Compliance to Hypertensive Management and Blood Pressure Control among Patients Attending the Health Promotion Clinic of AAR Williamson House Outpatient Centre, Nairobi, Kenya

Abstract

Hypertension remains a public health disorder of concern globally even in developed countries with functioning health care systems and a large number of available effective treatments. In the year 2000, approximately 972 million people were diagnosed with hypertension worldwide and this is expected to increase to 1.56 billion by the year 2025. Hypertension has been ranked among the leading causes of disabilities and deaths from non-communicable diseases in Africa. Uncontrolled blood pressure is associated with complications. Patient directed assessment of compliance and interventions to improve adherence to medication and lifestyle changes have been a challenge. Despite more people being diagnosed with hypertension in Kenya, compliance to medication and life style changes that are needed in proper hypertension management remain a major concern. The main objective of this study was to assess the compliance of hypertensive management and blood pressure control among patients attending the health promotion clinic of AAR Williamson House Outpatient Centre in Nairobi, Kenya. The first specific objective was to determine the level of compliance to various aspects of hypertension management among hypertensive patients attending selected AAR Health Promotion Clinic in Nairobi. The second was to establish the level of blood pressure control among hypertensive patients attending selected AAR Health Promotion Clinic in Nairobi. The third was to determine the factors associated with compliance among the hypertensive patients attending the selected AAR Health Promotion Clinic in Nairobi. The study adopted a descriptive cross-sectional design to determine the level of compliance in hypertensive patients. The study targeted hypertensive patients that were on follow up in the Health Promotion Clinic. These included insurance members and cash paying patients. Convenience sampling method was used to recruit 172 respondents. WHO instrument for stepwise surveillance (STEPS) of chronic disease risk factors was administered and the blood pressure and anthropometric measures of the respondents recorded. Data entry and statistical analysis was done using Statistical Package for Social Sciences version 23. Pearsons chi-square test was used to determine the association between variables while correlation between variables was determined using the Cramer’s phi coefficient and Phi-coeffecient. Bionomial regression analysis was done to determine the risk factors in compliance to blood pressure control. Ethical approval was given by KNH-UoN ERC and the management of AAR Healthcare (K) also gave their consent. Written consent was sought from the partcipants for data collection to ensure participation was voluntary. Those that were found to have uncontrolled BP were referred to see the doctor. The study found that only 27.4% of the patients controlled their blood pressure. The male respondents were 55% and 45% were female. Those who were in university, or already graduates or pursing postgraduate degrees were 61%. The respondents who did not smoke were 97%, 40% were taking alcohol, 52% kept within the recommended diet with 88% of them adhering to the recommended sodium intake. The respondents who engaged in physical activities at work were 63% and only 19.2% had normal BMI. As for associated factors for non-compliance, the study found there was no significant association (p > 0.05) between compliance and age, education level, marital status, employment status, smoking tobacco and number of people living with the respondent. However, sex was significant (p = 0.020) with men being less compliant. The odds of female respondents being more complaint were 0.402 times more than males. Alcohol intake (p = 0.037), high BMI (p = 0.002), high sodium intake (p = 0.030) and not engaging in physical activities (p = 0.007) were also significantly associated with lack of compliance. Binomial regression analysis indicated alcohol and BMI were the factors that added significantly to blood pressure control. The study concludes that compliance to various aspects of hypertensive management varied among the hypertensive patients with overall compliance being low. This study recommends the Clinical Operations Department of AAR Healthcare provide health information regarding different aspects of hypertension management and control to patients and also put in place measures to monitor and evaluate the performance of the health promotion clinic. Recruitment of a counselor to provide support to patients with compliance challenges was also recommended. Finally, studies were recommended to be carried out on the compliance to hypertension management of patients followed up in the health promotion clinics of the other AAR Healthcare Outpatient Centres.