Risk factors distribution assessment is essential for prevention and control of CNCDs. This study focused on estimating prevalence of known behavioral, biophysical and biochemical risk factors for CNCDs. To assure validity of findings, the study has used standardized methods recommended by WHO STEPS guideline and sampling methods which involved simple random sampling technique. However, underreporting of smoking, khat chewing and alcohol consumption could have happened due to social desirability bias. This study is the first of its kind in the country to undertake all the three components of WHO STEPS in a community setting. Non-response for physical and biochemical measurement were discussed in article 3, 4, and 5 of this special issue. Low response rate perhaps affected the true distribution of the risk factors and results should be interpreted with cautions.
The prevalence of current smoking (9.3%) was higher than findings of a national study in Ethiopia (17
), findings of community-based studies in Butajira, Ethiopia (18
), and findings among higher education communities in Ethiopia and elsewhere (20
). The fact that considerable proportion of the community was smoking that puts them at higher risk for CNCDs (23
) clearly demands prompt action. Current smoking was more prevalent among men (18.3%) compared to women (1.0%). This finding is consistent with findings of other studies (17
). The prevalence for rural community (10.6%) was twice higher than urban (5.3%). Similarly, though not as big, a slightly higher prevalence was observed in rural population in the national study in Ethiopia (17
). The reasons for such difference need to be investigated further. This rural to urban difference could be due to social desirability bias for cigarette smoking in urbanized society.
The current prevalence of alcohol consumption in the population (7.3%) was much lower than the prevalence found in Butajira town, Ethiopia (25
). The lower prevalence in our study population might be due to religion difference where most of our respondents were Muslim where alcohol consumption is prohibited. Alcohol consumption prevalence was higher among men (8.5%) compared to women (5.7%). Similarly, studies conducted at community settings in Ethiopia (18
) and among University students in Ethiopia (20
) and South Africa (26
) showed the same pattern. The prevalence of alcohol consumption was higher for urban (19.6%) population than rural (2.9%).
The current prevalence of khat chewing (38.6%) is lower than the finding in Butajira, Ethiopia (18
) but higher than findings of other studies in Ethiopia (20
). The difference could be due to cultural and age differences among the study populations.
Concerning dietary pattern about a quarter (27.0%) of the population reported to consume fruits and vegetables below adequate level (below five servings per day). The proportion of the population who consumed fruits and vegetables below adequate level in this study is by far lower than the findings in all 52 countries taking part in the 2002–2003 world health survey including Ethiopia. The prevalence of low fruit and vegetable intake in pooled sample from all the 52 countries was 78.0% (29
). One possible reason contributing for such a difference could be the fact that coverage of world health survey was national but this study was carried out in specific locality of the nation where the production of fruit and vegetable is better due to abundant rain fall. Population in the study area produced more of sorghum, maize and other cereals which could affect their consumption.
Low level of physical activity was reported by 16.9% of the population which is higher than findings of other studies in Ethiopia (17
). This puts the population at higher risk of cardiovascular, strokes and even cancer (23
). The level of inactivity was higher in urban (20.4%) than rural (15.8%) and among women (22.7%) than men (10.7%). This is consistent with findings of other studies in Ethiopia (17
). The difference might be due to the fact that the occupation for rural population than urban and for men than women was farming which contributes for their physical activity. Despite the level of physical inactivity in rural was lower than urban, still higher than expected most people in rural areas are active and have significant amount of exertion which needs further studies using different tools that are more sensitive to rural population.
The prevalence of hypertension (9.3%) is similar with the finding in rural Butajira, Ethiopia (18
) and most of the findings in systematic review of 25 studies conducted in 10 sub-Saharan African countries (30
) but it is lower than the finding in Addis Ababa, Ethiopia (18
) and systematic review of findings of studies in Europe and North America (31
). The possible reasons for the difference could be variations of study populations in socio-demographic and economic characteristics. The observed prevalence of hypertension was more than two times higher in urban (17.0%) than rural (7.8%) areas. This is consistent with the findings in Ethiopia (18
) and the systematic review of sub-Saharan studies (30
). Hypertension was more prevalent among men (10.3%) than women (8.4%) in this study which is consistent with findings in Ethiopia (18
) and review of European and North American studies (31
). But the findings in review of sub-Saharan Africa didn't show consistent difference across countries (30
The prevalence of overweight (BMI ≥ 25kg/m2
) was 2.6%. The prevalence of overweight was lower than the findings in Addis Ababa, Ethiopia (18
) and other countries like South Africa (32
) Pakistan (33
) and Germany (34
). This difference could be explained by genetic, dietary, economic and socio-cultural differences between the study populations. The other reason could be the fact that more than three-fourth of the study participants were from the rural setting where they are physically more active. Our study participants were mainly from rural areas which could also explain their lower BMI. Women (3.5%) were more likely to be overweight compared to their men counterparts (1.5%). One possible reason for the difference might be due to the fact that men are involved more in farming activities which involves more physical exertion. Similar sex variation was found in the studies in South Africa (32
) and Pakistan (35) but reversed in the German study (34
). The distribution of overweight was higher among urban population (8.9%) compared to rural (1.3%) which is consistent with the findings in Pakistan (33
). The variation between urban and rural could be due to dietary habit change and more sedentary lifestyle associated with urbanization (2
Central obesity as measured by WHC was present in 33.3% of the study population showing huge difference between women (59.4%) and men (6.2%). There could be some pregnant women who could have affected the prevalence in women. Similar pattern of sex variation was reported in other studies (32
) and particularly the South African study found roughly comparable huge difference between women (42%) and men (9.2%) (32
). Again like for overweight, the fact that men are engaged more in field farm activities could explain the low level of central obesity in men as compared to their women counterparts. The prevalence of central obesity in men is lower as compared to the findings of the other studies whereas the prevalence in women is higher (32
). Though this difference could be explained partially by the difference in genetic and lifestyle of the study population, the existence of such significant difference between the genders in this study needs further investigation. Like for overweight the prevalence of central obesity is higher in urban prevalence than in rural area.
Cholesterol level was high in 10.7% of the population. It was more common in urban (19.5%) than rural (9.3%) residents. This could be explained by higher prevalence of obesity and physical inactivity in the urban residents. The distribution was higher among women (12.3%) than men (9.0%). This observation is consistent with the above findings on obesity. The prevalence of raised triglyceride was 7.7%. Consistent with findings on obesity and high cholesterol, raised triglyceride was more common in urban (13.3%) than rural (6.8%) population.
In conclusion the distribution of risk factors for CNCDs is considerably high in the study population. In terms of residence alcohol consumption, low dietary intake of fruits and vegetables, and low level of physical activity were more common in urban area whereas smoking and khat chewing habits were more common in rural area. High BMI and central obesity as well as high cholesterol were common among women while hypertension was more common among men. These findings are crucial for evidence based decision making. It will help policy makers for planning of preventive and control measures of these modifiable risk factors. This study will also give baseline information that will enable researchers to conduct longitudinal studies.