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Characteristics of Inpatient Hypertension Cases and Factors Associated with Admission Outcomes in Ashanti Region, Ghana: an Analytic Cross-Sectional Study

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Characteristics of Inpatient Hypertension Cases and Factors Associated with Admission Outcomes in Ashanti Region, Ghana: an Analytic Cross-Sectional Study Hindawi International Journal of Hypertension Volume 2017, Article ID 6537956, 11 pages https://doi.org/10.1155/2017/6537956 Research Article Characteristics of Inpatient Hypertension Cases and Factors Associated with Admission Outcomes in Ashanti Region, Ghana: An Analytic Cross-Sectional Study Kenneth Nuamah,1 Harriet Affran Bonful,2 Joseph Danso Yeboah,3 Ebenezer Antwi Amankwaah,1 Daniel Boakye,1 Samuel Kwame Owusu,1 Adwoa Aduako Owusu,4 Freddie Amponsah,5 Fred Adomako-Boateng,1 Alexis Nang-Beifubah,1 Margaret Gyapong,6,7 Anthony Ofosu,5 Bertha Garshong,6 and Evelyn K. Ansah6,7 1 Ashanti Regional Health Directorate, P.O. Box 1908, Kumasi, Ghana 2Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana 3Sekyere Central District Health Directorate, P.O. Box 36, Nsuta, Ashanti, Ghana 4Suntreso Government Hospital, P.O. Box 14775, Kumasi, Ghana 5Policy Planning Monitoring and Evaluation Division, Ghana Health Service, PMB Ministries, Accra, Ghana 6Research Development Division, Ghana Health Service, P.O. Box MB-190, Accra, Ghana 7InstituteofHealthResearch,UniversityofHealth&AlliedScience,PMB31,Ho,Ghana Correspondence should be addressed to Kenneth Nuamah; [email protected] Received 8 July 2017; Revised 10 October 2017; Accepted 31 October 2017; Published 5 December 2017 Academic Editor: Tomohiro Katsuya Copyright © 2017 Kenneth Nuamah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Hypertension remains a cause of morbidity and mortality in the Ashanti Region of Ghana. It has been featured in the top ten causes of OPD attendance, admissions, and deaths since 2012. We investigated the sociodemographic characteristics and spatial distribution of inpatient hypertensives and factors associated with their admission outcomes. Methods. A 2014 line list of 1715 inpatient HPT cases aged ≥25 years was used for the cross-sectional analytic study. Accounting for clustering, all analyses were performed using the “svy” command in Stata. Frequencies, Chi-square test, and logistic regression analysis were used in the analysis. Arc view Geographic Information System (ArcGIS) was used to map the density of cases by place of residence and reporting hospital. Results. Mean age of cases was 58 (S.D 0.0068). Females constituted 67.6% of the cases. Age, gender, and NHIS status were significantly associated with admission outcomes. Cases were clustered in the regional capital and bordering districts. However, low case densities were recorded in the latter. Conclusion. Increasing NHIS access can potentially impact positively on hypertension admission outcomes. Health educational campaigns targeting men are recommended to address hypertension-related issues. 1. Introduction blood pressure being normal. If hypertension is left uncon- trolled, it can lead to several cardiovascular complications The World Health Organization (WHO) defines hyperten- including a heart attack, an enlargement of the heart, and sion as a systolic blood pressure equal to or above 140 mm Hg eventually heart failure [1]. Kidney failure, blindness, rupture and/or diastolic blood pressure equal to or above 90 mm Hg of blood vessels, and cognitive impairment can be attributed [1]. Overall health and wellbeing of human rely on efficient to hypertension [1]. functioning of vital organs such as the heart, brain, and The prevalence of hypertension rose from 600 million in kidneys [1]. This largely depends on both systolic and diastolic 1980 to about 1 billion in 2013 [1]. Worldwide, there are over 2 International Journal of Hypertension 17 million deaths attributed to cardiovascular diseases, which in the region. The proportion of hypertension to total OPD is nearly one-third of total deaths in a year [2]. Complications attendance increased from 3.8% in 2012 to 5.4% in 2014 [13]. due to hypertension account for 9.4 million deaths every year More importantly, the proportion of admissions attributed to [3]. Hypertension accounts for at least 5% of deaths from hypertension increased from 1.1% in 2010 to 2.4% in 2014. heartdiseaseand51%ofdeathsduetostroke[3]. In 2014, hypertension was ranked sixth, third, and fifth, for The African region has the highest prevalence of hyper- top ten causes of OPD attendance, cause of admissions and tension, affecting 46% of all adult aged 25 years and above deaths, respectively [13]. A review of literature suggests that [4]. The prevalence (35%) in high-income countries is lower there is little knowledge on the local factors driving the comparedto40%inlow-incomecountries.Thegreatest increasing burden of the disease and hospitalization. This health challenge facing the African region after HIV/AIDS is study describes the characteristics of inpatient hypertension hypertension [4]. In sub-Saharan Africa, Noncommunicable Diseases cases; establishes the factors associated with the outcomes of (NCDs) have become important causes of morbidity and hypertension admissions; and also determines the geospatial mortality, contributing 22% of total deaths [4]. It has been distribution of these admissions in the Ashanti Region for the forecasted that, by 2025, the hypertensive population in year 2014. developing countries will be 125.5 million people, which will correspond to an increase of 68% from 2008 to 2025 [5, 6]. 2. Materials and Methods Hypertension disease risk factors include age, race, fam- ily history, being overweight or obese, physical inactivity, Data collected was used purposely for a cross-sectional tobacco use, high-salt diet, too little vitamin D and potassium analytic study. The study was conducted in Ashanti Region, in diet, excessive alcohol use, stress, and certain chronic which is one of the ten administrative regions of Ghana conditions [3]. The prevalence of hypertension increases with locatedinthemiddlebeltofthecountryandcoversabout increasing age. Sidhu and colleagues noted that the highest 10.2% of the total land surface area. It has an estimated prevalence is found in ages equal to or above sixty (60 years) 2014 mid-year population of 5,461,933, constituting 19.8% of followed by ages between fifty and fifty-nine (50–59 years) [7] the national population (projection from 2010 population whilst Opie and Seedat also noted that, at age 65 in rural West and housing census, Ghana Statistical Service). The Komfo Africa, there is a 30%–40% chance of being hypertensive as Anokye Teaching Hospital (KATH) is the teaching hospital compared to 50% chance in semiurban areas in West Africa for the region. Health services are delivered in public, private, [4]. quasi-, and mission facilities totaling 548. These facilities are Others have identified level of education and occupation as factors associated with hypertension [8]. The risk of comprised of 121 hospitals, 103 health centres, 282 clinics, hypertension can vary in geographical areas depending on and 133 CHPS compounds. Inpatient services are rendered environmental conditions and socioeconomic position [9] in the 121 hospitals for hypertensive patients. Population to Ghana like other middle-income countries is no excep- health facility ratio is 1 : 9967. Most facilities report on health tion as hypertension is the number three killer today [10]. indicators into the District Health Information Management The prevalence of high blood pressure in Ghana is estimated System (DHIMS2) software; however, the only teaching at 12.9% and 15% for women and men, respectively [10]. hospital which also serves as the main referral hospital in the The 2014 Demographic Health Survey puts the prevalence region does not. of hypertension in Ashanti at 15.3% for women and 18.1% This study used secondary data extracted from DHIMS for men, which is higher than the national average [10]. 2 for the Ashanti Region. DHIMS 2 is a developed software Prevalence of hypertension for Ashanti is highest among that operates on DHIS2 (District Health Information Software) males in Ghana and second highest for females [10]. application platform. DHIMS 2 is used by GHS to collect Earlier studies in the Ashanti Region have shown that and collate data on health care service provision. DHIMS 2 there is a long-standing perception that hypertension disease helps to generate routine data, analyse reports using maps, is associated with affluence and that it is a disease of the and graphs and health profiles for indicators across facilities rich and wealthy in society [11]. This perception has led to over a period. many people in low-income communities failing to report for The study population included records of all hypertension medical check-ups and undertake routine exercises and not patients on admission aged between 25 years and above, fully participate in health education programmes [11]. diagnosed by clinicians within the Ashanti Region and Over the years, some of the steps taken to control the reported in the DHIMS platform. increasing burden of hypertension in the country by the Diagnosis made in this study was done by prescribers Ghana Health Service (GHS) have included the introduction in accordance with the standard Treatment Guidelines of of the Regenerative Health and Nutrition Program as well Ghana [14]. Recruitment of study participants was based on as the institutionalization of hypertension clinics in health diagnosis of hypertension by clinicians providing care
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