International Journal of Medicine and Biomedical Research [602966]

International Journal of Medicine and Biomedical Research
Volume 2 Issue 1 January – April 2013
www.ijmbr.com
© Michael Joanna Publications
Original Article
Int J Med Biomed Res 2013;2(1 ):57-68
57

Cardiovascular risk factors and non -communicable
diseases in Abia state, Nigeria: report of a community –
based survey

Ogah O.S1,2*, Madukwe O.O1, Onyeonoro U.U3, Chukwuonye I.I4, Ukegbu A.U3, Akhimien
M.O1,3 , Okpechi I.G5

1Ministry of Health, Nnamdi Azi kiwe Secretariat, Umuahia, Abia State, Nigeria .2Division of
Cardiovascular Medicine, Department of Medicin e, University College Hospital, Ibadan, Oyo
state, Nigeria .3Department of Community Medicine , 4Division of Renal Medicine (Nephrology),
Department of Medicine, , Federal Medical Centre, Umuahia, Abia State, Nigeria.5Division of
Nephrology and Hypertension, University of Cape Town, South Africa.

*Corresponding author : [anonimizat], osogah561 [anonimizat]

Received: 20.10.12 ; Accepted: 15.01.13

INTRODUCTION

Non-communicable diseases (NCDs) are
responsible for 60% of all deaths
worldwide .[1] This is so especially in developing countries NCDs are rapidly
emerging with attendant health, soci al and
economic consequences. The major chronic
diseases that are attributable to the common
risk factors include heart disease, diabetes ABSTRACT

Background: There is limited population based data on the prevalence of
cardiovas cular risk factors and non -communicable diseases in Nigeria, and Abia
state in particular. Aims: The purpose of this survey was to determine the
burden of non -communicable diseases as well as associated cardiovascular risk
factors in the state using the Wo rld Health Organization steps approach. It is
believed that information obtained will provide the basis for policies, plans and
programs as well as evolve strategies in designing, implementing and evaluation
of appropriate interventions that are geared tow ards controlling them. Methods:
The house to house survey was conducted in randomly selected communities in
Abia State of Nigeria. Respondents had their biophysical parameters measured:
weight, height, waist circumference, hip circumference, pulse rate blo od
pressure and some biochemical parameters. Results: Women constituted
52.1% of the 2999 participants. The mean age of the participants was 41.7±18.5
years. Three hundred and eighty seven respondents had ever smoked cigarette,
373 men (96.4%) and 14 wome n (3.6%). Many of the respondents (65.5%) were
engaged in work involving sedentary activity. Over eighty percent of the study
populations were aware of cancer. Hypertension was present in 31.8% and
diabetes mellitus in 3.6%. Obesity was present in 13.8% wh ile low high density
lipoprotein -cholesterol was detected in 54.1%. Conclusions: A suggestion is
made for the establishment and strengthening of non -communicable diseases
surveillance systems in the state. Surveillance of non -communicable diseases
and asso ciated risk factors using the World Health Organization stepwise
surveillance for non -communicable diseases should be ongoing in the state and
should be conducted every two years.

Key words: Cardiovascular risk factors, non -communicable disease,
hypertens ion, cholesterol, Abia, Nigeria

Ogah et al. : Cardiovascular risk factors and non -communicable diseases
Int J Med Biomed Res 2013;2(1 ):57-68
58
mellitus, stroke, cancer and chronic
respiratory disease .[2,3] In 2005 chronic
NCDs accounted for 60% of all global
mortality and 47% of global morbidity. It is
projected that by 2020, these figures will rise
to 73% and 60% respectively. Currently
80% of chronic diseases are now occurring
in developing economies .[2,4]

The key to controlling the rising prevalence
of NC Ds in the world is primary prevention
through comprehensive population based
programs. To do this identification of major
risk factors as well as their prevention and
control is imperative .[1,5]

The changing pattern of disease is already
occurring in Nig eria. Recent hospital based
reports indicate that NCDs have overtaken
communicable diseases as a cause of
medical admissions at least in urban
areas .[6,7] Despite the increasing prevalence
of risk factors for NCDs, most developing
countries including Niger ia do not have
current and reliable population based data
on the burden of these risk factors to guide
programs targeted at control. The last
survey on NCDs in Nigeria was in 1997 (15
years ago) and since then little attempt has
been made as a form of foll ow up survey to
determine the trends in NCDs and
associated risk factors in the country.[8] In
addition, Abia State was not included in the
1997 national survey.

The aim of this survey was, therefore to
determine the burden of NCDs as well as
associated cardiovascular risk factors in the
state using the WHO steps approach. It is
believed that information obtained will
provide the basis for policies, plans and
programs as well as evolve strategies in
designing, implementing and evaluation of
appropriate int erventions that are geared
towards controlling them.

METHOD OLOGY

Study area
The house to house survey was conducted
in randomly selected communities in Abia
State of Nigeria. Abia is one of the 36 states
in Nigeria with an estimated population of
3,152 ,691 inhabitants and located in the
South Eastern part of the country. (Figure
1)The state is divided into three senatorial
zones and 17 local government areas and
has 291 political wards. It is largely
inhabited by Igbo people (one of the three
major ethn ic groups in Nigeria). The state’s
economy depends mainly on agriculture and commerce; the later contributing about 27%
to the state’s gross domestic product. In
terms of health facilities it has 517 public
primary healthcare centres, 17 public
secondary h ealthcare facilities, two public
tertiary healthcare centres and two
diagnostics centres. This is complimented
by many privately owned primary and
secondary healthcare facilities.

Target population
These were adult men and women aged 18
years and above w ho are resident in the
state. Pregnant women, temporary visitors
to the state and those who refused consent
were excluded from the study.

Study design
The study was cross -sectional in design.

Sample size
The calculated minimum sample size was
2,880 usin g the appropriate sample size
formula.[9] The minimum sample size made
allowance for design effect, age -sex
estimates as well as non response rate.

Sampling technique
A multistage stratified cluster sampling
technique was used to select the study
partic ipants. The state is traditionally divided
into three senatorial zones: Abia North, Abia
Central and Abia South. From each
senatorial zone, one rural and one urban
LGA were randomly selected. They were
Ohafia and Isuikwuato/Bende for Abia
North, Umuahia No rth and Ikwuano for Abia
Central and Aba South and Ukwa East for
Abia South Senatorial Zones.

In each of the LGAs, four Enumeration
Areas (EAs) were randomly selected from
the listing of all the EAs. Households in
these EAs were further listed and eligibl e
participants were selected. The selection
was such that not more than two eligible
participants of either sex were selected from
each household. Using the EA map and
starting from prominent landmark, trained
interviewers proceeded from household to
house hold; interviewing eligible listed
respondents until a minimum of 120
respondents were interviewed.

Data collection
Questionnaire
A modified WHO -STEPs questionnaire was
used for data collection. These were
administered by a team of trained health
worke rs comprising of six interviewers and a
supervisor. The supervisors were public

Ogah et al. : Cardiovascular risk factors and non -communicable diseases
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59
health physicians, cardiologist and
nephrologist. Information collected included
socio -demographic parameters such as
gender, age, use of alcohol and tobacco and
dietary inform ation on consumption of salt
fruits and vegetable. Other data recorded
includes personal history and family history
of chronic NCDs such as hypertension,
diabetes, cancer and asthma and
awareness of common NCDs and physical
activity.

Anthropometry and blo od pressure
measurement
Weight was measured with a pre -calibrated
weighing scale with measurements recorded
to the nearest 0.1kg. Heights were
measured with a stadiometer to the nearest
0.1cm. The waist circumference was
determined using a tape measure. The mid
axillary line midway between the last rib and
the superior iliac crest was used as the
reference point . Measurement was taken to
the nearest 0.1cm. Hip circumference was
measured at the point of maximum
circumference over the buttocks. Blood
pressur e was determined with Omron Digital
Blood Pressure machine which was battery
powered. This was after 5 minutes of rest
and the legs uncrossed. Three blood
pressure reading at interval were taken but
the average of the second and third
readings were used fo r analysis.

Definitions of terms
The definition of the terms used for this
study is as contained in Table 1.

Ethics approval
The ethics approval was obtained from the
Abia State Ministry of Health research ethics
committee. Approval was obtained fro m the
community leaders prior to the study and all
the respondents gave informed consent.

Statistical analysis
Data obtained were entered using Epi -Data
Software Version 3.1 (Epi -Data Association
Odense, Denmark), while analysis was done
using SPSS Versio n 17.0 (SPSS Inc,
Chicago Illinois, USA). Relevant means and
standard deviation were calculated for
continuous variables. Findings were
presented using relevant frequency tables
and appropriate charts.

RESULTS

A total of 2999 respondents par ticipated in
the study. Figure 2 shows the flow chart of
the study. Recruitment from the three traditional zone of the state are as follows:
Abia North 956(31.9%), Abia Central
1083(36.1%) and Abia South 960(32.0%).
The respondents were evenly distributed in
all the u rban and rural LGAs.

Socio -demographic characteristics
The socio -demographic characteristics of
the subjects are shown in table 1. Women
constituted 52.1% and the mean age of the
entire population was 41.7±18.5 years with
majority in the 20 -29 years age group. Fifty
eight percent were married, 99% were
Christians, 9.4% had no formal education
and great majority were Ibos. Many of the
respondents belong to the following
occupational groups: artisans (19.9%),
traders (16.2%), apprentice/student’s
(13.7%) an d farmers (13.6%). Fifteen
percent of the subjects were unemployed. In
terms of housing the common types of
residence were bungalow (34.4%) and
single/double apartment. Many do not own
means of mobility of their own (78.5%). The
current places of domicile of the
respondents were equally distributed. Forty
percent have lived continuously in the urban
area in the last 5 years compared to 49% in
the rural area. Ten percent had lived in both
areas during the same period (Tables 2, 3).

Cardiovascular risk facto rs
Awareness of cancer
Over eighty percent of our populations are
aware of cancer and 25% had ever lost a
relative or friend to cancer such as cancer of
the breast (75.2%), cervix (3.2%) and
prostate (3.0%) (Table 4).

Tobacco use
Three hundred and eig hty seven
respondents had ever smoked cigarette,
373 men (96.4%) and 14 women (3.6%).
One hundred and eighty seven were current
smokers, 178 men (95.2%) and women
(4.8%). Majority (97, 84.4%) started
smoking before the age of 30 years. The
mean duration of smoking was 13.9±12.0
years. The major sources of information on
smoking include radio adverts,
radio/television programs and from cigarette
packs. Many of the respondents were
exposed to passive smoking (Table 5).

Alcohol use
Out of the 2,978 subjects w ho responded to
the question on alcohol, 55.8% had ever
used alcohol, 84.2% of these did so in the
last one year. The commonest alcohol
beverages consumed include beer (50.2%),
gin (18.3%) and palm wine 9.4%. In a typical

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60
day, 89.4% of them consume three
bottles/shots/glass or less. Alcohol drinking
was commoner in men (67.9%), urban
dwellers, and those within the age group of
20-52 years.

Fruit and vegetable consumption/dietary
pattern
Ninety percent of the subjects consume
fruits but only 15.9% on a dai ly basis. Only
175(6.1%) consume uncooked vegetables
daily while 1350(47.2%) consume cooked
vegetables every day. Consumption of
sodas, sweet/chocolate, coffee/tea and fast
foods is low in our population (2.0%, 1.8%,
8.3% and 1.3% respectively). About 5% a dd
extra salt to already prepared food on a
daily basis. However, the use of bullion salt
in prepared food is very high (78.1%). Also,
there is low consumption of protein rich diet
while the consumption of carbohydrate is
high.

Physical activity
Many o f the respondents (65.5%) were
engaged in work involving sedentary
activity. Few were engaged in work involving
moderate or vigorous intense activity (35.5%
and 18.2% respectively). Only 254 (9.1%)
respondent received advice to increase
physical activity i n the last 12 months.

Personal and family history
Twenty percent of the respondents had past
history of hypertension, while 4.1% were
known with diabetes mellitus.
Care -seeking behavio ur
Thirty five percent had visited a health
facility in the last one year. However the place of
primary care for m any was patent medicine
vendors (Table 6)

Traffic safety practices
Only 10.2% almost always use seat belt as
driver or front seat passenger, 20(0.7%)
respondents use seatbelts as back seat
passengers, wh ile 1.1% always use helmet
on a motorcycle. 103 subjects had
previously driven a vehicle under the
influence of alcohol.

Prevalence of NCDs
Hypertension
Systolic hypertension was present in 30%
and diastolic hypertension in 15.3%. Both
systolic and dia stolic hypertension was
present in 31.8%.

Obesity/Overweight
Obesity diagnosed based on BMI was
present in 13.8%. 28.2% were overweight,
56% had normal weight while 2.1% were
underweight.

Diabetes m ellitus
Diabetes diagnosed based on FBS ≥ 126/dl
or RBS ≥180mg/dl was present in 3.6% of
the population.

Cholesterol
Elevated serum cholesterol and triglycerides
was found in 2.4% of the population
respectively while 54.2% had low HDL
cholesterol.

Figure 1: Map of Nigeria showing the locati on as well as map of Abia state showing the 17 Local
Government Areas.

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Table1. Definition of terms used in the survey
Term Definition
1.Overweight/ Obesity Overweight was defined as a BMI 25 -29.9 kg/m2 and obesity as BMI ≥30 kg/m2.
Increased CV risk referred to waist circumference >=88cm (women ) or >=102cm
(men)
2. Hypertension Subjects having a systolic blood pressure of 140 mmHg and above, or a diastolic
blood pressure of 90mmHg and above or who had been treated pharmacologically for
hypertension though had a normal blood pressure were categorized as hypertensive
3. Diabetes Mellitus
and Impaired Glucose
Tolerance A previously known diabetic or subject with a fasting plasma glucose of 126mg/dl or
more and impaired fasting glucose is defined as fasting plasma glucose of 100 to 125
mg/dl or a random blood glucose of 180mg/dl or higher was classified as diabetes
mellitus and impaired glucose tolerance (IGT) was defined as random blood glucose
between 140 and 180mg/dl
4. Lipid abnormality Hypercholesterol
HDL-C 40 mg/dl for men or 50 mg/dl for women, and/or triglyceride concentration of
150 mg/dl or more.
Metabolic syndrome was defined using the national cholesterol education programme
(NCEP ) adult treatment panel (ATP) III criteria .[16] According to this criteria a subject
has metabolic syndrome if he or she has three or more of the following:
waist circumference >102 cm in men and >88 cm in women; triglyceride levels ≥ 150
mg/dl; HDL chole sterol concentration <40 mg/dl in men and <50 mg/dl in women;
blood pressure ≥ 130/85 mmHg; and fasting plasma glucose value ≥110 mg/dl.[16]
Atherogenic index (AI) was calculated as the ratio of HDLc to TC. High risk was
defined as HDLc/TC < 0.18, while a verage and low risk was 0.18 to 0.40
and >0.40 respectively, according to the European Atherosclerosis society
guidelines .[16]

Table 2: Distribution of respondents by demographic characteristics

Characteristic
Frequency
%

Gender (n=2983)
Males 1430 47.9
Females 1553 52.1
Age (in years) (n=2956)
<20 168 5.7
20-29 864 29.2
30-39 561 19.0
40-49 389 13.2
50-59 380 12.9
60-69 282 9.5
70-79 201 6.8
≥80 111 3.8
Mean age ±SD = 41.7±18.5
Marital Status (n=2972)
Single 1026 34.5
Married 1733 58.3
Others -Widowed, Divorced/Separated 213 7.2
Religion (n=2945)
Christianity 2917 99.0
Islam 20 0.7
Others -traditional religion 8 0.3
Educational Status attained (n=2975)
No formal Education 282 9.4
Primary 731 24.6
Secondary 1387 46.6
Tertiary 538 18.1
DNK 37 1.3
Ethnicity (n=2981)
Ibo 2875 96.4
Yoruba 36 1.2
Hausa 15 0.5
Others 55 1.9
DNK: Did not know

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Table 3: Distribution of respondents by Occupation, type of residence, ownership of means of mobility and
income

Frequency
%
Occupation (n=2950)
Artisa ns
588
19.9
Traders 479 16.2
Unemployed 430 14.6
Student/Apprentice 403 13.7
Farmers 402 13.6
Unskilled worker 188 6.4
Retirees 139 4.7
Low level skilled worker 124 4.2
Highly skilled worker 99 3.4
Intermediate level skilled worker 68 2.3
Relig ious/community leader 30 1.0
Type of Residence (n=2928)
Single hut unit 39 1.3
Multiple hut units 56 1.9
Mud house with cement plastering 186 6.4
Single/double apartment shared with others 745 25.4
Flat shared 426 14.5
Flat self contained 409 14.0
Bungalow 1006 34.4
Storey building/duplex 59 2.0
Ownership of means of mobility (n=2922)
Bicycle 156 5.3
Motorcycle 237 8.1
Tricycle 26 0.9
Car/Bus 209 7.2
None 2294 78.5
Average Annual Income in Naira* (n=2006)
<50000 593 29.6
50000 -99999 411 20.5
100,000 -199999 435 21.7
200,000 -499,999 392 19.5
≥500,000 175 8.7
*150 naira = 1 dollar

Table 4: Knowledge of malignancy among the respondents
Awareness of malignancy/cancer (n=963)
Yes 857 89.0
No 106 11.0
Ever lost a friend or relative to cancer (n=844)
Yes 209 24.8
No 635 75.3
Type of c ancer the person died of (n=209)
Cancer of the breast 154 73.7
Cancer of the cervix 9 4.3
Cancer of the blood 5 2.4
Cancer of the prostate 4 2.4
Cancer of the lungs 4 2.4
Cancer of the liver 4 2.4
Cancer of the uterus 4 2.4
Cancer of the brain 2 1.2
Cancer of the stomach 2 1.2
Cancer of the breast and kidney 1 0.6
Not specified 18 8.6

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Table 5 : shows pattern of residence, use of cigarette and alcohol and physical activity status
Variable Frequency %
Current place of domicile (n=2959)
Urban 1458 49.2
Rural 1451 50.8
Duration of continuous stay in urban area in years (n=2957)
<10 1040 35.2
10-19 499 16.9
20-29 637 21.5
30-39 335 11.5
40-49 173 5.9
50 and above 273 9.2
Mean ±SD = 18.88±17.06
Duration of continuous stay in rura l area in years (n=2957)
<10 1002 33.9
10-19 461 15.6
20-29 527 17.8
30-39 277 9.4
40-49 210 7.1
50 and above 480 16.2
Mean ±SD = 22.29±21.27
Area of residence in the past 5 years (n=2906)
Urban 1168 40.2
Rural 1437 49.4
Mixed
Ever smoked (n=2986)
Yes
No
Male
Female 301

387
2599
373
14 10.7

13.0
87.0
96.4
3.7
Timing of Initiation of Smoking in years (n=115)
<20 45 39.2
20-29 52 45.2
30-39 11 9.6
40-49 4 3.5
≥50 3 2.6
Mean±SD 23.00±10.21
Duration of smoking in years (n =108)
<10 48 44.4
10-19 35 32.4
20-29 14 13.0
30-39 9 8.3
40-49 2 1.8
Mean±SD 13.85±12.00
Ever consumed Alcohol (n=2978) Frequency %
Yes 1663 55.8
No 1315 44.2
Consumed alcohol in the last 12 months (n=1663)
Yes 1402 84.2
No 253 15.2
No response 9 0.6
Type of alcohol usually consumed (n=1402)
Beer 835 50.2
Gin 305 18.3
Palm wine 157 9.4
Wine 57 3.4
Spirit (Brandy) 42 2.5
Any type 12 0.7
No response 255 15.3
Eat Fruits (n=2973) Frequency %
Yes 2929 98.5
No 44 1.5
Consumptio n of fruits in a week/Weekly consumption of
fruits (n=2875)
Everyday 457 15.9
4-6 days 796 27.7
1-3 days 1622 56.4
No response
Daily consumption of fruits/consumption of fruits in a typical day (n=2855)
Once 1846 64.7
Twice 791 27.7
More t han twice 218 7.6

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Consumption of uncooked vegetable in a week (n=2878)
Everyday 175 6.1
4-6 days 418 14.5
1-3 days 2085 72.5
None 200 6.9
Consumption of cooked vegetable in a week (n=2860)
Everyday 1350 47.2
4-6 days 677 23.7
1-3 days 826 28.9
None 7 0.2
Engaged in work involving vigorous intense activity (n=2931) Frequency %
Yes 725 24.7
No 2206 75.3
Engaged in work involving moderate intense activity (n=2939)
Yes 1503 51.1
No 1436 48.9
Engaged in RSL involving sedentary activi ty (n=2922)
Yes 1914 65.5
No 1008 34.5
Engaged in RSL involving vigorous intense activity (n=2905)
Yes 547 18.2
No 2358 81.8
Engaged in RSL involving moderate intense activity (n=2928)
Yes 1040 35.5
No 1888 64.5
Received advice in the last one year to increase physical activity (n=2806)
Yes 254 9.1
No 2552 90.9

Table 6: Care seeking behaviour of r espondents
Visited a Doctor in the last one year (n=935)
Yes 277 29.6
No 658 70.4
Place of primary care (n=957)
Chemist 714 74.6
Clinic 118 12.1
Health center 48 5.0
Self medication 42 4.4
Laboratory 9
Prayer house 9 0.8
Invites a (family) care provider – doctor/nurse 10
Others
Herbalist 2
Perception of present state of health (n=957)
Very good 169 17.7
Good 486 50.8
Average 244 25.5
Bad 56 5.9
Very bad 1 0.1
Use of seat belt as a driver or a front seat passenger (n=945)
Almost Always 106 11.2
Sometimes 383 40.5
Never 416 44.0
Do not have a seat belt in a car 10 1.1
Never use a car 30 3.2
Use of se at belt as a back seat passenger (n=941)
Always 6 0.6
Sometimes 110 11.7
Never 712 75.7
Do not have a belt at the back seat 96 10.2
Never travel in the back of a car 17 1.8

DISCUSSION

The main findings in this study include: (i) a
third of the population were hypertensive; high prevalence of overweight/obesity and
high prevalence of dyslipidaemia, (ii) high
alcohol consumption but relatively low
prevalence of cigarette smoking; (iii) low

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65
consumption of uncooked vegetables,
relatively high s edentary lifestyle and high
cancer awareness and (iv) poor care
seeking behavior and traffic safety practices.

The age structure of our study population is
a true reflection of the demographic
structure of Nigeria and Abia State based on
the report of t he 2006 National census .[10-12]
According to this data , 54.6% of Nigerians
are between 15 and 65 years. Similar age
structures have been reported by other
workers.[10,13-16] The high literacy rate in our
study corroborates an area report by the
Abia State Planning Commission[11] in 2008
which gave a literacy rate of 85.6%.

Our report also conf irmed an earlier report in
the s tate’s core welfare indicators document
which showed that the predominant
occupation of the people of the State were
farming, art isan and trading .[12] The
predominant tribes in the State are Ibos who
are naturally very mobile, thus the high
number of people who have live in urban as
well as rural areas in the last first years prior
to the study. Rural residents were generally
older than their urban counterparts. Most
often the younger age groups migrate to
urban areas for white collar jobs and other
means of livelihood. On the other hand older
people generally tend to retire to the rural
areas after active service in the urban
commun ities.

The prevalence of cigarette smoking of
6.3% was lower than that previously
reported from the 2003 NCDs survey in
Southwest Nigeria (9.7%).[17] The WHO in
2008 estimated about 4.6% (7.6% men and
1.7% women) smoke cigarette daily .[18] The
Nigeria De mographic and Health S urvey
reported a prevalence of 9% in men and
0.2% in women.[10] This is far less than the
21.7% reported from Mauritius or 18.7%,
8.7%, 7.1%, and 19.6% reported from
Mozambique, Eritrea, Swaziland, and
Madagascar respectively.[19] The proportion
of female smokers is also very low (1.5%)
compared to what has been reported in
most other African countries.[19] The peak
age of smoking in this study was 30 –
39years. This is similar to a 1997 report in
the country .[20] Twenty five percent of those
who currently smoke have done so for less
than 10 years compared to 44% reported
from Lagos .[17] Awareness of the warning
against smoking is encouragingly high in
this population and the commonest source
of information was identified as radio advert . A significant proportion of them initiated
smoking due to influence of friends/peers
the study revealed. Health -related, personal
and religious reasons were the most
common reasons for quitting smoking,
similar to what was reported in a national
NCDs sur vey in 2003 .[17]
Alcohol consumption was noted to be high
in the state especially in urban areas and
younger people. In the 1997 report of the
National Survey of NCDs in Nigeria, 57.4%
of men and 81.1% of women were lifetime
abstainers from alcohol consump tion. The
prevalence of heavy alcohol drinking was
6.8% for men and 1.3% for women.[20]
Sixteen percent (16%) were heavy drinkers,
10% drank at least 4 standard drinks
(bottle/shot/glass) in a typical day, and while
about 23.4% were binge drinkers
(consume d ≥4 standard drinks for at least
one day).

Almost all the respondents consumed fruits
and 16% of them did so, on a daily basis
compared to 4.1% reported from
Lagos .[17,21] Only 6.9% did not consume
fresh vegetable and almost everybody
consumed cooked ve getable at least once a
week. Daily consumption of soft drinks
(2.0%) was significantly less compared to
16.3% observed in Lagos ,[17] while 4.5%
compared to 10% always used extra salt in
an already prepared food .[17]

A greater proportion of the population
surveyed always use bullion salt (78.1%) to
prepare their meals. Predominant sources of
protein was fish (70.0%), beef (32.9%) and
beans (24.1%), while commonest sources of
carbohydrate was cassava/garri (72.8%),
grains (51.1%) and yam (25.6%). Palm oil
was found to be the major cooking oil
among households in the state. Dietary
habit of most people in the state remained
unchanged in the last one year. Among the
few that made changes, changes made
involved mainly consumption less sugar, salt
and fat and co nsumption of more vegetable.

A significant proportion of respondents were
engaged in work that was predominantly
sedentary in nature, hence more people in
the state are becoming less physically
active. Average duration of time spent on
sedentary activiti es at workplace was
2.3±2.7 hours, even as more hours were
spent on sedentary activities at home
3.0±2.1hours. About 65% of the
respondents spent their recreation, sports
and leisure (RSL) time on sedentary

Ogah et al. : Cardiovascular risk factors and non -communicable diseases
Int J Med Biomed Res 2013;2(1 ):57-68
66
activities, compared to 18.5% and 35.5%
who spent theirs on vigorous or moderately
intense activities respectively. Most people
in the state relax at home and it often
involves either watching television or
chatting. A quarter and about half of the
inhabitants in the state were engaged in
vigorous and mo derate intense activity
respectively in their workplace. More people
in the state were engaged in vigorous or
moderately intense activity than their
counterparts Lagos in 2003 where 20.9%
and 27.6% of the population engaged in
similar activities in their workplace.[17] In
Mauritius only 16.5% were engaged in either
vigorous or moderately intense physical
activity in workplace. Similar data was also
reported from many other African
countries .[19]

Only few people received advice in the last
one year to redu ce their weight and majority
of the people in the state considered their
weight to be normal similar to what was
reported among residents in Lagos .[17]
Globally, increasing use of modern means
of transport and changing pattern of nature
of predominant occu pation has been
identified as one of the primary reason for
increasing physical inactivity .[2]

Awareness of cancer among residents in
Abia State was high, and brea st cancer was
the most commonly known cause of cancer –
related mortality among them. Fewer a lso
lost a loved one to cancer of the prostate,
cervix or lungs. The predominance of breast
cancer could be probably because of the
site involved that makes it easily
recognizable, as well as a reflection of
intense campaign aimed at preventing the
disease compared to other forms of
malignancies.

Hypertension and diabetes were the two
NCDs often reported in families. Fewer
people measured their blood sugar
compared the proportion that had their blood
pressure measured, and majority of the
people did so i n the last one year. This is
because blood pressure measurement is a
routine practice during care seeking in most
formal health facilities, while most people
only carry out blood sugar measurement
either following a doctor’s prescription or on
suspicion of diabetes. Only about one -third
of the respondents had occasion to visit a
doctor in the last one year, however the
patent medicine vendors enjoyed the most
patronage as the first point contact following onset of illness. The patronage of patent
medicine v endors can be attributed to low
coverage of health services, low health
literacy, poverty and ease of accessibility.

Expectedly, more front seaters used seat
belts either as a driver or a passenger than
back seaters. Forty four per cent and 79.4%
of the s ubjects compared to 65% and 86.6%
in south west Nigeria never used seat belt in
the front or back seat respectively.[17] Driving
under the influence of alcohol was not a
common practice in the state. However,
most people in the state do not own or drive
a car/bus. Use of crash helmet in the state
was observed to be very low, and the
implementation of the law enforcing the use
of crash helmet among motorcycle riders or
their passengers is weak. However, there is
a ban on the use of motorcycle as a means
of transport in urban areas of the state.

Prevalence of systolic and diastolic
hypertension reported in the survey was
30.0% and 15.3% respectively. Prevalence
of systolic hypertension was higher than
22.9%, while prevalence of diastolic
hypertension was lowe r than 29.7%
reported in south west Nigeria .[17] In general,
prevalence of hypertension in the state was
found to be high (31.8%), similar to various
studies in the same region of the
country.[13,15,16] Diabetes prevalence of 3.6%
was similar to the repo rt of other workers in
the country in recent times.

The prevalence of obesity in the study was
13.8% and is comparable to 16% reported in
Mauritius but lower than ≥30% reported
among the Caucasians. Prevalence of
dyslipidemia among the respondents was
46.9%, and the most common form of
dyslipidemia was low HDL rather high total
cholesterol. This pattern has been observed
in many other parts of Nigeria and
elsewhere .[21-30]

In conclusion , the study showed current
prevalence of modifiable -risk factors in Abia
state Nigeria. Prevalence of current tobacco
use in the state was found to be relatively
higher than national average and suggests
rising trend of tobacco use. Many residents
of the state were physically active; however
more time was spent at home on sedentary
activities. The most common NCDs in the
state were hypertension which was
observed in about one -third of the
population. Prevalence o f other NCDs was
13.6% for obesity and 3.6% for diabetes.

Ogah et al. : Cardiovascular risk factors and non -communicable diseases
Int J Med Biomed Res 2013;2(1 ):57-68
67
Low le vel HDL – cholesterol was high. Th e
authors recommend the following:
1. An increase in the priority accorded
to NCDs and integration of their prevention
and control into relevant policies across a ll
tier of government through advocacy to
policy makers as well as development of
policies, plans and programmes for the
prevention and control of NCDs in the state.
2. Development standards for NCDs
care and integration of their management
into the state hea lth care system as well as
reduction in inequality in health services
through adoption and expansion of health
insurance to include routine screening for
NCDs (measurement of blood pressure,
blood sugar, lipid profile and BMI).
3. Increase in access to NCDs
prevention and control information and
services at the primary healthcare levels in
the state through; distribution of NCDs –
related IEC/BCC materials, training of health
care providers, provision of essential
medicines and basic technologies and well
funct ioning referral mechanism
4. Creation of awareness on NCDs
including self care of patients through media
adverts, radio phone -in programmes, bulk
SMS and social networks. Mobilization of
communities in the state towards reducing
modifiable -risk factors of NCD s through
advocacy to community
leaders/stakeholders and community
sensitization meetings. There is also need to
develop or adapt relevant policies, plans
and strategies for the promotion of healthy
diet, physical activity , infant and young child
feeding , and control of tobacco use .
5. Establishment of a coordinated
agenda for NCDs research to cover the
following priority areas – analytical, health
systems, operational, economic and
behavioral researches aimed at effective
programme implementation and evaluat ion
through collaboration with academic and
research institutions in the state as well as
building research capacity of health care
workers.
6. Establishment and strengthening of
NCDs surveillance systems in the state and
standardization of the collection of data on
disease incidence , risk factors, and mortality
by cause. Surveillance of NCDs and
associated risk factors using the WHO
stepwise surveillance for NCDs should be
ongoing in the State and should be
conducted every two years.

ACKNOWLEDGMENT
The auth ors thank all the research
assistants who participated in the survey.
The project was funded by the Abia State
Government through the Health Systems
development project II (World Bank
Assisted)

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doi: http://dx.doi.org/ 10.14194/ijmbr. 2110

How to cite this article: Ogah O.S,
Madukwe O.O, Onyeonoro U.U,
Chukwuonye I.I, Ukegbu A.U, Akhimien
M.O, Okpechi I.G . Cardiovascular risk
factors and non -communicable di seases
in Abia state, Nigeria: report of a
community -based survey . Int J Med
Biomed Res 2013;2(1): 57-68

Conflict of Interest: None declared