KNOWLEDGE AND ATTITUDE ON THE RISK FACTORS ASSOCIATED WITH NON

COMMUNICABLE DISEASES: A CASE STUDY OF THE KENYA ARMED FORCES PERSONNEL,

KAHAWA BARRACKS

Presented by: Esther Mwende A56/68041/2011

Supervisor: Prof. Jasper K Imungi

Date: 19/04/2012 Venue: ANP Lecture Hall

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INTRODUCTION• A Non Communicable Disease (NCD), is a medical

condition or disease which is non-infectious. • NCDs are diseases of long duration and generally

slow progression. • The dietary NCDs of importance are CVD, Cancer and

Diabetes.• Worldwide NCDs currently represent 43% of the

burden of disease and are expected to be responsible for 60% of the disease burden and 73% of all deaths by 2020.(WHO NCD Surveillance Strategy ).

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STATEMENT OF THE PROBLEM• NCDs are already of major importance in developing

countries and are rapidly becoming a major public health threat.

• The burden of disease from NCDs is expected to rise by more than 60% by 2020 .

• The underlying cause is the increase in lifestyle related risk factors resulting from social and economic changes.

(WHO NCD Surveillance)

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JUSTIFICATION (reasons)

• NCDs develop gradually over a period of time. • Active screening • Diseases are detected when at advanced stages and

already chronic. • Develop disease at younger ages, suffer longer and

die sooner than those in developing countries. • Undermines countries’ economic development as

many of those affected are at the peak of their productive and economic activity.

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GENERAL OBJECTIVES To determine the knowledge and attitude on the risk

factors that the soldiers are exposed to and that may eventually lead to development of NCDs.

SPECIFIC OBJECTIVES1. To determine the lifestyle risk factors that may

expose the soldiers to NCDs.2. To establish the nutritional knowledge among the soldiers.3. To determine the blood cholesterol levels of the soldiers4. To assess the BMI and Waist to hip ratio of the

soldiers

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HYPOTHESES1. The soldiers maintain healthy diets2. The soldiers are physically active.3. The soldiers are not engaged in behavioral

habits that expose them to risks associated with NCDs.

4. The blood cholesterol level of the soldiers are within the normal limits.

5. The blood pressure levels of the soldiers are within the normal limits.

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STUDY AIM

The aim of this study is to contribute information that will assist in designing appropriate interventions to reduce the risks associated with NCDs.

PURPOSEDetermine the risk factors that may increase the chances of Kenyan military developing NCD.

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RESEARCH QUESTIONS

1. Is there a significant risk among the soldiers of developing NCDs?

2. How much nutritional knowledge do the soldiers have on lifestyle diseases?

3. What are the cholesterol levels among the soldiers?

4. Are the soldiers physically active lifestyle when not attending drills or on mission?

5. Do the anthropometric measurements of the solders reflect normal weight?

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LIMITATIONS OF THE STUDY

1. It may be difficult to get a research permit from Kenya Department of Defense. 2. It will be expensive to perform blood cholesterol test on the entire study population.

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LITERATURE REVIEW• NCDs are thought to be a problem of the developed

world• Only 20% occur in the developed world (WHO 2007)Urbanization and dietEpidemiology transitionNutritional transitionChronic disease mortalityMorbidity related to NCDsRisk factors of NCDsMethods of data collection

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Risk factor Cardiovascular diseases Diabetes Cancer Respiratory conditions

Smoking * * * *

Alcohol * * * *Nutrition * * * *

Physical inactivity * * * *

Obesity * * * *

Raised blood pressure * * * *

Raised blood glucose * * * *

Abnormal blood lipids * * * *

Figure 1: Risk factors common to major chronic diseases conditionsSource: African Health Monitor January to June 2008

KNOWLEDGE GAP

• Scanty data is available on prevalence of NCDs from the Ministry of Public Health Department of NCDs

• Few studies has been done in the country on NCDs

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STUDY DESIGN

A cross sectional study will be conducted. Exposure to risk factors, knowledge and attitude will be assesses. It will be both descriptive and analytical in nature

STUDY POPULATIONThe study population will comprise of the Kenya Army Service Branch of the KDF soldiers at the Kahawa Barracks

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SAMPLING PROCEDURE

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INCLUSION AND EXCLUSION CRITERIA

Inclusion Criteria

• Soldiers in the senior, mid level and junior officers of the Army Service based at Kahawa Barracks.

Exclusion criteria• Pregnant soldiers since they may have lifestyle habits

and that could be different from their usual.• Soldiers that have recently been seriously ill.• Any army personnel who refuses to participate in the

study

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SAMPLE SIZE DETERMINATION

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The sample size was calculated using Infinite population using the Fisher’s

formula (Fisher et. al 1991)  n= (Zα/2)²Pq

-------------------

(L²) n= (1.96)²(0.5 x 0.5)

--------------------------- (0.05)² 

=384 + 5 % Attrition = 403 

n=estimates sample sizeP=estimated proportionq= (1-p)Zα/2= Z value CI @ 95 %Precision= 5%

DATA COLLECTION TOOLS

• A semi structured pre-tested questionnaire will be administered.

• Bathroom scale• Pro sport measuring tape• Digital blood pressure machine• Lipid profile kit

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DATA COLLECTION PROCESS

• Legal permits from National Council for Science & Technology, KNH/UON Ethical clearance committee and DOD

• Informed consent from respondents• Guarantee confidentiality • Recruitment and Training of Research Assistants

– Form four graduates, fluent in English & Swahili, and assertive

– Engage services of a Kenya registered Nurse

• Pre testing of questionnaire - DOD

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DATA COLLECTION METHODS• Demographic Information• Behavioral information: physical activity, tobacco

use, alcohol consumption, food frequency.• Physical measurements: BMI, Hip and Waist ratio,

blood pressure• Biochemical measurements: cholesterolDATA QUALITY CONTROL Calibration of scale, Examining questionnaires, Direct

field supervision

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DATA ANALYSISData collected will be analyzed using the Statistical Package for Social Sciences (SPSS)The following analysis will be done:

1. Descriptive StatisticsProportions (%)CountsFrequenciesSkewnessKurtosis

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Measure of central tendencyModeMedianMeanRange

Inferential statisticsChi- square (χ²) for comparison of proportions (counts)Man Whitney –U test for rankingt-test compare means of two groupsANOVA- Multi Variant AnalysisRegression for confounding variablesCorrelation

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• BMI, Hip & Waist Ration cut off points will be done using WHO referencing

• Activity profiling using WHO classification.

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Quant Chart

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2012 2013

ACTIVITY MAR A M J J A S O N D JAN F M A M J

PROPOSAL DEVELOPMENT

PROPOSAL PRESENTATION

ADJUSTMENT OF PROPOSAL

SUBMITION OF PROPOSAL

FIELD VISIT

AQUIRE RESEARCH PERMITS

RECRUITMENT & TRAINING ENUMERATORS & NURSE

TOOL PRE-TESTING

MODIFY TOOLS

DATA COLLECTION

DATA MANAGEMENT AND ANALYSIS

DATA ENTRY

DATA ANALYSIS

THESIS WRITE UP

THESIS REPORT WRITING

PRESENTATION OF THESIS

MODIFY THESIS

DEFEND THESIS

Study Budget

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ITEM NO. OF UNITS UNIT COST TOTAL COSTTransport to and from Barracks 30 700 21 000Nurse Allowance 1 500 15 000Field Assistants Allowance 2 250 15 000Hiring of Lipid Profile Kit 1 4 500 4 500Cholesterol Strips 120 120Hiring of BP Kit 1 3 000 3 000Weighing Scale 1 5 000 5 000Printing Paper 2 500 1 000Photocopying Questionnaire 420 1.50 630Stapler 1 200 200Staples 1 100 100Biro pens 8 10 80Pencils 8 10 80Erasers 3 25 75Rulers 2 40 80Note books 4 45 180Cotton wool 1 250 250Surgical Spirit 1 300 300Surgical gloves 30 20 600Supervisors Per DM 2 8500 17 000Supervisors Transport 1 6000 6 000Printing of Thesis 4 430 1 720Binding of Thesis 4 500 2 000TOTAL 31 001 108 195