Prevalence and determinants of hypertension among pastoralists in Monduli District, Arusha region in Tanzania: a cross-sectional study
Authors: Khamis Ahmed Gharib , Senkoro Mbazi , Mwanri Akwilina Wendelin , Kreppel Katharina , Mfinanga Sayoki Godfrey , Bonfoh Bassirou , Kwesigabo Gideon 
Published: October 2020

Abstract
Background
Hypertension is among the growing non-communicable diseases (NCDs) in developing countries and the leading cause of death worldwide. Pastoral areas have been identified to be at a higher risk of diseases due to challenges in their daily food production, livelihoods or mobility. Unfortunately, the prevalence of hypertension and the risk factors particularly affecting rural and pastoral populations are not fully understood, making intervention efforts challenging. The aim of this study was to determine the prevalence of hypertension and identify the risk factors among adults living in Monduli district in Tanzania. The findings will be useful for the provision of tailored interventions focused on community-specific nutritional and behavioral practices.

Methods
We conducted a community based cross-sectional study involving a sample of 510 adults aged above 18 years selected using a multistage cluster sampling in the Monduli district of Arusha region, Tanzania. Data were collected by using interviewer-administered questionnaires containing socio-demographic, physical activity, smoking and alcohol consumption. Anthropometry, systolic (SBP) and diastolic blood pressure (DBP) levels were measured. A one-day 24 h diet recall was conducted to evaluate the dietary habits of all participants. Both linear and logistic regression analysis were used to identify the independent predictors for hypertension and blood pressure levels.

Results
The prevalence of hypertension in this study was 25.7% (n = 131, 95% CI; 22.1–29.7). The odds of hypertension increased with being male (AOR = 1.75, 95%CI, 1.06–2.88), belonging to the older age group of 30–39 year olds (AOR = 3.3, 95%CI, 1.76–6.38), 40–59 year olds (AOR = 3.34, 95%CI, 1.75–6.37) and ≥ 60 year olds (AOR = 4.2, 95%CI, 2.02–8.87), being overweight or obese (AOR = 3.37, 95%CI, 1.18–9.62), have more hours spent sedentary (AOR = 3.19, 95%CI, 1.61–6.32), and consumption of fatty foods (AOR = 2.23, 95%CI, 1.27–3.93). The odds for hypertension was significantly reduced among participants who reported higher income (AOR = 0.47, 95% CI, 0.25–0.91), high level of physical activity (AOR = 0.55, 95%CI, 0.31–0.96) and those reported to consume fruit (AOR = 0.37, 95% CI, 0.18–0.77). Consumption of cereals was negatively associated with levels of SBP (β = − 17.4, 95% CI, − 23.8; − 11.0) and DBP (β = − 6.6, 95% CI, − 11.5,-1.79).

Conclusion
About one in every four adults living in pastoral communities have been found to have hypertension in this study. Our findings suggest that older age, obesity or overweight, low physical activity, low income, and consumption of fatty foods increase the risk of hypertension among study population. Their diet was dominated by cereals with moderate intake of meat and milk and low fruits. There is a need to promote physical activities and consumption of fruits in the study population in order to fight against hypertension. Further research should be done to confirm the associations.