Transcript KMA ppt_Lydia 2.07MB 2015-11-24 09:03:52

Lydia Kaduka (PhD)
Centre for Public Health Research
Kenya Medical Research Institute

In Kenya, NCD accounts for >50% of total hospital admissions
and over 55% of hospital deaths (MOH SP, 2014)

Overall, CVDs, diabetes, cancer and chronic lung disease
contribute to over two thirds of morbidity & mortality from NCDs
in Kenya (WHO 2010).

Leading CVDs RFs
◦ Conventional - high blood pressure, dyslipideamia, tobacco and alcohol use,
physical inactivity, obesity, unhealthy diets and raised blood glucose
◦ Novel – homocysteine, CRP

Obesity - associated with CVDs, diabetes and cancers → ↑risk
of premature death and disabilities → reduced quality of life.
(Narkiewicz, 2006)

To assess the relationship between obesity
and conventional and novel metabolic risk
markers in an urban population in Kenya

Study site – Kibra and Karen Constituency of
Nairobi County – hosts all the five SEC (Upper,
Lower Upper, Middle, Lower Middle and Lower
class).

Study design: Cross sectional design based on a
three-stage cluster sampling methodology –
selection of clusters, households and
respondents.

Sample size – 536 (Fisher et al., 1983)

Sampling – 30 clusters sampled using the
systematic Probability Proportional to Size (PPS)
sampling method

Inclusion – adults aged >18yrs, absence of
debilitating disease, residence>2years
Sampling Procedure
Kibra and Karen Constituencies
Upper Upper Middle Middle
Upper Lower
Lower
Quick Count of EA
Select one Segment
Identify Eligible Respondents
Select one Respondent from the Eligibles per Household
Interview and testing

Socio-economic and demographic assessments

Anthropometric assessments – weight, height
(BMI), WC

Clinical examination- blood pressure

Biochemical assessments – fasting blood glucose,
lipid profile, homocysteine and CRP

Permission – Ethical (KEMRI SERU) and informed
consent

Total n = 539 (m: 50.5%; w: 49.5%); mean age
38.09 + 13.4 years.

Prevalence of overweight (BMI 25.0-29.99)
◦ m: 29.6%; w: 5.9%

Prevalence of obesity (BMI>30)
◦ m: 30.3%; w: 27.3%
Men
Women
Increased blood pressure
P=0.003
P=0.010
Fasting blood glucose
P<0.001
P=0.010
C-reactive protein
P>0.05
P=0.002
Homocysteine
P>0.05
P=0.003
Total cholesterol
P=0.002
P>0.05
LDLC
P<0.001
P=0.003
HDLC
P<0.001
P<0.001
TAG
P<0.001
P<0.001
SES
P<0.001
P>0.05
Increasing age
P<0.001
P<0.001
Men
(WC>95cm)
Women
WC (80cm)
Increased blood pressure
P<0.001
P=0.010
Fasting blood glucose
P<0.001
P=0.036
C-reactive protein
P>0.05
P=0.032
Homocysteine
P=0.021
P=0.025
Total cholesterol
P<0.001
p= 0.004
LDLC
P<0.001
P<0.001
HDLC
P<0.001
P=0.002
TAG
P<0.001
P<0.001
SES
P<0.001
P>0.05
Increasing age
P<0.001
P<0.001

Prevalence of CVD risk factors is high - consequence of
components associated with urbanization

Components
• More than an economic issue
• Changes in lifestyle related factors, living conditions,
social structures etc, associated with and induced by
urbanization as probable contributing factors
• Accelerated effects of cultural and behavioral shifts in
transitional societies

Lifestyle management focusing on diet and physical
activity.

Gender disparities → Patient-physician discussions of
individual risks are paramount

Simple measures should be adapted as clinical
components in the routine assessment and
management of metabolic and cardiovascular risks

Risk factors operate in continuum - follow up
longitudinal studies and prospective validation of the
risk factors.

KEMRI

Kenya National Bureau of Statistics

Administration-Karen and Kibra Constituencies

University of Southampton

Coca-Cola Company