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Erschienen in: BMC Cardiovascular Disorders 1/2020

Open Access 01.12.2020 | Research article

Knowledge of cardiovascular risk factors among caretakers of outpatients attending a tertiary cardiovascular center in Tanzania: a cross-sectional survey

verfasst von: Pedro Pallangyo, Nsajigwa Misidai, Makrina Komba, Zabella Mkojera, Happiness J. Swai, Naairah R. Hemed, Henry Mayala, Smita Bhalia, Jalack Millinga, Upendo W. Mollel, Happiness L. Kusima, Ester Chavala, Ziada Joram, Halifa Abdallah, Rajabu Hamisi, Mohamed Janabi

Erschienen in: BMC Cardiovascular Disorders | Ausgabe 1/2020

Abstract

Background

Health literacy on cardiovascular diseases (CVDs) plays an effective role in preventing or delaying the disease onset as well as in impacting the efficacy of their management. In view of the projected low health literacy in Tanzania, we conducted this cross-sectional survey to assess for CVD risk knowledge and its associated factors among patient escorts.

Methods

A total of 1063 caretakers were consecutively enrolled in this cross-sectional study. An adopted questionnaire consisting of 22 statements assessing various CVD risk behaviors was utilized for assessment of knowledge. Logistic regression analyses were performed to assess for factors associated with poor knowledge of CVD risks.

Results

The mean age was 40.5 years and women predominated (55.7%). Over two-thirds had a body mass index (BMI) ≥25 kg/m2, 18.5% were alcohol drinkers, 3.2% were current smokers, and 47% were physically inactive. The mean score was 78.2 and 80.0% had good knowledge of CVD risks. About 16.3% believed CVDs are diseases of affluence, 17.4% thought CVDs are not preventable, and 56.7% had a perception that CVDs are curable. Low education (OR 2.6, 95%CI 1.9–3.7, p < 0.001), lack of health insurance (OR 1.5, 95%CI 1.1–2.3, p = 0.03), and negative family history of CVD death (OR 2.2, 95%CI 1.4–3.5, p < 0.001), were independently associated with poor CVD knowledge.

Conclusions

In conclusion, despite of a good level of CVD knowledge established in this study, a disparity between individual’s knowledge and self-care practices is apparent.
Hinweise

Publisher’s Note

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Abkürzungen
BMI
Body mass index
CVDs
Cardiovascular diseases
DBP
Diastolic blood pressure
FBG
Fasting blood glucose
NCDs
Non-communicable diseases
RBG
Random blood glucose
SBP
Systolic blood pressure
SSA
Sub-Saharan Africa

Background

As the pervasive struggle against infectious diseases continue, sub Saharan Africa (SSA) is facing a rapid epidemiological transition characterized by an increasing predominance of chronic diseases particularly those affecting the cardiovascular system [1]. Although the ever-present communicable diseases remain the leading contributors to disease burden in the SSA region, non-communicable diseases (NCDs) are escalating at an alarming pace and it is projected that coming 2030 they will become the leading cause of morbidity and mortality [2, 3]. Nevertheless, low-middle income countries (SSA region inclusive) are currently witnessing a disturbingly disproportionate share of global NCDs deaths (i.e. > 75%) [4]. Owing to urbanization and sedentary life-style adoption, several NCD risk factors (i.e. smoking, heavy drinking, unhealthy diets, physical inactivity and overweight) are increasingly widespread in SSA communities and are postulated to be the drivers of the rapidly growing CVD burden in the region [46].
By virtue of their chronic nature, CVDs are of long duration and generally slow in progression necessitating life-long care inevitably with continuous expenditure [3, 5]. Nonetheless, these conditions are largely preventable through life-style modification to curb the exposure to the established risk factors [13]. It is evident that health literacy of CVD risk factors plays a considerably effective role in preventing or delaying the onset of disease as well as in impacting the efficacy of their management [710]. Likewise, persons with low functional health literacy have been associated with diminished use of the health system, less likelihood of engaging in health-promoting behaviors and poorer overall health outcomes [710].
Whilst SSA region is having one of the lowest adult literacy rates (65%) [11] in the world, just about a third of the Tanzanian population is estimated to have adequate health literacy [12]. Several studies have addressed the growing burden and pattern of CVD risk factors; however, there is dearth of information regarding public knowledge of CVD risk factors in SSA region particularly Tanzania. In this cross-sectional survey, we sought to assess the CVD risk knowledge and its associated factors among companions of outpatients attending a tertiary-level cardiovascular hospital in Tanzania. Such estimation of the baseline knowledge regarding CVD risks has potential public health relevance particularly in the development of targeted educational programs which are pivotal amidst the rapidly rising crisis.

Methods

Recruitment process and definition of terms

A cross-sectional survey was conducted between December 2019 and February 2020 at Jakaya Kikwete Cardiac Institute (a tertiary care public teaching hospital) in Dar es Salaam, Tanzania. A consecutive sampling method was utilized to recruit consented individuals who escorted known patients with CVD for a scheduled clinic visit. A structured questionnaire bearing questions pertaining to sociodemographic and clinical characteristics, measurement of key vitals (blood pressure, blood sugar, height, weight and waist circumference), and standard questions for assessing CVD risk knowledge was utilized. Physical activity was assessed using the Physical Activity Vital Sign (PAVS) scale [13]; with scores of 0 min/week denoting inactivity, 1 - < 150 min/week signifying underactivity and ≥ 150 min/week indicating physical activeness. We defined underweight as BMI < 18.5 kg/m2, normal: BMI 18.5–24.9 kg/m2, overweight: BMI 25.0–29.9 kg/m2 and obese: BMI ≥30.0 kg/m2 [14]. Individuals who smoked at least 1 cigarette in the past 6 months were regarded as current smokers, those who last smoked over 6 months or self-reported quitting smoking were considered past smokers and those who never smoked were regarded as non-smokers. Alcohol drinking was defined as at least a once consumption every week. Hypertension was defined as SBP ≥140 mmHg or DBP ≥90 mmHg, or use of blood pressure lowering agents [15]. Diabetes was diagnosed using a random blood glucose (RBG) ≥11.1 mmol/L and/or fasting blood glucose (FBG) ≥7 mmol/L or use of glucose-lowering agents [16]. An adopted questionnaire consisting of 22 statements assessing various CVD risk behaviors was utilized for assessment of knowledge [17]. A percentage score for each participant was computed by dividing the sum of correct responses divided by the total number of questions (i.e. 22) multiplied by 100. A score of < 50% was classified as low; 50–69% moderate and ≥ 70% good knowledge [18, 19].

Statistical analysis

All statistical analyses were performed by STATA v11.0 software. Summaries of continuous variables are presented as means (± SD) and categorical variables are presented as frequencies (percentages). Categorical and continuous variables were compared using the Pearson Chi square test and student’s T-test respectively. Bivariate analyses were performed to assess for factors associated with poor knowledge of CVD risks. Factors included in this analysis were age, sex, education level, marital status, employment status, residence, possession of health insurance, BMI, self-perceived health status, medical check-up history, self-reported knowledge of CVDs, family history of CVD, family history of CVD-related death, physical activity, smoking status, alcohol use, dietary habits, hypertension and diabetes history. Wald Chi-Square tests was used to assess for the interaction terms, with a p < 0.05 cut-off used as criteria for inclusion in multivariate analysis. Variables maintained in the multivariate model underwent stepwise and backward selection procedures. Odd ratios with 95% confidence intervals and p-values are reported. Statistical significance was set at p < 0.05 and all tests were two tailed.

Results

Study population

A total of 1063 individuals who escorted outpatients with established diagnosis of CVD were consecutively enrolled in this study. Table 1 displays the sociodemographic and clinical characteristics of the study participants. Their mean age was 40.5 years and there was a female predominance (55.7%). Majority (59%) of participants had at least secondary school education and 79.4% had a regular income generating activity. Over 85% of participants resided in urban areas and just over a third were health insured. Regarding participants’ relationship to the patient: 13.4% were spouses, 62.2% were children, 15.2% were siblings, 3.6% were parents and 5.6% were friends. Over two-thirds (66.8%) of participants had a BMI ≥ 25, 18.5% were alcohol drinkers, 3.2% were current smokers, 17.8% reported a regular healthy eating, and 47% were physically inactive. Nearly one-fifth (19.2%) of participants had a personal history of hypertension and 4.1% were known to have diabetes mellitus.
Table 1
Characteristics of participants in survey assessing knowledge of CVD risk factors (N = 1063)
Characteristic
Proportion (%)
Age (Mean, SD)
40.5 (13.0)
 Range
18–77
Age group
 18–34
379 (35.7%)
 35–54
525 (49.3%)
  ≥ 55
159 (15.0%)
Sex
 Male
471 (44.3%)
 Female
592 (55.7%)
Education
 No Formal
22 (02.1%)
 Primary
404 (38.0%)
 Secondary
385 (36.2%)
 University
252 (23.7%)
Marital status
 Single
279 (26.3%)
 Married
711 (66.9%)
 Divorced
26 (02.5%)
 Widowed
47 (04.4%)
Occupation
 Jobless
112 (10.5%)
 Student
54 (05.1%)
 Self-employed
640 (60.2%)
 Employed
204 (19.2%)
 Retired
53 (05.0%)
Residence
 Urban
907 (85.3%)
 Rural
156 (14.7%)
Region of Residence
 Dar es Salaam
752 (70.7%)
 Other regions
311 (29.3%)
Relationship to Patient
 Spouse
142 (13.4%)
 Child
661 (62.2%)
 Sibling
162 (15.2%)
 Parent
38 (03.6%)
 Friend
60 (05.6%)
Health insured
 Yes
358 (33.7%)
 No
705 (66.3%)
Perceived health status
 Good
439 (41.3%)
 Average
577 (54.3%)
 Bad
47 (04.4%)
When last check-up
 Never
583 (54.9%)
 Within a Year
399 (37.5%)
 Over a Year
81 (07.6%)
Personal Disease History (% Yes)
 CVD/Hypertension
204 (19.2%)
 Diabetes
43 (04.1%)
 Chronic kidney disease
12 (01.1%)
 HIV/AIDS
26 (02.5%)
 Cancer
6 (0.6%)
 Chronic pulmonary disease
19 (01.8%)
 Chronic back pain
83 (07.8%)
Knowledge of CVD risk factors (self-reported)
 Yes
366 (34.4%)
 No
697 (65.6%)
Family history of CVD
 Yes
389 (36.6%)
 No
661 (62.2%)
 Don’t know
13 (01.2%)
CVD death in the family
 Yes
218 (20.5%)
 No
799 (75.2%)
 Don’t know
46 (04.3%)
Smoking status
 Current
34 (03.2%)
 Past
43 (04.0%)
 Never
986 (92.8%)
Alcohol intake
 Yes
197 (18.5%)
 No
866 (81.5%)
Perceived healthy eating
 Irregularly
874 (82.2%)
 Regularly
189 (17.8%)
≥30 min Exercise (days/week)
 0 days
500 (47.0%)
 1–3 days
300 (28.2%)
 4–6 days
80 (07.6%)
 7 days
183 (17.2%)
Body Mass Index (mean, SD)
28.0 (5.9)
BMI categories
 Underweight
32 (03.0%)
 Normal
321 (30.2%)
 Overweight
358 (33.7%)
 Obese
352 (33.1%)
Waist circumference (mean [cm], SD)
94.6 (13.3)
 Men ≥94 cm
207 (44.0%)
 Women ≥80 cm
528 (89.2%)
Blood Pressure (mean, SD)
 Systolic Blood Pressure
128.5 (20.2)
 Diastolic Blood Pressure
83.0 (13.5)
Blood Pressure Range
  < 140/90
754 (70.9%)
  ≥ 140/90
309 (29.1%)
Blood Sugar Range
 FBG < 7.0/RBG < 11.1
 FBG ≥ 7.0/RBG ≥ 11.1
1029 (96.8%)
34 (03.2%)

Knowledge and attitude regarding CVD risk factors

While 583 (54.9%) of participants had never had a general health check-up before, 41.3% had a perception of being in good health while 34.4% reported to have knowledge of CVD risk factors. Table 2 summarizes responses to the 22 questions used to assess knowledge about CVD risk factors. The mean CVD knowledge score was 78.2% with a range of 31.8–100%. A total of 847 (79.7%) participants had good knowledge, 204 (19.2%) had moderate knowledge, and 12 (1.1%) had low knowledge of CVD risk factors. About 16.3% believed CVD are diseases of rich people and 42.4% were unaware that they are the leading cause of mortality globally. Additionally, 17.4% thought CVD are not preventable, 67.4% believed one may know that they have CVD based on symptoms alone and 56.7% had a perception that CVD are curable. Smoking was recognized by 77% as a CVD risk, physical inactivity by 95.6%, excessive alcohol drinking by 90.1%, overweight by 90.1%, high-salt diet by 85.9%, and elevated cholesterol by 92.9% of participants. Furthermore, while just 38.6% were aware that men have a higher risk of CVD compared to women, 65.6% acknowledged positive CVD family history as a risk, whereas 89.5 and 72.4% knew that hypertension and diabetes respectively are risk factors for CVD.
Table 2
Responses of the Cardiovascular Disease Knowledge Questionnaire used in this study (N = 1063)
Item
Question
Correct response
% answered correctly
Q1
Cardiovascular diseases (CVD) are diseases of rich people
No
890 (83.7%)
Q2
Smoking does not increase a risk of CVD
No
818 (77.0%)
Q3
Consuming a lot of vegetables and fruits increases the risk of CVD
No
1006 (94.4%)
Q4
Consumption of too much salt is a risk to CVD
Yes
913 (85.9%)
Q5
Having excess body weight increases ones risk of CVD
Yes
958 (90.1%)
Q6
A family history of CVD increases ones risk of acquiring CVD
Yes
697 (65.6%)
Q7
Generally, regular consumption of red meat is healthier than white meat
No
864 (81.3%)
Q8
Cardiovascular diseases are curable upon completion of described dose.
No
460 (43.3%)
Q9
Diabetes increases ones risk of CVD
Yes
770 (72.4%)
Q10
Men are at higher risk of CVDs compared to women
Yes
410 (38.6%)
Q11
Excessive alcohol drinking is dangerous to cardiovascular health
Yes
958 (90.1%)
Q12
CVDs are the leading cause of deaths globally
Yes
612 (57.6%)
Q13
A person may know that he/she has CVD based on signs and symptoms alone
No
347 (32.6%)
Q14
A person with CVD may infect a close person
No
1006 (94.4%)
Q15
High blood pressure is a risk factor of CVD
Yes
951 (89.5%)
Q16
Animal fat is healthier than plant oil
No
892 (83.9%)
Q17
Old age is a risk factor for CVD
Yes
850 (80.0%)
Q18
Stress increases ones risk of acquiring CVD
Yes
1000 (94.1%)
Q19
Exercising regularly is harmful to cardiovascular health
No
1016 (95.6%)
Q20
High cholesterol in blood prevents one from CVD
No
988 (92.9%)
Q21
CVD are not preventable
No
878 (82.6%)
Q22
Doing health check-ups frequently is harmful
No
1004 (94.5%)
Mean score (SD), Range 78.2% (10.9), 31.8–100%

Factors associated with knowledge of CVD risk factors

Table 3 displays findings of chi-square analyses of various characteristics by CVD knowledge status (i.e. score < 70% vs score ≥ 70%). Participants with low education had a higher likelihood of having poor knowledge of CVD risks compared to individuals with at least secondary education (30.8% vs 12.9%, p < 0.001). Moreover, individuals who possessed a health insurance displayed higher rates of good CVD knowledge compared to their uninsured counterparts (89.4% vs 75.2%, p < 0.001). Likewise, non-smokers showed a higher chance of having a good CVD knowledge compared to current smokers (80.4% vs 58.8%, p < 0.01). Furthermore, physically inactive participants had inferior likelihood of having good CVD knowledge compared to their physically active counterparts (77.0% vs 82.1%, p = 0.04). Additionally, participants with unhealthy eating pattern displayed a higher chance of having poor knowledge compared regular healthy dieters (22.3% vs 16.7%, p = 0.03). Participants with a positive family history of CVD death displayed a superior CVD risks knowledge compared to ones without a CVD-related death in the family, (88.5% vs 77.4%, p < 0.001).
Table 3
Bivariate analyses of potential associated factors for CVD risk knowledge (N = 1063)
Characteristic
n
Score < 70
Score ≥ 70
p-value
Age > 40
502
96 (19.1%)
406 (80.9%)
 
Age ≤ 40
561
117 (20.9%)
444 (79.1%)
0.46
Female
592
121 (20.4%)
471 (79.6%)
 
Male
471
92 (19.5%)
379 (80.5%)
0.72
≤Primary education
426
131 (30.8%)
295 (69.2%)
 
≥Secondary education
637
82 (12.9%)
555 (87.1%)
< 0.001
Single
279
65 (23.3%)
214 (76.7%)
 
Ever married
784
148 (18.9%)
636 (81.1%)
0.12
No regular income
219
52 (23.7%)
167 (76.3%)
 
Regular income generating activity
844
164 (19.4%)
680 (80.6%)
0.16
Rural
156
39 (25.0%)
117 (75.0%)
 
Urban
907
174 (19.2%)
733 (80.8%)
0.09
Uninsured
705
175 (24.8%)
530 (75.2%)
 
Health insurance
358
38 (10.6%)
320 (89.4%)
< 0.001
BMI ≥ 25
710
133 (18.7%)
577 (81.3%)
 
BMI < 25
353
80 (22.7%)
273 (77.3%)
0.12
Perception on self-health ≤average
624
119 (19.1%)
505 (80.9%)
 
Perceive to be in good health
439
94 (21.4%)
345 (78.6%)
0.36
Never had health check-up
583
118 (20.2%)
465 (79.8%)
 
Ever had a check-up
480
98 (20.4%)
382 (79.6%)
0.94
No knowledge of CVD risks (self-reported)
Knowledgeable on CVD risks
697
366
171 (24.5%)
45 (12.3%)
526 (75.5%)
321 (87.7%)
< 0.001
No history of CVD death in family
845
191 (22.6%)
654 (77.4%)
 
Positive history of CVD death
218
25 (11.5%)
193 (88.5%)
< 0.001
No regular exercise
500
115 (23.0%)
385 (77.0%)
 
Exercises ≥1 day/week
563
101 (17.9%)
462 (82.1%)
0.04
irregular diet (< 5 days/week)
691
154 (22.3%)
537 (77.7%)
 
Regular healthy diet (≥5 days/week)
372
62 (16.7%)
310 (83.3%)
0.03
Current smokers
34
14 (41.2%)
20 (58.8%)
 
Non-smokers
1029
202 (19.6%)
827 (80.4%)
< 0.01
Current alcohol drinkers
197
40 (20.3%)
157 (79.7%)
 
Non-drinkers
866
176 (20.3%)
690 (79.7%)
1.0
Positive personal history of CVD
204
35 (17.2%)
169 (82.8%)
 
Negative personal history of CVD
859
181 (21.1%)
678 (78.9%)
0.21
Known to have diabetes
43
10 (23.3%)
33 (76.7%)
 
Negative diabetes history
1020
206 (20.2%)
814 (79.8%)
0.62
A total of seventeen potential characteristics associated with knowledge of CVD risks were featured in logistic regression analysis, Table 4. During bivariate analyses seven out of the seventeen factors showed significant associations (i.e. p < 0.05) and were subsequently included in the multivariate regression model to control for confounders. At the end of multivariate regression analysis, three factors remained independently associated with poor CVD risks knowledge. These included: low education level (OR 2.6, 95%CI 1.9–3.7, p < 0.001), lack of health insurance (OR 1.5, 95%CI 1.1–2.3, p = 0.03), and negative family history of CVD death (OR 2.2, 95%CI 1.4–3.5, p < 0.001).
Table 4
Logistic Regression Analysis of Factors Associated with Poor knowledge of CVD risks
Age > 40
Age ≤ 40
1.2
0.9–1.6
0.2
Female
Male
0.9
0.6–1.2
0.3
≤Primary education
≥secondary education
2.9
2.1–3.9
< 0.001
2.6
1.9–3.7
< 0.001
Single
Ever married
0.8
0.6–1.1
0.2
No regular income activity
Employed/self-employed
1.3
0.9–1.8
0.2
Rural
Urban
0.8
0.5–1.2
0.3
Uninsured
Insured
2.3
1.6–3.3
< 0.001
1.5
1.1–2.3
0.03
BMI ≥ 25
BMI < 25
1.5
1.1–2.1
< 0.01
1.3
0.9–1.8
0.2
≤Average perception
Perceive to be good health
1.0
0.8–1.4
0.9
Never had health check-up
Positive check-up history
1.0
0.7–1.4
0.9
Irregular diet
Regular healthy diet
1.4
1.0–2.0
0.03
1.2
0.8–1.7
0.4
No CVD death history in family
Positive history of CVD death
2.3
1.4–3.5
< 0.001
2.2
1.4–3.5
< 0.001
Never exercise
Exercises ≥1 day/week
1.4
1.0–1.8
0.04
1.2
0.9–1.7
0.2
Current smokers
Non-smokers
2.9
1.4–5.8
< 0.01
2.1
0.9–4.6
0.08
Alcohol drinkers
Non drinkers
1.0
0.7–1.5
1.0
Positive hypertension history
Negative hypertension history
1.3
0.9–1.9
0.2
Diagnosed with diabetes
Negative diabetes history
0.8
0.4–1.7
0.6

Discussion

As the NCD epidemic continues to accelerate amidst the ongoing infectious diseases battle, health-care systems in SSA are increasingly regarding CVDs in particular and NCDs in general as a top public health priority [20]. To curb this distressing trend, health literacy has a prominent significance in prevention of CVD both at the primary and secondary levels [710]. Sorensen K et al. [21] defined health literacy as the “individual’s knowledge, motivation, and competences to access, understand, appraise, and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention, and health promotion to maintain or improve quality of life during the life course”. Inspite of its evidence-based [710] benefits in NCDs prevention, variably low rates of health literacy have been documented around the globe making public health measures particularly the development and implementation of targeted educational programs challenging or ineffective.
With about four-fifths of participants having an overall adequate knowledge regarding CVD risk factors, this present study demonstrated a modest level of health literacy in an urban setting of SSA. Our rates of CVD literacy echoes findings of previous studies from South Africa [17], Iran [22] and Malaysia [23] which produced knowledge rates of 75.3, 78.7 and 81% respectively. Contrary to our findings, regional studies from Nigeria [24] (44%) and Cameroon [25] (47.5%) revealed considerably low rates of CVD literacy. This observed variability in literacy rates between cited studies could be explained by the education-level differences among study participants and diversity of tools used for knowledge assessment. With regards to knowledge of specific risk behaviors, over nine-tenth of participants in this study recognized excess body weight, physical inactivity, and excess alcohol intake as risks, while more than three-quarters acknowledged smoking, unhealthy diet, hypertension and diabetes as attributable risks.
A wide variation of knowledge rates regarding individual risk factors is observed in the literature. For instance, smoking [17, 2333] has been recognized as a CVD risk by 36.2–93.2% of participants, excess alcohol intake by 40.7% [29]–65% [31], unhealthy diet [2326, 2831, 33] by 2.8–88%, physical inactivity [17, 2331, 33] by 1.2–96%, excess body weight [2331, 33] by 1.6–100%, hypertension [2331, 33] by 6.2–94% and diabetes [17, 2331] by 5.3–92.4%. Astonishingly, despite of a predominant blood-relationship between study participants and the escorted patients, just over one-third of participants realized they are living in a family with a positive CVD history and less than two-thirds were aware that it increases ones risk of CVD. In unison to our findings, studies by Awad et al.26 (62.6%), George et al.27 (68%), and Shafiq et al.28 (60%) revealed similar rates of recognition of family history as an attributable risk of CVD. Nonetheless, in a couple of other studies [25, 29, 30] majority (> 50%) of participants were unaware of the increased risk of acquiring CVD in the presence of a positive family history.
Irrespective of a predominant positive family history of CVD and acknowledgement of the importance of regular check-ups by large majority of participants, over a half of study subjects have never had a basic check-up their entire lives. Notwithstanding the relatively good CVD risk knowledge, risk behaviors were disproportionately high among participants of this present study. For instance, although excess body weight was recognized as a risk by over 90% of participants just one-third had a healthy weight. Similar pattern was observed with nearly 96% recognizing physical inactivity as a risk and yet just about a half of participants were physically active. Furthermore, certain risk factors (i.e. overweight, hypertension, and diabetes) revealed comparatively similar rates of knowledge to participants free from such risks. Nevertheless, current smokers, physically inactive and unhealthy eaters displayed inferior knowledge rates compared to their counterparts with healthy behaviors respectively.

Conclusions

Despite a fairly good level of knowledge regarding CVD risk factors established in this study, a vivid disconnection between individual’s knowledge and self-care practices (i.e. CVD risk behaviors) is apparent. These findings reflects alarming public health concerns and underscore the urgent need to establish and implement wide-spread and effective educational initiatives aiming at mitigating the community’s practices towards cardiovascular risk factors.

Acknowledgements

We extend our gratitude to all the study participants for their willingness, tolerance and cooperation offered during this study.
Participants gave written informed consent to participate in the study. The study protocol was approved by the local ethics committees (Jakaya Kikwete Cardiac Institute) and was conducted in accordance with the Declaration of Helsinki.
Not applicable.

Competing interests

The authors declare that they have no competing interests.
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Metadaten
Titel
Knowledge of cardiovascular risk factors among caretakers of outpatients attending a tertiary cardiovascular center in Tanzania: a cross-sectional survey
verfasst von
Pedro Pallangyo
Nsajigwa Misidai
Makrina Komba
Zabella Mkojera
Happiness J. Swai
Naairah R. Hemed
Henry Mayala
Smita Bhalia
Jalack Millinga
Upendo W. Mollel
Happiness L. Kusima
Ester Chavala
Ziada Joram
Halifa Abdallah
Rajabu Hamisi
Mohamed Janabi
Publikationsdatum
01.12.2020
Verlag
BioMed Central
Erschienen in
BMC Cardiovascular Disorders / Ausgabe 1/2020
Elektronische ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-020-01648-1

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