Distribution of study participants by parish in Mukono and Buikwe districts. A final sample of 4372 participants were drawn from 20 parishes into this study (Figure 1). Mean (SD) and median participant enrolment were 218 (±20.9) and 221 respectively.
Figure 1: Distribution of participants by parish and district
Distribution of demographic characteristics of study participants by parish
Majority of participants (overall and across parishes) were females (60.2%), younger (55.5% were aged 25-40 years, mean age = 41.4 years (SD±12.74)), had obtained primary/no education (67.1%), reported doing subsistence farming or casual work (76%), were married 63.9% and catholic by religion (35.2%). Table 1 shows that across all parishes, differences in mean age, sex, education level, occupation and religion were observed; all p-value <0.001).
Distribution of prevalence of risk factors by Parish
Seven major modifiable risk factors for cardiovascular disease are included in this comparative descriptive study: – Hypertension (Table S1), high blood sugar (self-reported diabetes) (No table), overweight/obesity (Table S2), physical inactivity (Table S3), smoking (Table S4), unhealthy diet (Table S5), and alcohol consumption (Table S6).
Hypertension: The overall prevalence of hypertension (Table S1) in our sample was 23.4% with no overall significant difference observed among males (23.4%) compared to females (24.4%), p= 0.467. However, sub-analysis at the parish level revealed differences. Some parishes had higher prevalences of hypertension among men compared to females and vice versa. Higher estimates among men compared to women were observed in the parish of Nsakya, [males (29.2%) vs females (17.9%), p=0.047]; Seeta-Nazigo, [males (30.3%) vs females (23.6%), p=0.28] and Wakisi [males (32.9%) vs females (21.7%), p=0.28]. On the other hand, higher prevalences among women compared to men were observed in the parishes of Misindye [males (19.2%) vs females 34.3%, p=0.021]; and Nabalanga, [males (15.3%) vs females (26.2%), p=0.04]. Meanwhile, bivariate and multivariate analysis across parishes revealed striking differences in the prevalences of hypertension, p=0.001. We observed that in 11 parishes, the prevalences of hypertension were significantly different (Table 2 & 3). The prevalence of hypertension was about twice as higher in Busabaga (adjPPR= 1.88, 95%CI: 1.27-2.77), Misindye (adjPPR= 1.98, 95%CI: 1.33-2.95), Kitovu (adjPPR= 1.86, 95%CI: 1.25-2.77), Mawoto (adjPRR= 1.80, 95%CI: 1.21-2.69) and Mpunge (adjPPR= 1.73, 95%CI: 1.14-2.63) compared to estimates in Namuganga Parish. The prevalence of hypertension was also higher in Kabanga (adjPPR= 1.75, 95%CI: 1.18-2.60), Kyabazaala (adjPPR= 1.55, 95%CI: 1.04-2.33), Lugala (adjPPR= 1.57, 95%CI: 1.05-2.34), Nsakya (adjPPR= 1.52, 95%CI: 1.00-2.31), Seeta Nazigo (adjPPR= 1.62, 95%CI: 1.07-2.45) and Wakisi (adjPPR= 1.53, 95%CI: 1.04-2.34). Meanwhile, alcohol consumption (adjPPR= 1.47, 95%CI: 1.29-1.67), higher age – 40-70 years (adjPPR= 2.34, 95%CI: 1.06-2.66), being married/cohabiting (adjPPR= 1.41, 95%CI: 1.04-1.92) and being divorced or widowed (adjPPR= 1.65, 95%CI: 1.20-2.27) also remained significantly associated with hypertension at multivariable analysis.
Self-reported diabetes: The prevalences of diabetes was reportedly 1.6% overall, lower among males (1.1%) compared to females (1.9%), p=0.029. Further analysis by parish level was not conducted due to inadequate sample sizes. Only those who reported having ever been screened for blood sugar were asked their diabetes status.
Overweight/Obesity: The overall prevalence of overweight/obesity (Table S2) in our sample was 30.4% with no overall significant difference observed among males (30.2%) compared to females (30.6%). Further analysis at bivariate revealed significant prevalence proportion ratios in the parishes of Mawotto (unadjPPR= 1.37, 95%CI: 1.01-1.85), Nagojje (unadjPPR= 1.35, 95%CI: 1.01-1.81), Namabu (adjPPR= 1.35, 95%CI: 1.00-1.82) and Namuganga (adjPPR= 1.37, 95%CI: 1.00-1.86), (Table 2). The associations were not retained at multivariate analysis, (Table 3).
Physical inactivity: The overall prevalence of physical inactivity was 4.0%, [lower among males (3.0%) compared to females (4.8%)], p=0.002. By parish, differences in physical inactivity were also observed, p<0.001. Indeed, physical inactivity was highest in Njeru West (12%), [higher among males (12.7%) compared to females (11.7%)]; and lowest in Mpunge and Mawotto parishes at (0.5%), with no observed difference by gender. Overall, all parishes had lower levels of physical inactivity. At bivariate analysis, differences were observed for 6 of the parishes. However, the confidence intervals were very wide possibly due to very small numbers in the comparison as majority of the people fell within the physically active category (Table 2). Thus, we never carried forward to analyse the outcomes at multivariate to avoid very small cells.
Smoking: The overall prevalence of smoking was 6.8%, [higher among males (13%) than females (2.7%)], p<0.001. Differences across parishes were prevalent p=0.012. Smoking prevalences were relatively higher in Kyabakadde (11.9%), [higher among males (17.7%) than females (7.7%), p=0.024]; Namaliga (9.0%), [higher among males (22.9%) than females (3.8%), p<0.001]; and Mpunge (9.3 %), [lower among males (8.7%) thanfemales (9.8%), p=0.008]. Lowest smoking prevalences were noted in Buikwe parish (4.1%), [higher among males (8.6%) thanfemales (2.2%)], p=0.04, Njeru West (3.8%), [higher among males (9.8%) thano females (1.5%)], p=0.009; and Nsakya (3.1%), [only among males (6.6%)] and Misindye (3.2%), [only among males (7.2%)]. At bivariate and multivariate analysis, differences were only retained in Namaliga parish (adjPPR= 3.47, 95%CI: 1.18-10.19). This possibly meant parish was not a predictor but rather, other attributes may explain the smoking behaviour. Indeed, alcohol consumption (adjPPR= 4.55, 95%CI: 3.32-6.24), male gender (adjPPR= 4.18, 95%CI: 3.11-5.60), higher age (adjPPR= 1.43, 95%CI: 1.11-1.84), and Muslim religion (adjPPR= 1.72, 95%CI: 1.20-2.47) remained significantly associated with smoking practices at multivariate analysis. Moreover, post primary education (adjPPR= 0.62, 95%CI: 0.47-0.82), protestant religion (adjPPR= 0.72, 95%CI: 0.55-0.93), cohabiting/being married (adjPPR= 0.66, 95%CI: 0.46-0.96) and formal/ informal occupation other than subsistence farming (adjPPR= 0.62, 95%CI: 0.44-0.86) had lower prevalence proportional ratios, suggesting that these are possibly protective factors against smoking.
Alcohol consumption: The overall prevalence of alcohol consumption was 23.0%, significantly higher among males (34.6%) than females (15.5%), p<0.001 and across parishes, p<0.001. By parish, highest prevalences were observed in Nagojje (41.7%), [higher among males, (58.8%) compared to females (23.4%), p<0.001]; Lugala, 38%, [higher among males (47.7%) compared to females (24.0%), p<0.001]; and Busabaga (33.5%), [higher among males (49.0%) than females (23.8%), p<0.001]. Lowest prevalences of alcohol consumption were observed in Nsakya (11.2%), [higher among males (17.0%) thanfemales (6.0%)]; Buikwe, (13.0%), [higher among males (22.4%) than females (9.0%)]; and Namabu (15.7%), [higher among males 19.8% thanfemales (12.3%)]. At bivariate and multivariate analysis, significant differences were retained across 14 parishes (Table 2 &3). In addition, high blood pressure (adjPPR= 1.37, 95%CI: 1.23-1.53), smoking (adjPPR= 2.03, 95%CI: 1.79-2.04), and male gender (adjPPR= 1.82, 95%CI: 1.63-2.04) remained significant with higher prevalence proportional ratios at multivariate analysis. On the other hand, being protestant (adjPPR= 0.80, 95%CI: 0.72-0.99), Muslim (adjPPR= 0.19, 95%CI: 0.14-0.25), and other religion (adjPPR= 0.19, 95%CI: 0.14-0.26) retained low prevalence proportion ratios compared to being catholic at multivariate analysis.
Unhealthy diet: Inadequate fruit and vegetable consumption was used as a proxy measure for unhealthy diet. The prevalence of unhealthy diet was (88.6%), with no significant differences among males (88.7%) compared to females (88.5%), p=0.831. Across all parishes, inadequate fruit and vegetable consumption was very prevalent and we opted not to conduct further analysis.
Risk factor combination: We combined four risk factors; hypertension, BMI, alcohol consumption and smoking to generate a composite outcome (Table 2 &3). People with high risks (≥ 2 risk factors) were more in Busabaga (adjPPR= 1.33, 95%CI: 1.13-1.58), Kabanga (adjPPR= 1.21, 95%CI: 1.02-1.43), Kyabazaala (adjPPR= 1.21, 95%CI: 1.01-1.45), Lugaala (adjPPR= 1.23, 95%CI: 1.04-1.46), Mawoota (adjPPR= 1.28, 95%CI: 1.08-1.52), Misindye (adjPPR= 1.29, 95%CI: 1.07-1.55), Mpunge (adjPPR= 1.22, 95%CI: 1.02-1.46), Nagojj (adjPPR= 1.22, 95%CI: 1.04-1.44), and Njeru West (adjPPR= 1.23, 95%CI: 1.01-1.50). Other independent predictors of high risk category were being male (adjPPR= 1.37, 95%CI: 1.30-1.45), older age (40-70) (adjPPR= 1.35, 95%CI: 1.27-1.43) and being divorced or widowed (adjPPR= 1.22, 95%CI: 1.07-1.40). Post primary education had a protective association (adjPPR= 0.85, 95%CI: 0.80-0.91).