Date of Award

4-2023

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr Anthony Ngugi

Second Supervisor/Advisor

Mr George Ongete

Department

AKU-East Africa

Abstract

Introduction: According to the World Health Organization (WHO), non-communicable diseases such as stroke, contribute to about 70% of the top ten causes of mortality in the world. The growing burden of Cardiovascular (CVD) risk factors has also been noted to affect the health workforce. According to the Ministry of Health in Kenya employing the WHO STEPS survey, 27% of Kenyans are either overweight or obese. Few studies have been done in Kenya to highlight the prevalence and impact of cardiovascular risk factors amongst healthcare workers. The variety of findings and paucity of data bring about the need to evaluate this phenomenon among healthcare workers in Kenya.

Objectives: The primary objective was to determine the association between the presence of CVD risk factors (Tobacco use, alcohol consumption, inadequate physical activity, overweight and obesity, and hypertension) and the cadre of hospital staff (clinicians and non-clinicians) working at Aga Khan University Hospital, Nairobi. The secondary study objective was to determine the distribution of cardiovascular risk factors among clinicians and non-clinicians working at Aga Khan University Hospital, Nairobi.

Methods:The study used an analytical cross-sectional design collecting data from 453 healthcare workers at the Aga Khan University Hospital, Nairobi; clinicians were 387 and non-clinicians 66. Demographic data were collected first followed by anthropometric measurements using the WHO STEPs Questionnaire. For the primary analyses, associations between the outcome (CVD risk factors) and the key factors of interest (cadre) were performed using univariate regression. Multivariate logistic regression analysis was used for variables with a univariate p-value

Results: The median age of the study participants was 37.19 years (IQR 32, 41). Females constituted 78% of the entire study population. More than half of the respondents (56%) were married. Clinicians constituted 86% (n=387) of the total population while non-clinicians comprised 14% (n=66). The overall prevalence of tobacco use, harmful alcohol consumption, and inadequate physical activity were at 2%, 39%, and 63% respectively. Approximately one-quarter of the HCWs were hypertensive. Sixty-four percent of the HCWs were overweight and obese and 68% of the HCWs had truncal obesity. There was no association between any of the CVD risk factors investigated and the cadre of staff. In the post hoc analysis, we found that being male (OR 6.14; 95% CI: 1.06 – 35.66) was significantly associated with tobacco use. The study participants with hypertension had 5.95 (95% CI: 1.30 – 27.34) odds of using tobacco. Study participants who were male (OR 2.34; 95% CI: 1.35 – 4.09) and those who had truncal obesity 1.73 (95% CI: 1.01 – 2.96) were more likely to engage in harmful alcohol consumption. Hypertensive patients were 50% less likely to be involved in harmful alcohol intake (OR 0.52; 95% CI: 0.32 – 0.85). The study participants with an abnormal BMI had twelve times higher odds of having truncal obesity compared to those with a normal BMI (OR 12.41; 95% CI: 7.23 – 21.32). The HCWs with hypertension had a two-fold risk of having truncal obesity compared to the HCWs with normal blood pressure (OR 2.03; 95% CI:1.06 – 3.89). The odds of having hypertension were noted to increase with age (OR 1.04; 95% CI: 1.01 – 1.08). The study participants who were not married had a nearly two-fold risk of developing hypertension when compared to married participants (OR 1.81; 95% CI: 1.12 v – 2.92). The cadre of staff that reported harmful intake of alcohol were 46% less likely to have elevated blood pressure compared to those who consumed alcohol within limits or did not consume at all (OR: 0.54; 95% CI: 0.33 – 0.87). Other findings from the post hoc analysis recorded tobacco use (OR: 5.53; 95% CI: 1.24 – 24.61) and truncal obesity (OR: 2.16; 95% CI:1.11 – 4.18) being associated with hypertension.

Conclusion: HCWs were found to have CVD risk factors with similar prevalence to other HCWs across the globe. There was no association found between the cadre of staff and all the CVD risk factors evaluated in the study. This would mean that preventive interventions set up at the workplace should target all staff regardless of cadre. Increased physical activity rates and cessation of smoking are practical and feasible interventions that can be employed both at work and outside the work setting. Further qualitative and prospective cohort studies are recommended.

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