Background: Hypertension and diabetes are among the most common diseases in the Western world and Haiti is no exception. The World Health Organization estimates that forty-six percent of adults with hypertension are unaware of this condition.

Purpose of this study: This survey aimed at studying the prevalence of hypertension and diabetes in a rural section of La Vallee de Jacmel where HAPI is currently establishing a Healthy Heart Program like the one PSI and Aztraneca have in Africa.

Methods: The authors used a suitability sample of 400 people in 400 households.

Results: The prevalence was 45 to 55% for hypertension and around 5% for diabetes.

Conclusion: It is urgent to establish a national program to combat hypertension and diabetes in Haiti.

The study define hypertension and diabetes as blood pressure greater than or equal ( ≥ ) to 140/90 mm Hg [1] and fasting or a random blood sugar test respectively over or equal to 126 and 200 mg/dl [2]. These two diseases are leading risk factors for severe cardiovascular disease and are prevalent comorbidities with significant overlap for underlying risk factors like ethnicity, familial, dyslipidemia, and lifestyle determinants [3]. Both diseases can negatively affect the heart, the kidney, and the brain by causing myocardial infarction, congestive heart failure, stroke, and renal insufficiency. These are among the most important risk factors for heart problems. Practicing healthy lifestyle strategies like daily physical activity, weight control, a heart- healthy diet, or medications can prevent or at least postpone heart diseases.

Hypertension and diabetes are among the most common diseases in the Western world and Haiti is no exception. The World Health Organization estimates that forty-six percent of adults with hypertension are unaware of this condition and that the prevalence of this disease is 27% in Africa and 18% in the region of the Americas [4]. In Haiti, the prevalence of hypertension varies among the studies researchers identified. It ranges from 20% [5] to 36% [6] and exceeds 40% in some studies [7]. The worldwide estimates of the age-adjusted comparative prevalence of diabetes for people 20-79 years old was around 9.8% in 2021 [8]. In Haiti, diabetes was around 5% in a cross-sectional study conducted in 2022 [9]. Another study confirmed a national prevalence of around 7% [10] in 2021.

The authors survey aimed at studying the prevalence of hypertension and diabetes in Southeast Haiti, particularly in ten localities of Musac, a rural section of La Vallee de Jacmel, where HAPI is currently establishing a "Healthy Heart Program" similar to the ones AstraZeneca and Population Services International have in Africa [11]. The survey also looked at the daily use of salt and sugar in meals.

An excerpt of a map of La Vallée-de-Jacmel, Haiti [12] where Musac is located-not all 10 localities are indicated on this map. The researchers carried out a community-based survey at Musac during January 2023. In oral communication with community leaders, authors learned Musac has a population range varying between 18,000 to 35,000 people, among them approximately 1,800 to 3,500 elderly people (ages 55 to 65+) comprising around 10% of the population [13]. No accurate census exists due in part to residents frequent internal and external migration. The researchers cohort consisted of all persons aged 18 years and above residing in Musac for more than 3 months before the survey. The authors used a suitability sample of 400 people in 400 households. Where health care is established, researchers chose the closest households to the health center. In the other nine localities, estimated at a radius of an average walking distance of 30 minutes from the health center, researchers chose households closest to the main road. Forty individuals in 40 households were surveyed in each of the ten localities. In each household, the surveyor interviewed either a young person or an adult older than fifty. If a young person was interviewed in household one, a person older than 50 was included in the next household. If no adults over 50 years were found in the two closest households, the surveyor equilibrated the survey with two adults greater than 50 years old as soon as the nurse saw them in another household. People who were very ill or could not communicate clearly were excluded from the sample. The authors administered a structured questionnaire of 20 questions about socioeconomic variables, hypertension, and diabetes risk factors, taking drugs daily for those diseases, exercises, eating habits and previous hospital stays for diabetes or hypertension.

Among the parameters included in the questionnaire, researchers measured blood glucose and high blood pressure. A result ≥ to 126 mg/dl was considered "abnormal" at the time of the survey for fasting patients and to 200 mg/dl if the patient ate before. The authors surveyors, who were nurses, took blood pressure using digital sphygmomanometers in the sitting position with the left upper arm kept at the level of the heart. Researchers recorded systolic and diastolic blood pressures of three readings at five minutes intervals. The study considered systolic blood pressure of ≥ 140 mm Hg, and a diastolic blood pressure of ≥ 90 mm Hg as "abnormal". The study also defined anyone on antihypertensive or antidiabetic medications as positive for hypertension or diabetes.

As Port-au-Prince was under gang control at the time of conducting this study, researchers could not submit the protocol to the ethics committee of the Haitian Ministry of Health for clearance. The study asked for informed written consent from all the subjects.

Figure 1: Mu sac Map-Hamlet-Haiti.

As authors used a convenient sample, no statistical analysis was done. The researchers only made univariate and bivariate analysis. The study interviewed 142 (35.5%) men and 258 (64.5%) women. 154 (38.5%) were less than 50 years old. 246 (61.5%) were above 50 years. Table 1 shows demographic variables.

Table 1: Demographic variables.

Table 2 shows the results for fasting and 2-hour postprandial glucose.

Around one participant in twenty (5%) had a fasting glucose greater than 126 mg/dl. Sugar and salt are used on a daily basis.

Table 2: Fasting and postprandial glucose-including use of sugar and salt.

Table 3 shows that the percentage of patients with hypertension is almost double in people over 50 years as compared with those who are between 18 and 50. The same statistical results were found for hyperglycemia as illustrated in Table 4. For hypertension, females have a higher rate (51%) than males (40%).

Table 3: Percentage of patients with hypertension.

Table 4: Percentage of patients with hyperglycemia.

This study consisted of a 5-day survey to get an idea of the burden that Hypertension and Diabetes has in ten localities of Musac. The sample being a convenient one, researchers cannot extrapolate precise results. In comparison to many other local studies, authors found similar results for the prevalence of hypertension and diabetes in Haiti [9,14]. The same goes for the percentage of women in researchers’ sample who have hypertension, which is concordant with other studies [14,15]. Research carried out by the Department of Nursing, Daegu University study found elevated fasting and postprandial blood glucose readings in 4.5% and 3.5% of the participants. These numbers are also close to the results of author’s study. Risk factors like salt and sugar in meals need careful attention as almost all the participants use them on a daily basis. Although it is difficult to quantify those parameters, evidence-based medicine confirmed researchers have a significant role in the development of hypertension and diabetes. Because behavior is difficult to change on a case-by-case basis, it might benefit medical intervention to include community outreach in preexisting social organizations.

It is also noteworthy to underscore that 98% percent of the participants were Christians, which means churches could be useful partners in preventing diabetes and hypertension in Musac. These findings could help to define hypertension and diabetes control strategies not only in Musac but also in other areas of Haiti. As many Haitians are living in the United States and as Haiti shares the same island with the Dominican Republic, authors compared results with studies conducted on the prevalence of diabetes and hypertension in those countries. In a study of a convenient sample of Haitian Americans in New York and Florida [16], Bivins et al. found an age-adjusted prevalence of diabetes mellitus of 39.9% (CI 29.8-50.1%), which is eight to ten times higher than the prevalence for Haitians living in Haiti. In the Dominican Republic, a prevalence rate of 8.6% for diabetes was found among agricultural residents [17. For hypertension, the Dominican Republic has a prevalence of around 35% [18], which is in the same range as the data found by studies made in Haiti.

The study should be seen as an overview estimating the prevalence of hypertension and diabetes-and risk factors associated with these diseases-in Musac and probably in other rural areas of the Southeast regions of Haiti. Unfortunately, for cultural reasons, authors surveyors did not take the weight of the participants to see if being overweight was an issue. Another weakness is the fact that a convenient sample does not reflect the totality of the situation at the community level.

However, research limitations aside, having similar results as other studies is surely intriguing. Financial and technical support from donors, and local and foreign universities to develop rigorous studies on the burden of hypertension and diabetes in Haiti will tell us if what authors are seeing is only the tip of the iceberg or the reality.

Evidence shows that hypertension and diabetes are becoming “epidemic” in many countries. An astounding 45% of those (over 50 years of age) who were evaluated in researchers study were found to be hypertensive, and over 5% fall into the diabetic range. Haitian technical and political leaders need to support research in the field for a better understanding of the burden of these diseases, and their impact on the social and economic life of the population. Targeting the health of females of all ages and males over age 50 should be a key strategy. Improvements will surely require a multi-sectoral approach involving churches and community leaders, public health institutions, and social influencers. By working together, authors will significantly increase the probability of preventing premature and unnecessary deaths from these two harmful conditions. Local control programs to combat diabetes and hypertension in Haiti need to be established with no delay.

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12. Mapcarta Map from Open Data Commons Open Database License Based on Data from Openstreetmap Contributors (ID Node 617870799), Geonames Contributors (ID 3720384), Wikidata Contributors and Wikimedia Commons Contributors. Musac Map-Hamlet-Haiti. 2023.

13. Haiti Statistics-Haiti Partners. 2023.

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