CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
AFRICA
53
of people living in Kampala may have type 2 diabetes (T2D),
8
while deaths attributed to NCDs in Uganda were estimated at
31 700 in 2002.
9
Estimates of age-standardised mortality from NCDs suggest
that countries in SSA, including Uganda, might have a more than
three-fold higher mortality rate than several European countries,
including the UK.
9
However, these estimates are based on limited
data and statistical models derived from child mortality rates and
cause-specific rates from external sources. Several publications
have highlighted the need for local high-quality epidemiological
data on the burden of NCDs and their risk factors, particularly in
SSA where such data are scarce.
10,11-14
To date, there has been no systematic population-based
study on NCD risk factors conducted in Uganda. Accordingly,
between December 2011 and February 2012, we conducted a
cross-sectional survey using the WHO NCD STEPS survey
tools to determine the magnitude of NCDs and their risk factors
in Kasese district, Uganda to serve as a pilot study for the
nationwide survey of NCD risk factors.
Methods
Ethical approval was granted by the Uganda National Council
for Science and Technology’s Human Research and Ethics
Committee, and the President’s Office Research Secretariat.
Written informed consent was obtained before participants
were enrolled in the study, using the WHO NCD STEPS survey
consent form.
This study was a community population-based, cross-sectional
survey designed according to a WHO STEPwise approach to
chronic disease risk-factor surveillance.
15
Data were collected in
three steps; step 1 used a questionnaire to collect demographic
and lifestyle data; step 2 involved measurements of height,
weight, blood pressure (BP), waist and hip circumference; and
step 3 used laboratory (biochemistry) investigations.
Kasese district is divided into two counties, Bukonzuo (10
sub-counties) and Busongora (12 sub-counties). One sub-county
was selected from each county. Bugoye sub-county from
Busongora is predominantly rural, whereas Mpondwe sub-county
from Bukonzuo is peri-urban. The two sub-counties selected are
the most populous in each county. Both sub-counties comprise
14 parishes, 61 villages with a total of 11 986 households.
Using the cluster sampling method, seven households were
randomly selected from each village. Finally, at least one adult
in the selected households was invited to participate. Where a
household had no consenting adults, the neighbouring household
was approached.
The survey was conducted using the WHO recommended
STEPwise approach.
16
Step 1, the survey questionnaire, was
administered by the field staff. It consisted of core (age, gender,
education in years, current exposure to tobacco and alcohol,
diet and physical activity), expanded (rural/urban setting,
occupation, average household income) and optional (marital
status, medical and health history, past history of smoking and
alcohol consumption) variables. The medical and health history
component included questions on medication, cigarette use,
diabetes mellitus and hypertension.
Step 2 involved physical body measurements, including BP,
height, weight, and waist and hip circumference measurements.
BP measurements were taken using battery-powered digital BP
machines (Omron M3-I). The participant was asked to sit on the
chair and rest quietly for 15 minutes with his/her legs uncrossed.
The left arm of the participant was then placed on the table with
the palm facing upward. Three readings, three to five minutes
apart, were then taken on the left arm. During the analysis the
average of the last two readings was the final BP reading used.
Height was measured with the participant standing upright
against a wall on which a height mark was made. Measurements
were taken with the participant barefoot, standing with the back
against the wall and head in the Frankfort position, with heels
together. The participant was asked to stretch to the fullest.
After being appropriately positioned, the participant was asked
to exhale and a mark was made with a white chalk to mark the
height. The height was then measured to the nearest 0.1 cm from
the mark to the floor using a tape measure.
Weight measurements were taken on a pre-calibrated weighing
scale (Seca scale). Participants were weighed dressed in light
clothing and barefoot. Measurements were taken to the nearest
0.1 kg.
Step 3 involved laboratory tests. Consenting participants were
asked not to consume any food, only water from after supper that
day until the survey team collected the blood samples the next
day (eight-hour fast). People converged at the agreed place in
their community. Those who had complied with the overnight
fast were eligible for finger-prick blood sample collection. Total
cholesterol (TC) and triglyceride (TG) levels were measured
using Reflotron-Plus machines manufactured by Roche. Fasting
blood glucose (FBG) level was measured on two machines, the
Accu-Chek Active glucometer from Roche and the Soft-Style
glucometer from Chem-labs.
Hypertension was defined as a diastolic BP of 90 mmHg
or more, or a systolic BP of 140 mmHg or more, or currently
on medication for hypertension (documented in the health
booklet). Diastolic BP
≥
110 mmHg or systolic
≥
180 mmHg
was considered to be severe hypertension. Raised fasting blood
glucose was defined as a blood glucose level
≥
7.0 mmol/l or
currently on medication for diabetes mellitus (documented in
the health booklet). Raised total cholesterol was defined as
cholesterol level
≥
5.0 mmol/l. Overweight was defined as body
mass index (BMI)
≥
25.0 kg/m
2
and obesity as BMI
≥
30.0 kg/
m
2
.
Excessive or harmful use of alcohol was defined as the
consumption of five or more for men, four or more for women,
standard units per day for three or more days per week.
Physical activity was measured using questions on four different
aspects: physical activity at the workplace, physical activity
during recreation time, physical activity while travelling, and
physical resting time. A heavy smoker is, according to the
recommendations of the World Health Organisation (WHO), a
smoker with a daily consumption of more than 20 cigarettes.
Statistical analysis
Data were collected manually using case record forms (CRFs),
captured into epi-data and later transferred to STATA version
10 for analysis. Values are expressed as percentages of total
respondents. Simple bivariate analysis was used to analyse
the data. Priority was given to practical benefit and clinical
significance in interpreting statistically significant data.
Statistical significance was set at
p
<
0.05.
