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. 2023 Mar 30;13(3):e067312.
doi: 10.1136/bmjopen-2022-067312.

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

Tapendra Koirala  1   2 , Udaya Bahadur B C  3 , Carmina Shrestha  4 , Ujjawal Paudel  2   5 , Rolina Dhital  4 , Sunil Pokharel  6 , Madhusudan Subedi  7
Affiliations

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

Tapendra Koirala et al. BMJ Open. .

Abstract

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 and 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 sociodemographic, anthropometric and behavioural covariates.

Results: Of the 85 eligible participants, 81 (median age 35 years (IQR: 26-51), 46.9% female) were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of males 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.

Keywords: Cardiology; EPIDEMIOLOGIC STUDIES; Hypertension; PUBLIC HEALTH; QUALITATIVE RESEARCH; VASCULAR MEDICINE.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study area map showing temporary Raute settlements (camps) and the data collection sites. Maps were created exclusively for the study using the QGIS V.3.28.0, and the GPS coordinates were taken from the study sites. (Data source: Shapefiles, Survey Department, Government of Nepal, http://nationalgeoportal.gov.np; Basemap, OpenStreetMaps contributors, https://www.openstreetmap.org).
Figure 2
Figure 2
Age-related changes in systolic (A), diastolic (B)and mean arterial (C)blood pressure in nomadic Raute adults. Males are green dots; females are red dots. Displayed curves are third-order polynomial fits. The shaded area represents the 95% CI. The prevalence of hypertension (D)by age groups and sex. Bars represent the percentage for each category of normotensive, prehypertensive and hypertensive participants. The cutoffs for normotension, prehypertension and hypertension were mean SBPs of <120, 120–139 and ≥140 mm of Hg, respectively, and/or mean DBPs of <80, 80–89, and ≥90 mm of Hg, respectively. SBP, systolic blood pressure; DBP, diastolic blood pressure; MAP, mean arterial pressure.
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