Cardiovascular disease risk factors among school attending adolescents in rural Nigeria

[摘要] ENGLISH ABSTRACT: Background: The prevalence of Cardiovascular Disease (CVD) is increasing in Nigeria,particularly hypertensive heart disease among the working class population. Unfortunately,resources for effective management of CVD at acute stage are sparse and expensive for theaverage Nigerian making preventive measure the best option for Nigeria. CVD risk factors havebeen identified in adolescents in many countries but information on CVD risk factors amongNigerian adolescents, especially rural adolescents, are sparse. This study aimed to developculturally appropriate lifestyle CVD risk factors questionnaire for adolescents in Nigeria and toinvestigate CVD risk factors and its associates among 15-18 years school attending adolescentsin rural Nigeria.Methods: The study was conducted in rural south west Nigeria, one of the six geopolitical zonesof Nigeria. The people living in this area are Yoruba speaking population of Nigeria. The studywas conducted in four phases. Phase 1: development of a composite lifestyle CVD risk factorsquestionnaire through systematic review, expert panel and target population. Phase 2: Crosscultural validation of composite measure developed to facilitate its use among rural adolescents.Phase 3: Pilot study to assess the logistics of the study and to test the reliability of the newlydeveloped questionnaire. Phase 4: investigation into CVD risk factors among adolescents. CVDrisk factors such as smoking, alcohol, Physical inactivity, and poor diet using the newlydeveloped questionnaire were assessed. Blood pressure, BMI and waist hip ratio were alsoassessed using standardized protocol. Data was analyzed qualitatively and quantitatively.Content validation of the questionnaire was done qualitatively using expert consensus andadolescents' feedback. Reliability was tested using ICC (Intraclass Correlation), Kappa and paired t test. CVD risk factors data was analyzed descriptively first, then with Pearsoncorrelation and multiple regressions to determine associations among risk factors at 95%confidence interval (0.05 level of significance). Result: European countries showed highprevalence of smoking among adolescents in the systematic review. The prevalence ofdyslipidemia ranged from 2.5% of total cholesterol (TC) in rural Iran adolescents to 48.9% highTriglyceride (TG) in rural Mexican adolescents. Overweight and obesity prevalence ranged from0.6% prevalence in an age (10 y) of a study to 48.7%. Studies from the United States showed adecreasing trend in pre hypertension and hypertension, overweight and obesity. The newlydeveloped composite lifestyle CVD risk factors questionnaire for adolescents had moderate togood reliability. Intraclass correlation (ICC) ranged from 0.3 - 0.7 and 0.3-0.8 in English andYoruba versions' subscales respectively. Kappa statistics showed moderate to strong agreementin priority questions in English and Yoruba versions. Investigation into the CVD risk factorsshowed high prevalence and clustering of CVD risk factors; 7.1% adolescents were smokers,10.2% drank excessive alcohol, 27.9% had low physical activity level, 59.8% consumed highcholesterol diet, 6.1%, consumed low vegetable 8.1% consume low fruit 65.5% had high saltintake, 33.1% had pre hypertension ( systolic), 5.5% had pre hypertension (diastolic) 3.2% hadhypertension (systolic) 0.8% had hypertension (diastolic). Smoking and drinking weresignificantly higher in males and physical activity was significantly higher in females. Smokingand drinking were significantly associated in both males and females and the odd of drinking andsmoking was more elevated in girls. Systolic pre- hypertension was associated with age and highBMI in boys and was associated with only high BMI in girls. Conclusion: Nigerian ruraladolescents are at risk of future adult CVD. There is an urgent need to put measures in place to prevent future epidemic of CVD in adulthood. CVD prevention program for boys and girlsshould be tailored to address gender specific CVD risk factors.

[发布机构] Stellenbosch University