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ABSTRACT

Cardiovascular disease is the leading cause of worldwide preventable morbidity and mortality. Globally certain risk factors have been found to account for up to 90% of cardiovascular disease and a large percentage are preventable through the reduction of the modifiable risk factors. However it is reported that there are millions of people with undiagnosed cardiovascular disease risk factors who are not being managed to prevent the development of cardiovascular disease. A qualitative and quantitative descriptive research design was adopted. A sample size of 422 adults were drawn from a total population of 85,630 adults using power analysis. The 422 adults, males and females were selected through the stratified proportional sampling technique from the sixteen communities in Orlu Local Government Area and the household sampling technique was used to reach each respondent who met the inclusion criteria. Biophysical data were obtained using weight and height scales, sphygmomanometer and dry chemistry test for the fasting blood glucose and cholesterol values. A questionnaire with a reliability of 0.89 was also adopted. Data was subjected to descriptive statistics and analyzed using Chisquare and Squareman’s Rank correlation coefficient. Probability value less than 0.05 was considered statistically significant. The prevalence of the different cardiovascular disease risk factors among the 422 respondents are as follows: alcohol intake 243 (57.6%), obesity215 (50.9 %), family history of CVD 191 (45.3%), cholesterolaemia185 (43.8%), hypertension118 (28%), diabetes mellitus 112 (26.5%), smoking101 (23.9%), physical inactivity50 (11.8%). There was a high prevalence of multiple CVD risk factors among respondents with 2 CVD risk factors being the least and 7 CVD risk factors being the most. It is recommended that health professionals should double their efforts in educating the public on these cardiovascular disease risk factors through awareness campaigns and regular screening programmes.

      CHAPTER ONE

      INTRODUCTION

Background of the Study

 Globally, there is an uneven distribution of cardiovascular disease (CVD) mortality rates, the lowest are in the advanced industrialized countries and parts of Latin America. Whereas the highest rates today are found in Eastern Europe and a number of low and middle income countries (World Health Organization, 2011). According to Lim, Vos, and Flaxman (2010), these mortality rates generally appear to be closely linked to a country’s stage of epidemiological transition. The developing countries in Africa are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors which in turn raised the incidence of non-communicable diseases especially cardiovascular diseases (Mozaffarian, Fahimi, & Singh, 2014).

Cardiovascular disease is an umbrella term that refers to any of a number of disease affecting the heart and blood vessels, and it is the leading cause of worldwide preventable morbidity and mortality (Mendis, Puska & Norrving, 2011). According to WHO (2011), more than 17million people died from CVD in 2008 and more than 3million of these deaths occurred before the age of 60 and above and could have largely been prevented. Cardiovascular disease is largely driven by preventable risk factors and these risk factors are classified as modifiable and non-modifiable risk factors. Age, sex and family history of the disease are non-modifiable whereas tobaccosmoking, insufficient physical activity, abnormal cholesterol level, hypertension, obesity and diabetes mellitus are some of the modifiable risk factors (Olamide, Ogunmola, Adeleke, Olutoyin, & Oluwole 2013).

Angeli, Reboldi and Verdecchi (2012) in their study reported that hypertension is quantitatively the most important risk factor for premature cardiovascular death, being more common than tobacco use, high cholesterol and obesity. In particular they estimated that hypertension accounts for as much as 5.0% of the total mortality in the middle income countries, tobacco use 4.0%, high cholesterol 2.17% and obesity 2.7%. Similarly, Rapsomaniki, Timmis and George (2012), in their study asserted that five risk factors which include a current or former tobacco use, hypertension, diabetes mellitus and high cholesterol were responsible for 89.2% of risk of myocardial infarction in Africa.

While the risk factors so far mentioned are individually important, having more than one risk factor tends to magnify the risk of the disease (Kannel 2010).  For example, a person with mildly raised blood pressure and no other risk factor will be at a lower risk of cardiovascular disease event than someone with mild hypertension and one or two other risk factors. Khan and Mensah (2010), cited a study conducted by the Boyalusa Heart foundation where autopsy of participants who had died revealed that the more risk factors the individual had, the more their arteries were affected. They therefore concluded that multiple risk factors accelerate the development of cardiovascular diseases.

Peach (2012) reported that there are millions of people with undiagnosed CVD risk factors who are not being managed to prevent the development of CVD. Furthermore, it is predicted that more than 30% of cases of Hypertension, 25% of diabetes and 18% of hypercholesterolemia remain undiagnosed sometimes until an acute and often life threatening event occurs as a consequence (National Institute for Health and Clinical Excellence, 2013). These people need to be identified earlier and given the support and treatment they need. In addition to reducing morbidity and mortality, if these conditions are treated at an early stage, additional health and social care cost could be avoided (Perkins & Cooke 2010)

According to Awosan, Ibrahim, Sabir and  Ejimodu (2013), the Nigerian

population is vulnerable to cardiovascular disease due to the physiologic risk factors such as high cholesterol, high blood pressure, unhealthy weight and diabetes mellitus. In addition, socio economic factors including poverty, diet and poor living conditions and lack of access to healthcare add to this vulnerability. This implies that the assessment of cardiovascular risk factors are important as it will lead to early detection, control, or treatment of these risk factors and consequently to a decline in cardiovascular disease deaths.

Thompson (2014) reported that the decline in cardiovascular disease mortality incidence and prevalence observed in the developed countries since the mid-1960s were due to cardiovascular risk factor reductions and treatment, each accounting for between 40 and 60 percent of reductions in cardiovascular disease mortality. Unfortunately, many low and middle income countries have not seen such a drastic decline and some regions such as sub-Saharan Africa have experienced no significant decline (Bridget 2010). This is most likely because many in developing regions have poor access to primary care and living conditions that do not promote reduction in risk for cardiovascular disease.

Reflecting on the predominant role of cardiovascular disease and its related risk factors in global mortality, it has become pertinent to determine the prevalence of cardiovascular risk in Orlu Local Government Area of Imo State in order to provide some data on this public health problem, create awareness on the need for strategies to control or manage identified risk factors.

Statement of the Problem

In the recent years, chronic diseases have become dominant contributors to the global burden of disease and cardiovascular diseases are the largest contributor to the chronic disease disaster (Global burden of Disease Study, 2010). According to WHO (2014), an estimated 17.5 million people died from CVD in 2012, representing 31% of all global deaths and over three quarter of CVD deaths take place in low and middle income countries. Globally, the number of deaths due to CVD increased by 41% between 19902013, climbing from 12.3 to 17.5 million deaths. Over the same period, death rates from

CVD were steady or fell in every region of the world except Western sub –Saharan Africa where the rates increased.

Worldwide certain risk factors have been found to account for up to 90% of cardiovascular disease and a large percentage are preventable through the reduction of the modifiable risk factors. In terms of attributable deaths, the leading CVD risk factor globally is raised blood pressure (to which 13% of global death is attributed), followed by tobacco use (10%), raised blood glucose (6%), physical inactivity (6%) and obesity (5%)  (American Heart Association 2012). In Nigeria, reports on the prevalence of CVD risk factor are scarce and the important component of the socioeconomic gradient in CVD and its risk factors has not been clearly elucidated (Oguoma, Nwose, Skinner, Digban, Onyia & Richards 2014).

From the personal observation of the researcher at the Imo State University Teaching hospital, Orlu, the admission of cardiovascular disease cases into the medical wards had been on a daily bases. Most of these patients usually present late with complications which reduces their chances of survival. Particularly some underlying risk factors such as hypertension, obesity and diabetes were diagnosed in these patients who if detected earlier and managed appropriately would have prevented the death due to cardiovascular diseases. In addition, patients who presented with co-morbid conditions were found to have some risk factors during the process of investigations. History obtained from these patients showed that they sought medical attention only when alternative medicine failed and symptoms became unbearable. This leaves the researcher wondering how many more people have those risk factors in Orlu Local Government and are yet to be detected.

The fact remains that if these cardiovascular risk factors are not detected and managed earlier, they may degenerate to cardiovascular disease and the increasing burden of these diseases have important economic implications such as loss of revenue at household level. From a health perspective huge resources are needed to provide health care to a large number of chronic patients and for sustaining increasing sophisticated equipment and more skilled and harder to replace workforce than it would take to manage the risk factors of cardiovascular disease if detected early.

The most efficient and effective means of preventing cardiovascular disease is through primary prevention by targeting individuals without established cardiovascular disease. This requires identification of those at risk and the prevalence of those cardiovascular risk factors. These observations as a matter of concern triggered the need to research into the prevalence of undiagnosed cardiovascular risk factors among adults in Orlu Local Government Area of Imo State. 

 

Purpose of Study

The purpose of this study was to determine the prevalence of  cardiovascular disease risk factors among adults in Orlu Local Government Area of Imo State Nigeria.

The specific objectives of this study were to:

1. Determine the prevalence of cardiovascular disease risk factors among adults in

Orlu Local Government Area.

2. Determine the prevalence of cardiovascular disease risk factors among adults in Orlu Local Government Area based on their demographic data (gender, age, occupation and economic background).
3. Determine the prevalence of multiple cardiovascular disease risk factors among adults in Orlu Local Government Area.
4. Assess the association between the cardiovascular disease risk factors among adults in Orlu Local Government Area. 

Research Questions

1. What are the cardiovascular disease risk factors among adults in Orlu Local Government Area?
2. What are the demographic related differences in the prevalence of cardiovascular disease risk factors among adults in Orlu Local Government Area?
3. What are the multiple cardiovascular disease risk factors among adults in Orlu Local Government Area?
4. What association is there between the cardiovascular disease risk factors among adults in Orlu Local Government Area?

 

Significance of the Study

Findings may sensitize the public and community health programme planners to mount up aggressive awareness and health promotion programmes about the currently existing cardiovascular risk factors. The primary health care approach can also be utilized to strengthen early detection and timely treatment through regular periodic checkups and assessment of those individuals at risk. This will lead to a reduction in complications and deaths resulting from these risk factors. Furthermore, it will facilitate the establishment of healthy public policies that promote CVD prevention and reorientation of health systems to address the needs of people with CVD risk factors. In addition, information gathered from this study will serve as a source of literature and guide for future researchers as well as empirical reference for future studies.

 

Scope of Study

This study was delimited to males and females between the ages of 18-65 who reside within the communities in Orlu Local Government Area. It was also delimited specifically to the cardiovascular disease risk factors as well  as the  group at risk in relation to their  demographic data, the existing multiple risk factors and the association between the  risk factors. 

Operational Definition of Terms

Prevalence: The total number of cases of a disease in a population at a given time Cardiovascular Risk Factors: They are a range of health related behaviors and conditions that increase the chance of developing cardiovascular diseases. They include modifiable and non-modifiable risk factors.

Non-modifiable Risk Factors: These are risk factors that cannot be controlled or treated. E.g. Age, Sex and family history.

Modifiable Risk Factors: These are risk factors that can be treated or controlled and in this study include obesity, hypertension, diabetes, mellitus, hypercholesterolemia, cigarette smoking, consumption of alcohol, physical inactivity, socioeconomic status and occupation.

Hypertension: For this study is defined as a systolic blood pressure 140mmHg and above, and/or a diastolic blood pressure of 90mmHg. The mean blood pressure readings will be obtained using two independent measurements taken at least five minutes apart for all participants in sitting position.

Diabetes Mellitus: For this study is defined as fasting blood glucose level of 7mmol/L (126mg/dl). Dry chemistry test will be used to measure the fasting blood glucose level using the Accutrend GC system. Sample volumes needed for the device will be one drop of blood applied directly from the finger tip.

Obesity: For this study is defined as Body Mass Index (BMI) of greater than 25kg/m²

Hypercholesterolemia: For this study is defined as fasting total cholesterol of above 6.2mmol/L (112mg/dl).Dry chemistry test will be used to measure total cholesterol using the Accutrend GC system (Accutrend GC system does not measure LDL, HDL or VLDL cholesterol). Sample volumes needed for the device will be one drop of blood applied directly from the fingertip.

Cigarette Smoking: For this study will be measured using two categories:

1. Current Smokers: Individuals who smoked at least one stick of cigarette (1g of tobacco) per week, in the previous 12 months. ii. Non-Smokers: Individuals who did not smoke at all in the previous 12 months.

Alcohol Consumption: For this study will be measured using two categories:

1. Current Drinkers: Defined as individuals who drank 3-4 units of alcohol (42-56g of ethanol) per day for men OR 2-3 units of alcohol (28-42g of ethanol) per day for women in the previous 12 months.
2. Non-Drinkers: Defined as individuals who did not drink any alcohol in the previous 12 months.

Level of Physical Activity: For this study, scores will be categorized in three levels as follows:

1. Category 1 will be inactive, that is the lowest level of physical activity. The participants who did not meet the criteria for categories 2 or 3 are considered inactive.
2. Category 2 will be minimally active, participants who will be in this category should meet any of the following 3 criteria:
3. Three or more days of vigorous activities of at least 20 minutes per day. Vigorous activity may include, brisk walking, running, swimming, bicycling, roller skating and skipping.
4. Five or more days of moderate intensity activity or walking of at least 30 minutes per day. Moderate activity includes pleasure walking, climbing stairs, gardening, washing clothes and dishes, dancing, sweeping, and cooking. iii) Five or more days of any combination of walking moderate intensity or vigorous intensity activity achieving a minimum of at least 60 minute per day.
5. Category 3 will be active with the following criteria:

• Vigorous activity on at least 60 minutes per day.
• 5 or more days of any combination of walking, moderate intensity or vigorous intensity activities for at least 90 minutes per day.

Socioeconomic Status: For this study refers to the social class of the respondents based on the kind of houses they live in e.g single room, self contained room, flats, duplex. Also household ownership of consumer durable items or assets found in their homes such as television, video set, air conditions personal cars e.t.c. For this study they will be categorized into upper class, middle class, and lower class.

Upper Class: Defined as individuals who live in duplex and own Refrigerators, washing machines, gas cookers, brand new cars and KVA generators, in addition to other household assets.

Middle Class: Defined as individuals who live in two/three bedroom flats and own refrigerators, gas cooker/washing machine, fairly used cars and small or big generators, in addition to other household assets.

Lower Class: Defined as individuals who live in single or self contained room own any three or less of the following assets, firewood stove, kerosene stove, television, fan, bicycle, pressing iron, furniture.