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A RURAL-URBAN COMPARISON OF RISK FACTORS FOR NON-COMMUNICABLE DISEASES AMONG IN-SCHOOL ADOLESCENTS IN PUBLIC SECONDARY SCHOOLS OF LAGOS STATE
Abstract
Introduction: Non-communicable diseases (NCDs) have become the leading cause of death globally and the four main behavioural risk factors for NCDs – excessive alcohol, cigarette smoking, physical inactivity and poor dietary patterns are often initiated in adolescence. Global trends indicate that these NCD related behaviours are on the rise among adolescents and they establish patterns of behaviour that persist throughout life and are often hard to change. This study aimed to determine the knowledge and attitude of behavioural risk factors, the prevalence of these risk factors, and prevalence of selected metabolic risk factors (overweight, obesity, high blood pressure, hyperglyceamia, and microalbuminuria) for NCDs among adolescents in urban and rural public secondary schools of Lagos State.
Methods: This was a cross-sectional analytical study, which focused on rural-urban comparison, carried out among adolescents from public secondary schools in Ikeja and Ibeju-Lekki Local government areas of Lagos State. One thousand and eighteen (1018) respondents (514 from rural and 504 from urban) were selected using multi-stage sampling technique. Data was collected using a self-administered questionnaire adapted from the WHO/CDC Global School-Based Student Health Survey questionnaire, WHO STEPS chronic disease risk factor surveillance instrument, and a modified International Physical Activity Questionnaire (IPAQ-A) for adolescents. Knowledge, attitude, prevalence of alcohol intake, cigarette smoking, physical inactivity, poor dietary pattern, high blood pressure, obesity, hyperglyceamia and microalbuminuria was analysed using IBM SPSS Statistics Software package version 20. Frequency tables, measures of central tendency, and measures of dispersion were used to describe data. The proportions were compared using Chi-square and means were compared using Student t-test. Level of significance was at p-value<0.05. Variables attaining significance were further subjected to multivariate analysis.
Results: The mean age in the rural was 14.8±2.0 compared to the urban 14.4±1.9 location. The mean knowledge score was higher in the urban 53.4±18.5 compared to the rural 44.9±19.5 area (p<0.001). The mean attitude score was higher in the urban 86.9±10.1 compared to the rural 78.8±12.4 (p<0.001). A higher proportion of respondents in the urban compared to the rural area were current alcohol users (32.5% urban versus 28.4% rural). A higher proportion of respondents in the rural area compared to urban were smokers. Sedentary behaviour was higher in urban compared to the rural area and the prevalence of obesity was 1.2% and 1.4% in the urban and rural areas respectively. The prevalence of high blood pressure was 3.3% in the rural and 3.2% in the urban, while the prevalence of impaired fasting glucose (prediabetes) was 9.6% in the urban and 8.6% in the rural arear. The prevalence of microalbuminuria was 11.3% in the rural versus 11.2% in the urban area. The predictors of alcohol intake in the rural include number of children in the family while sex, religion and class were predictors in the urban area. The predictors of smoking in the rural consisted of religion, and birth position while the predictors of sedentary behaviour in the rural area was age.
Conclusion: Overall, the prevalence of NCD behavioural risk factors and metabolic risk factors was high in both rural and urban areas. Neither of the locations had a consistently higher proportion of risk factors than the other hence preventive measures have to be put in place to improve levels of knowledge, fruit and vegetable consumption, physical activity and reduce alcohol intake and smoking in both rural and urban areas. Findings from this study have the potential to inform effective school-based NCD control programmes.
Key words: NCDs, adolescents, knowledge, attitude, behavioural risk factors, high blood pressure, hyperglyceamia, microalbuminuria, obesity, public secondary schools, rural, urban
