25 / 42
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 17 NUMBER 1 • JULY 2020
23
Prevalence of hypertension and selected cardiovascular
risk factors among adolescents in selected rural and
urban secondary schools in Botswana
MATSHIDISO MOKGWATHI, JULIUS CHACHA MWITA
Correspondence to: Julius Chacha Mwita
Department of Internal Medicine, Faculty of Medicine, University of
Botswana; Department of Internal Medicine, Princess Marina Hospital,
Gaborone, Botswana
e-mail:
jmwita@gmail.comMatshidiso Mokgwathi
Department of Internal Medicine, Faculty of Medicine, University of
Botswana; Department of Internal Medicine, Princess Marina Hospital,
Gaborone, Botswana
Previously published in
Cardiovasc J Afr
2020;
31
: 142–146
S Afr J Diabetes Vasc Dis
2020;
17
: 23–28
Abstract
Background:
Adolescent hypertension and other cardio-
vascular risk factors tend to track into adulthood.
Consequently, there is a need to determine the prevalence
of hypertension and pre-hypertension, and its co-existence
with glycaemia, obesity, tobacco and alcohol use among
senior secondary school students in Botswana.
Methods:
A cross-sectional study was undertaken between
December 2015 and March 2016 among students in selected
rural and urban senior secondary schools in Botswana. Data
were collected through a self-administered questionnaire,
measurements and fasting blood glucose testing. Participants
were asked about cigarette smoking, alcohol use and levels
of physical activity. Bodyweight, height, waist circumference,
blood pressure and fasting blood glucose levels were
measured. Hypertension, pre-hypertension, overweight and
obesity were defined based on gender, age and height from
normative tables.
Results:
A total of 252 students with a mean age (standard
deviation) of 17.1 (0.9) years participated in the study.
Rural students were older than urban students (17.5 vs
16.7 years;
p
< 0.001). The prevalence of hypertension and
prehypertension were 13.1 and 15.5%, respectively. Physical
inactivity (37.7%), overweight/obesity (10.3%) and alcohol
intake (9.1%) were also prevalent. Cigarette smoking was
rare (2.0%). Impaired fasting glucose levels were found
in 1.6% of participants, and none had diabetes mellitus.
Hypertension (
p
< 0.001) and cigarette smoking (
p
= 0.019)
were more prevalent among male than female participants.
Female students were more likely to be overweight or obese
than male students (
p
< 0.001). There were no urban–rural
differences in hypertension, pre-hypertension and smoking.
Urban students were more likely to drink alcohol than rural
students (
p
= 0.008).
Conclusion:
Hypertension, overweight/obesity and alcohol
intake were common among these adolescents in Botswana.
Strategies to reduce the risk factors of cardiovascular
diseases should be urgently developed and implemented
to prevent cardiovascular disease-related morbidity and
mortality in the future.
Keywords:
hypertension, cardiovascular risk factors, adolescents,
Botswana
Demographic and epidemiological changes in sub-Saharan Africa
(SSA) have resulted in an increase in non-communicable diseases,
including hypertension, leading to concerns and activities to
reduce rising rates.
1-4
In children and adolescents, hypertension is
often underdiagnosed and may progress into adulthood.
5-8
The
prevalence of hypertension among children in developed countries
is 1–5%.
9
By contrast, the prevalence of hypertension in SSA
paediatric populations is 0–12.5 and 0–21.5% for boys and girls,
respectively.
10
Hypertension is usually found in constellation with obesity,
smoking, alcohol intake and physical inactivity.
10
All these may track
from childhood to adulthood and are predictive of cardiovascular
risk later in adult life.
10
The prevalence of all the above risk factors
has been increasing among children, mainly as a consequence of
urbanisation and changes in lifestyle.
11-13
Urbanisation has led to an
increase in the use of tobacco and alcohol, poor diet and physical
inactivity.
14-16
For a country with a high burden of HIV/AIDS, the increase in non-
communicable diseases, including cardiovascular disease (CVD) and
diabetes, poses a challenge for health policymakers and providers
to the already stretched health system and progress towards the
development of millennium goals.
17-19
This is particularly important
in Botswana with its high rate of HIV/AIDS, alongside the wish to
maintain universal healthcare.
There is evidence that early identification and modification
of risk factors during childhood decreases the occurrence and
magnitude of associated complications due to CVD.
10,20
However,
data on the burden of hypertension and other cardiovascular
risk factors among adolescents in Botswana are currently scarce.
Consequently, the objective of this study was to determine the
prevalence of hypertension and co-existing selected cardiovascular
risk factors among secondary school students in Botswana and to
use the findings, if pertinent, to guide future strategies in Botswana.
Methods
This cross-sectional study was conducted from December 2015 to
March 2016 among students in the rural Shakawe senior secondary
school and the urban St Joseph’s College in Botswana. Shakawe is