WELCOME TO KENTERPRO:
ASSESSMENT OF THE KNOWLEDGE, ATTITUDE AND PRACTICES OF HYPERTENSION PREVENTION AMONG ACADEMIC STAFF OF FEDERAL COLLEGE OF EDUCATION

CHAPTER ONE

INTRODUCTION

1.1 background to the Study

Hypertension is the major risk factor for cardiovascular disease, it is growing in prevalence and poorly controlled virtually worldwide. It is the commonest non communicable disease in the world with important public health challenge in both economically developing and developed countries (Kearny, 2004). Hypertension is a Non-Communicable Disease, which is developed as a result of certain behavioural or lifestyle choices. These include high job strain, environmental and mental stress, sedentary lifestyle, alcohol consumption, smoking, poor diet (food containing too much salt and fat) and obesity (Abdulaziz, Awosan, Oche, Yunasa, Unmar, & Isah, 2017; World Health Organisation, 2013). However, having a family history of hypertension also makes one prone to the condition. Hypertension has no symptoms, therefore, it is referred to as the “silent killer.” Sometimes, severe headache, shortness of breath, dizziness and chest pain, only occur when the blood pressure is already high; if left uncontrolled, hypertension can lead to stroke, dementia, coronary heart disease, kidney failure and ultimately, sudden cardiac death (Bloch, 2018). Several studies have also shown that Nigerians demonstrate poor, undesirable health-seeking behaviours and often visit patient and propriety medicine vendors also referred to as chemists; rather, than clinics, hospitals and primary health care centres (Omeiza, 2017). Consequently, many Nigerians are not aware of their blood pressure, many are living with hypertension without the knowledge of it and many more are likely to be practising risk behaviours.

Poorly controlled hypertension is a significant public health concern all over the world in terms of morbidity, mortality and economic burden especially among older adults (Ogedegbe, 2013). Prevention is possible although rarely achieved and treatment can lead to reduced incidence of complications such as stroke, coronary heart disease, heart failure and kidney disease. By the year 2030, 23 million cardiovascular deaths are projected with 85% occurring in low and middle income countries (Mathers, 2006). Hypertension contributes to approximately 17 million deaths worldwide every year despite the fact that it is one of the major, modifiable risk factors of cardiovascular diseases (Yach, 2004). The prevalence of hypertension is higher in low- and middle-income countries (Ibrahim, 2012) where health resources are scarce and stretched by a high burden of infectious diseases such as HIV, malaria and tuberculosis. (Ibrahim, 2012). Currently the world wide burden of hypertension is greatest in low and middle income countries (LMIC‘s) where it affects about 1 out of 5 adults which is projected to increase and the mortality rates of cardiovascular diseases are also higher in these countries, these accounts for major economic burdens(Seedat.,2000).

According to the World Health Organization (WHO), worldwide raised blood pressure is estimated to cause 7.5million deaths which is about 12% of the total of all deaths.  Globally, the overall prevalence of raised blood pressure in adults aged 25 and above was around 40% in 2008, however because of the growing population, the number of people with uncontrolled hypertension rose from 600million in 1980 to nearly 1billion in 2008.The increase in physical activity and reduced salt intake were associated with successful blood pressure control while increased BMI was negatively associated with adequate blood pressure control (Myung, 2017).

Prevalence of hypertension is high in Nigeria and the overall awarenessis low in the country (Adeloye, Basquill, Aderemi, Thompson & Obi, 2015), and ranks first among the non-communicable diseases in the country. The prevalence of hypertension is high among the Nigerian population, appropriate interventions need to be developed and implemented to reduce the preventable burden of hypertension especially at primary health care center‘s which is the first point of call for over 50% of the Nigerian population. A community based study of rural and semi urban population in Enugu, Nigeria put the prevalence of hypertension in Nigeria at 32.8% (Ulasi, Ijoma & Onodugo, 2010) and increasing (8-46%), (Ogah, Okpechi, Chukwuonye, Akinyemi, Onwubere & Falase, 2012). A similar figure (31.8%) was reported for Abia (Ogah et al., 2013).  In Nigeria, Hypertension is basically managed with pharmacotherapy, interventions such as lifestyle and dietary modifications often not emphasized. Lifestyle and dietary modification programs in developing countries are often affected by low literacy levels and income (Okwuonu, Ojimadu, Okaka & Akemokwe,2014). The 8^th Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure and the Nigerian Hypertension Society (NHS) guideline for the management of hypertension recommends lifestyle modification for all patients with hypertension. These modifications previously referred to as nonpharmacologic therapy serve as adjunctive therapy for hypertension and include weight reduction, increased physical activity, moderation of dietary sodium and alcohol intake using the Dietary Approach to Stop Hypertension (DASH) eating plan (Okwuonuetal.,2014).

The goal of hypertension management is to prevent short and long term complications by achieving and maintaining the blood pressure lower than 140/90mm Hg (Lambert, 2006). Individuals need to be aware of various modifiable risk factors associated with hypertension which can improve their blood pressure (Akter, 2014). The Dietary Approach to Stop Hypertension (DASH) eating plan which effectively lowers blood pressure should be encouraged in these patients (Okwuonu, 2014). The DASH plan emphasizes fruits, vegetables and low fat dairy products, protein and reduction in fat and cholesterol etc. (Okwuonu, 2014).

A study conducted among adult hypertensive patients in Nigeria showed that more than half the respondents (54.2%) have a poor level of knowledge of lifestyle and diet modification measures but have a high level of willingness to adapt (Dallas,2007). Recent surveys reveal continued lack in the awareness, treatment and control of hypertension. (Hennis, 2002). Hence assessing the knowledge, perception, attitudes and lifestyle practices of hypertensive patients is vitally important in achieving hypertension control goals at the population level and also for meeting quality standards in health care delivery (Conner, 1996). Knowledge, Attitude and Practices is linked as it provides a quantitative method (predefined questions formatted in standardized questionnaires) that provides access to quantitative and qualitative information. KAP surveys reveal misconceptions or misunderstandings that may represent obstacles to the activities that we would like to implement and potential barriers to behavior change. Note that a KAP survey essentially records an ―opinion‖ and is based on the ―declarative‖ (i.e., statements). In other words, the KAP survey reveals what was said, but there may be considerable gaps between what is said and what is done (Medecins du monde, 2011).

Lifestyle modification also known as non-pharmacological therapy is the cornerstone of helping out hypertensive patients to attain lifestyle behaviors that are healthy (Cakir and Pinar, 2006). The increasing prevalence of hypertension is attributed to ageing and behavioral risk factors such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress (WHO, 2008). Patient education by physicians and other members of healthcare team about lifestyle modification plays an important role in the control of hypertension (Ogedegbe., 2009).

Lecturers in Federal College of Education engage in strenuous activities where they work so hard that they hardly get time to eat good food. Most of them resort to eating junks or fast food which are some of the related causes of hypertension. It is in line with this and the above discussion that this study seeks to make an assessment of the knowledge, attitude and practices of hypertension prevention among academic staff of Federal College of Education, Pankshin.

1.2 Statement of the Problem

Hypertension is a leading cause of morbidity and mortality in Africa, and Nigeria, the most populous country in the continent hugely contributes to this. It is clear that hypertension associated diseases and events such as stroke, myocardial infarction, angina pectoris, heart failure, and peripheral vascular disease, are risk factors for disability. Hypertension (HTN) continues to be a serious public health problem in the United States and is a major risk factor for stroke, heart failure, myocardial infarction, and other serious cardiovascular and renal diseases. Hypertension can be asymptomatic, its detection and control continues to be a challenge. The total economic burden of HTN was estimated at $73.4 billion in 2009(Cohen, 2009) in United States. From a public health point of view, the prevention and control of hypertension are cost-effective interventions, particularly in the elderly patients. Risk factors for hypertension include dietary habits, such as high sodium or low potassium intake, high alcohol consumption, low levels of physical activity and overweight. An effort to reverse these habits is the pivotal aspect of suggested lifestyle/dietary changes.

Knowledge attitude and Practice of persons have great influence on determining the quality of health care services. research is required to clarify the relationship between lifestyles, individual behaviors, health and illnesses. This can only be achieved based on the knowledge derived from the public. Hypertension has been on high prevalence recently in developing countries as Nigeria, academic staff of Federal College of Education, Pankshin

From the available literature search there is generally poor knowledge and practices of lifestyle/diet modification measures among Nigerians. The high prevalence and low awareness/practices indicated a need to conduct a study in order to assess knowledge, attitude and practice of hypertension prevention among academic staff of Federal College of Education, Pankshin.

1.3. Purpose of the Study

            The main purpose of this study is to make an assessment of the knowledge, attitude and practices of hypertension prevention among academic staff of Federal College of Education, Pankshin. The specific objectives of the study are:

1. To assess knowledge of hypertension prevention among academic staff of Federal College of Education Pankshin.
2. To assess attitude of hypertension prevention among academic staff of Federal College of Education Pankshin.

• To assess practices of hypertension prevention among academic staff of Federal College of Education Pankshin.

1.4 Research Questions

          The following research questions were raised to guide the study:

1. To what extent does knowledge of hypertension prevention exist among academic staff of Federal College of Education Pankshin?
2. What is the attitude of hypertension prevention among academic staff of Federal College of Education Pankshin?

• What are the practices of hypertension prevention among academic staff of Federal College of Education Pankshin?
  • Significance of the Study

The study when completed will be of benefit to the following; lecturers, government and future researchers.

The government will benefit from this study as they will come to understand the prevention measures of hypertension among lecturers. Therefore, they will take measures which will help in curtailing this hypertension to the barest minimum be employing more hands, granting frequent holidays to lecturers, organizing sensitization workshops on hypertension and other health benefits that will keep the lecturers motivated and healthy.

The study will be of benefit to lecturers because they will come to understand the prevalence of hypertension, its causes, effects and how to prevent it. Again, all the recommendations given at the end of this work, if properly utilized, will be of benefit to them as it will mitigate cases of hypertension.

When this study is finally, completed, it will be a reference material to future researchers who would want to research further into the topic at hand. It will also add to the already existing body of research available on academic staff and hypertension. Other researchers will develop their researches on the gaps that this research will identify in the final report. Thus, they (other researchers) will build their researches on the recommendations of the research report.

• Delimitation of the Study

The researcher is aware of other problem areas in Federal College of Education, Pankshin such as students’ workload and their academic achievement among others. However, for the purpose of the present research, this study covers assessment of the knowledge, attitudes and practices of hypertension prevention among academic staff of Federal College of Education, Pankshin. However, despite the fact that the study is limited to Federal College of Education Pankshin, its findings will be generalized to other colleges of education in the state and country at large.

1.7. Operational Definition of Terms

Hypertension: Hypertension is another name for high blood pressure. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death. Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels.

Lecturer: a person who gives lectures, especially at a college or university.

College: an institution for higher education or professional training.

Education: a process of training and instruction, especially of children and young people in schools, colleges, etc, which is designed to give knowledge and develop skills