Assessment Of Dietary Compliance Among Hypertensive Patients Of Medical Outpatient Clinic In Ladoke Akintola University Hospital, Ogbomoso, Oyo State

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Assessment Of Dietary Compliance Among Hypertensive Patients Of Medical Outpatient Clinic In Ladoke Akintola University Hospital, Ogbomoso, Oyo State


Abstract


The purpose of this study was to assess dietary compliance among hypertensive patients of medical outpatient clinic in Ladoke Akintola University Hospital, Ogbomoso, Oyo State. Data was collected in Ladoke Akintola University Hospital, Ogbomoso, Oyo State using researcher administered questionnaires on a sample of 387 patients out of the targeted 403, which was calculated using Fisher et al as cited by Mugenda & Mugenda (2003). Data was analyzed using Statistical Package for Social Sciences (SPSS Version 21) computer software. Mean age of the respondents was 58.5 years. Half (50.1%) of the respondents were farmers and 75.2% of the respondents had attained at least primary level education. The study recorded high level of knowledge on dietary recommendations in management of hypertension at 76.2%. There was a strong association between the level of knowledge on the recommended dietary practices in management of hypertension and level of formal education (P<0.001). Mean level of compliance to recommended dietary practices in management of hypertension as reported by respondents was 59.6% The study found no association between compliance to recommended dietary practices in management of hypertension and sex (P=0.938), age (0.914), or level of formal education (0.779). The study accepted the null hypothesis that compliance to recommended dietary practices among patients with hypertension was not influenced by the level of knowledge on the recommendations (P=0.872). Respondents reported financial constraints (47%) as a major hindrance to compliance to recommended dietary practices. Some of the facilitators to compliance were adequate finances and government support to hypertension care. Other facilitators included availability of a variety of food as well as family support. Hypertension is expensive to manage and it is even more expensive with the complications that accompany prolonged undiagnosed hypertension or long standing poorly managed hypertension. There is therefore need for government, donors and other implementing partners to come up with ways that will ease the burden of hypertension care.

 


Table of Content


Preliminary Page(s)

  • Title Page
  • Declaration
  • Approval
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of Content

Chapter One

1.0 Introduction

  • 1.1 Background Of The Study
  • 1.2 Statement Of Problem
  • 1.3 Research Objectives
  • 1.4 Research Questions
  • 1.5 Hypothesis
  • 1.6 Significance Of The Study
  • 1.7 Operational Definition Of Terms
  • 1.8 Organization Of Study

Chapter Two

2.0 Literature Review

  • 2.1 Concept Of Hypertension
  • 2.2 Level Of Knowledge On Recommended Dietary Practices In Management Of Hypertension
  • 2.3 Level Of Compliance To Recommended Dietary Practices In Management Of Hp
  • 2.4 Factors That Influence Compliance And Non-Compliance To Recommended Dietary Practices In Management Of Hp
  • 2.5 Theoretical Review

Chapter Three

3.0 Research Methodology

  • 3.1 Research Design
  • 3.2 Study Area
  • 3.3 Study Population
  • 3.4 Sampling Techniques
  • 3.5 Data Collection Techniques
  • 3.6 Data Analysis

Chapter Four

4.0 Results And Discussion

  • 4.1 Results
  • 4.2 Discussion

Chapter Five

5.0 Conclusion And Recommendation

  • 5.1 Conclusion
  • 5.2 Recommendation
  • References
  • Appendix

Chapter One


1.0 Introduction

1.1 Background of the Study

Hypertension is increasing rapidly. In 1980, prevalence of Hypertension globally was 4.7% and has since risen to 8.5% in 2014 (WHO, 2017). Olokoba et al. (2012) estimated that the number of adults with hypertension in the world would rise from 135 million in 1995 to 300 million in the year 2025. Global mortality attributable to hypertension in 2000 was estimated at 2.9 million deaths, equivalent to 5.2% of all deaths (Roglic et al., 2005). The study also revealed that the mortalities were higher in 35–64 years old people with 6–27% of deaths attributable to hypertension. Hypertension accounts for over 90% of hypertension in Sub-Saharan Africa (Hall et al., 2011 and mortality attributable to hypertension in 2010 was 6% (Mbanya et al., 2010). Christensen et al. (2009) recorded a 4.2% prevalence of HP in Nigeria; with a high prevalence being recorded in urban areas (12.2% in urban areas & 2.2% in rural areas). About 1% deaths in Nigeria were attributable to hypertension (WHO, 2014). Ladoke Akintola University Hospital had a higher prevalence of HP (6.6%) than the national prevalence (4.2%) (Mathenge et al., 2010).

Effective management of Hypertension requires that patients learn and practice new and complex behaviors like blood glucose monitoring, taking medications (some self-injecting), keeping track of meal times, diet and exercise, besides dealing with their routine work, social and family life (Kapur et al., 2008). Compliance to these new practices is important. Dietary modification is one of the major aspects in management of Hypertension (Ministry of Public Health and Sanitation, 2010). A patient should consume high-fiber foods, low glycemic index (GI) with caloric restrictions. This includes consuming more fruits and vegetables, nuts and whole grains, and choosing unsaturated vegetable oil as opposed to saturated animal based fats. World Health Organization (WHO) recommends 30g fiber intake in a day for good health while higher fiber content is recommended for hypertensive patients (Joshi, et.al., 1991). A diet plan for patients with HP also includes avoiding alcohol and limiting consumption of snacks that are high in fat, sugar or salt. These snacks may include potato chips, cakes, biscuits, soda and among others (American Hypertension Association, 2015). Portion sizes as well as meal times should also be observed. The diet plan is normally individualized. Management of HP also involves lifestyle modifications and adherence to medication. Delamater (2006) in his study on improving adherence noted that Hypertension care regimen is complex; however, there are patients with good hypertension self-care behaviors who always manage to attain excellent glycemic control.

Compliance to recommended lifestyle changes improves glucose levels, and leads to decreased blood pressure and corrects lipid abnormalities which are factors associated with complications of hypertension (Ganiyu et al., 2013). The same study also reported 63% rate of adherence to dietary regimen. Patient’s knowledge on Hypertension is vital in proper management of HP. Patients with adequate understanding and knowledge of their medication have better gycemic control (McPherson et al., 2008). However studies have shown that knowledge is not always translated into practice. A study by Saleh et al. (2012) reported high levels of nutritional knowledge on management of HP but adherence to these guidelines was very low; for instance, only a third of the respondents partially followed the rules of measuring food before eating. This study therefore set out to determine compliance to recommended dietary practices among hypertensive patients, attending selected hospitals in Ladoke Akintola University Hospital.


1.2 Statement of Problem

Compliance to dietary recommendations is one of the important factors in management of HP. It improves blood glucose control, reduces incidences of hyperglycemia and hypoglycemia and other complications of HP (Ganiyu et al., 2013). Researches and literature on compliance to dietary recommendations on HP in Nigeria and factors affecting compliance is limited. The study sought to establish compliance to recommended dietary practices among patients with HP. The study also helped establish factors that affect compliance.

Hypertension (HP) is a chronic disorder that is not curable. Hypertension (HP) relies heavily on proper management which includes hypoglycemic drugs/insulin injections and lifestyle changes. Hypertension complications are common and they are the major causes of morbidity and mortality among hypertensive patients. Managing hypertension complications is almost triple the annual cost of managing hypertension (Bate & Jerums, 2003).

Compliance to hypertensive regimen (diet, exercise, drugs and other self-care) prevents/ delays the onset of hypertension complications (Bate & Jerums, 2003). Compliance to dietary recommendations also improves glucose levels, reduces obesity and leads to decreased BP and other complications of HP (Ganiyu et al., 2013). Compliance to dietary regimen in management of HP in Nigeria was 63% (Ganiyu, 2013). Patients attending hospitals in Ladoke Akintola University Hospital recorded high HP complications and frequent hospitalization attributable to poor management of HP. However, there was limited literature on compliance to recommended dietary practices among patients with HP attending hospitals in Ladoke Akintola University Hospital.


1.3 Research Objectives

The main aim of this study is to assess dietary compliance among hypertensive patients of medical outpatient clinic in Ladoke Akintola University Hospital, Ogbomoso, Oyo State. The specific objectives are outlined below;

  1. To establish the level of knowledge of the recommended dietary practices in management of HP among hypertensive patients attending selected hospitals in Ladoke Akintola University Hospital.
  2. To establish the level of compliance to recommended dietary practices among hypertensive patients attending selected hospitals in Ladoke Akintola University Hospital.
  3. To establish factors that influence compliance to recommended dietary practices among hypertensive patients attending selected hospitals in Ladoke Akintola University Hospital.

1.4 Research Questions

  1. What is the level of knowledge of the recommended dietary practices in management of HP among hypertensive patients attending selected hospitals in Ladoke Akintola University Hospital?
  2. What is the level of compliance to recommended dietary practices among hypertensive patients attending selected hospitals in Ladoke Akintola University Hospital?
  3. Which factors influence compliance to recommended dietary practices among hypertensive patients attending selected hospitals in Ladoke Akintola University Hospital?

1.5 Hypothesis

  • H0: Compliance to recommended dietary practices among hypertensive patients is not influenced by the level of knowledge on the dietary recommendations.
  • HA: Compliance to recommended dietary practices among hypertensive patients is influenced by the level of knowledge on the dietary recommendations.

1.6 Significance of the Study

Results of this study will add value to the policy makers in their work of developing policies and guidelines on dietary management of Hypertension as well as compliance to recommended dietary practices. The study will also benefit Ladoke Akintola University Hospital in understanding some of the challenges hypertensive patients face that hinder compliance to recommended dietary practices in management of HP. The State and stakeholders will now have a chance to use the evidence to prioritize strategies that would eliminate the barriers to compliance. Health facility workers will also use the results to develop key messages that will improve on compliance to recommended practices. Results of the study will benefit hypertension community since the challenges they face on diet in management of Hypertension will be documented and different actors can now take up different roles to address them.


1.7 Operational Definition of Terms

Compliance:

Was the extent to which patients adopted the recommended dietary practices in management of Hypertension.

Recommended:

Dietary practices: Was the meal composition, meal frequency and meal timings in management of HP

Meal Composition:

Meal composition referred to the choice of food by groups, for instance; cereals, tubers and roots, meats and pulses, vegetables, fruits and oils, among others. It also referred to the portion sizes of each food type in household measures and in grams.

Frequency of Meals:

Frequency of meals in hypertension management was considered to be the number of meals a patient should/ actually consumes in a day. Main meals and snacks were regarded as individual meals.

Meal Timings:

Referred to consuming meals at almost exact time in a day e.g. taking breakfast at 7, most of the days


1.8 Organization of Study

The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.


Chapter Five


5.0 Conclusion and Recommendation

5.1 Conclusion

There was a relatively good knowledge (76.16%) among patients on dietary recommendations in management of hypertension. Older patients had lower level of education on recommended dietary practices. Consequently, knowledge on need to carry candy as a first aid when one is hypoglycemic was low. In addition, knowledge on the need for patients with hypertension to keep the times one consume their meals (meal timings) as well as consume snacks in between main meals in order to reduce incidences of hypoglycemia was low. Level of formal education of patients with hypertension influenced strongly the assimilation of information provided by health care providers. Age was also strongly associated with how much a patient was able to grasp information and remember. Continuous education on recommended dietary practices was noted as important.

Compliance to recommended dietary practices was 59.6%. Unlike the level of knowledge which was influenced by various demographic characteristics like age and level of formal education, compliance was not influenced by any of the assessed demographic factors. While the level of knowledge was high at 76.2%, this was found not to directly translate to compliance to recommended dietary practices in management of hypertension.

Compliance to recommended practices was not influenced by level of knowledge on recommended dietary practices in management of hypertension. Support by those related/ living with the patients was reported as one of the strong facilitators towards compliance. Management of hypertension was reported to be resource intense; financially and time wise. It was therefore sometimes difficult for patients to balance all aspects of recommendations.


5.2 Recommendation

The following recommendations were made;

  1. There is need for comprehensive education at the health facility on management of hypertension, including those aspects that are often neglected for instance the need to observe meal times, need to carry candy at all times and also take snacks in between main meals for better blood glucose control.
  2. There is also a need to review and educate patients on a regular basis in order to reinforce the information and promote compliance.
  3. The national government of Nigeria, state governments and donors are encouraged to come up with a way of reducing cost of diabetes care.

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