Arterial hypertension and its covariates among nomadic Raute hunter-gatherers of Western Nepal: a mixed-method study

Objectives To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal. Design A mixed-method study. Setting The study was carried out at Raute temporary campsites in the Surkhet District of Karnali Province between May to September 2021. Participants The questionnaire-based survey included all males and non-pregnant females of the nomadic Raute group aged 15 years and above. In-depth interviews were conducted among purposively selected 15 Raute participants and four non-Raute key informants to help explain and enrich the quantitative findings. Outcome measures The prevalence of hypertension (defined as brachial artery blood pressure of systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg) and its socio-demographic, anthropometric, and behavioral covariates. Results Of the 85 eligible participants, 81 [median age 35 years (interquartile range: 26–51), 46.9% female] were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of men, and 30.9% of the total population. Current alcohol and tobacco use were high (91.4% and 70.4%, respectively), with concerning high rates among youths. Males, older people, current drinkers, and current tobacco users were more likely to have hypertension. Our qualitative analysis suggests that the traditional forest-based Raute economy is gradually transitioning into a cash-based one that heavily relies on government incentives. Consumption of commercial foods, drinks, and tobacco products is increasing as their market involvement grows. Conclusion This study found a high burden of hypertension, alcohol, and tobacco use among nomadic Raute hunter-gatherers facing socioeconomic and dietary transitions. Further research is needed to assess the long-term impact of these changes on their health. This study is expected to help appraise concerned policymakers of an emerging health concern and formulate context-specific and culturally sensitive interventions to limit hypertension-related morbidities and mortalities in this endangered population. Strengths and limitations of this study This is the first study to report the prevalence of hypertension and its covariates among the nomadic Raute hunter-gatherers of Nepal. The major strengths of this study are the use of a mixed-method design to have both quantitative and qualitative perspectives, near total population enrollment, and robust methodology. The cross-sectional design of this study limits its ability to establish causal relationships between the variables. Several important factors, such as dietary fruits and vegetable consumption, salt intake, and level of physical activities, as well as the presence of diabetes mellitus, dyslipidemia, or central obesity, were not assessed, preventing this study from determining the community’s actual cardiovascular disease risk. Interviews taken in language non-native (Nepali) to the Raute may be subject to language bias.