Students’ Awareness And Attitude Towards Risk Factors For High Blood Pressure
The prevalence rate of high blood pressure (HBP) among youths in Nigeria and the world at large is said to be on the increase. This is attributed to lack of knowledge of several modifiable risk factors (excessive alcohol consumption, smoking, lack of exercise etc) and non-modifiable risk factors (age, hereditary, race and sex). Literatures reviewed on HBP hold that no specific cause for the disease in question has been discovered. This study set out to assess the level of awareness of risk factors for high blood pressure; level of youth engagement in unhealthy lifestyles and dietary habits; level of knowledge of preventive and control measures for high blood pressure; and possible strategies for enhancing youth awareness of risk factors for high blood pressure as well as it’s preventive and control measures among students of Ahmadu Bello University (ABU), Zaria.
The ―Health Belief Model‖ was adopted for the study with its basic assumptions that people were afraid of getting serious illness and that health related behaviors reflect the level of threat perceived; that is a person’s perceived seriousness and susceptibility of an illness provokes the likelihood of preventive action. The functionalist theory was also adopted. Data were collected from three hundred and ninety-eight (398) undergraduate students in both Main and Kongo campuses of ABU. Eight in-depth interviews were conducted. Findings from the study revealed poor knowledge of most risk factors associated with high blood pressure among students; poor dietary habit with most students consuming carbohydrate foods mostly for breakfast, lunch or dinner weekly; high rate of snack foods and sugared drinks consumption on daily bases; low rate of students‘ engagement in regular physical activities.
On consumption of alcohol, findings revealed that about 51% of students who consumed alcohol had parent(s) who do not consume alcohol indicating that youth alcoholic habit may not be associated with parental influence. On the other hand, parental influence on cigarette smoking proved to be likely as about 54% of students who smoke cigarette indicated having parent(s) who smoke cigarette as well. Also, about 78% of students who consume alcohol and 100% of those who smoke cigarette were males, revealing part of the reasons why the male gender is said to be more prone to high blood pressure compared to the female gender.
About 52% of students who indicated ever being diagnosed of HBP were from polygamous homes. Furthermore, students‘ knowledge of preventive measures for high blood pressure was revealed to be below average. The qualitative data also revealed that no health education sessions or any form of awareness on high blood pressure with particular reference to students (youth) either during the daily health education sessions held at the university sick-bay or during the annual orientation for new students. Findings from the study showed that there is urgent need for awareness campaign on risk factors for high blood pressure in the university and possibly the wider society, and further recommends annual health seminars by respective faculties and places of worship, information on risk factor for HBP through fliers and bill boards by the University Health Service and the Guidance and Counselling.
1.1 Background to the Study
High blood pressure otherwise called hypertension is a major threat to public health. The disease has been identified as a major cause of morbidity and mortality globally. It is as a result of this global burden, that the world’s premier blood pressure society known as the International Society of Hypertension (ISH) was established in 1966 to encourage and promote the advancement of scientific research and its application to the prevention and management of heart diseases, stroke, hypertension and other cardiovascular diseases (CVD) around the world (www.ish.org ; 2013).
According to the Report of WHO (2002), hypertension is the most prevalent CVD affecting at least 600million people worldwide. The report refers to hypertension as an important contributor to cardiovascular diseases, which according to Mathers, et al (2000), were responsible for the deaths of 17million people each year, or approximately one – third of the global deaths annually. This rose to about 17.5million deaths in 2009 (WHO, 2009). It is projected to account for about 23.3 million deaths annually by the year 2030 (WHO, 2013).
A review of the global burden of high blood pressure by the International Society of Hypertension (ISH) indicated that approximately 54% of stroke, 47% of ischemic heart disease
(IHD), 75% of hypertensive disease and 25% of other Cardiovascular Diseases (CVDs) are attributed to hypertension, equating approximately 7.6 million deaths attributable to high blood pressure (Lawes et al, 2008).
In Africa however, the World Health Report (2001), stated that Non – Communicable Diseases (NCD) especially hypertension, accounted for 22% of the registered deaths in the year 2000, killing even more than malaria (WHO, 2002). It has been projected that up to three quarters of the world’s hypertensive population will be in economically developing countries by the year 2025 (Kearney et al, 2005). According to the final report of a national survey (1997), the national Experts Committee on Non-communicable Diseases (NCDs) ranks hypertension first among the NCDs in Nigeria. However, as Ekwunife and Aguwa (2011) pointed out, the disease is yet to be considered a problem in the country.
More importantly, it is essential to note that from high blood pressure from time immemorial has been no respecter of age. To this, the World Health Organization (1985) asserted that although there were several epidemiological reports on the prevalence of hypertension in adults, a dearth of information continued to exist in adolescent hypertension in many parts of the world. Several studies have observed and documented the distribution of cardiovascular risk factors in childhood and adolescent population in many countries (Berenson et al, 1980 and Harris 1987 and Webber et al, 1993).
After decades of the existence of the disease, as well as the existence of international and national societies of hypertension, the depth of knowledge youths have of hypertension and its risk factors which could make them prone to it, as well as its preventive and control measures are the concern of this research.
1.2 Statement of the Research Problem
It has been observed in recent times by medical experts that young adults especially the black skinned, now suffer and die from high blood pressure. According to Savoca et al (2009), in the year 2000, African Americans aged 25-29 died from the disease at almost three times the rate among whites, while hospitalized hypertensive patients among African Americans consisting of ages of 18- 44, were six times greater than hospitalizations among the whites. In Sub-Saharan Africa according to Mayosi et al, (2009), high blood pressure is also the predominant driver of Cardiovascular Diseases (CVD) especially among black Africans.
In Nigeria, Adebayo (2013) confirmed that very often, children and young adults in their 20s and 30s are being diagnosed with the disease. In relation to this, he noted that hypertension in youth is increasing abnormally. This he said could be hereditary and has been linked to an increased intake of salt, fatty foods, obesity, lack of exercises, inadequate intake of vegetable and fruits, smoking, uncontrolled consumption of alcohol and low level of awareness of the disease. Ogunbo (2013), stated that one in every four adults in Nigeria has hypertension and that more young persons are presently dying of the complications of the disease. He thereby stressed that there is need for aggressive enlightenment on early detection of the disease. Ajayi (2013) also maintains that the reason why more young adults in Nigeria are dying of the disease is ignorance, wrong socio-cultural beliefs and poor health seeking behaviour.
Results of a study carried out by Berenson et al (1984) showed that high blood pressure in childhood indicated the early stages of hypertension which therefore was a risk for young adult and adult cardiovascular disease.
In Nigeria, Musa and Lawal (2000), Balogun et al (1990) and Eferakaye et al (1982) have also carried out studies on the levels of blood pressure in adolescent children, all of which confirmed its existence. Mijinyawa et al (2008) further maintains that hypertension is known to track from
youth to adulthood, which makes it a useful predictor of essential hypertension adulthood. In the study carried out on the prevalence of hypertension and associated cardiovascular risk factors among secondary school teenagers in Kano, between ages 13 and 19 years, seventy students had systolic blood pressure 140mmHg and/or diastolic blood pressure 90mmHg indicating high prevalence. The result further revealed that the prevalence rate of hypertension among the younger participants rose from 4.3% to 11.8% among the oldest students. Out of the 70 participants, a majority (88,5%) had grade 1 hypertension, 10.0% had grade 2 hypertension and 1.5% had grade 3 hypertension (Mijinyawa et al, 2008).
The autopsy of the tragic incident of the sudden death of a famous Nigerian football player, Samuel Okwaraji, which occurred ten minutes from the end of a world cup qualifier against Angola in Lagos in 1989, revealed that the 25-year old died of an enlarged heart and high blood pressure (Ojo, 2002). This incident proves that hypertension is indeed a “silent killer” and it has not been a disease affecting only the old as perceived by many.
However, due to the fact that there are no clear-cut symptoms for high blood pressure, millions of people are said to be living with it ignorantly. This is thus often referred to as “the silent killer” in various publications and among health workers. In this light, some heart organizations, such as the Nigerian Hypertension Society among others, with support from state governments like Abia State have been said to make efforts in organizing awareness campaigns to keep the public abreast with the preventive and control measures of the disease. Notwithstanding, ignorance still remains one of the major reasons for the increasing prevalence of the disease not only among the aged, but also among the youth who are the strength and future of any nation.
A cross-sectional study of undergraduate students of the University of Ibadan, conducted by Ameen and Fawole (2007), revealed that the prevalence of risk factors for Cardiovascular Diseases (CVDs) such as hypertension was high. This was drawn from students’ consumption of baked snacks, cigarettes, alcohol and less physical exercises. In ABU, these risk factors are observable in reasonable number of students as they feed on snacks and soft drinks, others (predominantly males) smoking cigarettes mostly at the social centre and sculpture garden and taking alcohol in specific locations (1759, Exodus and Mami market Bassawa Barracks) off campus. Overweight and stress are also observable risk factors.
However, the crux of the matter is whether students are ‘aware’ of these risk factors. Also, it is important to note that a major risk factor, though not mentioned in the list of risk factors for hypertension by scholars is the ‘lack of awareness’. It can be said to be the most dangerous risk factor and the fastest means of encountering death in any disease, for ignorance in itself is a disease.
Shaikh et al (2011), having carried out a study on ‘knowledge regarding risk factors of hypertension among first year students of a medical university, discovered that knowledge of the predisposing risk factors is vital in the modification of lifestyle behaviors conducive to optimal cardiovascular health. Also, measuring and appropriately disseminating knowledge of controllable risk factors at an early age is an essential preventive educational approach. So far, risk factors of hypertension are not well studied in young adults and public awareness of hypertension in countries undergoing epidemiological transition is dismal. There is a paucity of data on the knowledge of hypertension and its risk factors among teenagers and young adults as most studies describe knowledge of hypertension and its risk factors in older adults and the elderly, the young are considered to be at a lower risk developing the disease.
Considering the above mentioned problem, the study sets to fill this gap by addressing the following questions.
1.3 Research Questions
- What is the level of ABU students‘ awareness of risk factors for high blood pressure?
- What are the students‘ unhealthy risks – laden lifestyles for high blood pressure?
- Are students aware of the preventive and control measures for high blood pressure?
- What are the strategies that could be adopted to improve awareness of preventive measures of risk factors for high blood pressure among youth?
1.4 Aims and Objectives of Study
- To assess the level of awareness of risk factors for high blood pressure among ABU students.
- To examine the level of students’ engagement in unhealthy lifestyles.
- To ascertain the level of knowledge of the preventive and control measures of high blood pressure among students of ABU.
- To proffer possible strategies to enhance ABU students‘ awareness of risk factors for high blood pressure as well as control measures among youth.
1.5 Significance of the Study
This study will help identify the social factors responsible for youth proneness to high blood pressure. Findings such as the level of youth awareness to hypertension, their proneness to it and the preventive and control measures, as well as socio-economic backgrounds of youths who engage most in risk factors for hypertension, will be brought to light and this will aid the government, heart and hypertensive related organizations in strategizing, for better and more effective awareness programs in the future.
Also, this research will provoke the minds of students to reflect on their lifestyles that predispose them to hypertension, as well as to seek more knowledge on the disease and adopt precautionary measures to avoid it.
Findings from this study will add to the existing stock of knowledge in the field of hypertension and cardiovascular diseases especially as it relates to youth and their knowledge on the risk factors of the deadly disease. Therefore, it will be of immense help to anyone who intends to carry out a similar research in the future.
Finally, the importance of a research of this sort cannot be over emphasized as it affects the youths who are the strength and future of a better and healthier Nigeria.
1.6 Scope and Delimitation of the Study
The study was carried out in both campuses (Main-campus and Kongo-campus) of Ahmadu Bello University, Zaria. It was basically centered on high blood pressure, precisely students’ knowledge of risk factors as well as lifestyles associated with the disease.
This study is interested in students of all Federal Universities in Nigeria, as well as other youths in the general society, but due to manpower and financial constraints, it was limited to students of AB.U. However, this restriction did not compromise the quality of the study. The population of the study is undergraduate students of both campuses of A.B.U.
1.7 Definition of terms
Cardiovascular Disease (CVD)
Is defined as illness of the heart and blood vessels, including high blood pressure, heart attack, stroke and heart failure (HPLP, 2004).
High Blood Pressure (HBP)
Is a condition through which blood is passed through the body’s blood vessels at greater force than normal. It can lead to tiredness, heart attack, stroke and other health problems. It is also called hypertension (HPLP, 2004).
Ischemic Heart Disease (IHD)
Is a disease characterized by reduced blood supply to the heart muscle usually due to coronary arteries diseases. Its risks increase with age, smoking, diabetes, and hypertension (Gulati, 2006).
Non – Communicable Disease
Is a medical condition or disease which by definition is non-infectious or non-transmissible among people. It may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types of sudden stroke (Wikipedia, 2013).
Something that contributes to illness: a feature of somebody’s habits, genetic makeup, or personal history that increases the possibility of disease or harm to health (Encarta English Dictionary, 2009).
Is a young male or female aged from 14 – 35years. Young people in this age group require social, economic and political support to realize their full potential (NYC, 1997).
Summary, Conclusion and Recommendations
This chapter consists of three sections: the summary of findings, conclusion and recommendation as regards enhancement of awareness on risk factors for high blood pressure among youths.
5.2 Summary of Key Findings
This work is titled ―Awareness and Attitude of Students towards Risk Factors for High Blood Pressure in Ahmadu Bello University, Zaria‖. Specific objectives addressed were level of awareness of risk factors for high blood pressure among students, level of students’ engagement in unhealthy lifestyles and dietary habits, level of knowledge of preventive and control measures for high blood pressure, and possible strategies to enhancing youth awareness of risk factors for high blood pressure as well as it’s preventive and control measures among youth. To buttress our understanding of the topic in question, several relevant literatures were reviewed and the ―Health Belief Model‖ which was introduced in the 1950s by psychologists was adopted for the study. Its basic assumptions is that people were afraid of getting serious illness and that health related behaviors reflect the level of threat perceived, that is a person’s perceived seriousness and susceptibility to an illness that provokes the likelihood of preventive action. Furthermore, both quantitative (survey) and qualitative (in-depth interview) methods were employed to elicit information from the target population on the above mentioned objectives.
Information for this research was sort from both the Main-Campus and Kongo-Campus of Ahmadu Bello University Zaria, Kaduna State, Nigeria. The sample size was four hundred (400), all being undergraduate students. However, a total of 398 valid responses were analyzed.
From the analysis, the male respondents constituted 62% (245%), while the female respondents were 38% (153) (see table 1). On the basis of religion 227(57%) of the respondents were Christians, 42% (167) were Muslims and 2(1%) were traditional worshipers (see table 1). On the basis of age range, the highest total percentage of respondents were those between ages 21 and 25 with a total population of 233(58%) while the lowest total percentage of respondents were those aged 36years and older with a total population of 10(2%). As regards marital status, majority a significant proportion 372(94%) were single and a few 26(7%) were married.
As regards students‘ knowledge of risk factors for high blood pressure, results showed that most students are not aware of some modifiable risk factors such as the consumption of snacks, alcohol and tobacco. On regular consumption of snacks as a risk factor for high blood pressure, 79(20%) of respondents agreed it was a risk factor for high blood pressure, while 102(26%) disagreed and 217(54%) were not sure (see table 3). Also, on regular consumption of alcohol, results revealed that most students are not aware of it being a risk factor for high blood pressure as 50(13%) disagreed and 170(43%) were not sure, put against 178(45%) who indicated being aware (see table 4). Again, information collected showed that most students are not aware that regular consumption of tobacco is a risk factor for high blood pressure as 57(14%) disagreed and 190(48%) indicated not being sure, against 151(38%) who agreed, indicating that they are aware (see table 5).
It was also discovered that most students are not aware of the unmodifiable risk factors (hereditary and male gender). As regards hereditary, 169(43%) agreed it is a risk factor for high blood pressure, while 49(12%) disagreed and 45% (180) indicated not being sure (see table 7). Also, on asking which gender is more prone to high blood pressure, majority (64%) think the female gender is more prone while 32% correctly indicated that the male gender was more prone to high blood pressure and 5% were not sure (see fig.1). Findings from the qualitative data however confirmed that majority of respondents were indeed not aware that the male gender is a risk factor itself when one of the medical doctors said that research so far, has it that the male sex are more prone to the disease compared to the female sex.
However, results also revealed that most students are aware of some modifiable risk factors for high blood pressure such as stress, obesity and lack of exercise. As regards stress, a significant proportion 345(87%) agreed to it being a risk factor for high blood pressure while few 10(2.4%) disagreed and 43(11%) indicated not being sure (see table 2). From the professional point, a medical doctor of the university health service (sick-bay) agrees with the above results, ―A lot of students may not be aware of other risk factors for high blood pressure, but I‘m sure most of them think that stress is the only risk factor that predisposes one to hypertension, in fact even some uneducated people believe that‖.
On obesity, 53% (211) agreed it was a risk factor for high blood pressure while few 29(7%) disagreed and 39% (157) were not sure (see table 6). Lastly on lack of exercise, 202(51%) agreed that lack of exercise could pose one to high blood pressure, while 49(12%) disagreed and 147(37%) indicated not being sure (see table 8).
As regards lifestyle habits of students, results revealed that not many students were of the habit of consuming alcohol and tobacco. When asked if they consumed alcohol, 55(14%) of the total respondents indicated they do, while 343(86%) indicated they do not consume alcohol (see fig.2). However, of the 55 respondents who take alcohol, results also showed that majority 20(36%) consume it occasionally (see fig. 3). Also, results revealed that it is not certain that most students who take to the habit of consuming alcohol were influenced by parents who also consume it, as 28(51%) of the 55 respondents who consume alcohol indicated that their parent(s) do not consume alcohol and 27(49%) indicated that their parent(s) consume it (see fig. 4). Lastly on alcohol consumption, results revealed that male students indulge more in alcohol consumption than female students as 43(78%) of the 55 respondents who consume alcohol are males and 12(22%) were females (see fig. 5).
When asked if they consume tobacco, 24(6%) of the total respondents indicated they do, while 374(94%) indicated they do not consume alcohol (see fig.6). However, of the 24respondents who take tobacco, results also showed that majority 13(54%) consume at least a packet of cigarette daily (see fig. 7). Also, results revealed that it is likely that most youths who take to the habit of smoking cigarette were influenced by parents who also consume it, as 13(54%) of the 24 respondents who consume alcohol indicated that their parent(s) do smoke cigarette are more than those 11(46%) who indicated that their parent(s) do not smoke cigarette (see fig. 8). Lastly on tobacco consumption, results revealed that male students indulge most in cigarette smoking compared to female students as results showed that all 24(100%) of respondents who smoke cigarette are males (see fig. 9).
As regards dietary habits of students such as consumption of snacks or baked foods, results revealed that most respondents 142(36%) indulge in this habit 4-5times weekly (see table 9). The qualitative data also corroborated the above information as one of the informant said: ―also, bad eating habits such as feeding on junks and snacks on a daily basis by majority of the students, is something we can see every day on campus‖. On the consumption of sugared drinks among students, findings show that majority 146(47%) of respondents consume sugared drinks 4-5times weekly (see table 10). Also, on the three square meals consumed daily by students, results revealed that majority 270(68%) of respondents consume bread for breakfast mostly (see table 11), another majority 184(46%) of respondents consumed rice mostly for lunch while for dinner, most [107(27%), 98(25%), 86(22%)] respondents consumed indomie, solid starchy meals (eba, semo) and rice mostly for dinner.
On students‘ engagement in physical activities or exercise, results showed that majority 197(49%) of the respondents engage in regular walking for 30-45 minutes daily, indicating that most students do not engage in ‗active‘ exercise (see table 14) and those who engage in active exercises such as jogging, competitive sports, to mention a few, do so less than 4times weekly (see table 15). From the professional point, a medical doctor expressed his view on the above thus, ―Lack of proper physical exercise is a risk factor for high blood pressure and nowadays most of you young adult especially students do not engage in other exercises apart from walking around the school premises‖.
This study also revealed that 31(8%) of the respondents have been diagnosed with high blood pressure (see fig. 10) with a majority 12 indicating that they were diagnosed of the HBP between 20-24years of age. When asked for the suspected ‗cause‘, another majority 12 out of the 31 respondents who indicated ever being diagnosed with hypertension maintained that the suspected cause was said to be stress (see table 16). However, on medications given, majority (13) of the 31 respondents indicated that they could not remember the medications received (see table 17). Furthermore, studies also show that 16(52%) of the 31 respondents who indicated haven being diagnosed of hypertension come from polygamous homes (see fig. 11).
As regards knowledge of preventive measures for hypertension, findings show that majority 185(47%) of respondents gave the preventive measure to be avoidance of excessive thinking, worry and stress (see table 18). This further indicate that majority of students view stress, excessive thinking or worrying to be the major risk factor for high blood pressure. In contrast to the quantitative data above, from the qualitative data other preventive measures for high blood pressure were equally stressed upon, such as eat healthy diets, control rate of consuming of junks, sugary drinks, alcohol and if possible avoid tobacco completely, have general check-ups in the clinic every now and then, not only when one feel sick.
Lastly, when respondents were asked to proffer possible measures to enhance awareness on risk factors for high blood pressure amongst youths, 168(42%) suggested that organizing seminars in each faculty once every session as well as free check-ups. Unlike the quantitative data above, the key informants from the qualitative data did not lay emphasis on organization of seminars alone, but on other measures such as funding of preventive health education or campaign by the federal and state government on non-communicable diseases in general, carrying out health education in places of worship, the use of bill boards and the university‘s electronic bill boards, the media, to mention a few.
In conclusion, it is obvious and evident that almost all students are aware of the disease ‗high blood pressure‘ or hypertension,‘ being that they either have a parent or a relative or an acquaintance, who has ever been diagnosed to have this condition in question. This conclusion is drawn from comments made by majority of the respondents encountered in the course of the field work. However, findings from this study have brought to light, the information that quite a significant proportion of youths or students may be aware of the disease in question but are lacking in the knowledge of most of the risk factors which could make them prone to high blood pressure in their young age.
This lack of knowledge can be said to be due the way and medium through which information on high blood pressure has been carried out over the years both on the media, among peer groups and families. High blood pressure has been projected to be a disease exclusively for the old or adults in our society, hence the lack of motivation on the part of the youth for preventive action. Thus, confirming the assumptions of the health belief model, for instance, Rosenstock et al, (1988) maintains that health promotion messages through mass media, peer education, and other interventions act as cues to action. These cues are often necessary to overcome habitual unhealthy behaviors such as eating primarily high-fat foods, smoking, etc.
As often said, information is key, knowledge is the key to success, and regarding health, prevention will always be better than cure. The importance for the effective knowledge or awareness on the risk factors for high blood pressure for especially the youths in our society cannot be over emphasized. Therefore, the following recommendations are given to assist in the enhancement of the awareness especially among the students so as to sustain a healthy people for a healthy future of our society and Nigeria as a whole.
- Interactive health seminars should be encouraged and organized by every faculty in Ahmadu Bello University at least once every session with focus on risk factors, causes and preventive measures of both hypertension and other cardiovascular diseases
- Religious gatherings especially the churches and mosques on campus of which students constitute the majority of congregation should also inculcate the habit of organizing health seminars as often as possible on several health issues especially risk factors for deadly silent killers like hypertension.
- Also, the University Health Service should provide and promote the distribution of fliers containing information on risk factors for high blood pressure and other diseases at least for year one students annually.
- The Guidance and Counseling Unit of the main and Kongo campuses, should provide sign boards or make use of the university‘s electronic bill boards with information about hypertension. This will speak to people passing every day thereby creating better awareness.
- On the part of the individual (students), conscious evaluation of the types of foods consumed daily should become a habit, so as to create and maintain a healthy dietary habit and weight. Also, sugared drinks and snacks should be consumed at most three (3) times weekly with 2-3days interval. Pick on a game of his/her choice to help exercise for 30minutes at least three (3) times weekly and lastly, imbibe the habit of regular medical check-up at least once in every four (4) months as recommended by a doctor of the University Sick-Bay.
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