|Year : 2022 | Volume
| Issue : 1 | Page : 1-10
Knowledge and exposure to non-communicable disease risk factors amongst undergraduates in the University of Lagos
OO Ricketts-Odebode, TW Ladi-Akinyemi, OJ Kanma-Okafor
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
|Date of Submission||24-Jan-2022|
|Date of Decision||30-May-2022|
|Date of Acceptance||19-Jul-2022|
|Date of Web Publication||1-Feb-2023|
Dr. T W Ladi-Akinyemi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos
Source of Support: None, Conflict of Interest: None
Context: Non-communicable diseases (NCDs) are known as chronic diseases which are of long duration and progress slowly. There has been increasing evidence of NCDs amongst university students, youths and adolescents.
Aims: This study aimed to assess the knowledge, perception and exposure to the risk factors for NCDs amongst students of the University of Lagos.
Settings and Design: This was a cross-sectional study carried out amongst non-medical Undergraduates of the University of Lagos.
Materials and Methods: About 413 respondents were recruited into the study using multi-stage sampling. A Google link containing a pre-tested self-administered questionnaire was shared amongst respondents to obtain data from them.
Statistical Analysis Used: SPSS version 27 was used to analyse the data.
Results: The mean age of the respondents was 22.8 ± 2.1 years with a proportion of females-to-males at almost 1:1. The majority (73.1%) of the respondents had good knowledge of NCDs and almost two-thirds (64.4%) of the respondents had a right perception of the risk factors of NCDs, respectively. More than two-thirds of the respondents (67.2%) were exposed to at least one risk factor of NCDs. Variables that are statistically significantly associated with exposure to the risk factors of NCDs are gender (P = 0.000), employment status (P = 0.000), religion (P = 0.013), income (P = 0.000), knowledge of NCDs (P = 0.002) and perception of NCDs (P = 0.000).
Conclusions: This study has shown that while the level of knowledge of NCDs is satisfactory amongst the undergraduates, many of the respondents engaged in one or more risk factors that could lead to the development of NCDs.
Keywords: Exposure, knowledge, non-communicable disease, risk factors, undergraduates
|How to cite this article:|
Ricketts-Odebode O O, Ladi-Akinyemi T W, Kanma-Okafor O J. Knowledge and exposure to non-communicable disease risk factors amongst undergraduates in the University of Lagos. Niger J Health Sci 2022;22:1-10
|How to cite this URL:|
Ricketts-Odebode O O, Ladi-Akinyemi T W, Kanma-Okafor O J. Knowledge and exposure to non-communicable disease risk factors amongst undergraduates in the University of Lagos. Niger J Health Sci [serial online] 2022 [cited 2023 Oct 3];22:1-10. Available from: http://www.https://chs-journal.com//text.asp?2022/22/1/1/368998
| Introduction|| |
Non-communicable diseases (NCDs) have remained a major public health problem globally, majorly contributing to the increased morbidity and mortality rates, especially in low-income and middle-income countries. Their devastating social, human, economic and public health impacts are recognised as a global burden by all societies and economies. They are not transmissible from one person to another. The health impact of NCDs in developing counties cannot be over-emphasised. The World Health Organization (WHO) estimated that 36 million deaths in 2008 were due to NCDs, of which 9 million were in people younger than 60 years, and 80% of the 36 million deaths occurred in developing countries. Likewise, its burden also brings a significant impact on the quality of life amongst the affected population, with a high disability-adjusted life year.
Arguably, NCDs are as much an economic problem, as they are a health epidemic. Cumulative economic losses from NCDs and mental disorders could surpass US$47 trillion (which is more than 75% of global GDP) by 2030. Recent studies have increasingly shown the intimate link between NCDs and poverty, in which NCDs drain household resources, diminish labour supply and productivity, as well as impose catastrophic expenditures on poor and uninsured households during the treatment of chronic NCD conditions., Majority of low-income NCD patients tend to use out-of-pocket payment when seeking medical care. Out-of-pocket payments for health-care services drive about 100 million people into poverty every year. Therefore, emerging market economies (such as those in sub-Saharan Africa) will be hit harder, even as they continue to grow if the rising NCD burden remains unchecked.
The four most common NCDs are cardiovascular diseases (CVDs) including heart attack and stroke; cancers; diabetes and chronic respiratory disease (CRD) including chronic obstructive pulmonary disease (COPD) and asthma. Together, these diseases are responsible for 82% of all NCD deaths. The NCDs tend to be of long duration with slow progression and are, consequently, often referred to as chronic diseases. They are caused by a combination of both modifiable and non-modifiable risk factors, including genetic, metabolic, behavioural and environmental factors. However, the majority of NCDs are preventable and there is much that can be done to reverse the impact of this menace.
CVDs have been recognised as the leading cause of death in the world. An estimated 17.9 million people died from CVDs in 2015. Ischaemic heart disease and stroke were the top two leading causes of CVD health loss in each world region. It has been presumed that by 2030, more than 22.2 million people will die annually from CVDs, with greater impact amongst the developing and underdeveloped nations. Currently, populations in low- and middle-income countries now contribute 75% of the CVD deaths, which leads to a 7% reduction in gross domestic product in these countries.,
A larger proportion of the global morbidity burden of CVDs is present in low- and middle-income countries than in high-income countries. This is despite a comparatively lower burden from risk factors in low compared to high-income countries. Nigeria, just as the other developing countries, though faced with the increasing burden of CVDs has the least contribution in articles published on cardiovascular research, hypertension is the most common form of CVD in North-Western Nigeria, and in South-Western Nigeria, heart failure was the most prevalent.
The burden of cancer has increased worldwide. Despite improvements in treatment and prognosis over the past decades, at present cancer is the second-most common cause of death in the United States, with an estimated 1630 cancer deaths each day. Alarmingly, the WHO predicts that the number of new cancer cases is expected to rise by approximately 70% over the next 20 years. While there is considerable overlap in common types of cancers worldwide, developing countries tend to have higher incidence and death rates for viral infection-related cancers such as hepatitis-related liver cancer and human papillomavirus-related cervical cancer. Cancer pattern in Nigeria as extracted from the Nigerian National System of Cancer Registries shows that there were 4209 cases of cancer recorded from two registration Centers in Lagos State between 2009 and 2013, being the highest amongst all the states of the nation during the same period. The most common cancer recorded in Lagos University Teaching Hospital (LUTH), one of Lagos cancer registries, from 2009 to 2013 for males were prostate (7.1%) and colorectal (3.4%) while that of females was breast (41.2%), cervix (14.5%) and colorectal (3.1%) cancers.
CRDs describe a range of diseases of the airways and the other structures of the lungs. They include asthma and respiratory allergies, COPD, occupational lung diseases and sleep apnoea syndrome. Just as with other NCDs, there are little data available concerning the epidemiology of CRDs in Nigeria. In a retrospective study in Ibadan, the frequency of respiratory disease amongst the patients was reported as 217 (66.8%) patients were diagnosed with pulmonary tuberculosis, 81 (24.9%) with pneumonia, 16 (4.9%) patients with asthma, 7 (2.2%) patients with COPD and only 2 (0.6%) patients with lung cancer and interstitial lung disease. There was no significant gender difference in the frequency of respiratory disease. The age distribution of the chest diseases shows that tuberculosis and pneumonia were more common within the 30–44 years of age bracket and least common within the population above 65 years. Asthma and COPD were more common within the 45–64 years of age bracket followed by the 15–29 and 30–44 years of age bracket. Smoking was significantly associated with COPD, lung cancer and chest infections.
Diabetes is a chronic metabolic disorder characterised by persistent hyperglycaemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin or both. Diabetes is broadly classified by aetiology and clinical presentation, Type 1 diabetes, Type 2 diabetes and gestational diabetes. Type 1 diabetes accounts for 5%–10% of diabetes and is characterised by autoimmune destruction of insulin-producing beta cells in the islets of the pancreas. As a result, there is an absolute deficiency of insulin. A combination of genetic susceptivity and environmental factors such as viral infection, toxins or some dietary factors have been implicated as triggers for autoimmunity. It is most commonly seen in children and adolescents though it can develop at any age.
Type 2 diabetes mellitus accounts for around 90% of all cases of diabetes. In this type, the insulin response is diminished and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases resulting in this diabetes. It is most commonly seen in persons older than 45 years, but it is increasingly seen in children, adolescents, and younger adults due to rising levels of obesity, physical inactivity and energy-dense diets.
There has been an increase in the prevalence of diabetes in Nigeria. All regions of the country have been affected, with the highest prevalence seen in the South-South geopolitical zone. Urban dwelling, physical inactivity, advanced age and unhealthy diet are important risk factors for diabetes that have been identified amongst Nigerians.
There has been increasing evidence of NCDs amongst university students, youths and adolescents. This trend has been projected to increase the morbidity and mortality rates globally, especially in developing countries where poor health facilities, coupled with poor health-seeking behaviour have been a major issue. Assessing the knowledge and practice of risk factors of NCDs amongst university students are of huge importance as this helps to have a first-hand account of the problem and how to proffer possible solutions.
| Materials and Methods|| |
Study design and setting
This was a descriptive cross-sectional study amongst non-medical undergraduate at the University of Lagos. The University of Lagos is one of the 40 federal universities in Nigeria. It was established in 1962 as an incorporation of three faculties – Commerce and Business administration, Law and Medicine. Currently, the university has expanded to 12 faculties, which include Art, Basic Medical Sciences, Business Administration, Clinical Sciences, Dental Sciences, Education, Engineering, Environmental Sciences, Law, Pharmacy, Science and Social sciences. The University Main Campus is located in Akoka, with its annex campus for medical students located in Idi-Araba. The estimated number of undergraduate students is over 40,000.
Study population and eligibility criteria
Respondents selected were undergraduates at the University of Lagos who had spent at least 6 months in full-time programs and had valid university identification cards. Basic medical and clinical students as well as students who were critically ill during data collection were excluded from the study.
Sample size estimation
The minimum sample size was determined using the Kish and Leslie formula (1965) below:
n = Z2 pq/d2. A minimum sample size of 410 was calculated. p which is the proportion of respondents with good knowledge on risk factors for NCDs amongst undergraduates in a study in South-West Nigeria = 57.7% = 0.58.
Sampling and data collection tools and techniques
A multistage sampling method was used to select the students.
Stage 1: Selection of faculty
There are 12 faculties at the University of Lagos. Four faculties were selected using a simple random sampling method by balloting. They include faculty of Science, Arts, Education and Social Sciences.
Stage 2: Selection of department
The average number of departments in each faculty of the university spans between 7 and 13. Five departments were selected using a simple random sampling method by balloting. Selected departments in the faculty of science were Biochemistry, Botany, Mathematics, Physics and Zoology. Departments selected in the faculty of Arts were Linguistics, Philosophy, Creative Arts, English and History and Strategic studies. Departments selected in the faculty of Education include Adult Education, Early childhood education, Education Management, Human Kinetics Education and Arts and Social Science Education. Departments selected in social sciences were Economics, Geography, Mass Communication, Psychology and Sociology. Twenty departments were selected for the study.
Stage 3: Selection of level
All levels of each selected department were included in the study.
Stage 4: Selection of students
An equal number of students (using their WhatsApp numbers) were selected from each department for the study using systematic random sampling.
A Google form was designed and shared across WhatsApp group platforms of faculty, department, class and course representatives to obtain required data. The Google form link was sent to about 40 students in each of the 20 departments.
The Google form link sent to the respondents was accompanied by a small narrative. This narrative serves as an informed consent explaining the nature of the study, benefits and objectives were properly explained to the respondents, and they were assured that the information given would be treated with utmost confidentiality and the rights to withdraw their consent freely at any point during the study as participation was made voluntary.
Physical administration of the questionnaire was impractical due to the government-imposed restrictions to halt the spread of the coronavirus-19. A structured self-administered questionnaire, developed from previous studies was used to collect data amongst the respondents. The questionnaire was designed to assess the knowledge, perception and practices of the risk factors for NCDs amongst students of the University of Lagos. The questionnaire consists of the following sections:
- Section A: Sociodemographic characteristics of the respondents
- Section B: Knowledge of risk factors for NCDs amongst respondents
- Section C: Perception of risk factors for NCDs amongst respondents
- Section D: Exposure to risk factors for NCDs amongst respondents.
Data management and analysis
A total of 20 questions were used to assess the students' level of knowledge on NCDs. A correct answer gives a score of one and wrong answers are scored 0. Hence, the minimum possible score is 0 and the maximum possible score is 20. Scores between 0 and 10 put the respondent as having poor knowledge and scores between 11 and 20 as having good knowledge.
Likewise, a total of 15 questions and 17 questions were used to assess perception amongst the male and female respondents, respectively. The perception was compressed to a 3-point Likert scale, with agreed to a correct statement having a score of 2, neutral 1 and disagreed to a correct statement having a score of 0 as appropriate for each question. The minimum possible score is 0 and the maximum possible score is 45 for males and 51 for females. These scores are converted to percentages, hence 0%–50% were graded as poor perception and 51%–100% as good perception.
All completed questionnaires were checked for completeness and consistencies of variables. The data obtained were entered and analysed using SPSS Version 27.0. (IBM Corp., Armonk, NY). Findings were presented using frequency tables and charts. Descriptive statistics were used to describe the socio-demographic, knowledge about NCD and the risk factors amongst these undergraduates. Chi-square was used to test and determine any significant association between the outcome variables, i.e., knowledge, perception and exposure to risk factors of NCDs amongst the respondents. The confidence interval for all statistical tests was set at 95% and the level of significance was at P < 5%.
Ethical approval was obtained from the Health Research and Ethics Committee of LUTH. The nature of the study, benefits and objectives was properly explained to the respondents, and they were assured that the information given would be treated with utmost confidentiality and the rights to withdraw their consent freely at any point during the study as participation was made voluntary. Informed consent was obtained from the respondents. To ensure the confidentiality of research participants, identifiers such as names and other information that can reveal the identity of research participants were not included in the research instruments. The confidentiality of each participant was maximally maintained during and after the collection of their information. Information gathered from the respondents was stored in the computer for analysis by the researcher while copies of the filled instruments have been kept for maximum safety.
| Results|| |
Over 700 respondents received the Google form link and 459 forms were successfully submitted. The submitted forms were then sorted to select the students in the sampled departments for this study. A total number of 413 non-medical undergraduates of the University of Lagos who filled the Google forms were recruited for this study.
[Table 1] shows that most of the respondents were <20 years with the mean age of 22.8 (2.1) years. The ratio of males to females was about 1:1. More than half of the respondents were singles (93.2%), Christians (62.7%), full-time students (64.4%) and earn monthly income within the range of ₦40,001–₦100,000 (56.7%).
[Table 2] describes the knowledge of the respondents on NCDs and NCDs' risk factors. All the respondents have heard about NCDs, school/lectures (61.0%) was the most common source of information on NCDs. About 81.4% and 76.3% were rightly aware that NCDs are not passed directly from one person to another and do not affect for a short time and cannot be cured by few drugs. Majority of the respondents selected a sedentary lifestyle (94.9%), physical inactivity (93.2%), alcohol consumption (93.2%) and smoking (89.8%) as risk factors of NCDs. Most of them also knew that tobacco smoking (79.7%), high intake of sweet drinks (79.7%), fatty food (74.6%), physical inactivity (74.6%) and high salt intake (78.0%) are modifiable risk factors for NCD's.
|Table 2: Knowledge of non-communicable diseases and its risk factors among the respondents (n=413)|
Click here to view
[Figure 1] shows the ability of the respondents to correctly identify examples of NCDs. Heart disease (93.2%) was mostly selected by the respondents followed by hypertension (91.5%), diabetes (76.3%), cancer (66.1%) and stroke (59.3%). However, some of the respondents also incorrectly selected some communicable diseases.
|Figure 1: Respondents knowledge of examples of NCDs (n = 413). NCDs: Non-communicable diseases|
Click here to view
Majority of the respondents agreed that smoking in places where others can inhale the smoke is bad (67.8%), smoking tobacco can cause lung cancer (66.1%), there is a need to eat fruits and vegetables regularly for good health (72.9%), daily physical activity is important to health (71.2%), quantity and frequency of alcohol consumption can affect one's health (74.6%) and a regular self-breast examination can prevent a female from having breast cancer (63.3%) as revealed in [Table 3].
|Table 3: Perception of the risk factors for non-communicable diseases among the respondents (n=413)|
Click here to view
[Figure 2] shows the overall knowledge of NCDs amongst the respondents. Almost 3 in every 4 (73.1%) of the respondents had good knowledge of NCDs.
|Figure 2: Overall knowledge of NCDs among the respondents (n = 413). NCDs: Non-communicable diseases|
Click here to view
[Figure 3] demonstrates the overall perception of the risk factors for NCDs amongst the respondents. More than half of the respondents (64.4%) had the right perception about the risk factors of NCDs.
|Figure 3: Overall Perception of the risk factors for NCDs among the respondents (n = 413). NCDs: Non-communicable diseases|
Click here to view
[Table 4] shows the exposure to risk factors of NCDs amongst the respondents. More than half of the respondents eat fast food/snacks in a week (79.7%), do not engage in regular exercise (76.3), frequently consume soft drinks (59.3%) and do not engage in frequent consumption of vegetable (50.8%).
|Table 4: Exposure to risk factors of non-communicable diseases among respondents (n=413)|
Click here to view
[Figure 4] shows the proportion of respondents who are engage in behavioural risk factors of NCDs. More than two two-thirds (67.2%) of the respondents engaged in at least one behavioural risk factor of NCD.
|Figure 4: Proportion of respondents who engage in behavioural risk factors of NCDs (n = 413). NCDs: Non-communicable diseases|
Click here to view
[Table 5] shows the association between socio-demographic characteristics and the knowledge of NCDs and NCDs risk factors amongst the respondents. There were significant associations between employment status (P = 0.002), income (P = 0.000) and knowledge of NCDs.
|Table 5: Association between the knowledge of non-communicable diseases and socio-demographic characteristics of respondents|
Click here to view
[Table 6] shows an association between the perception of NCDs and the sociodemographic characteristics of the respondents. There were significant associations only with gender (P = 0.000) and perception of NCDs amongst the respondents.
|Table 6: Association between perception of non-communicable diseases and socio-demographic characteristics of respondents|
Click here to view
[Table 7] shows the association between exposure to risk factors of NCDs and sociodemographic characteristics, knowledge of NCDs and perception of NCDs amongst the respondents. Gender (P = 0.000), employment status (P = 0.000), religion (P = 0.013), income (P = 0.000), knowledge of NCDs (P = 0.002) and perception of NCDs (P = 0.000) were statistically significantly associated with the practice of the risk factors of NCDs amongst the respondents.
|Table 7: Association between the exposure to the risk factor of non-communicable diseases and socio-demographic characteristics, knowledge of non-communicable diseases and perception of non-communicable diseases among the respondents|
Click here to view
| Discussion|| |
The overall good knowledge of NCDs and its risk factors amongst the respondents was 73.1%. Less than two-thirds (64.4%) of the respondents has the right perception about NCDs and its risk factors. A high proportion (67.2%) of the respondents were exposed to one or more risk factors for NCDs. Exposure to risk factors for NCDs amongst the respondents was significantly associated with the respondent's gender, employment status, religion, income, knowledge and perception of NCDs.
Studies amongst rural adolescents in Nigeria and India revealed that only 0.3% of the respondents had good knowledge regarding the lifestyle risk factors for NCDs. These findings are in contrast to the finding in this study, the findings amongst adolescents in rural areas may be due to less exposure to media or opportunities to interact with health communication materials that may be available in urban areas. While the challenge may be more acute in rural areas and amongst less-educated youths, variable gaps in knowledge have been reported amongst in-school youths. The findings in this study buttress, the fact that a good number of undergraduates have some knowledge of the risk factors for NCDs. Reasons for these findings may include access to the health information on the internet, contact with health-care workers in clinics when registering in school or when they present when ill. This may also be due to the preponderance of health information on all forms of media, health programmes organised by non-governmental organisations or faith-based organisations or the school during the academic session.
The only two socio-demographic variables that were significantly associated with knowledge of NCDs in these studies were respondent's employment status and average monthly income, which is similar to a similar study done amongst undergraduates in a private institution in Nigeria. This indicates that economic power possibly increases the pattern of exposure to information about the risk behaviours or factors for NCDs as this finding is similar for the different demographic groups in this study. The school/lectures were the most common source through which the respondents access information about risk factors for NCDs. Some other studies have also cited friends, family members, the media and social media which is very popular amongst undergraduates-as avenues where young people can learn about these behavioural risk factors for the development of NCDs.,
This study revealed different values for the exposure to various risk factors for the NCDs. Regarding gender differences, a similar study done amongst private and public undergraduate students in Nigeria reported that females had a higher value of unhealthy diets (in the private university) and physical inactivity in both universities. While males had a higher percentage of alcohol use and current smoking compared to the females in both schools.
These identified risk factors for NCDs, i.e., physical inactivity and unhealthy diets were also corroborated in a similar study amongst adolescents in South-West Nigeria. Furthermore, physical activity was assessed in another study in the school area during leisure time, and about four-fifths of the students were engaged in a sedentary lifestyle in school with a little over two-thirds reporting physical activity outside school time, corroborated by a study amongst undergraduates in two countries. This may be possibly due to prolonged sitting in classes for lectures and convenience eating which is popular amongst undergraduates. Similar to the evidence from other regions, respondents were generally not committed to regular physical activities even when aware of the importance. Some of the reasons given were lack of motivation, lack of time, distance from their rooms to places of exercise and lack of social support. Interestingly, the built environment of the universities provides the opportunity for targeted interventions that encourage physical activities (provision of pedestrian walkway beside all tarred roads in the school, by improving knowledge and linking it to action) amongst undergraduates' residents in and around the university environment.
The proportion of respondents who had ever smoked tobacco was 27.1%, this was higher than the findings of another study amongst undergraduates in Ibadan. This is however much lower than what was recorded in a similar study in India (70%). However, consistent with findings from other studies, males and those slightly older had higher smoking rates. Apart from cigarettes, some of these respondents also smoked hookah/shisha, pipe and e-cigarettes. Tobacco smoking is generally more easily accessible, can be bought online, in restaurants, and increasingly, females (though less than males) are also engaging in this behavior.
Alcohol use by respondents in this study was lower than findings from some other countries. Similar to other local studies conducted outside Africa, more males than females reported excessive use of alcohol. This is probably explained by maybe higher alcohol tolerance and social acceptability of the drinking culture amongst males.
None of the respondents in this study consumed the recommended five fruit and vegetable servings per day, despite the expanded definition used for this study. Seasonal variations in fruit supply and sometimes the occasional prohibitive costs of some fruits may be possible contributors. In addition to the inadequate intake of fruits and vegetables, many respondents also had unhealthy eating habits of daily consumption of soda/soft drinks, and other diets high in sugar and fats.
Despite the reported good knowledge of NCDs and its risk factors observed in this study, 67.2% of the students are exposed to at least one risk factor of NCDs. This finding could be a result of peer pressure and youth's willingness to explore and enjoy their “youth age” with unhealthy behaviours including smoking, alcohol consumption and high intake of fast foods and junks.This was further buttressed by BJ Fogg's behavioural model of motivation-belonging and also by pleasure which are described as a powerful tool to influence people's behaviour despite prior absolute knowledge of that character.
The exposure to multiple risk factors amongst the respondents was substantial in this study. These risk factors are attributable to increase peer group pressure and westernisation. This is a very important finding necessitating urgent steps taken in line with national guidelines to address the NCD epidemic in Nigeria. Furthermore, more than half (54.3%) agreed that there should be no limit on the amount of alcohol taken on a single occasion. It may be this lack of self-awareness that has prevented many from commencing or sustaining healthy lifestyles.
This study has shown that while the knowledge and perception of the risk factors of NCDs were satisfactorily high amongst these undergraduates, this knowledge and perception has not translated to reduction in the exposure to these risk factors. A high proportion of the respondents were engaged in at least one or more risk factors for developing NCDs. A few of them (32.8%) were engaged in the preventive practices against these risk factors. The study population which are mainly adolescents and youths' have identified risky but modifiable health behaviours such as sedentary lifestyle, physical inactivity, alcohol use and unhealthy diets as the major risk factors for the development of NCDs. Public health interventions at tertiary institutions should be aimed at better lifestyle choices to reduce individual risk of developing NCDs. There is a need for continued surveillance of NCDs and their risk factors amongst students to provide data-driven targeted interventions for NCD prevention for relevant population segments.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gowshall M, Taylor-Robinson SD. The increasing prevalence of non-communicable diseases in low-middle income countries: The view from Malawi. Int J Gen Med 2018;11:255-64.
Bukhman G, Mocumbi AO, Horton R. Reframing NCDs and injuries for the poorest billion: A Lancet Commission. Lancet 2015;386:1221-2.
Juma K, Juma PA, Mohamed SF, Owuor J, Wanyoike A, Mulabi D, et al
. First Africa non-communicable disease research conference 2017: Sharing evidence and identifying research priorities. Glob Health 2020;8:020301.
Alam K, Mahal A. Economic impacts of health shocks on households in low and middle income countries: A review of the literature. Global Health 2014;10:21.
Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, et al
. Action to address the household economic burden of non-communicable diseases. Lancet 2018;391:2047-58.
Wang Q, Fu AZ, Brenner S, Kalmus O, Banda HT, De Allegri M. Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: The case of rural Malawi. PLoS One 2015;10:e0116897.
Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff (Millwood) 2007;26:972-83.
Al-Mawali A. Non-communicable diseases: Shining a light on cardiovascular disease, Oman's biggest killer. Oman Med J 2015;30:227-8.
Islam SM, Purnat TD, Phuong NT, Mwingira U, Schacht K, Fröschl G. Non-Communicable Diseases (NCDs) in developing countries: A symposium report. Global Health 2014;10:81.
Ruan Y, Guo Y, Zheng Y, Huang Z, Sun S, Kowal P, et al
. Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: Results from SAGE Wave 1. BMC Public Health 2018;18:778.
Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol 2010;35:72-115.
Adedoyin RA, Adesoye A. Incidence and pattern of cardiovascular disease in a Nigerian teaching hospital. Trop Doct 2005;35:104-6.
Arem H, Loftfield E. Cancer epidemiology: A survey of modifiable risk factors for prevention and survivorship. Am J Lifestyle Med 2018;12:200-10.
Wu F, Guo Y, Chatterji S, Zheng Y, Naidoo N, Jiang Y, et al
. Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: The study on global AGEing and adult health (SAGE) wave 1. BMC Public Health 2015;15:88.
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current epidemiology and future directions. Circulation 2016;133:1605-20.
Umoh VA, Otu A, Okpa H, Effa E. The pattern of respiratory disease morbidity and mortality in a tertiary hospital in Southern-Eastern Nigeria. Pulm Med 2013;2013:581973.
Uloko AE, Musa BM, Ramalan MA, Gezawa ID, Puepet FH, Uloko AT, et al
. Prevalence and risk factors for diabetes mellitus in Nigeria: A systematic review and meta-analysis. Diabetes Ther 2018;9:1307-16.
Pengpid S, Peltzer K. Behavioral risk factors of non-communicable diseases among a nationally representative sample of school-going adolescents in Indonesia. Int J Gen Med 2019;12:387-94.
Owopetu OF, Adebayo AM, Popoola OA. Behavioural risk factors for non-communicable diseases among undergraduates in South-west Nigeria: Knowledge, prevalence and correlates: A comparative cross-sectional study. J Prev Med Hyg 2020;61:E568-77.
Idowu A, Fatusi AO, Olajide FO. Clustering of behavioural risk factors for non-communicable diseases (NCDs) among rural-based adolescents in south-west Nigeria. Int J Adolesc Med Health 2016;30. DOI: 10.1515/ijamh-2016-0008.
Elnaem MH, Jamshed SQ, Elkalmi R. Knowledge of the risk factors of non-communicable diseases (NCDs) among pharmacy students: Findings from a Malaysian University. Int J Health Promot Educ 2019;57:217-28.
Aliyu SU, Chiroma AS, Jajere AM, Gujba FK. Prevalence of physical inactivity, hypertension, obesity and tobacco smoking: A case of NCDs prevention among adults in Maiduguri, Nigeria. Am J Med Sci Med 2015;3:39-47.
Adegoke BO, Oyeyemi AL. Physical inactivity in Nigerian young adults: Prevalence and socio-demographic correlates. J Phys Act Health 2011;8:1135-42.
Htay SS, Oo M, Yoshida Y, Harun-Or-Rashid M, Sakamoto J. Risk behaviours and associated factors among medical students and community youths in Myanmar. Nagoya J Med Sci 2010;72:71-81.
Elegbede OE, Babatunde OA, Ayodele LM, Atoyebi OA, Ibirongbe DO, Adeagbo AO. Cigarette smoking practices and its determinants among university students in Southwest, Nigeria. Cigarette smoking practices and its determinants among university students in Southwest, Nigeria. J Asian Sci Res 2012;2:62-9.
Maharajan MK, Rajiah K, Sze Fang KN, Lui LY. Cervical cancer prevention in Malaysia: Knowledge and attitude of undergraduate pharmacy students towards human papillomavirus infection, screening and vaccination in Malaysia. J Cancer Educ 2017;32:166-74.
Manjrekar SS, Sherkhane MS, Chowti JV. Behavioral risk factors for noncommunicable diseases in working and nonworking women of urban slums. J Midlife Health 2014;5:143-9.
Haughton CF, Waring ME, Wang ML, Rosal MC, Pbert L, Lemon SC. Home matters: Adolescents drink more sugar-sweetened beverages when available at home. J Pediatr 2018;202:121-8.
Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of behaviour and behaviour change across the social and behavioural sciences: A scoping review. Health Psychol Rev 2015;9:323-44.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]