Rural-urban differentials in the prevalence and determinants of diagnosis of hypertension among reproductive women aged 30–49 years in Zambia

Abstract

Hypertension remains a major global public health concern and a leading cause of morbidity and mortality. In sub-Saharan Africa, its burden is rising, yet limited evidence exists on its prevalence and determinants among women of reproductive age (30–49 years) in Zambia. This study examined factors associated with self-reported diagnosis of hypertension among women aged 30–49 years and explored rural - urban differences. The study used data from the 2024 Zambia Demographic and Health Survey. The analysis included older women of reproductive age (30–49), with a sample size of 5,864 (urban = 3,025; rural = 2,839). Multivariable binary logistic regression was performed, and the results were reported with 95% confidence intervals (CIs). Overall, the prevalence of self-reported diagnosed hypertension was higher among urban than rural women, likely reflecting differential access to screening and diagnosis (19.5%; 95% CI: 17.80-21.34) than rural women (12.1%; 95% CI: 10.92–13.37). Age was a strong predictor, with the highest odds among women aged 45–49 years (urban: aOR = 2.44; 95% CI: 1.75–3.39; rural: aOR = 2.43; 95% CI: 1.73–3.40). In rural areas, insurance coverage significantly influenced hypertension diagnosis; women who had insurance coverage were at greater likelihood to be diagnosed (aOR = 1.82; 95% CI: 1.06–3.15). Furthermore, in urban areas those exposed to radio had more chances of diagnosis of hypertension (aOR = 1.35; 95% CI: 1.05–1.73). These findings highlight substantial inequalities in hypertension detection and diagnosis between urban and rural women in Zambia.” The study concludes that hypertension diagnosis among Zambian women aged 30–49 years is shaped by socioeconomic, demographic, and regional factors, with marked rural-urban disparities. Targeted, community-based screening and integration of non-communicable disease prevention within reproductive health programs are vital to address this growing burden.