Magnitude, trend, and pattern of hypertension among adults aged 15 and above -Dire Dawa, Ethiopia.

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Dagmawi Abebe Ayele, Hirbo Shore, Biruk Teklu, Teshome Ayalew This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8999334/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hypertension is a significant public health issue globally, recognized as a primary modifiable risk factor for cardiovascular, cerebrovascular, and end-stage renal diseases. However, there is limited knowledge regarding hypertension trends. This study aimed to analyze five years of secondary data to assess the magnitude, trend, and pattern of hypertension in Dire Dawa, Ehiopia. Method A descriptive cross-sectional study was conducted from November 25 to December 30, 2020. Data were sourced from Health Management Information System (HMIS) and District Health Information System 2 (DHIS2) reports covering the years 2015 to 2019. Completeness of data was ensured by reviewing all elements, while consistency was verified by comparing reports from health facilities with the regional health bureau database. Data were analyzed using Microsoft Excel 2013, with cleaning processes in place to correct errors and remove duplicates. Percentages, rates, and ratios were used to present the data in tables and graphs. Results A total of 30,623 cases of hypertension were reported between 2015 and 2019, indicating a prevalence of 3.7% among adults aged 15 years and older. Of these cases, 97.5% were urban residents. The prevalence among females was higher (359 per 10,000), compared to males (285 per 10,000). Notably, the prevalence trend increased from 2.2% in 2015 to 3.7% in 2019. The death-to-case ratio was recorded at 17 per 10,000. Conclusion The prevalence of hypertension in this report is notably low compared to previous studies. The data shows a higher prevalence among females and in urban areas. These findings underscore the need for enhanced screening and routine assessments in health facilities, alongside regular monitoring for hypertension. Promoting community interventions that encourage healthier eating and increased physical activity is essential for prevention. Finally, developing systems for early detection and comprehensive treatment of hypertension, especially targeting urban populations and women at higher risk, is vital for improving health outcomes. Infectious Diseases Hypertension Magnitude Pattern Trend Dire Dawa Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 INTRODUCTION Hypertension is an important public health problem worldwide and is the most widely recognized modifiable risk factor for cardiovascular disease, cerebrovascular disease, and end-stage renal disease (Forouzanfar et al., 2017 , Subbiah A.K., 2016). It is a leading modifiable risk factor for non-communicable disease (NCD) and mortality. Hypertension is a quiet public health challenge worldwide and is a major modifiable risk factor for non-communicable disease (NCD) and mortality (Ciccozzi et al., 2018, Bayray et al., 2018). The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of the increase due to population growth, change in lifestyle, and aging. (Zhou et al., 2017 ). The prevalence of hypertension is declining in high-income and some middle-income countries; It has not changed elsewhere. During the past four decades, the world's highest blood pressure levels have shifted from high-income countries to low-income countries. (Zhou et al., 2017 ) In Africa, the burden of communicable diseases is fast shifting towards chronic non-communicable diseases.over the past 2 to 3 decades, the magnitude of hypertension among adults has increased significantly (de et al., 2013 ). In Ethiopia, hypertension has emerged as a common public health problem, with studies indicating that prevalence increases with age (Bekele et al., 2018 ). Despite the evidence of rising hypertension rates, there is a lack of published data regarding prevalence trends in Dire Dawa. Therefore, this study aims to describe the magnitude, trend, and pattern of hypertension by analyzing five years of secondary data from the region. METHODS STUDY AREA AND PERIOD The study was conducted in Dire Dawa Administration, located in eastern Ethiopia, approximately 515 km from Addis Ababa. As of 2019/20, the total population was estimated at 506,639, with 68% urban and 32% rural residents. Dire Dawa comprises the city and surrounding rural areas, which include 9 urban kebeles and 38 rural associations. Healthcare facilities consist of two public hospitals, 15 health centers, and 36 health posts. The study was conducted from November 25 to December 30, 2020. STUDY DESIGN Descriptive cross-sectional study. DATA SOURCE Data were sourced from HMIS and DHIS2 disease reports from health facilities and the regional health bureau covering the period from 2015 to 2019. HMIS classified diseases as hypertension and related conditions, while DHIS2 included classifications for essential hypertension (I10-619), secondary hypertension (I10-621), unspecified secondary hypertension (I10-624), other secondary hypertension (I10-623), renal vascular hypertension (I10-622), and unspecified maternal hypertension (O10-1230). The DHIS2 classifications were merged and summarized with HMIS diagnoses for easier analysis. OPERATIONAL DEFINITION Hypertension : persistent Blood Pressure measurements of ≥ 140 mmHg for systolic blood pressure (SBP) and/or ≥ 90 mmHg for diastolic blood pressure (DBP) of at least three readings taken at different times or individuals currently undergoing treatment for hypertension. The number of reported hypertension cases were used for numenator, while the total number of all reported cases during the same period was used as the denominator to calculate prevalence. DATA QUALITY CONTROL Data were reviewed to identify missing values, ensuring all required elements were fully completed. Consistency was verified by comparing reported values between health facility reports and the regional health bureau database, confirming alignment between the two sources. DATA ANALYSIS Data were entered into a computer and analyzed using Microsoft Excel 2013. Data cleaning was performed to correct errors and remove duplicates. The analysis focused on time, place, and personal characteristics, with the magnitude and trends described using ratios, percentages, and proportions. Results were summarized using tables and graphs. ETHICAL CONSIDERATION Prior to conducting the study, formal permission was obtained from the Dire Dawa Regional Health Bureau, granting access to data from all health institutions and the Regional Health Bureau's Plan and Program Department. The study adhered to ethical guidelines to ensure the confidentiality and anonymity of patient data. All data used were aggregated and anonymized to protect individual identities. Since the study relied solely on secondary data, there was no direct human involvement, and no informed consent was required for participation. However, institutional consent for the use of this data was obtained from the Regional Health Bureau. RESULT A total of 30,623 hypertension cases were reported from 2015 to 2019. As showen in Table 1 , females constituted the larger proportion of hypertension cases (55.9%), compared to males (44.1%). The vast majority of patients (97.5%) were urban residents, and all cases were reported among individuals aged ≥ 15 years. Table 1 Demographic characteristics of hypertensive patients in Dire Dawa from 2015 to 2019. Characteristics Category Frequency Percent Age >=15 years 30623 100% Sex Male 13608 44.1% Female 17203 55.9% Place of residence Urban 30007 97.5% Rural 804 2.5% Distribution of hypertension by Personal characteristic Figure 1 demonstrates that hypertension disproportionately affects females compared to males, with a prevalence of 359 per 10,000 among females and 285 per 10,000 among males. Distribution of hypertension cases by place As shown in Fig. 2 , out of the total 30,623 reported hypertension cases from 2015 to 2019, the highest proportion was found in urban settings, with 29,866 cases (97.5%), compared to 757 cases (2.5%) in rural areas. Table 2 shows that Dilchora Hospital reported the highest number of hypertension cases, totaling 11,940 (39%), while Addis Ketema operational woreda reported the lowest number at 777 (2.5%) from urban settings. In rural settings, Melka Jebdu operational woreda had the highest number of cases with 708 (2.3%), whereas Wahil operational woreda reported the lowest at 13 (0.04%) during the reporting period from 2015 to 2019. Name of Hospitals and Operational Woredas Number of Cases Percent Dilchora Hospital 11940 39% Sabiyan Hospital 6135 20% Legehare 4546 14.8% Gendekore 3463 11.3% Diredawa (Nemberwan) 3005 9.8% Addis Ketema 777 2.5% Melka Jebdu 708 2.3% Biyoawale 14 0.05% Jeldesa 22 0.07% Wahil 13 0.04% Total 30623 100% Table 2 : Distribution of hypertension cases by reporting facilities in Dire Dawa from 2015 to 2019. Figure 3 shows that the highest proportion of hypertension cases were reported from outpatient departments (OPD) at 98.6%, compared to inpatient departments (IPD), which accounted for 14% during the period from 2015 to 2019. Figure 4 shows that a higher proportion of hypertension cases (63.4%) were reported among public health facilities compared to private health facilities, which accounted for 36.6% over the five-year period from 2015 to 2019. Figure 5 shows that among all types of admissions, hypertension accounted for 6% in 2016, while a proportion of 0.6% was recorded in 2019. The trend indicates a decreasing pattern in the proportion of hypertension among total admissions from 2016 to 2019. Distribution of hypertension cases by time. Figure 6 shows an increase in hypertension cases over the period from 2015 to 2019. The highest number of cases was observed in 2017, while the lowest number occurred in 2015. Figure 7 shows an increase in the number of hypertension cases among both males and females over the years, with hypertension consistently being higher among females than males across all years. Table 3 shows that the overall death-to-case ratio was 17 per 10,000 between 2015 and 2019. The highest ratio was observed in 2017 at 25.4 per 10,000, while the lowest was recorded in 2015 at 6.2 per 10,000. Table 3 Hypertension death to case ratio per 10,000 cases in Dire Dawa from 2015 to 2019. Year No of deaths No of cases Death to case ratio per 10,000 cases 2015 1 1611 6.2 2016 4 2666 15 2017 15 5914 25.4 2018 10 9846 10.2 2019 22 10586 20.8 Total 52 30623 17 DISCUSSION The aim of this study was to describe the magnitude, trend and pattern of hypertension using five year secondary data. Accordingly, this study found that the overall prevalence of hypertension among adult was 3.7% in the period between 2015 and 2019. The prevalence of hypertension in this report is lower when compared to previous studies conducted in Ginbi (9.3%), Sidama zone (9.9%), North West Tanzania (8%), and Saudi Arabia (6%).(Zeleke, 2017 , Araya Giday, 2008, Neema R. Mosha, 2017, Aldiab et al., 2018 ) Moreover, the prevalence of hypertension in this study is significantly lower than that reported from the study in Awasa (12.3%), Kenya (12.6%), Addis Ababa(14.0%), India (11.3%),Bahirdar (25.1%), Canada (19%), Sweden (20%), China (23.2%) and Ghana (28.1%). (Wachamo et al., 2019, Mark David Joshi1*, 2014, AGAMA, 2017 , Ghosh and Kumar, 2019 , Anteneh et al., 2015, Joffres et al., 2013 , ULF LINDBLAD 1, 2012, Wang et al., 2018b, Dosoo et al., 2019 ). This is likely due to low coverage of hypertension screening in the majority of health facilities. Conversely, the prevalence in this study is higher than that reported in Nigeria (2.1%) (Akinlua et al., 2015 ). This discrepancy could be attributed to differences in demographic factors, healthcare access, lifestyle habits, and methodologies used in those studies. This study found a higher prevalence of hypertension among female patients compared to males, aligning with findings from studies conducted in Brazil, India, Senegal, Kombolcha, Bedele, Arbaminch, Cameroon and Bangladeshi (Malta et al., 2017 , Ingale and Dixit, 2017 , Pessinaba et al., 2013 , Abate, 2017 , Bonsa et al., 2014, Kebede et al., 2020 , Mbouemboue and Ngoufack, 2019 , Al Kibria et al., 2019 ). However, contrary findings were noted in studies from Addis Ababa, Hosanna, Assosa, Mizan Aman, France, Sudan, Zambia and Sidama, where males exhibited higher prevalence rates (Senbeta Guteta Abdissa1, 2014, Dereje et al., 2020 , Gadisa*, 2018 , Mohammed Muze Edris et al., 2018, Lola Neufcourt1*, 2020, Saeed M. Omar1, 2018 , Fastone M Goma1, 2011, Badego et al., 2020 ). This inconsistency may arise from differences in socio-economic status and access to healthcare resources between genders across various regions. The study found that hypertension prevalence was higher in urban areas compared to rural settings, consistent with previous studies from Ethiopia, Bahirdar, Dabat, Tanzania, Nigeria, Uganda, Madagascar and Jima (Legese and Tadiwos, 2020 , Tesfaye et al., 2019 , Li et al., 2015 , Neema R. Mosha, 2017, Adediran Olufemi Sola1, 2013, Guwatudde et al., 2015 , Ratovoson et al., 2015 , Gudina et al., 2013). In contrast, studies in China, Turkey, and Malaysia reported a higher prevalence in rural areas (Wang et al., 2018a , Dastan et al., 2017 , Abdul-Razak et al., 2016 ) This study observed that the prevalence of hypertension increased with age, a finding supported by research done in Dire Dawa, Addis Ababa, Arbaminch, Debremarkos, Chiro,United States, Canada, Korea, Sudan, Senegal, Malaysia and Ghana (Malta et al., 2017 , Roba et al., 2019 , DeGuire et al., 2019 , The Korean Society Hypertension (KSH), 2018, Awadalla et al., 2018 , Duboz et al., 2014 , Ab Majid et al., 2018 , Dosoo et al., 2019 ). This trend is expected, as age is a known risk factor for hypertension due to physiological changes in blood vessels and overall health. Furthermore, the study indicated a consistent increase in hypertension prevalence over the years, suggesting an urgent need for public health interventions to address this growing concern. This study has limitations that should be acknowledged. First, it relied on health institution reports, which may limit the generalizability of the findings to the broader community. Additionally, there was no prior analysis of secondary data in the same area to serve as a baseline or comparative resource, which further restricts the contextual understanding of the findings. CONCLUSION The prevalence of hypertension in this report is notably low compared to previous studies. The data shows a higher prevalence among females and in urban areas. These findings underscore the need for enhanced screening and routine assessments in health facilities, alongside regular monitoring for hypertension. Promoting community interventions that encourage healthier eating and increased physical activity is essential for prevention. Finally, developing systems for early detection and comprehensive treatment of hypertension, especially targeting urban populations and women at higher risk, is vital for improving health outcomes. Abbreviations DBP: Diastolic blood pressure, DHIS: District Health Information System, HMIS: Health Management Information System, NCD: Non-communicable disease. SBP: Systolic blood pressure. Declarations FUNDING No funding was received for this study COMPETING OF INTEREST: The authors declare no competing conflicts of interest. ETHICS APPROVAL AND CONSENT TO PARTICIPATE Prior to conducting the study, formal permission was obtained from the Dire Dawa Regional Health Bureau, granting access to data. The study followed ethical guidelines to ensure confidentiality and anonymity, with all data aggregated and anonymized. As the study used secondary data, no human involvement or informed consent was required for participation. However, institutional consent for the use of this data was obtained from the Regional Health Bureau. AVAILABILITY OF DATA AND MATERIALS The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. AUTHORS’ CONTRIBUTIONS DA developed the proposal, conducted data analysis, wrote the results, and made significant contributions to the manuscript. HS, BT, and TA participated in the critical review of the study, reviewed and approved the final manuscript, and agreed to submit the current manuscript. CONSENT FOR PUBLICATION Not applicable. ACKNOWLEDGEMENT I would like to express my heartfelt gratitude to my mentors Hirbo Shore, Daniel Teshome, and Teshome Ayalew for their invaluable comments. I appreciate Lema Bogale for sharing updated materials and thank the FMoH, CDC, and EFETP for their guidance and support. Special thanks to the Dire Dawa Regional Health Bureau's staff for their cooperation and to Biruk Teklu for his encouragement. References AB MAJID, N. L., OMAR, M. A., KHOO, Y. Y., MAHADIR NAIDU, B., LING MIAW YN, J., RODZLAN HASANI, W. S., MAT RIFIN, H., ABD HAMID, H. A., ROBERT LOURDES, T. G. & MOHD YUSOFF, M. F. 2018. 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J., SINGH, G., HAJIFATHALIAN, K. & BENNETT, J. E. 2017. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19· 1 million participants. The Lancet, 389 , 37-55. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8999334","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":598707514,"identity":"9641549d-905a-41fc-bf5c-c49f88ecdfb6","order_by":0,"name":"Dagmawi Abebe Ayele","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYDCCAxAkx8/eAOQZWBCvxViy5wBIiwRxWkBk4oYbCSAGEVr4jh+/eOhGzZ3EDTefX93wo0CCgb+9OwGvFskzOQWHc449M555O6fsZg/QYRJnzm7Aq8XgQE7C4Ry2w7J9t3PSbvAAtRhI5BLQcv4NUMu/w4wNN8+k3fxDlJYb6QcO57YdVpxwg/3YbaJskbzxhuFwbt8zYCDnsN2WMZDgIegXvvPpjz/nfLsDjMrjz26++WMjx9/ei18LAwOPAQqDh4ByEGB/gM4YBaNgFIyCUYAKAMNvWK+St/5GAAAAAElFTkSuQmCC","orcid":"","institution":"DDAHB","correspondingAuthor":true,"prefix":"","firstName":"Dagmawi","middleName":"Abebe","lastName":"Ayele","suffix":""},{"id":598707555,"identity":"dc7c597d-79d8-411c-aa1c-bc15a3f71ef5","order_by":1,"name":"Hirbo Shore","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Hirbo","middleName":"","lastName":"Shore","suffix":""},{"id":598708786,"identity":"1c3a08c4-060d-4fe8-8f75-f7d9ecb7b9e1","order_by":2,"name":"Biruk Teklu","email":"","orcid":"","institution":"Dilchora Hospital","correspondingAuthor":false,"prefix":"","firstName":"Biruk","middleName":"","lastName":"Teklu","suffix":""},{"id":598708787,"identity":"f66340e0-5c3e-4105-ba9b-66b5a81b8d59","order_by":3,"name":"Teshome Ayalew","email":"","orcid":"","institution":"RTSL","correspondingAuthor":false,"prefix":"","firstName":"Teshome","middleName":"","lastName":"Ayalew","suffix":""}],"badges":[],"createdAt":"2026-03-01 05:23:28","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-8999334/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8999334/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104177456,"identity":"f5a913b8-e221-442c-8cb2-82baa666d735","added_by":"auto","created_at":"2026-03-08 16:46:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66363,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of hypertension by Sex per 10,000 population in Dire Dawa from 2015 to 2019.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/93f707e8a567a574a974f086.png"},{"id":104404584,"identity":"33be729f-e6aa-4786-8a4c-f289005aca76","added_by":"auto","created_at":"2026-03-11 12:20:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28483,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of hypertension cases by Place of residence in Dire Dawa from 2015 to 2019.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/103438887a5de9a08b11ebad.png"},{"id":104405040,"identity":"b659f356-499c-4959-9f5b-7ccb5c2c5016","added_by":"auto","created_at":"2026-03-11 12:21:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":22033,"visible":true,"origin":"","legend":"\u003cp\u003eProportion hypertension cases by service unit in Dire Dawa from 2015 to 2019.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/637b939c3d4d51044f9cc347.png"},{"id":104177457,"identity":"6be610f4-d059-4809-a4da-593f455c959d","added_by":"auto","created_at":"2026-03-08 16:46:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":27764,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of hypertension cases among public and private health facilities in Dire Dawa from 2015 to 2019.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/72ef9e92f585004d03b89458.png"},{"id":104177452,"identity":"7dc3d178-b9bb-46c8-9388-98c53efff9fe","added_by":"auto","created_at":"2026-03-08 16:46:06","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":25391,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of hypertension admitted cases among total admission in Dire Dawa from 2015 to 2019.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/13d2c86001a8aa92e83f1d1e.png"},{"id":104177454,"identity":"95ef5fb2-fcb8-4943-915f-2acec039fea4","added_by":"auto","created_at":"2026-03-08 16:46:06","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":36624,"visible":true,"origin":"","legend":"\u003cp\u003eTrend of hypertension Cases in Dire Dawa from 2015 to 2019.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/05983a1819e9d3f887f92f96.png"},{"id":104177455,"identity":"52a36c42-753c-4d07-84ee-68984e520998","added_by":"auto","created_at":"2026-03-08 16:46:06","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":30656,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of hypertension cases by Sex and year per 10,000 population in Dire Dawa from 2015 to 2019.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/1738276c49718314b612cf80.png"},{"id":104409123,"identity":"4852ee3d-ee3e-43c9-9612-f29660f305a9","added_by":"auto","created_at":"2026-03-11 12:44:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":841460,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8999334/v1/73137738-435f-4e3c-9228-4d436a9bf421.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eMagnitude, trend, and pattern of hypertension among adults aged 15 and above -Dire Dawa, Ethiopia.\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHypertension is an important public health problem worldwide and is the most widely recognized modifiable risk factor for cardiovascular disease, cerebrovascular disease, and end-stage renal disease (Forouzanfar et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Subbiah A.K., 2016). It is a leading modifiable risk factor for non-communicable disease (NCD) and mortality. Hypertension is a quiet public health challenge worldwide and is a major modifiable risk factor for non-communicable disease (NCD) and mortality (Ciccozzi et al., 2018, Bayray et al., 2018).\u003c/p\u003e \u003cp\u003eThe number of adults with raised blood pressure increased from 594\u0026nbsp;million in 1975 to 1\u0026middot;13\u0026nbsp;billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of the increase due to population growth, change in lifestyle, and aging. (Zhou et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of hypertension is declining in high-income and some middle-income countries; It has not changed elsewhere. During the past four decades, the world's highest blood pressure levels have shifted from high-income countries to low-income countries. (Zhou et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn Africa, the burden of communicable diseases is fast shifting towards chronic non-communicable diseases.over the past 2 to 3 decades, the magnitude of hypertension among adults has increased significantly (de et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In Ethiopia, hypertension has emerged as a common public health problem, with studies indicating that prevalence increases with age (Bekele et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the evidence of rising hypertension rates, there is a lack of published data regarding prevalence trends in Dire Dawa. Therefore, this study aims to describe the magnitude, trend, and pattern of hypertension by analyzing five years of secondary data from the region.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSTUDY AREA AND PERIOD\u003c/h2\u003e \u003cp\u003eThe study was conducted in Dire Dawa Administration, located in eastern Ethiopia, approximately 515 km from Addis Ababa. As of 2019/20, the total population was estimated at 506,639, with 68% urban and 32% rural residents. Dire Dawa comprises the city and surrounding rural areas, which include 9 urban kebeles and 38 rural associations. Healthcare facilities consist of two public hospitals, 15 health centers, and 36 health posts. The study was conducted from November 25 to December 30, 2020.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSTUDY DESIGN\u003c/h3\u003e\n\u003cp\u003eDescriptive cross-sectional study.\u003c/p\u003e\n\u003ch3\u003eDATA SOURCE\u003c/h3\u003e\n\u003cp\u003eData were sourced from HMIS and DHIS2 disease reports from health facilities and the regional health bureau covering the period from 2015 to 2019. HMIS classified diseases as hypertension and related conditions, while DHIS2 included classifications for essential hypertension (I10-619), secondary hypertension (I10-621), unspecified secondary hypertension (I10-624), other secondary hypertension (I10-623), renal vascular hypertension (I10-622), and unspecified maternal hypertension (O10-1230). The DHIS2 classifications were merged and summarized with HMIS diagnoses for easier analysis.\u003c/p\u003e\n\u003ch3\u003eOPERATIONAL DEFINITION\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eHypertension\u003c/b\u003e: persistent Blood Pressure measurements of \u0026ge;\u0026thinsp;140 mmHg for systolic blood pressure (SBP) and/or \u0026ge;\u0026thinsp;90 mmHg for diastolic blood pressure (DBP) of at least three readings taken at different times or individuals currently undergoing treatment for hypertension. The number of reported hypertension cases were used for numenator, while the total number of all reported cases during the same period was used as the denominator to calculate prevalence.\u003c/p\u003e\n\u003ch3\u003eDATA QUALITY CONTROL\u003c/h3\u003e\n\u003cp\u003eData were reviewed to identify missing values, ensuring all required elements were fully completed. Consistency was verified by comparing reported values between health facility reports and the regional health bureau database, confirming alignment between the two sources.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDATA ANALYSIS\u003c/h2\u003e \u003cp\u003eData were entered into a computer and analyzed using Microsoft Excel 2013. Data cleaning was performed to correct errors and remove duplicates. The analysis focused on time, place, and personal characteristics, with the magnitude and trends described using ratios, percentages, and proportions. Results were summarized using tables and graphs.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eETHICAL CONSIDERATION\u003c/h3\u003e\n\u003cp\u003ePrior to conducting the study, formal permission was obtained from the Dire Dawa Regional Health Bureau, granting access to data from all health institutions and the Regional Health Bureau's Plan and Program Department. The study adhered to ethical guidelines to ensure the confidentiality and anonymity of patient data. All data used were aggregated and anonymized to protect individual identities. Since the study relied solely on secondary data, there was no direct human involvement, and no informed consent was required for participation. However, institutional consent for the use of this data was obtained from the Regional Health Bureau.\u003c/p\u003e"},{"header":"RESULT","content":"\u003cp\u003eA total of 30,623 hypertension cases were reported from 2015 to 2019. \u003cb\u003eAs showen in\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, females constituted the larger proportion of hypertension cases (55.9%), compared to males (44.1%). The vast majority of patients (97.5%) were urban residents, and all cases were reported among individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;15 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of hypertensive patients in Dire Dawa from 2015 to 2019.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics Category Frequency Percent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=15 years 30623 100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale 13608 44.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale 17203 55.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban 30007 97.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural 804 2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDistribution of hypertension by Personal characteristic\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates that hypertension disproportionately affects females compared to males, with a prevalence of 359 per 10,000 among females and 285 per 10,000 among males.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDistribution of hypertension cases by place\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, out of the total 30,623 reported hypertension cases from 2015 to 2019, the highest proportion was found in urban settings, with 29,866 cases (97.5%), compared to 757 cases (2.5%) in rural areas.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshows that Dilchora Hospital reported the highest number of hypertension cases, totaling 11,940 (39%), while Addis Ketema operational woreda reported the lowest number at 777 (2.5%) from urban settings. In rural settings, Melka Jebdu operational woreda had the highest number of cases with 708 (2.3%), whereas Wahil operational woreda reported the lowest at 13 (0.04%) during the reporting period from 2015 to 2019.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName of Hospitals and Operational Woredas\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilchora Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSabiyan Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLegehare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGendekore\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiredawa (Nemberwan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAddis Ketema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMelka Jebdu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiyoawale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJeldesa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWahil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Distribution of hypertension cases by reporting facilities in Dire Dawa from 2015 to 2019.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the highest proportion of hypertension cases were reported from outpatient departments (OPD) at 98.6%, compared to inpatient departments (IPD), which accounted for 14% during the period from 2015 to 2019.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that a higher proportion of hypertension cases (63.4%) were reported among public health facilities compared to private health facilities, which accounted for 36.6% over the five-year period from 2015 to 2019.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows that among all types of admissions, hypertension accounted for 6% in 2016, while a proportion of 0.6% was recorded in 2019. The trend indicates a decreasing pattern in the proportion of hypertension among total admissions from 2016 to 2019.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDistribution of hypertension cases by time.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows an increase in hypertension cases over the period from 2015 to 2019. The highest number of cases was observed in 2017, while the lowest number occurred in 2015.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e shows an increase in the number of hypertension cases among both males and females over the years, with hypertension consistently being higher among females than males across all years.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the overall death-to-case ratio was 17 per 10,000 between 2015 and 2019. The highest ratio was observed in 2017 at 25.4 per 10,000, while the lowest was recorded in 2015 at 6.2 per 10,000.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHypertension death to case ratio per 10,000 cases in Dire Dawa from 2015 to 2019.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo of deaths\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDeath to case ratio per 10,000 cases\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe aim of this study was to describe the magnitude, trend and pattern of hypertension using five year secondary data. Accordingly, this study found that the overall prevalence of hypertension among adult was 3.7% in the period between 2015 and 2019.\u003c/p\u003e \u003cp\u003eThe prevalence of hypertension in this report is lower when compared to previous studies conducted in Ginbi (9.3%), Sidama zone (9.9%), North West Tanzania (8%), and Saudi Arabia (6%).(Zeleke, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Araya Giday, 2008, Neema R. Mosha, 2017, Aldiab et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) Moreover, the prevalence of hypertension in this study is significantly lower than that reported from the study in Awasa (12.3%), Kenya (12.6%), Addis Ababa(14.0%), India (11.3%),Bahirdar (25.1%), Canada (19%), Sweden (20%), China (23.2%) and Ghana (28.1%). (Wachamo et al., 2019, Mark David Joshi1*, 2014, AGAMA, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Ghosh and Kumar, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Anteneh et al., 2015, Joffres et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, ULF LINDBLAD 1, 2012, Wang et al., 2018b, Dosoo et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This is likely due to low coverage of hypertension screening in the majority of health facilities.\u003c/p\u003e \u003cp\u003eConversely, the prevalence in this study is higher than that reported in Nigeria (2.1%) (Akinlua et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This discrepancy could be attributed to differences in demographic factors, healthcare access, lifestyle habits, and methodologies used in those studies.\u003c/p\u003e \u003cp\u003eThis study found a higher prevalence of hypertension among female patients compared to males, aligning with findings from studies conducted in Brazil, India, Senegal, Kombolcha, Bedele, Arbaminch, Cameroon and Bangladeshi (Malta et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Ingale and Dixit, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Pessinaba et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, Abate, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Bonsa et al., 2014, Kebede et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Mbouemboue and Ngoufack, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Al Kibria et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, contrary findings were noted in studies from Addis Ababa, Hosanna, Assosa, Mizan Aman, France, Sudan, Zambia and Sidama, where males exhibited higher prevalence rates (Senbeta Guteta Abdissa1, 2014, Dereje et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Gadisa*, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Mohammed Muze Edris et al., 2018, Lola Neufcourt1*, 2020, Saeed M. Omar1, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Fastone M Goma1, 2011, Badego et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This inconsistency may arise from differences in socio-economic status and access to healthcare resources between genders across various regions.\u003c/p\u003e \u003cp\u003eThe study found that hypertension prevalence was higher in urban areas compared to rural settings, consistent with previous studies from Ethiopia, Bahirdar, Dabat, Tanzania, Nigeria, Uganda, Madagascar and Jima (Legese and Tadiwos, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Tesfaye et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Li et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, Neema R. Mosha, 2017, Adediran Olufemi Sola1, 2013, Guwatudde et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, Ratovoson et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, Gudina et al., 2013). In contrast, studies in China, Turkey, and Malaysia reported a higher prevalence in rural areas (Wang et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2018a\u003c/span\u003e, Dastan et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Abdul-Razak et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis study observed that the prevalence of hypertension increased with age, a finding supported by research done in Dire Dawa, Addis Ababa, Arbaminch, Debremarkos, Chiro,United States, Canada, Korea, Sudan, Senegal, Malaysia and Ghana (Malta et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Roba et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, DeGuire et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, The Korean Society Hypertension (KSH), 2018, Awadalla et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Duboz et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2014\u003c/span\u003e, Ab Majid et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Dosoo et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This trend is expected, as age is a known risk factor for hypertension due to physiological changes in blood vessels and overall health. Furthermore, the study indicated a consistent increase in hypertension prevalence over the years, suggesting an urgent need for public health interventions to address this growing concern. This study has limitations that should be acknowledged. First, it relied on health institution reports, which may limit the generalizability of the findings to the broader community. Additionally, there was no prior analysis of secondary data in the same area to serve as a baseline or comparative resource, which further restricts the contextual understanding of the findings.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe prevalence of hypertension in this report is notably low compared to previous studies. The data shows a higher prevalence among females and in urban areas. These findings underscore the need for enhanced screening and routine assessments in health facilities, alongside regular monitoring for hypertension. Promoting community interventions that encourage healthier eating and increased physical activity is essential for prevention. Finally, developing systems for early detection and comprehensive treatment of hypertension, especially targeting urban populations and women at higher risk, is vital for improving health outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDBP: Diastolic blood pressure, DHIS: District Health Information System, HMIS: Health Management Information System, NCD: Non-communicable disease. SBP: Systolic blood pressure.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING OF INTEREST:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to conducting the study, formal permission was obtained from the Dire Dawa Regional Health Bureau, granting access to data. The study followed ethical guidelines to ensure confidentiality and anonymity, with all data aggregated and anonymized. As the study used secondary data, no human involvement or informed consent was required for participation. However, institutional consent for the use of this data was obtained from the Regional Health Bureau.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS\u0026rsquo; CONTRIBUTIONS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDA developed the proposal, conducted data analysis, wrote the results, and made significant contributions to the manuscript. HS, BT, and TA participated in the critical review of the study, reviewed and approved the final manuscript, and agreed to submit the current manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to express my heartfelt gratitude to my mentors Hirbo Shore, Daniel Teshome, and Teshome Ayalew for their invaluable comments. I appreciate Lema Bogale for sharing updated materials and thank the FMoH, CDC, and EFETP for their guidance and support. Special thanks to the Dire Dawa Regional Health Bureau\u0026apos;s staff for their cooperation and to Biruk Teklu for his encouragement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAB MAJID, N. L., OMAR, M. A., KHOO, Y. Y., MAHADIR NAIDU, B., LING MIAW YN, J., RODZLAN HASANI, W. 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Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19\u0026middot; 1 million participants. \u003cem\u003eThe Lancet,\u003c/em\u003e 389\u003cstrong\u003e,\u003c/strong\u003e 37-55.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Magnitude, Pattern, Trend, Dire Dawa","lastPublishedDoi":"10.21203/rs.3.rs-8999334/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8999334/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHypertension is a significant public health issue globally, recognized as a primary modifiable risk factor for cardiovascular, cerebrovascular, and end-stage renal diseases. However, there is limited knowledge regarding hypertension trends. This study aimed to analyze five years of secondary data to assess the magnitude, trend, and pattern of hypertension in Dire Dawa, Ehiopia.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional study was conducted from November 25 to December 30, 2020. Data were sourced from Health Management Information System (HMIS) and District Health Information System 2 (DHIS2) reports covering the years 2015 to 2019. Completeness of data was ensured by reviewing all elements, while consistency was verified by comparing reports from health facilities with the regional health bureau database. Data were analyzed using Microsoft Excel 2013, with cleaning processes in place to correct errors and remove duplicates. Percentages, rates, and ratios were used to present the data in tables and graphs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 30,623 cases of hypertension were reported between 2015 and 2019, indicating a prevalence of 3.7% among adults aged 15 years and older. Of these cases, 97.5% were urban residents. The prevalence among females was higher (359 per 10,000), compared to males (285 per 10,000). Notably, the prevalence trend increased from 2.2% in 2015 to 3.7% in 2019. The death-to-case ratio was recorded at 17 per 10,000.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of hypertension in this report is notably low compared to previous studies. The data shows a higher prevalence among females and in urban areas. These findings underscore the need for enhanced screening and routine assessments in health facilities, alongside regular monitoring for hypertension. Promoting community interventions that encourage healthier eating and increased physical activity is essential for prevention. Finally, developing systems for early detection and comprehensive treatment of hypertension, especially targeting urban populations and women at higher risk, is vital for improving health outcomes.\u003c/p\u003e","manuscriptTitle":"Magnitude, trend, and pattern of hypertension among adults aged 15 and above -Dire Dawa, Ethiopia.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 16:46:01","doi":"10.21203/rs.3.rs-8999334/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"877d8759-4f8f-4de5-b9f7-3e8861c03a36","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63740824,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2026-03-08T16:46:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 16:46:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8999334","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8999334","identity":"rs-8999334","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}