NCDs-COVID19 Preventions, Environmental – Nutrition Perspective Approach; (The Case of Tanzanian Students)

INTRODUCTION; : Non-communicable diseases (NCDs) are serious public diseases. They are affecting a larger a number of young people who are from developing countries. Characterized by been non-transferrable diseases. The main risk factors include unhealthy behaviors and metabolic syndromes. Unhealthy behaviors include excess use of salts, sugar, fats food and alcohol, other are cigarettes, physical inactive and inadequate intake of fruits and vegetable, but also overweight/obesity, hypertension high cholesterol and hyperglygriciride. Common NCDs killers are CVDs, chronic respiratory diseases, diabetes and cancer OBJECTIVES;: main objective of this study was to assess the student knowledge on NCD-COVID-19 prevention; environmental – nutrition perspective approach.. METHOD;: Cross section study design conducted at Dar-es-salaam- Tanzania. Purposive method used to select participants within six secondary schools that are situated at city center. The likert scale questioner used to obtain non-parametric data. The validation and reliability of tool pre-tested before actual data collection. The data were analyzed under ordinal regression analysis under the help of computer with SPSS- 20 version software. The descriptive statistics established frequencies and percentages while statistical measures were median and IQR. RESULTS;: about 600 students were recruited and participated, 54.7% were female and 45.3% male, (SD) mean was 18.3 and SD was 0.64. Students were knowledgeable on nutrition perspective by 81% while on environmental perspective was 50%. CONCLUSION; : the study concluded that, to speed up NCDs–COVID19 prevention, the multipart environmental education, curriculum education review and adoption of new NCDs strategic action (2018-2020) are needed. now for the

growing rapidly. With this has been experiencing frequently climate changes events include like frequency natural disasters events, ood, earthquake and weather changes (5). However, Tanzania is in East of Africa, foundered with Kenya, Uganda in north part, Congo, Burundi and Rwanda at west part, Zambia, Zimbabwe, and Malawi at south part while eastern part is Indian Ocean.

Sample Size
The con dence interval or margin error used to obtain sample size was 5. This established an estimated representation either +/-5% of the total population. The population size used was 10,000 and a con dence level was 95 percent was used to calculate the sample size by using Cochran equation formula (Cochran 1963). Obtained sample size 400 but was approximately to 600 to add the value of the study.

Sampling procedure
Purposive sampling procedure was used to select the participants regarding their age. The student's age between 16-21years were purposively selected equally from both private and governments secondary schools that are in city center, with the ratio of 50; 50 male and female. However, only students who have been schooling in Dar-es-salaam for six and above months, Data collection and management Data collection A Likert 5-scale form was developed whereas the responses were valued from 1-strongly agree to 5 strongly disagree. The questionnaire development was guided by theme of the study following the speci c objectives and then the data was collected from august to September 2020. But, prior to actual data collection, a tool was a pre -tested and validated, and a written informed consent was given to each participant who was above 18 years. However, below 18, their request was directed to their parents/caretaker.

Data analysis
Then, the non-parametric data were cleaned and analyzed through ordinary regression analysis. Before, ordinary regression analysis, the descriptive statistics analysis was performed to establish the frequency and percentages in tabulation form and then the ordinal regression analysis was performed to disseminate the median, model and IQR and Chi-square test value to determine variance. Moreover, the ndings were supported by relevant reviewed literatures and the data analyzed through the stages. description, data classi cation, and interpretation (15) Creswell, 2013. Nonetheless, the value of tool validation accepted by p-value was (.000).

Ethical clearance
Before get into site, the research protocol was observed, whereby the letter for ethical approval was offered by the Ethical Review Board of Universities' Muhimbili Health alliances, Tanzania Ref no; MUHAS-REC-92020.0.046

Results
Before, ordinal regression analysis, , the data was pre-tested to find out the fitness and accurate of tools. The pre-test results demonstrated that, the tool was acceptable p -value of (.891) of which about 32 items was tested, whereas the p-value was higher than standard (>.70) (15). Subsequently, the ordinary regression analysis was done to determine the relationship between variables (Table1), of which, the findings was statistical significant as the p -value was equal to (.000), whereas the goodness of fit was below (.005) by (.001) which was statistically significant fit A total of 600 participants comprising 328 (54.7%) female and 272 (45.3%) males. were interviewed with regard to their understanding on the socio-demographic factors. The statistical mean age and standard deviation were 18.3 and SD = 0.64 respectively. 87% were advanced students and 12.3% were ordinary education students while 45% were sciences students, 21.3% art, and 21.5% economy and (11%) were general knowledge students (Table; 2). Generally, half of the participants -300 (50%), were knowledgeable. Female were statistical significant higher than men. Student level of Knowledge on socio-demographic characteristics perspective (sex education and subject specialized) Cross-tabulation was done to examine the association between socio-demographic variables and the knowledge of the participants on NCDs prevention on environmental-nutrition perspective approach. Specifically Age, sex, education were significantly associated with the knowledge of participants. Education was significantly associated with NCDs prevention knowledge in univariate analyses.
In the multivariable analysis, age sex and education area were significantly associated with knowledge of NCDs prevention on aspect of environmental-nutrition approach. A clear dose-response association was observed with educational level (P-for linear trend from logistic regression <0.000). The female and science student's respondents were more likely to have knowledge than other social-demographic characteristics (Table 3) . Knowledge on Nutrition perspective approach towards NCDs-COVID 19 prevention The study had two perspectives approaches; nutrition and environmental.

Discussion
This study is the rst signi cant quantitative study attempt in Tanzania to assess the concepts of students on environmental-nutrition perspective on NCD -COVID-19 prevention. We found that more than half of the participated secondary students have inadequate environmental-nutrition knowledge.
Further the study discovered that, acquired knowledge among students was through experience and education attained. Adequate engagement and involvement of youths, speed up awareness within community, use as are fasting adopting and keep in action the new changes. In other way, youth are source for promoting quick healthy behavior changes in a society. And education institute is center for youth capacity building that also empowering and strengthen on decision making, transforming information now and for the future generations. thus, youth have in uencer for diseases prevention (16). But the ndings revealed that, students were lacking the knowledge of which the ndings were likely the same with study conducted at Indonesia (17). But different from study conducted among high secondary students in Bangladesh (18).
However, the study assessed student's concepts on NCDs-COVID 19 on nutrition prevention perspective. The study mainly conducted to identify the nutrition education coverage among students in achieving adequate and healthier. The quality of food and nutrition has crucial role in NCDs-COVID-19 prevention. But in COVID 19 episode measures reported to limit the accesses and availability of healthier foods and also limit physical activity (8).
However, many nutrition studies have been directed to individually dietary intakes of which it is different from this. But this study is the rst as assessed the nutrition knowledge among students towards NCDs-COVID 19 prevention was directed to assess the provision of healthier food and quality nutrition in public and not individual diet consumption. Like one study that conducted to assessed the potential of performing nutrition analysis and Hazard Analysis Critical Control point in public health for NCDs prevention of which suggested it is important to provide nutritional quality (19) However, the study basically evaluated the student's concepts on nutrition knowledge towards NCDs-COVID 19 prevention. present ndings revealed that, the students had average knowledge. Nonetheless, the highest knowledge were on proper Hazard Analysis and Critical Control Point practices (HACCP), food law practices, In house food budget, and Physical Activity reduction of processed food, nutrition analysis, and balance diet. These was statistically identi ed by median = 4 and IQR 2. Although Fruits and Vegetable intake, GMO, high price for processed food, practicing moveable patch and riding bicycle statistically shown had average nutrition knowledge as many factors had media of 4 and IQR 2. The study ndings revealed that, students have average knowledge. in this perspective, further the literatures are conspicuous missing on NCDs-COVID -19 prevention. But, in Gujarat-India m the study conducted among higher secondary school students of which was based on NCDs preventive m the ndings illustrated that, students had su cient knowledge (20).
Regardless of nutrition assessed but also the study evaluated the student's knowledge on environmental towards NCDs-COVID 19 prevention.. In this, the study assessed the concept of fruits tree plantation, moveable vegetable patch around home, tree plantation campaign. Also, assessed an increase of price processed foods as measures for NCDs-COVID-19 prevention, not only that but also evaluated the concepts of genetically modi ed food products reduction, organics food reduction (GMO) and friendly infrastructure for bicycle riding. Generally, variables assessed scored between 70% and 50%, whereas statistically was approved that. The students were adequate knowledgeable by median of 4 and IQR 4. Besides, the student were highly clear on environmental education, protection and management, fruits tree plantation campaign, reforestation and exported items while FV, GMO, processed foods, practices movable patch was not clearly. However, the study wanted to expose the level of student knowledge on environmental protection towards NCDs-COVID-19 prevention. However, Environmental is good source for providing natural food/ healthier foods whereas are power for diseases prevention. However, farther investigations are needed as the literatures were conspicuously missing on NCDs-COVID 19 prevention-environmental perspective. Nonetheless, like ndings to study conducted Pulchowk Campus, Lalitpur, (21) but dissimilar to study conducted at Maharagama Educational Division in Sri Lanka, mainly assessed the knowledge on NCDs, and lifestyle choices include health diet and physical activity the students had low level of knowledge (4) Conclusions