An ethnographic study of predictors of hypertension and its preventive strategies in a rural community in Delta State, Nigeria.

Abstract

This study investigated the blood pressure profiles of residents in Ibusa community in Delta State Nigeria. Predictors of hypertension in the community were also established and traditional and cultural practices associated with hypertension management were explored, with the aim of developing guidelines for management of hypertension through a “System Support Strategy” combining appropriate and effective clinical care with community action, and taking into account facilities and social and environmental factors influencing the development of hypertension in rural settings. Conducted in three phases, the study has given rise to four articles: one covering the literature review and the other three linked to the three phases of the study. The first phase assessed the prevalence of hypertension and associated risk factors in adults in three villages in the community. From a simple random sample of homesteads in the three villages, all adults aged 18 and above who were available and willing to participate (134 individuals: 48 males; 86 females) were recruited into the cross-sectional study. Hypertension prevalence in this rural community was 44%. Increasing age, increasing body mass index and high salt intake emerged as prominent risk factors for hypertension. The second phase described the experiences of the community in terms of their cultural practices and how these influenced the management of hypertension. Ten known hypertensive patients who had used traditional practices for management of hypertension were purposively selected and an in-depth interview was conducted with each. The traditional and cultural practices identified include medicinal plants, sacrifices, scarification and tribal marks. Where these traditional practices fail, local diets serve as a remedy. Some cultural practices potentially predispose individuals to risk factors for certain diseases (e.g., high cholesterol palm kernel soup) while some potentially promote their health (e.g., medicinal plants). The third phase was development of guidelines for the prevention and management of hypertension using nominal group technique in a meeting with experts (six key stakeholders) knowledgeable in the field. Major concepts addressed included blood pressure measurement and assessment and pharmacological and non-pharmacological measures for management. This study will hopefully help in empowering individuals to take more and greater responsibility for their own health issues, reinforcing community self-reliance and self-determination.