|Year : 2013 | Volume
| Issue : 1 | Page : 24-27
Prevalence of hypertension and its modifiable risk factors amongst traditional chiefs of an oil-bearing community in south-south Nigeria
Best Ordinioha1, Seiyefa Brisibe2
1 Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
2 Department of Family Medicine, Niger Delta University Teaching Hospital, Okolobiri, Nigeria
|Date of Web Publication||17-May-2013|
P. O. Box 162 Omoku, Onelga - Rivers State
Background: The epidemiological transition has firmly berthed in Nigeria's oil-bearing communities, but the pace is often different in subsets of the community, depending on how readily the western lifestyle is being adopted. This study determined the prevalence of hypertension and its modifiable risk factors amongst the traditional chiefs of an oil-bearing community in Rivers State, Nigeria. Materials and Methods: A descriptive cross-sectional study design was used, with the data collected using a modified form of the WHO STEPS instrument that consists of a questionnaire component and measurement of body mass index (BMI) and blood pressure. The questionnaire was used to collect information on the socio-demographic characteristics of the respondents, the use of tobacco, and consumption of alcohol. Results: A total of 106 traditional chiefs were studied. They were all males, mostly married (95.28%), with a mean age of 56.5 ± 4.10 years. The study population had a mean systolic blood pressure of 149 ± 17 mmHg, a mean diastolic blood pressure of 98.7 ± 14.8 mmHg, and prevalence of hypertension was 68.9%. Most (63.01%) of the hypertensive chiefs were aware of their status and were on anti-hypertensive drugs (50.68%). None of the chiefs were underweight, and most were either overweight (51.89%) or obese (26.42%). Nearly all (92.45%) the chiefs regularly took alcoholic beverage, while 24.53% currently smoke cigarettes.
Conclusion: The prevalence of hypertension amongst the traditional chiefs was higher than in the general population. This can be attributed to their older age and acculturation.
Keywords: Hypertension, traditional chiefs, oil producing communities
|How to cite this article:|
Ordinioha B, Brisibe S. Prevalence of hypertension and its modifiable risk factors amongst traditional chiefs of an oil-bearing community in south-south Nigeria. Sahel Med J 2013;16:24-7
|How to cite this URL:|
Ordinioha B, Brisibe S. Prevalence of hypertension and its modifiable risk factors amongst traditional chiefs of an oil-bearing community in south-south Nigeria. Sahel Med J [serial online] 2013 [cited 2020 May 27];16:24-7. Available from: http://www.smjonline.org/text.asp?2013/16/1/24/112065
| Introduction|| |
The epidemiological transition from infectious to non-communicable diseases has firmly berthed in the oil-bearing communities of the Niger delta region of Nigeria. The prevalence of hypertension has more than doubled, from 11.2% in the 1990s  to 27.9% in 2010, in Barako, a rural Ogoni community in Rivers State,  while as much as 60% of the patients admitted into the medical wards of the tertiary hospitals in the region are being treated for non-communicable diseases.  This transition has been attributed to wholesale adoption of western lifestyle, , made possible by the massive oil wealth of the region. 
The traditional rulers of the oil-bearing communities of the region are among the active players in the oil industry, as they often serve as a liaison between the oil companies and their communities. This role may be financially very rewarding. 
The epidemiological transition is often not uniform in a community. It occurs at different paces in the subsets of the community, influenced by how readily the western lifestyle is being adopted.  This study assessed the prevalence of hypertension and its risk factors amongst the traditional chiefs of an oil-bearing community in Rivers State, south-south Nigeria.
| Materials and Methods|| |
The study was carried out in January 2012, with the traditional chiefs in Ogba Council of Chiefs as the study population. These traditional chiefs are the rulers of communities in the Ogba ethnic group. Ogba is the most populous ethnic group in the Ogba/Egbema/Ndoni Local Government Area (LGA) of Rivers State, with a population of about 200,000 people (projected from the 2006 national census of Nigeria). Omoku, the largest community in the Ogba land, is urban and also the headquarters of the LGA, while the other communities are mainly semi-urban and populated mainly by farmers, fishermen, traders, and artisans. The LGA has the highest concentration of oil and gas facilities in Nigeria, and the Ogba communities are host to two major international oil companies (Nigerian Agip Oil Company and Total), with major oil facilities such as flow stations and natural gas plants.
A descriptive cross-sectional study design was used, and the study was designed to detect a 5% difference in prevalence of hypertension, with an alpha error of 5%, acceptable beta error of 20%, and a statistical power of 80%. The estimated prevalence of hypertension in the study population was put at 27.9%,  and the minimum required sample size for the study was thus determined to be 75, using the usual formula for sample size determination for studying proportions in populations of less than 10,000.
The subjects for the study were randomly chosen from a list of 139 traditional chiefs, obtained from the Secretary of the Traditional Rulers Council, while the data were collected using a modified form of the WHO STEPS instrument for chronic disease risk factor surveillance that consists of a questionnaire component and physical measurement. 
The questionnaire was structured, self-administered, and used to collect information on the socio-demographic characteristics of the respondents, the use of tobacco, the consumption of alcohol, the type of diet, and the history of raised blood pressure.
The physical measurements included weight, height, and blood pressure. Weight was measured to the nearest 0.1 kg using a portable weighing scale, while height was measured to the nearest 0.5 cm using a stadiometer. The body mass index (BMI) for each of the subjects was then calculated as weight (in kilograms) divided by square of the height (in meters), and the subjects were classified as obese (≥30 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), normal (18.5-24.9 kg/m 2 ), and underweight (18.5 kg/m 2 ).
Blood pressure was measured in the sitting position using a mercury sphygmomanometer with the appropriate cuff size. Standard measures were taken to ensure accuracy. Systolic blood pressure was recorded at phase I Korotkoff sounds, while the diastolic blood pressure was recorded at phase V Korotkoff sounds. Three consecutive measurements were taken at an interval of at least 3 min, but only the second and third measurements were used in calculating the mean blood pressures. A subject was said to be hypertensive according the WHO/ISH criteria when the mean systolic blood pressure was greater than or equal to 140 mmHg and/or the mean diastolic blood pressure was greater than or equal to 90 mmHg.
| Results|| |
A total of 106 members of the Ogba Council of Chiefs were studied. They were all males, married 101 (95.3%) or widowed 5 (4.7%), and had an average age of 56.5 ± 4.1 years. The members had a mean systolic blood pressure of 149 ± 17 mmHg and a mean diastolic pressure of 98.7 ± 14.8 mmHg; 73 (68.9%) members were found to be hypertensive. Of the 73 hypertensives, 46 (63.0%) were aware of their blood pressure status, 37 (50.7%) were on anti-hypertensive drugs, and 17 (23.3%) were on low-salt diet; 21 (28.8%) had been hospitalized as a result of hypertension.
Most of the subjects [98 (92.5%)] regularly took alcoholic beverage, and 26 (24.5%) were cigarette smokers. The BMI of the subjects ranged from 20.5 to 53.4 kg/m 2 , with a mean of 27.8 ± 2.9 kg/m 2 . [Table 1] compares the BMI class between hypertensives and normotensives. None of the subjects were underweight, and most were either overweight (51.9%) or obese (26.4%). Most of the subjects [22 (61.3%)] with BMI more than 24.1 kg/m 2 were hypertensive, and there was a statistically significant difference between obesity/overweight and hypertension (P < 0.001).
| Discussion|| |
The traditional chiefs who participated in the study had a mean age of 56.5 ± 4.10 years and the prevalence of hypertension was 68.87%. This is much higher than the prevalence in the general population in the rural  and semi-urban communities  of the Niger delta region, but closer to the prevalence recorded among market traders in Enugu, south-east Nigeria (42.2%),  patients seen in an out-patient clinic in Ogbomosho, south-west Nigeria (50.5%),  and the general population of Lagos, the commercial capital of Nigeria (44.3%).  The prevalence of hypertension in Barako, a rural community in Rivers State,  and in a semi-urban community in Edo State were 27.9% and 20.2%, respectively.
The high prevalence of hypertension amongst the traditional chiefs might be due to their older age and wholesale adoption of western lifestyle in spite of their being semi-urban community dwellers. In the rural communities of Mangu LGA in north-central Nigeria, the prevalence of hypertension increased threefold in less than 20 years, from 7.4% in 1991 to 20.9% in 2008.  The traditional chiefs with a mean age of 56.5 years were older than the study populations of the other studies, ,,,, and the prevalence of hypertension has consistently been shown to increase with age, especially in acculturated populations. 
The adoption of western lifestyle by the traditional chiefs is exemplified by the fact that 24.53% of them smoked cigarette, which is even higher than the 9.9% recorded in Lagos.  Cigarette smoking has been shown to be responsible for at least 12% of all vascular diseases, including hypertension.  Acculturation might also be responsible for the high BMI recorded among the traditional chiefs, as was also observed in the Mangu communities,  where the mean BMI increased from 20.7 to 23.7 kg/m 2 . More than 75% of the traditional chiefs were either overweight or obese, which is much higher than the 39.6% found in the Lagos study  and the 47.5% recorded in the rural community in Rivers State.  The prevalence is, however, similar to the 82.67% recorded amongst the lecturers of a medical school in Port Harcourt.  This study, like the study of the medical lecturers, was carried out not in a general population, but amongst a more affluent population that is known to have the tendency to adopt the western diet, as suggested by the nutrition transition theory. 
Our study also showed that 92.45% of the traditional chiefs regularly took alcoholic beverages. This is not surprising considering that alcoholic beverages are not just used for recreation in most Niger delta communities, but also serve several social and religious functions. A study carried out in another Niger delta community had shown that 90.99% of the general population regularly took alcoholic beverages, as a solvent for various traditional medicines, for oral hygiene, and often ancestral worship.  The consumption of alcohol is a known risk factor of hypertension, and studies have demonstrated a direct relationship between alcohol intake and the elevation of blood pressure. 
The traditional chiefs, like the medical lecturers in a previous report,  had good health-seeking behavior, especially as 63.01% of those found to be hypertensive were aware of their condition, with several taking concrete steps to control the hypertension. This is much higher than the 18.5% awareness recorded in the semi-urban community in Edo State  and the 29.4% recorded among the Enugu market traders.  However, the management of the hypertensive traditional chiefs, like several other hypertensive patients in Nigeria, was almost entirely restricted to drug therapy.  This is said to be responsible for the poor blood pressure control achieved in the management of the patients,  Hence, there is a need to include proven adjuncts such as Dietary Approach to Stop Hypertension (DASH), weight loss, and other lifestyle modification programs. DASH has particularly been found to be very effective in the management of hypertension in Blacks. 
The traditional chiefs were so afflicted with hypertension perhaps because they adopted the western lifestyle. Western lifestyle is promoted as a life of glamour and sophistication in these communities, but has been recognized as unhealthy and abandoned by people of higher socioeconomic class in the developed countries, who have reversed their cardiovascular morbidity and mortality by the action.  Health promotion activities to stem the rising prevalence of hypertension should involve the retention of the traditional physically active lifestyle and/or the acquisition of only the healthy components of western lifestyle.
| Conclusion|| |
The prevalence of hypertension amongst the traditional chiefs was higher than in the general population. This can be attributed to their older age and acculturation. We recommend retention of the traditional lifestyle and/or the adoption of healthy western lifestyle.
| Acknowledgments|| |
We wish to thank the Oba, Eze Ogba, the Secretary of Oba-in-Council, and the entire chiefs in the Ogba Council of Chiefs for their assistance and cooperation during the study. We also wish to thank Anyasodo Chisom, Avundaa Owhonda, Chikwendu Chinemerm, and Uzoigwe Adanna who assisted in data collection.
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