title: The Epidemiology of Hypertension in Uganda: Findings from the National Non-Communicable Diseases Risk Factor Survey.
abstract: BACKGROUND
  Hypertension is an important contributor to global burden of disease and mortality, and is a growing public health problem in sub-Saharan Africa. However, most sub-Saharan African countries lack detailed countrywide data on hypertension and other non-communicable diseases (NCD) risk factors that would provide benchmark information for design of appropriate interventions. We analyzed blood pressure data from Uganda's nationwide NCD risk factor survey conducted in 2014, to describe the prevalence and distribution of hypertension in the Ugandan population, and to identify the associated factors.
  
  
  METHODS
  The NCD risk factor survey drew a countrywide sample stratified by the four regions of the country, and with separate estimates for rural and urban areas. The World Health Organization's STEPs tool was used to collect data on demographic and behavioral characteristics, and physical and biochemical measurements. Prevalence rate ratios (PRR) using modified Poison regression modelling was used to identify factors associated with hypertension.
  
  
  RESULTS
  Of the 3906 participants, 1033 were classified as hypertensive, giving an overall prevalence of 26.4%. Prevalence was highest in the central region at 28.5%, followed by the eastern region at 26.4%, western region at 26.3%, and northern region at 23.3%. Prevalence in urban areas was 28.9%, and 25.8% in rural areas. The differences between regions, and between rural-urban areas were not statistically significant. Only 7.7% of participants with hypertension were aware of their high blood pressure. The prevalence of pre-hypertension was also high at 36.9%. The only modifiable factor found to be associated with hypertension was higher body mass index (BMI). Compared to participants with BMI less than 25 kg/m2, prevalence was significantly higher among participants with BMI between 25 to 29.9 kg/m2 with an adjusted PRR = 1.46 [95% CI = 1.25-1.71], and even higher among obese participants (BMI ≥ 30 kg/m2) with an adjusted PRR = 1.60 [95% CI = 1.29-1.99]. The un-modifiable factor found to be associated with hypertension was older age with an adjusted PRR of 1.02 [95% CI = 1.02-1.03] per yearly increase in age.
  
  
  CONCLUSIONS
  The prevalence of hypertension in Uganda is high, with no significant differences in distribution by geographical location. Only 7.7% of persons with hypertension were aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure. Thus a big percentage of persons with hypertension are at high risk of hypertension-related cardiovascular NCDs.
authors.affiliation: Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: Control of Non-Communicable Diseases Desk, Ministry of Health, Kampala, Uganda.
authors.forename: Gerald
authors.initials: G
authors.lastname: Mutungi
authors.affiliation: School of Statistics and Planning, Makerere University College of Business and Management Sciences, Kampala, Uganda.
authors.forename: Ronald
authors.initials: R
authors.lastname: Wesonga
authors.affiliation: Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Kajjura
authors.affiliation: World Health Organization, Uganda Country Office, Kampala, Uganda.
authors.forename: Hafisa
authors.initials: H
authors.lastname: Kasule
authors.affiliation: Division of Socioeconomic Surveys, Uganda Bureau of Statistics, Kampala, Uganda.
authors.forename: James
authors.initials: J
authors.lastname: Muwonge
authors.affiliation: Division of Socioeconomic Surveys, Uganda Bureau of Statistics, Kampala, Uganda.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ssenono
authors.affiliation: Department of Internal Medicine, Nsambya Hospital, Kampala, Uganda.
authors.forename: Silver K
authors.initials: SK
authors.lastname: Bahendeka
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D015995:Prevalence; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult