Adherence to Dietary Approaches to Stop Hypertension (Dash) Diet and Associated Factors Amongst Hypertensive Patients Attending Uganda Heart Institute&mulago National Referral Hospital

Abstract Background: Hypertension is a major cause of death worldwide with an estimate of 1.3 billion people having the condition. In low-income countries, the prevalence is increasing with urban areas being more affected that rural areas. In Uganda, the prevalence of hypertension is 20.5% in peri-urban Uganda. Hypertension has devastating effects such as stroke, heart failure, myocardial infarction, renal failure, vascular diseases, retinopathy and weighs a heavy burden on the health care system. Poorly controlled hypertension is therefore a significant public health concern hence the dire need to achieve optimal blood pressure control in the population. This can be obtained through lifestyle modification. The Dietary Approaches to Stop Hypertension (DASH) are guidelines internationally recommended, adopted and utilized as one of the essential lifestyle measures for controlling blood pressure. Although these guidelines are recommended by the Ministry of Health, little is known about the DASH diet adherence levels and associated factors amongst hypertensive patients attending Uganda Heart Institute& Mulago National Referral Hospital. To determine the adherence to DASH diet and associated factors (Health systems, patient related and psychosocial) amongst hypertensive patients attending Uganda Heart Institute & Mulago National Referral Hospital. Methods: This was a cross sectional study employing quantitative data collection methods. A structured questionnaire was used for data collection. A total of from 199 participants receiving nutrition education were enrolled in the study. Data was extracted from Open Data Kit and analysed using STATA. A DASH adherence score was used to determine the level of adherence to the DASH diet. The outcome variable was adherence to DASH diet. At bi-variate analysis, chi-squares and fischer’s exact test was used to test the independent associations between adherence to DASH diet and associated factors. A multivariate analysis will then be obtained using logistic regression. Odds ratios and p value of less than 0.05 will be used to determine statistical significance Results: Overall 199 participants met the inclusion criteria and agreed to participate in the study, majority of the participants were female 141 (70.9%). The mean age of the participants was 45.9 years and standard deviation (SD 12.2), and a big proportion was aged between 45years and 59 years 61 (30.7%). Patients aged 25-35 years were less likely to adhere compared to those that were older. (AOR: 0.027; P=0.03). Receiving nutrition education from a health care provider (AOR: 0.47; P=0.0430 and those that had a perceived understanding of the messages – equating to the Quality of messages provided were 2.15 times likely to adhere to the DASH diet (P=0.037). Conclusions: The adherence levels to the DASH diet are low. Age, understanding of nutrition information shared and receiving nutrition counselling from a health care provider were associated with adherence to the DASH diet amongst hypertensive patients attending Mulago national referral and Uganda Heart Institute. A model based on building the capacity of health care providers to provide nutrition education as well as promoting nutrition counselling within the hospital can improve the care of hypertensive patients