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Cardiovascular risk factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area
Geofrey Musinguzi1,2, Rawlance Ndejjo3,4, Isaac Ssinabulya5
1Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. mgeof@musph.ac.ug.
Insights
Cardiovascular disease risk factors are common in Uganda, with significant geographic and gender differences in prevalence. Small-area mapping reveals patterns in hypertension, inactivity, smoking, and alcohol use, highlighting the need for targeted interventions.
Area of Science:
- Public Health
- Epidemiology
- Geographic Information Systems (GIS)
Background:
- Sub-Saharan Africa faces a growing burden of cardiovascular diseases (CVDs).
- Modifiable risk factors like hypertension, diabetes, obesity, and unhealthy diets contribute significantly to CVDs.
- Small geographical area mapping of CVD risk factors is lacking in most of Sub-Saharan Africa.
Purpose of the Study:
- To map and describe the distribution of cardiovascular disease risk factors in 20 parishes in Uganda.
- To identify small-area geographic heterogeneity in CVD risk factor prevalence.
- To inform targeted CVD risk reduction interventions.
Main Methods:
- A baseline survey was conducted in December 2018 and January 2019.
- A sample of 4372 adults aged 25-70 years was drawn from 3689 households across 80 villages in 20 parishes in Mukono and Buikwe districts, Uganda.
- Descriptive statistics, generalized linear modelling, and GIS mapping were used for analysis.
Main Results:
- Mapping revealed substantial gender and small-area geographic heterogeneity in CVD risk factor prevalence.
- Patterns and clustering were observed for hypertension, physical inactivity, smoking, and alcohol consumption.
- Unhealthy diet prevalence was high across all parishes with no significant observable differences.
Conclusions:
- Modifiable cardiovascular risk factors are prevalent in this low-income setting.
- Significant differences in risk factor distribution exist across small geographic areas.
- Small-area mapping is valuable for informing targeted risk reduction interventions.
Background:
Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda.
Methods:
A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25-70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS.
Results:
Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity which was masked on aggregate analysis. Patterns and clustering were observed for hypertension, physical inactivity, smoking, alcohol consumption and risk factor combination. Prevalence of unhealthy diet was very high across all parishes with no significant observable differences across areas.
Conclusion:
Modifiable cardiovascular risk factors are common in this low-income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored. In addition, the differences emphasize the value of small geographical area mapping and analysis to inform more targeted risk reduction interventions.
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