A systematic review and meta-analysis of the Ethiopian cohort of adult hypertensive people's adherence to healthy behaviors

BACKGROUND: Adherence to healthy behavior has become increasingly important in recent years for better blood pressure management. For the management and prevention of hypertension, it is a strong recommendation. But there have been a number of observational studies conducted in Ethiopia on hypertensive people's healthy lifestyle choices. An extensive review, however, that would have provided even a sliver of supporting data for developing an intervention, is missing. The purpose of this review and meta-analysis was to fill in this gap. METHODS: The meta-analysis of an observational study was followed by a systematic review. Searches and extracts from the databases CINAHL (EBSCO), MEDLINE (via Ovid), PubMed, EmCare, and Google Scholar have been conducted by three reviewers. Only studies with low and moderate risk were included in the analysis after the quality of the articles was evaluated by two independent reviewers using the Newcastle-Ottawa Scale. After accounting for heterogeneity and publication bias, this study presented the estimated overall and six major domains of adherence to healthy behaviors among hypertensive adult individuals. The PROSPERO database had this systematic review registered under protocol number CRD 42020206150. RESULTS: The overall estimated adherence to healthy lifestyle habits among Ethiopian hypertensive adult individuals was 42.45% (95% CI: 33.51–51.38, I(2) = 95.2%). We also investigate the adherence of major domains of healthy behaviors, such as the estimated healthy dietary adherence: 50.86% (95% CI: 39.61–62.11%), the estimated adherence to physical activity: 48.74% (95% CI: 36.60–60.96), and the estimated adherence to sodium intake: 51.79% (95% CI: 36.77–66.8). The following variables were statistically significant predictors of adherence to the overall health behavior: education level (Pooled Odds Ratio (POR): 2.8; 95% CI: 1.98–3.63, I(2) = 0.0%), duration of hypertension (POR: 3.1; 95% CI: 1.80–4.32, I(2) = 0.0%), and hypertensive people who was knowledgeable of hypertension (POR: 6.8; 95% CI: 1.05–12.58, I(2) = 89.3%). CONCLUSIONS: Less than half of the hypertension population in Ethiopia had healthy lifestyle behaviors. A low percentage of hypertensive adults also had adhered to salt (sodium) intake, physical activity, and weight management. So, intervention programs should focus on the health faithfulness of the specific section of adherence to healthy lifestyle practice according to recommended lifestyle practice guidelines.