title: Risk factors of hypertension among adults aged 35-64 years living in an urban slum Nairobi, Kenya.
abstract: BACKGROUND
  Hypertension is an emerging public health problem in Sub Saharan Africa (SSA) and urbanization is considered to favor its emergence. Given a paucity of information on hypertension and associated risk factors among urban slum dwellers in SSA, we aimed to characterize the distribution of risk factors for hypertension and investigate their association with hypertension in an urban slum in Kenya.
  
  
  METHODS
  We conducted a community based cross-sectional survey among adults 35 years and older living in Kibera slum Nairobi, Kenya. Trained interviewers collected data on socio demographic characteristics and self reported health behaviours using modified World Health Organization stepwise surveillance questionnaire for chronic disease risk factors. Anthropometric and blood pressure measurements were performed following standard procedures. Multiple logistic regression was used for analysis and odds ratios with 95 % confidence intervals were calculated to identify risk factors associated with hypertension.
  
  
  RESULTS
  A total of 1528 adults were surveyed with a mean age of 46.7 years. The age-standardized prevalence of hypertension was 29.4 % (95 % CI 27.0-31.7). Among the 418 participants classified as hypertensive, over one third (39.0 %) were unaware they had hypertension. Prevalence of current smoking and alcohol consumption was 8.5 and 13.1 % respectively. Over one quarter 26.2 % participants were classified as overweight (Body Mass Index [BMI] ≥25 to ≤29.9 kg/m(2)), and 17 % classified as obese (BMI ≥30 kg/m(2)). Overweight, obesity, current smoking, some level of education, highest wealth index, moderate physical activity, older age and being widowed were each independently associated with hypertension. When fit in a multivariable logistic regression model, being a widow [AOR = 1.7; (95 % CI, 1.1-2.6)], belonging to the highest wealth index [AOR = 1.6; (95 % CI, 1.1-2.5)], obesity [AOR = 1.8; 95 % CI, 1.1-3.1)] and moderate physical activity [AOR = 1.9; (95 % CI, 1.2-3.0)], all remained significantly associated with hypertension.
  
  
  CONCLUSIONS
  Hypertension in the slum is a public health problem affecting at least one in three adults aged 35-64 years. Age, marital status, wealth index, physical inactivity and body mass index are important risk factors associated with hypertension. Prevention measures targeting the modifiable risk factors associated with hypertension are warranted to curb hypertension and its progressive effects.
authors.affiliation: School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. olackb@gmail.com.|College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda. olackb@gmail.com.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Olack
authors.affiliation: School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. fwabwire@musph.ac.ug.
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. liam.smeeth@lshtm.ac.uk.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. ztq9@cdc.gov.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.affiliation: School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. nkiwanuka@gmail.com.
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.affiliation: Emory Global Health Institute, Emory University Atlanta, Atlanta, Georgia, USA. rfbreiman@emory.edu.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D000886:Anthropometry; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology; D011204:Poverty Areas; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*