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VOLUME 13 NUMBER 1 • JULY 2016
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
December 2011 and February 2012, we conducted a cross-sectional
survey using the WHO NCD STEPS survey tools to determine the
magnitude of NCDs and their risk factors in Kasese district, Uganda
to serve as a pilot study for the nationwide survey of NCD risk
factors.
Methods
Ethical approval was granted by the Uganda National Council for
Science and Technology’s Human Research and Ethics Committee,
and the President’s Office Research Secretariat. Written informed
consent was obtained before participants were enrolled in the
study, using the WHO NCD STEPS survey consent form.
This study was a community population-based, cross-sectional
survey designed according to a WHO STEPwise approach to
chronic disease risk-factor surveillance.
15
Data were collected in
three steps; step 1 used a questionnaire to collect demographic
and lifestyle data; step 2 involved measurements of height, weight,
blood pressure (BP), waist and hip circumference; and step 3 used
laboratory (biochemistry) investigations.
Kasese district is divided into two counties, Bukonzuo (10 sub-
counties) and Busongora (12 sub-counties). One sub-county was
selected from each county. Bugoye sub-county from Busongora
is predominantly rural, whereas Mpondwe sub-county from
Bukonzuo is peri-urban. The two sub-counties selected are the most
populous in each county. Both sub-counties comprise 14 parishes,
61 villages with a total of 11 986 households. Using the cluster
sampling method, seven households were randomly selected from
each village. Finally, at least one adult in the selected households
was invited to participate. Where a household had no consenting
adults, the neighbouring household was approached.
The survey was conducted using the WHO recommended
STEPwise approach.
16
Step 1, the survey questionnaire, was
administered by the field staff. It consisted of core (age, gender,
education in years, current exposure to tobacco and alcohol, diet
and physical activity), expanded (rural/urban setting, occupation,
average household income) and optional (marital status,
medical and health history, past history of smoking and alcohol
consumption) variables. The medical and health history component
included questions on medication, cigarette use, diabetes mellitus
and hypertension.
Step 2 involved physical body measurements, including BP,
height, weight, and waist and hip circumference measurements.
BP measurements were taken using battery-powered digital BP
machines (Omron M3-I). The participant was asked to sit on the
chair and rest quietly for 15 minutes with his/her legs uncrossed.
The left arm of the participant was then placed on the table with
the palm facing upward. Three readings, three to five minutes apart,
were then taken on the left arm. During the analysis the average of
the last two readings was the final BP reading used.
Height was measured with the participant standing upright
against a wall on which a height mark was made. Measurements
were taken with the participant barefoot, standing with the back
against the wall and head in the Frankfort position, with heels
together. The participant was asked to stretch to the fullest. After
being appropriately positioned, the participant was asked to exhale
and a mark was made with a white chalk to mark the height. The
height was then measured to the nearest 0.1 cm from the mark to
the floor using a tape measure.
Weight measurements were taken on a pre-calibrated weighing
scale (Seca scale). Participants were weighed dressed in light clothing
and barefoot. Measurements were taken to the nearest 0.1 kg.
Step 3 involved laboratory tests. Consenting participants were
asked not to consume any food, only water from after supper that
day until the survey team collected the blood samples the next day
(eight-hour fast). People converged at the agreed place in their
community. Those who had complied with the overnight fast were
eligible for finger-prick blood sample collection. Total cholesterol
(TC) and triglyceride (TG) levels were measured using Reflotron-Plus
machines manufactured by Roche. Fasting blood glucose (FBG) level
was measured on two machines, the Accu-Chek Active glucometer
from Roche and the Soft-Style glucometer from Chem-labs.
Hypertension was defined as a diastolic BP of 90 mmHg or more,
or a systolic BP of 140 mmHg or more, or currently on medication
for hypertension (documented in the health booklet). Diastolic BP
≥ 110 mmHg or systolic ≥ 180 mmHg was considered to be severe
hypertension. Raised fasting blood glucose was defined as a blood
glucose level ≥ 7.0 mmol/l or currently on medication for diabetes
mellitus (documented in the health booklet). Raised total cholesterol
was defined as cholesterol level ≥ 5.0 mmol/l. Overweight was
defined as body mass index (BMI) ≥ 25.0 kg/m
2
and obesity as BMI
≥ 30.0 kg/m
2
.
Excessive or harmful use of alcohol was defined as the
consumption of five or more for men, four or more for women,
standard units per day for three or more days per week. Physical
activity was measured using questions on four different aspects:
physical activity at the workplace, physical activity during recreation
time, physical activity while travelling, and physical resting time. A
heavy smoker is, according to the recommendations of the World
Table 1.
Characteristics of the study participants
Male
Female
Total
n
%
n
%
Gender*
528 297 45.5 231
54.5
Age (years)
25–34
179
98 34.0
81 35.1
35–44
118
63 21.9
55 23.9
45–54
104
57 19.9
47 20.2
55–64
57
36 12.8
21 9.3
> 64
60
33 11.5
27 11.5
Education
None
112
41 14.1
71 30.9
Primary school
243 129 45.1 114 49.7
Secondary school (O level)
113
82 28.3
31 13.5
Secondary school (A level)
27
18
6.4
9 3.9
University/college
23
17
6.1
6 2.0
Occupation
Peasant
326 159 55.6 167 72.2
Trader
20
11
3.7
9 3.9
Teacher
28
22
7.4
6 2.5
Housewife/homemaker
10
0
0
10 4.49
Other
80
66 23.3
14 6.2
None
54
29 10.1
25 10.7
Marital status
Married
411 244 84.9 167 71.9
Separated
38
17
6.1
21 9.3
Widowed
39
8
2.4
31 13.5
Never married
30
18
6.7
12 5.3
*Percentage is by column for gender only. The rest of the variables are by
rows.