Risk Factors of Elevated Blood Pressure In Purworejo, Central Java Province, Indonesia: Preliminary Study

Author: Nawi Ng
Abstract :
Background:
Cardiovascular diseases (CVDs) have become the main cause of death in both developed and developing countries. The incidence of cardiovascular disease in developed countries has declined recently, partly because of improved knowledge on risk factors of CVDs which direct to preventive measure. On te other hand, developing countries still suffer from the double burden of both communicable and non-communicable diseases, especially cardiovascular disease. Many life-style related risk factors, such as hypertension, obesity, smoking, hypercholesterolemia, and lack of activity have been reported to increase the morbidity and mortality of cardiovascular disease. However, epidemiological study on these risk factors is rarely done Indonesia despite its important contribution.
Aim: To get general picture of CVDs risk factors in Purworejo District, Central Java Province, Indonesia.
Subject and Method: Data was taken from a ongoing surveillance in CHN-RL (Community Health and Nutrition Research Laboratory) research area in Purworejo district 2000 out of 31000 individuals over 35 years old were chosen. Sample was drawn randomly based on computer generated random numbers. Demographic data and data on smoking were collected using questionnaires. Blood pressure and anthropometric measurements such as body weight, body height, waist circumference, and hip circumference were performed by trained surveyor. Blood pressure above 140/90 mgHg were categorised as elevated blood pressure.
Result and Discussion: A higher proportion of elevation blood pressure was noted in women (38.5) compared to men (32.1%). Female tended to have higher blood pressure measurements. Overweight and obesity (body mass index (BMI) >= 25) was more common among women. Correlated with WHR (r=0.44, p<0.000). Smoking was common practice in men (54%) and only one hundredth in women. Smokers have lower systolic blood pressure compared to non-smoker, and heavy smoker groups had lower blood pressure reading. Obesity indices were weakly correlated (r=25 (OR=2.66, CI=1.22-5.77) and obesity based on waist circumference (OR=3.22, CI=2.22-4.69) increased the risk of elevated blood pressure. Elderly has 5.83 times (CI=4.41-7.70) risk of elevated blood pressure compared to 35-44 years old individuals.
Conclusion: Elevated blood pressure and obesity prevalence was high in research area. Females are more inclined to elevated blood pressure and obesity, but the smoking habit favours the women. The risk of elevated blood pressure increases with BMI and obesity indices. However, smoking does not appear to increase the risk of elevated blood pressure. Waist circumference can be used along with BMI and it can provide information about central obesity, which is more related to the risk of disease.

Nutritional And Reproductive Health In Central Java, Indonesia An Epidemiological Approach

Author: Detty Siti Nurdiati
Abstract :
Background: Indonesian maternal mortality rate is still high. Poor nutritional status of women is considered one of the major factors which contribute to the existing high rates of maternal mortality. However, the nutritional issues of women themselves are rarely investigated.
OBJECTIVES: To estimate and characterise the nutritional status in non-pregnant women as reflected by anthropometry and to explore the possible associations between reproductive, demographic and socio-economic factors and nutritional status.
METHODS: A cross-sectional study was carried out to estimate nutritional status among non-pregnant women of reproductive age in the Community Health and Nutrition Research Laboratory (CHN-RL) surveillance area, in the Purworejo district, Central Java, Indonesia. A sample of approximately 13.000 households was selected using the probability proportional to estimated size. The data on socio-economic, demographic and reproductive factors were taken from surveillance data collected in August – October 1995. The collection of anthropometric data including weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness on non-pregnant women took place between January – March 1996. The quality of data collection was monitored by a checking system.
RESULTS: Married women defined as being at risk of becoming pregnant were available for this study (n=8442) and 69.7% of these eligible women were included in the analyses (n=5817). The mean weight of the women in the study sample was 47.8 7.9 kg, mean height was 149.1 5.1 cm, mean MUAC was 25.8 2.9 cm, mean triceps skinfold thickness was 15.0 6.3 mm and mean body mass index (BMI) was 21.2 3.1. The BMI of the study sample was compared with the classification for chronic energy deficiency (CED) and obesity among adults (James et al., 1988; WHO, 1995). The total prevalence of CED was 17.0%. Further, CED grades III, II, I, normal, Obese I and Obese II were found among 1.2, 3.0, 12.8, 71.7, 10.0 and 1.4% of the women, respectively. Multivariate regression models that controlled for possible associated factors showed that occcupation was a significant factor which influenced the nutritional status of the women. The women working with agriculture or domestically were 40-48% more likely to be CED. Women with better economic status, as shown by the availability of drinking water, television and refrigerator ownership had better nutritional status. We found that status of using contraceptive methods was related to nutritional status. In multivariate analyses parity and family size were not significantly related with CED. However in univariate analyses these factors were significant; it could be that those are related to the background factors.
CONCLUSION: The results of this study suggest that 17% of non-pregnant women of reproductive age had CED, that 71.7% were normal and that 11.4% were obese. The major reasons for malnutrition, i.e., limited resources and poor socio-economic status of the population, need to be addressed to improve nutritional status of girls and women prior to and subsequent to pregnancy. Continuing research in the area of preconception nutrition is needed to ensure better health status and pregnancy outcomes. A more detailed understanding of the socio-economic determinants of malnutrition among women could help improve interventions.