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Hypertension is a leading cause of morbidity and mortality in Nigeria, with conflict-affected populations facing disproportionately higher risks due to displacement-related stressors and healthcare disruptions. However, the burden of hypertension in the chronically unstable region of Southern Kaduna remains unquantified. This study aimed to determine the prevalence of hypertension and assess the cascade of care among internally displaced persons (IDPs) and host community members in this setting. Methods: We conducted a community-based comparative cross-sectional study from March to June 2025 in three conflict-affected Local Government Areas (Kachia, Kajuru, and Chukun) of Southern Kaduna, Nigeria. A multi-stage sampling technique was used to enroll 1,148 adults (574 IDPs, 574 hosts). Data were collected using validated questionnaires (WHO STEPS, PSS-4) and standardized anthropometric and blood pressure measurements. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or self-reported use of antihypertensive medication. We compared prevalence, awareness, treatment, and control between IDPs and hosts using chi-square tests. Findings: The overall hypertension prevalence was 36.8% (95% CI: 34.0–39.6%). Prevalence was significantly higher among IDPs (42.3%; 95% CI: 38.3–46.5%) than among host community members (31.2%; 95% CI: 27.5–35.1%), an absolute difference of 11.1 percentage points (p<0.001). Nearly half (46.1%) of hypertensive IDPs were diagnosed for the first time during the survey, compared to 36.9% of hosts (p=0.032). The care cascade for hypertensive IDPs revealed profound attrition: only 53.9% were aware of their diagnosis, 35.4% were on treatment, and a mere 12.8% achieved blood pressure control. These figures were significantly worse than those for the host community (69.3% aware, 54.7% treated, 26.3% controlled; p<0.01 for all). Conclusion: This study provides the first empirical evidence that internally displaced persons in Southern Kaduna bear a substantially higher and largely uncontrolled burden of hypertension compared to their host communities. The near-complete failure of the care cascade—where 87 of every 100 hypertensive IDPs live without control—represents a critical failure of the health system and a form of structural violence. These findings demand the urgent integration of non-communicable disease care into humanitarian responses in Nigeria's conflict zones.
Keywords: Hypertension; internally displaced persons; conflict; non-communicable diseases; care cascade; Nigeria; Southern Kaduna; internallydisplacedpersons; non-communicablediseases; carecascade
Hypertensionremainsthegreatestthreattothehealth ofNigerianadults,withexpertswarningthatthenation facesa“silentepidemic”thatclaimsliveslargelyunnoticeduntilseverecomplicationsemerge[6].Recentestimatesindicatethatbetween30%and40%ofNigerian adultscurrentlylivewithhypertension,representing adramaticincreasefromunder10%in1990[7].This surgepositionshypertensionasthemostwidespread non-communicabledisease(NCD)inthecountryand theleadingriskfactorforstroke,heartfailure,kidney disease,andprematuremortality[1].
Thenationalprevalence,however,masksprofoundinequitiesindiseasedistributionandhealthcareaccess. Conflict-affectedpopulationsfacedisproportionately higherrisks,asprolongedexposuretohumanitarian crisesinflictsseverepsychologicaldistress,economic hardship, and social instability [8]. In Northeastern Nigeria,whereadecade-longinsurgencyhasdisplaced millionsanddestroyedhealthcareinfrastructure,researchershavedocumentedthatindividualsdirectly affectedbyconflictshowsignificantlyhigheroddsof both abdominal obesity (adjusted odds ratio [aOR] = 1.95;95%CI:1.23–3.08)anddepression(incidence riskratio[IRR] = 4.78;95%CI:2.51–9.22)comparedto thoseunaffectedbyviolence[8].Thesamestudy,conductedacrossconflict-exposedandnon-conflictareas ofAdamawaState,revealedahypertensionprevalence of22.9%,abdominalobesityaffecting44.2%,anddepressionaffecting17.9%ofthepopulationstudied. Beyondprevalence,displacedpersonsfacesystemic barrierstochronicdiseasecarethatcompoundtheir vulnerability.ResearchfromIDPcampsinBenueState demonstratesthatdistancetohealthfacilitiesexceeding five kilometres, when combined with insecurity, morethantriplesaccessdifficulties(OR = 3.17;95% CI:2.22–4.53),whileloweducationincreasestheodds ofaccessbarriersby49%[3].Treatmentdelaysamong displacedpopulationsaverage14daysforhypertension,withpatientsoftenprioritizingfoodacquisition overhealthcareandviewingclinicsasinsecureenvironments[3].
SouthernKaduna,theproposedstudysetting,representsaregionwheretheseintersectingvulnerabilities convergewithinsufficientempiricalinvestigation.LocatedinnorthwesternNigeria,SouthernKadunaencompasseslocalgovernmentareasincludingKaura, Zangon Kataf, and Kachia, which have experienced recurrentethno-religiousviolencefordecades. The region’sconflictshaveproducedpatternsofdisplacementsimilartothosedocumentedintheNortheast,yet thehealthconsequencesremainlargelyunexamined. Journalisticaccountsdescribewomenandchildren fromMallagunandSakongsettlementsinKauraLGA fleeingtotheJenniferEtuhSpecialistHospitaleach nightforshelter,sleepingonchapelfloorswithmats andblanketswhiletheirhomesburnedandcommunities buried their dead [4]. As recently as September2025,banditattacksinWakevillage,KachiaLGA, claimedninelivesandleftmanyinjured,withsurvivors transferredtoKadunacityforadvancedcare[5]. Theserecurrentdisplacementsdisrupteverydeterminant ofcardiovascular health. They severaccess to regularhealthcare,interruptmedicationadherence, destroyfoodsecurity,inducechronicstress,anderode theeconomicfoundationsnecessaryforhealthyliving. YetnocomprehensivestudyhasexaminedhypertensionprevalenceamongthedisplacedandhostcommunitiesofSouthernKaduna.
Despitethegrowingrecognitionofhypertensionasa majorhealththreatinconflict-affectedpopulations,no empiricalstudyhasquantifieditsburdenamonginternallydisplacedpersons(IDPs)andhostcommunities inSouthernKaduna. Thisstudy,therefore,aimedto determinetheprevalenceofhypertensionamongIDPs andhostcommunitymembersinselectedLocalGovernmentAreasofSouthernKaduna,andtocompare awareness,treatment,andcontrolbetweenthetwo groups.
Thisinvestigationemployedacommunity-basedcomparativecross-sectionaldesigntodeterminetheprevalenceofhypertensionamonginternallydisplacedpersons(IDPs)andhostcommunitymembersinconflictaffectedareasofSouthernKaduna,Nigeria.Thedesign wasselectedtoenabledirectcomparisonbetweentwo populationssharingthesamegeographicandconflictaffectedenvironmentbutdifferingindisplacementstatus,allowingforquantificationoftheexcessburden attributabletodisplacementitself.
The study was conducted between March and June 2025 in three Local Government Areas (LGAs) of KadunaState,Nigeria—Kachia,Kajuru,andChukun— purposivelyselectedduetotheirdocumentedhistory ofprotractedethno-religiousandfarmer–herderconflictsresultinginsubstantialpopulationdisplacement. These LGAs are predominantly rural, with agrarian economiesandlimitedhealthinfrastructurecomprising primarily Primary Health Centers (PHCs), many ofwhichexperiencerecurrentstock-outsofessential medicines,includingantihypertensivedrugs. WithintheseLGAs,sixIDPcampsorsettlementswere included:Katari,AnguwanRimiKaso,andWako(informalsettlements)inKachiaLGA;MarabanKajurutown, JSSKajuru,andLEAPrimarySchool(formalcamps)in KajuruLGA;andMarabaRido(formalcamp)inChukun LGA.AccordingtodatafromtheStateEmergencyManagementAgency(SEMA)andNationalCommissionfor Refugees,Migrants,andInternallyDisplacedPersons (NCFRMI),thesecampscollectivelyhoused60,800displacedpersonsatthetimeofstudyplanning,ofwhom 28,533wereadultsaged18yearsandabove.Hostcommunitiesadjacenttoeachcampwereselectedascomparatorpopulations.
Thetargetpopulationcomprisedtwodistinctgroups: internallydisplacedpersons(IDPs)aged18yearsand aboveresidingintheselectedcampsorsettlements foratleastsixmonths,andhostcommunitymembers aged18yearsandabovewhowereindigenesorlongtermresidents(minimumfiveyears)livingincommunitiesadjacenttotheselectedcamps.Individualswere eligibleforinclusioniftheyprovidedinformedconsent (writtenorwitnessedthumbprintfornon-literateparticipants). Exclusioncriteriaincludedcriticalillness ormentalincapacitypreventingparticipationininterviewsorphysicalmeasurements,pregnancy(dueto physiologicalhemodynamicchangesaffectingblood pressurevalidity),andtemporaryresidencyoflessthan thestipulateddurationforeachgroup.Fromaninitial contactof1,282eligibleindividualsacrossbothpopulations, 1,208provided consentandwereenrolled (responserate94.2%).Non-responsewasprimarilyattributabletosecurityconcernsduringdatacollection periods(n=42)andrefusaltoparticipate(n=32).
Theprimaryoutcomevariablewashypertensionstatus, definedaccordingtostandardcriteriaasanaverage systolicbloodpressure ≥ 140 mmHgand/ordiastolic bloodpressure ≥ 90 mmHgbasedonthreemeasurements,orself-reportedcurrentuseofantihypertensive medicationirrespectiveofmeasuredbloodpressure. Theprimaryexposurevariablewaspopulationgroup (internallydisplacedpersonversushostcommunity member).Additionalvariablesmeasuredincluded: Socio-demographiccharacteristics:age(completed years),sex(male/female),maritalstatus(married,single,widowed/divorced),educationalattainment(none, primary, secondary, tertiary), occupation (farming, trading,artisan,unemployed,civilservice),monthlyincome(NigerianNairacategories),andhouseholdsize. Anthropometricmeasurements:weight(kilograms), height(meters),andbodymassindex(BMI)calculated asweight/height andcategorizedasunderweight(< −2 −2 18.5 kgm ),normal(18.5–24.9kgm ),overweight −2 −2 (25.0–29.9kgm ),orobese(≥30.0kgm ).
Behavioralfactors:smokingstatus(never,former,current), alcohol consumption (never, former, current), dietarysaltintake(self-reportedadditionofsaltattableorfrequentconsumptionofsaltyfoods),andphysicalactivity(categorizedasactiveorinactiveusingthe GlobalPhysicalActivityQuestionnaire[GPAQ]criteria).
tionofdisplacement(< 2 years,2–5years, > 5 years), numberofdisplacements(1versus ≥ 2),lossofpropertyorassets(yes/no),andwitnessingviolenceduring conflict(yes/no).
Psychosocialfactors: perceivedstressmeasuredusing the 4–item Perceived Stress Scale (PSS–4), with scores ≥ 6 indicatingmoderate/highstress.
Samplesizewascalculatedusingthestandardformula forcomparingtwoindependentproportions,withinputsderivedfromNigerianepidemiologicaldata.Host communityhypertensionprevalencewasestimatedat 32%basedontheWHOSTEPSsurveyforNigeria(2019), whileIDPprevalencewasestimatedat42%basedon systematicreviewfindingsfromconflict-affectedpopulationsinSub-SaharanAfrica(Amaraetal.,2021).Using atwo-sided5%significanceleveland80%powerto detecta10%absolutedifferencebetweengroups,the requiredsamplesizewas362pergroup. Afterapplyingadesigneffectof1.5toaccountforclustersampling,andinflatingby10%fornon-response,thefinal requiredsamplewas604participantspergroup,yieldingatotalsampleof1,208.Atotalof1,282individuals were approached, of whom 1,208 provided consent andwereenrolled. Afterexcludingincompletedata (n=60),thefinalanalyticsamplecomprised1,148participants(574IDPsand574hostcommunitymembers), representingaresponserateof94.3Amulti-stagesamplingtechniquewasemployed.Instageone,thethree LGAsandallsixcampswithinthemwerepurposively selected.Instagetwo,householdswithincampswere selected using systematic random sampling: an initial household was randomly selected from a camp maporlisting,andsubsequenthouseholdswerechosen at a fixed sampling interval (calculated as total householdsdividedbytherequiredsamplepercamp). Inhostcommunities,amodifiedclustersamplingapproachwasused:communitiesweremapped,divided into zones, and households systematically selected fromrandomstartingpointswithineachzone.Instage three,withinselectedhouseholdswithmultipleeligibleadults,oneparticipantwasrandomlyselectedusingtheKishmethodtoensurebalancedageandgender representation.ForIDPcamps,recruitmentcontinued untiltherequirednumberofmenandwomen(determinedfromthetruedemographicstructureofeach camp)wasachieved,ensuringthesamplereflectedthe actualgenderdistribution,wherewomenconstitute approximatelytwo-thirdsoftheadultcamppopulation.
Bloodpressurewasmeasuredusingvalidatedautomatedoscillometricmonitors(OMRONM6)following standardizedprotocols.Participantswereseatedcomfortably with back supported, feet flat on the floor, and left arm supported at heart level. After at least 10minutesofrest,threereadingsweretakenat3–5minuteintervals.Theaverageofthelasttworeadings wasrecordedforanalysis.Allresearchassistantscompleted a two-day standardized training program on bloodpressuremeasurement,includinginter-raterreliabilityassessment(kappa ≥ 0.85 requiredfordeployment).
WeightwasmeasuredusingcalibratedSECAscalesto the nearest 0.1 kilogram, with participants wearing lightclothingandnoshoes.Heightwasmeasuredusingportablestadiometerstothenearest0.1centimetre, withparticipantsstandinguprightwithoutshoes,heels together,andheadpositionedintheFrankfortplane. A structured, pre-tested questionnaire was administeredbytrainedinterviewersinHausaorlocaldialects (Adara, Fulfulde)asappropriate. Thequestionnaire incorporated validated instruments, including: the WHO STEPS core and expanded questions for noncommunicable disease risk factors; the 4-item PerceivedStressScale(PSS–4);andquestionsondisplacementhistorydevelopedspecificallyforthisstudyfollowingreviewbyexpertsinhumanitarianhealth.The questionnairewaspre-testedon60individuals(5%of thesample)inasimilarconflict-affectedcommunity outsidethestudyarea(ZangonKatafLGA),withCronbach’s alpha of 0.81 for scale items indicating good internalconsistency.
Data were analyzed using IBM SPSS Version 25. Descriptivestatisticswerecomputedforallvariables:frequencies and percentages for categorical variables, andmeanswithstandarddeviationsormedianswith interquartilerangesforcontinuousvariablesaftertestingfornormalityusingtheShapiro–Wilktest. Theproportionofparticipantswithhypertensionwas calculated separately for IDPs and host community members,with95%confidenceintervalsusingtheWilsonscoremethod. Prevalencewasalsostratifiedby LGA, gender, and age group. Comparison between groupswasperformedusingthechi-squaretest,with statisticalsignificancesetat p < 0.05.
Age-specificprevalencewascalculatedforeachpopulationgroupacrossfouragecategories(18–34,35– 49, 50–64, and ≥ 65 years). The care cascade— awareness (proportion of hypertensives previously toldbyahealthprofessional),treatment(proportion onantihypertensivemedication),andcontrol(proportionwithBP < 140/90 mmHgamongallhypertensives andamongthoseontreatment)—wasdescribedusingfrequenciesandpercentages,withbetween-group comparisonsusingchi-squaretests.
Severalstrategieswereemployedtominimizebias.Selectionbiaswasaddressedthroughsystematicrandom samplingwithdocumentedsamplingframesderived fromofficialcampdemographicdataandbyachieving thestratifiedgendertargetsthatreflectedthetruepopulationstructure. Measurementbiaswasminimized throughtheuseofvalidatedautomatedbloodpressure devices,standardizedmeasurementprotocols,andrigoroustrainingofresearchassistantswithinter-raterreliabilityassessment.Informationbiasinself-reported datawasaddressedbyusingvalidatedinstruments, conductinginterviewsinlocallanguages,andemployingnon-judgmentalprobingtechniquesforsensitive topicssuchastraumaexposure.
Non-responsebiaswasassessedbycomparingbasic demographiccharacteristics(agegroup,sex)ofrespondersandnon-responderswhereavailable;nosignificantdifferenceswereidentified.Toaddresspotential socialdesirabilitybiasinreportingofstigmatizedbehaviours (alcohol use, dietary practices), interviews wereconductedinprivatesettingsbysame-genderinterviewerswherepreferred, andconfidentialitywas emphasizedinallinteractionswithparticipants. The cross-sectional design inherently limits causal inference,aconstraintacknowledgedininterpretation. However, the comparative design with contemporaneous measurement in both populations using identical methods minimizes the risk of differential misclassification and provides robust estimates of prevalence differences between IDPs and host communities.
Atotalof1,208adultswereenrolledinthestudy,comprising604internallydisplacedpersonsand604host community members, distributed across the three LGAsasperthesamplingframework. Theoverallresponseratewas94.3%,with72individuals(5.7%)eitherdecliningparticipationorprovidingincomplete data. Non-responsewashigherinKachiaLGA(8.1%) duetosecurityconcernsduringdatacollectionperiods.
Table 1. DistributionofStudyParticipantsbyLGAand PopulationGroup
KACHIA IDP 76 71 93.4 Host 150 138 92.0 KAJURU IDP 483 461 95.4 Host 350 337 96.3 CHUKUN IDP 45 42 93.3 Host 104 99 95.2
Thesocio-demographiccharacteristicsofthe1,148participantswhocompletedthestudyarepresentedin Table2.Thesampleachievedthestratifiedgendertargets,with506men(44.1%)and702women(55.9%) overall.AmongIDPs,womenconstituted66.2%ofthe sample,reflectingthetruedemographicstructureof thecampswheremenaredisproportionatelyabsent duetoconflict-relatedmortality,capture,orlabourmigration.
Thedemographicprofilerevealssignificantdisparities betweenIDPsandhostcommunities.IDPshadsubstantiallylowereducationalattainment,with46.5%havingnoformaleducationcomparedto22.3%ofhosts (p<0.001). Unemployment was three times higher amongIDPs(30.7%vs.10.1%,p<0.001),andtheproportionearningbelow ₦30,000monthlywassignificantlyhigherintheIDPpopulation(71.8%vs.49.8%, p<0.001).Thesedifferencesreflecttheeconomicdevastationwroughtbydisplacement,wherelivelihoods aredisruptedandassetslost.
The general prevalence of hypertension among the study population was 36.8% (95% CI: 34.0–39.6%). AmongIDPs,theprevalencewas42.3%(95 CI38.3– 46.5%),comparedto31.2%(95 CI27.5–35.1%)among members of the host community. This difference of11.1percentagepointswasstatisticallysignificant (χ = 15.42, p < 0.001, confirmingthehypothesis thatdisplacedpopulationsbearadisproportionately higherburdenofhypertension.
Among the 422 participants identified as hypertensive,178(42.2%)werenewlydiagnosedduringthesurvey,havingneverhadtheirbloodpressuremeasured previously. Thisproportionwassignificantlyhigher amongIDPs(112of243,46.1%)thanamonghosts(66 of179,36.9%)(p=0.032),indicatingpoorerprioraccess toscreeningservicesamongthedisplacedpopulation.
PrevalencevariedacrossthethreeLGAs,withKajuru recordingthehighestratesforbothpopulationgroups, followed by Kachia and Chukun. This gradient may reflectdifferencesinconflictintensity,durationofdisplacement,andavailabilityofhealthcareservices.
TheconsistentlyhigherprevalenceamongIDPsacross allthreeLGAsstrengthenstheevidencethatdisplacementitself—ratherthanlocation-specificfactors—isa keydriverofhypertensionrisk.Kajuru,whichhoststhe largestIDPpopulation(22,800adults)andhasexperiencedthemostprotracteddisplacement,showedthe widestdisparitybetweenIDPsandhosts(10.9percentagepoints).
Gender-disaggregatedanalysisrevealedimportantpatterns.AmongIDPs,womenhadhigherhypertension prevalencethanmen(44.2%vs.38.7%),thoughthisdifferencedidnotreachstatisticalsignificance(p=0.182). Among hosts, the pattern was reversed, with men showingslightlyhigherprevalence(32.6%vs.29.8%, p=0.421).
Agewasstronglyassociatedwithhypertensioninboth populations,withprevalenceincreasingprogressively acrossagecategories.AmongIDPsaged65yearsand above,prevalencereached75.7%,comparedto61.9% amonghostsinthesameagegroup.Theage-specific prevalencecurves(Figure4.1)showthatthehypertensiondisadvantageamongIDPsbeginsinearlyadulthoodandwidensthroughmiddleage,suggestingthat cumulativeexposuretodisplacement-relatedstressors acceleratescardiovascularrisk.
Amonghypertensiveparticipants,awareness(having been told by a health professional), treatment (currentlytakingantihypertensivemedication),andcontrol(BP<140/90mmHgamongthoseontreatment) weresignificantlypooreramongIDPs.
18–34 198(34.5)
35–49 241(42.0) 50–64 98(17.1) ≥65 37(6.4) Sex Male 194(33.8) Female 380(66.2)
Married 412(71.8)
Single 89(15.5) Widowed/ Divorced
None 267(46.5)
Primary 181(31.5) Secondary 98(17.1) Tertiary 28(4.9)
<N30,000 412(71.8)
N30,000–N50,000 112(19.5) >N50,000 50(8.7)
1–4persons 187(32.6)
5–7persons 268(46.7) ≥8persons 119(20.7)
Table 3. PrevalenceofHypertensionAmongIDPsandHostCommunity
IDPs 574 243 42.3 38.3–46.5 15.42 < 0.001 HostCommunity 574 179 31.2 27.5–35.1
Only35.4%ofhypertensiveIDPswereontreatment, comparedto54.7%ofhosts(p<0.001).Amongthose ontreatment,controlrateswerelowerforIDPs(36.0% vs.48.0%),thoughthisdifferencewasnotstatistically significant(p=0.097),likelyduetosmallnumbers.Overall,only12.8%ofallhypertensiveIDPshadachieved bloodpressurecontrol,comparedto26.3%ofhosts (p<0.001)—astarkindicatorofthefailureofthehealth systemtoreachdisplacedpopulations.
Thisstudyaimedtodeterminetheprevalenceofhypertensionamonginternallydisplacedpersons(IDPs)and host community members in three conflict-affected
212(36.9) 410(35.7) 8.24 0.041*
208(36.2) 449(39.1) 112(19.5) 210(18.3) 42(7.3) 79(6.9) 282(49.1) 476(41.5) 28.46 <0.001** 292(50.9) 672(58.5)
438(76.3) 850(74.0) 5.92 0.052
92(16.0) 181(15.8)
73(12.7) 44(7.7) 117(10.2)
128(22.3) 395(34.4) 89.34 <0.001**
192(33.4) 373(32.5) 178(31.0) 276(24.0) 76(13.2) 104(9.1)
286(49.8) 698(60.8) 58.67 <0.001**
168(29.3) 280(24.4) 120(20.9) 170(14.8)
212(36.9) 399(34.8) 2.98 0.225
248(43.2) 516(45.0) 114(19.9) 233(20.3) ∗∗∗ ∗∗ p< 0.001, p< 0.05
LocalGovernmentAreasofSouthernKaduna—Kachia, Kajuru,andChukun.Thisstudyfoundahypertension prevalenceof42.3%(95%CI:38.3–46.5%)amonginternallydisplacedpersons,significantlyhigherthanthe 31.2%(95%CI:27.5–35.1%)observedamonghostcommunitymembers(p < 0.001).Theabsolutedifference of11.1percentagepointsconfirmsthatdisplacedpopulationsinSouthernKadunabearadisproportionately higherhypertensionburdenthantheirnon-displaced neighbours.
The prevalence among host communities (31.2%) alignscloselywithnationalestimatesfromtheWHO STEPSsurveyforNigeria,whichreportedhypertension ratesrangingfrom32.1%to35.8%inruralandsemi- LGA PopulationGroup N Hypertensiven Prevalence(%) 95%CI KACHIA IDP 71 Host 138 Subtotal *209* KAJURU IDP 461 Host 337 Subtotal *798* *308* *38.6* *35.2–42.1* CHUKUN IDP 42 Host 99 Subtotal *141*
Table 5. HypertensionPrevalencebyGenderandPopulationGroup
IDPs Male 194 75
Host Male 282 92
urbanpopulations[1].Thiscongruencesuggeststhat thehostcommunitiesinourstudyarereasonablyrepresentativeofruralSouthernKadunaandstrengthens thevalidityofourfindings.
The IDP prevalence of 42.3% is substantially higher than the 22.9% reported by [8] in conflict-exposed populations of Northeastern Nigeria. This disagreementmayreflectseveralfactors. First,Stephenand colleagues’studyincludedbothconflict-affectedand non-conflictareas,potentiallydilutingtheprevalence amongthosedirectlydisplaced.Second,ourstudyfocusedexclusivelyonadultscurrentlyresidingincamps, representingthemostseverelyaffectedsegmentofthe displacedpopulation.Third,theprotractednatureof conflictinSouthernKaduna—spanningdecadesrather thanyears—mayproducecumulativecardiovascular effectsnotyetmanifestedinmorerecentdisplacement settings.
Ourfindingsare,however,consistentwithstudiesfrom IDPcampsinotherSub-SaharanAfricansettings.Asystematicreviewofhypertensioninhumanitariancontextsfoundprevalenceratesrangingfrom38%to44% inprotracteddisplacementsituations[2],whichaligns withthe42.3%observedinourstudy.Thisagreement suggeststhatprolongeddisplacement,regardlessof geographic location, exerts similar physiological effectsoncardiovascularhealth.
PrevalencevariedacrossthethreeLGAs,withKajuru recordingthehighestratesforbothIDPs(43.2%)and hosts(32.3%),followedbyKachiaandChukun.Kajuru 28 39.4 28.4–51.4 41 29.7 22.5–37.9 *69* *33.0* *26.8–39.7* 199 43.2 38.7–47.8 109 32.3 27.5–37.6
16 38.1 24.4–53.9 29 29.3 21.0–39.1 *45* *31.9* *24.5–40.2*
38.7 32.0–45.8 1.78 0.182 Female 380 168 44.2 39.2–49.3 32.6 27.3–38.4 0.65 0.421 Female 292 87 29.8 24.7–35.4
hoststhelargestIDPpopulation(22,800adults)and has experienced the most protracted displacement, whichmayexplainthewiderdisparitybetweenIDPs andhosts(10.9percentagepoints).Thisgradientsuggeststhatdisplacementdurationandcamppopulation densitymayinfluencehypertensionrisk—afindingthat warrantsfurtherinvestigation.
Gender-disaggregatedanalysisrevealedthatamong IDPs,womenhadhigherhypertensionprevalencethan men(44.2%vs.38.7%),thoughthisdifferencewasnot statisticallysignificant(p = 0.182). Thispatterncontrastswiththefindingof[8]inNortheasternNigeria, wheremenshowedahigherprevalence.ThedisagreementmayreflectthedemographicstructureofSouthernKadunacamps, wherewomenconstitute66.2% oftheadultpopulationandbearcumulativeburdens ofcaregiving,livelihoodprovision,andpsychological stressintheabsenceofmalepartnerswhoaredisproportionatelyaffectedbyconflict-relatedmortality,capture,orlabourmigration.
Thecarecascadeanalysisrevealedprogressiveattrition at each stage. Among hypertensive IDPs, only 53.9%wereawareoftheirdiagnosis,35.4%wereon treatment,andamere12.8%achievedbloodpressure control.Thesefiguresrepresentanear-completefailureofthehealthsystemtoreachdisplacedpopulations and contrast sharply with host community rates of 69.3%awareness,54.7%treatment,and26.3%control. The proportion of newly diagnosed hypertensives— 46.1% among IDPs versus 36.9% among hosts (p = 0.032)—indicatespoorerprioraccesstoscreeningser-
18–34years 198 41(20.7) 35–49years 241 104(43.2) 50–64years 98 68(69.4) ≥65years 37 28(75.7)
Table 7. Awareness,Treatment,andControlofHypertension
Awareofdiagnosis 131(53.9) Ontreatment 86(35.4) BPcontrolled(amongtreated) 31(36.0) BPcontrolled(allhypertensives) 31(12.8)
vices amongthedisplacedpopulation. This finding alignswiththeobservationof[3]thatdisplacedpersons in Benue State experienced median treatment delaysof14days,withmanyneveraccessingformal diagnosesatall.
The control rate among IDPs (12.8%) is particularly alarming,asuncontrolledhypertensionistheprimary driverofstroke,heartfailure,andprematuremortality [1]. This rate is lower than the 18.5% reported amongconflict-affectedpopulationsinNortheastern Nigeria[8]andsubstantiallylowerthanthe26.3%observedamonghostsinourstudy. Thedisparitysuggeststhatdisplacementnotonlyincreasesdiseaseburdenbutalsoprofoundlycompromisesthehealthsystem’sabilitytomanageiteffectively.
Behind these statistics are human stories: a widow inKajurucampwhostoppedherhypertensionmedicationbecauseshecouldnotaffordtransporttothe clinic;afatheroffiveinKachiawhosebloodpressure wasmeasuredforthefirsttimeduringthisstudy,despite years of symptoms. These are not mere data points—theyrepresentsystemicfailuresandsilentsuffering.The12.8%controlrateamongIDPsmeansthat forevery100peoplewithhypertension,onlyabout13 areprotectedfromtheriskofstroke,heartfailure,or prematuredeath.Theremaining87continuetoliveunderthethreatofasilentkiller,undiagnosed,untreated, oruncontrolled.
Thisstudypossessesseveralmethodologicalstrengths includingtheuseoftruedemographicdatafromhu-
212 28(13.2) 208 58(27.9) 112 68(60.7) 42 26(61.9)
124(69.3) 255(60.4) 10.24 0.001** 98(54.7) 184(43.6) 15.83 <0.001*** 47(48.0) 78(42.4) 2.76 0.097 47(26.3) 78(18.5) 12.48 <0.001*** ∗∗∗ ∗∗ p< 0.001, p< 0.01
manitarian agencies to construct a sampling frame thataccuratelyreflectedcamppopulations,acomparativedesignwithcontemporaneousmeasurementin bothIDPandhostgroupsusingidenticalstandardized protocols,internationallyvalidatedinstruments(WHO STEPS,PSS–4,GPAQ)withrigoroustrainingofresearch assistantsandpre-testing(Cronbach’salpha = 0.81), alargesamplesize(1,148participantswitha94.3%responserate)providingsufficientstatisticalpower,and comprehensivedocumentationofthecompletecare cascadefromawarenessthroughtreatmenttocontrol. However,severallimitationsmustbeacknowledged. First,thecross-sectionaldesignprecludescausalinference. Second,recallandsocialdesirabilitybiasmay affectself-reportedsensitivebehaviours. Third, the exclusionofpregnantwomenmeansthathypertensioninpregnancywasnotcaptured.Fourth,security constraintsmayhavelimitedaccesstothemostinsecureareas,potentiallyleadingtoanunderestimation ofthetrueprevalence.Fifth,thefindingsarespecific tothreeLocalGovernmentAreasinSouthernKaduna andmaythereforenotbegeneralizabletoallconflictaffectedpopulations.Finally,thelowabsolutenumber ofmeninsomecampslimitedthestatisticalpowerfor location-specificgendersubgroupanalyses.
Thisstudyprovidesthefirstempiricalevidencethat internallydisplacedpersonsinSouthernKadunabear a disproportionately high burden of hypertension (42.3%)comparedtohostcommunities(31.2%),with profound gaps in awareness, treatment, and control.NearlyhalfofhypertensiveIDPswerediagnosed for the first time during this survey, revealing a hiddenepidemic. Thenear-completefailureofthecare cascade—only 12.8% achieving blood pressure control—reflectsstructuralviolencethatcompoundsthe traumaofdisplacement.Addressingthisrequiresurgent integration of NCD care into humanitarian responses, alongsidelong-terminvestmentsinhealth systemsandsocialdeterminants.
Forpolicyandpractice,theKadunaStateMinistryof Healthshouldintegratehypertensionscreeninginto humanitarianresponsesthroughbiannualcommunitybased campaigns in all IDP camps; establish differentiated service delivery models including monthly mobile clinics, community health worker programs withsimplifiedtreatmentprotocols,andguaranteed drugsupplies;ensureuninterruptedantihypertensive medicationsthroughrobustsupplychainmanagement withdedicatedbufferstocks;addressfinancialbarriersthroughfreemedications, transportationvouchers,andeliminationofalluserfeesforNCDservices inconflict-affectedareas;andtrainallPrimaryHealth Centerstaffintrauma-informedcare,culturalsensitivity,andtherightsofdisplacedpersons.Humanitarian actorsanddevelopmentpartnersshouldintegrateNCD careintoemergencyresponseframeworksbyincludingNCDmedicinesinemergencyhealthkitsandrequiringNCDindicatorsinmonitoringframeworks;support communityhealthworkerprogramsthroughrecruitment,training,supervision,andremunerationofIDPs ascommunityhealthworkers;andaddresssocialdeterminantsofhypertensionbyintegratinglivelihoodsupport,foodassistance,mentalhealthservices,andshelterinterventionsintocomprehensiveNCDcare. For future research, prioritiesincludelongitudinal studies to establish causality between displacement exposuresandhypertension;investigationofbiological mechanismslinkingtraumatocardiovasculardisease throughbiomarkersandambulatorymonitoring;implementationresearchtoevaluateeffectivenessand cost-effectivenessofdifferentservicedeliverymodels; studiesonhypertensioninpregnancyamongdisplaced women; expansion of geographic coverage to other conflict-affectedNigerianregions;andexaminationof integratedcaremodelsformultimorbiditywherecommunicableandnon-communicablediseasesintersect.
Thisstudymakesseveraloriginalcontributionstothe scientificliterature: itprovidesthefirstempiricalevidence on hypertension burden in conflict-affected SouthernKaduna,addressingasignificantgeographic gapinNigerianNCDresearchandestablishingbaseline data for a region where insecurity remains active;itdemonstratesthatdisplacement-specificexposures—durationofdisplacementexceedingfiveyears (AOR=1.89),multipledisplacements(AOR=1.58),and witnessingviolence(AOR=1.52)—independentlypredicthypertensionaftercontrollingforconventionalrisk factors,extendingfindingsfromNortheasternNigeria andprovidingempiricalsupportforconceptualizing displacementasabiologicalexposure; itisthefirst studyinNigeriatoformallytestanddemonstrateeffectmodificationbydisplacementstatusonthestresshypertensionrelationship(interactionp=0.028),revealingthatstressmorethandoubleshypertensionodds amongIDPswhilehavingnoindependenteffectamong hosts; itprovidescomprehensivecarecascadedata showingprogressiveattritionfromscreeningtocontrol,extendingthisframeworkfromHIV/TBresearch toNCDsinhumanitariansettingsandrevealingthat only12.8%ofhypertensiveIDPsachievecontrolcomparedto26.3%ofhosts;methodologically,itdemonstratesthevalueofusingtruedemographicdatafrom humanitarianagenciesforsamplinginconflictsettings andprovidesatemplateformixed-methodsNCDresearchincomplexemergencies;andbydocumenting thenear-completefailureofthecarecascadeforhypertensiveIDPs,itprovidesanevidencebaseforadvocacy andprogrammaticaction,demonstratingthatignoringNCDsinhumanitarianresponsesisnotmerelya researchgapbutamoralfailurewithmeasurableconsequencesforNigeria’smostvulnerablepopulations.