Nationwide prevalence study of hypertension and related non‐communicable diseases in The Gambia

Abstract

SummaryThe prevalence of hypertension, diabetes and obesity in The Gambia was assessed in a 1% population sample of 6048 adults over 15 years of age. 572 (9.5%) subjects were hypertensive according to WHO criteria (a diastolic blood pressure (DBP) of 95 mmHg or above and/or a systolic blood pressure (SBP) of 160 mmHg or above); 325 (5.4%) had a DBP of 95 mmHg or above, and 39 (2.3%) a DBP of 105 mmHg or above; 428 (7.1%) had a SBP of 160 mmHg or above. By less conservative criteria (a DBP of 90 mmHg or above and/or SBP of 140 mmHg or above), 24.2% of subjects were hypertensive. The prevalence of hypertension was similar in the major ethnic groups and in urban and rural communities. Age and obesity were risk factors for hypertension; female sex was an additional risk factor for diastolic hypertension. Several communities had a prevalence of diastolic hypertension double the national rate, and significant community clustering of diastolic hypertension (P Ͻ 0.01) was confirmed by Monte Carlo methods. Genetic and/or localized environmental factors (such as diet or Schistosoma haematobium infection), may be involved. 140 (2.3%) subjects were obese. Obesity was associated with female sex, increasing age, urban environment, non-manual work and diastolic hypertension. Only 14 (0.3%) subjects were found to be diabetic. Hypertension appears to be very prevalent in The Gambia, with a substantial population at risk of developing target organ damage. Further studies to delineate this risk and appropriate interventions to reduce it are needed.

Geographical variation in prevalence of hypertension within The Gambia

“…4 Other studies from sSA have observed variation in prevalence of hypertension between urban and rural communities, but our studies show such variation also exists within rural communities, as seven out of the nine 'high prevalence' and 10 out of the 18 'low prevalence' communities were rural. From a public health, preventive point of view, modification of risk factors at population level is likely to be the most cost-effective approach with the highest impact on morbidity.…”

“…4 The objective of the present study was to determine if such a high degree of geographical variation in the prevalence of hypertension could be confirmed. If confirmed, this would suggest novel opportunities for control strategies and future research; while estimates of geographical variation between communities are essential in the design and analysis of CRTs.…”

“…4 The 1998 follow-up study Between January and March 1998, we conducted a cross-sectional follow-up study to verify this geographical variation in the prevalence of hypertension. We selected the nine high prevalence communities, as well as 18 communities (eight urban, 10 rural) where hypertension was at lowest prevalence in the original survey, to represent the two poles of the distribution.…”

“…3 In The Gambia, recent studies found a nationwide prevalence of 9.5% (among adults Ͼ15 years of age), with a slightly higher prevalence in urban compared to rural areas. 4 Worldwide, hypertension is the most prevalent cardiovascular risk factor. Though not as common as in western societies, cardiovascular conditions impose a sizeable morbidity burden in sSA, notably in the form of stroke, renal failure and heart failure.…”

Blood pressure patterns and cardiovascular risk factors in rural and urban Gambian communities

“…In a previous nationwide rapid assessment we found that 9.5% of adults above the age of 15 had a BP у160/95 mm Hg. 17 The aim of the present study was to assess in more detail BP patterns, and to investigate the prevalence of hypertension and other cardiovascular risk factors in rural and urban settings in The Gambia.…”