OBJECTIVES :
C REACTIVE PROTEIN :
The cost involved in the execution of this study was borne by the researcher.
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CHAPTER FOUR RESULTS
The study was conducted between 1st of February and 31st of March, 2015 (two months) at the GOPC of Benue State University Teaching hospital Makurdi. A total number of two hundred and twenty seven (227) subjects were recruited for the study, 45.8% of whom were males and 54.2%
were females giving a male to female ratio (M:F) of 1:1.2.
Table 4.1 shows the socio-demographic characteristics of the study population. The respondents in the 41-50 years age group had the highest frequency (71, 31.3%) while respondents in the age group of >80 years had the least frequency (2, 0.9%). The age range of the respondents was 32-90 years with a mean age of 53.66 (± 11.39years). There were no respondents in the age range of 18-30 years. There were more females (123, 54.2%) than males (104, 45.8%). At least three-quarters (171, 75.3%) of the respondents were married while less than a quarter (46, 20.3%) were widowed. The singles were the least of all the respondents (7, 3.1%). Those with tertiary education had the highest frequency (118, 52%) while those with secondary education were the least (30, 13.2%).
Among the various occupations, civil servants had the highest frequency (87, 38.3%), farmers came second (43, 18.9%) and retirees were third (28, 12.3%). The professionals included Doctors, Lecturers and Nurses. Among the ethnic groups, the Tivs (171, 75.3%) constituted the majority of the respondents. Next to these were the Idomas (26, 11.5%) then the Igedes (11, 4%).
Of the two hundred and twenty seven participants of this study, only (3, 1.3%) of the respondents were Muslims. The rest were Christians (224, 98.7%)
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Table 4.1: Socio-demographic characteristics of the respondents (N=227)
Variable CAM use
No. (%)
No CAM use No. (%)
Total Total Percentage (%) Age group (years)
31-40 9(27.3) 24( 72.7) 33 14.5
41-50 27(38.0) 44( 62.0) 71 31.3
51-60 23( 32.4) 43( 67.6) 66 29.1
61-70 17( 44.7) 21(55.3 ) 38 16.7
71-80 3( 17.6) 14( 82.4) 17 7.5
>80 1( 50.0) 1(50.0) 2 0.9
Mean age ± SD 53.58±10.13 53.70±12.06 Sex
Male 34(32.7) 70(67.3) 104 45.8
Female 46(37.4) 77(62.6) 123 54.2
Marital status
Single 4(57.2) 3(42.8) 7 3.1
Married 65(38.0) 106(62.0) 171 75.3
Separated 1(33.3) 2(66.7) 3 1.3
Widowed 10(21.7) 36(78.3) 46 20.3
Educational status
No formal educ. 14(32.6) 29(67.4) 43 18.9
Primary 11(30.6) 25(69.4) 36 15.9
Secondary 9(30.0) 21(70.0) 30 13.2
Tertiary 46(40.0) 72(60.0) 118 52.0
Occupation
Unemployed 7(35.0) 13(65.0) 20 10.6
Civil Servant 28(32.6) 58(67.4) 86 38.3
Professional 4(44.4) 5(55.6) 9 5.3
Business Execu. 7(41.2) 10(58.8) 17 9.7
Student 1(50) 1(50) 2 0.9
Retired 11(39.3) 17(60.7) 28 12.3
Farmer 13(30.2) 30(69.8) 43 18.9
*Others 9(40.9) 13(59.1) 22 4.0
Ethnic group
Tiv 58(33.9) 113(66.1) 171 75.3
Idoma 8(30.8) 18(69.2) 26 11.5
Igede 4(44.4) 5(55.6) 9 4.0
Igbo 6(54.5) 5(45.5) 11 4.8
*others 4(40) 6(60) 10 4.4
Religion
Christianity 78(34.8) 146(65.2) 224 98.7
Islam 2(66.7) 1(33.3) 3 1.3
*others include clergy, artisans and security men
** others here include Igalas, Etulos, Nupe, Ijaw and Jukun.
78 Table 4.2: BMI of respondents [N=227]
BMI categories (Kg/m2) CAM use No. (%)
No CAM use No. (%)
Total Total
Percentage (%)
Under weight (<18.5) 2(66.7) 1(33.3) 3 1.3
Normal weight (18.5-24.9) 17(32.1) 36(67.9) 53 23.3
Over weight (25.0-29.9) 35(40.7) 51(59.3) 86 37.9
Obese (>30) 26(30.6) 59(69.4) 85 37.5
Mean BMI ± SD 27.85 ± 4.37 29.88 ± 7.81
Table 4.2 above shows the BMI of respondents.
Respondents that were overweight had the highest total frequency (86, 37.9%). Next to these were those in the obese category (85, 37.5%).
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Table 4.3 shows the characterization of respondents according to their hypertension characteristics. Most of the respondents (104, 45.8%) had hypertension for 1-5 years while a few of the respondents (29, 12.8%) had hypertension for <1year. Almost all the respondents (220, 96.9%) were currently taking their conventional antihypertensives. The rest of the respondents (7, 3.1%) were not currently taking their antihypertensive medication.
Majority of the respondents (114, 50.2%) used only two antihypertensives. However only 1 (0.4%) respondents took more than four antihypertensives. Seven (3.1%) of the respondents did not know the number of antihypertensives they were taking.
The mean BP was 141.01/89.46 ± 23.66/14.44 mmHg. About one-third of the respondents (78, 34.4%) had a controlled blood pressure (BP < 140/90mmHg). The rest of the respondents (149, 65.6%) had uncontrolled blood pressure (BP>140/90mmHg).
80
TABLE 4.3: Characterization of respondents according to their hypertension characterisitics. [N = 227]
Characteristics
CAM use No. (%)
No CAM use.
No. (%)
Total No. (100%)
Total
percentage (%) Duration of hypertension
<1 year 9(31.0) 20(69.0) 29 12.8
1-5 years 40(38.5) 64(61.5) 104 45.8
6-10 years 16(32.0) 34(68.0) 50 22.0
>10 years 15(34.1) 29(65.9) 44 19.4 Mean duration of
hypertension ± SD (years)
6.96±6.72 7.17±6.83 Current intake of
antihypertensive medications
Yes 77(35.0) 143(65.0) 220 96.9
No 3 (42.9) 4(57.1) 7 3.1
No of antihypertensives
1 13(34.2) 25(65.8) 38 16.8
2 38(33.3) 76(66.7) 104 50.2
3 24(38.7) 38(61.3) 62 27.3
4 1(20.0) 4(80.0) 5 2.2
>4 1(100.0) 0(0.0) 1 0.4
Do not know 3(42.9) 4(57.1) 7 3.1
Blood pressure control
Controlled 17(21.8) 61(78.2) 78 34.4
Uncontrolled 63(42.3) 86(57.7) 149 65.6
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Table 4.4 shows descriptions of the use of CAM among hypertensive respondents.
A total of eighty (35.2%) respondents used CAM therapies along with their conventional antihypertensives. Most of the respondents did not use CAM (147, 64.8%). Among the various types of CAM, moringa usage had the highest frequency (28, 25.2%) followed by fasting and prayers (24, 21.6%) while aloe vera was the least frequently used CAM, (4, 3.6%). Some respondents (30, 37.5%) reported usage of more than one type of CAM. Three-quaters of CAM users had used their CAM therapies for 1-5 years (60, 75%). Only two (2.5%) of the respondents had used CAM therapy for >10 years.
The main reason given for the use of CAM therapies alongside other antihypertensives was the belief that the two streams complement each other (45, 45%). However, 15 (15%) of the respondents had no particular reason for using CAM. Some of the respondents (13, 16.3%) gave more than one reason for their use of CAM
The major source of information on CAM was from family and friends (53, 57%). The media/advertisement came second (14, 15.1%). Information obtained from pastors/religious leader was the third (12, 12.9%). Some of the respondents (10, 12.5%) obtained information on CAM use from more than one source.
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TABLE 4.4: The use of CAM among the hypertensive respondents.
Characteristics Frequency Percentage (%)
Concurrent use of CAM
Yes 80 35.2
No 147 64.8
¥Types of CAM used by respondents
Garlic 13 11.7
Native Herbs 19 17.1
Ginger 5 4.5
Moringa Seeds 28 25.2
Bitter leaf 8 7.2
Aloe Vera 4 3.6
Prayers and Fasting 24 21.6
*Others 10 9.1
Duration of CAM use
<1year 14 17.5
1-5years 60 75.0
6-10years 4 5.0
>10years 2 2.5
¥Reason given for concurrrent CAM use
Readily Available 22 22.0
CAM is perceived to counteract Western Medicine's side
effects 4 4.0
The two streams complement each other 45 45.0
Disappointment with conventional health care and staff 4 4.0
#Others 24 24.0
No reason 1 1.0
¥Sources of information on CAM
Family and Friends 53 56.9
Media/Advertisement 14 15.1
Doctors 6 6.5
CHEWS 3 3.2
Pastor/religious Leader 12 12.9
+Others 5 5.4
* Others- food supplements, green tea, cucumber and Chinese tea.
# Others -CAM is cheaper, to get cure for hypertension and to help in weight reduction + Others- Nurses
¥ some participants gave more than one response
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Table 4.5: Socio-demographic characteristics of CAM users (N=80)
Characteristics Frequency Percentage (%)
Age group (years)
31-40 9 11.3
41-50 27 33.7
51-60 23 28.7
61-70 17 21.2
71-80 3 3.8
>80 1 1.3
Sex
Male 34 42.5
Female 46 57.5
Marital status
Single 4 5.0
Married 65 81.3
Separated 1 1.2
Widowed 10 12.5
Educational status
No Formal Education 14 17.5
Primary 11 13.7
Secondary 9 11.3
Tertiary 46 57.5
Occupation
Unemployed 7 8.8
Civil Servant 28 35.0
Professionals 4 5.0
Business Executive 7 8.8
Student 1 1.2
Retired 11 13.7
Farmer 13 16.2
*Others 9 11.3
Ethnic group
Tiv 58 72.5
Idoma 8 10.0
Igede 4 5.0
Igbo 6 7.5
**Others 4 5.0
Religion
Christianity 78 97.5
Islam 2 2.5
*others include clergy, artisans and security men
** others here include Igalas, Etulos, Nupe, Ijaw and Jukun.
84
Table 4.5 shows the socio-demographic characteristics of the respondents who used CAM in the study population. Most of the CAM users were in the age range of 41-50 years (27, 33.7%).
CAM use was found to be least among the age group of above 80 years (1, 1.3%).
Most of the CAM users were females (46, 57.5%). Majority of the respondents who used CAM had tertiary level of education (46, 57.5%). Also, majority of CAM users were civil servants (28, 35%).
CAM use was highest in proportion among the Tivs (58, 72.5%) and least among the Igedes (4, 5.0%).
85
Table 4.6 shows the bivariate analysis of socio-demographic characteristics and CAM use among hypertensives. The prevalence of CAM use was higher in the age groups >80 years (50%) and age group 61-70 (44.7%). The respondents in the age group 71-80 (17.6%) used CAM least. CAM use was higher amongst females (46, 37.4%).
CAM use was highest amongst the singles (4, 57.2%) and least amongst the widowed (10, 21.7%). CAM use was found also to be higher amongst those with tertiary level of education (46, 40%) and least among those with secondary level of education (9, 30%)
Among the various occupations, the professionals (4, 44.4%) and business executives (7, 41.8%) were seen to use CAM more often. Out of the two students interviewed, one (50%) used CAM.
Among the various ethnic groups, CAM use was highest among the Igbos (6, 54.5%) and lowest among the Igedes (4, 44.7%)
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Table 4.6: Relationship between socio-demographics and CAM use among hypertensives Variable
CAM use No. (%)
No CAM use No. (%)
Total No. (100%)
Chi-square
( χ2 ) p-value
Age 5.162 0.396
31-40 9(27.3) 24( 72.7) 33
41-50 27(38.0) 44( 62) 71
51-60 23( 32.4) 43( 67.6) 66
61-70 17( 44.7) 21(55.3 ) 38
71-80 3( 17.6) 14( 82.4) 17
>80 1( 50.0) 1(50.0) 2
Sex 0.547 0.460
Male 34(32.7) 70(67.3) 104
Female 46(37.4) 77(62.6) 123
Marital status 5.726 0.126
Single 4(57.2) 3(42.8) 7
Married 65(38.0) 106(62.0) 171
Separated 1(33.3) 2(66.7) 3
Widowed 10(21.7) 36(78.3) 46 Educational
status
No formal educ.
14(32.6)
29(67.4)
43
1.567 0.667
Primary 11(30.6) 25(69.4) 36
Secondary 9(30.0) 21(70.0) 30
Tertiary 46(40.0) 72(60.0) 118
Occupation
Unemployed 7(35.0) 13(65.0) 20
2.042 0.956
Civil Servant 28(32.6) 58(67.4) 86
Professional 4(44.4) 5(55.6) 9
Business Execu. 7(41.2) 10(58.8) 17
Student 1(50) 1(50) 2
Retired 11(39.3) 17(60.7) 28
Farmer 13(30.2) 30(69.8) 43
*Others 9(40.9) 13(59.1) 22
Ethnic group 2.588 0.629
Tiv 58(33.9) 113(66.1) 171
Idoma 8(30.8) 18(69.2) 26
Igede 4(44.4) 5(55.6) 9
Igbo
*others
6(54.5) 4(40)
5(45.5) 6(60)
11 10
Religion 1.315 0.251
Christianity 78(34.8) 146(65.2) 224
Islam 2(66.7) 1(33.3) 3
*others include clergy, artisans and security man
** others here include Igalas, Etulos, Nupe, Ijaw and Jukun.
87
Table 4.7 shows the relationship between CAM use and hypertension characterization of the respondents. Respondents who had hypertension for 1-5 years had the highest frequency of CAM use (40, 38.5%) and those who had hypertension for <1 year were found to use CAM therapy least (9, 31%).
The respondents who took up to three antihypertensives (24, 38.7%) took CAM more often while that who took up to 4 antihypertensives (1, 20%) used CAM least. The only respondent who took more than 4 drugs (1, 100%) used CAM.
Majority of CAM users had uncontrolled hypertension (63, 78.78%). Only a few CAM users had controlled hypertension (17, 21.25%). p-value is <0.05.
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Table 4.7: Relationship between CAM use and hypertension characterization of the respondents [N=227]
Characteristics
CAM use No. (%)
No CAM use.
No. (%)
Total No. (100%)
Chi-Square ( χ2 )
p-value
Duration of hypertension
0.953 0.813
<1 year 9(31.0%) 20(69.0%) 29 1-5 years 40(38.5%) 64(61.5%) 104 6-10 years 16(32.0%) 34(68.0%) 50
>10 years 15(34.1%) 29(65.9%) 44 Mean Duration of
hypertension ± SD (years)
6.96±6.72 7.17±6.83 Current intake of
antihypertensive medications
0.184 0.668
Yes 77(35.0%) 143(65.0%) 220
No 3(42.9%) 4(57.1%) 7
No of
antihypertensives
3.051 0.692
1 13(34.2%) 25(65.8%) 38
2 38(33.3%) 76(66.7%) 104
3 24(38.7%) 38(61.3%) 62
4 1(20.0%) 4(80.0%) 5
>4
Donot know
1(100%) 3(42.9%)
0(0.0%) 4(57.1%)
1 7 Blood pressure
control
9.416 0.002
Controlled 17(21.8) 61(78.2) 78
Uncontrolled 63(42.3) 86(57.7) 149
89
Table 4.8 shows the relationship between BMI and CAM use. Two-thirds of the respondents with BMI in the underweight category (2, 66.7%) were found to use CAM. Many CAM users (35, 40.7%) were in the overweight category.
4.8: Relationship between CAM use and BMI
Characteristics
CAM use No. (%)
No CAM use No. (%)
Chi-square (X2)
P-value
BMI categories
(Kg/m2) 3.459 0.326
Underweight (<18.5) 2(66.7) 1(33.3) Normal (18.5-24.9) 17(32.1) 36(67.9) Overweight (25.0-29.9) 35(40.7) 51(59.3) Obese (>30) 26(30.6) 59(69.4) Mean BMI ± SD 27.85±4.37 29.43±7.81
90
4.9: Logistic regression model of independent variables predicting CAM use
Variables Adjusted odds ratio
(aOR)
95% confidence interval (CI)
p-value Age (Years)
31 – 40 1.00
41 – 50 1.79 0.69 – 4.61 0.229
51 – 60 1.51 0.57 – 4.03 0.406
61 – 70 2.30 0.78 – 6.73 0.130
71 – 80 0.70 0.14 – 3.43 0.656
81 – 90 2.70 0.14 – 52.14 0.512
Marital Status
Single 5.61 0.96 – 32.78 0.056
Married 2.33 0.99 – 5.47 0.052
Separated 2.61 0.18 – 39.08 0.486
Widowed 1.00
Religion
Christianity 1.00
Islam 6.61 0.44 – 98.78 0.17
Blood pressure control
Controlled 1.00
Uncontrolled 2.54 1.30 – 4.96 0.006*
BMI
<18.5 6.60 0.53 – 82.67 0.143
18.5 – 24.9 1.36 0.60 – 3.08 0.458
25.0 – 29.9 1.66 0.83 – 3.30 0.150
≥30 1.00
*Statistically significant
91
Table 4.9 shows multivariate logistic regression of factors associated with CAM use. The independent variables eligible to be entered into the logistic regression model were age, marital status, blood pressure control status, religion and BMI. Respondents with uncontrolled hypertension status had aOR=2.54 (95% CI=1.30-4.96, p =0.006). Table 4.9 thus illustrated that cofounders such as age, marital status, religion and BMI had less influence on the use of CAM among respondents with uncontrolled blood pressure status as the only statistically significant variable did not lose its significance when subjected to multivariate logistic regression.
.
.
92
CHAPTER FIVE DISCUSSION
Having uncontrolled blood pressure as an outcome following the management of hypertension is frequently associated with frustration for both the physician and the patient. Furthermore, the chronicity of treatment and the rising cost of orthodox medications amongst others are major concerns to patients being managed for HTN. The use of CAM is one of the consequences of this displeasure.