Dissertation
Spatiotemporal trends of cardiovascular disease risk factors, overweight, obesity, and tobacco use, in East Africa
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2022
DOI: 10.17077/etd.006377
Abstract
Cardiovascular disease, such as coronary heart disease and stroke, is the leading cause of global mortality. From 2000 to 2019, cardiovascular mortality increased across the world, except in high-income countries, where cardiovascular mortality declined. In the low- and middle-income countries (LMICs) of sub-Saharan Africa (SSA), however, the morbidity and mortality burden of CVD and associated risk factors continue to rise in the context of shifting political, economic, sociodemographic, and health landscapes. In HICs, the relationship between modifiable risk factors and sociodemographic factors, such as wealth, education, race, ethnicity, residential neighborhood, etc., for CVD are widely documented and used to guide public health intervention strategies. Cardiovascular risk factor research in SSA is limited in scope, unevenly distributed across the region, and constrained to ecological studies that measure the prevalence and incidence of risk factors. A critical knowledge gap remains about the spatial, temporal, and sociodemographic factors that influence modifiable cardiovascular risk factor incidence and prevalence across and within nations in SSA.
This dissertation addresses a critical knowledge gap about the spatiotemporal patterns of overweight/obesity and tobacco use, modifiable cardiovascular risk factors, in sub-Saharan Africa and enhances our understanding of associated sociodemographic factors in varying locations and cultural contexts. Multivariable logistic regression and cross-sectional, nationally representative demographic and health survey (DHS) data from five nations, Burundi, Rwanda, Uganda, Tanzania, and Kenya, in the East African Community (EAC) were used to determine the sociodemographic factors associated with overweight/obesity and tobacco use. Geospatial data from the DHS surveys, which span 13-years from 2003 to 2016, and adaptive kernel density estimation was used to explore the spatiotemporal dynamics of overweight/obesity and tobacco use at subnational and subpopulation (rural and urban) levels.
Spatial and subpopulation analysis revealed that regional and national level analysis mask important trends in CVD risk factor prevalence. For instance, rural populations were more likely to use tobacco compared to urban populations and the likelihood of use varied substantially between nations. However, prevalence estimate maps reveal that tobacco use increased in and around major cities and urban centers in all the nations, except Burundi, but declined in rural areas.
Urbanicity, higher education, higher wealth, and age have previously been identified as overweight/obesity risk factors in SSA. This study finds that in most nations and survey waves these characteristics were also risky, but the level of risk increased or attenuated over time. For instance, the overweight/obesity risk associated with urban residents declined over time in all the nations, suggesting a narrowing gap in overweight/obesity between urban and rural areas.
Being male, older, having no formal education, having less wealth, and not being married or cohabitating were significant risk factors for tobacco use in this study. The magnitude of risk, however, differed between nations and over time.
These studies highlight the importance of de-homogenizing research about CVD risk factors in SSA. Studies of national prevalence trends for CVD risk factors, of which most of the literature in SSA consists, mask important information about subpopulation and place-specific behavior and drivers of risk factor prevalence. For instance, within region variability of factors associated with CVD risk factors and how the influence of those factors varies over time and space is lost. This type of understanding is not only vital to increase knowledge at local scales but should be a starting point for place-specific research to understand local drivers of risk factor dynamics which can inform locally appropriate surveillance, policy, and public health intervention.
Details
- Title: Subtitle
- Spatiotemporal trends of cardiovascular disease risk factors, overweight, obesity, and tobacco use, in East Africa
- Creators
- Barbara Chebet Keino
- Contributors
- Margaret Carrel (Advisor)Caglar Koylu (Committee Member)Carly Nichols (Committee Member)William Story (Committee Member)Mark Vander Weg (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Geography
- Date degree season
- Spring 2022
- DOI
- 10.17077/etd.006377
- Publisher
- University of Iowa
- Number of pages
- xii, 188 pages
- Copyright
- Copyright 2022 Barbara Chebet Keino
- Language
- English
- Description illustrations
- illustrations (chiefly color), maps, tables, graphs
- Description bibliographic
- Includes bibliographical references.
- Public Abstract (ETD)
- All too often health and disease patterns in Sub-Saharan Africa (SSA) are studied at a regional, i.e., East Africa, or national level. Analysis at these levels mask place-specific information that is necessary to create targeted policy and public health interventions that meet community needs. Cardiovascular disease (CVD), such as stroke and heart attacks, has rapidly increased in SSA since the early 2000s. Factors that contribute to the onset of CVD include overweight/obesity and tobacco use. This dissertation addresses a critical knowledge gap about the spatial and temporal patterns of factors associated with CVD in SSA. Data from five East African nations over a 10-year period is used to show that the rates of tobacco use and overweight/obesity varies across and within nations. Although overweight/obesity is increasing in all the countries, the rate of increase differs between and within countries. A closer look within national borders, using spatial analysis methods, reveals that although overweight/obesity rates are higher in urban areas, rural areas are experiencing a significant increase in overweight/obesity. The opposite is true for tobacco use, where rural populations are more likely to use tobacco compared to urban population, and use is declining in rural areas and increasing in and around urban centers. These findings show that to understand CVD in SSA, we must look beyond regional or national level analysis and use other methods, such as spatial analysis, to determine place-specific patterns which will better inform policy and health intervention strategies.
- Academic Unit
- Geographical and Sustainability Sciences
- Record Identifier
- 9984271353702771
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