Browsing by Author "Bahendeka, Silver K."
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Item Alcohol use among adults in Uganda: findings from the countrywide non-communicable diseases risk factor cross-sectional survey(Global Health Action, 2016) Ndugwa Kabwama, Steven; Ndyanabangi, Sheila; Mutungi, Gerald; Wesonga, Ronald; Bahendeka, Silver K.; Guwatudde, DavidThere are limited data on levels of alcohol use in most sub-Saharan African countries. Objective: We analyzed data from Uganda’s non-communicable diseases risk factor survey conducted in 2014, to identify alcohol use prevalence and associated factors. Design: The survey used the World Health Organization STEPS tool to collect data, including the history of alcohol use. Alcohol users were categorized into low-, medium-, and high-end users. Participants were also classified as having an alcohol-use-related disorder if, over the past 12 months, they were unable to stop drinking alcohol once they had started drinking, and/or failed to do what was normally expected of them because of drinking alcohol, and/or needed an alcoholic drink first in the morning to get going after a heavy drinking session the night before. Weighted logistic regression analysis was used to identify factors associated with medium- to high-end alcohol use. Results: Of the 3,956 participants, 1,062 (26.8%) were current alcohol users, including 314 (7.9%) low-end, 246 (6.2%) medium-end, and 502 (12.7%) high-end users. A total of 386 (9.8%) were classified as having an alcohol-use-related disorder. Male participants were more likely to be medium- to high-end alcohol users compared to females; adjusted odds ratio (AOR)2.34 [95% confidence interval (CI)1.882.91]. Compared to residents in eastern Uganda, participants in central and western Uganda were more likely to be mediumto high-end users; AOR1.47 (95% CI1.012.12) and AOR1.89 (95% CI1.312.72), respectively. Participants aged 3049 years and those aged 5069 years were more likely to be medium- to high-end alcohol users, compared to those aged 1829 years, AOR1.49 (95% CI1.161.91) and AOR2.08 (95% CI1.522.84), respectively. Conclusions: The level of alcohol use among adults in Uganda is high, and 9.8% of the adult population has an alcohol-use-related disorder.Item Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey(International Journal for Equity in Health, 2016) Wesonga, Ronald; Guwatudde, David; Bahendeka, Silver K.; Mutungi, Gerald; Nabugoomu, Fabian; Muwonge, JamesModification of known risk factors has been the most tested strategy for dealing with noncommunicable diseases (NCDs). The cumulative number of NCD risk factors exhibited by an individual depicts a disease burden. However, understanding the risk factors associated with increased NCD burden has been constrained by scarcity of nationally representative data, especially in the developing countries and not well explored in the developed countries as well. Methods: Assessment of key risk factors for NCDs using population data drawn from 3987 participants in a nationally representative baseline survey in Uganda was made. Five key risk factors considered for the indicator variable included: high frequency of tobacco smoking, less than five servings of fruit and vegetables per day, low physical activity levels, high body mass index and raised blood pressure. We developed a composite indicator dependent variable with counts of number of risk factors associated with NCDs per participant. A statistical modeling framework was developed and a multinomial logistic regression model was fitted. The endogenous and exogenous predictors of NCD cumulative risk factors were assessed. Results: A novel model framework for cumulative number of NCD risk factors was developed. Most respondents, 38 · 6% exhibited one or two NCD risk factors each. Of the total sample, 56 · 4% had at least two risk factors whereas only 5.3% showed no risk factor at all. Body mass index, systolic blood pressure, diastolic blood pressure, consumption of fruit and vegetables, age, region, residence, type of residence and land tenure system were statistically significant predictors of number of NCD risk factors (p < 0 · 05). With exception to diastolic blood pressure, increase in age, body mass index, systolic blood pressure and reduction in daily fruit and vegetable servings were found to significantly increase the relative risks of exhibiting cumulative NCD risk factors. Compared to the urban residence status, the relative risk of living in a rural area significantly increased the risk of having 1 or 2 risk factors by a multiple of 1.55.Item Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries(The lancet Diabetes & endocrinology, 2016) Manne-Goehler, Jennifer; Atun, Rifat; Stokes, Andrew; Goehler, Alexander; Houinato, Dismand; Houehanou, Corine; Hambou, Mohamed Msaidie Salimani; Longo Mbenza, Benjamin; Sobngwi, Eugène; Balde, Naby; Kibachio Mwangi, Joseph; Gathecha, Gladwell; Ngugi, Paul Waweru; Wesseh, C. Stanford; Damasceno, Albertino; Lunet, Nuno; Bovet, Pascal; Labadarios, Demetre; Zuma, Khangelani; Mayige, Mary; Kagaruki, Gibson; Ramaiya, Kaushik; Agoudavi, Kokou; Guwatudde, David; Bahendeka, Silver K.; Mutungi, Gerald; Geldsetzer, Pascal; Levitt, Naomi S.; Geldsetzer, Joshua; Yudkin, John S.; Vollmer, Sebastian; Bärnighausen, TillDespite widespread recognition that the burden of diabetes is rapidly growing in many countries in sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic and economic gradients of met need for diabetes diagnosis and care. Methods We did a pooled analysis of individual-level data from nationally representative population-based surveys that met the following inclusion criteria: the data were collected during 2005–15; the data were made available at the individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of core health services for diabetes diagnosis and care. We fi rst quantifi ed the population in need of diabetes diagnosis and care by estimating the prevalence of diabetes across the surveys; we also quantifi ed the prevalence of overweight and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the overweight and obese population. Finally, we did survey fi xed-eff ects regressions to establish the demographic and economic gradients of met need for diabetes diagnosis, counselling, and treatment. Findings We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing 38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes was 5% (range 2–14) and the median prevalence of overweight or obesity was 27% (range 16–68). We estimated seven measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese population who received a blood glucose measurement (median 22% [IQR 11–37]); and percentage of the diabetic population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27–63]); (3) had ever been told that they had diabetes (median 27% [IQR 22–51]); (4) had ever been counselled to lose weight (median 15% [IQR 13–23]); (5) had ever been counselled to exercise (median 15% [IQR 11–30]); (6) were using oral diabetes drugs (median 25% [IQR 18–42]); and (7) were using insulin (median 11% [IQR 6–13]). Compared with those aged 15–39 years, the adjusted odds of met need for diabetes diagnosis (measures 1–3) were 2·22 to 3·53 (40–54 years) and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of education than for the group with less than 1 year of education. Finally, need for diabetes care was signifi cantly more likely to be met (measures 4–7) in the oldest age and highest educational groups. Interpretation Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care. Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational attainment, policy makers should pay particular attention to improved access to diabetes services for young adults and people with low educational attainment.Item The Epidemiology of Hypertension in Uganda: Findings from the National Non- Communicable Diseases Risk Factor Survey(PLoS ONE, 2015) Guwatudde, David; Mutungi, Gerald; Wesonga, Ronald; Kajjura, Richard; Kasule, Hafisa; Muwonge, James; Ssenono, Vincent; Bahendeka, Silver K.Hypertension is an important contributor to global burden of disease and mortality, and is a growing public health problem in sub-Saharan Africa. However, most sub-Saharan African countries lack detailed countrywide data on hypertension and other non-communicable diseases (NCD) risk factors that would provide benchmark information for design of appropriate interventions.We analyzed blood pressure data from Uganda’s nationwide NCD risk factor survey conducted in 2014, to describe the prevalence and distribution of hypertension in the Ugandan population, and to identify the associated factors.Item Low consumption of fruits and vegetables among adults in Uganda: findings from a countrywide cross-sectional survey(Archives of Public Health, 2019) Ndugwa Kabwama, Steven; Bahendeka, Silver K.; Wesonga, Ronald; Mutungi, Gerald; Guwatudde, DavidAdequate consumption of fruits and vegetables has protective benefits against development of coronary heart disease, hypertension and chronic obstructive pulmonary disease. However, approximately 2.7 million deaths annually can be attributed to inadequate fruit and vegetable consumption. We analyzed data from a countrywide survey in Uganda, to estimate the prevalence of adequate fruit and/ or vegetable consumption, and identify associated factors. Methods: Data were collected using the World Health Organization STEPwise approach to surveillance, a standard approach to surveillance of risk factors for Non Communicable Diseases. Fruit and vegetable consumption was assessed by asking participants the number of days in a typical week they eat fruits or vegetables and the number of servings eaten in one of those days. Adequate fruit and/ or vegetable consumption was defined as consuming 5 or more servings of fruits and/ or vegetables per day in a typical week. We used modified Poisson regression analysis to estimate prevalence risk ratios (PRRs) and identify factors associated with eating 5 or more servings of fruits and/ or vegetables per day, per week. Results: Of 3962 participants, 484 (12.2%) consumed 5 or more servings of fruits and/ or vegetables per day in a typical week. Participants who were married or cohabiting were more likely to consume at least 5 servings of fruits and/ or vegetables per day in a typical week compared with those who had never been married PRR = 1.51 [95% CI 1.07–2.14]. Compared with participants from Western region, those from Central region were more likely to consume 5 or more servings of fruits and/ or vegetables per day in a typical week, PRR = 3.54 [95% CI 2.46–5.10] as were those from Northern, PRR = 2.90 [95% CI 2.00–4.23] and Eastern regions PRR = 1.60 [95% CI 1.04–2.47]. Conclusions: Fruit and vegetable consumption in Uganda is low and does not differ significantly across social and demographic characteristics, except marital status and geographical region of residence. There is a need to develop and strengthen policies that promote adequate consumption of fruits and vegetables in the Ugandan population.Item Physical Activity Levels Among Adults in Uganda: Findings From a Countrywide Cross-Sectional Survey(Journal of Physical Activity and Health, 2016) Guwatudde, David; Kirunda, Barbara E.; Wesonga, Ronald; Mutungi, Gerald; Kajjura, Richard; Kasule, Hafisa; Muwonge, James; Bahendeka, Silver K.Being physically active is associated with lower risk of many noncommunicable diseases (NCDs). We analyzed physical activity (PA) data collected as part of Uganda’s countrywide NCD risk factor survey conducted in 2014, to describe PA levels in Uganda. Methods: PA data were collected on the domains of work, travel and leisure. We calculated the percentage of participants meeting the World Health Organization (WHO) PA recommendations, and the types of intense-specific duration of PA. Prevalence ratios (PR) were used to identify factors associated with meeting WHO PA recommendations. Results: Of the 3987 participants, 3758 (94.3%) met the WHO PA recommendations. Work-related PA of moderate intensity, and travel-related PA contributed most to participants’ overall weekly duration of PA, each contributing 49.6% and 25.2% respectively. The median weekly duration of all moderate-intensity PA was 1470 minutes (interquartile range [IQR] = 540 to 2460). Weekly duration of all vigorous-intensity PA was low with a median of 0 minutes (IQR = 0 to 1080). The median daily sedentary time was 120 minutes (IQR = 60 to 240). Factors significantly associated with meeting WHO PA recommendations were body mass index and level of education. Conclusions: PA levels in Uganda are high, mostly achieved through travel and work-related activities of moderate intensity.Item Prevalence and correlates of abdominal obesity among adults in Uganda: findings from a national cross-sectional, population based survey 2014(BMC obesity, 2018) Ndugwa Kabwama, Steven; Kirunda, Barbara; Mutungi, Gerald; Wesonga, Ronald; Bahendeka, Silver K.; Guwatudde, DavidOverweight and obesity are associated with health complications the gravity of which, vary with the regional deposition of the excess fat. The Body Mass Index (BMI) is often used to measure obesity although is an inferior predictor of cardiovascular disease risk mortality and morbidity compared with measures of abdominal obesity. We analyzed data from Uganda’s 2014 World Health Organization (WHO) STEPwise approach to surveillance of Non-communicable diseases (NCDs) survey to estimate the prevalence of abdominal obesity and associated factors to provide information on the prevention and control of overweight and obesity. Methods: Data were collected using the WHO STEPS protocol. Waist measurement was taken using a non-stretchable standard tape measure mid-way between the lowest rib and iliac crest with the subject standing at the end of gentle expiration. Participants with waist circumference > 102 cm for men and 88 cm for women were classified as abdominally obese. We used weighted modified Poisson regression with robust error variance to estimate the prevalence of abdominal obesity and associated factors. Results: Of the 3676 participants, 432 (11.8%) were abdominally obese; with the prevalence higher among females 412 (19.5%) compared with males 20 (1.3%). Compared with males, female participants were more likely to be abdominally obese Adjusted Prevalence Rate Ratio (APRR) 7.59 [5.58–10.33]. Participants who were married or cohabiting APRR 1.82 [1. 29–2.57] and participants who were separated or divorced APRR 1.69 [1.17–2.46] were more likely to be abdominally obese compared with those who had never married before. Compared with rural dwellers, participants from urban areas were more likely to be abdominally obese APRR 1.29 [1.09–1.53]. Compared with participants with normal blood pressure, those with elevated blood pressure were more likely to be abdominally obese APRR 1.83 [1.57–2.14]. Compared with participants without any education, those with secondary education were more likely to be abdominally obese APRR 1.42 [1.12–1.78]. Conclusions: There is a high prevalence of abdominal obesity among adults in Uganda which puts many at risk of developing associated metabolic complications. These data provide useful information for developing interventions and formulation of policies for the control and prevention of abdominal obesity in Uganda.Item Tobacco use and associated factors among Adults in Uganda: Findings from a nationwide survey(Tobacco induced diseases, 2016) Ndugwa Kabwama, Steven; Ndyanabangi, Sheila; Mutungi, Gerald; Wesonga, Ronald; Bahendeka, Silver K.; Guwatudde, DavidTobacco use and the exposure to tobacco smoke is one of the most preventable causes of death and disability globally. The risk is even higher among daily tobacco users. The World Health Organization (WHO) has recommended that surveillance of major risk factors for Non Communicable Diseases (NCDs) such as tobacco use is imperative to predict the future burden of NCDs, identify interventions to reduce future burden and monitor emerging patterns and trends. In 2014 the first Uganda nation-wide NCD risk factor survey was carried out to estimate the prevalence of major NCD risk factors. We analyzed data from this survey to estimate the prevalence of daily tobacco use and associated risk factors.