Hypertension is a growing public health problem and remains
Title: Determinants of
hypertension among
adult population in
Jigjiga City public
hospitals case control
study
Author Abdikarin Arab Ibrahin
Jigjiga Health science collage Ethiopia 2021
Abstract:
Hypertension is a prevalent health issue in Ethiopia, often
detected incidentally during hospital visits for unrelated
conditions. This study aimed to identify determinants of
hypertension among adults in Jigjiga City's public hospitals in
2021. Conducted as a hospital unmatched case-control study,
data from 375 individuals (125 cases, 250 controls) were
collected through standardized interviews and physical
measurements. Binary logistic regression analysis was
employed, presenting both crude and adjusted odds ratios with
95% confidence intervals (CI). Findings revealed that
individuals aged 59-68 had a 24% lower likelihood of
hypertension compared to those over 69 (Adjusted odds ratio
[AOR] = 0.24, 95% CI: 0.08-0.75), while females exhibited a
lower risk than males (AOR = 0.35, 95% CI: 0.18-0.67).
Unmarried status (AOR = 5.8, 95% CI: 2.22-15.21) and
inadequate sleep (AOR = 4.1, 95% CI: 2.2-7.74) were
associated with increased hypertension risk. Furthermore,
participants with primary education or below had lower odds
of hypertension (AOR = 0.30, 95% CI: 0.132-0.663), as did
those with BMI below 25 kg/m² (AOR = 0.35, 95% CI: 0.15-
0.85). These findings underscore the multifactorial nature of
hypertension, with implications for tailored intervention
strategies to mitigate risk factors and improve public health
outcomes.
Keywords: hypertension, determinants, odds ratio,
1.1 Background
major global public health challenge in many developing
countries including Ethiopia (5, 6). Rapid unplanned
urbanization in the developing world, lead to developing
countries major hypertension problems (5).
Hypertension is defined as arterial blood pressure that exceeds
140/90 mmHg at several determination. Hypertension is a
major contributor to the growing global pandemic of
cardiovascular disease and stroke. It is behind only under
nutrition and unsafe sex in its contribution to the burden of
disease worldwide. Globally, about 62% of cerebro vascular
diseases and 49% of ischemic heart disease are attributable to
elevated blood pressure (BP) that could have been reduced by
antihypertensive drug therapy (1,2).
The African region has the highest of hypertension among
adults aged over 25, are developing complications arising
from hypertension such as cerebro vascular disease, ischemic
heart disease and congestive heart failure as well as indirect
costs such as the lost productivity of workers struck by stroke,
heart failure, and ischemic heart disease (30,18). Another
study conducted in Dar es Salaam, Tanzania and Cameron
indicate that Major risk factors for hypertension was
overweight, obesity, inadequate physical activity, and limited
access to quality medical care, and age, regular alcohol
consumption, level of physical activity, obesity, stress
Although effective lifestyle modifications are available,
proportion of hypertension awareness, treatment, and control
are low (5,8).
In developing country the Emerging economies elsewhere,
are transitioning from infectious illness to chronic disease
burden (20). In 2018 Evidence of review in Niger delta
suggested that hypertension remains a major public health
issue in LMIC and one-third of the adult population in these
countries are hypertensive (19).
Hypertension is a risk factor for coronary heart disease and the
single most important risk factor for stroke - it is responsible
for at least 45% of deaths due to heart disease, and at least
51% of deaths due to stroke (2).
Study conducted in 2020 in Ethiopia, suggested that both
modified and non-modified risk factors increased
complications of the disease such as stroke, heart failure, and
renal failure occurred for hypertension (27). Among civil
servants in Sidama Zone, south Ethiopia found that being
Males, older individuals, current moderate alcohol consumers,
current khat chewers, and individuals with obesity and central
obesity are major determinants of hypertension (9).
Nearly 20% of those older than 18 years in Ethiopia are living
with hypertension and the researcher had found that
determinants of hypertensive patients are less engaged in
health behaviors in Ethiopia (21,24). Hence Behavioral risk
factors that lead to the development of hypertension need to
modify life style. Therefore, the better understanding and to
identify the determinants of hypertension is very important.
However, there is still limited study in eastern Ethiopia to
identifying determinants of hypertension among adult’s public
hospitals in Jigjiga City. The aim of this study is to identify
determinants of hypertension among adult population in
Jigjiga City public hospitals.
METHODS AND MATERIALS
4.1. Study area and period
The study was conducted among adult population in public
hospitals at Jigjiga City, Eastern Ethiopia. Jigjiga is capital
city of Somali region. Jigjiga city is located 676 km from
Addis Ababa, the capital city of Ethiopia. The health service
coverage of Jigjig city is estimated to be 85% and existing
health facilities are 2 regional hospitals, 2 private hospitals, 2
functional health centers, 2 mother and child health clinic and
27 private clinics and 10 health posts. The total adult
population (>20 years) are 62,633 (33,758 are males and
28,875 are females) (24).the study was conducted from June to
august 2021.
4.2. Study design
Hospital based unmatched case control study design was
employed.
4.3. Source and study population
4.3.1 Source Population
Adults With confirmed and diagnosed of hypertension during
study period
4.3.2. Study Population
All selected adults who was visited outpatient department
(OPD) of the two public hospitals .with confirmed diagnosis
of hypertension during study period.
4.3.3 Inclusion and exclusion criteria
4.3.3.1 Inclusion criteria
Case definition
Case;-All adult population who visited in OPD of the two
public hospitals and who diagnosed as having Hypertension
(BP ≥ 140/90mmhg)
Control;-All adult population who visited in OPD of the two
public hospitals who are free from hypertension or who
diagnosed as not having HTN (BP ≥ 140/90mmhg)
4.3.3.2 Exclusion criteria
Population in either of the cases and control must above 18
years, permanent resident at least 6 month and free from other
chronic disease such as diabetic mellitus renal disease,
autoimmune disease, those who are pregnant women, serious
illness, and abnormal mental status were excluded
4.4 Cases and Controls
Cases are adult population who visited OPD of two public
hospitals with blood pressure ≥ 140 mmHg systolic or ≥90
mmHg diastolic or that on antihypertensive treatment.
Controls are adult population who visited OPD both hospitals
and that are not diagnosed as hypertensive or who are free
from hypertension (BP ≤ 140/90mmhg).
4.5 Sample size determination
The desired sample size was calculated by using EPI-info
version 7.2.1 for unmatched case–control studies. Using 95%
confidence level, 80% power, case to control ratio 1:2,
expected frequency of hypertension among the control was
53.1 (44). And considered odds ratio (OR) closest to 1 is 1.9.
Accordingly, 132 cases and 264 controls for 396 study
participants were included in the study (44).
n = the number of cases
r = ratio of control to cases p= average proportion of exposure
among cases and controls,
p1=the proportion of exposure among cases=46.9 p2=the
proportion of exposure among controls, = 53.1 ZB= is power
for which 0.84 for 80 % power and
Zα/2 level of significance 95% confidence interval or 1.96,
P1-p2,
4.6 Sampling technique.
The study was conducted on two public hospitals, in jigjig city
public hospitals from each hospital; participants were selected
by consecutive/sequential sampling technique based on the
proportion of selected hospitals total patient flow as
denominator.
All population identified with and confirmed as having HTN
were included prospectively when they meet inclusion criteria
until the required sampling achieved and for each case a
sample of two consecutive adults were taken as control and
cases and controls were selected from the same hospitals and
two controls were selected for each and non probability
connivance sampling technique was used.
4.7 Sampling procedure
The study was conducted on two public hospitals, in jigjig city
public hospitals from each hospital; The total number of
hypertensive patients at study hospitals based on last year data
on similar time with the data collection period one month’s
report was totally 154 hypertensive patient; 43 from
Kharamara general hospital and 111 jigjiga university Sultan
Hasen Yabere Referral Hospital (SHYRH).
Proportional allocation was used to select the sample size
(sampling fraction=sample size/total patient
flow=132/154=0.857). Based on the proportional allocation
total number of patients were 132, including 37(0.857*43)
from Kharamara general hospital and 95(0.857*111) from
(SHYRH).
During selection of participants based on sampling technique
if the person was not eligible to be included or not willing to
participate, then data collectors proceeded to the next person.
The detail description of the sampling techniques is presented
below.
4.8 Data collection techniques and tools
4.8.1 Tool 1: Questionnaire-based assessment
The interview questionnaire was structured into three logical
sections; socio demographic characteristics, modifiable risk
factor, non modifiable risk factor and measurements. A
modified WHO STEPS instrument (Questionnaire) for chronic
disease risk factor surveillance was used to collect data (56).
The questionnaire consisted of, 19 items related to behavioral
characteristics and socio demographic of sample and 8 items
related to the nutrition and diet of sample and 12 item related
to eating and health habits , 6 item related to physical activity
of the sample (56).
4.8.2: Tool 2: Physical measurements
Physical assessment included blood pressure, weight, height,
measurements.
Blood pressure
Blood pressure was measured twice in a sitting position using
standard digital sphygmomanometer. BP cuff with the
appropriate cuff size that covers two-thirds of the upper arm
after the participant rested for at least five minutes and no
smoking or caffeine 30 minutes before measurement (56).
Weight
Weight measurements were taken on a pre-calibrated
electronic weighing scale. The scale was calibrated daily using
a known weight. Subjects were weighted dressed in light
clothing and barefoot. Measurements were made to the nearest
0.1 kg (56).
Height
Height was measured with the subject standing upright against
a wall on which was affixed a height measuring device.
Measurements were made with the subject barefoot, standing
with the back against the wall and head in the Frankfort
position with heels together. The subjects were asked to
stretch to the fullest and then exhale. When appropriately
positioned, they were asked to exhale and a mark was made to
mark the height, then measurements taken to the nearest 0.1
cm (56).
4.9 Data collection procedure
WHO STEPS instrument (Questionnaire) for chronic disease
risk factor surveillance was used to collect data. The
questionnaire consisted of, 19 items related to behavioral
characteristics and socio demographic of sample and 8 items
related to the nutrition and 9 item related to physical activity
of the sample (56). Data on relevant information and their
height, weight and BP was measured after securing written
consent from participants. BP was taken from record and
digitally re measured again. Two BP measurements were taken
from left arm with each subject sitting on a chair with
supported arm and 3 minute elapsing between successive
measurements after at least five minutes of rest. The
measurement was taken early in the morning from 7am- 10 am
and in the afternoon after 4pm in a calm environment.
4.10 Study variable
4.10.1 Dependent variable
Hypertension (Yes, No]
4.10.2 Independent variable
Non modifiable risk factor
Co-morbidity;-Family history HTN, Family history DM
Socio demographic;-Age, Sex, Marital status, Education,
Religion, Income, Occupation
Modifiable determinants
Behavioral factor;-Alcohol drinking, Khat chewing,
Overweight, Cigarette smoking, Physical activity, sleeping
duration
Nutrition and diet information;-Bread and Cereals, Greens and
vegetables, Fruits, Milk, Meat and eggs, Oil and fat and Sugar
and sweets
4.11 Data Quality Control
The data collectors was trained for two days on standardized
data collection, particularly in the proper filling of
questionnaire, and the use of the weight, height, in order to
minimize inter and intra observer errors. The questionnaire
was originally prepared in English and then translated in to the
local language (Somali). Before the actual study begins the
questionnaire pretested on 5% of the study participants found
outside of the study area (private hospitals and higher clinic in
patients) and modifications were done on the basis of the
findings. After completing the interview, the participant’s
height and weight was measured and recorded by interviewers.
To improve the quality of the data, the data collectors were
closely supervised by the principal investigators, each
completed questionnaire was checked to ascertain all
questions whether properly filled or not and necessary
corrections were made at spot when occurred.
4.12 Operational definition and terms
Hypertension: defined as systolic blood pressure of
≥140mmHg and/or diastolic blood pressure of ≥ 90 mmHg (1).
BMI categorized: underweight <18.50 kg/m2; normal 18.5-
24.99; overweight 25.0-29.99 and obese >30 (20). Current
khat use: Reported consumption of khat at the time of the
survey (55).
Past Khat chewers: Individuals who reported Khat use before
but stopped now (55).
Former alcohol drinker: A person who drink alcohol before
but discontinuous now (55). Current alcohol drinker: A person
who has been drink at the time of the survey (56). Ex-smoker:
Reported previous history of smoking, but quit at the time of
the survey (55). Current cigarette smoking: Reported current
smoking at the time of the survey (56).
Physical Activity
High Physical Activity: The two criteria for classification as
‘high’ are:a) Vigorous-intensity activity on at least 3 days
achieving a minimum total physical activity of at least 1500
minutes/week OR b) 7 or more days of any combination of
walking, moderate-intensity or vigorous intensity activities
achieving a minimum Total physical activity of at least 3000
minutes/week (56).
Moderate Physical Activity: The pattern of activity to be
classified as ‘moderate’ is either of the following criteria: a) 3
or more days of vigorous-intensity activity of at least 20
minutes per day OR b) 5 or more days of moderate-intensity
activity and/or walking of at least 30 minutes per day OR c) 5
or more days of any combination of walking, moderate-
intensity or vigorous intensity activities achieving a minimum
total physical activity of at least 600 minutes/week (56).
Low Physical Activity: is the lowest level of physical activity.
Those individuals who do not meet the criteria for moderate
and high are considered as ‘low’ (56).
4.13 method of data analysis
The data were checked for completeness, coded and entered
into Epi Data 3.1 then the descriptive statistics were computed
using frequency distribution and proportions for categorical
variables and, mean and standard deviations (SD) for
continuous variables (Age, BP, weight , no of person, , time
spent for physical exercises, height and body mass index) was
described. Generally, results were presented, using
frequencies, cross tabulations and percentages. Chi-square test
was used to assess the level of significant differences. A
threshold p value of less ≤ 0.25 was used to declare significant
association between hypertension and its predictors in the chi-
square test. Since we have used unmatched case control study
design Binary logistic regression were performed. Hence,
variables which were found to be associated with hypertension
were included in the bivariate binary logistic regression.
Furthermore, different variables were included in the
multivariable logistic regression to single out the effect of each
covariate with Hypertension and adjusted odds ratios, with
95% confidence interval was consider to see the association.
Co-founders, interaction and multicollinearity were checked to
minimize bias. Multicollinearity between independent
variables was checked to ensure that inserting as many
variables did not introduce statistically significant
multicollinearity, which was confirmed by the assumption of
VIF<10 as no multicollinearity. And the model goodness of
the test was checked by Hosmer - Lemeshow goodness of fit
test. The model is fit at x2 =3.624 and p-value of 0.889. A
95% confidence interval for crude and adjusted ORs and a
threshold p-value of ≤ 0.05 were used to decide significance of
association.
4.14 Ethical consideration
Ethical consideration Ethical approval and clearance was
obtained from Institutional Review Board of jigjig Health
Science prior to enrolment. Permission to conduct the study
was obtained Jigjiga Health Science College to data
collection. Objective of the study was clearly explained to
participants before conducting the interview and informed
consent was obtained from each participant. Data were kept
confidential throughout the conduct of the study and
participants were educated and consult on hypertension to
always follow on department of chronic follow up on their
condition and how to protect from this silent killer disease
during study for each participant was explained before starting
the questioner.
4.15 Dissemination and Utilization of Results
The result of this study will be submitted in hard and soft copy
to Jigjiga University, college of medicine and health science,
department of epidemiology. For the publication purpose the
abstract of the result thesis will be submitted to the national
and international publishers
5. RESULTS
5.1 Socio-Demographic characteristics cases and 173(45.9%) educational level of respondent unable

From those patients who came for different services at to read and write were 30(24%) and 80 (31.7) among the cases

Kharamara hospital and SHYRH, 377 participants that were and control respectively. Two matched controls with age group

approached, 2 people were excluded (1 case and 1 control) due were taken for each case so the percentage of controls comes

to failure to get age matched controls. A total of 375 patients to the same as cases in their respective age group the age

were enrolled in the study, which makes the response rate group between 29-40years 25(20%) and 50(20%)among cases

94.7%. Age and duration of the resident were the matching and controls respectively

variables in the study but the duration of the residence fail to

much from the total of the respondent 173(46.1%) had Table2: Distribution Socio-demographic characteristics

duration of the residence less than 5years among them only adult in Jigjiga city public hospitals, Eastern Ethiopia
27(7.2%) were a cases and 146(38.9) were controls and June – August 2021
from the total respondent had history of more than five
years were 202(53.9) and the majority them 98(26.1) were
cases and only 104(27.7%) were controls . For each case we
had plus or minus 3years old controls. Socio demographic
characteristics of cases and controls are depicted in Table 2.
The proportion of age were 29-40, 41-51, 62-62 and greater
than 63-73 years were found to be (20.3%). 28.8%, 29.6%,
and 21.3% respectively. From total participants, 31(24.8%)
cases and 202(53.3%) controls were females. The overall
mean systolic blood pressure was (mean ± SD) 127.73 ±
24.79mmHg, with mean systolic of 161.536±10.93mmHg and
110.96±3.20mmHg among cases and controls respectively.
The overall mean diastolic blood pressure was
85.94±19mmHg, with mean diastolic blood pressures of 99.94
±8.13mmHg and 77.88±4.48mmHg among cases and controls
respectively. Overall mean of age was (mean ± SD) 52.11
±11.487 years with the mean of age 52.82±11.5 and
51.75±11.48 years among cases and controls respectively.The
overall mean BMI were (mean ± SD) 21.95 ± 2.51 with the
mean of 22.96 ± 2.88kg/cm2 and 21.45± 2.13kg/cm

Being the Urban residences for more than 5years contributed

27(21.6%) and 175(58.7%) among cases and controls
respectively the majority of individual respondent marital
status were married 185(49.1%) and contributed 45(36.6) and
140(55.6) among cases and controls respectively Among cases
frequently reported occupation was house wife which accounts
for 36.4% and for controls daily labor is the commonest one
contributing 29% of the total. Majority of the individuals
responded that their monthly income were less than 5000
Ethiopian birr which accounts for around 116(30.8%) among
 Hypertension Chi
-
P
Variabl Catego CASE CONTR squ
val
e ry S OLS are
ue 5.2 Modifiable risk factor

N % N % X2 Among the cases only 16(12.8%) and 73(29.0%) controls had

reported history of smoking but among the cases those had
Age 3 66
1 3 history of smoking 16(88.9%) them & 73(17.8%) of controls
group 29-38 3. .7
1 6 10. had reported to had history of previous history of smoking.
3
354 Among the cases 30(24.0%) and 129(51.2%) of controls had
.0
3 66 history of chat chewing and out of smokers of cases
2 6 35
39-48 3. .7 23(44.1%) were had history of chewing chat every day
9 8
3 similarly 57(50.0) of controls had history of chewing chat
every day.
3 66
4 6
49-58 3. .7 Among respondent 12(9.6%) and % 84(33.3) had reported
4 2
3 history of vigorous activity among cases 5(41.7%) and
75(89.3%) controls had less than four days per week vigorous
2 6
59-68 activity 25( 23.6%) & 81(76.4%) of cases and controls had
3 3
history of within vigorous activity less than five hour and none
3 66 of cases had reported to had history of vigorous activity
1 2
>69 3. .7
8 1 greater than five hours per day and neither cases of nor
3
control had reported to had history of greater than five hours

Sex Female 3 24 13 53 10.7 .00 per day of vigorous activity. among respondent who had
1 .8 3 .6 9 0 reported history of moderate physical activity less than four
days/week 27(71.1%) and 78(56.9%) were cases and controls
Male 9 7 11 46
respectively. Among cases 79(73.2%) and 31(12.3%) had
4 5. 7 .4
reported to had history of walking activity per week and only
2
2(2.3%) and 5(15.2%) of cases and controls respectively had
Single 2 60 17 40 history walking physical activity greater than 5 hours. Among
Marital 6 respondent individuals those reported to had history of family
status history hypertensive 16(12.8%) and 67(26.6%) were cases and
Marri 4 24 14 75
34. .0 controls respectively. The total of 96 respondents had history
ed 5 .3 0 .7
486 00 of physical activity Only 12(9.6%) of cases and 84(33.3%)
Wido 1 25 38 74 Among the respondent those have Vigorous activity less than
wed 3 .5 .5 five hour 10(83.3%) of cases and 79(94.0%) controls
respectively
Divor 2 36 35 63
ced 1 .8 .2 About the total of 168(44.6%) the respondents of that had
history of moderate physical activity 32(8.2%) and 136(36.1)
Separ 2 48 21 51
cases and controls respectively and among those 22(12.4%)
ated 0 .8 .2
cases and 78(46.2%) of controls had history of moderate
Educati Can’t 3 41 79 58 .0 activity less than four days of moderate activity per week and
onal read 0 .8 .2 00
27.
&
Status 74
write
28(87.5%) cases and 129(94.2%) of controls had history
Table3: behavioral related variables of hypertension adult
moderate physical activity less than five hours. Among total of
population in Jigjiga city public hospitals, Eastern
94(84.7%) respondent those had history of less than four days
of walking in a week were 65(56.6%) and 29(26.1%) of cases Ethiopia June – August 2021

and controls respectively and 23 (28.8%) cases and none of

controls had history walking less than ten minute per days. see From the total of respondents reported to had history of eating
table 2 meal three times per day were 303(80.4%) and contributes
93(74.4%) & 210(83.3%) among cases and controls
respectively similarly Sleeping less than 6hour for 24 hour
contributes 61(48.7%) and 119(31.6%) among cases and
controls respectively among the cases 24(19.2%) and controls
113(44.6%) had history of sleeping more than ten hour. Only
14(11.2%) among the cases knows that they had hypertension.
From
Hypertension Chi-square
the total
X2 of
Cases Controls P value

Variable Category N % N %

smoking habit Yes 16 14.7 72 84.3 11.87 .000

No 109 38 178 62

Family history of HTN yes 16 19.5 66 80.5 9.021 .000

No 109 37.2 184 62.8

Are yes 14 58.3 0 41.7 29.007 .000

you hypertensive No 111 30.7 250 69.3

Chat yes 30 19 128 81 25.287 .000

No 95 43.8 122 56.2

No 64 22.4 219 77.6

hours to sleep <6hrs a day 61 51.3 58 49.9 .000

6-9hrs day 40 33.1 81 66.9 32.72

>10hrs day 24 17.5 111 82.5

BMI 30.5 69. (.015

<25 101 230
5
10.5
54.5 20 45.5
>25 24
respondent who had to had sugar and sweet once per days
were 52(41.6%) and 95(37.7%) cases and controls
respectively. Out of cases 33(26.4%) and from none
hypertensive cases 33(24.4%) had history of sugar and sweet
more than twice per week. Majority of the respondents were
eat bread and cereals among 56(44.8) and 140(55.6) cases and
control respectively among respondent those had history of
eating fruit once per week were 34(27.2) and 84(33.3)
respectively. Among 28(22.4%) of cases and 34(13.5%)of
controls respondent had history of eating fat and oil more
than twice a week and Among those respondent that history
of eating meat and egg once per week were 38(30.4%) and
123(48.8%) for cases and controls respectively. 52(41.6%) of
cases and 95(37.7%) of controls use sugar and sweat once per
day.

5.3 Determinant of hypertension

During bivariate logistic regression analysis age, sex,

educational status ,marital status, monthly income, cigarette
smoking, chat chewing, occupation, vigorous and moderate
physical activity duration of sleep for 24 hour, family history
of hypertension, duration of living in urban, BMI were
significantly associated with hypertension and had P.
value<0.25 However, According to the multivariate logistic
regression analysis, age, sex, cigarette smoking, number of
hours spent walking/cycling per day, number of hours spent
during sleeping per day, marital status, Educational status,
income and body mass index were statistically significant
predictors of hypertension (Table 3)

Table 3 multivariable Analyses of among adults public

hospitals, in Jigjiga city Eastern Ethiopia June – August 2021

 Exp(B)

for EXP(B)
Variable Hypertension
Category COR 95% C.I. AOR 95% C.I Sig.
control cas
e

≥69 18 21 .044

29-38 36 11 .36(.142-.897) .31(.083-1.13) .076

age 39-48 68 29 .5(.23-1.07) .66(.22-1.94) .447

49-58 62 44 .82(.40-1.73) .73(.24-2.24) .582

59-68 63 23 .43(.19-.94) .24(.08-.75) .014

sex male 117 94

female 133 31 .29(.18-.47) .35(.18-.67) .001

Occupational merchants 48 27 1 .233

status farmer 28 12 .76(.33-1.74) .63(.20-1.93) .416

housewife 66 39 1.1(1.57-1.9) 1.2(.51-2.7) .725

daily labour 73 21 .5(.26-1.01) .42(.16-1.1) .076

gov't &NGO 35 26 1.3(.66-2.6) .90(.33-2.45) .838

smoking yes 72 16 .36(.20-.66) .36(.157-.84) .018

No 178 109 1

>120min aday 49 31 .354

<30min a day 68 20 .47(.24-.91) .51(.20-1.3) .167

Time spent TV
and game 30-59min a day 79 40 .8(.44-1.44) .97(.42-2.2) .939
setting/day
60-89min a day 54 34 1.(.53-1.85) 1.1(.46-2.6) .838

≥6 hours 192 64 .000

Sleeping
≤6 hours 58 61 3.2(2.0-4.99) 4.1(2.2-7.74)

.366(.193-.693 .35(.15-.85) .020

≤25 230 101
)
BMI
≥25 20 24 1

place to place Cycle or walking 182 57 .313(.200-.49) .20(.106-.39) .000

car 68 68 1

MARITAL married 234 99 1 .

Being among age group of 59-68 years were 24% less likely to
develop hypertension the OR and CI 95% .24(.08-.75) when
compared to with those above the age group of ≥69years.
There was 35% reduced risk of being hypertensive among
female when compared with male the OR and CI 95%
.35(.18-.67) the odd of being hypertensive among those who
had history of low income OR and 95% CI, OR and 95%
CI, .27 (.14-.58) were 17% less likely to develop when
compared to those had high income. Odd of developing
hypertension were increase among those sleeping lees than 6
hour had by 4.1(2.2-7.74) when compared to those sleeps
more than ten hour. Odd of developing hypertension increased
among unmarried OR and CI 95% 5.8(2.22-15.21) times when
compared to those of married.
The odd of being hypertensive were less likely among
participants who were had history of primary cycle (1-8) and
unable to read and write OR and 95% CI, .30(.132-.663)
and .30(.132-.663) respectively. The odd of being hypertensive
were 35% less likely to be hypertensive among the
participants those had BMI of less than 25kg/m 2 OR and 95%
CI,.35(.15-.85) when compared to those who had BMI of
2
greater than 25kg/m
6. DISCUSSION
odd of developing hypertension among female and male
respondent Being female had 35% less likely to be
hypertensive than male the study supported by study done in
study conducted in Ethiopia specially in Arba Minch Town,
Debre Markos in northwest, Gondar in Dire Dawa City,
found female have more hypertensive then male (6). The
study also in lined with Study conducted in Northwest
Ethiopia and southern Ethiopia, which males were a higher at
risk than females (53) (16Study in Akaki Kality Sub city
Health Centers, Addis Ababa, Ethiopia suggest that
Hypertension was associated with age≥44 years old, body
mass index ≥25kg/m2, alcohol drinking, cigarette smoking,
and chat chewing (41,43). The study also in line d with
Systemic review conducted in Africa also in lined with our
study and found that hypertension in most studies among
older adults in Africa(11). ). As age increases Hypertension
also increase Study conducted in few years ago in Ethiopia
specially in South West Ethiopia, and north west Ethiopia
(39,40). But the study finding were not in lined with study
conducted South West Ethiopia In 2015 have indicate that age
have not association with hypertension (41).
The odd of being female were 57% less likely to be
hypertensive when compared with male the OR and CI
95% .57(.37-.89) study in lined with Study conducted in
Sidama that shows The odds of hypertension were 4.31 times
higher in males as compared to female study Participant’s
Different studies have showed that several factors have
significant association with hypertension the study also in line
study conducted in jigjiga (23). The reason for these
differences might be due to the exposure towards different
behavioral risk factors for hypertension, which is higher
among males than among females in most areas (9). In
contrast; some studies from Ethiopia Africa report the
prevalence of hypertension to be higher in females than in
males. The study in lined with study done in Ethiopia specially
South West , Debre Markos , Gondar, , Southern Ethiopia
durame town, Southern Ethiopia , in Tigrai, in Addis Ababa ,
in jigjiga sex associated with hypertension and male were
more hypertensive than female (6). A study conducted in
vagrancies and west Africa indicated that sex have
association with hypertension and male are more hypertensive
than female (11,47). But in opposite direction study
conducted in Ethiopia specially in Arba Minch Town, Debre
Markos in northwest, Gondar city , in Dire Dawa City,
Eastern Ethiopia have found sex to have association with
hypertension and female were had more hypertensive then
male (6)
Study showed highest risk of hypertension among who had
low level of income and found that the odd of developing
hypertension among respondent who had less than 2500
monthly income less likely to be hypertensive when
compared to those who had more income the study in lined
with study conducted in bale and in Mattu (44,58,6).
the odd of developing hypertension among those who sleep
lees than 6 within twenty four hours hour were 4 times more
likely to develop hypertensive when compared with those
sleep more than 6 hours the study founding were lined with
study conducted in Mattu southwest Ethiopia sleeping
duration less than five hours with in twenty four hours had 11
times higher odds of developing hypertension his is due to
stress or substance abuse (44).
The odds of developing hypertension among respondents who
had smoking habit of where less likely to be hypertensive
than those who had habit of cigarette smoking the study
founding were not in lined with study conducted in Mattu,
Bale zone and some parts of Ethiopia (44) (58)(6) . This
supports that substance use is associated with cardiovascular
diseases including hypertension.
The study shows that the odd of being hypertensive reduced
among those who had history of low income when compared
to those had high income. Study conducted in Mattu of
southwest Ethiopia was in lined with them and showed that
people who had low monthly income developing HTN more
than individuals with relatively high monthly income but study
conducted in Addis Ababa and Tigrai Unlikely study done in
Addis Ababa The odd of developing hypertension those had
family history of high family monthly income 6times more
likely to develop HTN (44-47).
The odd of developing hypertension more likely increase by 4
times among those sleeping less than six hour when compared
to those sleep more than six hour. the study founding in lined
study conducted in Mattu southwest Ethiopia sleep duration
less than five hours with in twenty four hours had 11 times
higher odds of developing hypertension this is due to stress or
substance abuse (6,42,44).
The odd of developing hypertension increased among
unmarried OR and CI 95% 1.7(1.08-2.63) times when
compared to those of married (The odds of hypertension
reduced among married adults when compared to unmarried.
Similar to this finding, a study conducted among arbaminch
showed that the risk of hypertension increases among those
who never married (20). Previous studies indicated possible
explanations for the effect of marital status on hypertension.
Adherence to physical activity, diet, better sleep, moods, lower
self-rated symptoms, less stress and low night-time systolic
blood pressure were more common among married couples.
That might have an effect on reduced odds of hypertension
among married couples (20).
The odd of being hypertensive were 35% less likely to be
hypertensive among the participants those had BMI of less
than 25kg/m2 when compared to those who had BMI of
greater than 25kg/m2 The study in lined with study done in
Ethiopia specially South West, Debre Markos , Gondar, ,
Southern Ethiopia durame town, Southern Ethiopia , in Tigrai,
in Addis Ababa. (6, 16,58).
7. LIMITATION
Limitation of the study are, since the study is hospital based it
is difficult to generalize to the general population and their
might be social desirability bias due to interviewer
administered questioner. Use of case control study design
could not establish temporal relationships Case control study
can only identify associations, could not proof causations,
Recall bias might have affected the accuracy of information
related to substance use such as cigarette smoking
8. CONCLUSIONS & RECOMMENDATION
8.1 Conclusions
This study has shown that exposure to risk factors such age,
sex, cigarette smoking, number of hours spent walking/cycling
per day, number of hours spent during sleeping per day,
marital status, Educational status, income and body mass
index were statistically significant predictors of hypertension
are determinants of hypertension individuals should have to
Increase beneficiaries behavior hours to spent on walking and
cyclic getting enough time to sleep decreasing your weight
and the government and NGOs working on non-
communicable areas should have to give due emphasis on
promoting healthy life style like having optimal sleep to
avoiding unnecessary risk behavior
ACKNOWLEDGEMENT
First, we would like to thank my Almighty Allah for keeping Based Studies From 90 Countries.,” Circulation, vol. 134, no.
me in all aspects of my life and helping me in doing this 6, pp. 441–450, Aug. 2016, doi:
proposal. 10.1161/CIRCULATIONAHA.115.018912.

Next, we would like to express my deepest appreciation and (4) Wartiningsih. M, “Determinant Factors of
heartfelt thanks to jigjiga Health science collage research and Hypertension in pre-geriatric group (18-35 years old) in
community directorate. My deepest appreciation also goes to Surabaya,” J. PROMKES, vol. 7, p. 173, Dec. 2019, doi:
jigjiga Health science collage forgive me grant opportunity 10.20473/jpk.V7.I2.2019.173-181.

8.2 Recommendation
To the community 1).All adults had better check their blood
pressure and Increase beneficiaries’ behavior of optimal sleep.
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