorced and widowed respectively. 54.9% of employees attended but not finished secondary education and 34.3% did attend primary education. 8% of all the respondents attained tertiary level qualifications. Thus, 74.2% of respondents were unskilled workers, semi-skilled labor accounted for 17% and only 8% were skilled. Ninety three percent (198 employees) stay at the mine compound and 7% commuted from Gwanda town.
The majority of respondents were Ndebele (39%) followed by Shonas (34.7%) and Chawa
(10.3%). Other ethnic origins such as Yawe, Shangaan and Nambiya were fairly represented.
Christianity (61.1%) was the most popular faith, followed by African tradition believers
(16.4%). The apostolic sect was followed by 15.5% percent of employee population with
4.2% being Islam and 2.8% are Judaism followers.
5.2 Awareness of Hypertension
Most employees (93%) had their blood pressure checked within a year preceding the date of survey and the remainder (6.1%) had their blood pressure checked between one to five years preceding the date of survey.
[33]
5.2.1 Awareness of Hypertension among Vubachikwe Mine Employees
percentage awareness
60 percentage employee representation
50
40
30 percentage 20
10
0 <30 30-40 40-50 50-60 60+ Age (years)
Figure 3; Awareness of Hypertension among Vubachikwe Mine Employees (aggregated by age); Hypertension awareness, treatment and control study, 2013
The representation of employees decreases with increase in age while awareness of hypertension increases with increase in age. This trend of awareness is statistically significant
(Chi=13.76, p<0.05).
[34]
5.2.2 Awareness of hypertension among Vubachikwe Mine Employees
Table 5; Awareness of hypertension among Vubachikwe Mine Employees, hypertension awareness, treatment and control study, 2013
Male % Female % Total % 95%CI
Awareness prevalence 57 29.1 1 5.9 58 27.2 21.4-33.7
Ever taken medication (among 49 86.0 1 100 50 86.2 18.0-29.7 those that are aware of having
BP)
Overall 27.2% of all the employees had reported awareness of being diagnosed of hypertension. Prevalence of hypertension was higher in males (29.1%) while only one female reported having been diagnosed of hypertension. Among those that reported awareness, 50
(86.2%) had ever taken antihypertensive treatment. Of note, 8/58 (14%) of the employees know they were diagnosed with hypertension and have refused to start taking medication.
Hypertension prevalence by age group was mostly among the 50-60 years (48.3%), followed by the 40-50 years (24.1%) with the least being the youngest age range 20-30 years (5.2%)
[35]
5.2.3 Regularity of taking medication among Vubachikwe mine employees.
Table 6; Frequency of taking medication among Vubachikwe mine employees that ever took antihypertensive treatment, 2013
Frequency of taking Males Col % 95% CI Females medication
Always 32 65.3 50.4-78.3 1
Intermittent (defaults 3 6.1 1.3-16.9 on and off)
Not taking 14 28.6 16.6-43.3
Total 49 100
Among those that had ever taken antihypertensive treatment, 46 (93.9%) got medication from the mine clinic while 6.1% consult a private doctor. The only female hypertensive always took her medication regularly. For men, 56.3% always took their treatment without interruption. 34.7% of men were defaulting treatment with 28.6% not taking treatment at all while 6.1% do intermittently stop and start treatment.
[36]
5.3 Compliance with medication
7% n=58
50%
43% aware of BP diagnosis
ever taken medication for BP
never started on Rx
Figure 4; Compliance with medication among Vubachikwe mine employees who are aware of
Hypertension, 2013
The pie chart shows that, of the 58 employees that are aware of having been diagnosed of high blood pressure, 43% had ever taken medication while 7% never started antihypertensive medication.
[37]
5.3.1 Compliance patterns among age groups in patients who have ever taken
antihypertensive medication
Table 7; Compliance Patterns among Age Groups in Patients Who Have Ever Taken Anti- hypertensive Medication, Vubachikwe Mine, 2013
No of years 20-30y 30-40y 40-50y 50-60y >60y Totals %
Always 0 1 11 17 4 33 66
Intermittent as 0 1 1 0 1 3 6 needed
Not taking 0 3 1 9 1 14 28
Total 0 5 13 26 6 50 100
Compliance with taking antihypertensive treatment improved with age. The older employees had higher chances of consistently complying with treatment. However, 66% of employees always take their medication, 28% are not taking and 6% intermittently interrupt treatment.
[38]
5.4 Hypertension diagnosis and report ever taking medication
awareness treatment
30
25
20
15 frequency 10
5
0 <30 30-40 40-50 50-60 60+
Age (years)
Figure 5; Comparison of Vubachikwe mine employees aware of hypertension diagnosis and ever taking medication for hypertension, 2013.
Among all employees, compliance to treatment was most problematic in the 20-30 years olds where 0/3 were taking medication while aware they had hypertension. Awareness of hypertension and compliance to treatment increased with increase in age. This trend was statistically significant (Chi=3.72, p=0.05).
Of the 50 patients that reported ever taking anti-hypertensive treatment, 56% had their blood pressure checked within a month, 20% between 1-3 months and 24% over 3 months from the day of data collection.
[39]
5.5 Blood pressure control
Table 8; Blood pressure control among employees that have ever taken antihypertensive treatment; Hypertension, awareness, treatment and control study, Vubachikwe mine 2013
Is Your BP Well Controlled? Reported Verified
n=50 % n=50 %
Yes 33 66 35 70
No 8 16 15 30
Don’t Know 9 18 - -
Seventy percent of employees who were aware of hypertension diagnosis and had been on treatment had well controlled blood pressure. Thirty percent of employees had uncontrolled blood pressure, they included defaulters and those that intermittently interrupt treatment.
Twenty eight (56%) of employees who were currently on treatment for blood pressure had ever defaulted treatment for various reasons. More so, 7 patients alluded to have consulted traditional healers for blood pressure management and 12 employees reported using herbal remedies for blood pressure control.
[40]
5.6 Distribution of blood pressure
60
SBP (%) DBP (%)
50
40
30 % frequency % 20
10
0 prehypertension hypertension stage 1 hypertension stage 2 normal BP
Stage of Hypertension
Figure 6; Distribution of systolic blood pressure (SBP) and Diastolic blood pressures (DBP) in hypertensive employees at Vubachikwe mine, 2013
Based on diastolic blood pressure ranges, the majority of patients (54.5%) had normal well controlled blood pressure, 29.1% had pre-hypertension and 5.6% had stage 2 hypertension.
However, using systolic blood pressure as a baseline, the majority of hypertensive employees had pre-hypertension (46.9%) while 31.5% had normal blood pressure and 14.6% had stage 1 hypertension.
[41]
5.7 Factors associated with hypertension
5.7.1 Socio-demographic factors
Table 9; Socio-demographic factors associated with hypertension among Vubachikwe mine employees, 2013
Hypertensive Non- POR 95% CI p- hypertensive value Frequency Frequency Age 20-30 3 32 0.063 0.011 - 0.353 0.017 30-40 7 40 0.117 0.026 - 0.522 0.005 40-50 14 40 0.233 0.057 - 0.950 0.042 50-60 28 39 0.479 0.123 - 1.856 0.286 60+ 6 4 * * 0.53 Educational Level None 2 4 1.318 0.227 - 7.669 0.759 Primary 29 44 0.413 0.071 - 2.407 0.325 Secondary 20 97 1.4 0.197 - 9.869 0.736 Tertiary 7 10 * * 0.429 Marital Status Divorced 2 3 0.551 0.089 - 3.889 0.52 Married 51 139 0.6 0.071 - 5.059 0.639 Single 4 10 0.5 0.028 - 8.951 0.637 Widowed 1 3 * * 0.657 Sex Female 1 16 6.561 0.850 - 50.642 0.071 Male 57 139 * * 0.007 Monthly Income >$600 8 8 1.5 0.456 - 0.934 0.032 <$300 36 126 0.429 0.198 - 0.927 0.505 $300-600 14 21 * * 0.24 Place Of Residence Mine 53 145 0.703 0.230 - 2.156 0.539 Town 5 10 * * 0.206
*- baseline (standard)
[42]
An increase in age was significantly associated with diagnosis with hypertension with the
60+ age group as the baseline. Male employees were 6.56 times more likely to be diagnosed of hypertension as compared to their female counterparts. A salary above US$600 was associated with 1.5 odds of a diagnosis of hypertension compared to those earning between
US$300-600 (p=0.032) while earning less than US$300 was associated with 0.43 odds of blood pressure diagnosis (though not statistically significant).
5.7.2 Lifestyle, family and disease related factors
Table 10; Lifestyle, family and disease related factors associated with hypertension among
Vubachikwe mine employees; Hypertension awareness, treatment and control study, 2013
Diagnosed of POR 95 % CI Hypertension? Environmental Factors
Yes No
Adding Salt to Yes 31 84 0.971 0.53 - 1.777 food No 27 71 Smoking Yes 20 39 1.566 0.816 - 3.000 tobacco (Ever) No 38 116 Drinking Yes 34 83 1.229 0.667 - 2.263 alcohol (Ever) No 24 72 Heavy manual Yes 23 73 0.189 0.042 - 0.852 work No 5 3
Sedentary Yes 39 90 1.565 0.823 - 2.977 leisure No 18 65
Family and Disease Related Factors
Family history Yes 44 40 9.036 4.489 - 18.209 of BP No 14 115
[43]
Family history Yes 6 6 2.865 0.885 - 9.277 of heart failure No 52 149 Family history Yes 7 11 1.797 0.661 - 4.884 of stroke No 51 144
Employees who were engaged in heavy manual work were less likely to be diagnosed of hypertension. Those employees with a family history of hypertension have 9.04 times the odds of being diagnosed of hypertension compared to those without family history of hypertension as shown in table 10 above.
5.8 Alcohol and smoking use
Chi=5.25 p=0.022
350 alcohol smoking
300
250
200 frequency 150
100
50
0 ever used current use stopped never used total substance use
Figure 7; Use of alcohol and smoking by Vubachikwe Mine Employees,2013.
[44]
117 employees reported ever drinking alcohol however 42% of these have stopped alcohol intake. Similarly 59 respondents used to smoke tobacco and currently 49% of them still are smoking. Reported trend of alcohol use and abuse was more prevalent than smoking. This trend was statistically significant, Chi=5.25 (p=0.022).
5.8.1 Frequency of alcohol use among employees
50 45 40
35
30 25
20 % frequency% 15 10 5 0 1 day/month 2-3 days/month 1-4 days/week 5+ days/ week stopped
frequency of alcohol intake
Figure 8; Frequency of alcohol use among employees that reported ever consuming alcohol at Vubachikwe Mine; Hypertension awareness, treatment and control study, 2013
The majority of employees consumed alcohol 2 to 3 days a month (20.1%) and once a month
(16%) which coincided with pay days. They consumed on average 1-2 units of alcohol a day.
[45]
5.9 Body Mass Indices (BMI
58.22
24.88 % frequency %
9.39 7.04 0.47
<18.5 18.5-24.9(normal) 25-29.9 (gr1 30-39.9 (gr2 >40 (obese) (underweight) overweight) overweight)
Body Mass Index (weight grading)
Figure 9; Body Mass Indices (BMI) for Vubachikwe Mine employees; Hypertension awareness, treatment and control study, 2013
The majority (58.2%) had normal weight with 24.9% and 9.4% being grade 1 and grade 2 overweight respectively. Only one employee was obese and 7% were underweight.
[46]
5.10 Co-morbidities
5.10.1 Random Blood Sugar
30
25
20
15
10 random blood sugar level sugar blood random 5
0 0 50 100 150 200 250
Employee Identification Code
Figure 10; Random Blood Sugar Levels among mine employees; Hypertension awareness, treatment and control study, Vubachikwe Mine, 2013
The line graph shows the levels of random blood sugar among Vubachikwe mine employees.
There were only 3/213 employees (1.4%) who knew they were diabetic and on treatment and of note they all were not hypertensive patients. One employee was newly diagnosed of diabetes mellitus during the study; he had a random blood sugar of 25.5mmol/l.
[47]
5.11 Knowledge on hypertension
Table 11; Knowledge on hypertension among Vubachikwe Mine employees; Hypertension awareness, treatment and control, 2013
Overall Hypertensives Non-hypertensive
n=213 % n=58 Col% n=155 Col %
Correct definition of hypertension 66 31 13 22.4 53 34.2
Wrong definition of hypertension 147 69 45 77.6 102 65.8
147 (69%) employees failed to define what hypertension was in their own words. Among hypertensive employees, only 13 (22.4%) percent could define what they were suffering from. Thirty four percent non-hypertensive employees knew what hypertension was. Seventy eight percent of all the employees alluded high blood pressure to being caused by stress.
Among the causes of hypertension, 103 (48.6%) employees correctly reported that BP can present without symptoms however there were various signs and symptoms that were reported by the employees as indicated below.
[48]
5.11.1 Signs and symptoms of hypertension as reported by employees
n=213 90 80 70
60 50
40 frequency 30 20 10 0 poor vision asymptomatic edema diziness headache palpitations don't know signs and symptoms
Figure 11; Signs and symptoms of hypertension as reported by Vubachikwe Mine employees;
Hypertension awareness, treatment and control study, 2013
Palpitations, headache and dizziness were the most reported signs and symptoms although edema and loss of vision were mentioned to be pointers of high blood pressure.
On complications of hypertension, death was most commonly reported by 70% (149) of respondents followed by stroke 22.5% and heart failure 9.9%. Renal failure and blindness were also reported however 15% did not know of any complication of untreated high blood pressure.
[49]
5.12 Risk factors for developing high blood pressure
Table 12; Risk factors for developing high blood pressure; Hypertension awareness, treatment and control, Vubachikwe mine, 2013
Frequency n=213 %
High fat intake 95 44.60
High salt intake 60 28.17
Excess alcohol intake 13 6.10
Hereditary 10 4.69
Smoking 10 4.69
Obesity 10 4.69
Don't know 83 38.97
High fatty food intake (44.6%) and high salt intake (28.2%) were reported as the most common risk factors in developing high blood pressure. Smoking, hereditary and obesity were also mentioned by respondents. Thirty eight percent had no knowledge of any risk factor.
Regarding prevention and control of blood pressure, reducing fatty foods (42.3%), treatment with anti-hypertensives (29.6%), reducing salt intake (27.2%) and regular exercise (12.7%) were commonly reported. Avoiding excess alcohol intake and avoiding smoking were reported by 3.8% of respondents respectively. Of note, 27.7% did not know any preventive measures of control activities against high blood pressure.
[50]
5.13 Possible reasons for defaulting blood pressure treatment
Table 13; Possible reasons for defaulting blood pressure tablets as reported by the employees; Hypertension awareness, treatment and control study, Vubachikwe Mine, 2013
Possible reason for defaulting n=213 % blood pressure treatment
Beliefs 73 34.4
Toxic to the Body 35 24.9
Ignorance 26 12.2
Afraid of Addiction 21 9.9
Lifetime Treatment 10 4.7
Healed by Divine Powers 2 0.9
Don't Know 28 13.1
Among all the employees, 34.4% said taking antihypertensive medication was against general beliefs in the community hence it was likely patients would refuse to start or default blood pressure medications. Twenty five percent alluded to medication being believed to be toxic to the body, while 12.2% said it was out of ignorance and 10% said it was out of fear of addiction. Interestingly 2 employees said blood pressure is healed using divine powers hence the need to stop medication.
[51]
5.13.1 Actual reported reasons for defaulting anti-hypertensive therapy among
employees taking blood pressure medication
Table 14; Actual reported reasons for defaulting anti-hypertensive therapy among employees taking blood pressure medication; Hypertension awareness, treatment and control,
Vubachikwe Mine, 2013
Reasons for default n=28
Stock out at mine clinic 2
Tablets make me sick 1
To avoid addiction 5
Treatment was not effective 3
Was using other alternatives 2
Was feeling much better 15
The majority of employees who defaulted treatment (15/28) cited they were feeling much better, 5/28 were avoiding addiction, 3/28 believed treatment was not effective while 2/28 were resorting to other alternatives to treat blood pressure hence the need to default. Two employees defaulted when there were stock-ruptures at the mine clinic as they could not afford to procure from private sector and one cited that the medication was making them sick.
[52]
6 CHAPTER 6:
6.1 Discussion
The prevalence of hypertension increases with an increase in age.30,31,34 In this study we demonstrated that awareness of blood pressure increased with age so is compliance to antihypertensive therapy. The younger employees are less aware of hypertension and are less likely to take antihypertensive treatment even if they are made aware of the condition.34,35
The society believes that when someone is still young even if they are diagnosed of high blood pressure they should not take medication as they are wary of medicinal side effects and toxicity. Increase in age is an independent factor associated with being diagnosed with hypertension and was statistically significant.1, 7, 35, 36 This finding was also reported in a study done in Ghana by Agyemang in 2006.14
It is biologically plausible that men have higher prevalence of blood pressure as compared to women. In our study we proved that men were more likely to be diagnosed with hypertension as compared to women. Studies done in Sub-Sahara Africa confirm that hypertension is higher in males that in females.33, 34, 35
A prevalence of hypertension of 27% is comparable to the general population in
Matebeleland South province. This is much higher that the prevalence quoted in some studies for Sub-Sahara Africa of 16.2%.33, 36 In 2004 Zimbabwe reported a 34% prevalence of hypertension in the healthy adult population.12 This is comparable to NHANES study done in the United States of America where they reported that for the population above the age of 20 years there is a hypertension prevalence of 33%. This calls for a dynamic shift in mindset and
[53]
channel resources towards improved diagnosis, management and mitigation for non- communicable diseases, hypertension included.5, 33 This is so because the prevalence of hypertension is higher than the prevalence of some communicable diseases which were receiving attention from health practitioners and decision makers at various levels in management.36
Having a family history of high blood pressure was associated with developing hypertension and this is biologically plausible.35 However other associated risk factors such as history of stroke, smoking and alcohol intake were not statistically significant but showed that they were associated with increased risk of developing hypertension.1,8, 36 Social habits such as alcohol intake were not a major problem in the community as most employees who reported consuming alcohol were social drinkers who would consume only on pay-days. This is so because the majority of employees earn meager salaries that are not enough to sustain the social habits and provide food for the family.
The employees who default medicines are 34.7%. This is happening in a set-up where the employer foots the medical bills for treatment in total. A few employees defaulted treatment when there were stock ruptures of antihypertensive therapy at the mine. This needs commitment from the management to ensure that therapy for employees is readily available as they have displayed no capacity to be self sufficient in procuring for their medical needs in case treatment is not readily available at the public health facility. This has risks in that these employees will present with complications of hypertension turn will increase medical bill for the employer who risks lost time shifts due to illness whilst starring reduced productivity.
[54]
70% of employees that are on medication have well controlled blood pressure though it is the intermittent defaulters and the full time defaulters who constitute 30% which needs to be focused on. In Sub-Sahara Africa there is poor awareness, diagnosis and control of hypertension.30, 36 This community has better awareness, diagnosis and control of hypertension comparing to rest of the community. This is contrary to studies reported by the
Centre for Disease Control and prevention CDC in 2012 where more than 50% of hypertensive patient do not have well controlled blood pressure.2 This shares findings with a study done in concession by Mungate et.al (2012) where about 41% hypertensive patients were not on treatment. 19 Default is happening despite the health education messages that are generated from the mine clinic even though cost of medical care is free to the employees.
Some employees allude to the use of alternative medicines for management of blood pressure. This was also noted as a factor that contributes to them defaulting treatment. Herbs, traditional healers and divine powers were touted as some remedies to hypertension. Such misconceptions would need positive reinforcement with medications as long as beliefs and values are respected so as not to promote passive or militant resistance from the community.
In this study, highest salary earners were more likely to be diagnosed with hypertension while the least earners were less likely to be diagnosed of hypertension considering the middle level earners as a baseline. This could be so because those that earn the most are the more educated who are the bosses at work, who live a more sedentary lifestyle and perform less vigorous work and can afford a diet that can contribute as risk factors for blood pressure development.32, 34
[55]
Similarly, those staying in the urban setup had a higher prevalence compared to those staying at the mine compound. This is comparable to studies where an urban population has higher prevalence of hypertension than semi-urban populations.30, 31 The STEPS survey reports that some individuals in the society have adopted a sedentary lifestyle and poor eating habits that are modifiable risk factors for developing hypertension.12 On the contrary the least paid are heavy manual workers who are physically fit and they do not afford a sedentary lifestyle and thus are less likely to develop hypertension.7
Obesity was not a problem in this mining community as most of the employees had normal body weight. However, some employees were actually underweight. The prevalence of diabetes was 1.4%. This is comparable to a diabetes prevalence of 1.8% reported by the
STEPS survey in 2005 for Zimbabwe.12 One employee was diagnosed of diabetes mellitus during the study and was sent for appropriate treatment. Interestingly, of all the diabetics, none of them was hypertensive. This is contrary to the findings reported by WHO which reported that about 60% of diabetic patients have hypertension.1 Therefore in this study, it could not be established that diabetes was a co-morbid condition in hypertension. Screening for diabetes mellitus was not a common practice at the mine. Diabetes was not very commonly diagnosed among these mine employees is that during initial screening if one is known to be diabetic they are disqualified from employment in the mining environment.
Poor knowledge on the causes, signs, symptoms, prevention and control was evident among the employees. It important to note that hypertension will not present with any signs and symptoms.2,7 However, hypertension could give rise to early-morning headache, nosebleed, irregular heartbeats, nausea, vomiting, anxiety and chest pains.1 These signs and symptoms [56]
cannot be relied upon but rather a physical measurement of blood pressure is done and interpreted.
The majority of mine workers were male workers due to the nature of works that are involved in the industry. Women were doing menial jobs such as making tea and secretarial duties.
The mining environment demands heavy manual work and less of technical expertise from the majority of its employees, thus only 8% have attained tertiary qualifications. Most employees are unskilled and semi-skilled employees that are trained on-job. This has an impact on their health seeking behaviors and their perceptions to “silent killer” diseases as hypertension. This was evident in that knowledge on complications was poor.
6.2 Study Limitations
The numbers of females that were employed by the mine and subsequently participated in the study was small and thus it was not possible to analyze and compare hypertension rates across gender. This was because the females that work at the mine are few and thus ultimately we sampled a representative number of women in the employee population. This sample is thus not representative of the general population and thus conclusions cannot be applicable in generality but to a specific group of individuals in the population. Workers are retired after attaining the age of sixty years and thus the age specific prevalence of hypertension for this population may not be a true reflection of the general trends in the general population.
[57]
7 CHAPTER 7
CONCLUSION AND RECOMMENDATIONS
7.1 Conclusion
The prevalence of hypertension at Vubachikwe mine is high at 27.2% and is comparable to the prevalence in the general population. Ageing, family history of hypertension and a sedentary lifestyle were significantly associated with developing hypertension. Heavy manual work and receiving a minimum band salary were associated with lower risks of being diagnosed of hypertension. There was poor knowledge on hypertension causes and prevention and control measures. Awareness of hypertension among employees was very high as most had been screened during clinic visits. The majority of employees had well controlled blood pressure while on treatment however there were unacceptably high numbers of employees who were defaulting medication. The reasons for default included a sense of feeling much better and ignorance on the part of employee due to lack of knowledge.
7.2 Recommendations
7.2.1 Vubachikwe mine clinic staff to come up with health education messages aimed to
improve knowledge of employees on hypertension. This should target lifestyle
changes including need to exercise and eating less fatty foods. Strategies that may
work include; conducting health talks during parades where information on non-
communicable diseases is discussed, hypertension included. Employees who
displayed good knowledge and analogy of how hypertension develops may be used as
opinion leaders for disseminating hypertension health education messages. [58]
7.2.2 Information, education and counseling (IEC) materials on hypertension should be
developed. These can be in form of posters, flyers, question and answer competitions
where T-shirts, hats or caps. Other health information dissemination strategies that
can be used include contracting local drama groups that perform in and around the
mine to conduct awareness plays that will be conveying information to the mining
community – Vubachikwe Mine Management
7.2.3 There is need to initiate a surveillance system on hypertension where there is
encouragement of high risk employees, those with a family history of hypertension to
undergo regular blood pressure checks possibly every 3 months to enable early
detection of hypertension – Vubachikwe Mine Clinic Staff
7.2.4 To improve on the defaulters, there is need to engage employees who default using
their peers who demonstrated good appreciation of the need to comply with
medication. These will be treatment buddies that are mine workers who are currently
on treatment and have demonstrated compliance themselves – Vubachikwe Mine
Management
7.2.5 The clinic should follow up defaulters by using community health workers who report
to the clinic nurse. These cadres can be identified and incentivized by the mine
management – Clinic Staff
[59]
7.2.6 Clinic staff should adopt the practice documenting height of patients and subsequently
calculate BMI so as to keep track of the weight grading of employees so that they can
be advised accordingly. This is an improvement since they routinely collect weights
of employees, however a BMI can be used as a better indicator to some risk factors
for hypertension.
7.2.7 The clinic staff to introduce routine screening of blood sugar when conducting
periodical medical examinations so that diabetics may be picked early and appropriate
management is instituted promptly.
7.2.8 The management should ensure there are resources availed to guarantee adequate
stocks of antihypertensive medication so as to avoid stock ruptures and subsequent
defaulters to treatment because there will not be readily available tablets.
7.3 Public Health Actions
The results of this study have been shared with the Vubachikwe Mine management. The management has pledged to establish a surveillance system for hypertension and to engage community health workers to follow-up defaulters. They have also pledged to set aside a monthly budget specific for the clinic to procure medicines for hypertension, reagents that will be used for screening of diabetes mellitus.
[60]
REFRENCES
1. Hypertension Fact Sheet, Department of Sustainable Development and Healthy
Environments, WHO, September (2011).
http://www.searo.who.int/linkfiles/non_communicable_diseases_hypertension-fs.pdf
(accessed 02/09/12).
2. Medical news today, What Is Hypertension? What Causes Hypertension?
http://www.medicalnewstoday.com/articles/150109.php (accessed 14.10.12)
3. Clinical guidelines for the management of essential hypertension in Zimbabwe, A
manual for the Primary and Secondary care workers Ministry of Health and Child
welfare, Zimbabwe, October (2005)
4. Harrison T.R. Harrisons; Principles of Internal Medicine 16th Edition, Mackgraw Hill
Medical Publishing Division USA (2006) p752-954
5. Riaz K, Hypertension, Medscape , 2012 http://emedicine.medscape.com/article/241381-
overview (accessed 15.10.12)
6. Matenga J.A, Hypertension lecture Notes; unpublished Department of Medicine
University of Zimbabwe, (2009) (unpublished)
7. Epidemiology of Hypertension, Best Practice, BMJ http://bestpractice.bmj.com/best-
practice/monograph/26/basics/epidemiology.html (accessed 15.10.2012)
8. Zimbabwe non-communicable diseases control policy, Ministry of Health and Child
Welfare, (2009)
9. EDLIZ, Ministry of Health and Child Welfare, Zimbabwe, (2011)
10. Katsung. B.G. Basic and Clinical pharmacology 7th Edition 153-155. Appleton and
Lange (1998).
11. BNF 2007 edition, BMJ Publishing House [61]
12. Ministry of Health and Child Welfare Zimbabwe Non Communicable Disease Risk
Factors Preliminary Report (using the WHO STEPwise approach) Ministry of Health and
Child Welfare, (2005)
13. Mufunda J, Chatora R, Nyarango P, Chifamba J, Sparks HV. Prevalence of non
communicable diseases in Zimbabwe: results from analysis of data from the National
central registry and urban survey. Ethnicity and Disease. (2006); 16: 718-722.
14. Agyemang C , Bruijnzeels MA, Owusu-Dabo E, Factors associated with hypertension
awareness, treatment, and control in Ghana, West Africa, Journal of Human
Hypertension (2006) volume 20, page 67–71.
15. Opie L.H, Seedat K.Y, Hypertension in Sub-Saharan African Populations, American
Heart Association (2005) 112:3562-3568.
16. Matenga J, Kitai I, Levy L. Strokes among black people in Harare, Zimbabwe: results of
computed tomography and associated risk factors. Br Med J 1986; 292:1649-51.
17. Mufunda J, Scott LJ, Chifamba J, Matenga J, Sparks B, Cooper R and Sparks H;
Correlates of blood pressure in an urban Zimbabwean population and comparison to
other populations of African origin, Journal of Human Hypertension (2000) 14, 65–73.
Macmillan Publishers Ltd.
18. Banda M, Tshuma C, Shambira G. Trends in non communicable diseases in
Mashonaland Central Province: 1994-2008 (unpublished)
19. Mungati M, Takundwa L, Manangazira P, Factors affecting diagnosis and management
of Hypertension in Mazowe District, Mashonaland Central Province, 2012 (unpublished)
20. Mufunda J , Mebrahtu G, Usman A, Nyarango P, Kosia A, Ghebrat A, Ogbamariam A,
Masjuan M and Gebremichael A; The prevalence of hypertension and its relationship
[62]
with obesity: results from a national blood pressure survey in Eritrea, Journal of Human
Hypertension (2006) 20, 59–65.
21. StockwelD.H, Madhavan S, Cohen H, Gibson G, Alderman M.H, The Determinants of
Hypertension Awareness, Treatment, and Control in an Insured Population, American
Journal of Public Health, (1994) Vol. 84, No. 11
22. Addo J, Smeeth L, Leon D.A, Hypertension In Sub-Saharan Africa A Systematic Review,
American Heart Association, (2007) 50:1012-1018
23. Marwiro A, Marape G, Hwalima Z, Gombe N.T; Prevalence and risk factors for
hypertension among Bulawayo City Council employees, 2010 (unpublished)
24. Vijayaraghavan M, Guozhong He, Pamela Stoddard and Dean Schillinger, Blood
pressure control, hypertension, awareness, and treatment in adults with diabetes in the
United States-Mexico border region, Review of Panamerican Journal (2010); 28(3)
25. Matenga JA, Allain TJ, Wilson AO, Adamchek DJ, Senzanje B, Mushangi E and Gomo
Z. Hypertension management in Zimbabwe-awareness, treatment and blood pressure
control. SAfr Med J (1997); 87(10): 1371-3.
26. Flack M.J, Sica D.A, Bakris G, Brown A.L, Ferdinand K.C, Grimm R.H, et.al,
Management of High Blood Pressure in Blacks, American Heart Association, (2010)
56:780-800
27. Zimbabwe National Statistics Agency, ICF International. Zimbabwe demographic and
health survey 2010-2011. Calverton, Maryland: ZIMSTAT & ICF International Inc. 2012
28. Wyatt SB, Akylbekova EL, Wofford WR, Coady SA, Walker ER, Andrew ME, et al.
Prevalence, Awareness, Treatment, and Control of Hypertension in the Jackson Heart
Study. Hypertension. American Heart Association Journal. (2008); 51:650-656.
[63]
29. Kyung O.H, Yang S.J, Lifestyle Factors Associated With Blood Pressure Control Among
Those Taking Antihypertensive Medication, Asia Pacific Journal of Public Health (2011)
23: 485
30. Addo J, Smeeth L, Leon D.A. Hypertension in Sub-Sahara Africa; A systematic review,
Journal of American Heart Association (2007), 50:1012-1018
31. Oppie L.H., Seedat Y.K. Hypertension in Sub-Sahara Africa; Circulation Journal of
American Heart Association (2005), 112; 3562-3568
32. Shutte A, Schutte R, Huisman H, van Rooyen J, Fourie CM, Malan NT, et.at,; Are
behavioural risk factors to be blamed for the conversion from optimal blood pressure to
hypertensive status in Black South Africans? A 5-year prospective study; International
Journal of Epidemiology, (2012) 41 (4): 1114-1123
33. Twagirumukiza M; De Bacquer D; Kips JG; de Backer G; Stichele RV; Van Bortel LM
Current and projected prevalence of arterial hypertension in sub-Saharan Africa by sex,
age and habitat: an estimate from population studies; Journal of Hypertension; (2011) 29
(7): 1243–1252
34. Edwards R, Unwin N, Mugusi F, Whiting D, Rashid S, Kissima J, Aspray T, Alberti K
GM. Hypertension prevalence and care in an urban and rural area of Tanzania, Journal
of Hypertension; (2000) 18 (2); 145–152
35. Pobe JO, Community-based high blood pressure programs in sub-Saharan Africa, Europe
PubMed Central, (1993) 3 (38) 45.
36. Steyn K, Fourie J, Lombard C, Katzenellenbogen J, Bourne L, Jooste P; Hypertension in
the black community of the Cape Peninsula, South Africa, East African medical journal,
(1996), 73 (11) 758-763
37. OCHA Maps and Graphics Zimbabwe www.unocha.org/zimbabwe/maps-graphics/ocha-
maps-and-graphics (accessed 28/8/13) [64]
APPENDICES
Appendix 1 English Questionnaire
No Question Options
1 How old are you Completed years……..
2 Sex (observe) male female Marital status single 3 married divorced widowed Other (specify)….. Where do you stay? Compound (mine) 4 Low density (mine) Town What is your ethnic origin? Ndebele Shona Sotho 5 Malawian origin Zambian origin Other (specify)……. What is your religion Christianity African tradition 6 Judaism Apostolic (specify)….. Other (specify)….. Does your religion permit you to seek modern medical Yes 7 assistance? No Are you aware of traditional remedies used to treat Yes 8 hypertension? No What is your highest educational level? None 9 Primary Secondary Tertiary 10 What is your occupation? Job………………….
11 Job description skilled unskilled
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Number of years working in mining environment? No of completed years 12 ……………………. What is your monthly income? < US $300 13 US$300-600 >US$600
14 How many dependents do you have? No. of dependents ………………….. 15 Have you ever consumed alcohol? Yes No (skip to Qn 15) In the past 12 months, have you frequently taken 5 or more days/week alcohol? 1-4 days/week 16 1-3 days/month Less than once a month Have you ever smoked (cigarette, snuff, pipe, chew) Yes 17 tobacco? No (skip to Qn 19) 18 Do you currently some? Yes No (skip to Qn 18) On average how many of the following do you smoke Manufactured per day. cigarettes……….. Hand rolled cigarettes 19 ……… Tobacco pipe filling …………. If currently non smoker, did you regularly smoke in the Yes 20 past? No 21 In a typical week, how many days do you eat fruits? No. of days ………………… 22 In a typical week, how many days do you eat No of days…… vegetables?
Do you often add salt to your food on the table? Yes 23 No What type of oil/fat is mostly used to prepare food at Vegetable oil your home? Animal fat 24 Margarine Peanut butter None Does your work involve mostly sitting or standing with Yes (skip to Qn 25) walking for less than 10 minutes? 25 No Does your work involve vigorous activity (heavy lifting, Yes digging, construction work) for at least 10 mins at a No (skip to Qn 27) 26 time? 27 How many days in a week do you work? No. of days [66]
…………………. 28 How long is your typical working day? No. of HH MM ………………….. Do you walk (or cycle) continuously for more than 10 Yes mins to get to places? 29 No (skip to Qn 30) In a week, how many days do you walk (of cycle) for at Record No. of days 30 least 10 mins to and from places? ……………………. On a typical day, how much time do you spend walking Record in hours & 31 (or cycling). Minutes (HH MM) ………………….. Does your recreation, sport or leisure time involve Yes mostly sitting with no physical activity lasting more 32 than 10 mins at a time? No 33 Do you do vigorous activities like running, strenuous Yes sports or weight lifting for at least 10 mins at a time? No (skip to Qn 34)
If yes, how many days do you do this form of exercise? Record No. of days 34 ……………………….. How much time in a day do you spend doing this? Record in hours & 35 minutes HH MM ……………………… 36 In your leisure time do you do moderate activities such Yes as brisk walking, cycling for at least 10 mins at a time? No (skip to Qn 37) How many days do you do moderate activities in a Record number of days 37 week? ………………………. How much time do you spend doing this? Record time in Hours & 38 minutes (HH MM) ………………….. In the past 7 days how much time in a day did you spend Record number of hours 39 sitting or reclining? in a day …………………… Is there anyone in your family (parents or siblings) who Yes suffered / has hypertension? 40 No Is there anyone in your family who suffered the following complications of 41 hypertension?
A Heart failure Yes No B Stroke Yes No C Kidney failure Yes No Is there anyone in your family suffering from diabetes? Yes
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42 No 43 What is high blood pressure? correct false What causes hypertension? Unknown Drugs Witchcraft 44 Old age Stress Other (specify)……. What are the signs and symptoms of high blood asymptomatic pressure? headache 45 palpitations Poor vision Dizziness Other (specify)……… Can one have hypertension without any signs and Yes 46 symptoms? No What can result if blood pressure remains untreated? stroke Heart failure Kidney failure 47 Loss of sight Death Don’t know What are the risk factors of developing high blood Hereditary pressure? Smoking 48 Obesity High fat intake Excess alcohol intake High salt intake Don’t know How can you prevent/ control hypertension? Minimize salt intake Reduce fatty foods
49 Avoid excess alcohol Avoid smoking Regular exercise Taking antihypertensives Why do people not like taking/ default antihypertensive Toxic to the body therapy? Against general beliefs 50 BP is curable Other (specify) When last was your blood pressure checked by a health Within the past 12 months professional? 1-5 years ago More than 5 years ago 51 Never before
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52 Have you been diagnosed of hypertension? Yes
No Has your blood sugar been checked in the past 12 yes months? No 53 54 Do you have diabetes mellitus? Yes No (skip to Qn 54) Are you taking medication for diabetes mellitus? Yes 55 No Do you have HIV disease? Yes 56 No Don’t know Have you ever taken medication for hypertension? Yes 57 No (skip to Qn 63) If yes, have you taken medication regularly in the past 2 Always regularly taking weeks? Intermittently as needed 58 Not taking 59 If not taking, when did you stop? Give date DD/MM/YY ………………… 60 Give reasons for stopping? …………………….. Where are you being treated for hypertension? Mine clinic Private doctor 61 Public hospital Other (specify)…… When last was your blood pressure checked? < 1 month ago 62 2-4 months ago >4 months ago Is your blood pressure well controlled? Yes 63 No Don’t know What medication are you taking for hypertension? List 64
65 Have you ever defaulted treatment? Yes No(skip to Qn 65)
Why did you default? Feeling much better Tablets make me sick Treatment is not effective To avoid addiction 66 Developed side effects Was trying alternative [69]
remedies Other (specify)……. Have you visited a traditional healer for hypertension related illnesses in the past year? Yes 67
No Are you currently taking herbal remedies for Yes 68 hypertension? No
How much stress do you feel in your normal life? Very severe
69 severe
some
Hardly ever
PHYSICAL MEASUREMENTS
70 Height measured to the nearest 0.1 cm Height (cm) 71 Waist circumference to nearest 0.1 cm Weight (cm) 72 BODY MASS INDEX In Kg/m2 73 Hip circumference to nearest 0.1 cm 74 Waist-hip ratio Blood pressure reading (to be 5 minutes apart) SBP1 DBP1 75 SBP2 DBP2 Did you eat or drink anything other than water in the last Yes (if yes obtain RBS 76 12 hours?
No
77 Random blood sugar (mmol/l) ………….mmol/l
[70]
Appendix 2 Ndebele Questionnaire
Mbuzo Umbuzo Izahluko 1 Uleminyaka emingaki? iminyaka…….. 2 Ubulili (observe) ungowesilisa ungowesifazane Utshadile na? Awukendi/ukuthatha 3 utshadile lehlukana wafelwa okunye (caca)….. Uhlala kuphi? Enkomponi (mine) 4 Emayadini (mine) Edolobheni Ungumhlobo bani? Ndebele Shona Suthu 5 Ovela eMalawian Ovela eZambia okunye (caca)……. Ulandela inkolo iphi? ungukrestu ungowezomdabuko 6 ungumjuda ulipostoli (caca)….. okunye (caca)….. 7 Inkolo yakho iakuvumela ukucinga uncedo Yebo kubomongi ungagula na? Hatshi Kulezihlahla ozaziyo ezisetshenziswa Yebo 8 ukwelapha i BP na? hatshi Ufunde wafika kuliphi ibanga esikolo? Awuzange ufunde 9 Imfundo ephansi Imfundo yaphakathi Imfundo yaphezulu 10 Umsebenzi wakho ngowani? umsebenzi………………….
11 wafundela yini umsebenzi wakho? Wawufundela ekolitshini awuwufundelanga Uleminyaka emingaki usebenza emgodini? Usebenze iminyaka emingaki 12 …………………….
Uhola malini ngenyanga? < US $300 13 US$300-600 >US$600 14 Ugcina abantu abangaki? Ugcine abantu abangaki [71]
………………….. 15 Sowake wanatha utshwala empilweni yakho? Yebo
hatshi (yeqa uye kumbuzo 15)
Kulezinyanga ezilitshumi lambili ezidluleyo Amalanga angadlula amahlanu unathe kangaki? ngeviki 16 Amalanga angadluli amane ngeviki Amalanga angadluli amathathu ngenyanga Onganathanga ngenyanga Sewake wabhema igwayi na? Yebo 17 hatshi (yeqa uye kumbuzo 19) 18 Okwamanje uyabhema na? Yebo hatshi (yeqa uye kumbuzo 18) Ngelanga, ubhema igwayi elilandelayo Imhlanga ethengwa igoqiwe elingaki? (mingaki)……….. Ugwini (elokugoqa)………… 19 Ingidi (kangaki)…………. Kudala waubhema nsuku zonke na? Yebo 20 hatshi 21 Ngeviki udla izithelo kangaki? Amalanga amangaki ………………… 22 Ngeviki udla imbida kangaki? Amalanga amangaki ………………….. Uyengeza isawudo ekudleni ngamalanga na? Yebo 23 hatshi Lisebenzisa amafutha waphi uma lipheka cooking oil ngekhaya? amahwahwa 24 imajalina idobi Kumbe kungela Uma usebenza uyabe uhlezi nokuhambahamba okungadluli imizuzu Yebo (yeqa uye kumbuzo 25) 25 elitsumi na?
hatshi Ungabe umsebenzi wakho usebenza Yebo ngamandla okwenza uphefumulele phezulu 26 okwesikhathi esidlula imizuzu elithsumi na? hatshi (yeqa uye ku 27) 27 Usebenza amalanga amangaki ngeviki? Amalanga amangaki …………………. 28 Usebenza amahola amangaki ngelanga? Amahola lemizuzu emingaki [72]
………………….. Ungabe uhamba ngenyawo kumbe utshova Yebo ibhayisikili okwemizuzu edlula itshumi? 29 hatshi (yeqa uye kumbuzo 30) Ngeviki okwenza kangaki lokhu? Amalanga amangaki 30 ……………………. Ngelanga uthatha imizuzu emingaki uhamba? Amahola lemizuzu emingaki 31 (HH MM) ………………….. Ucitha isikhathi sokujabula uhlezi kungelala Yebo kuginqa na? 32
hatshi Uyenza imidlalo loma ukuzithokozisa Yebo okudinga amandla amakhulu njengokudlala 33 ibhora, ukugijima kumbe ukuphakamisa hatshi (yeqa uye kumbuzo 34) insimbi?
Ukwenza lokhu okwamalanga amangaki Loba inani lamalanga 34 ngeviki?) ……………………….. Uthatha ibanga elingakanane usenza lokhu? Loba amahola lemizuzu (HH 35 MM) ……………………… 36 Uyazijabulisa ngendlela engadingi amandla Yebo amakhuku okwenza ukhefuzele njengokutshistha kumbeni ukutshova hatshi (yeqa uyeku mbuzo 37) ibhayisikili na? Ukwenza okwamalanga amangaki ngeviki Loba inani lamalanga 37 lokhu? ………………………. Kukuthathata isikhathi esingakanani ngelanga Loba amahola lemizuzu (HH 38 lokhu? MM) ………………….. Okweviki elidluleyo uqede isikhathi 39 aesingakanane ucambalele ungenzi lutho Loba inani lamahola ngelanga ngelanga? …………………… 40 Ukhona na emulini yangakini olomkhuhlane Yebo we BP? hatshi 41 Ukhona emulini owagula imikhuhlane elandelayo na?
A Owe nhliziyo ovuvukisa inyawo? Yebo hatshi B Ukufa uhlangothi? Yebo hatshi C ukungasebenzi kezinso? Yebo hatshi [73]
Ukhona emulini olomkhuhlane wetshukela? Yebo 42 hatshi 43 Kuyini I BP? kuqondile akuqondanga Ibangelwa yini i BP? akwaziwa Amaphilisi lezidakamizwa ukuloywa 44 ukuluphala Ukukhathazeka emngqondweni Okunye (caca)……. Umuntu ole BP, uzwa ngani ukuthi ulawo Ukungatshengiseli lomkhuhlane? kwezibonakaliso 45 Ukutshaywa likhanda Ukutshaya kwenhliziyo ngamandla Ukufiphala emehlweni olesiyezi Okunye (caca)……… Umuntu angaba lomkhuhlane lowu engezwa Yebo 46 buhlungu emzimbeni na? hatshi
Kungenzakalani nxa ulomkhuhlane we BP ungabayisigoga ungelatshwanga Heart failure Kidney failure 47 ungabayisiphofu Ungalahlekelwa yimpilo Angikwazi Kuyini okungezelela amathuba omuntu ukuthi kungabangokosendo abe le BP? ukubhema 48 Ukuzimuka okudlulisileyo Ukudla okulamafutha amanengi ukudakwa Itswayi elinengi Angikwazi Ungavikela kumbe iyelathswa njani yona i Yehlisa inani letswayi ekudleni BP? Yehlisa ukudla okulamafutha
amanengi 49 Unganathi utshwala okudlulisileyo Angabhemi
Ukwelula umzimba sikhathi sonke Kukunatha amapilisi ayehlisa iBP Kungani abantu bengathandi ukunatha/ Anangangcolisa umzimba [74]
besekela ukunatha amapilisi eBP? Aphikisana lenkolo yabo 50 iBP iyelapheka Okunye (caca) Wacina nini ukukhangelwa i BP? Kungakedluli umnyaka Kungakedluli iminyaka emihlanu 51 Okwedlula iminyaka emihlanu Angikaze ngihlolwe 52 Wake wabanjwa umkhuhlane we BP? Yebo hatshi Uke wahlolwa umkhuhlane wetshukela Yebo enyangeni ezilitshumi lambili ezidluleyo? hatshi 53 54 Ulomkhuhlane wetshukela? Yebo hatshi (yeqa uyekumbuzo 54) Uyanatha amaphilisi etshukela na? Yebo 55 hatshi Ulegcikwane elibangela ingulamakhwa na? Yebo 56 Hatshi angikwazi Sewake wanatha amapilisi eBP empilweni na? Yebo 57 Yeqa uye kumbuzo 63) Uma kunjalo, ube unatha na amaphilisi Ukunatha sikhathi sonke emavikini amabili adluleyo? Nginatha sekulendingeko 58 anginathi 59 Uma wayekela ukunatha ume nini? Phana usuku DD/MM/YY ………………… 60 Isizatho sokuma yikuyini? …………………….. Uyelatshwa ngaphi i BP yakho? Ekilinika ye-mine Kudokotela wami 61 esibhedlela Okunye (caca)…… Ucine nini ukuhlolwa i BP? Inyanga edluleyo 62 Inyanga ezimbili kusiyakwezine kunyanga ezine ezedluleyo Iyehliseka na i BP yakho? Yebo 63 Hatshi Angikwazi Unatha waphi amaphilisi we BP? Waqambe 64
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65 Wake wekela ukunatha amaphilisi eBP na? Yebo Hatshi (yeqa uye kumbuzo 65) Isizatho kuyini? Ubususizwa ngcono Amaphilisi ayangigulisa Amaphilisi awangenzeli ngcono Ukubalekela ukuphila ngawo 66 Avusa eminye imikhuhlane Bengidinga okungangisebenzela Okunye (caca)……. 67 Uke wavakatshela inyanga ukuze welatshwe Yebo in BP? Hatshi
68 Kulezihlahla ozinathayo ukwelapha i BP na? Yebo
Hatshi Uzizwa uhlukumezeke kangakanani? kakhulu
okunganeno 69 kancane Angihlukumezekanga
OKULINGANISWAYO EMZIMENI
70 Ubude (cm) 71 Isisindo (Kg) 72 BODY MASS INDEX In Kg/m2 73 Ubude obulinganisiweyo emilenzeni kwi 0.1 Imilenze (cm) cm 74 Waist-hip ratio iBP (ethstiyene ngemizuzu emihlanu) SBP1 DBP1 75 SBP2 DBP2 Uke wadla kumbe ukunatha okwamahola yebo (uma kunjalo thatha igazi 76 alithsumi lambili adhluleyo? lokuhlola itshukela)
hatshi
77 Isilinganiso setshukela egazini (mmol/l) ………….mmol/l
[76]
Appendix 3 Shona Questionnaire
Mubvunzo Mhinduro 1 Mune makore mangani? Makore akazara…….. 2 (Tarisa kuti) murume mudzimai Makaroora kana kuroorwa here? Handina kuroor(w)a 3 Ndkaroor(w)a takarambana ndakafirwa Zvimwe(tsanangura)….. Munogara kupi? Mukomboni (pano) 4 Kumayadhi Kudhorobha Muri werudzi rupi? Ndebele Shona Sotho 5 Veku Malawi Veku Zambia Zvimwe(tsanangura)…. Munotevedzera chitendero chipi? Chikirisitu chivanhu 6 muJudha Mupositori(upi)….. Zvimwe(tsanagura)….. Chitendero chenyu chinokubvumirai here kuuya hongu 7 kuchipatara here? kwete Pane midzi yamunoziva inoshandiswa kurapa BP? hongu 8 kwete Makadzidza kusvika papi kuchikoro? Handina kudzidza 9 Makore sere chete Fomu yechina Kupfuura fomu yechina 10 Monoita basa rei pano? Basa…………………. 11 Makadzidzira basa iri here? Basa rakadzizdirwa Basa risina kudzidzirwa 12 Mava nemakore mangani muchishanda mumigodhi? makore…………… Munotambira marii pamwedzi? Pasi pemazana matatu 13 Mazana matatu kusvika pamatanhatu Kupfuura mazana matanhatu
14 Munochengeta vanhu vangani? Huwandu hwevanhu vanochengetwa……………
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15 Makambonwa doro here muhupenyu hwenyu? hongu
Kwete (chino pindurura mubvunzo 15) Mugore rapfuura mainwa doro kawanda sei? Kudarika mazuva mashanu pasvondo 16 Kamwe kusvika kana pasvondo Kamwe kusvika katatu pamwedzi Kamwe kana kusanwa pamwedzi Munosvuta fodya here? hongu 17 kwete (chinopindura mubvunzo 19) 18 Muchiri kuputa here? hongu kwete (chinopindura mubvunzo 18)
19 Pazuva rimwe, fodya idzi munosvuta ngani? mdidzanga……….. chimonera…………
Ye chikwepa…………. Kare maisvuta mazuva ose here? hongu 20 kwete 21 Michero munoidya kangani pavhiki? Mazuva magani? ………………… 22 Munodya muriwo kangani pavhiki? Mazuva managani? ………………….. Munowedzera sauti mukudya kwabikwa mazuva hongu 23 ose here? kwete Munoshandisa mafuta api pamunobika kumba? Mafuta emuzvirimwa Mafuta enyama 24 Majrinhi dovi hapana Munoshanda mugere here zvekuti munofamba hongu (chinopindura kwemaminitsi ari pasi pegumi? mubvunzo 25) 25 kwete Basa renyu rakaomarara here zvekusimudza hongu zvinorema, kuchera kana kuvaka kwenguva 26 inodarika maminitsi gumi panguva? kwete (chinopindura mubvunzo 27) 27 Munoshanda mazuva mangani pavhiki? Mazuva mangani?……… [78]
28 Minoshanda maawa mangani pazuva? Maawa nemaminitsi mangani?………… Munofamba netsoka kana kuchovha bhasikoro hongu kwemaminitsi anopfuura gumi here? 29 kwete (chinopindura mubvunzo 30) Munozviita kangani izvi? Mazuva mangani?……. 30 Munotora nguva yakareba sei muchifamba kana Maawa nemaministi 31 kuchovha? mangani?……… Pakutandara munenge makagara here zvekudarika hongu maminitsi gumi? 32 kwete Munotandara muchiita mitambo inodikitirisa here, hongu sekutamba bhora, kumhanya kana kusimudza simbi? 33 kwete(chinopindura mubvunzo 34)
Zvemazuva mangani pavhiki? Mazuva mangani?……. 34 35 Kwenguva yakareba zvakadini? Maawa nemaminitsi mangani?……… 36 Munozvifamdza nekuita zvisingade samba hongu rakawanda sekufambisa kana kuchovha bhasikoro kwete(chinopindura here? mubvunzo 37) Zvemazuva mangani pavhiki? Mazuva mangani? 37 ………………………. Kwenguva yakareba sei pazuva? Mazuva nemaminitsi 38 mangani?………… Musvondo rapfuura munopedza nguva yakareba sei Mazuva mangani? 39 makazvambarara muchizorora? …………………… Pane ane BP mumhuri yekwenyu here? hongu 40 kwete
41 Pane wemumhuri akamborwara nezvirwere zvinotevera?
A Chirwere chemoyo chinozvimbisa makumbo? hongu kwete B Kufa mutezo? hongu kwete C Chirwere chi itsvo? hongu kwete Pane wemumhuri ane chirwere cheshuga? hongu 42 kwete 43 Chii chinonzi BP? ndizvo
[79]
hazvisizvo Inokonzereswa neiko iyo BP? hazvizivikanwe mishonga kuroyiwa 44 Kuchembera/kukura kushungurudzika Zvimwe(tsanangura)……. Munhu ane BP anonzwa sei kuti anayo kana kuti Hapana yakakwira? Kutemwa nemusoro 45 Kurohwa nehana Kusanyatsoona mumaziso dzungu Zvimwe(tsanangura)……… Munhu anogona here kuva ne BP asina chaanonzwa hongu 46 kurwadza mumuviri wake here? kwete Chii chinogona kuitika kana kukanganisika Kufa mutezo mumuviri nekuda kwe BP? Chirwere chemoyo Kufa itsvo 47 Kufa maziso rufu handizive Zvinogona kupa munhu mukana wekuita BP Zvinofamba nemuropa ndezvipi? remhuri 48 Kuputa fodya kufutisa Kudya zvinemafuta akawanda Kunwa doro zvakanyanya Kudya munyu wakawanda handizive BP inodzivirirwa kana kurapwa nei? Kudya munyu mushoma Kudya zvine mafuta mashoma
49 Kusanwa doro rakawandisa Susiya fodya Kushandisa muviri Kunwa mapiritsi eBP Sei vanhu vasingade kunwa mapiritsi eBP? Anouraya muviri Haafambirane nezvatinoziva 50 BP inorapika Zvimwe(tsanangura)…. Makaguma rinhi kutariswa BP? Mumwedzi gumi nemiviri yapfuura Pava negore kusvika mashanu 51 Mushure memakore mashunu akapfuura handisati [80]
52 Makambobatwa chirwere cheBP here? hongu kwete Makambotariswa chirwere cheshuga mugore hongu rapfuura here? 53 kwete 54 Mune chirwere cheshuga here? hongu kwete (chinopindura mubvunzo 54)
Munonwa mapiristi eshuga here? hongu 55 kwete Mune chirwere cheshuramatongo here? hongu 56 kwete handizive Makambonwa mapiritsi eBP here? hongu 57 kwete (chinopindura mubvunzo 63)
Naizvozvo, mumasvondo maviri apfuura manga Nguva dzose muchianwa mazuva ose here? Pandinenge ndonzwa kuti 58 yakwira Handinwi
59 Kana musisanwe makaregera rinhi? Nyora zuva……………
60 Zvikonzero zvekuregera kunwa zviri zvei? ……………………..
Munorapwepi BP yenyu? Kirinika yepamugodhi Chiremba wangu 61 Chipatara chehurumende Zvimwe(tsanagura)……
BP yenyu yakapezdesera rinhi kutariswa? Mumwedzi uno 62 Mwedzi miviri kusvika mina yapfuura Kupfurikidza mwedzi mina yapfuura Yakadzika here? hongu 63 kwete handizive Munonwa mapiritsi api eBP? Nyora 64
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65 Pane pamakamborega kunwa mapiritsi eBP? hongu kwete(chinopindura mubvunzo 65) Chikonzero chaiva cheyi? Ndanga ndava kunzwa zviri nani Mapiritsi aindirwarisa Mapiritsi aisashanda 66 Ndaisada kujairira mapiritsi Ndaisafambirana namapiritsi Ndairapwa nedzimwe nzira Zvimwe(tsanangura)……. Makamboenda kun’anga kunorapwa BP here? hongu 67 kwete 68 Pane midzi yamunonwa yekurapa BP here? hongu kwete Mungati munoshungurudzikana zvakadini zvakanyanyisisa muhupenyu hwenyu? zvakanyanya 69 ndizvowo kana
ZVINOONGORORWA NEMUTSVAKI
70 Kureba (cm) 71 Huremu (kg) 72 BODY MASS INDEX In Kg/m2 73 Hip circumference to nearest 0.1 cm 74 Waist-hip ratio Blood pressure reading (to be 5 minutes apart) SBP1 DBP1 75 SBP2 DBP2 Mambodya here zvisiri kunwa mvura mumaawa hongu (tora ropa rekutarisa 76 gumi nemaviri apfuura? shuga) kwete
77 Huwandu hweshuga muropa ………….mmol/l
[82]
Appendix 4 English Consent
(Adapted from the MRCZ Consent Form)
Factors associated with hypertension awareness, treatment and control at Vubachikwe Mine,
Gwanda.
Matabeleland South Province
Principal Investigator Dr. Pugie Tawanda Chimberengwa, [MBChB (UZ)]
Phone number: 0712 436 754
What you should know about this research study:
We give you this consent so that you may read about the purpose, risks, and benefits
of this research study.
The main goal of this research is to gain knowledge that may help you and future
patients.
We cannot promise that this research will benefit you directly.
You have the right to refuse to take part, or agree to take part now and change your
mind later.
Whatever you decide, it will not affect your regular care.
Please review this consent form carefully. Ask any questions before you make a
decision. [83]
Your participation is voluntary.
PURPOSE
You are being asked to participate in a research on: Factors associtated with hypertension awareness, treatment and control at Vubachikwe Mine, Gwanda; Matabeleland South
Province. This study intends to understand the knowledge of employees on hypertension and why some do default treatment while health care and cost of medication is borne by the employer. You were selected as one of the 216 possible participants for this study
PROCEDURES AND DURATION
If you decide to participate, you will undergo an interview, a physical examination where BP; height; weight; blood sugar; waist and hip measurements. Your BP will be measured twice and the average will be recorded. If taken, blood sugar level measurement will involve pricking on your finger and drawing blood. You will be informed of the results of your examination and tests. Appropriate treatment and follow up will be recommended to you. If you are pregnant you may not take part in this study as some of the measurements are not practical, e.g. body mass index, waist –hip ratio. Your participation will only be once and follow up if necessary will be done by your local health workers.
RISKS AND DISCOMFORTS
Discomforts in this study will include taking off the bulk of your clothes while measuring your weight and waist-hip ratio; and pricking while drawing blood for sugar test.
BENEFITS AND/OR COMPENSATION
There will not be any financial or material benefits to you in this study. This study is being conducted to improve awareness, treatment and control of hypertension. This will be the main benefit for the employees at Vubachikwe mine, Matabeleland South Province and
Zimbabwe as a whole. Where necessary, referrals will be recommended for participants. [84]
Those previously not diagnosed will benefit from the fact that their condition has been identified and appropriate treatment will be recommended.
ALTERNATIVE PROCEDURES OR TREATMENTS
If you are found to have any complications you may be referred.
CONFIDENTIALITY
If you indicate your willingness to participate in this study by signing this document, we plan to disclose any information found in this study to the Academic panel of the University of
Zimbabwe and the Ministry of Health and Child Welfare. Results may be shared at different fora but only for the purpose of improving service provision to patients. No personal information will be disclosed to anyone hence the absence of any names on these questionnaires. Any information that is obtained in connection with this study that can be identified with you will remain confidential and will be disclosed only with your permission.
The MRCZ or University panel may need to review your records for compliance audits hence they will be given access to the questionnaires.
ADDITIONAL COSTS
There will be no additional costs to you.
IN THE EVENT OF INJURY
In the rare event of injury resulting from your participation in this study, treatment can be obtained at Vubachikwe Mine clinic. You should understand that the costs of such treatment will be our responsibility. Financial compensation is not available.
In the event of injury, contact me (Dr Pugie Chimberengwa) on 0712436754
VOLUNTARY PARTICIPATION
Participation in this study is voluntary. If you decide not to participate in this study, your decision will not affect your future relations with the mine clinic or its personnel. If you
[85]
decide not to participate, you are free to withdraw your consent and to discontinue participation at any time without penalty.
ADDITIONAL ELEMENTS
Should you decide to withdraw from this study and its procedures you are free to do so. There will be no penalty for withdrawal. Your treatment and follow up will not be affected by your withdrawal from this study.
I may terminate your participation in this study without your consent if your participation puts you at risk. Should this happen to you, I will inform you.
OFFER TO ANSWER QUESTIONS
Before you sign this form, please ask any questions on any aspect of this study that is unclear to you. You may take as much time as necessary to think it over.
AUTHORIZATION
You are making a decision whether or not to participate in this study. Your signature indicates that you have read and understood the information provided above, have had all your questions answered, and have decided to participate.
The date you sign this document to enrol in this study, that is, today’s date, MUST fall between the dates indicated on the approval stamp affixed to each page. These dates indicate that this form is valid when you enrol in the study but do not reflect how long you may participate in the study. Each page of this Informed Consent Form is stamped to indicate the form’s validity as approved by the MRCZ.
______
Name of Research Participant (please print) Date
______
Signature of Participant or legally authorized representative Time [86]
______
Signature of Staff Obtaining Consent
YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.
If you have any questions concerning this study or consent form beyond those answered by the investigator, including questions about the research, your rights as a research subject or research-related injuries; or if you feel that you have been treated unfairly and would like to talk to someone other than a member of the research team, please feel free to contact the
Medical Research Council of Zimbabwe on telephone 04-791792 or 04-791193.
Appendix 5 Ndebele Consent
Okuphathelane lolwazi, ukwelatshwa lokwenqhabela umkhuhlane weBP eVubachikwe Mine, kwelase Gwanda.
Matabeleland South Province
Umqheqheshi omkhulu uDhokotela. Pugie Tawanda Chimberengwa, [MBChB (UZ)]
Inombolo zika makhla ekhukwini: 0712 436 754
OKUMELE UBEKWAZI NGALOLUPHENYO/ UCWAYISISO.
Sikupha lelifomu lokuvuma ukuba ubale ngenjongo, ingozi loncedo lwalolucwayisiso.
Ukwelatshwa kwemihla ngemihla kwenziwa kusetshenziswa indlela ezazakalayo
njalo ezophathesayo kakholo. Kodwa ke injongo mqoka yocwayisiso yilotholaulwazi
olungasiza isigokani kwelizayo.
Asithembisi ukuba lolucwayisiso kuzaba loncedo kuwe. Njengo kwelatshwa
okunjwayelekileyo, uncwayisiso lolu lungahambelami lomzimba.
[87]
Ulelungelo lokwala ukuphatheka kulolucwayisiso kumbe ungavuma khathesi
ubususala ngaphambili.
Iloba kuyini okunqumayo akusoke kuphambanise ukwelatshwa kakho okwejayeleyo.
Bala leli fomu uzwisise okugcweleyo, ungabuza, iloba yiphi imbuzo olayo anduba
wenze isiqumo.
Awubanjwa ngamandla ukuba uphatheke kulocwayisiso
INJONGO.
Ucelwa ukubana ube yingi enye kulolu cwayisiso lolwazi, ukubanjwa lokwenqabela iBP.
Injongo yalolucwayisiso yikuthola isilinganiso sezisebenzi zeVumbabchikwe mine ezilolwazi njalo eziyelatshwa iBP. Wena ke ukhethiwe njengomunye ongaphatheka kulolucwayisiso ngokuba ungesinye isisebenzi salapha emugodini. Izisebenzi zeVumbabchikwe ezingamakhulu amabili aletshumi lesifica munye zizaphatheka kulolucwayisiso.
INQOBO LOBUBANZI BAZO
Unganquma ukuphatheka, uzabuzwa imbuzo ephathelane leminyaka yokuzalwa iyakho, inzuzo, ezempilakahle yakho, ukubhema lokunatha utshwala, physical activity lokwemuli kanye losendo lakwenu. Ngemva kokuphendula imibuuzo uzathathwa iB.P. ubude, isisindo somzimba, ububanzi bekhalo kanye lenqulu kanye legazi lokuxwayisisa ukuthi ungabe ulomkhuhlane wetskukela na.
INGOZI LOKUNGAPHATHEKI KAHLE
Ukuthatha i B.P. kungenza ukungaphatheki kahle kancane kodwa okuphela masinyane uqeda kuthathwa i B.P. Kanjalo uzacelwa ukuthi ukhiphe impahla enengi emzimbeni wako kodwa uzasala ugqokile okulobuntu. Ungakhona ukuzwa ubuhlungu ungahlatshwa umunwe uma kuthathwa igazi lokuhlola itshukela.
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UNCEDO LOKUHLAWULELWA
Asithembisi ukuba uzathola uncedo lokuhlawulwa ngokuphatheka kulolocwayisiso
EZEMFIHLO
Ibizo lakho iloba kuyini okungakhomba wena akusoke kubhalwe ephepheni lembuzo njalo konke okutholakale kulolucwayisiso okhuphathalene lawe kuzahlala luyimfihlo, lungavezwa kuphela ngemvumo yakho.
NXA UNGALIMALA
Nxa ungalimala ngenxa yokuphatheka kwakho kulolucwayisiso ungelatshwa ekikika yalapha eVumbabchikwe. Ungaqhuma udhokotela omkhulu uPugie Chimberengwa kunombolo ezithi
0712436754. Ukubhadalela indleko zokwelatshwa kuzaba ngumlandu wenkampani yeVumbachikwe. Ukubhadalwa imali akukho kulolocwayisiso.
UKUPHATHEKA NGOKUZIFUNELA
Uphatheka ngokuzifunela kulolu cwayisiso. Ungala ukuphatheka akusoke kwaphambanisa ubudlelwano bakho logatisha lwezempilo ekikinika yalapha, kumbe lamakhiwa awalapha emugodhini. Ungaquma ukuphatheka kulolocwayisiso ulelungelo lokutshiya iloba yisiphi esikhathi. Awusoke ujeziswe ungatshiya.
UKUPHENDULWA KWEMBUZO ONGABALAYO
Uyavunyelwa ukubuza yonke imbuzo ongaba ulayo mayelana locwayisiso lolu. Ungathatha isikhathi obona sifanele ukucabangisisa ngalolu cwayisiso andubana usayine lelifomu.
UKUVUMA UKUPHATHEKA
Lapha wenza isinqumo sokuba uyafuna ukuphatheka kulolucwayisiso kumbe hatshi.
Isiginetsha yakho iveza ukuba obale wazwisisa konke osokubethwe ngaphambilini njalo yonke imbuzo obungabe ulayo isiphendululwe ngakho usunqume okhuphatheka. [89]
Nanzelela ukuba ilanga lapho ofaka khona isiginitsha yakho uvuma ukuphatheka alikadluli ilonga elibhalwe kusidindo esisekhasini lonke lalesi sivumelwano. Amalanga la atshengisa ukubana lelifomu liqotho njalo lisafanele ukusentshenziswa. Awatshengisi ukubana lolucwayisiso luzaphela nini.
___/______/_____
Ibizo lakho (maphatheka kulolocwayisiso) (Ilanga lanamuhla)
______
Isiginitsha kamaphatheka Isikhathi
______
Isiginitsha yomunye weqembu eliquba lolucwayisiso
OKUYE ONGAFUNA UKUBA KWAZI
Kumafomu ozawasayina enye izaba nyeyakho ukuba uyigcine.
Uma ungaba leminye imbuzo engaphendulwanga okusuthisekayo, kumbe uma ungaphathwa kakubi ngabacwayisisi loba ulokunye ongeke wakukhuluma labacwayisisi ungatshayela ucingo abe Medical Research Council of Zimbabwe ku (04) 791792 or 791193 okuyibo osibakhulu kwezencwayisiso ezempilo.
Appendix 6 Tsamba Yemvumo
Tsvakiridzo yekungorora ruzivo huye kurapwa kwechirwere cheBP pamugodhi weVumbachikwe, mudunhu reGwanda riri kuMatebeleland South.
Muongorori Dr. Pugie Tawanda Chimberengwa, [MBChB (UZ)]
Nhamba dzenhare: 0712436754
Zvamunofanira kuziva maererano neongororo ino:
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uye zvakanakira ongororo ino.
kwenyu nevamwe varwere vachabatsirwa neramangwana
a kutanga mabvuma mozofunga kuramba ongororo yava pakati.
yamungava nayo musati masarura kupinda kana kusapinda muongororo.
CHINANGWA
Muri kukokwa kupinda mu ongororo yekubatwa huye kurapwa kwechirwere cheBP mudunhu reGwanda riri kuMatebeleland South Province. Ongororo ino inotarisirwa kuburitsa ruzivo pakubatwa nekurapwa kweBP muvashandi vepano pamugodhi weVumbabchikwe.
Masarudzwa pakati pevamwe vashandi vanokwana mazana maviri ane gumi nevatanhatu vanoshanda pano kupinda muongoro ino.
MAITIRWO NENGUVA YEONGORORO
Kana mafunga kupinda muongoro muchakurukurwa nemi, motariswa huremu, marebero, BP, huye kukura kwemuviri wenyu. Simba riri mutsinga dzinobva neropa kumoyo kuenda kumuviri wenyu (BP) richayerwa ruviri. Huwandu hweshuga muviri huchatariswa paropa richatorwa pachigunwe chenyu. Muchaudzwa zvinenge zvabuda paropa renyu. Hurapwa
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hunoenderana nehosha yenyu hunobva hwataurwa. Kana Makazvitakura hamugoni kupinda muongororo ino. Kukurukura nemi kunoita pamwechete.
NJODZI KANA KUSHUNGURUDZIKA KUNGASANGANIKWA NAKO
Kushungurudzika kungangobva pakubvisa mbatya dzenyu huye pakubayiwa chigunwe badzi.
ZVAKANAKIRA KUVA MUONGORORO
Hapana muripo wemari kana zvinhu zvamuchapihwa muongororo ino. Ongororo irikuitwa kuti ruzivo, mabatirwo nemarapirwo echirwere cheBP anakiswe. Ndicho chinangwa chikuru che ongororo ino pano pamugodhi huye izvi Zvinogona kubatsira Zimbabwe yose. Pane chinangwa munogona kutumirwa kune vana mazvikokota vanenge vabatwa chirwere cheBP vanobatsirikana pakutangwa mushonga.
DZIMWE NZIRA DZIRIPO
Kana mawanikwa muine dambudziko kuburikidza neBP monutumirwa kuna mazvikokota.
KUVIMBIKA KWEONGORORO
Kana mafunga kupinda muongoro burikidza nerunyorwa rwenyu tinogona kuzivisa vadzidzisi vedu paYunivhesiti huru yeZimbabwe kana bazi rezveutano muhurumende.
Tinogona kukurukura zvabuda muongororo pamagungano akasiyanasiyana nechinangwa chekunakisa marapirwo eBP. Zvine chekuita nemazita kana hupenyu hwenyu hazvizoziviswa mumwe munhu. Tichavimba kuchengetedza zvine chekuita nehupenyu hwenyu muchivande.
Ve MRCZ kana Yunivhesiti vanogona kuda kuona mapepa ewongororo ino semutemo weongororo dzinoitwa munyika ino.
MUMWE MURIPO [92]
Hapana chamunotarisirwa kubhadhara burikidza neongororo ino.
TOTI MAKUVARA
Kurikuti makuvara nekuda kweongororo ino munozorapwa pano pakirinika yeVumbachikwe.
Mukurapwa kwenyu hamuna chamunobhadhara. Hapana mubhadharo wemari uchabuda muongororo ino.
Kuri kuti makuvara batai muongorori mukuru (Dr Pugie Tawanda Chimberengwa) panhamba idzi 0712436754
KUSUNUNGUKA KUPINDA MUONGORORO
Kupinda muongororo isarudzo yenyu. Kuramba kwenyu hakukanganise hukama hwenyu nevakuru vebasa kana vashandi vepakirinika yapano paVumbachikwe. Kana mafunga kupinda mozofunga kubuda muongororo ikodzero yenyu.
ZVIMWEWO ZVINECHEKUITA NEONGORORO
Kana mafunga kuzobuda muongororo ino ikodzero yenyu. Kubatsirwa kwenyu hakuzokanganiswa naizvozvo.
Tinogona kukuburitsai muongororo ino kana taona zvakakodzera. Zvikaitika izvi tinokutaurirai.
MIBVUNZO
Makasununguka kubvunza kana muine mibvunzo neongororo iyi musati masayina pepa iri.
Naizvozvo kana muchida chinguva chekuti mugofunga nezvazvo makasununguka kuita saizvozvo.
MVUMO
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Muri kutipa mvumo yekupinda muongororo. Runyorwa rwenyu riri kureva kuti manzwisisa ongororo huye mibvunzo yamungave nayo yapindurwa zvinokugutsai mukazvifungira kupinda muongororo.
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Zita remupinduri (nyorai zvinooneka) Zuva
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Chiratidzo chebvumirano chemupinduri Nguva Nguva
(*kana cheanotenderwa pamutemo)
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Chiratidzo chearikutambira chibvumirano
ZVAMUNGADA KUZIVA
no chino kuti mugare naro.
yakanangana nekubatwa kwamaitwa muongororo ino, kana kodzero dzenyu, uye kana musina kubatwa zvakanaka sunungukai kubata veMedical Research Council of Zimbabwe panhamba dzerunhare dzinoti: 04-791792 kana 04-791193
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Appendix 7 Medical Research Council of Zimbabwe Approval
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