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A Study of the Relationship Between Practice Of A STUDY OF THE RELATIONSHIP BETWEEN PRACTICE OF CARDIOVASCULAR RISK REDUCTION MEASURES AND CARDIOVASCULAR DISEASE RISK AMONG URBAN AND RURAL PRIMARY SCHOOL TEACHERS OF ANAMBRA STATE BY Cosmas Chiedozie OFOEGBU MBBS, MPH SUBMITTED TO NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILMENT FOR AWARD OF FELLOWSHIP IN PUBLIC HEALTH NOVEMBER, 2015 i DECLARATION I hereby declare that this work titled “A study of the relationship between practice of Cardiovascular risk reduction measures and Cardiovascular disease risk among urban and rural primary school teachers of Anambra State” was done by me under supervision and that it has not been submitted in part or in full for any other examination or any journal for publication. …………………………………………………………………………………… Dr. OFOEGBU Cosmas Chiedozie ii CERTIFICATION We certify that we supervised this work titled “A study on the relationship between practice of Cardiovascular risk reduction measures and Cardiovascular disease risk in urban and rural primary school teachers of Anambra State” carried out by Dr. OFOEGBU Cosmas Chiedozie in the department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria. …………………………………………………………………………………… Prof Amobi Linus Ilika Department of Community Medicine and Primary Health Care, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. …………………………………………………………………………………… Dr Ifeadike Chigozie Department of Community Medicine and Primary Health Care, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. iii I certify that Dr Cosmas Chiedozie OFOEGBU has undergone training in this department and is eligible to sit for the part 2 (final) examinations of the Faculty of Public Health, National Postgraduate College of Nigeria. …………………………………………………………………………………… Dr Echendu Adinma Department of Community Medicine and Primary Health Care, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. iv DEDICATION This book is dedicated to Almighty God who in his infinite mercies have brought me this far. v ACKNOWLEDGEMENTS I am very thankful for the innumerable contributions of my supervisors Prof Linus Amobi Ilika and Dr Chigozie Ifeadike for their encouragements and constant prompting towards the completion of this work and for painstakingly going through this work. God bless you both. I also appreciate the contributions of Prof Christian Ibe, Dr Echendu Adinma my indefatigable head of department, Dr Ifeoma Modebe, Dr Prosper Adogu, Dr Obiageli Emelumadu, Dr Chika Ubajaka, Dr Achunam Nwabueze, Dr Uzo Ebenebe, Dr Alphonsus Obi-Okaro, Dr Nonso Nnebue, Dr Ifeoma Udigwe, Dr Ifeoma Njelita and Dr Nkiru Ezeama. Thank you all for teaching me the act of medical research. I also want to thank all the residents in my department many of whom have encouraged me in many ways. For my research assistants am glad you didn’t disappoint me especially Emeka Ikeabbah for helping with data entry. My special thanks goes to my mum Lolo Kate Ofoegbu for her inspiring words. For all the staffs in the various schools were this research was carried out in thank you for making this work possible . Lastly am grateful for all those who have contributed to the success of this work in one way or the other especially the staffs of Anambra state universal basic education board. Thank you all. vi TABLE OF CONTENTS Page DECLARATION i CERTIFICATION ii DEDICATION iii ACKNOWLEDGEMENTS iv TABLE OF CONTENTS v LIST OF TABLES x LIST OF FIGURES xii LIST OF ABBREVIATIONS xiii ABSTRACT xiv CHAPTER ONE: INTRODUCTION 1.1 Background information 1 1.2 Statement of research problem 4 1.3. Rationale for the study 6 1.4 Objectives 7 1.4.1 General Objectives 7 1.4.2 Specific Objectives 8 CHAPTER TWO: LITERATURE REVIEW 2.1 Knowledge of cardiovascular risk reduction measures 9 2.2 Practice of cardiovascular risk reduction measures 12 vii 2.3 Risk for cardiovascular disease 13 2.4 Relationship between the practice of cardiovascular risk reduction measures and the risk of cardiovascular disease 17 CHAPTER THREE: METHODOLOGY 3.1 Study area 19 3.2 Study population 20 3.3 Study design 20 3.4 Sample size estimation 21 3.5 Sampling technique 22 3.5.1 Urban area 24 3.5.2 Onitsha North Local Government Area 25 3.5.3 Rural area 25 3.6 Sampling Procedure 25 3.6.1 Urban Area: 25 3.6.2 Rural Area: 26 3.7 Inclusion criteria 27 3.8 Exclusion criteria 27 3.9 Data collection Instruments 28 3.9.1 Questionnaire 28 3.9.2 Other data collection instruments 28 3.10 Validation of Questionnaire and Pretesting 29 viii 3.10.1 Questionnaire: 29 3.10.2 Pretesting 29 3.11 Validation of instruments of measurements 30 3.11.1 Mercury sphygmomanometer 30 3.11.2 Stadiometer 30 3.11.3 Beam balance: 30 3.11.4 Laboratory equipment: 31 3.12 Focus group discussion 31 3.13 Measurement procedure and standardization 31 3.13.1. Blood pressure measurement 31 3.13.2 Waist circumference 32 3.13.3 Height measurement 32 3.13.4 Weight measurement 32 3.13.5 Body mass index (BMI) 33 3.13.6 Blood cholesterol measurement 33 3.14 Training of the research assistant 33 3.15 Data analysis 33 3.16 Ethical consideration 34 3.17 Confounding variables. 34 3.18 Limitations 35 CHAPTER FOUR 4.0 Results 36 ix 4.1 Quantitative findings 37 4.1.1 Section A: Biodata (Socio demographic factors) 37 4.1.2 Section B: Awareness of cardiovascular disease risk and risk reduction measures 39 4.1.3 Section C: Practice of cardiovascular disease risk reduction measure 47 4.1.4 Section D: Anthropometric/laboratory measurements for urban and rural primary school teachers in Anambra State. 51 4.1.5 Section E: Relationship between awareness and practice of cardiovascular disease risk/reduction measures and the risk for cardiovascular diseases 70 4.2 Qualitative findings 73 4.2.1 Cardiovascular disease and risk factors 73 4.2.2 Cardiovascular disease risk factor reduction 74 4.2.3 Practice of Cardiovascular disease risk reduction 74 4.2.4 Relationship with weight and Cardiovascular disease 75 4.2.5 Impact of Cardiovascular disease risk reduction effort 75 CHAPTER FIVE: DISCUSSION 76 CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS 6.1 Conclusion 89 6.2 Recommendations 89 References 91 Appendices 99-117 x LIST OF TABLES Table 3.1: Instruments and tools for data collection and their manufacturers. 29 Table 1: Socio demographic characteristics of respondents (Categorical variables) 37 Table 2 Awareness of Cardiovascular disease risk factors 39 Table 3: Awareness of cardiovascular disease risk reduction measures 43 Table 4: Overall awareness of cardiovascular diseases risk/reduction measures in urban and rural primary school teachers in Anambra State 46 Table 5 Practice of cardiovascular disease risk reduction measure 47 Table 6: Overall practice of cardiovascular diseases risk/reduction measures in urban and rural primary school teachers in Anambra State 50 Table 7: Numerical measurements for anthropometric and laboratory data 51 Table 8: Categorized Body Mass Index for urban and rural primary school teacher in teachers in Anambra State 52 Table 9: Categorized Waist circumference of urban and rural primary school teachers in Anambra state 53 Table 10 Categorized Systolic blood pressure for urban and rural primary school teachers in Anambra State 55 Table 11 – Categorized Diastolic Blood Pressure for primary school teachers in urban and rural areas in Anambra state. 55 Table 12 – Categorized cholesterol level for urban and rural primary school teachers in Anambra State 56 Table 13: Risk Factor of Cardiovascular Disease For Urban and Rural primary school teachers in Anambra state. 57 Table 14: Cross tabulation of Body mass index (BMI) with systolic blood pressure, cholesterol, Diastolic blood pressure. 59 Table 15: Cross tabulation of waist circumference with Systolic blood pressure, Diastolic blood pressure and cholesterol 60 xi Table 16: Cross tabulation of Systolic blood pressure with BMI, Cholesterol, Diastolic Blood pressure and Waist circumference 61 Table 17: Cross tabulation of Diastolic blood pressure with Body mass index, Cholesterol, waist circumference and systolic blood pressure 63 Table 18: Cross tabulation of Cholesterol with Body mass index, diastolic blood pressure, waist circumference and systolic blood pressure 64 Table 19: Cross tabulation of categorized age of respondents with cholesterol, body mass index, diastolic blood pressure, systolic blood pressure and waist circumference and risk for Cardiovascular disease. 65 Table 20: Cross tabulation of gender with body mass index, waist circumference, systolic blood pressure, diastolic blood pressure and cholesterol 67 Table 21: Logistic regression showing adjusted odds ratio for predictors of risk for cardiovascular diseases 68 Table 22: Distribution of overall risk for cardiovascular disease in urban and rural primary school teachers in Anambra state 69 Table 23: Relationship of awareness of cardiovascular disease risk/reduction measures and practice of cardiovascular disease risk reduction measures 70 Table 24: Relationship of awareness of cardiovascular disease risk reduction measures and risk for cardiovascular diseases 71 Table 25 Relationship of overall practice of cardiovascular disease risk reduction measures and risk for cardiovascular diseases 72 xii LIST OF ABBREVIATIONS BMI Body Mass Index BP Blood Pressure CVD Cardio Vascular Disease ISH International Society for Hypertension LGA Local Government Area WHO World Health Organisation xiii ABSTRACT Introduction Cardiovascular diseases are a group of diseases that affect the heart and blood vessels. They are the leading course of deaths globally. Methods The study was a cross sectional comparative study to assess the relationship between the awareness and practice of cardiovascular disease risk reduction measures and the risk for cardiovascular diseases among urban and rural primary school teachers in Anambra State. Data was collected from teachers between 38 to 59 years using both quantitative and qualitative methods. A pre- tested and semi-structured interviewer administered questionnaire was used, anthropometric and laboratory measurements of cholesterol level was done. Qualitative data was analysed using Institute for Business Management- Statistical Packages for Social Sciences (IBM-SPSS) version 22.
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