title: Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey.
abstract: Modification of known risk factors has been the most tested strategy for dealing with non-communicable diseases (NCDs). The cumulative number of NCD risk factors exhibited by an individual depicts a disease burden. However, understanding the risk factors associated with increased NCD burden has been constrained by scarcity of nationally representative data, especially in the developing countries and not well explored in the developed countries as well.
  
  
  
  Assessment of key risk factors for NCDs using population data drawn from 3987 participants in a nationally representative baseline survey in Uganda was made. Five key risk factors considered for the indicator variable included: high frequency of tobacco smoking, less than five servings of fruit and vegetables per day, low physical activity levels, high body mass index and raised blood pressure. We developed a composite indicator dependent variable with counts of number of risk factors associated with NCDs per participant. A statistical modeling framework was developed and a multinomial logistic regression model was fitted. The endogenous and exogenous predictors of NCD cumulative risk factors were assessed.
  
  
  
  A novel model framework for cumulative number of NCD risk factors was developed. Most respondents, 38 · 6% exhibited one or two NCD risk factors each. Of the total sample, 56 · 4% had at least two risk factors whereas only 5.3% showed no risk factor at all. Body mass index, systolic blood pressure, diastolic blood pressure, consumption of fruit and vegetables, age, region, residence, type of residence and land tenure system were statistically significant predictors of number of NCD risk factors (p < 0 · 05). With exception to diastolic blood pressure, increase in age, body mass index, systolic blood pressure and reduction in daily fruit and vegetable servings were found to significantly increase the relative risks of exhibiting cumulative NCD risk factors. Compared to the urban residence status, the relative risk of living in a rural area significantly increased the risk of having 1 or 2 risk factors by a multiple of 1.55.
  
  
  
  The non-communicable disease burden is on the increase, with more participants reporting to have at least two risk factors. Our findings imply that, besides endogenous factors, exogenous factors such as region, residence status, land tenure system and behavioral characteristics have significant causal effects on the cumulative NCD risk factors. Subsequently, while developing interventions to combat cumulative risk factors of NCDs, the Ministry of Health needs to employ a more holistic approach to facilitate equitable health and sensitization across age, residence and regional divide.
authors.affiliation: School of Statistics and Planning, Makerere University, Kampala, Uganda. wesonga@wesonga.com.|East African Statistics Institute, Kampala, East Africa, Uganda. wesonga@wesonga.com.
authors.forename: Ronald
authors.initials: R
authors.lastname: Wesonga
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: Department of Internal Medicine St. Francis Hospital Nsambya, Kampala, Uganda.
authors.forename: Silver K
authors.initials: SK
authors.lastname: Bahendeka
authors.affiliation: Control of Non-communicable Diseases Desk, Ministry of Health, Kampala, Uganda.
authors.forename: Gerald
authors.initials: G
authors.lastname: Mutungi
authors.affiliation: Office of DVC, Kyambogo University, Kampala, Uganda.|East African Statistics Institute, Kampala, East Africa, Uganda.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nabugoomu
authors.affiliation: Division of Socioeconomic Surveys, Uganda Bureau of Statistics, Kampala, Uganda.
authors.forename: James
authors.initials: J
authors.lastname: Muwonge
mesh_terms: D000328:Adult; D015992:Body Mass Index; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000073296:Noncommunicable Diseases / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology
keywords: Cumulative risk factors; Disease burden; Non-communicable diseases; Prevalence; Uganda