The prevalence and socio-demographic correlates of hypertension among women (15–49 years) in Lesotho: a descriptive analysis

Africa is expected to have 216.8 million hypertensive people by 2030. Over 54.6 million cases of hypertension were estimated in 1990, 92.3 million cases in 2000 and 130.2 million cases in 2010 respectively. Hypertension is prevalent in Africa [1, 2]. Similarly, hypertension is widespread in Sub-Saharan Africa, its consequences include among others cardiovascular diseases and increased risk in morbidity and mortality [3]. According to the latest WHO data published in 2018, the WHO STEPS of 2012 and other surveys done in 2001 and 2012 show that the prevalence of hypertension in the population was 31%. Hypertension related deaths in Lesotho reached 536 or 1.91% of the total deaths [Who.int/ncds/surveillance/steps/Lesotho_2012_STEPS_fact_sheet.pdf]. Hypertension is the 9th leading cause of death in the world, and Lesotho is ranked number 4 at 46.81per 100 000 according to the world rankings.

Hypertension is a major cause of morbidity among adult patients in Lesotho; it is among the five causes of female admission into hospitals. Hypertension is also the third most common cause of outpatient attendance and one of the leading causes of admission to public health [4‐7]. The high prevalence of hypertension exerts a tremendous public health crisis [8, 9]. Mashea et al. [8], discovered that obstetric haemorrhage and hypertensive disorder escalates mortality by 31.4% and 28% respectively. The objective of this study is to identify prevalence and its associated socio-demographic correlates of hypertension among women aged 15–49 years in Lesotho. Prevalence of hypertension remains high (one in 3 persons are hypertensive) and it remains a challenge in the country despite concerted efforts made by the Lesotho government and development partners to curb it. Previous studies conducted in the country made investigations on hypertension treatment and control in primary care setting as well as knowledge of disease and medications among hypertension patients. The child-bearing women’s demographic and social factors which could be predictors of hypertension have not been examined in Lesotho. The study is intended to fill that gap in the literature.

This is a secondary data analysis of cross-sectional data of the 2014 Lesotho Demographic and Health Survey (LDHS). These are women of childbearing age (15–49 years) who had ever given birth in the five years preceding the 2014 LDHS. The total unweighted female population in the LDHS was 6,621. In determining the variable of interest, respondents were asked whether they were ever diagnosed with high blood pressure by a doctor or a nurse [10]. Blood pressure readings were taken from 3353 who were included in the final analysis. About fifteen percent (705) respondents were ever diagnosed with high blood pressure. The individual female dataset for the 2014 LDHS was used for this study and the data were extracted and processed using Stata version 14.

The objective of the study was to determine prevalence of hypertension and also identify socio-demographic correlates of hypertension in women in Lesotho. Baseline analysis has illustrated that a high proportion of women were aged 15–19 years, most (67%) of them resided in rural areas. More than half (54%) were married while 51% of the women had completed the secondary level of education.

In agreement with similar studies conducted in other African countries like Ethiopia, the study demonstrated that older age groups are a strong factor associated with hypertension. The proportion of women who were diagnosed with high blood pressure increases with an increase in age, the odds of being hypertensive were significantly higher among women aged 45–49 years. This is in line with other studies where the risks of hypertension increase with age [1, 13]. Thinyane, 2015 also discovered that age was among factors associated with poor blood pressure in Lesotho.

Moreover, there were higher odds for the ever-married (married, divorced, and widowed) to be diagnosed with hypertension. In Ghana, Tuoyire (2018) found significantly higher odds of hypertension for married, cohabiting, and previously married adults. It seems that married and widowed/divorced/separated, women were at higher risk of having hypertension and this could be due to the inevitable “vicissitudes of marriage.” [14]. Likewise, Wickham, 2001 found out that marital stress significantly increases the likelihood of earlier hypertension among long term married women. Using secondary data made it impossible to evaluate other confounding factors, such as stress levels among women, especially those living with a partner or widowed.

Specifically, the study addresses hypertension, a topic of particular relevance to Lesotho given its high rate of maternal mortality. Literature suggests a link between hypertension and maternal morbidity and mortality. However, there is a limitation to the generalizability of the results because only female data was utilized.

This study showed that age was associated with hypertension among a sample of the women adult population in Lesotho. The study further suggests that 741 (22.10%) of the respondents were in prehypertension stage, which adds to the overall future risk of hypertension. The socio-demographic correlates of hypertension among women include: advancement in age, living with partner, being married, being widowed, and living in Maseru and Mafeteng districts. While the primary prevention strategies should start with Basotho women in high-risk groups, the importance of focusing on prehypertensive individuals should not be overlooked because it indicates a future risk of hypertension.