Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

01-12-2020 | Hypertension | Research

Socioeconomic inequalities in hypertension in Kenya: a decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors

Authors: Samwel Maina Gatimu, Thomas Wiswa John

Published in: International Journal for Equity in Health | Issue 1/2020

Login to get access

Abstract

Background

One in four Kenyans aged 18–69 years have raised blood pressure. Despite this high prevalence of hypertension and known association between socioeconomic status and hypertension, there is limited understanding of factors explaining inequalities in raised blood pressure in Kenya. Hence, we quantified the socioeconomic inequality in hypertension in Kenya and decomposed the determinants contributing to such inequality.

Methods

We used data from the 2015 Kenya STEPwise survey for non-communicable diseases risk factors. We included 4422 respondents aged 18–69 years. We estimated the socioeconomic inequality using the concentration index (C) and decomposed the C using Wagstaff decomposition analysis.

Results

The overall concentration index of hypertension in Kenya was − 0.08 (95% CI: − 0.14, − 0.02; p = 0.005), showing socioeconomic inequalities in hypertension disfavouring the poor population. About half (47.1%) of the pro-rich inequalities in hypertension was explained by body mass index while 26.7% by socioeconomic factors (wealth index (10.4%), education (9.3%) and paid employment (7.0%)) and 17.6% by sociodemographic factors (female gender (10.5%), age (4.3%) and marital status (0.6%)). Regional differences explained 7.1% of the estimated inequality with the Central region alone explaining 6.0% of the observed inequality. Our model explained 99.7% of the estimated socioeconomic inequality in hypertension in Kenya with a small non-explained part of the inequality (− 0.0002).

Conclusion

The present study shows substantial socioeconomic inequalities in hypertension in Kenya, mainly explained by metabolic risk factors (body mass index), individual health behaviours, and socioeconomic factors. Kenya needs gender- and equity-focused interventions to curb the rising burden of hypertension and inequalities in hypertension.
Appendix
Available only for authorised users
Literature
1.
2.
World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization; 2013.
3.
Kenya National Bureau of Statistics. World health organisation, Ministry of Health: Kenya STEPwise survey for non-communicable diseases risk factors 2015 report. Nairobi: Kenya National Bureau of Statistics; 2015.
4.
Ogola E, Okello FO, Macgregor-skinner E, Jimenez J, Yonga G. [OP.3C.03] blood pressure screeningresults from healthy heart Africa: screening locations, participant characteristics, and hypertension classification in Kenya. J Hypertens. 2017;35:e30–1.CrossRef
5.
van de Vijver SJ, Oti SO, Agyemang C, Gomez GB, Kyobutungi C. Prevalence, awareness, treatment and control of hypertension among slum dwellers in Nairobi, Kenya. J Hypertens. 2013;31:1018–24.CrossRefPubMed
6.
Oyando R, Njoroge M, Nguhiu P, Kirui F, Mbui J, Sigilai A, Bukania Z, Obala A, Munge K, Etyang A, Barasa E. Patient costs of hypertension care in public health care facilities in Kenya. Int J Health Plann Manag. 2019;34:e1166–78.CrossRef
7.
Cha SH, Park HS, Cho HJ. Socioeconomic disparities in prevalence, treatment, and control of hypertension in middle-aged Koreans. J Epidemiol. 2012:JE20110132.
8.
Palafox B, Mckee M, Balabanova D, Alhabib KF, Avezum AJ, Bahonar A, Ismail N, Chifamba J, Chow CK, Corsi DJ, et al. Wealth and cardiovascular health : a cross-sectional study of wealth-related inequalities in the awareness , treatment and control of hypertension in high- , middle- and low-income countries. Int J Equity Health. 2016;15:15–7.CrossRef
9.
Vellakkal S, Millett C, Basu S, Khan Z, Aitsi-Selmi A, Stuckler D, Ebrahim S. Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey. J Epidemiol Community Health. 2015;69:218–25.CrossRefPubMed
10.
Leng B, Jin Y, Li G, Chen L, Jin N. Socioeconomic status and hypertension: a meta-analysis. J Hypertens. 2015;33:221–9.CrossRefPubMed
11.
Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol. 2008;23:335–9.CrossRefPubMed
12.
Olack B, Wabwire-Mangen F, Smeeth L, Montgomery JM, Kiwanuka N, Breiman RF. Risk factors of hypertension among adults aged 35-64 years living in an urban slum Nairobi, Kenya. BMC Public Health. 2015;15:1251.CrossRefPubMedPubMedCentral
13.
Ploubidis GB, Mathenge W, De Stavola B, Grundy E, Foster A, Kuper H. Socioeconomic position and later life prevalence of hypertension, diabetes and visual impairment in Nakuru, Kenya. Int J Public Health. 2013;58:133–41.CrossRefPubMed
14.
Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Socioeconomic inequalities in the risk factors of noncommunicable diseases among women of reproductive age in sub-saharan Africa: a multi-country analysis of survey data. Front Public Health. 2018;6:307.CrossRefPubMedPubMedCentral
15.
Fateh M, Emamian MH, Asgari F, Alami A, Fotouhi A. Socioeconomic inequality in hypertension in Iran. J Hypertens. 2014;32:1782–8.CrossRefPubMed
16.
Joshi MD, Ayah R, Njau EK, Wanjiru R, Kayima JK, Njeru EK, Mutai KK. Prevalence of hypertension and associated cardiovascular risk factors in an urban slum in Nairobi, Kenya: a population-based survey. BMC Public Health. 2014;14:1177.CrossRefPubMedPubMedCentral
17.
Ministry of Health. Kenya National Strategy for the Prevention and Control of Non-Communicable Diseases (NCDs) 2015–2020. Nairobi: Ministry of Health, Kenya; 2015.
18.
Kenya National Bureau of Statistics: Kenya - Kenya Stepwise Survey for Non Communicable Diseases Risk Factors 2015. Statistics KNBo ed., Version 1.0 (May 2016) edition. Nairobi. Kenya; 2015.
19.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, et al. The seventh report of the joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.CrossRefPubMed
20.
Ministry of Health. Kenya National Guidelines for Cardiovascular Diseases Management. Nairobi: Ministry of Health, Division of Non-Communicable Diseases; 2018.
21.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21:459–68.CrossRefPubMed
22.
Rutstein SO. Steps to constructing the new DHS wealth index. Rockville, MD: ICF International; 2015.
23.
Rutstein SO, Staveteig S. Making the demographic and health surveys wealth index comparable; 2014.
24.
Howe LD, Hargreaves JR, Huttly SR. Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg Themes Epidemiol. 2008;5:3.CrossRefPubMedPubMedCentral
25.
Mohamed SF, Mutua MK, Wamai R, Wekesah F, Haregu T, Juma P, Nyanjau L, Kyobutungi C, Ogola E. Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in Kenya. BMC Public Health. 2018;18:1219.CrossRefPubMedPubMedCentral
26.
Ba HO, Camara Y, Menta I, Sangare I, Sidibe N, Diall IB, Coulibaly S, Keita MA, Millogo GRC. Hypertension and associated factors in rural and urban areas Mali: data from the STEP 2013 survey. Int J Hypertens. 2018;2018:6959165.CrossRefPubMedPubMedCentral
27.
Bosu WK, Aheto JMK, Zucchelli E, Reilly ST. Determinants of systemic hypertension in older adults in Africa: a systematic review. BMC Cardiovasc Disord. 2019;19:173.CrossRefPubMedPubMedCentral
28.
Sarki AM, Nduka CU, Stranges S, Kandala NB, Uthman OA. Prevalence of hypertension in low- and middle-income countries: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94:e1959.CrossRef
29.
Veisani Y, Jenabi E, Nematollahi S, Delpisheh A, Khazaei S. The role of socio-economic inequality in the prevalence of hypertension in adults. Tabriz University of Medical Sciences. 2019;11:116–20.
30.
World Health Organisation. Global physical activity questionnaire (GPAQ): analysis guide. Geneva: World Health Organization; 2009.
31.
Dickson KS, Ahinkorah BO. Understanding tobacco use and socioeconomic inequalities among men in. BMC Archives of Public Health. 2017:1–8.
32.
Irazola V, Santero M, Melendi S, Herna A. Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in Argentina : Analysis of three cross-sectional nationally representative surveys in 2005 , 2009 and 2013. PLoS One. 2019:1–16.
33.
Lawana N. Decomposing socioeconomic inequalities in alcohol use by men living in south African urban informal settlements. BMC Public Health. 2018;18:1–9.CrossRef
34.
Ondimu DO, Kikuvi GM, Otieno WN. Risk factors for hypertension among young adults (18-35) years attending in Tenwek Mission hospital, Bomet County, Kenya in 2018. Pan Afr Med J. 2019;33:210.CrossRefPubMedPubMedCentral
35.
Akpa OM, Made F, Ojo A, Ovbiagele B, Adu D, Motala AA, Mayosi BM, Adebamowo SN, Engel ME, Tayo B, et al. Epidemiology / population science regional patterns and association between obesity and hypertension in Africa evidence from the H3Africa CHAIR study. Obesity and Hypertension in Africa. 2020:1167–78.
36.
Oladimeji AM, Fawole O, Nguku P, Nsubuga P. Prevalence and factors associated with hypertension and obesity among civil servants in Kaduna , Kaduna State , June 2012. PanAfrican Medical Journal. 2014;18:1–5.
37.
O'Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. 2008. Washington, DC: The World Bank; 2008. p. 220.
38.
39.
Wagstaff A. Correcting the concentration index: a comment. J Health Econ. 2009;28:516–20 author reply 521-514.CrossRefPubMed
40.
Wagstaff A, Doorslaer VE, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. The World Bank; 2001.CrossRef
41.
Amroussia N, Gustafsson PE, Mosquera PA. Explaining mental health inequalities in northern Sweden: a decomposition analysis. Glob Health Action. 2017;10:1305814.CrossRefPubMedPubMedCentral
42.
Gonzalo-Almorox E, Urbanos-Garrido RM. Decomposing socio-economic inequalities in leisure-time physical inactivity: the case of Spanish children. Int J Equity Health. 2016;15:106.CrossRefPubMedPubMedCentral
43.
Heckley G, Gerdtham UG, Kjellsson G. A general method for decomposing the causes of socioeconomic inequality in health. J Health Econ. 2016;48:89–106.CrossRefPubMed
44.
Lai S, Shen C, Yang X, Zhang X, Xu Y, Li Q, Gao J, Zhou Z. Socioeconomic inequalities in the prevalence of chronic diseases and preventive care among adults aged 45 and older in Shaanxi Province, China. BMC Public Health. 2019;19:1460.CrossRefPubMedPubMedCentral
45.
Mutyambizi C, Booysen F, Stokes A, Pavlova M, Groot W. Lifestyle and socio-economic inequalities in diabetes prevalence in South Africa: a decomposition analysis. PLoS One. 2019;14:e0211208.CrossRefPubMedPubMedCentral
46.
Vusirikala A, Wekesah F, Kyobutungi C, Oyebode O. Assessment of cardiovascular risk in a slum population in Kenya: use of World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction charts - secondary analyses of a household survey. BMJ Open. 2019;9:e029304.CrossRefPubMedPubMedCentral
47.
Gomez-Olive FX, Ali SA, Made F, Kyobutungi C, Nonterah E, Micklesfield L, Alberts M, Boua R, Hazelhurst S, Debpuur C, et al. Regional and sex differences in the prevalence and awareness of hypertension: an H3Africa AWI-gen study across 6 sites in sub-Saharan Africa. Glob Heart. 2017;12:81–90.CrossRefPubMed
48.
Onyango MJ, Kombe I, Nyamongo DS, Mwangi M. A study to determine the prevalence and factors associated with hypertension among employees working at a call Centre Nairobi Kenya. Pan Afr Med J. 2017;27:178.CrossRefPubMedPubMedCentral
49.
Price AJ, Crampin AC, Amberbir A, Kayuni-chihana N, Musicha C, Tafatatha T, Branson K, Lawlor DA, Mwaiyeghele E, Nkhwazi L, et al. Prevalence of obesity , hypertension , and diabetes , and cascade of care in sub-Saharan Africa : a cross-sectional , population-based study in rural and urban Malawi. Lancet Diabetes Endocrinology. 2018;6:208–22.CrossRefPubMed
50.
51.
Steyn NP, Nel JH, Parker WA, Ayah R, Mbithe D. Dietary, social, and environmental determinants of obesity in Kenyan women. Scand J Public Health. 2011;39:88–97.CrossRefPubMed
52.
Onyango EM, Onyango BM. The rise of noncommunicable diseases in Kenya: an examination of the time trends and contribution of the changes in diet and physical inactivity. J Epidemiol Glob Health. 2018;8:1–7.CrossRefPubMedPubMedCentral
53.
Wang Z, Li C, Yang Z, Zou Z, Ma J. Infant exposure to Chinese famine increased the risk of hypertension in adulthood : results from the China health and retirement longitudinal study. BMC Public Health. 2016:1–11.
54.
Mackenzie HS, Uk M, Brenner BM. Fewer nephrons at birth : a missing link in the etiology of essential hypertension ? Am J Kidney Dis. 1995;26:91–6.CrossRefPubMed
55.
Gurusinghe S, Brown RD, Cai X, Samuel CS, Ricardo SD, Thomas MC, Kett MM. Does a nephron deficit exacerbate the renal and cardiovascular effects of obesity ? PLoS One. 2013;8.
56.
Rockers PC, Laing RO, Wirtz VJ. Equity in access to non-communicable disease medicines: a cross-sectional study in Kenya. BMJ Glob Health. 2018;3:e000828.CrossRefPubMedPubMedCentral
57.
Karinja M, Pillai G, Schlienger R, Tanner M, Ogutu B. Care-seeking dynamics among patients with diabetes mellitus and hypertension in selected rural settings in Kenya. Int J Environ Res Public Health. 2019;16.
58.
Song J-J, Ma Z, Wang J, Chen L-X, Zhong J-C. Gender Differences in Hypertension. J Cardiovasc Transl Res. 2020;13:47–54.CrossRefPubMed
59.
60.
Wekesah FM, Nyanjau L, Kibachio J, Mutua MK, Mohamed SF, Grobbee DE, Klipstein-Grobusch K, Ngaruiya C, Haregu TN, Asiki G, Kyobutungi CK. Individual and household level factors associated with presence of multiple non-communicable disease risk factors in Kenyan adults. BMC Public Health. 2018;18:1220.CrossRefPubMedPubMedCentral
61.
Mathenge W, Foster A, Kuper H. Urbanization, ethnicity and cardiovascular risk in a population in transition in Nakuru, Kenya: a population-based survey. BMC Public Health. 2010;10:569.CrossRefPubMedPubMedCentral
62.
Stiftung FE. Regional Disparities and Marginalization in Kenya. Nairobi: Elite PrePress; 2012.
63.
Mugo I. Nyeri's chronic disease burden. In Daily Nation. Nation Media Group: Nairobi, Kenya; 2018.
64.
Freiberg MAT, Onyango NO, Ashbaugh SJ, Mehta K. Chronic diseases in Nyeri, Kenya: a study of knowledge and perceptions. Healthcare in Low-Resource Settings. 2016;4.
65.
Belue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, Ogedegbe G. Globalization and health an overview of cardiovascular risk factor burden in sub-Saharan African countries : a socio-cultural perspective. BMC Globalization and Health. 2009;12:1–12.
66.
Hulzebosch A, van de Vijver S, Oti SO, Egondi T, Kyobutungi C. Profile of people with hypertension in Nairobi's slums: a descriptive study. Glob Health. 2015;11:26.CrossRef
67.
Mecha JO, Kubo EN, Odhiambo CO, Kinoti FG, Njau K, Yonga G, Ogola EN. Burden of prehypertension among adults in Kenya: a retrospective analysis of findings from the healthy heart Africa (HHA) Programme. BMC Public Health. 2020;20:281.CrossRefPubMedPubMedCentral
Metadata
Title
Socioeconomic inequalities in hypertension in Kenya: a decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors
Authors
Samwel Maina Gatimu
Thomas Wiswa John
Publication date
01-12-2020
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-020-01321-1

Other articles of this Issue 1/2020

International Journal for Equity in Health 1/2020 Go to the issue

Commentary

Who is going to pay the price of Covid-19? Reflections about an unequal Brazil

Review

State-society nexus in Brazil and Venezuela and its effect on participatory governance efforts in health and other sectors

Research

Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study

Commentary

Addressing the caste system in U.S. healthcare in the era of COVID-19

Research

Ethnicity recording in health and social care data collections in Ireland: where and how is it measured and what is it used for?

Research

To connect between worlds, to bridge over gaps: learning about the complex role of cultural mediators in perinatal health promotion from a case in Israel