| Isang Iwot |
| Department of Family Medicine, Stellenbosch |
| December, 2009 |
Abstract |
| Background: Coronary heart disease is a global public health problem. Formerly considered rare in sub-Saharan Africa, evidence has shown that urbanization and the adoption of more affluent and sedentary lifestyle in sub-populations of this region may result in an increased prevalence. One such sub-population is male workers in the Nigerian petroleum industry and this study examines their risk factors for coronary heart disease. In addition the study compares the risk profile of on-shore and off-shore workers. Method: This is a descriptive cross sectional study. Four hundred workers were randomnly selected and invited to participate, with a desired sample size of 234. The data was collected by using an electronic questionnaire to explore life style factors: exercise, diet, and smoking. Anthropometric indices included body mass index, waist circumference and waist to hip ratio. Biochemical tests included lipid profile and fasting blood glucose. Systolic and diastolic blood pressure was also recorded. The prevalence of known hypertension and diabetes as well as the metabolic syndrome were determined. The questionnaire data was analysed and compared with the chi-square test using Epi-info 2008 and the means of the continuous variables were determined and compared using analysis of variance (ANOVA). Results: 231 workers were included (121 on-shore and 110 off-shore). 153 (66.2%) exercised less than 3 times per week. Activity during the eight hours working day showed that more off-shore employees (71.8%) compared with their onshore counterparts (29.3%) were engaged in various levels of physical activities (p less than 0.01). 160 (69.3%) consumed fruit less than 4 times a week although there was no difference between the groups. Only 74 (32.0%) ate 3 full meals a day, but this was significantly higher amongst the off-shore workers (50.9% vs. 14.9%, p less than 0.01). More off-shore workers ate eggs (usually fried in oil) and consumed a combination of assorted meat types (offals, beef) than the onshore workers. Offshore workers ate significantly more fish, while onshore workers ate more beef and chicken. 212 (91.8%) were non-smokers and there was no difference between the groups. Out of the 196 with results, 97 (49%) were overweight (BMI of 25-29.9 kg/m2)) while 53 (27%) were obese (BMI greater than and equal to 30 kg/m2)). When assessed with the waist circumference (greater than 94cm) and the weight to hip ratio (less than 0.9), 45% and 35% respectively had truncal obesity. The lipid profile showed that 69% had low HDL, while 30% and 9% had high total cholesterol and triglycerides respectively. 26% had fasting hyperglycaemia. Onshore workers had increased waist circumference, increased rates of metabolic syndrome, diabetes and hypertension. Conversely the offshore workers had a higher BMI and lower levels of protective HDL. There was no difference in fasting glucose and blood pressure between the groups and the mean levels were systolic (126.0mmHg) and diastolic (76.7mmHg). Conclusion: The prevalence of cardiovascular risk factors showed a mixed outcome, with on-shore employees being more sedentary, having a higher prevalence of truncal obesity, diabetes and hypertension. However, the off-shore employees had lower levels of HDL, higher triglycerides and a tendency to an unhealthy choice of diet. As a combined group the obesity and overweight profile is amongst the highest in the world and far above the local and sub-Saharan region. This is likely to translate into diabetes, hypertension and stroke. Health promotion activity, especially motivation on exercise and diet would encourage an overall improvement in the BMI, and ensure that the present overweight individuals do not become obese in future. This opportunity can be used to reinforce the need for abstinence even with the comparatively low rate of smoking. |
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