Socio-Economic Differences in the Quality of Life of Adult Hypertensives Attending the Out Patient Clinic at the Eastern Regional Hospital
Date
2016-07
Authors
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Publisher
University of Ghana
Abstract
Background: Hypertension now largely affects low and middle income countries with a higher prevalence of 46% in African adults of 25 years and above. In Ghana the prevalence of hypertension ranges between 19% and 54% which is higher than the African regional average and this has been consistent and high in the urban areas than rural mostly due to urbanization. The increase in the prevalence rates reported is mostly thought to be attributable to certain unhealthy lifestyles and behaviours such as smoking, excessive alcohol intake. Hence with the current spate of urbanization, the burden of hypertension is expected to be high in Ghana as life expectancy increases. This study aims to determine the quality of life among adult hypertensives and factors determining the quality of life and reasons for these differences.
Methods: The study was a cross-sectional quality of life (QOL) survey relying on quantitative data. Three hundred and fifty two diagnosed hypertensive patients aged 18 years and above and attending the Eastern Regional Hospital were recruited using simple random sampling technique. Participants were interviewed using a structured questionnaire adapted from the Ghana Demographic Health Survey and the World Health Organization Quality of Life - BREF (26 items) tools. Descriptive statistics were used to examine patients’ demographic characteristics and social factors (education and occupation) of SES. Economic factors (wealth status) of SES was determined from household assets using the principal component analysis. Mean scores were reported for the quality of life and categorized into domains of four (physical and psychological health, social relationships and environment). Non parametric two sampled Wilcoxon rank-sum and Kruskal-Wallis equality-of-populations rank test, were used to measure the relationship between QOL domains and demographic, wealth status and health behaviours of participants. Chi square tests were done to know the relationship between the SES and demographic variables. Spearman correlation was used to measure the strength and direction of association between SES and QOL. Data was entered in Epi Info, exported to Microsoft Excel and analyzed in STATA MP Version 13.
Results: Patients mean age was (61.2, SD (12.4)) with majority being females (78%). SES status of patients was generally low. Majority of patients had lower levels of education (77.5% - no education to primary education) and this was related to higher prevalence of hypertension. Out of the number of employed patients’ (88.8%) were in the informal sector of the economy engaged in trading and farming. Education, wealth and employment status were found to be significant SES indicators of QOL (P<0.01). Patients’ quality of life was found to be generally moderate (3.3, SD (0.96)) in all four domains ranging from (51.3, SD (24.4) – 67.6, SD (18.7)) with the environment domain having the highest satisfaction score and the social relationships having the lowest satisfaction score. Spearman’s rank correlation co-efficient revealed that education and wealth (P<0.05), high levels of fruits intake, moderate to high physical activity levels and the absence of comorbidities were positively associated with patients’ QOL in physical, psychological and environment domains whereas presence of co-morbidity and old age were negatively associated with QOL in the physical domain.
Conclusion: The results revealed lower SES and lower QOL in social relationships domain compared to other domains and differences in QOL across patients’ background characteristics health behaviours. Given the results, engaging more in physical activities, more fruits intake and enhancing adherence to treatment should be considered to improve patients’ QOL. Interventions to improve QOL among hypertensives and targeted towards women, older patients, lowly educated and married and widowed patients are needed. Keywords: Hypertension, Quality of life, Wealth, WHOQOL-BREF, SES, Adult Hypertensives, Ghana
Description
Thesis(MPH)-University of Ghana, 2016
Keywords
Adult Hypertensives, Socio-Economic Differences