Dataset Information

Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study.

ABSTRACT:

Objective

Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya.

Design

Descriptive, cross-sectional.

Setting

Medical wards and outpatient clinic of a national referral hospital.

Participants

Patients (n=229) diagnosed with primary hypertension for at least 6?months.

Primary outcomes

Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjusted for age, gender and education; antihypertensive adherence; views on prevention of hypertension and adequacy of hypertension information.

Results

Ageing was associated with elevated diastolic blood pressure (BP) (p<0.05), heart rate (HR) and cholesterol. Females had higher body mass index (BMI). More males reported drinking alcohol and smoking (p<0.001), especially the highly educated. Higher BPs were observed in smokers and drinkers (p<0.05). Daily vegetables and fruits intake were linked to lower BP, HR and BMI (p<0.05). Intake of foods high in saturated fat and cholesterol were associated with raised HR (p<0.05). Respondents on antihypertensive medication, those engaged in healthy lifestyle and took their prescribed medications had lower mean BPs than those on medication only (138/85 vs 140/90). Few respondents (30.8%) considered hypertension as preventable, mainly the single and highly educated (p<0.05). Respondents (53.6%) believed they should stop taking their antihypertensive medication once hypertension is controlled.

Conclusion

Missed targets for BP control and hypertension-related risks are associated with ageing, female gender, fast food and animal fat intake. Alcohol and smoking is common in males associated with poor BP control. Daily vegetables and fruits intake are associated with better BP control and overall hypertension risk reduction. Observed suboptimal BP control despite pharmacological adherence suggests lifestyle modification is needed besides antihypertensive medication. Interventions should address modifiable risk factors aggravated by age and adverse lifestyles through adopting combined lifestyle modification, pharmacological adherence and tailored expert delivered hypertension-related information.

SUBMITTER: Kimani S

PROVIDER: S-EPMC6340423 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study.

Kimani Samuel S Mirie Waithira W Chege Margaret M Okube Okubatsion Tekeste OT Muniu Samuel S

BMJ open 20190117 1

<h4>Objective</h4>Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya.<h4>Design</h4>Descriptive, cross-sectional.<h4>Setting</h4>Medical wards and outpatient clinic of a national referral hospital.<h4>Participants</h4>Patients (n=229) diagnosed with primary hypertension for at least 6 months.<h4>Primary outcomes</h4>Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjus ...[more]

PMID: 30782721

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Project description:BackgroundInappropriate utilization of higher-level health facilities and ineffective management of referral processes in resource-limited settings are becoming increasingly a concern in health care management in developing countries. This is characterized by self-referral and frequent bypassing of the nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. On July 1, 2021, Kenyatta National Hospital (KNH) enforced the Kenya Health Sector Referral Implementation Guidelines, 2014, which required patients to receive approval from the KNH referral office and a formal referral letter to be admitted at KNH to reduce the number of walk-ins and allow KNH to function as a referral facility as envisioned by the Kenya 2010 Constitution and KNH legal statue of 1987.ObjectiveTo determine the effect of enforcing the national referral guidelines on patterns of orthopaedic admissions to the KNH. This was a pre-post intervention study. Data abstraction was done for 459 and 446 charts before and after the enforcement of the national referral guidelines, respectively.ResultsEnforcement of the national referral guidelines reduced the proportion of walk-in admissions from 54.9% to 45.1%, while the proportion of facility referrals increased from 46.6% to 53.4% (p = 0.013). The percentage of non-trauma orthopaedic admissions doubled from 12.0% to 22.4% (p<0.001). There was also an increase in admissions through the Outpatient Clinic and Corporate Outpatient Clinic. The proportion of emergency admissions declined, while that of elective admissions increased. The increase in elective cases was mainly driven by the increase in female admissions with active insurance cover, tertiary education, non-trauma-related conditions and older age groups. However, the use of official formal written referral letters did not change despite the enforcement of the national referral guidelines.ConclusionThe enforcement of the national referral guidelines reduced the proportion of walk-ins' admissions to KNH. While the enforcement of the national referral guidelines had no effect on the use of official formal written referral letters, it did limit access and utilization of inpatient orthopedic services for young male patients with no active insurance cover and in need of emergency orthopedic care.

Project description:BackgroundNon-malarial febrile illnesses comprise of almost half of all fever presenting morbidities, among under-five children in sub-Saharan Africa. Studies have reported cases of prescription of antimalarial medications to these febrile under-fives who were negative for malaria. The treatment of these children with antimalarial medications increases incidences of antimalarial drug resistance as well as further morbidities and mortalities, due to failure to treat the actual underlying causes of fever.AimTo identify clinical and demographic factors associated with treatment type (malarial/non-malarial) of non-malarial febrile illnesses (NMFI) in children aged ≤5 at the Kenyatta National Hospital in Nairobi, Kenya.MethodsA positivist epistemological approach, cross sectional descriptive study design was used. A structured questionnaire was used on a sample of 341 medical records of children aged ≤5 years to extract data on clinical examinations (recorded as yes or no), diagnostic test results, and demographic data on the child's sex and age. Descriptive and inferential analysis was applied to the data.ResultsPrescription of antimalarial drugs despite negative microscopy results was found in 44 (12.9%) of the children, with mortality reported in 48 (14.1%). Assessment of respiratory distress was 0.13 (0.03,0.58) times associated with less likelihood of prescribing an antimalarial in those with a negative microscopy. A male patient was 0.21 (0.05,0.89) times less likely to receive an intravenous antimalarial after a negative microscopy. Patients aged ˂1 with a negative microscopy result were more likely to receive an antimalarial than older children.ConclusionThere is a need to eliminate incorrect treatment of NMFI with antimalarial medication, while ensuring correct diagnosis and treatment of the specific illness occurs. This requires strengthening and adherence to diagnostic and treatment guidelines of febrile illnesses in under-fives, consequently reducing morbidities and mortalities associated with inadequate management of NMFIs.

Project description:IntroductionAdherence to lifestyle modification in addition to medication adherence is very important in preventing complications. Nevertheless, lifestyle modification guidelines are not widely followed by patients with hypertension. The objective of the study was to explore the predictors of compliance with lifestyle modification among patients with hypertension at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2019.MethodA descriptive cross-sectional study design was used. A total of 384 patients with hypertension were included in this study. A systematic sampling method was used to select study participants. The data were collected through an interview method by using a structured questionnaire. The data were entered and analyzed using SPSS. Each variable was summarized using summary statistics. To measure the association between lifestyle modification and its predictors, a bivariate and multivariate logistic regression model was used. P-value < 0.05, odds ratio (OR), and 95% confidence interval (CI) were used to determine statistical significance, direction, and strength of association.ResultsTwo hundred six (53.6%) patients with hypertension had poor adherence to the recommended lifestyle modification. Male patients with hypertension were more adherent to lifestyle modification compared with female patients (adjusted OR (AOR) = 0.60, 95% CI: 0.39-0.92). The rate of poor adherence was 1.86 times higher among patients with hypertension diagnosis of <5 years compared with patients with hypertension diagnosis of ⩾5 years(AOR = 1.86, 95% CI: 1.19-2.89). Patients who were adherent to their medication were 2.13 times to have poor adherence to lifestyle modification compared with medication non-adherent patients (AOR = 2.13, 95% CI: 1.38-3.27).ConclusionHigh proportions of patients with hypertension were non-adherent to lifestyle modification. Sex, age, duration of the disease, and medication adherence were significantly associated with lifestyle modification adherence. Close follow-up of female patients, the elderly, and patients with a short duration of hypertension is recommended.

Project description:Trial of labour is a safe option for most women after one previous caesarean delivery. However, the proportion of women attempting trial of labour after previous caesarean delivery (TOLAC) has been declining in many countries. In addition, women with prior caesarean delivery appear to know little regarding their mode of delivery and healthcare providers' recommendations. The doctors' preferences exert a strong influence on patient's decision whether or not to pursue TOLAC. In Kenya, it is unclear whether women who opt for trial of labour after caesarean delivery (TOLAC) or elective repeat caesarean delivery (ERCD) do that based on clear understanding of risks and benefits of both modes of delivery. This study aimed at determining whether patients with one previous caesarean delivery make an informed decision on preferred mode of delivery following their interactions with doctors.A cross-sectional descriptive study was carried out on 202 pregnant women with one previous caesarean delivery at Kenyatta National Hospital (KNH) antenatal clinic. Data was collected from both the patients' records and women were interviewed using a structured questionnaire.Out of 202 women with mean age of 30.2 years 136 (67.2%) chose Elective Repeat Caesarean Delivery (ERCD), while 66 (32.8%) opted for TOLAC. Only 61/202 (30.6%; 95% C.I: 24.4 to 37.6%) made informed decisions. Few women (65: 32.2%) knew that the chance of successful TOLAC was high (60-80%) and 97 (48%) were not aware of the chances for a successful TOLAC. More than half of the women (109: 53.9%) were unaware of the risk of uterine rupture after one previous delivery and only few patients (64: 31.7%) knew that the risk of uterine rupture in TOLAC is low (< 1%). The majority of the women (112: 55.4%) did not know that the indications for previous caesarean delivery are an important factor in determining the chance of a successful Vaginal Birth after Caesarean Delivery (VBAC). For 47(23.3%) of the women, there was no documented indication for the previous caesarean delivery. The women's mode of delivery was significantly associated with the preference of the counseling doctor (p < 0.001) and their qualification (p = 0.020). Only 23 (11.4%) women signed the consent form for ERCD while none of the women for TOLAC signed any consent form.There was an overall lack of information on both modes of delivery while doctor's preferences affected women's decisions. Only just under one third of the women made an informed decision. There is a need to develop clear standard protocols and checklists for information to be disseminated to doctors and all patients with previous caesarean deliveries in subsequent pregnancies in Kenya.

Dataset Information

Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study.

Objective

Design

Setting

Participants

Primary outcomes

Results

Conclusion

Publications

Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study.

Similar Datasets

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