The disease burden for noncommunicable diseases (NCDs) is on the rise and now responsible for over 70% of global mortality burden [
The transition may be attributed to changes in lifestyle. Cardiovascular diseases are associated with a sedentary lifestyle [
A lot of data currently available from the African continent on NCDs are based on projections and few studies have collected empiric data. Secondly, data is required from different settings such as urban, periurban, and rural areas for comparison in order to obtain a more representative picture of disease burden. Many studies have been conducted in rural and urban areas [
We conducted a cross sectional study in Kakoba Division, a periurban location of Mbarara Municipality, south western Uganda. With a population of 40,500 residents, Kakoba Division is the most populous of the six divisions in the Municipality and home to almost 50% of the total municipal population. The area is densely populated and undergoing rapid urbanization; hence the residents here may be representative of those undergoing a transition in the lifestyle. The transition is a change from a predominantly active lifestyle, associated with rural areas to a more sedentary one associated with living in periurban and urban areas in developing countries [
Based on a survey of hypertension in western Uganda [
Participants were eligible to participate if they were residents of the selected villages for at least 12 months, 35 years or older, able to provide informed consent, and willing to complete study procedures including answering questions on diet, exercise, and medical history, taking an overnight fast and blood glucose test the following day.
Data was collected using a tool adopted from the WHO STEPS questionnaire. We collected demographic and socioeconomic data. We obtained anthropometric measurements with the participants in a standing position, with light clothes on and no shoes. Weight was measured to the nearest 0.1 kg, using a stand on balance, and height to the nearest 0.5 cm, using a stadiometer. Three measurements of blood pressure were taken from the right arm of seated subjects after resting for 5 minutes, using an automatic sphygmomanometer. Fasting blood glucose was measured the following day after the interview. Participants who consented were requested to perform an overnight fast (have dinner before 9 pm and no breakfast) up to the blood draw the following morning. Blood glucose was tested before 10 am using the OneTouch® select glucometer.
Sedentary work style was defined as having work involving mostly sitting or standing with walking for no more than 10 minutes at a time. Sedentary recreation was defined as recreation or leisure involving mostly sitting, reclining, or standing with no physical activity lasting more than 10 minutes at a time. A standard drink was defined as a bottle of beer, a glass of wine or spirits, a bottle of local brew, a glass of crude liquor, or a pot of local brew. We considered fruit and vegetable intake as not sufficient if consumption was less than five servings per day, as recommended by the World Health Organization [
Statistical analysis was done using STATA version 11 (College Station, Texas). Data were entered into Excel and exported to STATA for analysis. We calculated descriptive statistics using means and standard deviations for uniformly distributed continuous variables such as age, blood pressure, and BMI and nonuniform variables; we calculated medians and interquartile ranges (IQR). We calculated frequencies for categorical variables such as sex and educational level. We use independent samples
We obtained individual informed and written consent from the study participants before study procedures were done. Permission was obtained from the local council village chairperson to conduct sampling and engagement of households. For participants who were not able to read and write, the consent document was read for them and approval to participate obtained using a thumb print. The research protocol was approved by the Mbarara University of Science and Technology Research Ethics committee.
We enrolled 310 participants, 50% of them were female, and majority were aged 35 to 44 years. The sociodemographic characteristics of the participants are shown in Table
Sociodemographic characteristics of study participants in Kakoba Division of Mbarara Municipality (
Characteristic | |
---|---|
Sex | |
Male | 155 (50.0) |
Female | 155 (50.0) |
Age categories (years) | |
35–44.9 | 178 (57.4) |
45–54.9 | 87 (28.1) |
>55 | 45 (14.5) |
Marital status | |
Married monogamously | 199 (64.1) |
Married polygamous | 38 (12.3) |
Divorced/separated | 25 (8.1) |
Widow/widower | 30 (9.7) |
Never married | 18 (5.8) |
Level of education | |
No formal schooling | 39 (12.6) |
Primary school level | 154 (49.7) |
O Level | 73 (23.5) |
A level | 30 (9.7) |
Tertiary | 14 (4.5) |
Occupation | |
Peasant farming | 54 (17.4) |
Business/trading | 190 (61.3) |
Professional | 14 (4.5) |
Manual/casual labor | 52 (16.8) |
Frequency of health behaviours related to cardiovascular disease in Kakoba Division, Mbarara Municipality.
Characteristics | |
---|---|
Ever smoked tobacco products | |
Yes | 90 (28.4) |
No | 220 (71.6) |
Current smoking status (among ever smoked, | |
Still smoking | 25 (27.8) |
Stopped smoking | 65 (72.2) |
Ever consumed alcoholic drink | |
Yes | 145 (46.8) |
No | 165 (53.2) |
Alcohol in the past 12 months (among ever drank, | |
Yes | 83 (58.1) |
No | 60 (41.9) |
Frequency of having at least one standard drink in the last 12 months ( | |
5 or more days per week | 26 (31.3) |
1–4 days per week | 31 (37.4) |
1–3 days/month | 26 (31.3) |
Number of days that fruits are eaten per week, median (IQR) | 2 (1–3) |
Number of servings of fruits, mean (SD) | 1.04 (0.48) |
Number of days vegetables are eaten per week | |
None | 45 (14.5) |
1-2 | 143 (46.1) |
3–7 | 122 (39.4) |
Number of servings of vegetables, mean (SD) | 1.1 (0.5) |
Sedentary work style | |
Yes | 191 (61.6) |
No | 119 (38.4) |
Sedentary recreation/leisure | |
Yes | 213 (68.7) |
No | 97 (31.3) |
Told by health worker that you have high blood pressure in the past 12 months | |
Yes | 36 (11.7) |
No | 272 (88.3) |
Had cholesterol level measured in the last 12 months | |
Yes | 1 (0.3) |
No | 309 (99.7) |
Told by health worker that had a high cholesterol level in the past 12 months | |
Yes | 1 (0.3) |
No | 309 (99.7) |
The prevalence of systolic hypertension was 24.5%, diastolic hypertension was 31%, obesity was 46%, and diabetes was 9%. Of those with hypertension (
The mean systolic blood pressure among those reporting a sedentary work lifestyle was 129.3 compared to 122.6 among those reporting a more active work style. This difference was statistically significant with
Comparison of mean systolic blood pressure by physical activity status among residents of Kakoba, western Uganda.
Category of physical activity | Mean systolic BP | 95% CI | |
---|---|---|---|
Sedentary work style | |||
No | 122.6 | 119.3, 125.9 | |
Yes | 129.3 | 126.4, 132.1 | |
Sedentary recreation | |||
No | 128.4 | 123.6, 132.8 | 0.37 |
Yes | 126.1 | 123.6, 128.5 | |
Walks or pedals bicycle at least 10 minutes continuously daily | |||
No | 128.2 | 124.7, 131.6 | 0.28 |
Yes | 125.8 | 122.8, 128.6 | |
Vigorous work among those | |||
Not vigorous work | 120.9 | 115.9, 125.9 | 0.29 |
Vigorous work | 124.7 | 119.7, 129.7 |
In-bold results = significant at 0.05 level.
We explored several factors to determine those that were significantly associated with elevated blood pressure (hypertension). Age, employment status, smoking status (among ever-smokers), sedentary work style, having been told by health worker that they had an elevated BP in the past 12 months, past diagnosis of diabetes, fasting blood glucose above 6.1, and being obese were all significantly associated with hypertension in the bivariate analysis (Table
Bivariate and multivariate analysis of factors associated with hypertension.
Variable | cOR (95% CI), | aOR (95% CI), |
---|---|---|
Age (years) category | ||
35–44.9 | 1 | 1 |
45–54.9 | | |
>55 | | |
Sex | ||
Female | 1 | - - - |
Male | 1.33 (0.79, 2.26), 0.27 | |
Employment status | ||
Not working | 1 | - - - |
Self employed | | |
Employed | | |
Ever smoked | ||
No | 1 | - - - |
Yes | 0.24 (0.06, 1.1), 0.063 | |
Current smoking status (among ever smoked, | ||
Stopped smoking | 1 | - - - |
Currently smoking | | |
Sedentary work style | ||
No | 1 | 1 |
Yes | | |
Told you have elevated BP by health worker in the last 12 months | ||
No | 1 | - - - |
Yes | | |
Past diagnosis of diabetes | ||
No | 1 | - - - |
Yes | | |
Seen a traditional healer for diabetes in the past 12 months | ||
No | 1 | - - - |
Yes | | |
Fasting blood glucose | ||
<6.1 mmol/l | 1 | - - - |
6.1–6.9 mmol/l | | |
>7.0 mmol/l | 2.05 (0.90–4.68), 0.087 | |
Obesity (BMI >= 30) | ||
No | 1 | 1 |
Yes | | 1.72 (0.99, 2.99), 0.052 |
In-bold results = significant at 0.05 level.
Respondents engaged in work that is predominantly sedentary were 2.7 (95% CI 1.47, 4.88) times more likely to have hypertension compared to those who were not. Similarly, past diagnosis of diabetes, elevated fasting blood glucose, and obesity were all associated with increased odds of hypertension. Several other variables were not significant and these included diet of fruits, vegetables, family history of hypertension, and alcohol consumption.
In the multivariable analysis, our final model comprised age, sedentary work style, and obesity. Older persons and those in a sedentary work style were significantly more likely to have hypertension. Obesity was marginally significant.
Participants who had a sedentary work style had higher systolic blood pressure compared to those who were active. The mean adjusted systolic blood pressure difference between the sedentary and active work categories was 6.4 mmHg (95% CI 2.1, 10.7).
The purpose of this study was to determine the association between sedentary lifestyle and hypertension in periurban western Uganda. Sedentary lifestyle, older age, and obesity are associated with hypertension. The data indicate a high prevalence of hypertension, diabetes, obesity, work- and leisure-related sedentary lifestyle, smoking, and reduced fruit and vegetable consumption. Our results are unique because this is one of the few studies to explore factors associated with hypertension among adults from a periurban setting in western Uganda.
Prevalence of diabetes, obesity, and hypertension were all high in this study but not unanticipated. The prevalence of the three conditions is consistent with data from other surveys in Sub-Saharan Africa which increasingly show high prevalence. For hypertension, several studies have been done across the African continent and the prevalence has been quite variable. For instance, the prevalence was below 20% in some surveys [
The majority of study participants with hypertension were not aware they had the condition. Almost 70% of the hypertensive patients did not know about their condition. This proportion is extremely high compared to what has been found in other studies such as a recent one from Sri Lanka [
Our data show the factors significantly associated with hypertension were older age, obesity, and sedentary lifestyle. The findings about these risk factors for hypertension are not surprising and are in agreement with several other studies where age, obesity, and sedentary lifestyle were significant factors for hypertension [
Among ever-smokers, current smoking was associated with lower odds of hypertension compared to those who had quit. This observation is consistent with recent observations that suggest smoking is associated with lower blood pressure [
Our study has several limitations. First, we conducted a relatively small survey compared to the large national surveys that used similar tools such as ours. However, our sample size was well calculated and suited to answer the primary objective. Second, we did not administer a complete food frequency questionnaire and therefore are unable to comprehensively characterize the diet style for this community and relate the diet style with presence of hypertension. Although our study was based in a rapidly urbanizing periurban area in western Uganda, we were not able to measure the duration of stay in the area to determine how recently migration had occurred. Also, the findings are only generalizable to an African population, given the study setting. Lastly, the cross sectional nature does not allow for establishment of a cause-effect relationship.
Despite the several limitations, our study has an important strength. We conducted this study in a periurban location, an area that clearly is at high risk for noncommunicable diseases due to changes in diet and physical activity. The results from this study are generalizable to several periurban locations in Sub-Saharan African countries that are undergoing rapid urbanization.
In conclusion, our study has shown that, in this periurban area of western Uganda, there is a high prevalence of obesity, hypertension, and diabetes. Majority of participants with hypertension are not aware. Participants with a sedentary work style are more likely to have hypertension compared to the active ones. We recommend that routine measuring of blood pressure should be done to detect hypertension, more vegetables and fruits should be included in the diet, and a more active work and leisure lifestyle might help to protect from hypertension. Larger population based longitudinal studies in rapidly urbanizing areas of Sub-Saharan Africa should be conducted to understand risk factors in these largely unstudied populations.
Cardiovascular diseases
Noncommunicable diseases
World Health Organization
Blood pressure
Fasting blood glucose
Body mass index.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center of the National Institutes of Health.
The authors declare that they have no conflicts of interest.
Bruce Twinamasiko and Francis Bajunirwe conceived the idea, designed the study tools, conducted data analysis, and wrote drafts of the final version of the manuscript. Bruce Twinamasiko and Edward Lukenge provided overall coordination and supervision of data collection. Edward Lukenge, Winnie Nansalire, Lois Kobusingye, and Gad Ruzaaza participated in the design of the study, data collection and analysis, and writing and review of drafts of the manuscript. All authors read and approved the final version of the manuscript.
This project was supported by the MESAU-MEPI Programmatic Award from the Fogarty International Center (Award no. 1R24TW008886).