Cardiovascular disease risk factors among school attending adolescents in rural Nigeria
Date
2016-03
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background: The prevalence of Cardiovascular Disease (CVD) is increasing in Nigeria,
particularly hypertensive heart disease among the working class population. Unfortunately,
resources for effective management of CVD at acute stage are sparse and expensive for the
average Nigerian making preventive measure the best option for Nigeria. CVD risk factors have
been identified in adolescents in many countries but information on CVD risk factors among
Nigerian adolescents, especially rural adolescents, are sparse. This study aimed to develop
culturally appropriate lifestyle CVD risk factors questionnaire for adolescents in Nigeria and to
investigate CVD risk factors and its associates among 15-18 years school attending adolescents
in rural Nigeria.
Methods: The study was conducted in rural south west Nigeria, one of the six geopolitical zones
of Nigeria. The people living in this area are Yoruba speaking population of Nigeria. The study
was conducted in four phases. Phase 1: development of a composite lifestyle CVD risk factors
questionnaire through systematic review, expert panel and target population. Phase 2: Cross
cultural validation of composite measure developed to facilitate its use among rural adolescents.
Phase 3: Pilot study to assess the logistics of the study and to test the reliability of the newly
developed questionnaire. Phase 4: investigation into CVD risk factors among adolescents. CVD
risk factors such as smoking, alcohol, Physical inactivity, and poor diet using the newly
developed questionnaire were assessed. Blood pressure, BMI and waist hip ratio were also
assessed using standardized protocol. Data was analyzed qualitatively and quantitatively.
Content validation of the questionnaire was done qualitatively using expert consensus and
adolescents’ feedback. Reliability was tested using ICC (Intraclass Correlation), Kappa and paired t test. CVD risk factors data was analyzed descriptively first, then with Pearson
correlation and multiple regressions to determine associations among risk factors at 95%
confidence interval (0.05 level of significance). Result: European countries showed high
prevalence of smoking among adolescents in the systematic review. The prevalence of
dyslipidemia ranged from 2.5% of total cholesterol (TC) in rural Iran adolescents to 48.9% high
Triglyceride (TG) in rural Mexican adolescents. Overweight and obesity prevalence ranged from
0.6% prevalence in an age (10 y) of a study to 48.7%. Studies from the United States showed a
decreasing trend in pre hypertension and hypertension, overweight and obesity. The newly
developed composite lifestyle CVD risk factors questionnaire for adolescents had moderate to
good reliability. Intraclass correlation (ICC) ranged from 0.3 - 0.7 and 0.3-0.8 in English and
Yoruba versions’ subscales respectively. Kappa statistics showed moderate to strong agreement
in priority questions in English and Yoruba versions. Investigation into the CVD risk factors
showed high prevalence and clustering of CVD risk factors; 7.1% adolescents were smokers,
10.2% drank excessive alcohol, 27.9% had low physical activity level, 59.8% consumed high
cholesterol diet, 6.1%, consumed low vegetable 8.1% consume low fruit 65.5% had high salt
intake, 33.1% had pre hypertension ( systolic), 5.5% had pre hypertension (diastolic) 3.2% had
hypertension (systolic) 0.8% had hypertension (diastolic). Smoking and drinking were
significantly higher in males and physical activity was significantly higher in females. Smoking
and drinking were significantly associated in both males and females and the odd of drinking and
smoking was more elevated in girls. Systolic pre- hypertension was associated with age and high
BMI in boys and was associated with only high BMI in girls. Conclusion: Nigerian rural
adolescents are at risk of future adult CVD. There is an urgent need to put measures in place to prevent future epidemic of CVD in adulthood. CVD prevention program for boys and girls
should be tailored to address gender specific CVD risk factors.
AFRIKAANSE OPSOMMING: Nie beskikbaar nie.
AFRIKAANSE OPSOMMING: Nie beskikbaar nie.
Description
Thesis (PhD)--Stellenbosch University, 2016.
Keywords
UCTD, Cardiovascular system -- Diseases -- Risk factors -- Nigeria, Hypertension in adolescence -- Risk factors -- Nigeria, Coronary heart disease -- Risk factors -- Nigeria, Teenagers -- Health risk assessment -- Nigeria