Kathmandu University Medical Journal (2007), Vol. 5, No. 2, Issue 18, 273-278
Knowledge about heart attack and hypertension among individuals
attending a cardiac camp in Pokhara city
Shankar PR1, Partha P2, Shenoy N3, Chandrasekhar TS4, Dubey AK5
1,5Department of Pharmacology, 2Formerly Department of Medicine, 3Department of Pharmacy, 4Department of
Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal
Objectives: Previous studies in other countries had shown lacunae in patients’ and general publics’ understanding of
cardiovascular diseases. Such studies are lacking in Nepal. Hence the present study was carried out to: a) note the
respondent’s knowledge regarding myocardial infarction and hypertension and b) note the association, if any, of the
knowledge with demographic and personal characteristics.
Materials and methods: Respondents attending a cardiac camp organized in the Manipal Teaching hospital during
September 2002 were interviewed by previously briefed seventh semester students using a structured questionnaire.
Basic demographic information and knowledge about myocardial infarction and hypertension was collected. The
median score was calculated. Differences in scores among different subgroups of respondents were noted using
appropriate statistical tests (p<0.05).
Results: Sixty-six respondents were interviewed; 44 were male. The knowledge scores for heart attack and
hypertension were 6 (maximum score 8) and 11 (maximum score 14) respectively. The scores were significantly
lower among respondents with a monthly family income below 2000 rupees and was higher among
respondents/family members suffering from cardiovascular disease.
Conclusion: The respondents were aware of the basic facts regarding myocardial infarction and hypertension.
However, lacunae in knowledge were noted. Further studies are required.
Key words: Hypertension, Knowledge, Myocardial infarction, Nepal
he World Health Organization (WHO) currently
study.6 Better patient knowledge has been shown to
T tributes one-third of all global deaths (15.3
be associated with improved adherence to lifestyle
million) to cardiovascular diseases (CVD).1 In the
changes and medication in a Swedish study.7
South-East Asia region (SEAR) CVD accounts for
29% of all deaths and 11% of disease burden.2
Studies on the knowledge of the general population
about heart attack and hypertension are lacking in
In Nepal, it is estimated that 5.6% of people living in
Nepal. This knowledge may be important for both
the mountains, 1.5% in the hills and 5% of people in
disease prevention and management. Hence the
the terai region suffer from CVD.2 Five to 20% of
present study was carried out among individuals
adults are reported to suffer from hypertension, with
attending a cardiac camp in Pokhara, Western Nepal.
a lower prevalence in the rural areas.2 The mortality
from coronary artery disease (CAD) and the
prevalence of CAD risk factors is rising rapidly in
Unbalanced diets, obesity, physical inactivity and
tobacco use all contribute to CVD and addressing
these factors can help to stem the epidemic.1 Studies
on recognition by the public of the major signs and
symptoms of a heart attack4 and awareness of and
misconceptions about hypertension have been carried
out in developed countries.5
Manipal College of Medical Sciences
However, patients’ understanding of the prevention
Deep Heights, Pokhara, Nepal.
of CVD was found to be insufficient in a previous
The objectives of the study were to:
individuals had attended the cardiac camp (overall
Collect information on the
response rate 16.2%). Sixteen respondents (24.2%)
demographic and personal
were in the age group 40-50 years while 13 each
characteristics of the (19.7%) were in the age groups 10-20 and 30-40 years
respectively. Twenty-seven respondents (40.9%) had
Note the knowledge of the
five family members staying with them. Twenty-one
respondents about myocardial
respondents (31.8%) were agriculturists while 11
infarction and hypertension and
(16.7%) were students and 14 (21.2%) were
Note the association, if any, of
the knowledge with the
Twelve respondents had come for treatment while 13
had come for screening. The majority had come for
The study was carried out among individuals attending
further information about cardiovascular diseases. The
a cardiac camp organized in Manipal Teaching
source of medical care was the primary health centre
hospital, in September 2002. The respondents willing
(PHC)/health post in 21 respondents (31.8%) and
to participate were interviewed by previously briefed
hospital in 24 respondents (36.4%). The majority of
seventh semester students using a structured
respondents were staying within one hour walking
distance from a health centre or medical store. The
demographic and personal characteristics of the
Information was collected on the age, sex and address
respondents are detailed in Table 1.
of the respondents. The number of family members
staying with the respondent, the place of residence, the
The knowledge score for myocardial infarction was 6
level of education of the respondent and his/her
± 1. The scores for hypertension and the total score
occupation was noted. Information was collected on
were 11 ± 2 and 18 ± 3 respectively. The maximum
whether the respondent or a close family member was
possible scores for myocardial infarction and
suffering from cardiac disease and if yes, the name of
hypertension were 8 and 14 respectively. The median
the disease. The purpose of attending the cardiac camp
knowledge score for heart attack among residents of
and whether the respondent had attended a similar
Pokhara city was significantly lower compared to
program previously was noted. The source of medical
others. The knowledge scores for hypertension and the
care and the distance from the nearest health centre
total score was significantly lower among respondents
and medical store in minutes of walking was looked
with a monthly family income less than 2000 rupees.
into. The questionnaire used is shown in the
The median scores of hypertension and the total
knowledge score were significantly higher among
respondents with heart disease or a close family
Knowledge regarding heart attack and hypertension
member suffering from heart disease (p = 0.021, p =
was noted using a set of multiple responses and yes/no
0.020). The median total score according to selected
type questions. The median scores were calculated for
demographic and personal characteristics of
heart attack, hypertension and for both together. The
respondents are shown in Table 2.
median score among different subgroups of
respondents were compared using Mann-Whitney U
The common heart diseases noted in decreasing order
test for dichotomous variables and Kruskal-Wallis test
of frequency among the respondents/family members
for the others (p<0.05). The respondent was asked to
were hypertension, heart failure, rheumatic heart
name his/her major sources of information about heart
disease and congenital heart disease. Doctors in
hospital and health personnel in PHC/health posts
were the commonest source of information about heart
disease. Other sources were radio and magazines.
A total of 66 respondents were willing to participate in
the study and were interviewed. A total of 406
Table 1: Demographic and personal characteristics of respondents
Place of Pokhara city
residence Kaski district
status Primary school
Monthly family <2000
income (Nepalese 2000-4000
Self or family Yes
suffering from No
Purpose of attending Treatment
Attended similar Yes
camps before No
Distance from <10
health centre 10-30
(minutes of 30-60
Distance from <10
medical store 10-30
(minutes of 30-60
Table 2: Median total knowledge score according to selected demographic characteristics of respondents
Score (median ± interquartile
Address Pokhara city
17 ± 7
16 ± 3
18 ± 3
16 ± 6.5
18 ± 2
18 ± 5
18 ± 3
16 ± 6.5
The number of male respondents was 44 (66.7%). In
adult, 54 respondents (81.8%) could not name an
a previous study, 52.9% of respondents were male.8
allopathic antihypertensive. In a study conducted in
The interviewers in our study were all male.
Brazil, 41% of patients were not able to define
Unwillingness of female respondents to be
hypertension and only 40% said that changes in diet
interviewed by male interviewers was observed in a
and lifestyle are required to control hypertension.12 In
previous study.9 This could have been a reason in the
our study, 43 patients (65.1%) answered the
present study also. In our study, 54.5% of
questions relating to the role of lifestyle modification
respondents stayed within 30 minutes walking
in hypertension correctly.
distance from a health centre or medical store. The
percentage was lower than that reported in previous
The median knowledge score for heart attack was
high. A study in Jordan had concluded that type of
response to chest pain was good but more
Information was not obtained on whether the
improvement was recommended.13 In our study, only
respondents had a nuclear or a joint family structure.
32 respondents (48.5%) were aware of the role of
Sixty respondents (90.9%) were not trained in first
cholesterol in pathogenesis of heart disease. We did
aid or were not aware of the principles of first aid.
not investigate the knowledge of target levels of
More training sessions on first aid should be
cholesterol. In an American study, knowledge of
organized. Doctors in hospital or health personnel in
cholesterol levels and targets in patients with
PHC/health posts were the major sources of
coronary artery disease was poor and cholesterol
information regarding CVD. Sessions informing
education efforts appeared inadequate.14 Better
health personnel on how to provide accurate and
knowledge as already discussed improves adherence
relevant information about CVD may be helpful.
to lifestyle changes and medications.
Respondents could also be made aware of other
sources of information. However, we had not looked
Our study had many limitations. The response rate
at the respondents’ satisfaction with the information
was low The convenience sample may not have been
provided about CVD by health care providers in the
representative of the population. The number of
female respondents was low. Information was
collected using mainly multiple responses and yes/no
In our study the median knowledge score about heart
questions. Only the knowledge was examined and the
attack and hypertension were high. However, the
attitude and practice were not looked into. The
questions asked were fairly basic and the details of
sample size was low.
pathogenesis, preventive measures and lifestyle
modifications were not enquired into. No significant
This preliminary study showed that overall, the
changes in the knowledge score according to gender
respondents were aware of the basic facts regarding
of the respondents were seen. The knowledge scores
heart attack and hypertension. However, more
were lower among respondents staying in Pokhara
detailed studies in the general population are
city. This is contrary to expectations. However, the
required. The results may pinpoint lacunae in
small sample size could have led to errors while
patients’ and lay persons’ knowledge regarding CVD.
doing subgroup analysis. The scores were higher
The attitude and practice regarding CVD can be
among persons suffering from or whose family
examined in future studies. The results will be helpful
members were suffering from heart disease. The
in designing awareness and educational programs
respondents with self/family members suffering from
about CVD for the community.
CVD would have had a strong motivation to know
more about these conditions.
1. Diet, nutrition and the prevention of chronic
Hypertension was the commonest CVD noted. In a
diseases. Report of a joint WHO/FAO expert
study carried out at the Nepal Medical College
consultation. WHO Technical Report Series 916.
teaching hospital (NMCTH) the prevalence of
Geneva: 2003: 81.
hypertension among medical admissions was 9.4%.10
2. World Health Organization Regional Office for
In previous studies in Australia and Canada, lack of
South-East Asia. Health situation in the South-
public awareness and misconceptions about
East Asia region. 1998-2000. New Delhi: 2002.
hypertension and hypertensive complications was
3. Okrainec K, Banerjee DK, Eisenberg MJ.
commonly noted.5,11 In our study, though the total
Coronary artery disease in the developing world.
score was high, 50 respondents (75.5%) were not
Am Heart J 2004;148:7-15.
aware of the normal values of blood pressure in an
4. Greenlund KJ, Keenan NL, Giles WH, Zheng
9. Shankar P, Partha P, Shenoy N. Self-medication
ZJ, Neff LJ, Croft JB, et al. Public recognition of
and non-doctor prescription practices in Pokhara
major signs and symptoms of heart attack:
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seventeen states and the US Virgin Islands. Am
study. BMC Fam Pract 2002; 3: 17.
Heart J 2004; 147: 1010-6.
10. Dhungel S, Shrestha A, Bhattarai P, Paudel B.
5. Petrella RJ, Campbell NR. Awareness and
Study of cases of hypertension admitted at Nepal
misconceptions of hypertension in Canada:
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results of a national survey. Can J Cardiol 2005;
College Journal 2004; 6: 36-8.
11. Taylor C, Ward A. Patients’ views of high blood
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Timmermans D, Vaes J, Stoffers J, Grol R.
Physician 2003; 32: 278-82.
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Peres DS, Magna JM, Viana LA. Arterial
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Better knowledge improves adherence to
13. Al-Safi SA, Alkofahi AS, El-Eid HS. Public
lifestyle changes and medication in patients with
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coronary heart disease. Eur J Cardiovasc Nurs
Cardiovasc Nurs 2005; 49: 139-44.
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14. Cheng S, Lichtman JH, Amatruda JM, Smith
8. Shankar PR, Partha P, Shenoy N. A study on the
GL, Mattera JA, Roumanis SA et al. Knowledge
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of cholesterol levels and targets in patients with
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Knowledge about myocardial infarction and hypertension
Age: Sex: M/F Address:
Urban/rural Number of family members staying with respondent:
Level of education: Uneducated/Primary school/Tenth standard/Graduate/Postgraduate
Occupation: Religion: Monthly family income: <2000/2000-4000/>4000
Whether self or any family member staying with self is suffering from cardiovascular disease: Yes/No
If yes, then name of disease: Purpose of attending the cardiac camp:
Have you attended any similar programmes before? Yes/No Have you been trained in first aid? Yes/no
Source of health care:
Distance from the nearest health centre in mins. of walking: <10/10-30/30-60/>60
Distance from the nearest medical store in mins. of walking: <10/10-30/30-60/>60
What is a heart attack?
The heart muscle cell gets decreased blood supply? Yes/No
There may be pain in the chest which moves down to the arm: Yes/No
There may be increased sweating: Yes/No
The patient suffering from heart attack should be taken to a doctor/health centre immediately: Yes/No
A drug called streptokinase may be helpful in heart attacks: Yes/No
Eating a fat rich diet increases the risk of heart attacks: Yes/No
Regular exercise decreases the risk of heart attacks: Yes/No
The level of a type of cholesterol may be increased in heart attacks: Yes/No
What is hypertension?
The normal level of blood pressure for a healthy adult is
If the BP increases the heart has to work harder: Yes/No
Increases in BP increases the risk of cardiovascular diseases: Yes/No
In high blood pressure the amount of salt in the food should be: Decreased/Increased/Kept the same
Going to the temple, talking with friends, doing yoga are helpful/harmful in high blood pressure.
The BP of a person increases as he/she grows older: Yes/No
BP measurement is a painful procedure: Yes/No
Do you check your BP every year? Yes/No
Can you name a modern medicine used to treat high blood pressure?
High blood pressure can present as giddiness, general unease: Yes/No
High blood pressure may sometimes cause no problems and may be detected during a checkup: Yes/No
In some cases it can present as a life threatening emergency: Yes/No
High blood pressure increases the risk of stroke: Yes/No
If I am diagnosed to be suffering from and are prescribed medicines for high blood pressure then on feeling better: I will
stop the medicines abruptly/Continue till advised by the doctor
My major sources of information about cardiovascular