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Prevalence of hypertension and 

associated factors in Jalalabad 

City, Nangarhar Province, 

Afghanistan 
 
 

 

Khwaja Mir Islam Saeed 

 
Afghanistan National Public Health 
Institute, Ministry of Public Health, 
Kabul, Afghanistan 

 

 

 

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DOI 10.5195/cajgh.2015.134   |   http://cajgh.pitt.edu 

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Abstract 

Background: Hypertension affects an estimated one billion people, worldwide. It is a public health challenge characterized by 

increased morbidity, mortality, as well as cost to the community and health systems. The goal of this study is to determine the 

prevalence of hypertension and characterize associated risk factors in an urban setting in Afghanistan. 

Methods: A cross-sectional study of adults aged 25-65 years was conducted in Jalalabad city from May to June 2013 using the 

World Health Organization STEPwise approach to surveillance (WHO STEPS). A multistage technique was used to enroll 1,200 

participants in the study. Demographic and socio-economic variables were collected via individual interviews using the WHO 

STEPS survey, after which blood samples were collected using a locally developed standard operating procedure (SOP). Bivariate 

and multivariable analyses were performed to explore the association between hypertension and associated factors. 

Results: A total of 1,180 adults (40% males, 60% females) of 25-65 years of age were surveyed. The response rate was 98.5 % and 

the prevalence of hypertension was 28.4. Independent risk factors of hypertension were found to be: age ≥ 50 (AOR = 3.42, 95% 

CI: 2.50 – 4.76); sex (AOR = 0.58, 95% CI: 0.38 – 0.88); obesity (AOR = 2.1, 95% CI 1.49 – 2.94); and diabetes (AOR = 1.75, 

95% CI: 1.10 – 2.79). Independent protective factors were physically demanding occupations (AOR = 0.55, 95% CI: 0.36 – 0.85); 

physical activity itself (AOR = 0.69, 95% CI: 0.47 – 0.99) and consuming more vegetables (AOR = 0.59, 95% CI: 0.38 – 0.93). 

Conclusion: This urban setting in Afghanistan evidenced a high prevalence of hypertension; age, obesity, and diabetes were 

identified as risk factors and physical activity and consuming more vegetables were protective. These findings have implications 

for future public health intervention and clinical efforts. 

Keywords: prevalence, associated factors, hypertension, urban, Afghanistan 

 

Prevalence of hypertension and 

associated factors in Jalalabad City, 

Nangarhar Province, Afghanistan 

Khwaja Mir Islam Saeed 

 
Afghanistan National Public Health Institute, 
Ministry of Public Health, Kabul, Afghanistan 

Research 

Hypertension (HTN) is a global public health 

problem, affecting approximately one billion people 

worldwide, a figure that is predicted to increase to 1.5 

billion by the year 2025.1 The global prevalence of HTN 

is approximately 30% among adults; in developed 

countries, prevalence is beginning to stabilize or 

decrease, while in the developing regions, proportions 

continue to rise (between 20-50%).2,3 HTN is a global 

problem with some of the commen risk factors reported 

in the litearature being genetics, family history, advanced 

age, race, obesity, physical inactivity, lifestyle, cigarette 

smoking, excessive salt and alcohol intake, and dietary 

habits.4-7 HTN prevalence has been reported to be 15-

35% in Asia,8 20-33% in Africa,9 18-22% in the USA,10 

44% in some European countries,10 44% in Turkey,4 

26.3% in Egypt,11 32.2% in India,12 and 32.1% in Qatar.13 

In the Eastern Mediterranean Region (EMR), the 

prevalence of HTN has been estimated to be 29%, 

affecting approximately 125 million individuals.14 

In Afghanistan, due to years of war and conflict, 

few studies have been conducted to estimate the burden 

of hypertension. According to our previously published 

study of chronic disease risk factors in Kabul, in a sample 

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of individuals aged 40+, the overall prevalence of 

obesity, HTN, and diabetes mellitus was 31.2%, 46%, 

and 13.3%, respectively.15 However in neighboring 

countries such as Iran, the overall prevalence of HTN in 

the adult population was 23%, with 50% of those aged  

>55 years affected.16 Previously published research from 

Pakistan reported an overall prevalence of HTN of 26% 

which diffiered by 34% among males and 24% in 

females.17 

According to anecdotal reports from clinicians 

in Kabul, the number of people with HTN is increasing.  

In addition, the recent Afghan Mortality Survey (AMS 

2010) survey indicated that 35% of all-cause mortality in 

Afghanistan is due to non-communicable disease, 

particularly cardiovascular disease and cancer.18 As of 

2014, Afghanistan suffers from lack of reliable 

information on the burden of non-communicable disease, 

including HTN, due to the fact that high priority is given 

to the investigation of infectious diseases. The purpose of 

this study is to estimate the burden of HTN and 

associated risk factors among the adult population in 

Afghanistan’s eastern city, Jalalabad. This information is 

essential to provide evidence to support strategic 

decisions such as resource allocation and public health 

interventions to reduce risk factors and decrease the 

burden of disease.  

 

Methods and Materials 

We conducted a cross-sectional study using the 

World Health Organization STEPwise approach to 

surveillance (WHO STEPS)19 to estimate the prevalence 

and factors for non-communicable diseases in Jalalabad 

city, Afghanistan. STEPS was initiated by the WHO to 

establish the surveillance of risk factors for non-

communicable diseases. The survey tool collects 

information on behavioral, physical and biochemical 

measurements as a part of the core, expanded, and 

optional modules.19 Each country can use and modify the 

modules and steps based on their needs.   

Setting 

Jalalabad is a city in the Nangarhar province on 

the eastern border of Afghanistan. Five districts were 

selected for assessment while one was excluded due to 

safety concerns. Inclusion criteria included: ages 25-64 

(adult population, as outlined in WHO survey tool), city 

residents during study period, and consent to participate. 

Exclusion criteria included: refusal to participate and 

temporary residency. In addition, all five districts were 

classified into clusters, sub-clusters, target areas, and 

then households. In the series of households, every third 

household and one eligible adult in each household was 

selected for research assessment. The response rate was 

98.5% with a 1.5% refusal to participate. Temporary 

residents (less than six months) and those living in 

institutionalized settings along with unsafe areas were 

excluded from the survey. We excluded temporary 

residents because our goal was to obtain a reliable data 

about permanent residents, not migrant populations.  

 

Population 

Over 60% of the participants were female. Thus, 

we adjusted for sex in our analyses. After informing the 

community representatives, we approached all four 

clusters (A, B, C, D) and 20 sub-clusters of EPI, 

including five city districts, to obtain the target 

population. Our primary sampling unit (PSU) was sub-

clusters, secondary sampling units (SSU) were 

streets/areas, tertiary sampling units (TSU) were 

households, and ultimate sampling units (USU) were 

respondents more than 25 years of age in the household. 

The interviewer was instructed to find a the famous 

masjid as a fixed landmark or a very populated street 

within the boundaries of the selected location and 

following the bottle rotating rule to proceed to series of 

households. At last level random selection was carried 

out by writing the name of target members on a separate 

piece of paper and then drawing the names.  

 

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Measures 

As mentioned above, the WHO STEPS was 

used to collect demographic, socio-economic, clinical, 

and behavioral data via face-to-face interviews.  

Weighing scales and tension tape were used to measure 

body weight and height. A body mass index (BMI, 

hereafter reported without units) ≥ 30 kg/m2 were 

considered as obese, 25-29.9 was considered as 

overweight, and 18.5-24.9 was considered normal 

weight.20 A waist circumference ≥ 94 cm for men and 

≥80 cm for women was considered as central obesity.21 

Cuff type sphygmomanometers were used to measure 

systolic and diastolic blood pressure twice with five 

minutes between each measurement at a sitting or lying 

position by our trained surveyors. Systolic blood pressure 

levels ≥ 140 mmHg and diastolic pressure levels ≥ 90 

mmHg were considered hypertensive.22 HTN in this 

study was defined as having a previous diagnosis of HTN 

or having a BP of HTN status. Blood samples were 

collected and processed by lab technicians under 

supervision of lab coordinator. After shipment of samples 

to the Central Public Health Laboratory (CPHL) in 

Kabul, they were stored at -80°C until glucose 

measurement was completed. Close monitoring of all 

study steps by core group of investigator was 

implemented to enhance quality of data at all research 

stages. The study protocol was approved by institutional 

review board (IRB) at the ministry of public health, 

Afghanistan. Informed consent was provided by all study 

participants. 

 

Statistical Considerations 

Data entry was performed using Epi Info 

version 3.5.1.23 Analyses were performed using IBM 

SPSS software version 20.24 As data regarding risk factor 

prevalence in this province were not available, we 

assumed the highest prevalence and 95% confidence 

interval and band of error of 5%. To balance 

considerations of non-response rate, cost, resources, and 

time without compromising the representativeness of the 

sample, a two-phase cluster sampling technique was 

used. The sample size was calculated to be able to 

determine the effect of risk factors on non-communicable 

diseases. The resulting sample size was 1,200.  Data were 

collected May-June 2013. Participants with missing data 

for blood pressure were excluded from the final analysis, 

which incorporated 1,180 participants. Pregnant women 

were also excluded from obesity-related analyses. 

Logistic regression was used to examine the association 

of relevant variables adusting for all other vaiables and to 

calculate the adjusted odds ratio (AOR). 

 

Results 

Descriptive Analysis: 

The average age this sample was 39.16 ± 11.5 

years. The overall prevalence of HTN was 28.4% among 

age group of 25-65 years. Mean systolic blood pressure 

and standard deviation (SD) was 122 ± 20 mmHg and 

ranged from 70 to 220 mmHg. Mean diastolic blood 

pressure was 79 ± 13 mmHg and ranged from 40 to 130 

mmHg.  

Overall, 4% of hypertensive participants were 

previously diagnosed or were under treatment for HTN, 

which is very low and could be due to latent HTN or 

asymptomatic HTN. More than half (66.9%) were 

illiterate and 66.2% had income of less than 10,000 AFN 

(200USD) per month (Refer to Table 1 for details on 

demographic variables).  

 

Table 1: Participant characteristics among those surveyed 

using the WHO STEPS in Jalalabad, Nangarhar, 

Afghanistan 

 

The mean height, weight and waist 

circumference were 161.4 cm, 69.3 Kg and 85.4 cm 

respectively. The mean and SD of body mass index was 

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26.8 ± 6.8 Kg/m2. Descriptive statistics demonstrated that 

7.6% of respondents were current smoker and on average 

they smoked 12 cigarettes daily. 13.3% were mouth snuff 

users which are almost double of cigarettes smoker.  

Around 54% of study participants were using solid oil in 

their kitchen for cooking. As we had data on number of 

days per week that research participants consumed fruit 

(average number of fruit servings per day), these data 

were categorized dichotomous by cut of three days per 

week. Data shows 65% of participants were consuming 

fresh fruits less than three days per week as compared to 

27% who were consuming fruits more than three days per 

week. These variables have been described in Table 2.  

 

Table 2: Distribution of behavioral risk factors among 

those surveyed using the WHO STEPS in Jalalabad, 

Nangarhar, Afghanistan 

 

The study demonstrates that 32% of respondents 

were employed at jobs that required high level of 

physical activity and 49% moderate physical activity. 

Farmers, workers and business were categorized as high 

physical work and the office related jobs categorized low 

physical group. The proportions of pathophysiological 

factors potentially associated with HTN were diabetes 

(11%), overweight (30%), obesity (23%), and central 

obesity (50%). The biochemical measurements findings 

shows the mean and SD total triglycerides, cholesterol, 

HDL, LDL and fasting blood sugar were 187.5 ± 76.5, 

198.5 ± 42, 39.16 ± 8, 122.3 ± 41.6, and 92.3 ± 39.5 

mg/DL, respectively.  

 

Inferential Analysis:  

According to bivariate analysis, hypertensive 

status increased incrementally with age with highest 

prevalence in age group of 45-55 years old (Table 3).  

 

Table 3: Bivariate analysis of bio demographic and socio-

economic factors and hypertension among those 

surveyed using the WHO STEPS in Jalalabad, 

Nangarhar, Afghanistan 

 

There was a significant association between 

HTN and sex; females were two times more likely to be 

affected by HTN than males. In terms of education status, 

those who were illiterate were 1.3 times (95% CI: 1.01 – 

1.76) at greater risk for developing HTN. We found 

significant associations between the level of income and 

proxies of physical activities with hypertension. Smoking 

habits, mouth snuff use and diet were associated with 

HTN but it was not statistically significant. Overweight 

and obesity were significantly associated with HTN 

(overweight OR = 2.52, 95% CI: 1.28 – 4.98), (obesity 

OR = 4.55, 95% CI: 2.30 – 8.99). Those who were HTN 

had 2.32 (95% CI: 1.61 – 3.36) times higher odds of 

being diabetic compared with normal blood pressure. We 

did not find any significant relationship between level of 

blood lipids and HTN (Table 4).  

 

Table 4: Bivariate analysis of pathophysiologic factors 

and hypertension among those surveyed using the WHO 

STEPS in Jalalabad, Nangarhar, Afghanistan 

 

Multivariate analysis (Table 5) demonstrated 

that older age (AOR = 3.42, 95% CI: 2.50 – 4.76), sex 

(AOR = 0.58, 95% CI: 0.38 – 0.88), physically 

demanding jobs (AOR = 0.55, 95% CI: 0.36 – 0.85), 

general obesity (AOR = 2.1, 95% CI: 2.11 – 2.94), 

diabetic status (AOR = 1.75, 95% CI: 1.10 – 2.97), 

physical activity (AOR = 0.69, 95% CI: 0.47 – 0.99), and 

consuming more vegetables (AOR = 0.38, 95% CI: 0.38 

– 0.93) were independently associated with HTN. Sex 

was not associated with HTN. 

 

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Table 5: Multivariable analysis of risk factors and 

hypertension among those surveyed using the WHO 

STEPS in Jalalabad, Nangarhar, Afghanistan 

 

Discussion 

This is one of the few published studies on HTN 

prevalence in Afghanistan. Our findings suggest that 

HTN, which affected one third of this sample, is a 

growing public health challenge in the urban setting of 

Jalalabad. However, comparing with other regions, it was 

lower than in Kabul, the capital of the country.15-17  

Almost 60% of the study participants were 

female compare to 49% in general population. The main 

reason for this difference was employment of men 

outside the house during day time and not available for 

study assessment. Females were at higher risk of HTN, a 

finding that other investigations support.17,25 This 

disparity may be explained by females engaging in less 

physical activities at home or evidencing higher 

proportions of obesity; however additional studies are 

needed to test this hypothesis. Health care systems should 

be strengthened so they have the capacity for early 

detection and the means for effective treatment of those 

affected with HTN.  

Results shows 7.6% of respondents were 

smoking currently daily while double of that were mouth 

snuff users.  It could be due to low cost of snuff as 

compare to cigarettes. The saturated (solid) ghee for 

kitchen considered a risk factor for HTN and obesity 

while the unsaturated (liquid) ghee was considered to 

have lower risk. Physical activity and diet rich in 

vegetables were protective factors against HTN in this 

study. These findings have been corroborated by other 

authors exploring hypertensive disease in various parts of 

the world.13,26 In addition, obesity and diabetes were 

found to be the independent risk factors for HTN in this 

study, which is supported by previously published 

studies.27-29  

Based on this study, a baseline understanding of 

HTN prevalence in the region could be established for 

Jalalabad city, while further studies and public health 

programs can be established to compare rates in other 

geographic settings and evaluate interventions. 

Screening individuals over the age of 40, particularly for 

females, is recommended based on findings of this study 

for urban settings of Afghanistan. Policy changes are 

essential to reduce risk of HTN in various populations 

within Afghanistan, including public education to 

improve dietary habits and enhance physical activity. 

Furthermore, prevention strategies should focus on risk 

factors for metabolic syndrome, such as obesity and 

diabetes. Due to the government’s focus on 

communicable diseases, lesser emphasis is given to non-

communicable disease such as HTN.30 Recently, the 

national strategy for non-communicable diseases has 

been finalized in the country.31 Therefore, prevention and 

control of HTN needs political will, combined with 

community support and behavioral change on the part of 

the individuals and their families.  

 

Competing interests 

The author declares that he has no competing 

interests. 

 

Acknowledgement 

I would like to thank Afghan National Public 

Health Institute at Ministry of Public Health and World 

Health Organization for technical and financial support 

as well as surveillance staff for data collection and 

management in the field.  

 

  

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31. Ministry of Public Health Afghanistan. National strategy for 

prevention and control of noncommunicable diseases (NCDs) 

2013-2018. 2013; http://www.iccp-

portal.org/sites/default/files/plans/NCDStrategy_Draft_Final_fro

m%20Af%20MoH.pdf. 

 

  

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http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/223546-1296680097256/7707437-1296680114157/NCD_AF_Policy_Feb_2011.pdf
http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/223546-1296680097256/7707437-1296680114157/NCD_AF_Policy_Feb_2011.pdf
http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/223546-1296680097256/7707437-1296680114157/NCD_AF_Policy_Feb_2011.pdf
http://www.iccp-portal.org/sites/default/files/plans/NCDStrategy_Draft_Final_from%20Af%20MoH.pdf
http://www.iccp-portal.org/sites/default/files/plans/NCDStrategy_Draft_Final_from%20Af%20MoH.pdf
http://www.iccp-portal.org/sites/default/files/plans/NCDStrategy_Draft_Final_from%20Af%20MoH.pdf


 

 

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Table 1: Participant characteristics among those surveyed using the WHO STEPS in Jalalabad, 

Nangarhar, Afghanistan 

Variables Categories 

Un-weighted Weighted 

N % N % 

Age 

  25 - 34 445 37.7 450 38.2 

  35 - 44 305 25.8 281 23.9 

  45 - 54 207 17.5 211 17.9 

  54 and over 128 10.8 144 12.3 

  Missing 95 8.1 91 7.7 

Sex 

  Female 579 49.1 715 60.6 

  Male 600 50.9 465 39.4 

Level of education  

  Illiterate 841 71.3 779 66.9 

  Primary/Unofficial Education 140 11.9 163 13.8 

  Secondary School 135 11.4 158 13.4 

  University and more 53 4.5 65 5.5 

  Missing 11 0.9 13 1.1 

Residence 

  District 1 176 14.9 196 16.7 

  District 2 163 13.8 138 11.8 

  District 3 299 25.3 275 23.3 

  District 4 302 25.6 354 30.1 

  District 5 240 20.3 214 18.1 

Work status 

  Official Employee 109 9.2 131 11.2 

  Business 78 6.6 101 8.6 

  Farmer/worker 222 18.8 287 24.5 

  Homemaker 632 53.6 506 43.2 

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Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.134  |  http://cajgh.pitt.edu 

 

 

  Unable to work/retired 80 6.8 102 8.7 

  Refused 54 4.6 45 3.9 

  Missing 5 0.4 5 0.4 

Monthly income (Afghanis)  

  ≤ 10,000 698 59.2 736 62.5 

  10,000 – 20,000 41 3.5 42 3.6 

  ≥ 20,000 42 3.6 34 2.9 

  Refused 398 33.7 363 30.9 

  Missing 1 0.1 1 0.1 

Marital status 

  Single 88 7.5 95 8.1 

  Married 1,039 88.1 1,036 88 

  Widow/widower 44 3.7 38 3.2 

  Refused 9 0.8 8 0.7 

 

  

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Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.134  |  http://cajgh.pitt.edu 

  

 

Table 2: Frequency distribution of behavior risk factors of those surveyed using the WHO 

STEPS in Jalalabad, Nangarhar, Afghanistan 

Variables Categories Female (%) Male (%) Total (%) 

Smoking status* 

 No 535 (51.3) 507 (48.7) 1,042 (92%) 

 Yes 1 (1.1) 89 (98.9) 92 (8.0) 

Smoking duration in years 

 < 10 years 0 (0.0) 58 (100.0) 58 (43.3) 

 10 – 20 years 3 (6.1) 46 (93.9) 49 (36.6) 

 > 20 years 0 (0.0) 27 (100.0) 27 (20.1) 

Mouth snuff use* 

 No 536 (54.6) 446 (45.4) 982 (86.2) 

 Yes 3 (1.9) 154 (98.1) 157 (13.8) 

Fruit servings consumed in days per week* 

 ≤ 3 days 399 (52.2) 366 (47.8) 765 (70.2) 

 > 3 days 143 (44.1) 181 (55.9) 324 (29.8) 

Vegetable servings consumed in days per week* 

 ≤ 3 days 150 (65.2) 80 (34.8) 230 (19.7) 

 > 3 days 418 (44.7) 517 (55.3) 935 (80.3) 

Type of kitchen oil used* 

 Liquid 365 (77.8) 104 (22.2) 469 (42.1) 

 Solid 170 (26.4) 475 (73.6) 645 (57.9) 

Vigorous physical activity* 

 No 305 (40.6) 446 (59.4) 751 (66.8) 

 Yes 223 (59.6) 151 (40.4) 374 (33.2) 

Moderate physical activity* 

 No 190 (44.2) 240 (55.8) 430 (42.4) 

 Yes 326 (55.9) 257 (44.1) 583 (57.6) 

Pedal or bicycle for 10 minutes daily* 

 No 498 (67.1) 244 (32.9) 742 (66.5) 

 Yes 23 (6.1) 351 (93.9) 374 (33.5) 

Sitting in hours per day 

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Central Asian Journal of Global Health 

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 ≤ 3 hours 296 (45.7) 352 (54.3) 648 (64.9) 

 > 3 hours 145 (41.3) 206 (58.7) 351 (35.1) 

Note. *marks a significant difference between males and females p < 0.05 

 

  

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Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.134  |  http://cajgh.pitt.edu 

  

 

Table 3: Bivariate analysis of bio demographic and socio-economic factors and hypertension 

among those surveyed using the WHO STEPS in Jalalabad, Nangarhar, Afghanistan 

Variables Categories Hypertensive Normotensive Odds Ratio 95% CI 

Age 

 25 - 34 72 (16.0) 379 (84.0) 1 Reference 

 35 - 44 85 (30.1) 197 (69.9) 2.28 1.59 - 3.26 

 45 - 54 97 (46.0) 114 (54.0) 4.46 3.08 - 6.46 

 55 and over 62 (43.1) 82 (56.9) 4 2.64 - 6.06 

Sex 

 Female 207 (35.7) 373 (64.3) 1 Reference 

 Male 128 (21.3) 472 (78.7) 2.05 1.58 - 2.65 

Level of education 

 Illiterate 237 (30.3) 546 (69.7) 1 Reference 

 Literate 94 (24.5) 289 (75.5) 1.33 1.01 - 1.76 

Monthly income (Afghanis) 

 ≤ 10,000 192 (26.1) 544 (73.9) 1 Reference 

 > 10,000 34 (44.7) 42 (55.3) 0.44 0.27 - 0.70 

Smoking 

 No 289 (27.7) 754 (72.3) 1 Reference 

 Yes 19 (21.1) 71 (78.9) 1.43 0.85 - 2.42 

Fruit servings consumed in days per week 

 ≤ 3 days 214 (28.0) 551 (72.0) 1 Reference 

 > 3 days 88 (27.2) 236 (72.8) 1.04 0.78 - 1.40 

Vegetable servings consumed days per week 

 ≤ 3 days 67 (29.1) 163 (70.9) 1 Reference 

 > 3 days 264 (28.2) 671 (71.8) 1.04 0.76 - 1.44 

Type of kitchen oil  

 Liquid 156 (33.3) 313 (66.7) 1 Reference 

 Solid 156 (24.2) 489 (75.8) 1.76 1.31 - 2.37 

Vigorous physical activity 

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Central Asian Journal of Global Health 

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 No 231 (30.8) 520 (69.2) 1 Reference 

 Yes 75 (20.1) 298 (79.9) 1.04 0.78 - 1.40 

Moderate physical activity  

 No 145 (33.7) 285 (66.3) 1 Reference 

 Yes 133 (22.8) 450 (77.2) 1.72 1.30 - 2.27 

Sitting in hours per day  

 ≤ 3 hours 164 (25.3) 483 (74.7) 1 Reference 

 > 3 hours 113 (32.1) 239 (67.9) 0.72 0.54 - 0.95 

 

  

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Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.134  |  http://cajgh.pitt.edu 

  

 

Table 4: Bivariate analysis of pathophysiologic factors and hypertension among those 

surveyed using the WHO STEPS in Jalalabad, Nangarhar, Afghanistan 

Variables Categories Hypertensive Normal Odds Ratio 95% CI 

Basic mass index  

  Underweight 11 (14.3) 66 (85.7) 1 Reference 

  Normal weight  74 (18.9) 317 (81.1) 1.4 0.70 - 2.79 

  Overweight 105 (29.6) 250 (70.4) 2.52 1.28 - 4.98 

  Obese 119 (43.1) 157 (56.9) 4.55 2.30 - 8.99 

Central obesity 

  No 86 (19.1) 365 (80.9) 1 Reference 

  Yes 214 (35.7) 385 (64.3) 0.42 0.32 - 0.57 

Diabetes mellitus  

  Diabetic 61 (45.5) 73 (54.5) 1 Reference 

  No diabetic 270 (26.4) 752 (73.6) 2.32 1.61 - 3.36 

Total cholesterol  

  <190 mg/dL 142 (26.1) 402 (73.9) 1 Reference 

  ≥190 mg/dL 189 (30.9) 422 (69.1) 0.8 0.61 - 1.02 

Low density lipoprotein (LDL) 

  <100 mg/dL 87 (30.9) 195 (69.1) 1 Reference 

  ≥100 mg/dL 244 (27.9) 629 (72.1) 1.15 0.86 - 1.54 

High density lipoprotein (HDL) borderline 40 mg/dL for male and 50mg/dL for female  

  <40 and 50mg/dL  264 (28.5) 661 (71.5) 1 Reference 

  ≥40 and 50mg/dL 70 (27.6) 184 (72.40) 1.05 0.77 - 1.43 

Triglycerides 

  <150 mg/dL 95 (26.2) 267 (73.8) 1 Reference 

  ≥150 mg/dL 236 (29.8) 557 (70.2) 0.84 0.63 - 1.11 

 

 

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Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.134  |  http://cajgh.pitt.edu 

 

 

Table 5: Multivariable analysis of risk factors and hypertension among those surveyed 

using the WHO STEPS in Jalalabad, Nangarhar, Afghanistan 

Variables Categories Adjusted Odds Ratio 95% CI p-value 

Age 

 ≤ 40 years 1 Reference - 

 > 40 years 3.42 2.50 - 4.76 <0.01 

Sex 

 Female 1 Reference - 

 Male 0.58 0.38 - 0.88 <0.05 

Job nature 

 Non-physical 1 Reference - 

 Physical 0.55 0.36 - 0.85 <0.01 

Central obesity 

 BMI < 30 1 Reference - 

 BMI ≥ 30 2.1 1.49 - 2.94 < 0.01 

Diabetes mellitus 

 No 1 Reference - 

 Yes 1.75 1.10 - 2.79 < 0.05 

Physical activity 

 No 1 Reference - 

 Yes 0.69 0.47 - 0.99 < 0.05 

Vegetable servings consumed in days per week 

 ≤ 3 days 1 Reference - 

 > 3 days 0.59 0.38 - 0.93 < 0.05 

 

 

 

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