Immigrants in Oslo, Norway
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Prevalence of Hypertension among Pakistani Immigrants in Oslo, Norway. Farhad Mohsin Supervisor: Marte Karoline Kjøllesdal University of Oslo Faculty of Medicine Institute of Health and Society Department of Community Medicine November 2017 Thesis submitted as a part of the Master of Philosophy Degree in International Community Health 1 ACKNOWLEDGEMENTS Many people have played an important role in the completion of my study. First, I am very thankful to my parents and family members who helped me and encouraged me to study hard and achieve my goals. Without their guidance I would never have achieved my goals. I am very thankful to Department of Community Health, University of Oslo for supporting me and giving financial assistance for fieldwork. Special thanks to my supervisor, Marte Karoline Kjøllesdal, who helped me a lot during fieldwork and thesis. She was always very active and supportive and replied immediately whenever I needed help. Whenever I was stuck, she helped me to get out of it. With her useful and precious suggestions and guidance, I was able to complete this study. I am very grateful to Ahmad Ali Madar, who really helped me to improve my thesis and gave me very good suggestions and guidelines. Thanks to my coordinator, Terese Eriksen and Merita who helped me a lot throughtout the master’s program. Special thanks to my friend, Jamil Ahmed Soomro for his help and motivation. I remember his favorite quote “Don’t take tension, be easy and focus on what you have to do and you can do, you have capability”. In the end, a huge thanks to my wife. She always encouraged and supported me during my study. After birth of new born baby, it was difficult to study but my wife helped me a lot by staying awake whole night just to let me sleep so that the next day I can study freshly. 2 TABLE OF CONTENTS 1 INTRODUCTION ................................................................................................................. 9 2 LITERATURE REVIEW ...................................................................................................... 11 2.1 Background of Pakistani population in Oslo, Norway.......................................... 11 2.1.1 Facts of Pakistan .................................................................................................. 11 2.1.2 Immigrants Population in Norway .................................................................. 11 2.1.3 Pakistani immigration to Norway .................................................................... 13 2.1.4 Typically Pakistani diet ...................................................................................... 13 2.1.5 Lifestyle changes among Pakistanis immigrants in Norway ........................ 14 2.1.6 Change in food habits ......................................................................................... 14 2.1.7 Lack of physical activity ..................................................................................... 15 2.1.8 Health.................................................................................................................... 15 2.1.9 Risk factors of Hypertension ............................................................................. 16 Age ................................................................................................................................ 16 Family history .............................................................................................................. 16 Education ..................................................................................................................... 17 2.2 Hypertension Globally ............................................................................................... 17 2.3 Hypertension in South Asian .................................................................................... 18 2.4 Hypertension in Pakistan ........................................................................................... 19 2.5 Hypertension among South Asian immigrants in Europe .................................. 20 2.6 Hypertension among Asian immigrants in United States of America ................ 20 2.7 Hypertension among immigrants in Norway ........................................................ 21 2.1 Summary of literature review ................................................................................... 22 2.2 Rationale of study and objectives .................................................................................. 23 2.3 Rationale of study ....................................................................................................... 23 2.4 Objectives ..................................................................................................................... 23 2.4.1 Main objective ...................................................................................................... 23 3 SUBJECTS AND METHODS ............................................................................................. 24 3.1 Study area ..................................................................................................................... 24 3.2 Study design and population .................................................................................... 25 3 3.3 Sample Selection .......................................................................................................... 25 3.3.1 Inclusion Criteria ................................................................................................. 25 3.3.2 Exclusion Criteria ................................................................................................ 25 3.3.3 Operational Definition ....................................................................................... 25 3.4 Sample selection process ............................................................................................ 26 3.5 Sample size calculation .............................................................................................. 26 Sample Size for Frequency in a Population ............................................................ 26 3.6 Data collection ............................................................................................................. 27 3.6.1 Survey procedure ................................................................................................ 27 3.7 Statistical methods:........................................................................................................ 28 3.8 Ethical approval: ............................................................................................................ 29 4 RESULTS.................................................................................................................................. 30 4.1 Unadjusted binary logistic regression models in males and females showing the association between hypertension and possible risk factors . .................................... 34 4.2 Adjusted binary logistic regression models in males and females showing the association between hypertension and possible risk factors. ................................................... 35 5 DISCUSSION ............................................................................................................................ 37 5.1 Discussion of main findings ............................................................................................ 37 5.2 Methodological Discussion ........................................................................................ 40 5.2.1 Study design ........................................................................................................ 40 5.2.2 Population and sample size ............................................................................... 41 5.2.3 Assessment Tools ................................................................................................... 42 5.2.4 Bias ......................................................................................................................... 42 5.2.5 Validity: .................................................................................................................. 44 5.2.6 Strengths ............................................................................................................... 45 5.2.7 Limitations ........................................................................................................... 45 6 CONCLUSION .................................................................................................................... 47 7 RECOMMENDATION AND FUTURE RESEARCH ..................................................... 48 8 REFERENCES ...................................................................................................................... 49 9 APPENDICES ...................................................................................................................... 52 9.1 Appendix: 1 Questionaire .......................................................................................... 52 9.2 Appendix: 2 Informed consent .................................................................................. 54 9.3 Appendix: 3 Ethical Approval & Amendment from REK ..................................... 57 4 LIST OF TABLES Table 1: Demographic characteristics of study population ............................................. 30 Table 2: Demographic characteristics of hypertension in Females ................................. 31 Table 3: Demographic characteristics of hypertension