{"id":698,"date":"2026-01-21T04:59:00","date_gmt":"2026-01-21T04:59:00","guid":{"rendered":"https:\/\/academicsociety.org\/actasocialscience\/?p=698"},"modified":"2026-03-10T05:12:04","modified_gmt":"2026-03-10T05:12:04","slug":"determinants-of-hypertension-among-internally-displaced-persons-and-host-communities-in-conflict-affected-southern-kaduna-nigeria-a-comparative-cross-sectional-study","status":"publish","type":"post","link":"https:\/\/academicsociety.org\/actasocialscience\/2026\/01\/21\/determinants-of-hypertension-among-internally-displaced-persons-and-host-communities-in-conflict-affected-southern-kaduna-nigeria-a-comparative-cross-sectional-study\/","title":{"rendered":"Determinants of hypertension among internally displaced persons and host communities in conflict-affected Southern Kaduna, Nigeria: A comparative cross-sectional study\u00a0"},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

Hypertension remains the leading modifiable risk factor for cardiovascular disease and premature mortality globally, accounting for an estimated 10.8 million deaths annually \u200b(1)\u200b. In Nigeria, the burden has reached epidemic proportions, with recent estimates indicating that between 30% and 40% of adults currently live with hypertension\u2014a dramatic increase from less than 10% in 1990 \u200b(1,2)\u200b. This surge positions hypertension as the most widespread non-communicable disease in the country and the primary driver of stroke, heart failure, and chronic kidney disease \u200b(3)\u200b. <\/p>\n\n\n\n

Hypertension, defined as persistently elevated blood pressure, remains the leading modifiable risk factor for cardiovascular disease, stroke, and chronic kidney disease globally. The condition is typically diagnosed through screening of asymptomatic individuals, with treatment aimed at reducing the risks of mortality and cardiovascular, renal, and cerebrovascular complications \u200b(4)\u200b. <\/p>\n\n\n\n

Hypertension was defined according to the Seventh Report of the Joint National Committee (JNC 7) criteria as systolic BP \u2265140 mmHg and\/or diastolic BP \u226590 mmHg or current antihypertensive medication use. <\/p>\n\n\n\n

The determinants of hypertension are well-established in stable populations and include non-modifiable factors such as advancing age, male sex, and genetic predisposition, alongside modifiable behavioural and metabolic risks including unhealthy diet, physical inactivity, overweight and obesity, harmful alcohol consumption, and tobacco use \u200b(5)\u200b. Social determinants\u2014education, income, occupation, and access to healthcare\u2014further shape the distribution of these risk factors and ultimately determine who develops hypertension and who dies from its complications \u200b(6)\u200b. <\/p>\n\n\n\n

However, the aetiology of hypertension in conflict-affected populations cannot be fully understood through conventional risk factor frameworks alone. Humanitarian crises inflict severe psychological distress, economic devastation, and social instability that fundamentally alter disease pathways \u200b(7)\u200b. Chronic stress activates the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, leading to sustained elevations in cortisol and catecholamines that promote endothelial dysfunction, arterial stiffness, and sustained blood pressure elevation \u200b(8)\u200b. Among conflict-exposed populations in Northeastern Nigeria, individuals directly affected by insurgency had nearly five times the depression risk (incidence risk ratio = 4.78; 95% CI: 2.51\u20139.22) and nearly double the odds of abdominal obesity (adjusted odds ratio = 1.95; 95% CI: 1.23\u20133.08) compared to those unaffected by violence \u200b(7)\u200b\u2014findings that implicate psychosocial pathways in hypertension development. <\/p>\n\n\n\n

Displacement introduces additional layers of vulnerability. Internally displaced persons (IDPs) lose not only their homes but their livelihoods, social networks, and access to regular healthcare. Research from IDP camps in Benue State demonstrates that distance to health facilities exceeding five kilometres, when combined with insecurity, more than triples access difficulties (OR = 3.17; 95% CI: 2.22\u20134.53), while low education increases the odds of access barriers by 49% \u200b(9)\u200b . These barriers do not merely affect treatment\u2014they shape the entire exposure profile of displaced populations, influencing diet, physical activity, healthcare-seeking behaviour, and ultimately, cardiovascular risk. <\/p>\n\n\n\n

Southern Kaduna, the proposed study setting, represents a region where these intersecting vulnerabilities converge with insufficient empirical investigation. Located in northwestern Nigeria, the area encompassing Kachia, Kajuru, and Chukun Local Government Areas has experienced recurrent ethno-religious and farmer-herder conflicts for decades, producing substantial internal displacement. Demographic data from the State Emergency Management Agency indicates approximately 28,533 displaced adults reside in formal and informal camps across these three LGAs, with women constituting 66.2% of the adult camp population\u2014a demographic distortion reflecting conflict-related male mortality, capture, and labour migration. <\/p>\n\n\n\n

Despite the well-documented association between conflict and cardiovascular risk in other Nigerian regions, the determinants of hypertension in Southern Kaduna remain entirely unexamined. The region differs from the extensively studied Northeast in conflict dynamics, displacement patterns, healthcare infrastructure, and ethnic composition. Whether conventional risk factors operate similarly among displaced and host populations, whether displacement-specific exposures exert independent effects, and whether the relationship between stress and hypertension is modified by displacement status are questions that cannot be answered through extrapolation from other settings. <\/p>\n\n\n\n

The absence of this evidence has profound implications. Without understanding which factors most powerfully shape hypertension risk\u2014and whether these differ between IDPs and their host communities\u2014health authorities cannot design targeted interventions, allocate resources effectively, or address the root causes of cardiovascular disease in this conflict-affected population. Furthermore, the humanitarian imperative demands that we understand not only how many people have hypertension but why, so that interventions address causes rather than merely counting cases. <\/p>\n\n\n\n

This study therefore seeks to identify the determinants of hypertension among internally displaced persons and host community members in three conflict-affected Local Government Areas of Southern Kaduna, examining both conventional risk factors and displacement-specific exposures, and exploring whether the relationship between psychosocial stress and hypertension differs between these populations. <\/p>\n\n\n\n

This study tested three specific hypotheses — H\u2081: Conventional risk factors (age, BMI, salt intake, physical inactivity) are associated with hypertension in both IDPs and host communities, with similar effect sizes. H\u2082: Displacement-specific exposures (duration of displacement, number of displacements, witnessing violence) are independently associated with hypertension among IDPs after adjusting for conventional risk factors. H\u2083: Displacement status modifies the association between perceived stress and hypertension, such that the stress effect is stronger among IDPs than hosts. <\/p>\n\n\n\n

Method<\/strong> <\/p>\n\n\n\n

Research Design<\/strong> <\/p>\n\n\n\n

This study employed a community-based comparative cross-sectional design to identify the determinants of hypertension among internally displaced persons (IDPs) and host community members in conflict-affected areas of Southern Kaduna. The cross-sectional design was selected as it allows for the simultaneous measurement of exposure and outcome variables, enabling the identification of associations between potential determinants and hypertension status at a single point in time. This design is particularly appropriate for generating hypotheses about risk factors and providing prevalence estimates in hard-to-reach humanitarian settings where longitudinal follow-up is logistically challenging. <\/p>\n\n\n\n

The study was part of a larger mixed-methods investigation; however, this paper reports exclusively on the quantitative component addressing the determinants of hypertension. The comparative element\u2014contrasting IDPs with host communities\u2014was integral to the design, allowing examination of whether displacement status modifies the relationship between conventional risk factors and hypertension. <\/p>\n\n\n\n

Study Setting<\/strong> <\/p>\n\n\n\n

The study was conducted in three Local Government Areas (LGAs) of Kaduna State, Northwestern Nigeria: Kachia, Kajuru, and Chukun. These LGAs were purposively selected due to their documented history of protracted ethno-religious and farmer-herder conflicts, which have resulted in substantial internal displacement and the establishment of both formal and informal camps for internally displaced persons. <\/p>\n\n\n\n

According to data obtained from the State Emergency Management Agency (SEMA) and the National Commission for Refugees, Migrants, and Internally Displaced Persons (NCFRMI), the three LGAs collectively host approximately 60,800 displaced persons, of whom 28,533 are adults aged 18 years and above. The demographic distribution of the adult IDP population across the LGAs is as follows: Kajuru hosts the largest displaced population (22,800 adults), followed by Kachia (3,588 adults) and Chukun (2,145 adults). Women constitute 66.2% of the adult IDP population across all camps, reflecting conflict-related male mortality, capture, and labour migration. <\/p>\n\n\n\n

The study communities are predominantly rural with agrarian economies. Health infrastructure is limited to Primary Health Centres (PHCs), many of which are understaffed and experience frequent stock-outs of essential medicines, including antihypertensive drugs. Referral to secondary care requires travel to Kaduna City, hindered by poor road networks and active security concerns. <\/p>\n\n\n\n

Participants<\/strong> <\/p>\n\n\n\n

The target population comprised two distinct groups residing in the three selected LGAs: <\/p>\n\n\n\n

Internally Displaced Persons (IDPs):<\/strong> Adults aged 18 years and above who have been residing in the listed formal or informal camps for at least six months before data collection. This duration criterion was applied to ensure that participants had sufficient exposure to displacement-related conditions to potentially influence their hypertension status. <\/p>\n\n\n\n

Host Community Members (HCs):<\/strong> Adults aged 18 years and above who were indigenes or long-term residents (minimum of five years) living in host communities adjacent to the selected IDP camps. This five-year criterion ensured that hosts had not recently experienced displacement themselves, allowing for a clear distinction between the two comparison groups. <\/p>\n\n\n\n

Inclusion criteria<\/strong> for both groups were: age \u226518 years; willingness to provide informed consent (written or witnessed thumbprint); and for IDPs, registered or de facto residence in one of the specified camps, or for hosts, residence in one of the specified host communities. <\/p>\n\n\n\n

Exclusion criteria<\/strong>: critically ill or mentally incapacitated individuals unable to participate in interviews or physical measurements; “Pregnant women were excluded because: (1) physiological hemodynamic changes of pregnancy alter blood pressure independently of chronic hypertension status; (2) pregnancy-induced hypertension represents a distinct pathological entity with different etiology and risk factors; and (3) including pregnant women would require separate analysis beyond the scope of this study. A separate investigation of hypertension in pregnancy among displaced women is warranted. <\/p>\n\n\n\n

Variables<\/strong> <\/p>\n\n\n\n

Outcome Variable<\/strong> <\/p>\n\n\n\n

The primary outcome variable was hypertension status<\/strong>, defined as: <\/p>\n\n\n\n

An average systolic blood pressure \u2265140 mmHg and\/or diastolic blood pressure \u226590 mmHg based on three consecutive measurements, OR Self-reported current use of antihypertensive medication regardless of measured blood pressure. Blood pressure was treated as a binary outcome (hypertensive vs. normotensive) for primary analysis. <\/p>\n\n\n\n

Exposure Variables (Potential Determinants)<\/strong> <\/p>\n\n\n\n

Exposure variables were selected based on a priori evidence from the literature and organised into four domains: <\/p>\n\n\n\n

Sociodemographic factors:<\/strong> <\/p>\n\n\n\n

Age (continuous, years; also categorised as 18\u201334, 35\u201349, 50\u201364, \u226565), Sex (male\/female), Marital status (married, single, widowed\/divorced), Educational level (none, primary, secondary, tertiary), Occupation (farming, trading, artisan, unemployed, civil service), Monthly income (<\u20a630,000, \u20a630,000\u2013\u20a650,000, >\u20a650,000) and Household size (1\u20134, 5\u20137, \u22658 persons) <\/p>\n\n\n\n

Behavioural factors:<\/strong> <\/p>\n\n\n\n

Smoking status (never, current\/former), Alcohol consumption (never, current), Physical inactivity\u2014defined as <150 minutes of moderate-intensity activity per week or <75 minutes of vigorous-intensity activity per week, measured using the Global Physical Activity Questionnaire (GPAQ), High salt intake\u2014defined as self-reported addition of salt to meals at the table or consumption of processed foods high in salt on most days of the week (World Health Organization, 2023) <\/p>\n\n\n\n

Metabolic factors:<\/strong> <\/p>\n\n\n\n

Body Mass Index (BMI)\u2014calculated as weight (kg)\/height (m\u00b2) and categorised as normal (18.5\u201324.9 kg\/m\u00b2), overweight (25.0\u201329.9 kg\/m\u00b2), or obese (\u226530.0 kg\/m\u00b2). <\/p>\n\n\n\n

Psychosocial factors:<\/strong> <\/p>\n\n\n\n

Perceived stress\u2014measured using the 4-item Perceived Stress Scale (PSS-4), with scores \u22656 categorised as moderate\/high stress, and social support\u2014defined as availability of someone to accompany participant to a clinic if needed (yes\/no) <\/p>\n\n\n\n

Displacement-specific factors (assessed only for IDPs):<\/strong> <\/p>\n\n\n\n

Duration of displacement (<2 years, 2\u20135 years, >5 years), Number of displacements (1, \u22652), Loss of property\/assets during conflict (yes\/no) and Witnessing violence during conflict (yes\/no) <\/p>\n\n\n\n

Clinical Management Protocol: <\/strong>Participants with average BP \u2265160\/100 mmHg or symptomatic hypertension were referred immediately to the nearest Primary Health Centre with a referral note. All participants received health education about hypertension and were provided with their BP readings. Newly diagnosed hypertensives were given information about free screening services available at PHCs. <\/p>\n\n\n\n

Sample Size and Sampling Technique<\/strong> <\/p>\n\n\n\n

 Sample Size Determination<\/strong> <\/p>\n\n\n\n

Sample size was calculated using the standard formula for comparing two independent proportions. <\/p>\n\n\n\n

n = (Z\u03b1\/2 + Z\u03b2)\u00b2 \u00d7 [p\u2081(1\u2212p\u2081) + p\u2082(1\u2212p\u2082)] \/ (p\u2081\u2212p\u2082)\u00b2 <\/p>\n\n\n\n

Where: <\/p>\n\n\n\n