Study sites and Design
This was a cross-sectional study in 3 counties in Kenya; Mombasa, Muranga and Uasin Gishu. This was designed to sample a representative population of the country into the study due to the diversity in distribution of clients admitted in these rehabilitation centers. The study sites were six rehabilitation centers located in the three counties, two in each county. Community sensitization within counties hosting the study sites was done to encourage persons dependent on alcohol, cannabis and cocaine to visit the selected study rehabilitation centers. Samples were collected from consenting persons attending health facilities, admitted in rehabilitation centers and those sampled out from the community in the county who accepted to visit community sampling centers that were established in various parts of the country during the project.
Blood samples were collected from consenting individuals diagnosed as dependent to a substance or those who confess to be users and willingly visited the community sampling centers.
A convenient sample of 166 substance patients was used in the study selected from 6 participating rehabilitation centers and the surrounding community sampling centers. Purposive sampling was used to select the 6 rehabilitation sites. Severe cases were referred to selected rehabilitation facilities for further management. Intervention mechanisms were also put in place to provide treatment and counselling collaboratively with selected rehabilitation centers as per the current standard of care.
Height, weight, waist circumference and blood pressure measurements were taken during a private physical examination by a qualified nurse. The height was measured using a Seca Rod 220 stadiometer (Seca, Hamburg, Germany), a TANITA (TANITA, Arlington Heights, Illinois) weighing scale to measure the weight and a Gulick tape measure to measure the waist circumference. All anthropometric measurements were taken without shoes and wearing light clothing. Waist circumference was measured at the iliac crest upon exhalation. Blood pressure was taken after a five minutes rest using an Omron automated monitor (Omron, Kyoto, Japan). The WHO guidance on body mass index classification was employed.
SD Cholesterol/Lipid desktop analyzer was used to measure the biochemical measures for triglycerides, High Density Lipoproteins, and fasting glucose. Blood samples were acquired from a finger prick using a lancet and collected using a pipette. 12 hour fasting blood samples were assayed by standard methods for blood glucose, HDL-cholesterol and triglycerides in three minutes. A copy of the results was availed to each participant. If the results were outside normal parameters, the participant was referred for follow up and continued management with a health provider.
Metabolic and its elements’ defining criteria
The defining criteria stipulated in the Harmonized Joint Scientific Statement (HJSS)  on metabolic syndrome was used. This requires central obesity or an elevated waist circumference and at least two other components. Precisely, the criteria is as follows: Waist circumference: >94 cm (male) >80 cm (female), Blood pressure- > 130/85 mmHg. (Hypertension), Impaired glucose handling-PG >200 mg/dL (11.1 mmol/L), raised fasting plasma glucose >100 mg/dL (>5.6 mmol/L), Body mass index ≥30 kg/m2, Dyslipidemia: triglycerides (TG): ≥ 1.7 mmol/L /150 mg/dL and high-density lipoprotein cholesterol (HDL-C) ≤ 1.0 mmol/ L/40 mg/dL (male), ≤ 1.3 mmol/L /50 mg/dL (female).