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Gobopamang Letamo, Mpho Keetile, Kannan Navaneetham, Mpho Phatsimo, Prevalence and correlates of self-reported chronic non-communicable diseases in Botswana: a cross-sectional study, International Health, Volume 9, Issue 1, 1 January 2017, Pages 11–19, https://doi.org/10.1093/inthealth/ihw052
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Abstract
The purpose of this paper is to estimate the prevalence of self-reported chronic non-communicable diseases and their correlates in Botswana. This is a nationally representative, cross-sectional survey.
This is a cross-sectional study of respondents aged 10–64 years using data from the Botswana AIDS Impact Survey IV conducted in 2013. Three self-reported non-communicable diseases, namely, hypertension, diabetes and asthma were used. Multivariate logistic regression models were used to identify their correlates.
Out of the 2153 participants, the prevalence rates of hypertension, diabetes and asthma were 14.2%, 3.3% and 5.3%, respectively. The study found that among other factors, older populations are at a much higher risk of having more than one non-communicable disease. After controlling for other covariates, the ORs of self-reported non-communicable disease was highest among older respondents aged 50 years and over (AOR=12.01, p<0.001) followed by richer respondents (AOR=1.86, p≤0.025). The ORs were also higher among females (AOR=1.83, p<0.001) and urban village residents (AOR=1.41, p=0.038).
It is evident that chronic non-communicable diseases are likely to increase in the future due to the rise in the old age population resulting from fertility transition and improvement in life expectancy in Botswana. Therefore urgent and holistic intervention programmes are required to halt the problem. Failure to act now is likely to result in high morbidity and mortality.
Introduction
WHO observed that four conditions – cardiovascular disease, diabetes, cancer and chronic respiratory disease – are now the most common causes of premature death and disability in high-, middle- and low-income countries.1 Non-communicable diseases (NCDs) were estimated to cause 35 million of the 53 million deaths worldwide in 2011; more than three-quarters of these deaths were reported to occur in low- and middle-income settings1 and it is projected that deaths due to NCDs will rise by 15% by 2020.2 The greatest increases are projected to be in low- and middle-income regions like the African region, where they are projected to increase by more than 20%.1 This indicates that globally NCDs are on the increase and likely to have greater health burden in future.1,3,4 For instance, cardiovascular diseases and diabetes were reported to be responsible for 170 million disability adjusted life years (11.3% of global burden), while cancers account for 78 million disability adjusted life years (5.1% of global burden), and respiratory diseases, 60 million disability adjusted life years (3.9% of global burden) in 2011.1 Non-fatal NCDs, including depression5 and arthritis6 are also seen to contribute significantly to the global NCD burden. Without immediate and effective action, global NCD-related mortality is expected to reach 44 million in 2020, with a growing impact in low-resource settings.1
NCDs are rising as a result of the global epidemic of smoking, unhealthy diet, harmful use of alcohol and physical inactivity.7 The most common chronic NCDs reported globally include cardiovascular diseases, diabetes, cancer and chronic respiratory diseases.1,8 Their increase over the years has made substantial contribution towards global mortality, global burden of diseases and the loss of disability adjusted life years in high-, middle- and low-income countries.9 Meanwhile, the impacts of NCDs are far-reaching because they threaten the economies of many countries, place high demands on a health service delivery systems, and impact negatively on the health of the population as a whole.1,3,10 A substantial amount of NCDs burden worldwide has been attributed to behavioral, dietary, environmental metabolic risk factors.11–13 Several studies mainly from high-income countries have shown evidence of significant self-reported prevalence of NCDs and their risk factors among people and communities.14–16
However, NCDs are no more the diseases of an affluent society. A number of studies in low- and middle-income countries (LMICs) countries have indicated a substantial increase in the prevalence of NCDs in these settings.1,17–19 For instance, high blood pressure was observed to have increased in LMICs in 2011.20 The WHO Study on Global Ageing and Adult Health (SAGE) in LMICs (China, Ghana, India, Mexico, the Russian Federation and South Africa) observed that the prevalence rate of hypertension is broadly comparable with those of developed countries.21 South Africa, a neighbouring country which has a similar demographic and health transition as that of Botswana, reported the prevalence of hypertension as 77.9% among those aged 50 years and over.21 In another study in South Africa in the rural sub-district, the prevalence of hypertension (31.2%) was second highest, next to musculoskeletal pain (41.7%), followed by diabetes (6.1%) among those aged 50 and over.22 The most NCDs risk factors such as obesity and overweight in Oceania, the Middle East, Latin America and Southern Africa have been also observed to exceed those in most high-income countries.1 A study in Brazil also revealed that the prevalence of obesity among the lowest socioeconomic group women increased from 6.6% in 1975 to 15% in 1997.23 Furthermore, low-income countries have been associated with the extra burden of substantially higher levels of NCD risk factors that are typically associated with poverty, including use of biomass fuels and coal for cooking and heating, which are risk factors for chronic obstructive pulmonary disease and lung cancer,24 foetal and early childhood under nutrition, which are risk factors for cardiovascular and metabolic diseases in adult life.17
There has been reported increase in obesity prevalence in developing countries as depicted by a study in sub-Saharan Africa which reported that 10–15% of adults in sub-Saharan Africa are overweight.25 Moreover, prevalence rates for type 2 diabetes mellitus and cardiovascular disease in sub-Saharan Africa have been observed to have increased 10-fold in the last 20 years.26 Also there is an increase in the prevalence of obesity among the rich in developing countries.27 The Nigeria Demographic and Health Survey (NDHS) 2008 revealed that nearly one in four women in Nigeria were either overweight or obese (16% overweight and 6% obese), more urban women (31%) than rural women (17%) were overweight or obese and that overweight and obesity increased with increasing wealth.25 Abubakari et al. did a meta-analysis on the prevalence of and time trend of obesity in West Africa in 2007 and reported that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years.28 Another study done in Sagamu, Nigeria found that prevalence of overweight among male adolescents was 0 to 8.1% and for females 1.3 to 8.1% and these figures were considered high.29 The prevalence of hypertension among high ranking executives in Tanzania was found to be as high as 48.9% in 2002.30 A study in the poor health resource setting of Uganda indicated that the prevalence of angina and diabetes was higher among the HIV negative participants.31
One study found that more males suffered high mortality due to NCDs, while women suffered significantly higher morbidity and hospitalization due to NCDs than men.32 Less is known about within-country prevalence of self-reported NCDs in many sub-Saharan African countries33 despite the fact that within-country prevalence of NCDs have received explicit attention in global NCD discussions.
NCDs in Botswana were estimated to account for 31% of all mortality in 2008.34 The most prevalent NCDs in Botswana are cardiovascular diseases which accounted for 14% of total deaths across all age groups in 2008.35 Non-communicable diseases variants of respiratory diseases, cancers and diabetes, contributed 4%, 3% and 2% to total mortality, respectively.35 The 2008 Botswana STEPS Survey results indicate that hypertension (40.8%) and physical inactivity (32.6%) were the most common risk factors for NCDs in Botswana.35 Hypertension was observed to be almost equal among women (41%) and men (40.6%), while inversely, physical inactivity was more pronounced among women (43.4%) than among men (21.7%); only 2.6% of men were found to be obese and 16% overweight.34
The trends in ill-health in Botswana indicate a decline in the importance of childhood immunization preventable diseases and an increase in NCDs.34 The increase in NCDs, more especially hypertension, cancer and diabetes, affect the older more than the younger population. This is of greatest concern since Botswana is reeling from HIV/AIDS pandemic and is now faced with the double burden of diseases. Overall, Botswana has seen an increase in prevalence of NCDs and their risk factors over the past few years34 and therefore it is likely to have negative consequences on the socioeconomic development in the country. To mitigate against this, it is critical to generate evidence on the prevalence of chronic NCDs using a nationally representative survey so that sustainable interventions can be designed and implemented to prevent them. With this background, the purpose of the current study is to estimate the self-reported prevalence of chronic NCDs and their correlates in Botswana. Though other NCDs like musculoskeletal disorders36 are common in Botswana, the study is restricted to only three NCDs due to non-availability of other NCDs data.
Materials and methods
Data
Data for this paper were drawn from the Botswana AIDS Impact Surveys IV (BAIS IV) conducted in 2013.37 The main objectives of the BAIS IV include providing current information on the national HIV prevalence and incidence estimates among the population 18 months and above; to provide indicative trends in sexual and preventive behavior among the population aged 10–64 years; and to provide a comparison between HIV rate, behavior, knowledge, attitude, poverty and cultural factors that are associated with the epidemic with estimates derived from previous surveys.37 Data used in this study are a nationally representative sample.
Sampling design
BAIS IV was a national two stage sample survey. A total of 301 enumeration areas (EAs) were selected for this survey using the systematic random sampling method; a total sample size of 5415 households was included in the survey. In urban areas, a principle/sample of 15 households per EA versus 25 households in rural areas was selected.37
Study population
This study is based on participants aged 10–64 years old. The analysis is restricted to only those respondents who successfully completed the individual questionnaire and answered ‘Yes’ or ‘No’ to all the relevant dependent and independent variables. The study excludes all those who did not know or refused to answer the relevant questions asked in the survey.
Measurement of variables
Dependent variables
The outcome variable was self-reported diagnosis of chronic NCDs such as diabetes, high blood pressure (hypertension) and asthma. The questions asked were: Diabetes: ‘Have you ever been diagnosed with diabetes?’ High blood pressure/hypertension: ‘Have you ever been diagnosed with high blood pressure/hypertension’ Asthma: ‘Have you ever been diagnosed with asthma?’ All these variables were coded one if the respondent say ‘Yes’ and zero if the answer was ‘No’.
Independent variables
The independent variables were socio-demographic characteristics such as age, gender, education, socioeconomic (wealth) status, marital status, residence, and religion. Age was recoded into 10-year age groups starting from 10 and grouping those over 50. Gender was unchanged. Education variable was coded as follows: no education (none), primary (comprised non-formal and primary), secondary (combined junior and senior) and post-secondary (higher). Marital status was coded as follows: currently married (married and living together combined), formerly married (separated, divorced and widowed combined), and never married was unchanged. Residence was coded by combining cities and towns together and leaving other categories unchanged. Religion had a category for Christians, Other Religion for a combination of Islam, Bahai, Hinduism, Badimo and other, and No religion for those who did not follow any religion. In the absence of household income or expenditure, we have used assets, amenities and housing construction variables collected in BAIS IV to construct wealth index by applying method proposed by Filmer and Prichett.38 The weights for each of the variables were generated through principal components analysis method. The wealth index was computed for each household using the weights. The households were classified into five wealth quintiles group and each member of the household assigned to their household quintile category.
Statistical analysis
The data from the survey were captured and analysed using SPSS Version 24 (IBM, Armonk, NY, USA). Contingency tables were used to estimate the prevalence of self-reported NCDs. The χ2 test was used to estimate the socio-demographic correlates of chronic NCDs. Multivariate logistic regression analysis was used to identify the socio-demographic risk factors of the self-reported chronic NCDs (coded 1=yes, 0=no).
Results
Description of the study participants
Table 1 provides the socio-demographic characteristics of the study participants. A total of 2153 participants were used in the current analysis with 57.4% (1236/2153) of the participants being females. The majority of the study participants (61.5%; 1325/2153) were aged between 20 and 39 years and 16.4% (353/2153) of them aged 50 years or above. Almost three-quarters of the participants (1570/2153) had attained secondary education or above and roughly half (463/917) were currently married. Most participants (86%; 1847/2153) were affiliated to Christianity and 30.0% (646/2153) lived in rural areas.
Socio-demographic characteristics . | Men n=917 . | Women n=1236 . | Total n=2153 . | |||
---|---|---|---|---|---|---|
n . | % . | n . | % . | n . | % . | |
Age | ||||||
10–19 | 37 | 4.0 | 68 | 5.5 | 105 | 4.9 |
20–29 | 300 | 32.7 | 426 | 34.5 | 726 | 33.7 |
30–39 | 266 | 29.0 | 333 | 26.9 | 599 | 27.8 |
40–49 | 161 | 17.6 | 209 | 16.9 | 370 | 17.2 |
50–59 | 153 | 16.7 | 200 | 16.2 | 353 | 16.4 |
Education | ||||||
No education | 97 | 10.6 | 92 | 7.4 | 189 | 8.8 |
Primary | 157 | 17.1 | 237 | 19.2 | 394 | 18.3 |
Secondary | 411 | 44.8 | 626 | 50.6 | 1037 | 48.2 |
Post-secondary | 252 | 27.5 | 281 | 22.7 | 533 | 24.8 |
Marital status | ||||||
Currently married | 463 | 50.5 | 586 | 47.4 | 1049 | 48.7 |
Formerly married | 16 | 1.7 | 71 | 5.7 | 87 | 4.0 |
Never married | 438 | 47.8 | 579 | 46.8 | 1017 | 47.2 |
Residence | ||||||
Rural areas | 278 | 30.3 | 368 | 29.8 | 646 | 30.0 |
Urban villages | 292 | 31.8 | 406 | 32.8 | 698 | 32.4 |
Cities/towns | 347 | 37.8 | 462 | 37.4 | 809 | 37.6 |
Religious affiliation | ||||||
No religion | 116 | 12.8 | 68 | 5.5 | 184 | 8.6 |
Christians | 717 | 79.1 | 1130 | 91.7 | 1847 | 86.4 |
Others | 73 | 8.1 | 34 | 2.8 | 107 | 5.0 |
Wealth index | ||||||
Poorest | 96 | 10.5 | 121 | 9.8 | 217 | 10.1 |
Poorer | 222 | 24.2 | 319 | 25.8 | 541 | 25.1 |
Middle | 191 | 20.8 | 252 | 20.4 | 443 | 20.6 |
Richer | 208 | 22.7 | 281 | 22.7 | 489 | 22.7 |
Richest | 200 | 21.8 | 263 | 21.3 | 463 | 21.5 |
Socio-demographic characteristics . | Men n=917 . | Women n=1236 . | Total n=2153 . | |||
---|---|---|---|---|---|---|
n . | % . | n . | % . | n . | % . | |
Age | ||||||
10–19 | 37 | 4.0 | 68 | 5.5 | 105 | 4.9 |
20–29 | 300 | 32.7 | 426 | 34.5 | 726 | 33.7 |
30–39 | 266 | 29.0 | 333 | 26.9 | 599 | 27.8 |
40–49 | 161 | 17.6 | 209 | 16.9 | 370 | 17.2 |
50–59 | 153 | 16.7 | 200 | 16.2 | 353 | 16.4 |
Education | ||||||
No education | 97 | 10.6 | 92 | 7.4 | 189 | 8.8 |
Primary | 157 | 17.1 | 237 | 19.2 | 394 | 18.3 |
Secondary | 411 | 44.8 | 626 | 50.6 | 1037 | 48.2 |
Post-secondary | 252 | 27.5 | 281 | 22.7 | 533 | 24.8 |
Marital status | ||||||
Currently married | 463 | 50.5 | 586 | 47.4 | 1049 | 48.7 |
Formerly married | 16 | 1.7 | 71 | 5.7 | 87 | 4.0 |
Never married | 438 | 47.8 | 579 | 46.8 | 1017 | 47.2 |
Residence | ||||||
Rural areas | 278 | 30.3 | 368 | 29.8 | 646 | 30.0 |
Urban villages | 292 | 31.8 | 406 | 32.8 | 698 | 32.4 |
Cities/towns | 347 | 37.8 | 462 | 37.4 | 809 | 37.6 |
Religious affiliation | ||||||
No religion | 116 | 12.8 | 68 | 5.5 | 184 | 8.6 |
Christians | 717 | 79.1 | 1130 | 91.7 | 1847 | 86.4 |
Others | 73 | 8.1 | 34 | 2.8 | 107 | 5.0 |
Wealth index | ||||||
Poorest | 96 | 10.5 | 121 | 9.8 | 217 | 10.1 |
Poorer | 222 | 24.2 | 319 | 25.8 | 541 | 25.1 |
Middle | 191 | 20.8 | 252 | 20.4 | 443 | 20.6 |
Richer | 208 | 22.7 | 281 | 22.7 | 489 | 22.7 |
Richest | 200 | 21.8 | 263 | 21.3 | 463 | 21.5 |
Socio-demographic characteristics . | Men n=917 . | Women n=1236 . | Total n=2153 . | |||
---|---|---|---|---|---|---|
n . | % . | n . | % . | n . | % . | |
Age | ||||||
10–19 | 37 | 4.0 | 68 | 5.5 | 105 | 4.9 |
20–29 | 300 | 32.7 | 426 | 34.5 | 726 | 33.7 |
30–39 | 266 | 29.0 | 333 | 26.9 | 599 | 27.8 |
40–49 | 161 | 17.6 | 209 | 16.9 | 370 | 17.2 |
50–59 | 153 | 16.7 | 200 | 16.2 | 353 | 16.4 |
Education | ||||||
No education | 97 | 10.6 | 92 | 7.4 | 189 | 8.8 |
Primary | 157 | 17.1 | 237 | 19.2 | 394 | 18.3 |
Secondary | 411 | 44.8 | 626 | 50.6 | 1037 | 48.2 |
Post-secondary | 252 | 27.5 | 281 | 22.7 | 533 | 24.8 |
Marital status | ||||||
Currently married | 463 | 50.5 | 586 | 47.4 | 1049 | 48.7 |
Formerly married | 16 | 1.7 | 71 | 5.7 | 87 | 4.0 |
Never married | 438 | 47.8 | 579 | 46.8 | 1017 | 47.2 |
Residence | ||||||
Rural areas | 278 | 30.3 | 368 | 29.8 | 646 | 30.0 |
Urban villages | 292 | 31.8 | 406 | 32.8 | 698 | 32.4 |
Cities/towns | 347 | 37.8 | 462 | 37.4 | 809 | 37.6 |
Religious affiliation | ||||||
No religion | 116 | 12.8 | 68 | 5.5 | 184 | 8.6 |
Christians | 717 | 79.1 | 1130 | 91.7 | 1847 | 86.4 |
Others | 73 | 8.1 | 34 | 2.8 | 107 | 5.0 |
Wealth index | ||||||
Poorest | 96 | 10.5 | 121 | 9.8 | 217 | 10.1 |
Poorer | 222 | 24.2 | 319 | 25.8 | 541 | 25.1 |
Middle | 191 | 20.8 | 252 | 20.4 | 443 | 20.6 |
Richer | 208 | 22.7 | 281 | 22.7 | 489 | 22.7 |
Richest | 200 | 21.8 | 263 | 21.3 | 463 | 21.5 |
Socio-demographic characteristics . | Men n=917 . | Women n=1236 . | Total n=2153 . | |||
---|---|---|---|---|---|---|
n . | % . | n . | % . | n . | % . | |
Age | ||||||
10–19 | 37 | 4.0 | 68 | 5.5 | 105 | 4.9 |
20–29 | 300 | 32.7 | 426 | 34.5 | 726 | 33.7 |
30–39 | 266 | 29.0 | 333 | 26.9 | 599 | 27.8 |
40–49 | 161 | 17.6 | 209 | 16.9 | 370 | 17.2 |
50–59 | 153 | 16.7 | 200 | 16.2 | 353 | 16.4 |
Education | ||||||
No education | 97 | 10.6 | 92 | 7.4 | 189 | 8.8 |
Primary | 157 | 17.1 | 237 | 19.2 | 394 | 18.3 |
Secondary | 411 | 44.8 | 626 | 50.6 | 1037 | 48.2 |
Post-secondary | 252 | 27.5 | 281 | 22.7 | 533 | 24.8 |
Marital status | ||||||
Currently married | 463 | 50.5 | 586 | 47.4 | 1049 | 48.7 |
Formerly married | 16 | 1.7 | 71 | 5.7 | 87 | 4.0 |
Never married | 438 | 47.8 | 579 | 46.8 | 1017 | 47.2 |
Residence | ||||||
Rural areas | 278 | 30.3 | 368 | 29.8 | 646 | 30.0 |
Urban villages | 292 | 31.8 | 406 | 32.8 | 698 | 32.4 |
Cities/towns | 347 | 37.8 | 462 | 37.4 | 809 | 37.6 |
Religious affiliation | ||||||
No religion | 116 | 12.8 | 68 | 5.5 | 184 | 8.6 |
Christians | 717 | 79.1 | 1130 | 91.7 | 1847 | 86.4 |
Others | 73 | 8.1 | 34 | 2.8 | 107 | 5.0 |
Wealth index | ||||||
Poorest | 96 | 10.5 | 121 | 9.8 | 217 | 10.1 |
Poorer | 222 | 24.2 | 319 | 25.8 | 541 | 25.1 |
Middle | 191 | 20.8 | 252 | 20.4 | 443 | 20.6 |
Richer | 208 | 22.7 | 281 | 22.7 | 489 | 22.7 |
Richest | 200 | 21.8 | 263 | 21.3 | 463 | 21.5 |
Prevalence of self-reported chronic NCDs by socio-demographic factors
Table 2 presents the prevalence of three measured chronic NCDs, namely, diabetes, hypertension and asthma. Among the three NCDs considered, hypertension (14.2%; 305/2153) was the most prevalent chronic NCD, followed by asthma (5.3%; 115/2153). The prevalence of diabetes stood at 3.3% (71/2153). The prevalence of hypertension was higher among females (17.4%; 215/1236), people aged 50+ years (36.0%; 127/353), individuals with no education (23.0%; 44/189) or primary education (23.0%; 92/39), formerly married individuals (36.8%; 32/87), urban village residents (16.6%; 116/698), among Christians (14.8%; 274/187) and among the wealthiest people (17.1%; 79/463).
Socio-demographic characteristics . | Self-reported NCDs . | |||||
---|---|---|---|---|---|---|
Diabetes . | Hypertension . | Asthma . | ||||
n . | % . | n . | % . | n . | % . | |
Total | 71/2153 | 3.3 | 305/2153 | 14.2 | 115/2153 | 5.3 |
Gender | ||||||
Male | 30/917 | 3.3 | 90/917 | 9.8 | 40/917 | 4.4 |
Female | 41/1236 | 3.3 | 215/1236 | 17.4 | 75/1236 | 6.1 |
Age | ||||||
10–19 | 0/105 | 0.0 | 2/105 | 1.9 | 5/105 | 4.8 |
20–29 | 6/726 | 0.8 | 31/726 | 4.3 | 47/726 | 6.5 |
30–39 | 14/599 | 2.3 | 68/599 | 11.4 | 25/599 | 4.2 |
40–49 | 24/370 | 6.5 | 77/370 | 20.8 | 17/370 | 4.6 |
50–59 | 27/353 | 7.6 | 127/353 | 36.0 | 21/353 | 5.9 |
Education | ||||||
No education | 13/189 | 6.9 | 44/189 | 23.3 | 13/189 | 6.9 |
Primary | 15/394 | 3.8 | 92/394 | 23.4 | 21/394 | 5.3 |
Secondary | 19/1037 | 1.8 | 98/1037 | 9.5 | 50/1037 | 4.8 |
Post-secondary | 24/533 | 4.5 | 71/533 | 13.3 | 31/533 | 5.8 |
Marital status | ||||||
Currently married | 47/1049 | 4.5 | 167/1049 | 15.9 | 43/1049 | 4.1 |
Formerly married | 2/87 | 2.3 | 32/87 | 36.8 | 2/87 | 2.3 |
Never married | 22/1017 | 2.2 | 106/1017 | 10.4 | 70/1017 | 6.9 |
Residence | ||||||
Rural areas | 13/646 | 2.0 | 81/646 | 12.5 | 34/646 | 5.3 |
Urban villages | 26/698 | 3.7 | 116/698 | 16.6 | 45/698 | 6.4 |
Cities/towns | 32/809 | 4.0 | 108/809 | 13.3 | 36/809 | 4.4 |
Religious affiliation | ||||||
No religion | 7/184 | 3.8 | 18/184 | 9.8 | 6/184 | 3.3 |
Christians | 59/1847 | 3.2 | 274/1847 | 14.8 | 102/1847 | 5.5 |
Others | 5/107 | 4.7 | 12/107 | 11.2 | 7/107 | 6.5 |
Wealth index | ||||||
Poorest | 1/217 | 0.5 | 24/217 | 11.1 | 15/217 | 6.9 |
Poorer | 18/541 | 3.3 | 81/541 | 15.0 | 23/541 | 4.3 |
Middle | 7/443 | 1.6 | 44/443 | 9.9 | 29/443 | 6.5 |
Richer | 15/489 | 3.1 | 77/489 | 15.7 | 27/489 | 5.5 |
Richest | 30/463 | 6.5 | 79/463 | 17.1 | 21/463 | 4.5 |
Socio-demographic characteristics . | Self-reported NCDs . | |||||
---|---|---|---|---|---|---|
Diabetes . | Hypertension . | Asthma . | ||||
n . | % . | n . | % . | n . | % . | |
Total | 71/2153 | 3.3 | 305/2153 | 14.2 | 115/2153 | 5.3 |
Gender | ||||||
Male | 30/917 | 3.3 | 90/917 | 9.8 | 40/917 | 4.4 |
Female | 41/1236 | 3.3 | 215/1236 | 17.4 | 75/1236 | 6.1 |
Age | ||||||
10–19 | 0/105 | 0.0 | 2/105 | 1.9 | 5/105 | 4.8 |
20–29 | 6/726 | 0.8 | 31/726 | 4.3 | 47/726 | 6.5 |
30–39 | 14/599 | 2.3 | 68/599 | 11.4 | 25/599 | 4.2 |
40–49 | 24/370 | 6.5 | 77/370 | 20.8 | 17/370 | 4.6 |
50–59 | 27/353 | 7.6 | 127/353 | 36.0 | 21/353 | 5.9 |
Education | ||||||
No education | 13/189 | 6.9 | 44/189 | 23.3 | 13/189 | 6.9 |
Primary | 15/394 | 3.8 | 92/394 | 23.4 | 21/394 | 5.3 |
Secondary | 19/1037 | 1.8 | 98/1037 | 9.5 | 50/1037 | 4.8 |
Post-secondary | 24/533 | 4.5 | 71/533 | 13.3 | 31/533 | 5.8 |
Marital status | ||||||
Currently married | 47/1049 | 4.5 | 167/1049 | 15.9 | 43/1049 | 4.1 |
Formerly married | 2/87 | 2.3 | 32/87 | 36.8 | 2/87 | 2.3 |
Never married | 22/1017 | 2.2 | 106/1017 | 10.4 | 70/1017 | 6.9 |
Residence | ||||||
Rural areas | 13/646 | 2.0 | 81/646 | 12.5 | 34/646 | 5.3 |
Urban villages | 26/698 | 3.7 | 116/698 | 16.6 | 45/698 | 6.4 |
Cities/towns | 32/809 | 4.0 | 108/809 | 13.3 | 36/809 | 4.4 |
Religious affiliation | ||||||
No religion | 7/184 | 3.8 | 18/184 | 9.8 | 6/184 | 3.3 |
Christians | 59/1847 | 3.2 | 274/1847 | 14.8 | 102/1847 | 5.5 |
Others | 5/107 | 4.7 | 12/107 | 11.2 | 7/107 | 6.5 |
Wealth index | ||||||
Poorest | 1/217 | 0.5 | 24/217 | 11.1 | 15/217 | 6.9 |
Poorer | 18/541 | 3.3 | 81/541 | 15.0 | 23/541 | 4.3 |
Middle | 7/443 | 1.6 | 44/443 | 9.9 | 29/443 | 6.5 |
Richer | 15/489 | 3.1 | 77/489 | 15.7 | 27/489 | 5.5 |
Richest | 30/463 | 6.5 | 79/463 | 17.1 | 21/463 | 4.5 |
Socio-demographic characteristics . | Self-reported NCDs . | |||||
---|---|---|---|---|---|---|
Diabetes . | Hypertension . | Asthma . | ||||
n . | % . | n . | % . | n . | % . | |
Total | 71/2153 | 3.3 | 305/2153 | 14.2 | 115/2153 | 5.3 |
Gender | ||||||
Male | 30/917 | 3.3 | 90/917 | 9.8 | 40/917 | 4.4 |
Female | 41/1236 | 3.3 | 215/1236 | 17.4 | 75/1236 | 6.1 |
Age | ||||||
10–19 | 0/105 | 0.0 | 2/105 | 1.9 | 5/105 | 4.8 |
20–29 | 6/726 | 0.8 | 31/726 | 4.3 | 47/726 | 6.5 |
30–39 | 14/599 | 2.3 | 68/599 | 11.4 | 25/599 | 4.2 |
40–49 | 24/370 | 6.5 | 77/370 | 20.8 | 17/370 | 4.6 |
50–59 | 27/353 | 7.6 | 127/353 | 36.0 | 21/353 | 5.9 |
Education | ||||||
No education | 13/189 | 6.9 | 44/189 | 23.3 | 13/189 | 6.9 |
Primary | 15/394 | 3.8 | 92/394 | 23.4 | 21/394 | 5.3 |
Secondary | 19/1037 | 1.8 | 98/1037 | 9.5 | 50/1037 | 4.8 |
Post-secondary | 24/533 | 4.5 | 71/533 | 13.3 | 31/533 | 5.8 |
Marital status | ||||||
Currently married | 47/1049 | 4.5 | 167/1049 | 15.9 | 43/1049 | 4.1 |
Formerly married | 2/87 | 2.3 | 32/87 | 36.8 | 2/87 | 2.3 |
Never married | 22/1017 | 2.2 | 106/1017 | 10.4 | 70/1017 | 6.9 |
Residence | ||||||
Rural areas | 13/646 | 2.0 | 81/646 | 12.5 | 34/646 | 5.3 |
Urban villages | 26/698 | 3.7 | 116/698 | 16.6 | 45/698 | 6.4 |
Cities/towns | 32/809 | 4.0 | 108/809 | 13.3 | 36/809 | 4.4 |
Religious affiliation | ||||||
No religion | 7/184 | 3.8 | 18/184 | 9.8 | 6/184 | 3.3 |
Christians | 59/1847 | 3.2 | 274/1847 | 14.8 | 102/1847 | 5.5 |
Others | 5/107 | 4.7 | 12/107 | 11.2 | 7/107 | 6.5 |
Wealth index | ||||||
Poorest | 1/217 | 0.5 | 24/217 | 11.1 | 15/217 | 6.9 |
Poorer | 18/541 | 3.3 | 81/541 | 15.0 | 23/541 | 4.3 |
Middle | 7/443 | 1.6 | 44/443 | 9.9 | 29/443 | 6.5 |
Richer | 15/489 | 3.1 | 77/489 | 15.7 | 27/489 | 5.5 |
Richest | 30/463 | 6.5 | 79/463 | 17.1 | 21/463 | 4.5 |
Socio-demographic characteristics . | Self-reported NCDs . | |||||
---|---|---|---|---|---|---|
Diabetes . | Hypertension . | Asthma . | ||||
n . | % . | n . | % . | n . | % . | |
Total | 71/2153 | 3.3 | 305/2153 | 14.2 | 115/2153 | 5.3 |
Gender | ||||||
Male | 30/917 | 3.3 | 90/917 | 9.8 | 40/917 | 4.4 |
Female | 41/1236 | 3.3 | 215/1236 | 17.4 | 75/1236 | 6.1 |
Age | ||||||
10–19 | 0/105 | 0.0 | 2/105 | 1.9 | 5/105 | 4.8 |
20–29 | 6/726 | 0.8 | 31/726 | 4.3 | 47/726 | 6.5 |
30–39 | 14/599 | 2.3 | 68/599 | 11.4 | 25/599 | 4.2 |
40–49 | 24/370 | 6.5 | 77/370 | 20.8 | 17/370 | 4.6 |
50–59 | 27/353 | 7.6 | 127/353 | 36.0 | 21/353 | 5.9 |
Education | ||||||
No education | 13/189 | 6.9 | 44/189 | 23.3 | 13/189 | 6.9 |
Primary | 15/394 | 3.8 | 92/394 | 23.4 | 21/394 | 5.3 |
Secondary | 19/1037 | 1.8 | 98/1037 | 9.5 | 50/1037 | 4.8 |
Post-secondary | 24/533 | 4.5 | 71/533 | 13.3 | 31/533 | 5.8 |
Marital status | ||||||
Currently married | 47/1049 | 4.5 | 167/1049 | 15.9 | 43/1049 | 4.1 |
Formerly married | 2/87 | 2.3 | 32/87 | 36.8 | 2/87 | 2.3 |
Never married | 22/1017 | 2.2 | 106/1017 | 10.4 | 70/1017 | 6.9 |
Residence | ||||||
Rural areas | 13/646 | 2.0 | 81/646 | 12.5 | 34/646 | 5.3 |
Urban villages | 26/698 | 3.7 | 116/698 | 16.6 | 45/698 | 6.4 |
Cities/towns | 32/809 | 4.0 | 108/809 | 13.3 | 36/809 | 4.4 |
Religious affiliation | ||||||
No religion | 7/184 | 3.8 | 18/184 | 9.8 | 6/184 | 3.3 |
Christians | 59/1847 | 3.2 | 274/1847 | 14.8 | 102/1847 | 5.5 |
Others | 5/107 | 4.7 | 12/107 | 11.2 | 7/107 | 6.5 |
Wealth index | ||||||
Poorest | 1/217 | 0.5 | 24/217 | 11.1 | 15/217 | 6.9 |
Poorer | 18/541 | 3.3 | 81/541 | 15.0 | 23/541 | 4.3 |
Middle | 7/443 | 1.6 | 44/443 | 9.9 | 29/443 | 6.5 |
Richer | 15/489 | 3.1 | 77/489 | 15.7 | 27/489 | 5.5 |
Richest | 30/463 | 6.5 | 79/463 | 17.1 | 21/463 | 4.5 |
The next most prevalent chronic NCD was asthma which showed that although not substantially pronounced between different categories, it was higher among females (6.1%; 75/1236 compared to 4.4%; 40/917 for males), individuals aged 20–29 years (6.5%; 47/726), individuals with no education (6.9%; 13/189), never married individuals (6.9%; 70/1017), urban village residents (6.4%; 45/698), individuals affiliated to other religions (6.5%; 7/107) and the poorest people (6.9%; 15/217).
The distribution of diabetes was similar between males (3.3%; 30/917) and females (3.3%; 41/1236), but increased with increasing age of the respondent. It was also most prevalent among individuals with no education (6.9%; 13/189), currently married individuals (4.5%; 47/1049), residents of cities and towns (4.0%; 32/809), those who belong to other religions (4.7%; 5/107) and richer respondents (6.5%; 30/463).
Socio-demographic correlates of chronic NCDs
Table 3 presents the distribution of chronic NCDs correlated with socio-demographic characteristics. Overall, 80.3% (1727/2153) of the respondents reported that they were not diagnosed with any of these three chronic NCDs. About 17.1% (368/2153) reported being diagnosed with one chronic NCD while 2.6% (57/2153) reported two or more chronic NCDs. It is clear from Table 3 that the number of chronic NCDs differed significantly by gender, age, education, marital status, place of residence and wealth status. Table 3 shows that multi-morbidity was highest among females (2.9%; 36/1236), older individuals aged 50+ years (7.1%; 25/353), respondents with no education (5.8%; 11/189), currently married respondents (3.3%; 35/1049), urban village dwellers (3.9%; 27/698), those who belong to Christianity (2.9%; 53/1847) and the wealthiest people (4.3%; 20/463).
Socio-demographic characteristics . | Number of NCDs . | χ2p-value . | |||||
---|---|---|---|---|---|---|---|
0 . | 1 . | ≥2 . | |||||
n . | % . | n . | % . | n . | % . | ||
Total | 1728/2153 | 80.3 | 368/2153 | 17.1 | 57/2153 | 2.6 | |
Gender | |||||||
Male | 782/917 | 85.3 | 114/917 | 12.4 | 21/917 | 2.3 | χ2=26.1 |
Female | 946/1236 | 76.5 | 254/1236 | 20.6 | 36/1236 | 2.9 | p=0.000 |
Age | |||||||
10–19 | 98/105 | 93.3 | 7/105 | 6.7 | 0/105 | 0.0 | χ2=184.9 |
20–29 | 648/726 | 89.3 | 73/726 | 10.1 | 5/726 | 0.7 | p=0.000 |
30–39 | 508/599 | 84.8 | 79/599 | 13.2 | 12/599 | 2.0 | |
40–49 | 269/370 | 72.7 | 86/370 | 23.2 | 15/370 | 4.1 | |
50–59 | 205/353 | 58.1 | 123/353 | 34.8 | 25/353 | 7.1 | |
Education | |||||||
No education | 130/189 | 68.8 | 48/189 | 25.4 | 11/189 | 5.8 | χ2=55.1 |
Primary | 284/394 | 72.1 | 95/394 | 24.1 | 15/394 | 3.8 | p=0.000 |
Secondary | 835/1037 | 85.3 | 130/1037 | 13.4 | 13/1037 | 1.3 | |
Post-secondary | 429/533 | 80.5 | 86/533 | 16.1 | 18/533 | 3.4 | |
Marital status | |||||||
Currently married | 830/1049 | 79.1 | 184/1049 | 17.5 | 35/1049 | 3.3 | χ2=31.5 |
Formerly married | 53/87 | 60.9 | 32/87 | 36.8 | 2/87 | 2.3 | p=0.000 |
Never married | 845/1017 | 83.1 | 152/1017 | 14.9 | 20/1017 | 2.0 | |
Residence | |||||||
Rural areas | 527/646 | 81.6 | 110/646 | 17.0 | 9/646 | 1.4 | χ2=9.1 |
Urban villages | 545/698 | 78.1 | 126/698 | 18.1 | 27/698 | 3.9 | p=0.060 |
Cities/towns | 656/809 | 81.1 | 132/809 | 16.3 | 21/809 | 2.6 | |
Religious affiliation | |||||||
No religion | 155/184 | 84.2 | 28/184 | 15.2 | 1/184 | 0.5 | χ2=4.4 |
Christians | 1472/1847 | 79.7 | 322/1847 | 17.4 | 53/1847 | 2.9 | p=0.350 |
Others | 87/107 | 81.3 | 17/107 | 15.9 | 3/107 | 2.8 | |
Wealth index | |||||||
Poorest | 180/217 | 82.9 | 34/217 | 15.7 | 3/217 | 1.4 | χ2=13.5 |
Poorer | 432/541 | 79.9 | 97/541 | 17.9 | 12/541 | 2.2 | p=0.096 |
Middle | 373/443 | 84.2 | 62/443 | 14.0 | 8/443 | 1.8 | |
Richer | 386/489 | 78.9 | 89/489 | 18.2 | 14/489 | 2.9 | |
Richest | 357/463 | 77.1 | 86/463 | 18.6 | 20/463 | 4.3 |
Socio-demographic characteristics . | Number of NCDs . | χ2p-value . | |||||
---|---|---|---|---|---|---|---|
0 . | 1 . | ≥2 . | |||||
n . | % . | n . | % . | n . | % . | ||
Total | 1728/2153 | 80.3 | 368/2153 | 17.1 | 57/2153 | 2.6 | |
Gender | |||||||
Male | 782/917 | 85.3 | 114/917 | 12.4 | 21/917 | 2.3 | χ2=26.1 |
Female | 946/1236 | 76.5 | 254/1236 | 20.6 | 36/1236 | 2.9 | p=0.000 |
Age | |||||||
10–19 | 98/105 | 93.3 | 7/105 | 6.7 | 0/105 | 0.0 | χ2=184.9 |
20–29 | 648/726 | 89.3 | 73/726 | 10.1 | 5/726 | 0.7 | p=0.000 |
30–39 | 508/599 | 84.8 | 79/599 | 13.2 | 12/599 | 2.0 | |
40–49 | 269/370 | 72.7 | 86/370 | 23.2 | 15/370 | 4.1 | |
50–59 | 205/353 | 58.1 | 123/353 | 34.8 | 25/353 | 7.1 | |
Education | |||||||
No education | 130/189 | 68.8 | 48/189 | 25.4 | 11/189 | 5.8 | χ2=55.1 |
Primary | 284/394 | 72.1 | 95/394 | 24.1 | 15/394 | 3.8 | p=0.000 |
Secondary | 835/1037 | 85.3 | 130/1037 | 13.4 | 13/1037 | 1.3 | |
Post-secondary | 429/533 | 80.5 | 86/533 | 16.1 | 18/533 | 3.4 | |
Marital status | |||||||
Currently married | 830/1049 | 79.1 | 184/1049 | 17.5 | 35/1049 | 3.3 | χ2=31.5 |
Formerly married | 53/87 | 60.9 | 32/87 | 36.8 | 2/87 | 2.3 | p=0.000 |
Never married | 845/1017 | 83.1 | 152/1017 | 14.9 | 20/1017 | 2.0 | |
Residence | |||||||
Rural areas | 527/646 | 81.6 | 110/646 | 17.0 | 9/646 | 1.4 | χ2=9.1 |
Urban villages | 545/698 | 78.1 | 126/698 | 18.1 | 27/698 | 3.9 | p=0.060 |
Cities/towns | 656/809 | 81.1 | 132/809 | 16.3 | 21/809 | 2.6 | |
Religious affiliation | |||||||
No religion | 155/184 | 84.2 | 28/184 | 15.2 | 1/184 | 0.5 | χ2=4.4 |
Christians | 1472/1847 | 79.7 | 322/1847 | 17.4 | 53/1847 | 2.9 | p=0.350 |
Others | 87/107 | 81.3 | 17/107 | 15.9 | 3/107 | 2.8 | |
Wealth index | |||||||
Poorest | 180/217 | 82.9 | 34/217 | 15.7 | 3/217 | 1.4 | χ2=13.5 |
Poorer | 432/541 | 79.9 | 97/541 | 17.9 | 12/541 | 2.2 | p=0.096 |
Middle | 373/443 | 84.2 | 62/443 | 14.0 | 8/443 | 1.8 | |
Richer | 386/489 | 78.9 | 89/489 | 18.2 | 14/489 | 2.9 | |
Richest | 357/463 | 77.1 | 86/463 | 18.6 | 20/463 | 4.3 |
Socio-demographic characteristics . | Number of NCDs . | χ2p-value . | |||||
---|---|---|---|---|---|---|---|
0 . | 1 . | ≥2 . | |||||
n . | % . | n . | % . | n . | % . | ||
Total | 1728/2153 | 80.3 | 368/2153 | 17.1 | 57/2153 | 2.6 | |
Gender | |||||||
Male | 782/917 | 85.3 | 114/917 | 12.4 | 21/917 | 2.3 | χ2=26.1 |
Female | 946/1236 | 76.5 | 254/1236 | 20.6 | 36/1236 | 2.9 | p=0.000 |
Age | |||||||
10–19 | 98/105 | 93.3 | 7/105 | 6.7 | 0/105 | 0.0 | χ2=184.9 |
20–29 | 648/726 | 89.3 | 73/726 | 10.1 | 5/726 | 0.7 | p=0.000 |
30–39 | 508/599 | 84.8 | 79/599 | 13.2 | 12/599 | 2.0 | |
40–49 | 269/370 | 72.7 | 86/370 | 23.2 | 15/370 | 4.1 | |
50–59 | 205/353 | 58.1 | 123/353 | 34.8 | 25/353 | 7.1 | |
Education | |||||||
No education | 130/189 | 68.8 | 48/189 | 25.4 | 11/189 | 5.8 | χ2=55.1 |
Primary | 284/394 | 72.1 | 95/394 | 24.1 | 15/394 | 3.8 | p=0.000 |
Secondary | 835/1037 | 85.3 | 130/1037 | 13.4 | 13/1037 | 1.3 | |
Post-secondary | 429/533 | 80.5 | 86/533 | 16.1 | 18/533 | 3.4 | |
Marital status | |||||||
Currently married | 830/1049 | 79.1 | 184/1049 | 17.5 | 35/1049 | 3.3 | χ2=31.5 |
Formerly married | 53/87 | 60.9 | 32/87 | 36.8 | 2/87 | 2.3 | p=0.000 |
Never married | 845/1017 | 83.1 | 152/1017 | 14.9 | 20/1017 | 2.0 | |
Residence | |||||||
Rural areas | 527/646 | 81.6 | 110/646 | 17.0 | 9/646 | 1.4 | χ2=9.1 |
Urban villages | 545/698 | 78.1 | 126/698 | 18.1 | 27/698 | 3.9 | p=0.060 |
Cities/towns | 656/809 | 81.1 | 132/809 | 16.3 | 21/809 | 2.6 | |
Religious affiliation | |||||||
No religion | 155/184 | 84.2 | 28/184 | 15.2 | 1/184 | 0.5 | χ2=4.4 |
Christians | 1472/1847 | 79.7 | 322/1847 | 17.4 | 53/1847 | 2.9 | p=0.350 |
Others | 87/107 | 81.3 | 17/107 | 15.9 | 3/107 | 2.8 | |
Wealth index | |||||||
Poorest | 180/217 | 82.9 | 34/217 | 15.7 | 3/217 | 1.4 | χ2=13.5 |
Poorer | 432/541 | 79.9 | 97/541 | 17.9 | 12/541 | 2.2 | p=0.096 |
Middle | 373/443 | 84.2 | 62/443 | 14.0 | 8/443 | 1.8 | |
Richer | 386/489 | 78.9 | 89/489 | 18.2 | 14/489 | 2.9 | |
Richest | 357/463 | 77.1 | 86/463 | 18.6 | 20/463 | 4.3 |
Socio-demographic characteristics . | Number of NCDs . | χ2p-value . | |||||
---|---|---|---|---|---|---|---|
0 . | 1 . | ≥2 . | |||||
n . | % . | n . | % . | n . | % . | ||
Total | 1728/2153 | 80.3 | 368/2153 | 17.1 | 57/2153 | 2.6 | |
Gender | |||||||
Male | 782/917 | 85.3 | 114/917 | 12.4 | 21/917 | 2.3 | χ2=26.1 |
Female | 946/1236 | 76.5 | 254/1236 | 20.6 | 36/1236 | 2.9 | p=0.000 |
Age | |||||||
10–19 | 98/105 | 93.3 | 7/105 | 6.7 | 0/105 | 0.0 | χ2=184.9 |
20–29 | 648/726 | 89.3 | 73/726 | 10.1 | 5/726 | 0.7 | p=0.000 |
30–39 | 508/599 | 84.8 | 79/599 | 13.2 | 12/599 | 2.0 | |
40–49 | 269/370 | 72.7 | 86/370 | 23.2 | 15/370 | 4.1 | |
50–59 | 205/353 | 58.1 | 123/353 | 34.8 | 25/353 | 7.1 | |
Education | |||||||
No education | 130/189 | 68.8 | 48/189 | 25.4 | 11/189 | 5.8 | χ2=55.1 |
Primary | 284/394 | 72.1 | 95/394 | 24.1 | 15/394 | 3.8 | p=0.000 |
Secondary | 835/1037 | 85.3 | 130/1037 | 13.4 | 13/1037 | 1.3 | |
Post-secondary | 429/533 | 80.5 | 86/533 | 16.1 | 18/533 | 3.4 | |
Marital status | |||||||
Currently married | 830/1049 | 79.1 | 184/1049 | 17.5 | 35/1049 | 3.3 | χ2=31.5 |
Formerly married | 53/87 | 60.9 | 32/87 | 36.8 | 2/87 | 2.3 | p=0.000 |
Never married | 845/1017 | 83.1 | 152/1017 | 14.9 | 20/1017 | 2.0 | |
Residence | |||||||
Rural areas | 527/646 | 81.6 | 110/646 | 17.0 | 9/646 | 1.4 | χ2=9.1 |
Urban villages | 545/698 | 78.1 | 126/698 | 18.1 | 27/698 | 3.9 | p=0.060 |
Cities/towns | 656/809 | 81.1 | 132/809 | 16.3 | 21/809 | 2.6 | |
Religious affiliation | |||||||
No religion | 155/184 | 84.2 | 28/184 | 15.2 | 1/184 | 0.5 | χ2=4.4 |
Christians | 1472/1847 | 79.7 | 322/1847 | 17.4 | 53/1847 | 2.9 | p=0.350 |
Others | 87/107 | 81.3 | 17/107 | 15.9 | 3/107 | 2.8 | |
Wealth index | |||||||
Poorest | 180/217 | 82.9 | 34/217 | 15.7 | 3/217 | 1.4 | χ2=13.5 |
Poorer | 432/541 | 79.9 | 97/541 | 17.9 | 12/541 | 2.2 | p=0.096 |
Middle | 373/443 | 84.2 | 62/443 | 14.0 | 8/443 | 1.8 | |
Richer | 386/489 | 78.9 | 89/489 | 18.2 | 14/489 | 2.9 | |
Richest | 357/463 | 77.1 | 86/463 | 18.6 | 20/463 | 4.3 |
Socio-demographic correlates of NCDs
Table 4 shows the ORs of developing at least one of the three chronic NCDs. The adjusted odds ratios (AORs) show that females are more likely to suffer from NCDs than males (AOR 1.78, CI 1.42–2.22). When age increases, the risk of having any one of the three NCDs also increases. For instance, the risk of having NCDs is 12 times (AOR 12.01, CI 5.14–28.02) greater among the age group >50 compared to the younger age group, 10–19. The results showed that those living in urban areas are more likely to suffer from NCDs than those living in rural areas. The study found a clear socioeconomic gradient in the prevalence of NCDs in Botswana. The odds of having a NCD increases with the increase in wealth status. The probability of having NCDs is almost twice (AOR 1.86, CI 1.08–3.21) among the richest than the poor. In short being female, old, living in urban villages and being rich were the key risk factors of having chronic NCDs.
Socio-demographic characteristics . | Unadjusted odds ratios . | Adjusted odds ratios . | ||
---|---|---|---|---|
OR (95% CI) . | p-value . | OR (95% CI) . | p-value . | |
Gender | ||||
Male | 1.00 | NA | 1.00 | NA |
Female | 1.78 (1.42–2.22) | <0.001 | 1.93 (1.51–2.47) | <0.001 |
Age | ||||
10–19 | 1.00 | NA | 1.00 | NA |
20–29 | 1.69 (0.76–3.76) | NS | 1.75 (0.78–3.95) | NS |
30–39 | 2.51 (1.13–5.57) | 0.024 | 2.65 (1.17–5.99) | 0.019 |
40–49 | 5.26 (2.36–11.70) | <0.001 | 5.78 (2.51–13.32) | <0.001 |
50–59 | 10.11 (4.56–22.39) | <0.001 | 12.01 (5.14–28.02) | <0.001 |
Education | ||||
No education | 1.00 | NA | 1.00 | NA |
Primary | 0.85 (0.59–1.25) | NS | 0.98 (0.65–1.47) | NS |
Secondary | 0.38 (0.27–0.54) | <0.001 | 0.98 (0.63–1.54) | NS |
Post-secondary | 0.53 (0.37–0.78) | <0.001 | 0.98 (0.60–1.60) | NS |
Marital status | ||||
Currently married | 1.00 | NA | 1.00 | NA |
Formerly married | 2.43 (1.54–3.84) | <0.001 | 1.11 (0.68–1.82) | NS |
Never married | 0.77 (0.62–0.96) | 0.022 | 1.03 (0.81–1.32) | NS |
Residence | ||||
Rural areas | 1.00 | NA | 1.00 | NA |
Urban villages | 0.97 (0.74–1.26) | NS | 1.41 (1.02–1.95) | 0.038 |
Cities/towns | 1.20 (0.94–1.55) | NS | 1.15 (0.82–1.61) | NS |
Religious affiliation | ||||
No religion | 1.00 | NA | 1.00 | NA |
Christians | 1.36 (0.90–2.06) | NS | 0.98 (0.63–1.52) | NS |
Others | 1.23 (0.66–2.30) | NS | 1.11 (0.57–2.16) | NS |
Wealth index | ||||
Poorest | 1.00 | NA | 1.00 | NA |
Poorer | 1.23 (0.81–1.85) | NS | 1.49 (0.94–2.36) | 0.090 |
Middle | 0.91 (0.59–1.41) | NS | 1.08 (0.66–1.78) | NS |
Richer | 1.30 (0.86–1.97) | NS | 1.62 (0.97–2.70) | 0.064 |
Richest | 1.44 (0.95–2.19) | 0.082 | 1.86 (1.08–3.21) | 0.025 |
Socio-demographic characteristics . | Unadjusted odds ratios . | Adjusted odds ratios . | ||
---|---|---|---|---|
OR (95% CI) . | p-value . | OR (95% CI) . | p-value . | |
Gender | ||||
Male | 1.00 | NA | 1.00 | NA |
Female | 1.78 (1.42–2.22) | <0.001 | 1.93 (1.51–2.47) | <0.001 |
Age | ||||
10–19 | 1.00 | NA | 1.00 | NA |
20–29 | 1.69 (0.76–3.76) | NS | 1.75 (0.78–3.95) | NS |
30–39 | 2.51 (1.13–5.57) | 0.024 | 2.65 (1.17–5.99) | 0.019 |
40–49 | 5.26 (2.36–11.70) | <0.001 | 5.78 (2.51–13.32) | <0.001 |
50–59 | 10.11 (4.56–22.39) | <0.001 | 12.01 (5.14–28.02) | <0.001 |
Education | ||||
No education | 1.00 | NA | 1.00 | NA |
Primary | 0.85 (0.59–1.25) | NS | 0.98 (0.65–1.47) | NS |
Secondary | 0.38 (0.27–0.54) | <0.001 | 0.98 (0.63–1.54) | NS |
Post-secondary | 0.53 (0.37–0.78) | <0.001 | 0.98 (0.60–1.60) | NS |
Marital status | ||||
Currently married | 1.00 | NA | 1.00 | NA |
Formerly married | 2.43 (1.54–3.84) | <0.001 | 1.11 (0.68–1.82) | NS |
Never married | 0.77 (0.62–0.96) | 0.022 | 1.03 (0.81–1.32) | NS |
Residence | ||||
Rural areas | 1.00 | NA | 1.00 | NA |
Urban villages | 0.97 (0.74–1.26) | NS | 1.41 (1.02–1.95) | 0.038 |
Cities/towns | 1.20 (0.94–1.55) | NS | 1.15 (0.82–1.61) | NS |
Religious affiliation | ||||
No religion | 1.00 | NA | 1.00 | NA |
Christians | 1.36 (0.90–2.06) | NS | 0.98 (0.63–1.52) | NS |
Others | 1.23 (0.66–2.30) | NS | 1.11 (0.57–2.16) | NS |
Wealth index | ||||
Poorest | 1.00 | NA | 1.00 | NA |
Poorer | 1.23 (0.81–1.85) | NS | 1.49 (0.94–2.36) | 0.090 |
Middle | 0.91 (0.59–1.41) | NS | 1.08 (0.66–1.78) | NS |
Richer | 1.30 (0.86–1.97) | NS | 1.62 (0.97–2.70) | 0.064 |
Richest | 1.44 (0.95–2.19) | 0.082 | 1.86 (1.08–3.21) | 0.025 |
NA: not applicable; NS: not significant.
Socio-demographic characteristics . | Unadjusted odds ratios . | Adjusted odds ratios . | ||
---|---|---|---|---|
OR (95% CI) . | p-value . | OR (95% CI) . | p-value . | |
Gender | ||||
Male | 1.00 | NA | 1.00 | NA |
Female | 1.78 (1.42–2.22) | <0.001 | 1.93 (1.51–2.47) | <0.001 |
Age | ||||
10–19 | 1.00 | NA | 1.00 | NA |
20–29 | 1.69 (0.76–3.76) | NS | 1.75 (0.78–3.95) | NS |
30–39 | 2.51 (1.13–5.57) | 0.024 | 2.65 (1.17–5.99) | 0.019 |
40–49 | 5.26 (2.36–11.70) | <0.001 | 5.78 (2.51–13.32) | <0.001 |
50–59 | 10.11 (4.56–22.39) | <0.001 | 12.01 (5.14–28.02) | <0.001 |
Education | ||||
No education | 1.00 | NA | 1.00 | NA |
Primary | 0.85 (0.59–1.25) | NS | 0.98 (0.65–1.47) | NS |
Secondary | 0.38 (0.27–0.54) | <0.001 | 0.98 (0.63–1.54) | NS |
Post-secondary | 0.53 (0.37–0.78) | <0.001 | 0.98 (0.60–1.60) | NS |
Marital status | ||||
Currently married | 1.00 | NA | 1.00 | NA |
Formerly married | 2.43 (1.54–3.84) | <0.001 | 1.11 (0.68–1.82) | NS |
Never married | 0.77 (0.62–0.96) | 0.022 | 1.03 (0.81–1.32) | NS |
Residence | ||||
Rural areas | 1.00 | NA | 1.00 | NA |
Urban villages | 0.97 (0.74–1.26) | NS | 1.41 (1.02–1.95) | 0.038 |
Cities/towns | 1.20 (0.94–1.55) | NS | 1.15 (0.82–1.61) | NS |
Religious affiliation | ||||
No religion | 1.00 | NA | 1.00 | NA |
Christians | 1.36 (0.90–2.06) | NS | 0.98 (0.63–1.52) | NS |
Others | 1.23 (0.66–2.30) | NS | 1.11 (0.57–2.16) | NS |
Wealth index | ||||
Poorest | 1.00 | NA | 1.00 | NA |
Poorer | 1.23 (0.81–1.85) | NS | 1.49 (0.94–2.36) | 0.090 |
Middle | 0.91 (0.59–1.41) | NS | 1.08 (0.66–1.78) | NS |
Richer | 1.30 (0.86–1.97) | NS | 1.62 (0.97–2.70) | 0.064 |
Richest | 1.44 (0.95–2.19) | 0.082 | 1.86 (1.08–3.21) | 0.025 |
Socio-demographic characteristics . | Unadjusted odds ratios . | Adjusted odds ratios . | ||
---|---|---|---|---|
OR (95% CI) . | p-value . | OR (95% CI) . | p-value . | |
Gender | ||||
Male | 1.00 | NA | 1.00 | NA |
Female | 1.78 (1.42–2.22) | <0.001 | 1.93 (1.51–2.47) | <0.001 |
Age | ||||
10–19 | 1.00 | NA | 1.00 | NA |
20–29 | 1.69 (0.76–3.76) | NS | 1.75 (0.78–3.95) | NS |
30–39 | 2.51 (1.13–5.57) | 0.024 | 2.65 (1.17–5.99) | 0.019 |
40–49 | 5.26 (2.36–11.70) | <0.001 | 5.78 (2.51–13.32) | <0.001 |
50–59 | 10.11 (4.56–22.39) | <0.001 | 12.01 (5.14–28.02) | <0.001 |
Education | ||||
No education | 1.00 | NA | 1.00 | NA |
Primary | 0.85 (0.59–1.25) | NS | 0.98 (0.65–1.47) | NS |
Secondary | 0.38 (0.27–0.54) | <0.001 | 0.98 (0.63–1.54) | NS |
Post-secondary | 0.53 (0.37–0.78) | <0.001 | 0.98 (0.60–1.60) | NS |
Marital status | ||||
Currently married | 1.00 | NA | 1.00 | NA |
Formerly married | 2.43 (1.54–3.84) | <0.001 | 1.11 (0.68–1.82) | NS |
Never married | 0.77 (0.62–0.96) | 0.022 | 1.03 (0.81–1.32) | NS |
Residence | ||||
Rural areas | 1.00 | NA | 1.00 | NA |
Urban villages | 0.97 (0.74–1.26) | NS | 1.41 (1.02–1.95) | 0.038 |
Cities/towns | 1.20 (0.94–1.55) | NS | 1.15 (0.82–1.61) | NS |
Religious affiliation | ||||
No religion | 1.00 | NA | 1.00 | NA |
Christians | 1.36 (0.90–2.06) | NS | 0.98 (0.63–1.52) | NS |
Others | 1.23 (0.66–2.30) | NS | 1.11 (0.57–2.16) | NS |
Wealth index | ||||
Poorest | 1.00 | NA | 1.00 | NA |
Poorer | 1.23 (0.81–1.85) | NS | 1.49 (0.94–2.36) | 0.090 |
Middle | 0.91 (0.59–1.41) | NS | 1.08 (0.66–1.78) | NS |
Richer | 1.30 (0.86–1.97) | NS | 1.62 (0.97–2.70) | 0.064 |
Richest | 1.44 (0.95–2.19) | 0.082 | 1.86 (1.08–3.21) | 0.025 |
NA: not applicable; NS: not significant.
Discussion
The study set out to investigate the prevalence and correlates of chronic NCDs in Botswana. The results indicated that about 17% of the respondents had at least one chronic NCD and that the most common self-reported chronic NCDs were hypertension and asthma. This finding suggests that NCDs seem to be increasing in Botswana as evidenced from other research findings in the country39,40 and other low-income countries.1,41,42 The rise in the chronic NCDs is partly attributed to the problems of smoking, alcohol consumption, limited physical activity and lower consumption of fruits and vegetables in the general population.35 A recent study on the determinants of hypertension concluded that obesity was the only statistically significant determinant of hypertension.40 Other contributory factors include the negative effects of globalization, rapid urbanization, and changing trends of population ageing.7 With the rapid demographic transition in Botswana, there will be an increasing old age population in the future which, combined with rapid urbanization, will create a greater chronic disease burden in the country.
The results showed that the presence of chronic NCDs was highest among the older population. It was also noted that the risk of occurrence of NCDs is also higher among females, the rich and those residing in urban village areas. These results are consistent with the results from other studies.2,3,32,41 Rural-urban variation may be explained partly by differences in physical and dietary habits.42 Urban populations are said to have a higher intake of sodium which is a contributing factor to high blood pressure.42 Programme and policy interventions aimed at addressing chronic NCDs should identify these population groups as they are particularly vulnerable to these diseases and as such require targeted interventions.
The study also showed that the prevalence of multi-morbidity (≥2 conditions) among three NCDs was 2% in the country. However, multi-morbidity prevalence was about 7% among those aged 50 and over. The rates could be even higher if we considered all the WHO classification of NCDs. Other countries like South Africa have showed even higher prevalence rates of multi-morbidity.3 The differences in socioeconomic environments of these countries may partly explain the variation in the prevalence of NCDs. Given that daily smoking, hazardous drinking, lack of physical activity and low consumption of vegetables and fruits are high in Botswana it is not surprising that there is an increase in the prevalence of NCDs.35
Strengths, limitations and implications
There are potential strengths and limitations of this study. The main strength of this study is that there are not many studies on the prevalence NCDs and their correlates in Botswana. Therefore this study provides an idea about the prevalence of NCDs and is suggestive of the health burden of NCDs in the country. It is hoped that the study results will increase the attention accorded to NCDs in the country. The results could also help policy-makers and programme managers to identify NCD hot spots areas and population groups
With respect to limitations, the prevalence of NCDs may have been underestimated because the data used are self-reported. It has been observed that self-reported diagnosed cases of NCDs might be poor indicators of the true prevalence of NCDs especially among those who come from the lower socioeconomic stratum and those living in rural areas.4 It has also been reported that NCDs are typically either underreported or under-diagnosed in LMICs.43 This underreporting emanates from the fact that people from the lower socioeconomic stratum and rural areas might often fail to perceive and report the illness and those who are able to perceive might fail to access healthcare due to several constraints.4 However, this conclusion may not be tenable in Botswana where literacy rates are relatively high and health care access is fairly good. Second, the study deals with only three NCDs and therefore may not capture the accurate total burden of NCDs.
Third, the data used is cross-sectional which prevents us from making causal inferences on factors contributing to differentials in prevalence rate.
This study has important policy implications. One of the key policy recommendations is that although self-reported prevalence rates provide indications of the burden of NCDs in Botswana, more standardized objective diagnostic measures are required to have a reliable assessment of policy impacts. It should also be noted that NCDs are no longer diseases of affluent countries alone as LMICs are also affected.
It is also important that follow-up surveys are undertaken to monitor trends and patterns of NCDs over time. A comprehensive risk assessment and surveillance system would guide continuously updating, gender, social and economic groups, age disaggregated situation analysis of existing NCDs and their risk factors in specific settings.44 The risk assessment and surveillance system will enable policy-makers and programme managers to design and implement appropriate evidence-based interventions programmes.
Conclusions
The study found that NCDs are emerging as predominant health problems in Botswana. The results showed that there is evidence of multi-morbid condition of NCDs particularly among the aged. The findings of this study also contribute to the debate about whether NCDs are concentrated among the affluent or among poorer groups as in high-income countries.4 The NCDs are relatively concentrated among the rich in Botswana and it is expected that this would gradually move down to become a problem of the poor as the demographic and health transition advances. Therefore urgent attention is needed for evidence-based interventions to control the emerging NCDs before it is too late. Most NCDs do not have symptoms and therefore primary health care should focus on the prevention of NCDs by screening people at the primary health centre and more resources are to be put in place to develop a strategy for detection, treatment and control of those diseases.
Authors’ contributions: GL conceived and wrote the paper; MK and MP reviewed the literature; GL and KN performed data analysis. GL and KN incorporated reviewers’ comments. All authors read and agreed the final version of the paper. GL is the guarantor of the paper.
Acknowledgements: The authors would like to express their sincere gratitude to Statistics Botswana and National AIDS Coordinating Agency for granting them permission to use the BAIS IV data set.
Funding: None.
Competing interests: None declared.
Ethical approval: The study used secondary data collected by Statistics Botswana, which is the official body mandated by the Government of Botswana to collect and guide ethical collection of data. All identifier information has been removed from the data by Statistics Botswana. All study participants gave informed consent before participation and all information was collected confidentially.
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