The SA Journal Diabetes & Vascular Disease Vol 15 No 2 (November 2018)

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RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE
50 VOLUME 15 NUMBER 2 • NOVEMBER 2018
The combined prevalence of overweight and obesity, measured
by BMI in this study, was 62.8%, comparable to the 63.4 and 64.4%
reported by similar local studies,19-21 but higher than the reported
prevalence of 31 to 48% in the general Nigerian population.39,40
Similar international studies documented a prevalence of combined
overweight and obesity to be between 62.1 and 78.2%.13,41,42
Using waist circumference, the prevalence of obesity from this
study was 24.1%. This was lower than the 58.2 and 63.3% from
studies in Brazil and Iran, respectively.12,41 This difference might be
methodological. In these countries the cut-off for abdominal obesity
is 88 cm, less than the 102 cm used in our study.43,44Prolonged work
stress and long hours at work contribute to the development of
obesity and abdominal obesity in professional drivers.13
The prevalence of physical inactivity in this study was 50.9%,
comparable to the 53.4% from a local study,20 but lower than
the 72.8% reported by similar international studies.12,45 Both studies
were among truck drivers who probably do not have to stop on the
way for passengers to alight for refreshments. Physical inactivity
and dietary habits of professional drivers are known to predispose
to obesity. Obesity increases the risk of hypertension and abnormal
glucose profiles, as shown in this study. It is also known to increase
the risk of road traffic accidents among professional drivers due to
its association with obstructive sleep apnoea and excessive daytime
sleepiness, consequent fatigue and reduction in alertness while
driving.46
The prevalence of smoking in this study was 19.5%. Reported
prevalence in similar local studies is between 17.8 and 31.3%, all
higher than the 15% in the general population.20,21,47,48 The lower
prevalence from this study might be due to dilution effect from the
‘no smoking within the bus terminal’ policy of one of the transport
companies used in this study. Secondly, the subjects may not
have been truthful in their responses to the question on smoking
status. Comparable rates of 20 and 15.6% were reported in similar
international studies.12,45
Alcohol consumption was very common in this study group, with
a prevalence rate of 71.1%. Reported local prevalence in this group
ranged from 34 to 84.4%.20,48,49 These figures are much higher than
the 7.6 and 9.1% reported in the general male population.50,51
A recent local study from Muslim-dominated north-west Nigeria
documented a prevalence of 5.5% among inter-city bus drivers.21
This very low figure might be related to a religious obligation that
forbids Muslims from consuming alcohol.
It is pertinent to note that in this study, CVD risk factors
co-occurred, as has been documented in the past.52 This clustering
of risk factors increases the overall CVD risk of the individual and
also makes control difficult due to problems of pill burden.53,54In this
study 45.1%of the subjects hadmore than two risk factors clustered
together. Clustering of CVD risk factors has been documented in
the general population, with prevalence rates between 12.9 and
27.5%, depending on the study population. The commonest risk-
factor combinations are hypertension, obesity, abnormal glucose
profile and atherogenic dyslipidaemia.55-57 Our findings are similar
to the above pattern, although the combination of hypertension
and abnormal glucose level was most prevalent. These findings
are similar to the pattern reported in similar studies.12,13 There were
some limitations in this study. The use of glycosylated haemoglobin
would have been helpful in assessing the quality of glycaemic
control among the diabetic subjects. Bus drivers with poor control
of both BP and glucose levels were not assessed for medication
adherence.
Conclusion
Long-distance professional drivers in Nigeria are at a higher risk for
CVD than the general male population on account of the higher
prevalence of a plethora of risk factors they harbour: hypertension,
abnormal glucose profiles, overweight/obesity, alcohol use,
smoking and atherogenic dyslipidaemia. These risk factors not only
co-occur in a large number of drivers, but most are unaware of
their risk. Overweight/obesity is the common driver of hypertension
and abnormal glucose profiles among them, while age ≥ 45 years
increases the risk of developing hypertension. Contributing to their
risk is the social gradient of inequality, which affects their access to
healthcare and adherence to medical intervention.
There is therefore a need to increase CVD risk awareness in this
vulnerable yet important segment of our population through public
awareness campaigns, banning of smoking and selling of alcoholic
beverages in motor parks, compulsory annual health screening,
defined maximum driving hours per week, provision of facilities to
promote physical activity in the motor parks and medical facilities
to diagnose, treat and monitor risk-factor control. Universal health
insurance coverage as a national health policy would also help in
providing healthcare/health promotional services to this group, who
at the moment are not covered by the health insurance scheme.
Acknowledgements
The authors thank Drs Igebu, Anyakpele, Oyatokun, Eluogu and
Oshuntokun for helping out with data collection, and Chimamaka
Chibuike and Joy Alozie for their help in preparing the manuscript.
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