LIST OF ABBREVIATIONS/ACRONYMS/SYMBOLS
AAP : American Academy of Pediatrics
BP: Blood Pressure
BMI: Body Mass Index
CE1 : Cours Elémentaire 1
CE2 : Cours Elémentaire 2
CM1 : Cours Moyen 1
CM2 : Cours Moyen 2
CP: Cours Préparatoire
CO: Cardiac Output
CVD: Cardiovascular Disease
DASH: Dietary Approaches to Stop Hypertension
DBP: Diastolic Blood Pressure
FDA : Food and Drug Administration
HR:Heart Rate
HTN: Hypertension
LVH: Left Ventricular Hypertrophy
NHBPEP: National High Blood Pressure Education Program
OR : Odd's ratio
SBP : Systolic Blood Pressure
SDG : Sustainable Development Goals
SV: Stroke Volume
TPR: Total Peripheral Resistance
UTI : Urinary Tract Infection
WHO: World Health Organisation
ABSTRACT
BACKGROUND:Hypertension is a major long-term
health condition and is the leading cause of premature death among adults
throughout the world, including developed, and developing countries. In recent
years, there has been a progressive increase in hypertension among children and
adolescents. Evidence suggests that, high blood pressure in childhood is a
precursor of hypertension in adulthood and its presence is influenced by
various risk factors including; childhood obesity, lifestyle changes and
hereditary factors. Early diagnosis of hypertension in childhood is an
important strategy in its control in order to prevent its serious and long term
complications. In Cameroon, there is no available data on hypertension in
children in a rural setting.
OBJECTIVES: This study was carried out to
determine the prevalence of hypertension and elevated blood pressure; as well
as the associated factors to hypertension among primary school children in
Mbankomo subdivision, a rural area in theMefou and Akono division, Centre
Region.
METHODS: This study was a school based
cross-sectional analytic study, carried out within a period of 6 months (from
the 21th of November 2017 tothe 22th of May 2018) in 13
primary schools (10 public and 3 private schools) in Mbankomo subdivision.
These schools were selected using a 2 stage cluster sampling method. The blood
pressure was measured using an aneroid sphygmomanometer. Weight and height were
also measured and BMI calculated. Children with a high blood pressure were
screened a second and third time at 1 week intervals. Hypertension was defined
as high blood pressure on all 3 occasions according to the American Academy of
Pediatrics. Analysis was done using a software called Epi-Info™ 3.5.4.The
Chi-square test was used to evaluate the association between qualitative
variables and the Pearson correlation test was used to evaluate the association
between quantitative variables. The degree of association was assessed using
the Odd's ratio and its confidence interval at 95%, and statistical
significance was considered at a p-value < 0.05.
RESULTS: A total of 822 pupils were included
in our study, of which were 353 males and 469 females giving a sex ratio of
0.8. The mean age was 9 years (extremes from 5-17years) and the most
represented age range was 8-10 years. The prevalence of hypertension was 1.6%
(with 1.5% in stage I and 0.1% in stage II) and that of elevated blood pressure
was 8.1%, with a systolic predominance of 1.6%. SBP and DBP had a significant
positive correlation with age(r=0.17; p=0.000
andr=0.07; p=0.000 respectively) and BMI(r=0.18;
p=0.000 andr=0.11; p=0.000respectively).
The associated factors of hypertension after multivariate
analysis were: the pupil's age > 10years (OR=6.4614;
CI95=1.2581 - 33.1841; p=0.0254), family history of
overweight (OR=7.4624; CI95=1.6906 - 32.9401;
p=0.008), and excess weight(OR=10.1069; CI95=2.5094
- 40.7063; p=0.0011)which persisted as risk factors of hypertension,
and born at term (OR=0.0845; CI95=0.0216 - 0.3307;
p=0.0004) as a protecting factor.
CONCLUSION: The mean age of the pupils
enrolled in the study was 9years, and the most represented age range was 8-10
years (41.1%). Females were mostly represented in 57.1% giving a sex ratio of
1.3. Pupils mostly attended public schools in 82.8% and were mostly from a semi
urban setting in 56.7%. The most represented class was class 6 in 22.6%. Most
legal tutors carried out liberal professions (49.8%) and the most represented
socio economic status was that of the middle class in 87.5%.
The prevalence of hypertension was 1.6% (with 1.5% in stage I
and 0.1% in stage II) and that of elevated BP was 8.1%.Hypertension was
predominantly systolic in 1.6%, and diastolic in 0.4%. There was a positive
correlation between age, BMI, and blood pressure.
After multivariate analysis with logistic regression, only the
age> 10years, family history of overweight, excess weight persisted as risk
factors of HTN, and born at term as a protecting factor.
RECOMMENDATIONS:We thus recommend that
nutrition and physical education courses need to be reinforced in the school
curricular; that blood pressure monitoring be integrated as part of routine
clinical examination during medical visits of healthy and sick children; and
that the parents should encourage healthy eating habits at home and in school
and, ensure manual labour and physical activity at home.
Keywords: Hypertension, elevated blood
pressure, pupils, rural, associated factors.
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