CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 1, January/February 2010
AFRICA
29
2.1% of men and 2.7% of women in the study population had
at least three of the criteria, the commonest being HDL-C
<
40
mg/dl in men or
<
50 mg/dl in women, followed by BP
≥
130/85
mmHg, then by waist circumference
>
88 cm in women or
>
102
cm in men, followed by blood glucose
≥
110 mg/dl.
Discussion
There is an emergence of chronic NCDs, including CVD in
populations undergoing socioeconomic changes, and the rural
sub-Saharan population is thought to be at an early stage of
this epidemiological transition.
23
CVD and its risk factors can
adversely affect quality of life. The risk profile of a popula-
tion can be utilised to predict the burden of atherosclerosis and
its complications, such as stroke and CAD. The presence and
number of CAD risk factors predict future cardiovascular events,
especially heart attack and stroke in individuals with such risk
factors.
24
The present study was a population-based survey undertaken
to determine the prevalence of cardiometabolic risk factors in
a western Nigerian rural adult population, aged 18 to 64 years.
The first major finding of our study revealed a relatively high
frequency of hypertension (BP
≥
140/90 mmHg) affecting
20.8% of the study population, low levels of HDL-C affecting
43.1%, and abdominal obesity affecting 14.7%. These three were
the most common risk factors in the population. The pattern
observed suggests that the health transition might be occurring at
a rate faster than what should be seen in a population at an early
stage of transition. This may worsen the rate of strokes and other
cardiovascular events in the future.
Our study has contributed to determining the burden and
distribution of cardiometabolic risk factors from age 18 to 64
years. Previous studies were done in elderly Nigerians over 55
years of age in the south-western portion of Nigeria,
25
and were
hospital based.
Using the ATP III criteria, we found the prevalence of cardio-
metabolic risk factors to be 2.1% in men and 2.7% in women.
This rate was higher than that found in the city of Yaoundé in
Cameroon and in three rural villages, using the same criteria,
where the prevalence was
<
0.5% in men and
<
0.2% in women.
26
A much higher rate of 24% in men and 32% in women was found
in a nationwide study in the Seychelles.
27
The prevalence of the
metabolic syndrome in the Seychelles was noted to be similar to
that in western countries.
The overall prevalence of hypertension in this study was
20.8%, an indication that hypertension affects a large propor-
tion of the adult population in the rural community of Egbeda.
A previous nationwide study
28
and other studies
29,30
found the
prevalence rate ranging from 7% in the rural population to 20%
in the urban population. This relatively higher prevalence rate of
hypertension in a rural setting at an early stage of the economic
and health transition is worrisome, since Egbeda is populated
mainly by farmers, artisans and petty traders. The health systems
serving the population are inadequately developed to tackle the
burden of CVD. High and increasing rates of hypertension have
been reported in rural communities in India
31
and Indonesia.
32
In Nigeria, services are offered free at primary healthcare
centres (PHCs), but in spite of this, only a small proportion
(18.6%) of patients with high blood pressure were on any form of
treatment within three months prior to our study. Factors identi-
fied as contributory included care-seeker and caregiver apathy to
chronic health issues which appeared to be non-incapacitating.
The care seekers also complained of difficulties of transporta-
tion to clinics, missing the day’s work (most were daily-paid/
self-employed workers who depended on the day’s earnings),
competing issues, no drugs on arrival at PHCs, and no equip-
ment or personnel in the facilities. Most of the PHCs had no
programmes for chronic care in their practices. There was a
dearth of personnel trained in long-term care, as well as inad-
equate medical records, medical supplies, equipment and drugs
in almost all cases.
Our study is the first known documentation of the population
prevalence of BP
≥
130/85 mmHg, which was found in 39.2%
of the study population. This risk factor will probably increase
the burden of CVD in the near future if primordial and primary
prevention are not instituted early enough. Therefore, there is an
urgent need for early identification and treatment of persons in
the pre-hypertensive state, using non-pharmacological methods
of weight reduction, increased physical activity and increased
consumption of fruit and vegetables, with a reduction in salt
intake.
The results of our study showed that the prevalence of diabe-
tes mellitus was 2.5% and this was similar to the national crude
prevalence rate of 2.8%.
28
The Egbeda residents with diabetes
were more likely to be aware of their condition than the hyper-
tensives (73.5% vs 14.2%, respectively). The treatment rate for
diabetes was also higher than that for hypertension (36.1% vs
18.6%, respectively). It appeared that the reasons adduced for
these included the fact that the presence of glucose in the urine
TABLE 4. PREVALENCE OF MULTIPLE CARDIOMETABOLIC
RISK FACTORS BYAGE IN THE STUDY POPULATION
Age (years)
18–24 25–34 35–44 45–54 55–64 Overall
Risk factors (
n
) % (
n
) % (
n
) % (
n
) % (
n
) % (
n
) %
2
(0) 0.0 (13) 0.7 (57) 2.9 (63) 3.2 (38) 1.9 (171) 8.6
3
(0) 0.0 (0) 0.0 (30) 1.5 (21) 1.0 (9) 0.4 (60) 3.0
≥
4
(0) 0.0 (2) 0.1 (11) 0.5 (5) 0.3 (8) 0.4 (26) 1.3
TABLE 3. PREVALENCE OF SELECTED CARDIOMETABOLIC
RISK FACTORS BYAGE IN THE STUDY POPULATION
Age (years)
18–24 25–34 35–44 45–54 55–64 Overall
Risk factors
(
n
) % (
n
) % (
n
) % (
n
) % (
n
) % (
n
) %
Hypertension (3) 1.5 (39) 1.9 (155) 7.7 (171) 8.5 (47) 2.3 (415) 20.8
Diabetes
mellitus
(1) 0.1 (4) 0.2 (29) 1.5 (12) 0.6 (3) 0.2 (49) 2.5
Hypertri-
glyceridaemia (0) 0.0 (0) 0.0 (10) 0.5 (19) 1.0 (8) 0.4 (37) 1.9
Hypercholes-
terolaemia
(0) 0.0 (1) 0.1 (17) 0.9 (26) 1.3 (19) 1.0 (63) 3.2
Current
smokers
(9) 0.5 (17) 0.9 (6) 0.3 (0) 0.0 (1) 0.1 (33) 1.7
Waist
circumference
>
80 cm
(women)
(0) 0.0 (19) 0.9 (53) 2.7 (89) 4.4 (31) 1.6 (192) 9.6
>
94 cm (men) (0) 0.0 (2) 0.1 (52) 2.6 (24) 1.2 (24) 1.2 (102) 5.1
Physical
inactivity
(0) 0.0 (2) 0.1 (9) 0.4 (17) 0.8 (36) 1.8 (64) 3.2
