International Journal of

Nursing and Midwifery

Volume 9 Number 3, March 2017
ISSN 2141-2456
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 International Journal of Nursing and Midwifery

Table of Content: Volume 9 Number 3 March 2017

ARTICLES

Knowledge of obstetric danger signs and associated factors among pregnant women
attending antenatal care at selected health facilities in Illu Ababor zone, Oromia
National Regional State, south-west Ethiopia 22
Dereje Tsegaye, Muluneh Shuremu, Kebebe Bidira and Benti Negero

Prevalence and assessment of knowledge and practice towards hypertension among

Bahir Dar City communities, 2016: A community based cross-sectional study 33
Ayele Semachew Kasa and Abdurehman Kelifa Shifa
Vol. 9(3), pp. 22-32, March 2017
DOI: 10.5897/IJNM2016.0230
Article Number: F7A405363145
ISSN 2141-2456
International Journal of Nursing
Copyright © 2017 and Midwifery
Author(s) retain the copyright of this article
http://www.academicjournals.org/IJNM

Full Length Research Paper

Knowledge of obstetric danger signs and associated

factors among pregnant women attending antenatal
care at selected health facilities in Illu Ababor zone,
Oromia National Regional State, south-west Ethiopia
Dereje Tsegaye*, Muluneh Shuremu, Kebebe Bidira and Benti Negero
Department of Public Health, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, Ethiopia.
Received 5 August, 2016; Accepted 7 October, 2016

This research investigates awareness of the danger signs of obstetric complications. Pregnancy as a
normal process that results in a series of both physiological and psychological changes in pregnant
women. However, normal pregnancy may be followed by some problems and complications which are
potentially life threatening to the mother and/or the fetus. The study aims to assess level of knowledge
of obstetric danger signs and associated factors among pregnant women attending Antenatal care
(ANC) in ten districts at ten Health Centers (HCs) and Bedele Hospital in Ilu Ababor Zone, Oromia
Regional state, South-west Ethiopia. Here, institutional based cross sectional descriptive study was
used. A stratified multistage sampling procedure was employed. Both bivariate and multivariate logistic
regression analyses were used. Odds ratio with 95% confidence interval was estimated to identify the
predictors of knowledge level. The study thus revealed that mothers between the age of 30 to 34 and
above 35 yrs were 1.52 and 1.42 more likely to be knowledgeable during pregnancy than those below
the age of 30 years (AOR= 1.52 and 95 %CI = 1.28 to 1.99) and (AOR = 1.42 and 95% CI = 1.20 to 1.86)
respectively. Mothers with higher education were 1.46 times and 1.24 times more likely to know
obstetric danger signs during pregnancy and child birth than those with no formal education (AOR =
1.46 and 95% CI = 1.24 to 1.91) respectively. Mothers who previously gave birth in health institutions
were about 3.48 times more likely to be knowledgeable about the danger signs of childbirth and period
after delivery as compared to those who gave birth at home (AOR = 3.48 and 95%CI: 3.26 to 3.94 ), (AOR
=2.43 and 95%CI: 2.23 to 2.83) respectively. Finally, age, high level of education, place of last delivery
and discussion with husband about ANC service and level of satisfaction with the service were the
predictors of knowledge of the mothers about obstetric danger signs in pregnancy, labor and post-
partum period. Thus, provision of information, education and communication targeting women, family
and the general community on danger signs of pregnancy and childbirth and associated factors was
recommended.

Key words: Knowledge, determinate, danger signs, pregnancy, delivery and post-partum
 Tsegaye et al. 23

INTRODUCTION

Pregnancy is a normal process that results in a series of complications during pregnancy, childbirth or the 6 weeks
both physiological and psychological changes in pregnant following delivery. Almost all (99%) of these deaths occur
women. Though, normal pregnancy may be followed by in developing countries (WHO, UNICEF, UNFPA, 2010).
some problems and complications which are potentially Approximately 80% of maternal deaths worldwide are
life threatening to the mother and/or the fetus (Fraser and caused by direct obstetric complications such as
Cooper, 2003). hemorrhage, infection, obstructed and prolonged labor,
Preventable mortality and morbidity continued to be an unsafe abortion and hypertensive disorders of pregnancy.
alarming challenge in many developing countries like Indirect causes such as malaria, diabetes, hepatitis,
Ethiopia. Every pregnant woman faces the risk of anemia and other cardiovascular disorders which are
sudden, unpredictable complications that could end up aggravated by pregnancy can also lead to maternal
with death or injury to herself or to her infant. Pregnancy death.
related complications cannot be reliably predicted Almost 90% of the maternal deaths occur in Sub-
(JHIPEGO, 2008). Saharan Africa and Asia, making maternal mortality the
Obstetric danger signs include persistent vomiting, health statistic with the largest discrepancy between
severe persistent abdominal pain, vaginal bleeding during developed and developing countries. While women in
pregnancy and delivery, severe vaginal bleeding after north Europe have a 1 in 4,000 likelihood of dying from
delivery, swelling of face, fingers and feet, blurring of pregnancy related causes, for those in Africa the chance
vision, fits of pregnancy, severe recurrent frontal is 1 in 16 (Hogan H, 2010).
headache, high grade fever, marked change in fetal The Maternal Mortality Ratio (MMR) in developing
movement, awareness of heart beats, high blood regions was 15 times higher than in developed regions.
pressure, sudden escape of fluid from the vagina, Sub-Saharan Africa had the highest MMR at 500
prolonged labor (PL), loss of consciousness and retained maternal deaths per 100,000 live births and in sub-
placenta. Awareness about the significance of symptoms Saharan Africa; a woman’s maternal mortality risk is 1 in
and signs of obstetrics complications may lead to timely 30, compared to 1 in 5,600 in developed countries (WHO,
access to appropriate emergency obstetric care. UNICEF, UNFPA, 2010)
Obstetric nurse/midwife plays a crucial role in promoting According to the United Nations Millennium
an awareness of the public health issues for the pregnant Development Goal, five countries are committed to
woman and her family, as well as helping the pregnant reducing the maternal mortality ratio by three quarters
woman to recognize complications of pregnancy and between 1990 and 2015. Following this commitment,
where to seek medical assistance (WHO, 2010). Ethiopia is expected to reduce maternal mortality in 2015
To overcome obstetric related complications, the to 267 maternal deaths per 100,000 live births (UN,
Ethiopia government has created strong political will, 2010). But according to 2011 Ethiopian Demographic and
applying multi-pronged approaches at local and national Health Survey report, the maternal mortality ratio was
levels, organized capacity building efforts, and 676 maternal deaths per 100,000 live births for the seven
prioritization of funding for maternal health services year period preceding the survey (CSA, 2011).
utilizations, but the effect of large populations, health With the assumption that “every pregnancy faces risks”,
disparities still exist in vulnerable Ethiopian subgroups, women should be made aware of danger signs of
including girls, rural dwelling mothers, and poor obstetric complications during pregnancy, delivery and
communities are major challenges for implementation of the postpartum. The knowledge will ultimately empower
this strategy (FMOH, 2010) them and their families to make prompt decisions to seek
Globally, greater than 358,000 women die each year care from skilled birth attendants (JHPIEGO, 2004).
from pregnancy related complications or child birth. Only Most deaths resulting from complications of pregnancy
1% of the maternal death occurs in high income or childbirth are avoidable. This requires preventing of the
countries. A woman’s life time risk of dying from three delays in seeking health care to have proper
complications in child birth or pregnancy is an average of management of the complications; according to the
1 in 120 in developing countries as compared to 1 in National Rural Health Mission, India, the three delays
44,300 in developed countries. United Nations Millennium are: Deciding to seek care (1st delay), identifying and
Development Goals stated that every year, at least half a reaching health facility (2nd delay) and receiving adequate
million women and girls needlessly die as a result of and appropriate treatment (3rd delay). Among all cases,

*Corresponding author. E-mail: deretsegaye@gmail.com.

Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution
License 4.0 International License
24 Int. J. Nurs. Midwifery

the major cause of the first delay is ignorance regarding motherhood developed by the Maternal Neonatal Program of
danger signs in pregnancy, childbirth and post-delivery JHPIEGO, an affiliate of John Hopkins University (JHIPEGO, 2004).
It contains four sections namely; socio-demographic information
and delay in making decision to seek care on appearance and reproductive history, knowledge on pregnancy and childbirth,
of these danger signs (El-Zanaty and Way, 2008). factors associated to pregnancy and childbirth complications, and
Though maternal mortality rate in Ethiopia has been exposure to media and interventions. The questionnaire was
decreasing according to the latest estimation, maternal adapted to fit the study area population context and subsequently
mortality rate has declined from 676/100,000 live births in pretest was performed in the neighboring government health
2011 to 350/100,000 live births in 2014 (CSA, 2014). centers so that some modifications were performed.
Two supervisors (undergraduate of health sciences) and six data
However, still far to achieve the target for 2015 that is collectors who were diploma holders with experiences in survey
267/100,000 live births. Little is known about the current data collection and without language barrier were trained for one
level of knowledge and associated factors of obstetric week and participated in the pretesting five days prior to the actual
danger sign in the study area. The study will assess the data collection date and thereafter conducted the interviews under
current level of knowledge and associated factors among the supervision of principal investigators. The data collection was
conducted from March 01 to 31/2015.
pregnant women who are attending Ante-Natal Care
(ANC) at health facilities in Illu Ababor Zone, South-West
Ethiopia. The study, therefore, hoped that will provide a Data quality control
base line for further researches and come up with
significant recommendations which could help designing The appropriateness of the questionnaire in terms of content,
effective operational strategies that will improve the consistency, language and organization was checked thoroughly
and was modified in line with standards, guidance and suggestion
awareness concerning obstetric danger signs and from peer reviewers.
complications related to pregnancy, childbirth and post Pre test was employed at Mettu Health Center and Bedele Health
partum. Center five days prior to actual initiation of data collection on a total
of 42 (5%) of respondents was interviewed using the available
questionnaire. Findings were discussed among data collectors and
METHODS AND MATERIALS supervisors in order to ensure better understanding to the data
collection process.
Study design and setting Based on the pretest, questions were revised, edited, and those
found to be unclear or confusing was modified. Finally, structured
This institution based cross-sectional study was conducted in public closed ended Afan Oromo and Amharic version questionnaires
health facilities in Ilu Ababor Zone, Oromia Regional state, south- were used for data collection.
west Ethiopia. All pregnant women visiting ten health centers and Supervisors and data collectors were trained on data collection
Bedele hospital for ANC during the data collection period were process, accuracy and completeness for three consecutive days so
included in the study. that everything was clear. The overall activity was closely monitored
by principal investigators of the study during data collection.
To reduce non response rate and unwanted confusion necessary
Sample size determination
information and description was given to respondents prior initiating
interviewing. The data quality was controlled by designing ideal
The sample size was determined using the formula for single
data collection tools and close supervision with aggressive
population proportion by considering 45.9% proportion of
monitoring. The information obtained was checked and cleaned up
knowledge level of obstetric danger sign among pregnant women in
before and after data entry.
Aleta Wendo district, Sidama Zone (Hailu et al., 2010) , 95% level of
confidence, 5% margin of error, design effect 2 and 10% non-
response rate yielding the final minimum sample size of 844.
Data analysis
A stratified multi stage sampling technique was used. After
stratification of the health facilities into hospitals and health centers,
The data were double entered onto EPI data version 3.1 and
a two stage sampling technique was adopted. The first stage
exported to SPSS (SPSS Inc. version 16.0, Chicago, Illinois)
involves the selection of the Health Facilities from each stratum
computer software for further analysis. Errors related to
using simple random sampling (SRS) technique. The second stage
inconsistency of data such as missing values and outliers were
involves the selection of eligible women using systematic random
checked and considered during data cleaning.
sampling technique by applying proportionate to size (PPS)
Descriptive statistics were used to give a clear picture of
allocation to each Health Facility.
dependent and independent variables. The frequency distributions
A systematic sampling technique was used to recruit consenting
of the variables were worked out using tables and figures. The
pregnant women as they register at the ANC clinic. Each clinic day,
independent variables were tested for multicollinearity using
the sampling interval was determined using the expected client
variance Inflation Factor (VIF) and tolerance test in which the
turnover based on previous records. The first client is the one
values of both tests were found to be within the normal range.
whose serial number was randomly selected by lottery method.
Logistic regression model fit was checked by using Hosmer
Subsequent client was obtained by adding the day’s sampling
Lemshow test of significance and omnibus test.
interval to the previous client’s serial number.
Bivariate analyses were done to assess the association between
each independent variable and the outcome variables in the first
Data collection procedure step. All variables whose p-value was less or equal to 0.3 in the
bivariate logistic regression model were entered into the
Data were collected using structured questionnaire of a safe multivariable logistic regression model using backward elimination
 Tsegaye et al. 25

method to control for all possible confounders. At this step, odds acceptable role in the family.
ratio along with 95% CI was estimated to identify factors associated
with Obstetric dander signs among pregnant women and the level
of statistical significance was declared at p – value of less or equal
Knowledge of obstetric danger signs
to 0.05.
Regarding knowledge of key danger signs, severe
Ethical consideration vaginal bleeding was the most frequently mentioned
complication by women during the following phases;
The study was approved by the Institutional Research Ethics pregnancy (64.7%), childbirth (69.9%) and postpartum
Review Committee of Mettu University. Informed verbal and written (82.1%) (Table 2).
consent was obtained from the study participants before the
interview. Illiterate mothers consented by their thumb print after
verbal consent. Participants were also informed about the general
purpose and benefits of the study. To ensure confidentiality, Experience of obstetric danger signs
participants’ data were linked to code number.
Severe vaginal bleeding was the most frequently
mentioned complication by women during pregnancy 85
RESULTS (21.6%), and postpartum period 90(30.4%) (Table 3).
Vaginal bleeding, prolonged labour and severe headache
Socio-demographic characteristics of the were the most frequently identified obstetric danger signs
respondents during labour by respondents.
A total of 831 pregnant women were enrolled to this study
making the response rate of 98.9%. One-third (33.1%) of Knowledge level
the respondents were between the age of 25 - 29 years.
More than half (57.8%) of the participants were from rural More than one-third 309 (37.3%) of the respondents were
area. Nearly all 694 (97.5%) were married. able to mention at least two key danger signs during
Almost half (47.5%) were Muslim by religion. Out of the pregnancy, 194 (23.3%) during childbirth and 30 (3.6%)
total participants, 155 (21.71%) were illiterate. More than during postpartum period. Table 4. show overall
three-fourth of the participants (78%) were from Oromo Knowledge of Obstetric danger signs among pregnant
ethnic group. Three hundred ninety-four (47.7%) of the mothers attending ANC in selected Health facilities,
respondents and 38.1% of the respondent’s husband Illubabor Zone South West, Ethiopia April 2015.
attended primary education. Almost half (46.0%) of the
pregnant women were housewives and (22.0%) were
farmers. More than one - third of the respondents earn a Factors associated with anemia among pregnant
monthly income of ETB 501 – 1000 (Table 1). women

Obstetric characteristics Bivariate logistic regression was carried out to assess

possible relationship between knowledge of obstetric
More than one-third 308 (37.1%) of the respondents were danger signs and factors associated with it among
multiparas. Three hundred thirty-three (40.2%) of the pregnant women. Knowledge of obstetric danger signs
respondents did not attend ANC at all. Nearly half, was 1.6 times higher among age group 35 years and
382(46.0%) of the respondents reported to have had above [COR = 1.57, 95% CI (1.36, 1.90)]. Urban
ANC follow-up by Midwives. About one-third 354 (29.8%) residents were 2 times more likely to be knowledgeable
of the respondents delivered their last delivery at Health about obstetric danger signs during pregnancy than their
Center. More than two-third of the respondents 393 rural counter parts [COR=1.90 (95%CI (1.43, 2.53].
(70.7%) of the respondents had spontaneous vaginal Respondents with higher education were 1.3 times more
delivery (SVD) in last delivery. About two-third 463 likely to be knowledgeable during pregnancy, 1.4 times
(55.7%) of the respondents were in the second trimester more during delivery and 1.4 times more during
(gestational age greater than 28 weeks. postpartum period than those with no formal education
[COR = 1.28, 95% CI (1.17,1.48)], [COR = 1.40, 95% CI
(1.23,1.70)], and [COR = 1.40, 95% CI (1.23,1.70)], [COR
Information on gender and role in the family = 1.36, 95% CI (1.18,1.72)1.40] respectively. Employed
mothers and merchants were both 1.4 times more likely
The study revealed that greater part 710(85.4%) of the to be knowledgeable than housewives [COR =1.40, 95%
respondents discussed about ANC with their husbands CI ((1.25, 1.63)] and [COR =1.40, 95% CI (1.29, 1.65)]
and 354(42.6%) of the respondents reported to have respectively. Grandmultiparas were 3 times more likely
26 Int. J. Nurs. Midwifery

Table 1. Socio-demographic characteristics of mothers attending

ANC in selected Health facilities in Illubabor Zone, South West
Ethiopia, 2015 (n=831).

Characteristics Number Percent

Age
15 - 19 86 10.3
20 - 24 271 32.6
25 - 29 275 33.1
30 - 34 106 12.8
35 - 39 79 9.5
40 - 44 14 1.7
Residence
Urban 351 42.2
Rural 480 57.8

Marital status
Married 778 93.6
Divorced/separated 26 3.1
Widowed 16 1.9
Never Married 11 1.3

Religion
Orthodox 233 28.0
Muslim 380 45.7
Protestant 210 25.3
Others 8 1.0

Ethnicity
Oromo 648 78.0
Amhara 125 15.0
Gurage 36 4.3
Tigray 11 1.3
Others 11 1.3

Education of the Women

No formal Education 177 21.3
Primary 364 43.8
Secondary 193 23.2
Higher 97 11.7

Education of Husband
No formal Education 140 16.8
Primary 303 36.5
Secondary 230 27.7
Higher 158 19.0

Occupation
House wife 382 46.0
Employee 92 11.1
Merchant 136 16.4
Farmer 183 22.0
 Tsegaye et al. 27

Table 1 cont’d

Others* 38 4.6

Income
<500 181 21.8
501 - 1000 345 41.5
1001 - 3000 201 24.2
>3000 104 12.5

Table 2. Knowledge of obstetric danger signs during pregnancy,

delivery and postpartum period among pregnant mothers attending
ANC in selected Health facilities, Illubabor Zone South West,
Ethiopia April 2015 G,C.

Knowledge of obstetric Danger signs n %

During pregnancy
Vaginal Bleeding (n=566) 367 64.7
Gush of Blood from Vagina (n=566) 77 13.6
Swelling of hand/face (n=566) 203 35.9
Blurred Vision (n=566) 103 18.2
Severe Headache (n=566) 256 45.2
Convulsion (566) 101 17.8

During Delivery
Excessive Vaginal Bleeding (n=462) 323 69.9
Preterm Labor (n=462) 52 11.3
Prolonged Labor ( 462) 137 29.7
Convulsion (n=462) 58 12.6
Severe Headache (n=462) 84 18.2
Retained Placenta (n=462) 94 20.3

Postpartum period
Vaginal Bleeding (n=390) 321 82.3
Convulsion after child Birth (n=390) 53 13.6
High fever (n=388) 48 12.4

to be more knowledgeable about obstetric danger signs 95% CI ((1.52,3.74)] respectively. Mothers who were
during delivery than primiparas [COR = 3.29, 95% CI attended by skilled professionals during their last birth
((3.16, 3.50)]. Pregnant mothers who attended ANC at were 3.5 times and 1.6 times more to be knowledgeable
Health Center and Hospital were 2 times and 2.5 times about Obstetric danger signs during pregnancy and
more likely to be knowledgeable about Obstetric danger delivery than those who were attended by unskilled
signs during pregnancy than those who attended at professionals [COR = 3.45, 95% CI ((3.32,3.67)], [COR =
Health Post [COR = 2.31, 95% CI ((2.14,2.66)], [COR = 1.58, 95% CI (1.39,1.88)] respectively. Mothers who were
2.46, 95% CI ((2.28,2.74)]. satisfied by the care providers counseling during ANC
Mothers who have given their last birth at Health visit were 3 times and 1.6 times more to be
facilities were 2.3 times and 2.5 times more knowledgeable about obstetric danger signs during
knowledgeable about obstetric danger signs during pregnancy and delivery than those who were attended by
pregnancy and delivery than those who delivered at unskilled professionals [COR = 3.23, 95% CI
home [COR = 2.33, 95% CI ((1.58,3.42)], [COR = 2.39, ((3.14,3.38)], [COR = 2.21, 95% CI ((1.11, 2.42)],
28 Int. J. Nurs. Midwifery

Table 3. Danger signs experienced in last pregnancy, delivery

or postpartum period by pregnant mothers attending ANC in
selected Health facilities, Illubabor Zone South West, Ethiopia
April, 2015.

Danger signs Experienced n %

During Pregnancy
Vaginal Bleeding 85 21.6
Gush of Blood from Vagina 34 8.7
Swelling of hand/face 43 11.0
Blurred Vision 28 7.2
Severe Headache 78 19.9
Convulsion 20 5.1

During delivery
Excessive Vaginal Bleeding 91 25.6
Preterm Labor 13 3.7
Prolonged Labor 58 16.3
Convulsion 18 5.1
Severe Headache 52 14.6
Retained Placenta 13 3.7

Postpartum period
Vaginal Bleeding 92 30.4
Convulsion after child birth 48 15.8
High fever 27 9.0

Table 4. Overall Knowledge of Obstetric danger signs among pregnant mothers attending ANC in
selected Health facilities, Illubabor Zone South West, Ethiopia April 2015.

Knowledge Level Number Percent

Knowledge of key danger signs during pregnancy
Not Knowledgeable 522 62.8
Knowledgeable 309 37.2

Knowledge of key danger signs during Labor and Delivery

Not Knowledgeable 637 76.7
Knowledgeable 194 23.3

Knowledge of key danger signs during postpartum period

Not Knowledgeable 801 96.4
Knowledgeable 30 3.6

respectively. and (AOR = 1.42 and 95% CI = 1.20-1.86), respectively.

The independent variable, age was statistically Mothers between the ages of 30 - 34 were 1. 24 times
significant for the knowledge of obstetric danger signs more likely to be knowledgeable during delivery than
during the three phases. Mothers between the age of 30 those below the age of 30 years and above 35 years
– 34 and above 35 yrs were 1.52 and 1.42 more likely to (AOR= 1.24 and 95% CI = 1.11 - 1.52). Similarly,
be knowledgeable during pregnancy than those below Mothers between the ages of 20 – 24 were 1.42 times
the age of 30 years (AOR= 1.52 and 95% CI = 1.28-1.99) more likely to be knowledgeable during postpartum than
 Tsegaye et al. 29

those in other age group (AOR= 1.42 and 95% CI = 1.18- women who knew at least three danger sign related to
1.98). the period after delivery was 3.3% (Pembe et al., 2009).
Mothers with Higher education were 1.46 times and Level of education showed strong statistical association
1.24 time more likely to know obstetric danger signs with the mentioning of at least two danger signs of
during pregnancy child birth than those with who cannot pregnancy. Mothers with Higher education were 1.46
read and write and with primary education, (AOR = 1.46 times and 1.24 time more likely to be knowledgeable
and 95% CI = 1.24-1.91) respectively. Similarly Mothers about obstetric danger signs during pregnancy and child
with secondary education were 2.46 times more likely to birth than those with no formal education. This is
know obstetric danger signs during postpartum than their comparable with reports from Tigray region (Hailu and
counter parts, (AOR = 2.36 and 95% CI = 2.18 - 2.72). Berhe, 2014). This might be related to the fact that
The other strong predictor of knowledge about the educated women have better power to make their own
danger signs of pregnancy and childbirth was place of decision in matters related to their health.
delivery. Mothers who previously gave birth in health The other strong predictor of knowledge of women
institutions were about 3.48 times (more likely to be about danger signs of labor and childbirth was place of
knowledgeable about the danger signs of childbirth and last delivery. Mothers who delivered in Health institutions
period after delivery as compared to those who gave birth were 3.5 times and 2.4 times more likely to have higher
at home AOR = 3.48 and 95% CI: 3.26 -3.94), (AOR knowledge about the danger signs of pregnancy and
=2.43 and 95% CI: 2.23 - 2.83) respectively. Mothers who labor and delivery than those who gave birth at home.
were satisfied with the service they received were about Similar with other study conducted in Tsegedie District,
3.23, 2.21 and 4.32 times more likely to be Tigray Region (Hailu and Berhe, 2014).
knowledgeable about the danger signs of pregnancy, Discussion of the women on their health services
childbirth and period after delivery as compared to those utilization with their husband affects their level of
who who were not satisfied (AOR = 3.23 and 95%CI: knowledge about obstetrics danger signs. Mothers who
3.14 -3.38), (AOR = 2.21 and 95% CI: 1.11 - 2.42, AOR discussed their health service utilization were
=4.32 and 95% CI: 1.13 - 4.79), respectively (Table 5). knowledgeable as compared to those who had no
discussion. This can be due to the shared responsibility
of the husbands to take any action at any time of the
DISCUSSION health related matters of the mothers. This study
revealed that mothers who were satisfied with the service
Knowledge of danger signs of obstetric complications they received were about 3.23, 2.21 and 4.32 times more
during pregnancy, labour and postnatal period is the first likely to be knowledgeable about the danger signs of
essential step for appropriate and timely referral. More pregnancy, childbirth and period after delivery as
than one-third 309 (37.3%) of the respondents were compared to those who were not satisfied. This could be
knowledgeable about obstetric danger signs during due to hospitality, health worker skills, good infrastructure
pregnancy and during postpartum period. This finding is that could have resulted better attention to the health
consistent with the study conducted in Aleta Wondo in education given and better knowledge of the danger
which 30.9% of respondents mentioned at least two signs but other similar studies did not show any
danger signs of pregnancy (Hailu et al., 2010). Out of the significant association between level of satisfaction and
women under the study 194(23.3%) were knowledgeable knowledge of obstetric danger signs. These differences
about danger signs during childbirth. But the finding of could be attributed to the methodological approach of the
this study was higher than the study conducted in rural different studies in assessing the different factors which
Tanzania in which the percentage of women who knew at needs further study.
least three danger sign related to pregnancy was 6.9% Readers shall take into consideration the following
(Pembe et al., 2009). This difference could be resulted limitations when interpreting the finding of this study.
from the variation in educational level of respondents and First, the cross sectional nature of the data had made it
accessibility of information in these two study settings. impossible to reach at the causal relation between the
Similarly, it is higher than the findings from study different independent variables and knowledge of women
conducted in rural Uganda in which 19% mothers had about obstetric danger signs. Second, the source of data
knowledge of 3 or more key danger signs during for this study was based on the self-report of
pregnancy (Kabakyenga et al., 2011). These differences respondents, and provided no validation of obtaining
in knowledge level could again be due to a difference in information with any objective source such as health
socio-demographic, cultural, and health interventions as facility cards. But it is logical to assume that biases are
well as methodological difference. Additionally, 30(3.6%) less likely in delivery related events as compared to
were knowledgeable about danger signs during sensitive issues such as sexual behavior and drug abuse,
postpartum period which is consistent with similar study and respondents were informed about the importance of
conducted in rural Tanzania in which the percentage of giving accurate responses and also assured the
30 Int. J. Nurs. Midwifery

Table 5. Factors associated with knowledge of key obstetric danger signs during pregnancy, delivery and postpartum among
pregnant women attending ANC in selected Health Facilities in Illubabor Zone, south West Ethiopia.

During pregnancy During Delivery

Characteristics Postpartum period AOR
AOR AOR
Age
15 - 24 1.00 1.00 1.00
25 - 29 0.68(0.42,1.13) 0.83(0.47,1.50) 1.42(1.18,1.98)
30 - 34 1.52(1.28,1.99) 1.24(1.11,1.52) 0.42(0.15,1.18)
≥35 1.42(1.20,1.86) 0.60(0.23,1.48) 0.31(0.11,0.88)

Marital Status
In marital Union ** ** 0.42(0.15,1.09)
Not in Union 1.00

Education of the Mother

No formal Education 1.00 1.00 1.00
Primary 0.99(0.58,1.70) 0.69(0.36,1.34) 1.57(0.82,3.03)
Secondary 1.46(1.24,1.91) 1.41(1.18,1.89) 1.17(0.57,2.40)
Higher 1.09(0.48,2.48) 1.43(0.55,3.75) 2.36(2.18,2.72)

Education of the Husband

No formal Education ** ** 1.00
Primary 0.96(0.36,2.52)
Secondary 0.86(0.31,2.35)
Higher 0.38,0.13,1.07)

Income
<500 1.00 1.00 1.00
501 - 1000 0.87(0.48,1.56) 0.49(0.23,1.05) 0.87(0.33,2.24)
1001 - 3000 0.93(0.48,1.79) 1.33(0.15,1.74) 0.90(0.31,2.59)
>3000 1.38(0.17,1.73) 1.10(1.04,1.25) 2.32(0.12,2.92)

Parity
Nullipara 1.00
2- 3 ** 1.52(0.87,2.66) **
≥4 0.59(0.25,1.35)

ANC Provider
Nurse/Midwife 0.26(0.08,2.90) 0.13(0.03,1.49)
**
Physician 0.73(0.40,1.31) 0.37(0.18,2.78)
HEW 1.00 1.00

Place of last Delivery

Home 1.00 1.00 1.00
Health Facility 0.62(0.36,1.05) 3.48(3.26,3.94) 2.43(2.23,2.83)

Delivery Attendant
Skilled 2.43(1.01,5.84)
** **
Unskilled 1.00

Mode of Delivery
SVD 1.00 1.00 1.00
 Tsegaye et al. 31

Table 5 cont’d

Assisted Vaginal Delivery 0.21(0.32,1.71) 1.14(0.17,1.89) 0.67(0.37,1.18)

C/S 0.70(0.32,1.57) 0.47(0.21,1.08) 0.71(0.26,1.94)

Discussion about ANC with Husbands

Yes 3.32(3.16,3.66) 0.61(0.36,1.01) 0.55(0.25,1.23)
No 1.00 1.00 1.00

Satisfaction with Service

Yes 1.22(1.16,1.43) 1.12(1.05,1.29) 1.26(1.09,1.74)
No 1.00 1.00 1.00
The bolded values are the variables in the final model. **Indicating the p-value of the variable considered in that specific cell was greater
than 0.3 which was not a candidate for multiple logistic regression.

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 Vol. 9(3), pp. 33-40, March 2017
DOI: 10.5897/IJNM2016.0231
Article Number: CF4E4D163147
ISSN 2141-2456
International Journal of Nursing
Copyright © 2017 and Midwifery
Author(s) retain the copyright of this article
http://www.academicjournals.org/IJNM

Full Length Research Paper

Prevalence and assessment of knowledge and practice

towards hypertension among Bahir Dar City
communities, 2016: A community based cross-
sectional study
Ayele Semachew Kasa* and Abdurehman Kelifa Shifa
School of Nursing, Bahir Dar University, Ethiopia.
Received 15 August, 2016; Accepted 13 December 2016

Hypertension is a silent killer cardiovascular disease and is becoming a concerned public health
challenges particularly in developing countries up to date. The problem is significant particularly where
there is weak health system like sub-Saharan Africa. The global prevalence of raised blood pressure in
adults aged 18years and over was around 22% in 2014, and the number of people living with
hypertension is predicted to be 1.56 billion at 2025, increasing by 60%. Reducing the incidence of
hypertension through implementation of behavioral risk factor reduction is essential through creation
of awareness about the knowledge and practice associated with hypertension. This study aims to
determine the proportion of people with hypertension, and to assess knowledge and practice towards
hypertension among Bahir Dar city Administration communities. A community based cross sectional
study was conducted on April, 2016 among Bahir Dar city administration communities with age greater
than or equal to 20 years old. A multi-stage sampling technique was used to select 388 study
participants. Data was collected after oral informed consent secured for all study participants. Chi
square test was done to see whether there is an association between the predictor and outcome
variable. The mean age of study participant was 38.24(±17.2 SD), 46.5% of them were female. The
prevalence rate of hypertension was 16.45%. The percentage of knowledge and practice score of the
respondent with poor score level was 71.8 and 84.3%, respectively. Furthermore, socio-demographic
characteristics like education, occupation and health information concerning hypertension were
associated with level of knowledge and practice toward hypertension. Two hundred seventy five
(71.8%) and three hundred twenty three (84.3%) of the respondents had poor knowledge and poor
practice in the prevention of hypertension respectively. As part of prevention programme, regarding
hypertension health education should be planned and incorporated by Federal Ministry of Health along
with other health topics provided by health extension workers. Furthermore, mass media like radio
should have focus towards cardiovascular non-communicable diseases like hypertension.

Key words: Hypertension, cardiovascular disease, knowledge, Bahir Dar city.

INTRODUCTION

Raised blood pressure (RBP) is a major cardiovascular (HTN) fell modestly between 1980 and 2010.However,
(CVD) risk factor. The proportion of the world’s population because of population growth and ageing, the number of
with high blood pressure or uncontrolled hypertension people with uncontrolled HTN has risen over the years
34 Int. J. Nurs. Midwifery

(World Health Organization, 2014). According to the Measuring of knowledge and practices (KP) is a crucial
seventh report of joint national committee prevention, element of hypertension control, but little is known about
detection, evaluation, and treatment of high blood KP on HTN from developing countries including ours,
pressure (JNC7) HTN is defined as a systolic blood where hypertension has lately been recognized as a
pressure ≥140 and a diastolic blood pressure ≥90 based major health problem. Therefore, this study is aimed to
on the average of two or more accurate measurement examine KP and prevalence on hypertension among
taken during two or more contact with health care general population of Bahir Dar city residents.
provider. But, it is classified as pre-hypertension which is
120 to 139 systolic and diastolic 80 to 89, stage I systolic
of 140 to 159 and diastolic 90 to 99, stage II systolic of MATERIALS AND METHODS
≥160 and diastolic ≥100 (Suzanne et al., 2010).
The global prevalence of RBP in adults aged 18 years Study area and period
and over was around 22% in 2014 (World Health
A community based cross sectional study was conducted among
Organization, 2014). The prevalence of hypertension in Bahir Dar city administration communities from April 30 to May 30
SSA, particularly in urban areas, was high (ESH E, 2016. Bahir Dar is the capital of Amhara National Regional State
ESH/ESC Guidelines, 2013; Addo et al., 2007(. The and is one of the leading tourist destinations in North West Ethiopia.
estimated prevalence rate of HTN in overall Africa in The city is located approximately 565 km northwest of Addis Ababa,
adults aged 18 years and over 30 and 24.4% in Ethiopia and an elevation of about 1,800 m (5,906 feet) (United Nation
(World Health Organization, 2014). The common risk Education Science and cultural organization (UNESCO), 2002).
factors for HTN are obesity and weight gain, high sodium
intake, low calcium and potassium intake, alcohol Sampling technique and procedures
consumption, ageing, socioeconomic determinants
psychological stress and low physical activity also Randomly one kebele (the smallest administrative system in
heritability blood pressure is in the range of 15 to 35% Ethiopia) was selected from each (9 urban, 9 rural and 3 satellite
(Suzanne et al., 2010; ESH E, ESH/ESC Guidelines, kebele). After that the sample size was distributed proportionally to
randomly selected kebeles (3 kebele), then the household was
2013; Don Longo et al., 2012). selected by systematic random sampling; the first household was
Globally CVD accounts for approximately 17 million taken by tossing a coin and if more than one eligible individuals
deaths a year, nearly one third of the total, of these, present in the same household, one was recruited randomly, but if
complications of HTN account for 9.4 million deaths the eligible individuals not present in the selected household the
worldwide. Every year HTN is responsible for at least next house was taken, in this way the household was taken until the
45% of deaths due to heart disease, and 51% of deaths sample size was fulfilled for that kebele (Figure 1).
due to stroke (WHO, 2013). By 2025 the projected
number of people with hypertension is expected to rise by Operational definition
60% and reach 1.56 billion people (WHO, 2011). If left
uncontrolled, HTN causes stroke, myocardial infarction, The overall knowledge of the study participant’s was assessed
cardiac failure, dementia, renal failure and blindness, using the sum score of each outcome based on Bloom’s cut-off
causing human suffering and imposing severe financial point. The scores were classified into 3 levels as follow:
1. Good level knowledge: Knowledge score that fell above 80%.
and service burdens on health systems (World Health 2. Moderate level knowledge: Knowledge score that fell between
Organization, 2014). 60 and 79%.
From different studies, the prevalence of HTN in urban 3. Poor level knowledge: Knowledge score below 60%
is high due to low physical inactivity, better sedentary life,
stress full environment. A study done in Addis Ababa
Practice
showed that, the highest prevalence of 30.2% (Tesfaye et
al., 2009) whereas a study done in South West Ethiopia Practice Is the overt behavior, habit or custom that a person does,
showed the lowest prevalence of 2.6% (Muluneh et al., follow up or carry out in his/her daily life in prevention of
2012). hypertension. Each question contains 1 point for positive life style
Now a day, the prevalence of NCD including HTN is practice and 0 point for negative life style practices.
increasing dramatically posing a double burden to The total response classified in to 3 according to Bloom’s cut off
point:
countries of low socioeconomic status such as Ethiopia.
Moreover, because of weak health systems, the numbers 1. Good practice: Practice score 6 to 7 scores (above 80%).
of people with HTN who are undiagnosed, untreated and 2. Fair practice: Practice score 4 to 5 (60% - 79%).
uncontrolled are also higher (WHO, 2013). 3. Poor practice: Practice score that fell below 4(0-59%).

*Corresponding author. E-mail: ayele.semachew@yahoo.com. finoteayu24@gmail.com.

(Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution
License 4.0 International License
 Kasa and Shifa 35

9 Urban kebele 9 Rural kebele 3 Satellite kebele

SRS
SRS

SRS
Belay Zeleke-subcity (3555 HH) Meshenti-kebele (1397 HH) Wereb-kebele (1830 HH)
SS(203 HH) SS(80HH) SS(105HH)

388 House Holds

Figure 1. Schematic representation of sampling procedure, 2016. SS, Systematic sampling; SRS, simple random
sampling; HH, household.

Hypertension the study was explained in local language. Data collected from the
of each respondent was maintained throughout the data collection
Blood pressure of 140/90 mm Hg and above taken at least on two process. The sampled participant who gave consent to participate
occasions at 30- minute interval (Tadesse, 2016). in the study was interviewed face to face, and those with newly
detected hypertension, those who discontinue anti-hypertensive
medication as well as those with pre-hypertension stage was
Data collection procedure advised to start follow-up in their nearby health facility.

Blood pressure was taken using BP cuff (adult size) and

stethoscope. Patients’ BP was taken while the patient is in a sitting RESULTS
position, from the right arm after the patient rested for at least 10
min before measurement. Two measurements of BP on a single
visit was taken at least 30 min apart, and the averages of the two
Socio-demographic characteristics
records was used for the computation of the results (if the selected
individuals not taken caffeine within 30 min). But if the study The number of study participant enrolled in this study was
participant was taken caffeine within 30 min, 9 mm Hg systolic and 383 making the response rate 98.7%, of these 178
9 mm Hg diastolic will be subtracted from the average blood (46.5%) were females, 254 (66.3%) married, 351 (91.6%)
pressure of non-hypertensive individuals whose blood pressure was Anhara ethnic group, 272 (71%) orthodox religion
≥140/90 (Mort and Kruse, 2008).
follower, 134 (35%) illiterate and 29(7.6%), had Diploma,
and 34(8.9%) had degree, 106 (27.7%) merchant. The
Data processing and analysis procedures mean age of study participants were 38.24(±17.2 SD)
(Table 1).
The data was edited, coded and entered into Epi-Data version 3.1
and exported to IBM SPSS Statistics Version 20 for analysis.
Descriptive statistics like frequencies, mean, proportions and
Information and knowledge regarding hypertension
measures of dispersions was employed to describe socio-
demographic, knowledge and practice variables. The degree of
association between socio demographic and level of knowledge A total of 157(41%) had information regarding
and practice variables was measured using chi-square test, P-value hypertension. The majority (56.1%) of them did not know
of less than 0.05 was considered as statistical significance, then the normal level of BP. Around Fifty three percent of the
results was summarized and presented by using tables, charts and sample size respond hypertension as high BP while
graphs.
about eight of them respond as high sugar. Thirty three
percent of the participants mentioned stress as a risk
Ethical consideration factor and 53% answered that obesity is a risk factor for
hypertension. Around twenty percent of the participant
Ethical clearance and approval letter to conduct the research was did not know the complication of hypertension.
obtained from Bahir Dar University College of Medicine Health Regarding the diagnosis of hypertension, 70% of the
Sciences ethical review committee. A formal letter was written to participant answered that hypertension diagnosed
Bahir Dar city municipality office and written informed consent was
obtained from each respondent after the purpose and procedure of through BP measurement while 1.6% of them thought as
participant remain anonymous for indefinite time period, and privacy it is diagnosed by X-ray (Table 2).
36 Int. J. Nurs. Midwifery

Table 1. Respondent’s socio-demographic characteristics, Bahir Dar City administration, 2016.

Variable Response category N %

Male 205 53.5
Sex
Female 178 46.5
Married 254 66.3
Unmarried 101 26.4
Marital status
Divorced 11 2.9
Widowed 17 4.4
Amhara 351 91.6
Oromo 15 3.9
Ethinicity
Tigray 7 1.8
Other* 10 2.6
Orthodox 272 71
Muslim 102 26.6
Religion
Protestant 6 1.6
Catholic 3 0.8
Illitrate 134 35
Primary 83 21.7
Secondary 85 22.2
Educational status
University student 18 4.7
Diploma 29 7.6
Degree and Above 34 8.9
Merchant 106 27.7
Daily laborer 52 13.6
Occupation Governmental employee 51 13.3
House wife 88 23
Other€ 85 22.2

Practice regarding in prevention of hypertension Prevalence of hypertension among illiterate

respondents was 9.4% whereas the prevalence of those
From the total respondents 145 (37.8%) of the who have degree and above educational status was
respondents had previously measured their blood 0.78%. Among hypertensive individuals, 39(61.9%) were
pressure. Regarding to physical exercise 115 (30%) of newly diagnosed and the percentage of those reporting
the respondents reported that they perform physical previous history of anti-hypertensive medication/
exercise regularly. From these 115 individuals 48.6% hypertension were 19(30.1%), and individuals who
perform physical exercise for less than 30 minutes per discontinued antihypertensive medication and whose BP
day whereas 8.8% perform for one hour per day. was above normal (140/90 mmHg) were 5(7.94%).
Study respondents also were asked about whether they Among the total study participants 275 (71.8%) and 59
are addicted or not for different substances and 63 (15.4%) had poor and good knowledge regarding
(16.4%) were addicted of these 30 (7.8%) had alcohol hypertension prevention respectively whereas 323
addiction (Table 3). (84.3%) and 16 (4.2%) had poor practice and good
practice towards in the prevention of hypertension (Table
4).
Prevalence of hypertension A chi-square test was performed and educational
status, occupation and health information regarding
The mean systolic and diastolic BP was 118.6 and 76.6 hypertension have an association with the outcome
mmHg respectively. The overall prevalence of variable (knowledge level of the respondents), X2 (2, N =
hypertension was 16.45%. Prevalence of hypertension 383) = 18.4, P = 0.0001, X2 (8, N = 383) = 34.8, P =
among female respondents was 8.6%, for age groups 0.0001 and X2 (2, N = 383) = 59.6, P = 0.0001
between 20 and 40 years was 6.5 and 3.9% for age 41 to respectively. The rest do not show any association with
60 years. the outcome variable (knowledge level of the
 Kasa and Shifa 37

Table 2. Respondent’s Information Regarding hypertension, Bahir Dar City residents, 2016.

Information for hypertension N %

Yes 157 41.0
No 225 58.7
Level of cut point for hypertension mentioned by the respondents
90/60 29 7.6
120/80 126 32.9
140/90 13 3.4
i do not know 215 56.1
Respondent’s perception and definition about hypertension
High blood pressure 204 53.3
High level stress 58 15.1
High sugar 30 7.8
I do not know 91 23.8
Risk factors for hypertension as mentioned by the respondents
Stress 127 33.2
Age 07 1.8
Heredity 06 1.6
Diabetes Mellitus (DM) 20 5.2
Obesity 203 53.0
I don't know 20 5.2
Complication of hypertension as perceived by respondents
Blindness 29 7.6
Paralysis 127 33.2
Renal failure 22 5.7
Blindness, paralysis, renal failure 130 33.9
I do not know 75 19.6
Controlling method for hypertension as perceived by the respondents
Diet 72 18.8
Medication 26 6.8
Physical exercise 75 19.6
Diet, medication and exercise 177 46.2
I do not know 33 8.6
Diagnostic method of hypertension as mentioned by the respondents
Blood test 53 13.8
Urine analysis 12 3.1
Blood Pressure measurement 268 70
X ray 6 1.6
I do not know 44 11.5

respondents) (Table 5). Surprisingly educational status different variation as well as similarities with various
does not show significant association with practice studies, which was done in Ethiopia and other countries.
towards hypertension prevention whereas age and When compared to the prevalence of hypertension in
marital status has significant association with outcome other parts of the world, the prevalence hypertension in
variable (practice level of the respondent) at X2 (4, Bahir Dar city communities were lower than communities
N=383) =29.6, P=0.0001 and X2(4, N=383) =32.56, p- in USA, which was 18% and overall Africa, was 30%
value= (0.0001) respectively, but the rest has no (World Health Organization, 2014). The overall
association (Table 6). prevalence of hypertension in our study was 16.45%,
which is higher than the study done in Gilgelgibe,
Ethiopia was 2.6% (Muluneh et al., 2012) and 13% in
DISCUSSION Jimma (Gudina et al., 2013). This could be explained by
This community based cross-sectional study showed participants age variation in both studies they
38 Int. J. Nurs. Midwifery

Table 3. Respondents’ practice towards in preventing hypertension Bahir Dar City residents, 2016.

Respondents’ practice N %
History of previous blood pressure measurement
Yes 145 37.9
No 238 62.1
Exercise habit of respondents
Yes 115 30
No 268 70
Duration of exercise
< 30 minutes 56 48.6
30– 60 minutes 49 42.6
>60 minutes 10 8.8
Respondents’ habit of substance use
Yes 62 16.1
No 321 83.8
Type of substance used by the respondents
Alcohol 30 7.8
Cigarette 6 1.6
Alcohol and cigarette 6 1.6
Other 20 5.2

Table 4. Knowledge and practice level of study subjects regarding to hypertension, Bahir Dar city
administration, 2016.

Knowledge Practice
Score
n % n %
Good 59 15.4 16 4.2
Fair 49 12.8 44 11.5
Poor 275 71.8 323 84.3
Total 383 100 383 100

incorporated 15 years to 64 and 81 years old respectively the study. The former one included adults aged 25 to 64
and they used larger sample size 4469 and 734, years, which might have been exposed to different media
respectively. However, the current study is lower than talking about hypertension.
those found in Systemic meta-analysis study in overall In our finding, 1.6% of our study participants were
Ethiopia, which is 19.6% (Kibret and Mesfin, 2015), and smoking but the study done in Egypt (Abdelraziq et al.,
community based study of Addis Ababa, 30% (Tesfaye et 2015) shows, 11% of their study participants were
al., 2009). The possible reason for this discrepancy is the smokers, the reason behind this inconsistency result
sample size and setting in which the study was done. In could be explained by cultural influence.
our study 26.9% were from rural, 20.6% were from Another finding that we got from our study shows
satellite kebeles and the remaining one was urban 71.8% of our study participants did not engaged in any
dwellers. type of practice, meanwhile, the study done in Egypt
The finding of our study showed that poor knowledge (Abdelraziq et al., 2015) on general population attending
and practice towards hypertension. However, study done primary health care showed, 30.77% of their study
in India (Pragnesh, 2014) and Seychelles (Aubert et al., participants do not practice any type of exercise. This
1998) found that the majority had good knowledge and may be due to lack of knowledge about the advantage of
greater than 96% in Seychelles and 80.4%, India, of the exercise.
participant knew that obesity was associated with Our study reviled that health information regarding
hypertension, but in our study only 62.9% of the hypertension has an association with knowledge of the
participant mentioned it as a risk factor. This discrepancy respondents for hypertension and this finding is
could be explained by the type of participant included in supported by the previous study done in Ethiopia. But the
 Kasa and Shifa 39

Table 5. Chi square test of the association between level of Knowledge and socio-demographic characteristics of the respondents, Bahir Dar
city, 2016.

Variable Good Fair Poor X2 P-value

Male 38(64.4%) 28(57.1%) 139(50.5%) 4.048
Sex 0.132
Female 21(35.6%) 21(35.6%) 136(49.5%) df=2
20-40 47(79.6%) 38(77.5%) 184(66.9%)
8.02
Age 41-60 6(10.1%) 9(18.4%) 54(19.6%) 0.0908
df=4
≥61 6(10.3%) 2(4.1%) 37(13.5%)
Illiterate 11(18.6%) 9(18.4%) 114(41.5%) 18.4
Educational status 0.0001*
Litrate 48(81.4%) 40(81.6%) 161(58.5%) df=2
Merchant 23(38.9%) 12(24.48%) 71(25.8%)
Daily laborer 3(5.1%) 6(12.24%) 43(15.6%)
34.813
Occupation Governmental worker 17(28.8%) 11(22.4%) 23(8.3%) 0.0001*
df=8
Housewife 7(11.9%) 8(16.3%) 73(26.5%)
€
other 9(15.2%) 12(24.5%) 65(23.6%)
Health Yes 45(76.2%) 30(61.2%) 82(29.8%) 59.6 0.0001*
information No 14(23.7%) 19(38.8%) 192(69.8%) df=2
42 student, 18 farmer, 10 alcohol brewer, 15 weaver; *significant.

Table 6. Chi square test of the association between level of practice and socio-demographic characteristics of the respondents, Bahir Dar
city, 2016.

Variable Good Fair Poor X2 P-value

20-40 9(56.25%) 26(59.1%) 80(24.8%)
29.6
Age 41-60 4(25%) 11(25%) 97(30%) 0.0001
Df=4
≥61 3(18.75%) 7(15.9%) 146(45.2%)
Illiterate 6(37.5%) 14(31.8%) 122(37.8%) 0.44
Educational status 0.8025
Literate 10(62.5%) 30(68.2%) 201(62.2%) Df=2
Marital status Married 5(31.25%) 20(45.4%) 204(63.1%) 32.56 0.0001
Unmarried 10(62.5%) 18(41%) 87(27%)
Divorced and widowed 1(6.25%) 6(13.6%) 32(9.9%)

relationship between marital status and level of practice specific knowledge regarding hypertension should be
was inconsistent with our study (Tadesse, 2016). planned and incorporated by policymaker along with
other health topics which is provided by health extension
workers and other health care providers to tackle the
Conclusion incidence of hypertension. Furthermore, mass media like
radio and television programs should have a regular
HTN was found to be prevalent (16.45%), among health education programme regarding hypertension.
hypertensive individuals, 39(61.9%) were newly
diagnosed and the number of people discontinuing
medication was relatively increasing (7.94%). The Conflicts of Interests
percentage of people with poor level of knowledge and
practice was 71.8 and 84.3% respectively. Moreover, The authors have not declared any conflict of interests.
socio-demographic characteristics (Educational status,
occupation) and (marital status and age) has significant
association with the level of knowledge and practice of ACKNOWLEDGEMENTS
Bahir Dar city communities respectively. As part of
prevention, health education programme to the level of The authors are grateful to all study participants for their
40 Int. J. Nurs. Midwifery

commitment in responding to their questionnaires and to Muluneh AT, Haileamlak A, TessemaF, Alemseged F, Woldemichael K
(2012). Population based survey of chronic non-communicable
be measured for the screening.
diseases at Gilgel Gibe Field Research Center, Southwest Ethiopia.
Ethiop. J. Health Sci. 22:7-18.
Suzanne CS, Brenda GB, Hinkle JL, Cheever KH (2010). Brunner and
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 International Journal of
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