Detection of hypertension and its associated factors among Dessie Town Government School Staffs, Amhara Region, Dessie, Ethiopia, 2019

Hypertension or high blood pressure is the force that blood exerts on the vessel wall which varies continuously in arteries due to the intermittent nature of the pump (heart) and elastic recoil of the arterial wall [1]. The maximum arterial pressure during systole is called systolic blood pressure and minimum arterial pressure during diastole is called the diastolic blood pressure [2]. Contrasting to most diseases, hypertension has no symptoms and is therefore called the “silent killer”. The World Health Organization also stated that hypertension is the chief important cause of cardiovascular death [3,4].


Introduction
Hypertension or high blood pressure is the force that blood exerts on the vessel wall which varies continuously in arteries due to the intermittent nature of the pump (heart) and elastic recoil of the arterial wall [1]. The maximum arterial pressure during systole is called systolic blood pressure and minimum arterial pressure during diastole is called the diastolic blood pressure [2]. Contrasting to most diseases, hypertension has no symptoms and is therefore called the "silent killer". The World Health Organization also stated that hypertension is the chief important cause of cardiovascular death [3,4].
While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure [11]. Hypertension is said to be asymptomatic and so it could equally cause fatalities even without necessarily showing any symptoms 1 . Improvement of its management to reduce adverse cardiovascular outcomes will require an understanding of the patient characteristics and treatment factors associated with uncontrolled blood pressure [12]. Despite the availability of multiple effective antihypertensive medications with proven bene its in reducing cardiovascular morbidity and mortality, control of hypertension remains poor. In both high and low income countries, only less than 27% and 10% respectively of hypertensive patients have achieved their target blood pressure [12].
Hypertension risk factors are both modi iable and nonmodi iable. Non-modi iable factors are age, gender, ethnicity, and family history of hypertension or diabetes. Modi iable risk factors for hypertension are poor dietary and self-care practices such as excessive salt and fat intake, inadequate exercise or physical activity, excessive alcohol use etc. Some factors that contribute to hypertension are similar to those of other major chronic diseases for example unhealthy diet and inadequate exercise [11].
Many studies in the world and in Ethiopia had been studied at institutional (hospital level) however up to the researcher's knowledge there is shortage of literatures done through measuring BP at the community level in Ethiopia particularly to the study area. So this study was intended to detect magnitude of hypertension and associated factors among government school staffs in Dessie town which was targeted to the most neglected community in Ethiopia through measuring their Blood pressure.
This study is planned to determine the prevalence of hypertension and its associated factors among Dessie town government school staffs. Since there is no adequate research done regarding with this topic in different areas of Ethiopia, it will be the base line for future research. It helps policy makers to give much attention to hypertension in order to control blood pressure. In education, it will show gaps to give emphasis to hypertension in order to incorporate in the curriculum development.
The indings of this study was used as a base for the local health of icial speci ically those who are managing the community with the problem to educate, invoke, and cooperate with their clients to improve management of hypertension. It helps staffs to aware their blood pressure status and its associate factors.

General objective
To detect the prevalence of hypertension and its associated factors among Dessie town government school staffs.

Specifi c objectives
To determine prevalence of hypertension among Dessie town government school staffs from December 10 up to February 15, 2019 GC.
To identify factors associated with hypertension among Dessie town government school staffs from December 10 up to February 15, 2019 GC.

Study area and period
Dessie city is the capital city of south wollo zone which is located 401km away from Addis Ababa, the capital city of Ethiopia and 480 kms from Bahirdar, the capital city of Amhara regional sate. It lies at an altitude of 8,100 feet (2,470 meters). The study was conducted from December 10 up to February 15, 2019 G.C.
Study design: Institutional-based cross sectional study design was conducted.
Source of population: All permanent staffs of Dessie town government schools with age of 35 and above.
Study population: All permanent staffs of Dessie town government schools with age of 35 and above who will present on the data collection period. To select study units peoples who will ful ill the inclusion criteria and have willingness to participate.
Inclusion criteria: All male and female Dessie town government school staffs whose age is ≥ 35 years old and who have willingness to participate in this study was included.
Exclusion criteria: Those staffs that was not present in the speci ied data collection period and those who will not have willingness after giving the detailed information was excluded from the study.

Sample size determination
The size of study participants that was recruited in to the research is calculated using the single Population proportion formula.
Sample size was calculated by considering level of con idence of 95%, and margin error 5%.
Where p -Proportion of patients (23.5%) 4 who will have hypertension q-Proportion of patients (76.5%) who don't have hypertension, d2-margin of error, N-minimum sample size. Substituting the values for each of these variables in the above formula, the sample size is to be 280. Adding nonresponse rate of 10%, the inal sample size is 306. Since the source population is less than Sampling procedure and techniques: Proportional allocation of the speci ied sample for each school was made by considering the number of staffs recruited for each school whose age is ≥ 35 years old. Then sample units for each school was selected through systematic random sampling after calculating ''K'' value for all schools.

Independent variables
Socio-demographic characteristics, Environmental in luences

Data collection procedure
The data was collected from Dessie Town Government schools in 2 months and 2 weeks by 3 BSc nurses and 2 diploma nurses. The study was controlled by two supervisors who will have BSc nursing. The data collectors will introduce them to make rapport with staffs. They measure the blood pressure of each staffs whose age is above 35 years and give appropriate medical advice and only make interview to those selected by the sampling method.

Data collection tool
Interviewer administered structured questionnaire data collection tool was used, it contains three parts.
Part I was used to collect socio demographic data, part II was used to collect selfcare practice towards hypertension Part III is used to collect the status of the blood pressure of study participants should be illed by data collectors after 3 consecutive measurement of B/P.

Data quality assurance
Both the data collectors and supervisors were trained for one day on the objective and methodology of the research, data collection approach. Pretest was conducted in 5% [16] of the samples in Tropical college of Medicine staffs to see the completeness, consistency, and applicability of the instruments and will ratify accordingly. This was used because patients in each facilities share many similarities. This also will give a feedback to me on whether the intended study objectives will captured well, any omissions and any need for additional items so that appropriate modi ication was made after viewing the pre-test result.

Data processing and analysis
Data was checked, cleaned and entered in to Epi-data software, and then it was imported to SPSS version 22.0 software for analysis. Descriptive statistics was used to describe the sample. The results of the descriptive statistics were expressed as percentage and frequency. Associations between independent variables and dependent variables were analyzed irst using bi-variable analysis to identify factors which are signi icantly associated with the outcome variable. The magnitude of the association between the different independent variables in relation to dependent variables was measured using odds ratios and 95% con idence interval (CI) and P values below 0.05 was considered statistically signi icant.

Ethical consideration
Ethical clearance and of icial letter was obtained from Tropical college of Medicine research and Community service department. After getting permission letter from this department, written consent was obtained for willingness of staffs to participate in this study. Any information of each participant was kept con identially.

Socio-demographic characteristics of respondents
Out of the total two hundred twenty ive planned sample of Government school staffs in Dessie town, (two hundred twenty ive) of them were included in the study giving a response rate of 100 percent. The mean age of respondents was 52.4, out of the respondents 62.5% were within 41 -60 age groups. From all respondents 71.1% were Teachers. Of those 51.6% were 1 st degree holders educationally. Out of the study participants 73.77% of them were married, 43.6 % get monthly income of greater than 3000 Ethiopian birr, and 28% https://doi.org/10.29328/journal.ach.1001022 of respondents earn monthly income less than 1500 Ethiopian Birr. Regarding family history of hypertension 79.6% of these staffs had no family history of hypertension.
Out of all 60.2% of the respondents get information from health professionals (Table 1).

Blood pressure status of respondents
From the total study participants among staffs of government schools 34.7% and 37.3% of them had blood pressure of 120/80 mmhg-139/89 mmhg and 90/60 mmhg -120/80 mmhg respectively. Out of all 13.8 % of respondents had diagnosed hypertension. Among all 8.4% of total respondents had diagnosed stage I hypertension and 5.3% of them diagnosed with stage II hypertension ( Table 2, Figures 1,2).

Self-care practice towards hypertension
The indings of this study had shown that the mean score of total hypertension self-care practice was 37.69 ± 8.23; with dietary modi ication mean score of 19.46 ± 5.57, stress reduction of mean score 4.07 ± 1.42, regular physical activity mean score of 1.98 ± 0.96, Keeping weight down with mean score of 2.07 ± 0.87, see health workers regularly with mean of 3.25 ± 0.91 and moderation of alcohol with the 1.36 ± 0.75 (Table 3).   Over all B/P Hypertension 31 13.8 Table 3: Self-care practice of study participants in government school staff s of Dessie city. Administration, Dec, 2019, Dessie, Ethiopia (n = 225).

Item Minimum Maximum Mean(SD) Range
Regular physical activity 1.

Factors associated with magnitude of hypertension
Bivariate analysis and multiple logistic analyses showed that there were signi icant associations between detection of hypertension and educational status, source of information, religion, age, marital status, and occupation of the respondents maintain their signi icant association with detection of hypertension. Multivariate analysis revealed that there was statistical association between hypertension and educational status. Study subjects who were 1 st degree holders were approximately three times more likely to have hypertension as compared with those who had no formal education. {(p = 0.01, AOR (95%CI) = 3.05 [0.91, 13.43]}. Study subjects whose age were from 41-60 were approximately two times more likely to have hypertension as compared with those whose age were less than 40 years.  (Table 4).

Discussion
This study was conducted with the intention to detect hypertension and associated factors among government school staffs of Dessie city administration. The indings of this study shown that 87 (38.6%) of staffs were within the B/P of 120/80 mmhg-139/89 mmhg. This result implies that signi icant number of teachers and other administrative staffs will join to hypertension with in few years since their blood pressure was at the boundary of hypertension.
From all study participants about half 22 (9.8%) of them had hypertension. This result was similar to the study conducted in Addis Ababa (10.5%), higher than study in Birsheleqo Ethiopia (4.1%) and lower than study conducted in Nepal [22][23][24]. This might be study done Birsheleqo, Ethiopia might not have age restriction for selecting study participants however in this study there is age restriction (≥ 35 years) which is known non modi iable risk factor for the occurrence of hypertension. In other ways this study participants were government school staffs so that this study participants might have better income which will increase risk of developing hypertension compared to study participants in Birsheleqo, Ethiopia which was studied to whole community at hospital This study ascertained that there is statistical association between hypertension with educational status, source of information, religion, age, marital status, and occupation.
Multivariate analysis revealed that there was statistical association between hypertension and educational status. Study subjects who were 1 st degree holders were more likely to have hypertension as compared with those who write and read only. This might be related to the fact that the study participants with higher educational level had higher age in which is high risk for hypertension, which affects their B/P positively. In other ways study participants with better educational level might have better income so that it might increase their blood pressure.
Study participants who were teachers were more likely to have hypertension as compared with subjects who were cleaners. This differences might be due to teachers might have better income (salary) than cleaners so that this having better income might increase their blood pressure Study subjects who were divorced were more likely to have hypertension as compared with subjects who were single. This might be divorced staffs might have feeling of anger and emotional that increases pumping power of the heart and sympathetic vasoconstriction that directly leads to increase their blood pressure. In other ways divorced study participants have addiction of alcohol drinking, cigarrate smoking and other substance abuse which might increase the risk of developing hypertension [21].
Study subjects whose ages were from 41-60 were more likely to have hypertension as compared with those whose age was less than 40 years. This might be due to the fact that age is the major risk factor for the occurrence hypertension. When age increases blood (plasma) volume and vasoconstriction increases so that blood pressure might be increased [21].
Study participants who had hypertension information from news were more likely to had hypertension compared to those who had information through books.
This might be information disseminated through broadcasts will be more power full to be careful to prevent hypertension through implementing hypertension prevention practices.

Strength of study
 High response rate which is 100%  Nine government schools were included to make the study representative  Since prevalence of hypertension might be different from schools.
 More data collectors were recruited and adequate training was given to keep quality of data collection.
 Blood pressure status of non-selected school staffs and study participants were measured and medical advice and referral was made with full sponsor of Tropical College of medicine.

Limitations of study
 Dif iculty of understanding by respondents to some of the study variables.
 Limitation of related literatures to compare and discuss some of the indings.
 Because the data are cross sectional, the direction of causal relationship between variables can't always be determining.
 The data collection was not completed on the predetermined time plan due to different factors.

Conclusion
From all staffs 13.8 % of respondents have hypertension. This study had shown that there was statistically signi icant association between Hypertension and educational status, marital status, occupation, religion, source of information and age of respondents.
Despite health service coverage of Ethiopia had improvement; on this study newly diagnosed hypertension that has no information about their blood pressure before was high which shows there was poor coverage of health screening.

Recommendation
Health care personnel should increase community awareness towards the importance of BP screening and strongly promote self-care practice to prevent hypertension via strengthening information education communication.
Nursing research should be carried out to investigate the level of hypertension through measuring their BP in broader social context and larger sample size.
All academic higher educational health institutions should work intensively on community services including periodic B/P screening to the community especially.
All nurses' workings on hypertension should give strict advice on importance of periodic screening of B/P for staffs which has age of greater than 35 years during their community health care schedule and develop educational programs and activities to educate staffs on the prevention and treatment of hypertension.
The society particularly family members and friends https://doi.org/10.29328/journal.ach.1001022 should support and encourage those people about danger of hypertension and to do self-care practice to control high blood pressure.