Knowledge, attitudes, beliefs, and blood pressure control in a community-based sample in Ghana

Cardiovascular disease, in particular hypertension (HTN), is a significant and growing public health problem in developing countries, such as sub-Saharan Africa. As such, it is imperative to develop a public health approach to the management and treatment of hypertension. In order to address the growing prevalence of hypertension in this region, an in-depth understanding of patients' knowledge, and awareness about the treatment and prevention of hypertension is needed. As part of a faith-based medical clinic in the Sekondi-Takoradi area in Ghana, we conducted a cross sectional survey of 1135 patients who attended a free medical clinic between March 2001 and March 2002, to assess the prevalence, awareness, knowledge, and treatment of HTN. Using qualitative methodology, we also explored patients' beliefs about hypertension and its consequences. Of the 1135 patients, 30% were hypertensive (and 62% of these had Stage 11 hypertension), 73% were aware of their diagnosis, 59% were being treated, and only 5% had adequate blood pressure (BP) control defined as blood pressure <140/90 mm Hg. Patients with hypertension were typically older (average age was 61 vs 42 for normotensives), obese (30% had a BMI >= 30) and not physically active (65%). These findings resemble trends noted in developed countries. Results of the qualitative interviews indicated that patients had several misconceptions about hypertension that were not consistent with a traditional biomedical model. For example, one person defined high blood pressure as having "too much blood in the body." In collaboration with the Ghana ministry of health we plan to utilize the findings of this study to develop a community-based educational program that will provide culturally competent patient education about hypertension, with a particular emphasis on the misconceptions about the etiology of hypertension and its associated complications.