Determinants Of Hypertension Complications Among Adult Hypertensive Inpatients In Kenyatta ...

97 Pages·2016·1.43 MB·English

DETERMINANTS OF HYPERTENSION COMPLICATIONS AMONG ADULT
HYPERTENSIVE INPATIENTS IN KENYATTA NATIONAL HOSPITAL,
NAIROBI.

A RESEARCH DISSERTATION IN PARTIAL FULFILMENT OF THE
REQUIREMENT OF MASTER OF SCIENCE IN NURSING DEGREE (MEDICAL
SURGICAL NURSING)

LILIAN AMUGITSI ISIAHO
H56/75398/2014

2016

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DECLARATION
I, Lillian Amugitsi Isiaho, hereby declare that this dissertation is my original work and has never
been submitted for any academic award in any institution of higher learning.

Signature----------------------------- Date --------------------------------------
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CERTIFICATE OF APPROVAL
This dissertation has been submitted with our approval as University Supervisors
Mr. Anthony Ayieko Ong’any, KRCHN, BScN, MSc (Clin. Psych)

Signature: ……………………………… Date: ………………………..………

Dr. Blasio Osogo Omuga, MB,ChB, MMed
Signature: ………………….……….. Date: …………………………….
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DEDICATION
To my beloved mother Mrs. Alice Timothy who has been hypertensive for thirty two years.

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ACKNOWLEDGEMENT
I thank almighty God for this far He has enabled me to come in my studies.
I acknowledge my supervisors, Mr. Ayieko and Dr.Omuga, for their time and effort in guiding me
during the process of undertaking this research study.
Also acknowledged is my family for their financial support which enabled me to undertake this
Study.
Special appreciation to my close relatives; Gerald, Marlene, Tom, Patience, Smith, Maya and Kayla
for their support and encouragement in undertaking this research study.
Much appreciation to Mbagathi sub-county Hospital management for allowing me to pretest my
study tools there and to the medicine department of Kenyatta National Hospital am humbled by the
commitment by both the hypertensive patients and the staff to make this study successful.
Also appreciated are Moses Otieno and Philip Ayieko for analyzing the data.

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TABLE OF CONTENTS
DECLARATION .................................................................................................................................. ii
CERTIFICATE OF APPROVAL ........................................................................................................ iii
DEDICATION ..................................................................................................................................... iv
ACKNOWLEDGEMENT .....................................................................................................................v
TABLE OF CONTENTS ..................................................................................................................... vi
LIST OF FIGURES ............................................................................................................................. xi
LIST OF TABLES .............................................................................................................................. xii
LIST OF ABBREVIATIONS ............................................................................................................ xiii
OPERATIONAL DEFINITONS ....................................................................................................... xiv
ABSTRACT .........................................................................................................................................xv
CHAPTER ONE ....................................................................................................................................1
1.1 BACKGROUND INFORMATION ................................................................................................2
1.2 PROBLEM STATEMENT ..............................................................................................................2
1.3 JUSTIFICATION OF STUDY ........................................................................................................3
1.4 PURPOSE OF THE STUDY ...........................................................................................................3
1.5 BENEFITS OF THE STUDY ..........................................................................................................4
1.6 RESEARCH QUESTIONS .............................................................................................................4
1.7 RESEARCH OBJECTIVES ............................................................................................................5
1.7.1 BROAD OBJECTIVE ..................................................................................................................5
1.7.2 SPECIFIC OBJECTIVES .............................................................................................................5
1.8 HYPOTHESIS .................................................................................................................................5
CHAPTER TWO: LITERATURE REVIEW ........................................................................................6
2.1 HYPERTENSION ...........................................................................................................................6
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2.2 COMPLICATIONS OF HYPERTENSION………………………………………………………6
2.2.1 BLOOD VESSEL DAMAGE……………………………………………………………............6
2.2.2 HEART COMPLICATIONS…………………………………………………………………….7
2.2.3 BRAIN DAMAGE……………………………………………………………………………….7
2.2.4 KIDNEY DAMAGE/HYPERTENSIVE NEPHROPATHY…………………………………….7
2.2.5 EYE PROBLEMS/HYPERTENSIVE RETINOPATHY………………………………………..8
2.2.6 HYPERTENSIVE CRISIS……………………………………………………………………….8
2.3 DEMOGRAPHIC FACTORS AND HYPERTENSION COMPLICATIONS…………………...8
2.4 SOCIO-ECONOMIC FACTORS AND HYPERTENSION COMPLICATIONS……………….9
2.5 HEALTH RELATED FACTORS AND HYPERTENSION COMPLICATIONS……………...10
2.5.1 TOBACCO AND ALCOHOL USE…………………………………………………………….10
2.5.2 EXCESSIVE SALT INTAKE…………………………………………………………………..10
2.5.3 SEDENTARY LIFESTYLE/OBESITY………………………………………………………..11
2.5.4 CO MORBIDITIES……………………………………………………………………………..11
2.6 AWARENESS, DISPOSITION AND LIFESTYLE PRACTICE AND HYPERTENSION
COMPLICATIONS………………………………………………………………………………….11
2.7 THEORETICAL FRAMEWORK AND ITS APPLICATION TO THIS STUDY……………...13
2.7.1 HEALTH BELIEF MODEL……………………………………………………………………13
2.7.2 HEALTH BELIEF MODEL (Rosenstock 1974)……………………………………………….15
2.8 CONCEPTUAL FRAMEWORK…………………………………………………………..……16
2.9 OPERATIONAL FRAMEWORK………………………………………………………...……..17
2.10 DEFINITION OF KEY VARIABLES………………………………………............................18
CHAPTER THREE: RESEARCH METHODOLOGY……………………………………………..19
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3.1 STUDY DESIGN…………………………………………………………………………………19
3.2 STUDY AREA……………………………………………………………………………………19
3.3 STUDY POPULATION…………………………………………………………………………..19
3.4 INCLUSION AND EXCLUSION CRITERIA…………………………………………………...19
3.5 SAMPLE SIZE DETERMINATION……………………………………………………………..20
3.6 SAMPLING PROCEDURE……………………………………………………………………...21
3.7 STUDY TOOLS…………………………………………………………………………………..21
3.8 DATA MANAGEMENT AND ANALYSIS……………………………………………………..21
3.9 PRETESTING OF STUDY INSTRUMENT……………………………………………………..22
3.10 RESEARCH ASSISTANTS RECRUITMENT AND TRAINING……………………………..22
3.11 STUDY LIMITATION………………………………………………………………………….22
3.12 DISSEMINATION PLAN………………………………………………………………………22
3.13 ETHICAL CONSIDERATIONS………………………………………………………………..23
CHAPTER FOUR; RESULTS………………………………………………………………………24
4.1 DEMOGRAPHIC CHARACTERISTICS………………………………………………………..24
4.2.1 DEMOGRAPHICS AND HYPERTENSION COMPLICATIONS…………………………25
4.2 SOCIOECONOMIC FACTORS………………………………………………………………….28
4.2.1 MONTHLY EARNING……………………………………………………………………...29
4.2.2 RESIDENCE AND DISTANCE TO NEAREST HEALTH FACILITY……………………29
4.3 HEALTH RELATED FACTORS AND HYPERTENSION COMPLICATIONS………………30
4.3.1 HYPERTENSION COMPLICATIONS……………………………………………………..32
4.3.2 PHARMACOLOGICAL MANAGEMENT OF HYPERTENSION………………………..32
4.4 LEVEL OF AWARENESS, DISPOSITION AND LIFE STYLE PRACTICES………………...34
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4.4.1 KNOWLEDGE ON HYPERTENSION AND HYPERTENSION COMPLICATIONS……34
4.4.2 IF STOPS TAKING MEDICATIONS WHEN BP NORMALIZES………………………..34
4.4.3 PATIENTS LIFESTYLE PRACTICES ASSOCIATED WITH HYPERTENSION
COMPLICATIONS……………………………………………………………………………...35
4.4.4 COMPLIANCE WITH LIFESTYLE CHANGE…………………………………………….37
CHAPTER FIVE: DISCUSSION……………………………………………………………………39
5.1 DEMOGRAPHIC FACTORS AND HYPERTENSION COMPLICATIONS…………………..39
5.2 SOCIO ECONOMIC FACTORS…………………………………………………………………40
5.3 HEALTH RELATED FACTORS………………………………………………………………...41
5.4 AWARENESS, DISPOSITION AND LIFESTYLE……………………………………………..43
CONCLUSIONS…………………………………………………………………………………….44
REFERENCES………………………………………………………………………………………46
APPENDICES……………………………………………………………………………………….50
APPENDIX 1: PARICIPANT INFORMATION SHEET AND CONSENT FORM……………….50
APPENDIX 2: FOMU YA MAELEZO YA MSHIRIKI, HABARI NA RIDHAA…………………54
APPENDIX 3: STUDY QUESTIONNAIRE………………………………………………………..58
APPENDIX 4: FOMU DODOSA…………………………………………………………………..64
APPENDIX 5: KEY INFORMANTS INTERVIEW GUIDE………………………………………70
APPENDIX 6: FOCUSED GROUP DISCUSSION GUIDE ..............................................................71
APPENDIX 7: TIME FRAME………………………………………………………………………73
APENDIX 8. BUDGET……………………………………………………………………………...74
APPENDIX 9: APPROVAL TO PRETEST STUDY TOOLS……………………………………...76
APPENDIX 10: REGISTRATION OF RESEARCH IN KNH……………………………………...77
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APPENDIX 11: UON/KHN ERC APPROVAL…………………………………………………….78
APPENDIX 12 STUDY TOOLS……………………………………………………………………80
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