2.1 Study design, setting and duration
This was a community-based, cross-sectional study conducted between August and October 2018 in the Baham Health District (BHD), as part of the University of Bamenda Medical Students Association (UBaMSA) annual community health campaign. The study was conducted in 5 of the 9 health areas of the BHD including the Hiala Cheffou, Bapa, Baham and Ngouogoua health areas. Baham is a rural community located in the West Region of Cameroon. The Baham Health District had an estimated population of 51500 in 2001 [13] whose major activity is farming. It is made up of 9 health areas with a district hospital.
2.2 Study population and sampling
The five health areas in which our study was conducted were selected based on ease of accessibility. Consenting participants aged 18 years and older were consecutively recruited into the study. Participants with documented or reported diagnosis of chronic kidney disease, those who had taken cardiostimulants such as alcohol, “kola nut” (a caffeine containing fruit of the Kola tree; a genus of trees that are native to the tropical rainforests of Africa) and caffeine at least 30 minutes prior to the study, and pregnant women were excluded from the study.
The sample size was estimated using the following formula:
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uDqLMNnkSh3YqiQu0Bp4aRSxRbKCs2iQtzZA3UWKeUcGAgkxraCHJSlPbVu3BG6f8Wj7+qUxpGJ+MuD2mra5nn5LZkXFrXDY6GOOdnrs8kqgwFQlFTak9uuZIncZX26YHS/xZ1yRP0i9y0ElAXKSTByYgKSXZXqEv4hsts2nEZowa3LuH5hCkGu3FTdbxii510KS/t0zniFMlK/8MZ+GuJ+Ku5wqu3JeyS1yPEkQjBna3bho1sEbAZxkZDriDamFRjeCo1mpVqqFiLxoVf5zo4Svut3v/1DBRLAktWHezKx1xpchuhSBEXLOoZKsC2woPD1BozEFX8gjBGa5npJVFppX34IXOeuTRDlf4PkakRg5x//KRVwijFUoqyCDVJjFw6AqpevC1gkC0WIkPDdnwsd99BNFMYwNK+TfRq3+SYzE8RDECxEKHW6P/wwRP6H4MzdyDh6DldMVBNu+1KXluxwQR9lCTAko8iSM1OZEgJAS5FaZ9eEh8VM+LUUUJFVvq/lp/otfWKv7DCgz0u9djrWjBSjYwDfZ58L2jLCuhYiYCxNVoaZ2kfLpKjyNL/H1T8hRWeIacrLnfcZkyngg6CcOhCI4GvEqABsHlFHWExygFBR36pWaZYk6fd0n7p/w8y/rJTGgZfE8t4iFHj0tU+1iyCURqOJVPQWXVCkjiVL5ezmaWUPDeu0j5dG72RuchwLJlK/+sKDT/gr14CJzpGHWSuErRkCaOhiLoAWJuNFEvl0EP2uHYHfigDWVnlnMUqShBbJiOVkJlyU4N6aV98Vvq/IkS4sDJJabEEXECHZ2mUx3JjszALoWnkoEyrdeFmVBRCwOyZARNSXZqrCFrAamiI8bEs7efeopsqnBSdDF+V/tfQoYvgtuiaSpcJFzwZTiVVyAJQ/Z0UKZTlgRHLCx8Mq9AddIFHCDWptWO9ldmfPWuW+8Mf/uCefPJJ9/LLL7v27dq7I4860l16yaVu++23L/1PD9QMn+bHX/ZoQVIergZijKolMbgNtlbkwW5ElALKnUdorV13jQY9Nfth7CzDv6nl3inCJr2Z27/wwgvdJZdc4vY/4AB33XXXu5123gnlde4r557TKvofw8mAD2H8a6/w1oBQMtBCW0I0VyJ0E1LzHgqsKl/QEjRXFI2wFNCsMBUatHnav/rqn7iVq1a5Sy6+RLq0YP4C169/P9evXz83b948wTHbUvsfO2hAoaOGbNn+1+via1GUjBAyLAM5rq8MNNs3ClYjT3LJTIql/ita+YxK/Uyt2f6oUd92F1/EYFevLFiwQHwyaNAgKc1XLen/Bmh+esoU0c9sU/P/2rVr3dNPPy3t+yD6jw5rwhef+OWnQqUhYYwipfJG7iCodcmVoSBTrGSygVAQCZXWZH/ZO+/4vQcN8ttss42fNXO2+LSl+3/XXXf5ffbZx/ft09uvWb22MCTm/2nTpvrTTxvhxz3wAEa/epwopLwZTUCtRzAjFwxJpZpIDP9nzZrpO3fq4g8/7HA//uHx1aKBr9A2Uac6I6jVKnkEfE7J4YyX6IYatIBqKNCEOQkLjzJWUIJlpalADicV6uEatIDaVOxjdfK77rqL79V7B/z38r169fa9d0DJOuAdevWS/5mzZkjntPkN/t133/WHHXaY327brn7ixIlZxwNIRvj4/PPPF729oYf6ekF33359/f777+///bvf9fPnzydj+M9kgRs58ixfV1/vL7v8cv/ue+8I0eyzMnv2bH/a8FN9PXiwXfRPPfVUUIAi2E+IAKkCNC0AghbmxIrqnJdeLPRffdPLf2z33fwJx3/e33HHHQWFr772qj/jjDN8PY6gbrnl1o22rwo0jyu8dApmbeZoF5ArkDpAnkIHc1Ilc17P4SCTowK8Odt/7rm/8yrsO3bo6HEz6m+66Zf+pjFj/KWXXSp40oafOjw5DH1esXyFP+aYY/z2223vp/51apP+X75ipT/owANFFyfIzTff7L/xjW/4AXvsIUHat28fv2jRoqQ/DN7o/xgtMqNHj85oAGH/tdde8+ecc45v17ad796tu/B16tTJr1q9WhnyMQrSzRn/sWPvFN040/NXX321v/baa/yJQ0/0HTt2FPxVV14l2vPxHzbsJN+2TVv/4LhxwbIWzbFvgRwDvqpfFQitFpFSK6LQImtydeOqWLNuVNEqEFotIqVWRP1T7TMAGdQ33vjL2DOu3vtgq8JVc59P7Ovff//9SKOvTjrpJN+lSxc/Oayoa9es9b/+za/96lUMuJSs/wcccIDYuOGGGzScQWCQd2jfQfC33nqL4oPoK6+84tu3a+ePOPIIv3ZtlbM89sv+uOOO83+bOtWPQ2Cx/YcfcbjFR2yA2Y8IAIKrUll7/O+//37orvM9evTIVfivf/3rYnOnnXcu4Kl82bK3cWXo5XfaaWe/BlfPykZtiH0qJ388ltRbSnRXEttGgG3RlN94GlrORoJgvKmFoPKqbJ0cT2Y6gr7EX00Tu5uh/Y5bbeXOO+889+WvfAld0P6f/eWzHYLJYfV0d9811m0FHib2/6abbnJ33nmnO/DAA91jjz7qfvSjH7nTR5zuzhp5VnBx0f+rVqxyU6dNFXms8JxDMk7du3d3gz6hN7oLFy4q+H/MzWMcVmt3zlfOcfX1YbCCfSrCdsghGN2gvfd206ZNE92DDz64xcd/itwoe3fooYeKDRv/T3/601JftHChlJppv7beemt36qmnun/84yU3ftw4OC0Gm7BZ/1kxfWx4k/FnkV+YPTZrwxSyKnk1VWOMYmUVBxA5Lt8VKT6jGihlccXYnOxfddVVjFjftm1b/8Tjf6rqPwJV6OTBuhDhbbbeJutm6v+ECROEZ9vtuvoGWfGUbfny5b5bt25Ce+yxxwRpLuzdu7dsG955e1mVfZW2cWnwQ4cOFR1j7xxb077xm0SqV0Nm3yif+uSxuMrV+Wuvu1ZQNv44mhWbRxxxmLEm9VAyefIkoR9//PGJXuhJhs7ASvsUIS5uaYo6qtijqkgJCiLBFAhD5AI5wBEVgSRKqIAuVAp8kQIgwsIRalLklBxfZSjpzkUqNCemzCb4CyJWE2SDfwCnHPVt9AbwZz//WcZclIq6C+hCJbL85CcaHNyC0By5Vq5c4c8791wJioEDB/r33+OWSeXfXPymbKX2P2B/Q0VaVGoARHr27Ak9ddjXv2rYqlI1Aw0gwsIValLklAa/tmGt74pJTN1TpqSb4WeeecbjE2Wu2/6W39yS2UryPAho07aN799/x9zKBtnPBdvSU3IJCFcLVAUT8bLwGJH+CzAOhxXmpAEUti5sfeTJdQGvOlXe9FtpakUElYjPIGqIujdh+y/OftENHz7cYaTd2V86211wwVelWxvb/0mTJ4oe3Gi6b436pluw4GWHFVDKPQYMcPfee6/r2Em3TGRcMG8+QqzO9ejxURnkpuzPnTfXvf76627HHXd0PXvukHldpU4++WS3YuVyXoukDTaaLDn+3C2Rk5eqU085RfqvjHXuueeec2+/u0yqt912uxsz5mY3a/Zs9+QTT7i27dq5K77/A3fGmWcEvSzS+HMbxu3gK6+87Boa1mJb1kb5mjn+bfmhBrwiRkQTQA1awyXjWbhloYeemg+iFpMVjUoGKswJQZrWLc3+e++844YOPcG9/dZb7iDshW/4xQ0t1v8JEyaJ7zp37uyenzHDYdVEYJ3mBg8Z4o7//OfjoqOhV+fm44Ms7m27d+smqKb8P3nyZNF90EEHSeDa+Fjw3XfffQ5bJx1Q5hxzDnNIVmW5z957GVrKSRMnSoh1x8SbheeH2tTXu913+5g77rOfdTjzdzv0woS0BJ2V8fcRtJ+T8dXXXnd9evcWzhSLsEijISnYePy1VeaihNYSziAtVZnAQW8+X9RuchfrdDqvAMIe2xK0ShFgMgPUWsIZpOWmax+XTtx0jnDPP/+C67nDDnJD2qFDhxbp/7y5c93C1xfKonHPPfe47bbbTgOOTok+pQOZ1Nf81FISjybA15T/J02aJH4fgsmjftac8oQ4gRuowPGzWl5ndWUXIiO0HniWSLhnKTRpIq5MFP3i8C+6n157vSoUzhoZVKgWzclBiP8NuGJaZ4Ua+r0h8RdPaaQv4WQBWjUJEqASBeDM0rr1D0SxqHwmog3Smm1DBCeZqjc9rKkJk66gK1G4NmX737/i++7uu+92DPKxOH3ZoWdP6chLc16S04lpf8MJSzP7P2HiBPHzbrsPcNtti2CnN9TJjfq/f9++4Kpzbyx8Q/ib8v8krPB088E8obFkw4GyXft26Fc7175DR4cjUCnbd+wAXHvXoSNo7Q3fwbVp00a7GeJpUrgyDTlocLP6vwgnT7gfcr1690Qb0YvQrnX1H3st6Ukh/rI7hXxvX4ku1nFPkc4OiqSaStI9SMWdTk5QPdWY2vo3Nftj7xqL7Stnfp2/eczNhUbzAxYO0xtvvtHs/uO4k6PnR4wYEW7YmvBUIPF8njL77btfak9BTCvLli3z7XBWzw95lq9YkXgbgyC2vv7HVkTawP7PeWnOBvdfblrbtPF9+/ZNrdkA+yKU9VlWeG45NHH+GBxQkQLASGi9zhpDkJbBaRKqCOtGBpySVjZ3+88//7w74/QR6KN3+35iH3ni8eFHHpGbyDNHjnRj7x6LR393cd0+gr10M/q/fMVydw9uSJm69+ghOtbH/zyf74b/6S9Md8uWvaNur7DPG+Bvf+fbbjXO6usQDTNnvICbQ24dikmGLxvD9bFPDb+/4w5pL0V7dNe2J83rHn+e3+OUx+0xcGDLxF+cNtksqJwVqW5MoSwWFbMXUnbYSlCU5IAhQhkZmqobU9GwYZMR0xEpiZRQxQZU4mvWDRnKUJw0bBjGU/Z1HNea/6cOD48UmIqi9cxB1vbEsNtuu0X9fNble9+7XInFZtTQ0eC/i2ds2Kbbbr+9KIOx2XbbbbO28jxH+4CTED9t6rTUAEJiyxpfNGzY5GQV/e2tt+qzOcEnPIJcumRpUa/VopKACPVRo0ZJG+/4/f+CYEyhLBaJHHUafyKV74enO2Wc07UtLYJClAXJICsFWcjk1lwwJh95eXnLj0hkTgQuYVJO5kwmr3GiNeXIMcqb8tr258+d53bGF0uOPuYY9/DDDwd204aqgFpnztSS9kVXM/v/3rvvuAF7DHRYON0/8P2AdhU3w9pay2v3v9J++X548YgOMXM5fYg+VDyjwiCZGxIlxmSlXuSNj3s4g3k2TR0WUJQQWOMMNeVk3tL2++/Y3436znfcI9hiXXc9TkhC+rDs01xz+3/uuefLVx9//OMfS7BT10b7XxZ723qkK0C4fABRwNm1olgm8YzZkFCg2CwH+OKcFz2+zub/7d++5p/FJ26Sgvh9993vR436lr/iiu/5OS/iRmcdyUyZJdUVlDViP6kEX1KQ0NJq0jJUI2ASz5gNuQnYX4u2nHnGCLkxvf6nP614MG3T6/9bb73tv/a1CzknPU6+GvF6Qpur12f8eaNVlbJhE5rVtczzXNS4FJeMJ8i4b7zxRo+jKzm5YKc6dtwKT8Yt80uXLpVHZYmz/7q6ej/uwQezdqyf/cVLFvsl2C8uQbl4yZIAo1xKWP+XLjaYfEuwv9Q6ZdkWS9az3LLhjKdyZqReJyjxBqhaiRAq0VbXMs9zjcaluGRVodWr18hjuXwWfc8999RHvIsiUVkl2upa5nkUAWBcte3nnBEuiggaX2303bp383wqlE9YMhlbbtlwwlDgUkxl/40vC/jEUi0P9cGCzaaIMIIJxZZEwGxJ+UM8k81gxlNy/oKvfjUG9u233+YH4ds4XbpsLc9444nBSOPqZGbWx/7cuXPtuCnqsAm07lIumiL33nvvhba3XP9zr+QwO1ioV1ZCfX36r40uKIhjsGLlSv9gYQEx0odjP29VDlv/V+Gx6PEPPRTHO/alhfqfBbx1nGWxKTkl0Yo8xVouYY4EB/64jRl55ll+DZ775pNw+gFsnd9ll118165d/aRJk8X+6jWr/FZbdZLA22uvvTKFZslKJeU1fCpZEegpiGWTjJ2gnUiY/TQRAi820+/Jg1iZaQHNkpXV9osSxf4XVDTq56LuSn21LDYuUdpX3yDHX3p4LIy4DHfhRAEEo8lOQ2+wuIQqr9IFizDjPkU5dF/CWzmtKwEP/KsAdM3BJ5C8gScnPpRw48c/5A7GsxxMbdu0c53wINTy5e+7j+26a7BMZtXWlP1+/fu7xYsX46Nwu3GkjBiiakl6T4+oBlq6CxaBgwkc/4n9xE/L62dfW1i7/6JPGFRX0hj4BWEazLrpStxN9d+klbvo/9Zuvy2dI45BZgOf3GyQuBcVc2WAUlUZMQPMvVSq80bdbrESaqLr2Wf/GgzUuX/FFxQ+deyxoe7k7pxBS0t7DNwjWE4GBUpVlcvs4ytzoZGN2Ue/QxuFIzUstiEB1q9kcF3216f/lfY/bP+3RvttOahp8GqNesJZYDT+s/O2BoITo6eSWvJyIKu9eRl2J07C8yG0jwZccpm9rkKDCl920IaB/8ADddVvafs6IVum//J4NBWyf5K0H3IZ5GUP3tCcREByeRQ0ERGlPtNFKBNQnoo86QuEVmQf27oKb7BqMQcafKG+LMafBHx0suxHUOMOl96UBCAwyBhxrGQkjB7Jyi28OhTGp6o0N8XLl69wz/7fM5Cpc0MOPcT17dNXY4VGYP8JPCtNu9xaHHbo4ZnuddtfsWKF++3//Lc2TCykDyVEETL6S5/hpkMapE98rtvV8ak/Jw9AnXXWWWJ/ffovesMgsKfx1B26aAGFbPcEYCZ4FrSpdZsS5JUUAPrRemA0tWGMxq/U1mA/7zl7zT4zaYyqB2rFX1jhVUSDHMxBmrNIVy51d5wEYJfYoAXA+kLPIBSKqIQ8SHmjWMe3XeStW4Q/d9xxLMJcUPuP/+lxwe2N71put31XlTfd67D/Op6u43c4tQ20XCtRWQUNHcSr2ISZ/TsFX2TAF6yhZt39r73iJLvUas2vxjZCNf+jnZwMUR7suf/DKCe1NaBGLIRWNULdlO2HlnMINyT+JOBTYFgQqGsl2MV5ydniGpB1Jok1My2cKbTJyaQ6eS4SQCknTviLkoE8eDAeG5XgU9433njTzXhhhtAPP5yr+4bZ79KlszvyyCOiftGd28dDUmw/H5ESzaxIoKt9Ynll4ctNNW2YfcprfyitcGX/SUlBbPx5Ccm4wpT26RkmRhXd0tz4y57UN5W657GaWInBqMMnZmUwwIsWCCgtYYvYmlQqOuCoDCBx+nw3TmPq2uCb8wcogXQwPMVvuFMHkj6f7d2rr77m2uOZ7G74ute67OMLze7xx/4UbQVVVCdJ2xQaHAqjsaxGJYzqQn0j+08vSxhH1dbKD8f/rdX+P+398BMn4utqGOw999rTdcFX1vL08svzNepA59fTXsTx5WBcBU48cZiycVKFpJczVIgCfyQlFuFkXKlSsEoFDCwr+MilIWfcLCuYohHwqjLVs5nbxxvAHN4O4HbasZ/DK//kK4pTnnpqy+q/fogRcj2h18+WCFu9wMRKIOBjv8ZZGlcwc8YMhpr8n4tv3McUlD3+2OOBXicv4uEHUB/FC3z40iBNG2efOmq225As7V8NVuSBsZn9pzIzVVBsSLNt9QJTJt2C9vmmsc6dOvujjz7az58337/w/Au+01adPR9Nrk6hYS1oX2xYfz/A/ssXQLiqSQoLmSxghPHPyJOEvUuEbcXDZT2IJEYwCV+45Juslkp79q88f1fJwlfKgrLDjjjcHXXUUeDxbtEbb7hDDjnE8ZhyP7w0SFNgbKZ96ggagr5QBOQH3f9N0T7edObwzhj3u9/9zvXp1xeP5Q7A/+5u4aJF6pwWHP9/Zv836ffDz5w50+HFoa4z3kAVA9RmXQER9r2kRbyOE3NFN0JMbMaYYwQuSLLCFO1k2guMysY840jIWlCT8kGAPEzNsD99+nR85/Yeh9f9yf8FF5zvdtllV9XHPLOPl6s6vOfGfWHYMHcbJkHBHHkLiM3H/3W4KuF5ltDTrMOF/gNf/LDJGCuOyygUvUYeS/BOEDFJo+hNb21i5AVQ2k9nOtGZcGqOVZ+a11haUv9Pfmqy+8Ho0e5BvFqPVP7MDt5CHO5D0hhxQhx55JFY3Re6KU9NcR/F6zW2FP/HFd7cIxM3VIqdNOepu5nHDQ35w6SJINlFWZJLkHClKqBgUkVCpbSf+Tjzlrono4k7JRM/2n10Lf+PHz/effYzn3F9+/XHr4zMjVqDy91KfH/2xKHD3PTpz7mHHn3IDdhtQOQxYGPsqw5tq+ljafY/6PjDObwa19gMDQmBWgho8sm+3OIYTIE9X2fk4ibyQYnwKCNzJtObsEWMDZRh1RvgLu0H/6kX19f/ry181b25aLHrh28/8f6J9yiHHDIkiOsocLT4oN7xx5+AFzjNd3/B5yT86R1JMnBbhv8R8HlgMlx15VA3IKd3hCXwwQO4o0bsGZ5xaDSVUi8xNyeRnq1IgUEvCkFWREv7Len/Bx643/FndV7Amwg4FHxfTtdtusrFeMiQweGirP5fuXKV+8JJ/4JDgkXuz0/+Wd+OQKEtbPzjKY2cTCAQbVXVyyKckcWjeI08IcAZo/RJSmTmkFlCAHOTLknWfiMYKtZL++YSdfjG+n/MmDHuc3j9Ht5P78Y/8CDezfiKO/mUL0pA09KQIYekscUYDT9tOGgL3ROPP4F3UfZws2fOkpdKbXHjX33GSkx+IJpxVKENQYkEiwTvhptIVfwFXpO1MhCtamVms0pfK7b/3PS/4xc92uJcvZOfMVN/XocevPfee7j6eLyb0q9ek35w4ZprrhH8RRdd5K+//np/zTVX+49/fC9/6aWXFEYlunsz9j9X4NCP2AtDhLIqlKJE0RvFWqZNCUDkuDweFZ9RDZSytG/uSB6uxiSa90NP0Pe8850uMUFkzK9+xX2lx2cc8XvrixYt9O07dAjfPJOLswQ/LuP+kUcehfiW5X/s4cOVLe7ViGCfbTtjmxxy6g5GMGDJRYwiLoN8kgq6IKsXa63Hbb/hc2WlffWKOCx5Ekh1Lz3ZiP/fWvqWe2Dc/WR1I88aiTz5f+Jf8B0DVA/FB3nm/+54G9hKPE6dsRVkUAnjRsjYGrevejbd8ccb+0PSaIyViJceGBM7YiwGY88uzErRvXjkAnPYuwOlOgNfUBPt5CImIzyRAzWzSbUGl/Zz///9+ekOX4R2eKuY23PgnnSU+H3VmpXuj3f+UTw6eLCe0LASvdtK/F8vi2nqtniATki3mAmyEFNHmYdQGihySmVuSchQmrFF/aV9eimG3Ub7/3XcnDL1wDslLdHvP//PG/DK67flwGHw4INbrf8Lbx4TB8E7GpgpPA3SUgdH4DBOGrTmXpZpkrAm5zYQEPY4tkGrFAFW0dI+/RC8kEPqpab933/HHSni5uHHENasWSPwBHyV8rLLL4NK7/rjA6dt8W75J3H0iN9iDWZaj//TsSRdE48QxU8hQokXogCyyoeg1e0LKhbxAANJhyvos12ouDXzbWSOJkya9pCsKiUzTh0oCPjSfnBS5v9999vP4XUnsi8/HT+7881vfssde8yx7sorrxS/vbnkTXfxxRfLp62PPvIoFUhSFwfHFpCoKFGAzd7/8S4+AE3f/yemWvfuUVelkryew4VzG5UukKPCCgBMpf3GPTX6h6Pxq9syC3yfPn383XfdLQ785LGfZOjKz9v/4hf/BVy1jmpMhe9Z3Yz9L8/S6LrJpddmeL4MAx0o4sICifwBwdXcbv2NPy+LZFBSKu1z3WxZ/y/FT9QswWtOuMVpi1/ksOF5ac4c1xNPoHYKvxfLUWhN/o8Pj0ms58GcxbKEptQNGcpiofOloAMM2aeyQjIVKd4VqsTXrBsylMWitG/uMd9alKMeSREwplBW4mvWDRnKYpEZMZ1g2MTGv3w/vAyajhxzpjRnFU+cQVYSV0zh/gJIk4+8WeCpTKQExVpnzmTyyWqCMklljnlpX+4vMv9FX2X+L5zS0NE8XzHHyydL4lBTBboQI0d0NyVVPqBgxAauue8HL+1HD0Zflv5nfDU//nBKA2HOgKjHzlSAo3eFZI4Hk4BZHagkHvSIMssSjlJSw/FKUgNMUgCO0r56F34p/d/i8Zf28BafISjzkGaQWrDqCbvlmZCEcpLKb4TsliznFtgUVxAq0VbXMs9zQeNSXGnfvJ48kXtL4KLLIrkSbXUt8zyKADAuxSWrCcq5BS6KRHIl2upa5nkUAWBciktWE0RKPIenAEWYJGytInVU8CdBr4ffgI3ByjAlQjWFvq3YojpKsRZUKQGUXFOsgCq2QCztw2el/yVemht/NVd4iW4JrxCLhYJhGYI74zFsgVUqNsPAwcEqiDYm1RieCo1mpVos1hRnFF3rwFHab/X+Tw+PhVDSlZVRWUwMqBRshMCjSKGIBGNKapopbCs8OEytMQNRxS8IY0zKlI+50kr78EPmPHNphgrk0v8aMcj5J5+jMYxSLKUoi1CTxMilI6DqxdsCBtliITK8V+UxrZACPVOWgU0Sa/NFkQAUi9I+PNAa/S97eInLGJxZ/GhYIBeirhgInLTbruS1FRtMIZAJMNb4BgImzDApBVa1qr20D5ck30QnCa70P/0h3kG2kfGHNR7K6FIFqBGXwRCMNBR9boyCTFkBHSsRSIyNQMZZ2oeD5Ciy9P8HFX9hhWfIwdcIcu74zJhOBR0E4bBJgIpKgAbA1nXqkJlTBKQW+aVmmWJNvrRf+v+Djr/slIbBJ+t8KC0oi6Vx6aofaxmT4VgyBZ1VJyTpwqF8uZzNLKXkuXGV9una6I3MRYZjyVT6XyItxN//A+ShMONJnP/GAAAAAElFTkSuQmCC)
where n is the sample size (number of adult participants), P is the expected prevalence of HTN in an adult population (P= 0.378) [12], and d is the precision (if 5%, d= 0.05). Z statistics (Z): For the level of confidence of 95%, which is conventional, Z value is 1.96 for a 95% confidence interval (CI). A minimum of 361 adult participants was required for this study.
2.3 Study procedure and data collection
One month prior to the UBaMSA health campaign, members of the community were informed by mass communication (through the local radio stations), and interpersonal communication on the dates retained for activities of the campaign. The data collection process was guided by the World Health Organization (WHO) STEPwise approach to Surveillance (STEPS). Data was collected by trained medical students and medical doctors. Information on the participants’ socioeconomic status (like age, sex, and education), lifestyle (fruits and vegetable consumption, smoking status, and physical activity), and medical history (family history of hypertension). In cases where participants did not understand English or French, a translator was used.
Blood pressure was measured using a reference protocol in which participants were seated, and measurements were taken after at least 10 minutes of rest. This was done using the auscultatory method with a calibrated sphygmomanometer placed at least 0.5cm above the elbow joint, covering at least 80% of the arm, and a stethoscope was used to detect the sounds. The analysis was done for the average of two measures performed at least five minutes apart.
Height was measured using a calibrated stadiometer to the nearest 0.1 cm. Weights were measured to the nearest 0.5kg with the use of a scale, and the participants mounted the scale only with light clothes on. Abdominal circumference was measured to the nearest 0.5cm with a measuring tape placed all around the bare abdomen at the level of the umbilicus.
Definitions
- Respondents were considered as hypertensive if they had an average SBP of 140 mm Hg or higher, or DBP of 90 mmHg or greater, or reported current use of anti-hypertensive medication [14].
- Hypertension awareness rate was defined as the proportion of individuals who responded by a “yes” to have either been diagnosed with hypertension by a healthcare professional and/or “yes” to taking medication for hypertension.
- The rate of hypertension treatment included the proportion of participants who were diagnosed with hypertension and reported being on treatment for hypertension.
- Hypertension control was defined as the proportion of individuals on either pharmacotherapy or lifestyle modification or both for hypertension and who had an average SBP < 140 mmHg and DBP < 90 mmHg.
- Occupational level was classified into “low” (no technical know-how or expert training required, e.g. manual workers), “medium” (requiring a degree of technical know‐how but no expert training, like salesmen, and bike and taxi drivers) and “high” (major professionals requiring advanced training like teachers, health personnel, and accountants).
- We defined an ex-smoker as someone who has smoked at least 100 cigarettes in their lifetime but had stopped smoking at least 28 days before the interview. A smoker was defined as someone who has smoked at least 100 cigarettes in their lifetime and are still regular smokers at the time of the interview. Those who had never smoked or smoked less 100 cigarettes in their lifetime were classified as non-smokers.
- Alcohol units per week = (number of bottles of beer consumed per week) x 5% x 650ml/1000 [15]. The routine beer bottle in Cameroon occupies 650ml of beer with a concentration of alcohol of 5%.
- The intensity of physical activity was classified as “moderate” (e.g. brisk walking, moderate farm work like weeding and harvesting, haunting, lifting masses < 20kg, housework and domestic chores, and general building tasks such as roofing and painting) and “vigorous” (running, briskly ascending and descending hills, intense farm work such as manual tilling of the soil, digging ditches and carrying masses > 20kg) [16]. Sedentary lifestyles at work and home were classified as “No physical activity”.
- The body mass index (BMI) was calculated as the ratio of the weight in kilograms and the square of the height in metres. BMI based body habitus (in Kg/m2) was classified as underweight (BMI < 18.5), normal weight (BMI = 18.5‐24.9), overweight (BMI = 25.0‐29.9), and obese (BMI ≥30) [17].
- Abdominal obesity was defined as an abdominal circumference > 102 cm in men or > 88 cm in women [18].
2.4 Data analysis
Data was analysed with Stata v.16 (StataCorp 2019, College Station, TX: StataCorp LLC). Qualitative variables were reported using counts and percentages. Quantitative variables were summarised as means and medians with their corresponding standard deviation (SD) and interquartile range (IQR), respectively. We computed direct age-standardised prevalence of hypertension using the 2011 population structure of Cameroon [19]. For univariate analyses, the Pearson χ2 test was used to compare categorical variables while the Wilcoxon rank sum test was used to compare medians across independent groups. Independent factors associated with hypertension were determined using unconditional maximum likelihood multivariable logistic regression models. Variables with a p-value < 0.1 on univariate analysis qualified for inclusion in the multivariable model. We sequentially adjusted for socioeconomic factors (like age, gender, occupation, and education), lifestyle factors (smoking status, alcohol consumption, fruit consumption, and physical activity) and clinical characteristics (family history of hypertension and BMI). The maximum likelihood ratio test was used to evaluate model fit and select variables for the final multivariable model. Gender, alcohol consumption, and smoking status were retained in the final model as they have been reported as factors associated with hypertension in literature. Body mass index was retained in the final model over abdominal obesity to facilitate comparison of our findings with previously published studies and to prevention multicollinearity. Ordinal variables were assessed for linear trend using the χ2 test for linear trend. The χ2 test for heterogeneity was used to evaluate departures from linearity. Measures of association are reported as odds ratio (OR) with corresponding 95% confidence interval (CI). Missing data was handled using simple mean, median and mode imputation where appropriate. Two-tailed p-values below 0.05 were considered statistically significant.