Prevalence, Awareness, and Factors Associated with Hypertension Among Adults in Rural Southwestern Uganda: A Baseline Survey

Grace Kansiime,1 Edwin Nuwagira,1 Paul Stephen Obwoya,1 Joseph Baruch Baluku,1,2 Michael Kanyesigye,3 Christine Twesiime,4 Peter Ssebutinde,4 Rose Muhindo,1 Anthony Muyingo,1 Keneth Kananura,5 Pliers Denis Tusingwire,6 Esther C Atukunda,7 Robert Kalyesubula,8 Francis Bajunirwe,9,* Anthony Muiru10,* 1Department of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda; 2Division of Pulmonology, Kiruddu National Referral Hospital, Kampala City, Uganda; 3Global Health Collaborative, Mbarara University of Science and Technology, Mbarara City, Uganda; 4Ministry of Health, Mbarara District Local Government, Mbarara City, Uganda; 5Department of Medicine, Mbarara Regional Referral Hospital, Mbarara City, Uganda; 6School of Medicine, Kabale University, Kabale City, Uganda; 7Department of Pharmacy, Mbarara University of Science and Technology, Mbarara City, Uganda; 8Department of Physiology and Department of Medicine, Makerere University College of Health Sciences, Kampala City, Uganda; 9Department of Community Health, Mbarara University of Science and Technology, Mbarara City, Uganda; 10School of Medicine, University of California, San Francisco City, CA, USA*These authors contributed equally to this workCorrespondence: Grace Kansiime, Department of Medicine, Mbarara University of Science and Technology, PO Box 1410, Mbarara City, Uganda, Tel +256774233498, Email [email protected]: Hypertension is the leading cause of preventable deaths globally. However, reports on its prevalence and risk factors in rural sub-Saharan Africa have been inconsistent, making targeted interventions challenging. This study examines the prevalence, awareness, and associated factors of hypertension among adults in a rural community in southwestern Uganda.Methods: We conducted a baseline survey in Ngango, Mbarara district, enrolling adults aged 18– 79 years from eleven villages. Research assistants and community health workers recruited participants from their homes using the WHO STEPS questionnaire, collecting data on demographics, lifestyle behaviors (tobacco and alcohol use, diet, and physical activity), and other risk factors. Blood pressure (BP) was measured three times, with hypertension defined as BP ≥ 140/90 mmHg or self-reported antihypertensive use. Logistic regression was applied to identify factors associated with hypertension.Results: A total of 953 adults were enrolled, with a median age of 43 years (IQR: 30– 57). Women accounted for 61.5%, and only 43.5% recalled ever having their blood pressure measured. Hypertension prevalence was 27.3%, with 61.5% of cases undiagnosed. Among those receiving treatment (27.7%), 65.3% had controlled blood pressure. Despite 66.8% of participants reporting regular physical activity, 63.7% were overweight. The key factors associated with hypertension included age over 40 years (OR: 2.26), consuming fewer than three servings of fruits or vegetables per week (OR: 1.62), and being overweight (OR: 1.57) or obese (OR: 2.73).Conclusion: Hypertension is highly prevalent in rural southwestern Uganda, underscoring the need for targeted interventions—especially within a relatively young and physically active population.Plain language Summary: Hypertension (high blood pressure) is a leading cause of preventable deaths worldwide. However, data on its impact and risk factors in rural sub-Saharan Africa remain inconsistent, making targeted interventions challenging. This study examines the prevalence, awareness, and associated factors of hypertension in a rural community in southwestern Uganda. We conducted a community-based survey across all eleven villages of Ngango Parish, Mbarara District, enrolling adults aged 18– 79 years. Research assistants and community health workers collected demographic data (age, sex), behavioral factors (smoking and alcohol consumption), and lifestyle characteristics (diet and physical activity) through household visits. Blood pressure was measured three times while participants were seated comfortably. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported use of antihypertensive medication. We performed statistical analysis to identify factors associated with hypertension.Results: We enrolled 953 participants with a median age of 43 years. Women constituted the majority (61.5%). Hypertension was present in 27.3% of individuals, yet awareness was low—only 38.5% knew they had the condition, and just 27.7% were receiving treatment. Despite 66.8% of participants reporting good physical activity, more than half (63.7%) were overweight (BMI > 25 kg/m²).Key factors associated with hypertension included age over 40 years, consuming fewer than three servings of fruits or vegetables per week, and being overweight or obese.We conclude that hypertension is common in rural southwestern Uganda, affecting even younger and physically active individuals. This highlights the urgent need for targeted health interventions to address hypertension in these communities.Keywords: blood pressure, cardiovascular disease, hypertension, rural Uganda, Sub-Saharan Africa