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 v 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 .........................................................................................................