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VOLUME 13 NUMBER 1 • JULY 2016
31
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
The prevalence and distribution of non-communicable
diseases and their risk factors in Kasese district, Uganda
CHARLES KIIZA MONDO, MARCEL ANDREW OTIM, GEORGE AKOL, ROBERT MUSOKE,
JACKSON OREM
Correspondence to: Dr Charles Kiiza Mondo
Marcel Andrew Otim, Robert Musoke
Department of Medicine, College of Health Sciences, Makerere University,
Kampala, Uganda
e-mail:
charlesmondo2011@gmail.comGeorge Akol
Alcomed Specialist Diagnostic Service, Kasese, Uganda
Jackson Orem
Uganda Cancer Institute and Department of Medicine, College of Health
Sciences, Makerere University, Kampala, Uganda
Previously published in
Cardiovasc J Afr
2013;
24
(3): 52–57
S Afr J Diabetes Vasc Dis
2016;
13
: 31–36
Abstract
Background:
To date there has been no population-based
survey of the major risk factors for non-communicable
diseases (NCD) in Uganda. Hospital-based data from urban
centres report an increasing burden of NCDs in Uganda. Our
population-based survey aimed to describe the prevalence of
risk factors for NCDs in a rural Ugandan district.
Methods:
The survey was conducted using theWHO STEPwise
approach to surveillance of non-communicable diseases
(STEPS) methodology. Participants (
n
= 611) were residents of
the Kasese district selected in a one-step, complete survey of a
rural district. Standardised international protocols were used
to record history of disease, and measure behavioural risk
factors (smoking, alcohol consumption, fruit and vegetable
consumption, physical activity), physical characteristics
[weight, height, waist and hip circumferences, blood pressure
(BP)], fasting blood glucose (BG) and total cholesterol (TC)
levels. Data were analysed using simple descriptive analysis.
Results:
In this sample, the prevalence of hypertension
(systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg) was
22.1% for men and 20.5% for women. Fifteen per cent of men
and 16.8% of women were overweight [body mass index
(BMI) ≥ 25 kg/m
2
] and 4.9% of men and 9.0% of women were
obese (BMI ≥ 30 kg/m
2
). Nine per cent of participants were
diabetic, 7.2% ate five or more combined servings of fruit per
day while only 1.2% ate five or more combined servings of
vegetables per day. Fifty-one per cent of the population were
physically inactive and 9.6% were daily smokers. Thirty-one
per cent of females had fasting blood sugar levels (FBS) ≥ 6.1
mmol/l while 10% of males had FBS > 6.1 mmol/l.
Conclusion:
This study presents evidence on the magnitude
of NCDs, their risk factors and gender distribution in a rural
population in Uganda, a poor country in east-central Africa.
These data, when combined with urban population data,
could be useful in the formulation and advocacy of NCD
policy and plans of action in Uganda.
Keywords:
non-communicable diseases, WHO STEPS, smoking,
obesity, physical activity
Introduction
Non-communicable diseases (NCDs) are currently responsible for
35% of all deaths in low- and middle-income countries,
1
and this
alarming figure is predicted to rise in the near future. The World
Health Organisation projects that the burden of disease due to
NCDs will increase rapidly in the years ahead. From a projected total
of 58 million deaths from all causes in 2005, it was estimated that
NCDs would account for 35 million deaths, which was double the
number of deaths from all communicable diseases (including HIV/
AIDS, tuberculosis and malaria), maternal and perinatal conditions
and nutritional deficiencies combined.
1
This epidemiological transition in global health from infectious
diseases to NCDs is posing not only a threat to the health of those
affected but also places an enormous burden on the health systems
of nations, particularly those of the least-developed countries,
as they must now address a double burden of acute and chronic
diseases amidst scarce resources.
2-4
Furthermore, this epidemiological
transition is adversely impacting on socio-economic development
of nations, as NCDs tend to be more prevalent in young working
class people.
2
As a more sophisticated workforce becomes a highly
valued and harder-to-replace economic investment, the increasing
prevalence of NCD risk factors in developing countries, particularly
sub-Saharan Africa (SSA), becomes a real threat to economic
progress, adversely impacting on all the previous gains made in
combating HIV, malaria, tuberculosis and other infectious diseases.
5
In Uganda, while acute infectious communicable diseases still
contribute the major (75%) disease burden, with malaria, acute
respiratory infections and HIV/AIDS among the top 10 causes of
illness and death,
6
the burden of NCDs is increasingly posing a
threat of dual epidemics of communicable and non-communicable
diseases. The International Diabetes Federation put estimates
of incidence of diabetes mellitus in Uganda at 50 000 affected
individuals in the year 2003, and projected a 10-fold increase in
the cases of diabetes by 2025 if no interventions are initiated.
7
Estimates suggest that as many as 8% of people living in Kampala
may have type 2 diabetes (T2D),
8
while deaths attributed to NCDs
in Uganda were estimated at 31 700 in 2002.
9
Estimates of age-standardised mortality from NCDs suggest
that countries in SSA, including Uganda, might have a more than
three-fold higher mortality rate than several European countries,
including the UK.
9
However, these estimates are based on limited
data and statistical models derived from child mortality rates and
cause-specific rates from external sources. Several publications have
highlighted the need for local high-quality epidemiological data on
the burden of NCDs and their risk factors, particularly in SSA where
such data are scarce.
10,11-14
To date, there has been no systematic population-based study
on NCD risk factors conducted in Uganda. Accordingly, between