Early Detection and Preventive Measures on Non-Communicable Diseases and Its Prognosis Among Outpatients in Federal Teaching Hospital Ado-Ekiti
Chapter One
Aim of the study
The purpose of this study was to determine the early detection and preventive measures on Non-communicable diseases and their prognosis at Federal Teaching Hospital Ido Ekiti.
Specific objectives
- To determine the prevalence of health risk behaviors such as smoking, risky alcohol consumption and physical inactivity.
- To determine the prevalence of hypertension.
- To record anthropometrical measurements as they relate to obesity/overweight.
- To determine the association between socio-demographic factors and the prevalence of the above risk factors for non-communicable diseases.
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter presents a review of the relevant literature on the global evolution and epidemiology of chronic non-communicable diseases. The current trends in behavioral health risk factors are observed within and between different populations. Studies focusing on the associations between health risk factors and populations’ socio-demographic characteristics are reviewed, as well as theories underlying risk factors patterns among populations. The chapter also looks at the health and socioeconomic impact of non-communicable diseases upon individuals, societies and governments. Finally, global and regional models of evidencebased cost-effective preventive and control programs are presented.
Urbanization and emergence of non-communicable diseases
According to WHO (2008), the disease profile of the world is changing at an astonishingly rapid rate, especially in low- and middle-income countries. This report is consistent with the findings of a global health survey by Levenson, Skerrett, and Gaziano (2003) who showed that non-communicable diseases have in the past century drastically shifted from being relatively inconsequential to becoming leading causes of morbidity and mortality. In their report, Levenson et al (2003) also attribute the alarming trend of non-communicable diseases to improved public health measures and medical care, which has led to longer life spans and a reduction of mortality from infectious diseases and nutritional deficiencies.
However, they further argue that economic, social and cultural changes brought about by urbanization, especially in the developing countries, substantially contribute to the evolution of non-communicable diseases through the adoption of a sedentary lifestyle, western diet and health risk behaviours such as smoking and alcoholism. These observations confirm the historic emphasis put on infectious diseases control and prevention by health departments and international health organizations, with relatively little consideration being given to the impact of urbanization on disease profile and health.
The literature shows that the world has in the past few decades experienced the greatest historical improvements in health care. Health statistics further indicate that many of the achievements have been documented under infectious disease prevention and treatment following scientific advances in medical technology and public health infrastructure. This, together with the widespread consumption of high-calorie processed foods and a low energy expenditure due to increased mechanization, is a byproduct of urbanization which has substantially altered the health status and diseases profiles of most populations globally (Forrester, Cooper and Weatheral, 1998).
Most of the marked societal, economic and environmental changes have been closely associated with urbanization. The rates of urbanization, according to Chockalingam and Balaguer-Vinto (1999), are increasing globally, from 44.8% of the world living in urban areas in 1994 to a projected 61.1% by 2025. With urbanization being the major driving force behind the development of non-communicable diseases, this trend reflects an increasing risk of a potential global epidemic.
CHAPTER THREE
METHODOLOGY
Introduction
This chapter describes the study setting and the rationale for its selection, the research design employed, and the sampling techniques utilized. Tools of data collection and methods of data analysis are outlined, as well as a description of the pilot study. The protocol observed to ensure ethical considerations is also stated.
Research setting
The study was conducted in Federal Teaching Hospital, Ido Ekiti Nigeria. The major hospital in Ido Ekiiti is the Federal Teaching Hospital, Ido-Ekiti, which is a Federal Government-owned foremost cutting edge primary, secondary and tertiary health service provider and clinical training institution in Nigeria. The hospital which is one of the fastest growing teaching hospital in the country was established in 1998 by the federal government to the affordable, qualitative and accessible medicare to every state of the federation, particularly to the people living in the grass root of Ekiti State and its environment.
Study design
The researcher employed a cross-sectional quantitative design. The WHO STEP wise protocol (WHO, 2005b), which provides a framework for the surveillance of non-communicable disease risk factors, was used. This is a sequential process, starting with gathering questionnaire- based data on key risk factors (Step 1), then moving on to taking simple physical measurements (Step 2), followed by biomedical measurements (Step 3). The present study, however, only utilized the first two steps, as advised by WHO for resource-scarce settings like Nigeria.
Study population
The study was targeted at males and females aged between 15 and 70 outpatients in the Federal Teaching Hospital, Ido Ekiti. Table 3.2 below describes Ido Ekiti’s population for various age categories according to gender.
Pilot study
The researcher recruited two research assistants, a physiotherapist and an occupational therapist, and trained them on the protocol of taking the physical measurements and in assisting the participants with filling in the questionnaires. This was followed by a pilot study on 20 participants, composed of five from each of the four age and setting categories, in order to determine the time taken by participants to complete the questionnaire and to ensure that the research assistants understood the protocol for taking the anthropometric measurements. The piloted participants did not take part in the main study.
CHAPTER FOUR
RESULTS
Introduction
This chapter presents the descriptive and inferential statistic results of the study. The descriptive results mainly present the demographic characteristics of the study sample, while the inferential statistic results highlight the observed correlations and associations between various demographic variables and the risk factors for non-communicable diseases.
CHAPTER FIVE
DISCUSSION
Introduction
The aim of this study was to establish early detection and preventive measures on Non communicable diseases and its prognosis among in Federal Teaching Hospital Ido Ekiti. In order to realize the specific objectives of the study, a total of three hundred and five (305) participants were investigated using the WHO STEPwise questionnaire (Appendix I ), which involved gathering self-reported data on socio-demographics and health-related behaviour (Step 1), and taking anthropometrical measurements (Step 2). This chapter will discuss the individual prevalence of the investigated risk factors for non-communicable diseases, and the clustering of multiple risk factors, as well as associations and correlations between risk factors and various socio-demographics. Consistencies and disparities between the findings of the current study and other previous related studies will be established. The chapter will conclude by highlighting the limitations of the study.
CHAPTER SIX
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Introduction
This chapter emphasizes the key findings of the study. A concise summary as well as conclusion are highlighted. Finally, recommendations based on the main study outcomes are given.
Summary
The aim of the study was to determine the early detection and preventive measures on Non communicable diseases and its prognosis among in Federal Teaching Hospital Ido Ekiti. To realize this aim, identification and description of individual risk factors was done. Clusters of multiple risk factors as well as possible socio-demographic facilitators were investigated. Overall, 61% of the study participants possessed at least one of the investigated risk factors for non-communicable diseases. However, there were proportional variations according to the risk factor profiles of the participants. Those who had one risk factor accounted for 42%, while 13% proved to possess two risk factors, and 4% had three or more risk factors.
The investigated risk factors, which included physical inactivity, hypertension, overweight/obesity, smoking and risky alcohol consumption, were prevalent among participants in different proportions. The most common risk factor recorded was physical inactivity, which accounted for 42% of the entire study sample. This revelation indicates that most of the participants were living more sedentary lifestyles characterized by inadequate levels of appropriate physical activities.
Hypertension or elevated blood pressure was the second most common risk factor, and was possessed by 24% of the participants. Overweight/obesity, smoking and risky alcohol consumption accounted for 11%, 9% and 5% of the participants respectively.
Physical inactivity, hypertension and overweight/obesity were the three most common risk factors among the participants; this is typically the negative effect of urbanization which is characterized by poor diet and the adoption of more sedentary lifestyles.
Risk factors were also seen to co-occur in different numbers and in varying patterns of combinations. Double risk factor clusters were the most common (89%) among those with multiple risks. Participants who were both physically inactive and hypertensive composed a majority of 68% of those who had a total risk factor score of two. This observation suggests a possible relationship between physical inactivity and hypertension which could necessitate a future study in order to explore the dynamics facilitating their co-occurrence.
Socio-demographic characteristics such as age, gender and level of education or socioeconomic status were proved to influence health behaviour. Physical inactivity, which was the most common risk factor among participants, was seen to be influenced by age. The physical activity profiles of participants aged 25 years and under were the worst. This is the age of individuals in tertiary learning institutions. The situation could be improved were these institutions to promote physical activity through adapted facilities and targeted health education. Likewise, the study showed that increasing age was an indicator for hypertension.
The prevalence of hypertension was seen to vary across gender. Females were more hypertensive (59%) compared to their male counterparts (41%). Since hypertension is one of the intermediate risk factors for non-communicable diseases, the variations between male and female participants who were hypertensive suggests differences in their exposure to the underlying socioeconomic determinants of non-communicable diseases.
Apparently, there exists an intricate relationship between the underlying determinants and the behavioral health risk factors which in the researcher’s opinion warrants further exploratory studies in future.
Conclusion
As revealed in our current study, behavioral risk factors for non-communicable diseases, mainly physical inactivity, hypertension, overweight/obesity and smoking, are common among Ido Ekiti residents. The prevalence rates are high and show some increasing trends suggestive of likely future epidemics of non-communicable diseases. Identification and description of the most common patterns of multiple risk factor clusters gave a comprehensive picture of the future epidemiology of non-communicable diseases in Ido Ekiti. This is undoubtedly an essential component of the national health information system.
The unequal distribution of these risk factors among the people of Ido Ekiti has been attributed to the influence of various socio-demographic factors, including age, gender, level of education and economic status. This suggests that for any preventive and control interventions to be effective, public health authorities and other relevant stakeholders must exercise targeting in their planning and implementation of health promotion programmes.
Recommendations.
On the basis of the findings of this study, the following recommendations are suggested to the various stakeholders:
- Further risk factor surveillance studies incorporating Step 3 of the WHO STEPwise protocol should be done to give a more comprehensive profile.
- A continuous national surveillance system on risk factors should be instituted by the Centre for Diseases Control and Prevention to offer up-to-date analysis of the national risk factor profile.
- Data on multiple risk factors should be used as the baseline foundation for legislation and intervention by the public health authorities and policy planners.
- Clinicians, including medical doctors, physiotherapists and nurses in both public and private health care sectors, should incorporate enquiries on modifiable health risk behaviours in order to ensure early detection at the primary health care level.
- The Education Department, in collaboration with the Ministry of Health, should introduce health-promoting schools, to make healthy behaviour an easier option among students.
- Institutions, organizations and all workplaces in Ido Ekiti should be advised to uphold the strategy of health-promoting settings to ensure prevention and control of non-communicable diseases.
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