Our findings illustrate that 73.3% of respondents in our study had moderate-to-good knowledge level of heart disease risk factors (HDRF), with only about 38.5% having a good level of knowledge. Many modifiable risk factors were well recognized with about 3 out of 4 having good knowledge level of preventive behaviors towards heart disease (90.4%). Besides the general moderate-to-good knowledge of respondents, there was a lack of understanding that gender, advancing age and low socioeconomic status are known risk factors. Those who reported being aware of heart disease, being male, being a high risk of developing heart disease were about two times more likely to have a good knowledge level of heart disease than their counterparts; those who reported not having any risk factors were about three times more likely to have a good knowledge level than those with more than two risk factors (Table 4). These findings are supported by other survey data that found heart disease knowledge to differ by gender and education. Aminde et al. found in the SouthWest part of Cameroon that 52.5% of the studied population had poor level of knowledge regarding CVD. Significant predictors of moderate-to-good CVD knowledge level in that setting were high level of education, high monthly income, having a family history of CVD, and being a former smoker14. Compared to our results, Akintunde et al. in Nigeria found very poor knowledge level of heart disease risk factors among the majority of their respondents (19.9%), with no relationship with age, gender or education level17.
The self-reported prevalence of hypertension in our study was 12.8%, which is three times lower than that of a nationwide community-based survey conducted in four regions of Cameroon (47.5%), meaning that in our study they could have been many respondents unaware of their health status who underestimated their own risk of having high blood pressure8. The knowledge level found in our study was very close to that found in New Delhi, India (41%), it was also low and its predictors were physical exercise and no smoking; this is similar to our study where healthy people were more likely to have good heart disease knowledge level although reported risk factors were categorized into a risk factor summary score to have more meaning18. The Cameroonian population studied here was on average four times more likely to have better knowledge than the population of Karachi in Pakistan for numerous heart disease risk factors such as smoking, high blood pressure, lack of exercise, overweight, stress, family history of heart disease, high cholesterol and alcohol. In addition, respondents of Yaounde looked unhealthier than those from Karachi regarding the proportion of people reporting having two or more risk factors; this can be explained by the fact that our design integrated a summary score of 10 risk factors whereas that used in Karachi took only 3 major risk factors into account, so we can suggest that the risk factor summary score used in Karachi did not assess accurately the true respondent risk to heart disease25. Compared to our study, in the city of Buea in Cameroon Aminde et al. 10.1% were overweight, 6.4% were smokers, 21.9% drink alcohol, 49.6% were physically inactive and 83.3% had unhealthy lifestyles regarding eating habits.
Regarding effective interventions to reduce heart disease, Winham and Jones found similar results as their respondents well identified preventive actions to reduce heart disease risk, with a slightly better percentage. The differences lied on the types of risk factors as only major modifiable risk factors were recognized by African Americans whereas Cameroonians recognized major modifiable risk factors, non-modifiable risk factors (aging 53.8% and gender 23.3%) with other risk factors (drinking alcohol 61.8% and low socioeconomic status 45.7%)26. We could say Cameroonians are more likely than African Americans to identify a wide range of determinants of heart disease (Table 2).
Significant predictors of heart disease knowledge score in our study were awareness of heart disease, male gender, higher education, perceived high risk to heart disease and having no risk factors (Table 4). These results are partly consistent to that of Winham and Jones who found predictors of heart disease knowledge score to be higher education, high self-efficacy and female gender26. This difference can be due to the difference in proportions of females and males in both studied samples; male female ratios in our study and that of Winham were respectively 1.1 and 0.56 so proportions of female respondents in the second study was two times lower, which could have influenced both results knowing also that sample size differences could have been another influential element. Predictors of perceived self-efficacy to reduce heart disease risk were higher education, lower income, high susceptibility to heart disease and being medically insured. Winham and Jones26 found higher education and low susceptibility to heart disease to be predictors of perceived self-efficacy. We found high susceptibility as predictor in opposite to low susceptibility their study. Once more, this can be due to sample size differences and to the fact that more respondents in our study were had a high-risk factor summary score (Table 3).
To prevent heart disease is a sub-Saharan population such as Cameroonians, the level of knowledge on heat disease has to be well evaluated with the purpose of ascertaining its strengths and weakness while tailoring preventive educational programs targeting the reduction of heart disease risk in young adulthood. Knowledge of predisposing risk factors has been identified as a major step in the modification of lifestyle behaviors that ultimately lead to better cardiovascular health in developing countries27,28; furthermore, its increases program acceptance29.