Prevalence of hypertension and associated factors among sanitation workers: a community based cross-sectional survey in five urban regions of Nepal.

BACKGROUND

Sanitation workers represent a marginalized occupational group in Nepal often exposed to unsafe working conditions, physically demanding tasks, and occupational hazards. Despite their vulnerability, national surveys such as the Nepal Demographic Health Survey and the STEPwise Approach to surveillance, largely overlook this population. This study aimed to assess the prevalence of hypertension and associated factors among sanitation workers of Nepal.

METHODS

A community-based cross-sectional survey was conducted in five urban regions of Nepal. A total of 790 sanitation workers were enrolled using nonprobability total enumerative sampling through health camps organized in coordination with metropolitan/sub-metropolitan authorities. Data were collected through face-to-face interviews using a pre-coded, structured questionnaire, alongside clinical assessments including blood pressure, body mass index, and random blood sugar. Multivariable logistic regression analyses were performed to identify the factors associated with hypertension.

RESULTS

The overall prevalence of hypertension among sanitation workers was 30% (95% CI: 26.9–33.3), which is higher than the national estimates as reported by the Nepal Demographic Health Survey 2022 (20%) and the STEPwise Approach to Surveillance 2019 (24.5%). It was found that age (55–75 years) (AOR:7.46, 95% CI: 3.74–14.86), sex (male) (AOR:1.78, 95% CI:1.13–2.80), metropolitan/sub-metropolitan (residing in Janakpur) (AOR: 2.34, 95% CI: 1.53–3.57), alcohol consumption (daily) (AOR: 3.29, 95% CI: 2.02–5.36) and body mass index (obese) (AOR: 3.35, 95% CI: 2.09-5.35) were significantly associated with hypertension.

CONCLUSION

Sanitation workers in Nepal bear a disproportionately high burden of hypertension, driven by both lifestyle and occupational factors. These findings call for targeted health interventions, routine health screening, and occupational health programs integrated into local health systems to address hypertension among this underserved workforce. CLINICAL TRIAL NUMBER: Not Applicable.