Prevalence and Determinants of Ideal Cardiovascular Health in Kenya: A Cross-Sectional Study Using Data From the 2015 Kenya STEPwise Survey

James Odhiambo Oguta; Penny Breeze; Elvis Wambiya; Catherine Akoth; Grace Mbuthia; Peter Otieno; Oren Ombiro; Yvette Kisaka; Lilian Mbau; Elizabeth Onyango; Gladwell Gathecha; Pete R. J. Dodd

doi:10.5334/gh.1363

Prevalence and Determinants of Ideal Cardiovascular Health in Kenya: A Cross-Sectional Study Using Data From the 2015 Kenya STEPwise Survey

Volume 19 (2024): Issue 1

By: James Odhiambo Oguta , Penny Breeze , Elvis Wambiya , Catherine Akoth , Grace Mbuthia , Peter Otieno , Oren Ombiro , Yvette Kisaka , Lilian Mbau , Elizabeth Onyango , Gladwell Gathecha and Pete R. J. Dodd

Open Access

|Oct 2024

Figures & Tables

Table 1

Scoring of CVH metrics using AHA criteria to estimate CVH status.

		AHA CRITERIA	THE STUDY’S OPERATIONAL DEFINITION
Diet	Measurement	Daily intake of a DASH-style eating pattern	Fruit and vegetable servings
	100	≥95th percentile	> =4.75 servings (≥95th percentile)
	80	75th–94th percentile	3.75–4.74 servings (75th–94th percentile)
	50	50th–74th percentile	2.5–3.74 servings (50th–74th percentile)
	25	25th–49th percentile	1.25–2.49 servings (25th–49th percentile)
	0	1st–24th percentile	<1.25 servings (1st–24th percentile)
Nicotine exposure	Measurement	Self-reported use of cigarettes or inhaled NDS	Self-reported use of tobacco (smoked or smokeless)
	100	Never Smoker	Never Smoker
	75	Former smoker, quit ≥5 y	Former smoker, quit ≥5 y
	50	Former smoker, quit 1–<5 y	Former smoker, quit 1–<5 y
	25	Former smoker, quit <1 y, or currently using inhaled NDS	Former smoker, quit <1 y
	0	Current smoker	Current Smoker
Physical activity (PA)	Measurement	Self-reported minutes of moderate or vigorous PA per week	Similar to AHA
	100	≥150	≥150
	90	120–149	120–149
	80	90–119	90–119
	60	60–89	60–89
	40	30–59	30–59
	20	1–29	1–29
	0	0	0
BMI	Measurement	Weight/(height squared-(kg/m²)	Weight/(height squared-(kg/m²)
	100	<25	<25
	70	25.0–29.9	25.0–29.9
	30	30.0–34.9	30.0–34.9
	15	35.0–39.9	35.0–39.9
	0	≥40.0	≥40.0
Blood Pressure	Measurement	Systolic and diastolic BPs (mm Hg)	Systolic and diastolic BPs (mm Hg)
	100	<120/<80 (optimal)	<120/<80 (optimal)
	75	120–129/<80 (elevated)	120–129/<80 (elevated)
	50	130–139 or 80–89 (stage 1 hypertension)	130–139 or 80–89 (stage 1 hypertension)
	25	140–159 or 90–99	140–159 or 90–99
	0	≥160 or ≥100	≥160 or ≥100
		If drug-treated level, subtract 20 points	If drug-treated level, subtract 20 points
Blood lipids	Measurement	Non–HDL cholesterol (mg/dL)	Non–HDL cholesterol (mmol/L)
	100	<130	<3.3
	60	130–159	3.3–4.0
	40	160–189	4.1–4.8
	20	190–219	4.9–5.6
	0	≥220	≥5.7
Blood Glucose	Measurement	FBG (mg/dL) or HbA1c (%)	FBG (mmol/l)
	100	No history of diabetes and FBG <100 (or HbA1c <5.7)	No diabetes and FBG <5.6 mmol/l
	60	No diabetes and FBG 100–125 (or HbA1c 5.7–6.4) (prediabetes)	No diabetes and FBG 5.6–6.9 mmol/l
	40	Diabetes with HbA1c <7.0	Diabetic and FBG <7.0 mmol/l
	30	Diabetes with HbA1c 7.0–7.9	Diabetic and FBG <7.0 mmol/l
	20	Diabetes with HbA1c 8.0–8.9	Diabetic and FBG > = 7.0
	10	Diabetes with Hb A1c 9.0–9.9
	0	Diabetes with HbA1c ≥10.0

[i] DASH-Dietary Approaches to stop hypertension; NDS-Nicotine Delivery System; AHA-American Heart Association; BP-Blood Pressure; HDL-High Density Lipoprotein; FBG-Fasting Blood Glucose; HbA1c-Hemoglobin A1c; BMI-Body Mass Index.

Table 2

Sample characteristics and prevalence of ideal CVH in Kenya.

VARIABLE	SAMPLE	PREVALENCE OF IDEAL CVH (OVERALL CVH SCORE > = 80%)
	SAMPLE	OVERALL (KENYA)			RURAL KENYA		URBAN KENYA
	n (%)	n	% (95% CI)	p-value (Chi2)	n = 1988	p-value (Chi2)	n = 1830	p-value (Chi2)
Total	3818 (100)	1,674	45.6 [42.6,48.6]		48.7 [45.3, 52.1]		39.7 [35.0, 44.7]
Sex
Female	2250 (59)	1,022	47.4 [44.4,50.3]		49.5 [45.6,53.3]		43.0 [38.9,47.1]
Male	1568 (41)	652	43.8 [39.5,48.3]	0.1224	47.8 [43.0,52.3]	0.5321	37.0 [30.5,44.1]	0.0837
Age group (years)
18–29	1242 (32.5)	725	57.4 [52.3,62.3]		62.4 [57.5,67.0]		49.8 [41.5,58.2]
30–39	1066 (27.9)	490	43.3 [38.5,48.3]		47.3 [41.5,53.2]		35.9 [28.5,44.1]
40–49	697 (18.3)	249	34.0 [27.8,40.7]		41.2 [34.8,47.9]		20.3 [11.6,32.9]
50+	813 (21.3)	210	25.6 [21.6,30.2]	<0.001	26.2 [21.7,31.3]	<0.001	23.9 [15.8,34.4]	<0.001
Marital Status
In a union	252 (67.9)	1,134	43.7 [40.2,47.6]		48.4 [44.6,52.3]		34.5 [28.6,40.8]
Not in a union	1226 (32.1)	540	48.8 [45.2,52.4]	0.0203	49.2 [45.0,53.3]	0.727	47.1 [41.0,53.4]	0.0018
Education
No formal	1524 (39.9)	611	43.1 [38.7,47.6]		45.6 [40.8,50.5]		32.7 [24.4,42.2]
Primary	1237 (32.4)	555	44.0 [39.3,48.8]		48.8 [43.6,54.0]		33.2 [26.2,41.1]
Secondary +	1057 (27.7)	508	50.0 [44.2,55.7]	0.1059	54.5 [48.2,61.6]	0.072	46.3 [38.4,54.5]	0.021
Occupation
Unemployed/Unpaid	1567 (41.1)	717	47.6 [43.1,50.9]		49.7 [45.1,54.4]		40.4 [30.8,50.7]
Self-Employed	1536 (40.2)	671	46.6 [43.1,50.9]		47.5 [42.5,52.6]		44.7 [37.5,52.2]
Employed/Salaried	715 (18.7)	286	39.9 [33.2,47.0]	0.1212	48.1 [40.8,55.6]	0.7798	32.7 [24.7,41.9]	0.1569
Wealth quintile
Quintile 5	829 (21.7)	353	45.0 [39.2,51.0]		45.7 [39.2,52.3]		39.8 [29.9,50.7]
Quintile 4	815 (21.4)	356	44.9 [40.1,49.9]		47.8 [42.2,53.4]		36.5 [28.5,45.5]
Quintile 3	793 (20.8)	377	47.1 [40.9,53.5]		53.8 [48.5,58.9]		33.3 [23.1,45.4]
Quintile 2	737 (19.3)	317	42.4 [36.2,48.9]		45.9 [39.3,52.7]		38.2 [28.2,49.4]
Quintile 1	644 (16.9)	271	46.9 [40.3,53.7]	0.7904	52.8 [46.7,58.8]	0.1447	44.7 [36.1,53.6]	0.3955
Alcohol intake
Never/Past drinker	3024 (79.2)	1419	49.6 [46.6,52.5]		52.5 [49.0,55.9]		44.2 [39.7,48.8]
Current user	794 (20.8)	255	32.3 [26.6,38.4]	<0.001	34.9 [28.3,42.1]	<0.001	29.2 [20.7,39.4]	0.0023
Residence
Rural	1988 (52.1)	918	48.7 [45.3,52.0]		–		–
Urban	1830 (47.9)	756	39.7 [35.0,44.6]	0.0024	–		–
Region
Rift Valley	1189 (31.1)	535	47.0 [42.6,51.4]		45.7 [40.4, 51.2]		50.1 [43.4, 56.8]
Eastern	695 (18.2)	252	39.2 [34.1,44.6]		41.6 [36.0, 47.4]		30.9 [24.9, 37.8]
Nyanza	487 (12.8)	287	62.4 [52.7,71.2]		65.4 [52.8, 76.2]		54.4 [42.7, 65.7]
Coast	419 (11)	165	41.2 [32.7,50.3]		41.4 [27.6, 56.7]		41.0 [31.8, 50.9]
Nairobi	51 (1.3)	17	34.8 [26.8,43.8]		-		34.8 [26.7, 43.8]
Western	368 (9.7)	169	51.4 [46.7,56.1]		52.7 [47.4, 57.9]		45.9 [38.9, 53.2]
North Eastern	177 (4.6)	77	49.5 [42.6,56.6]		52.7 [44.5, 60.7]		32.6 [24.1, 42.4]
Central	432 (11.3)	172	38.0 [29.9,46.9]	<0.001	44.1 [37.3, 51.1]	0.0019	29.7 [18.7, 43.7]	0.003
Ethnicity
Kisii	195 (5.1)	119	62.9 [49.3,74.8]		72.0 [58.9, 82.3]		50.9 [30.3, 71.2]
Embu	86 (2.3)	34	41.2 [23.3,61.8]		43.3 [23.9, 65.1]		37.8 [9.9, 77.0]
Kalenjin	644 (16.9)	299	42.7 [36.7,48.9]		46.3 [39.6, 53.1]		35.6 [25.2, 47.6]
Kamba	347 (9.1)	120	33.5 [28.1,39.3]		35.6 [28.8, 42.9]		31.0 [23.5, 39.7]
Borana	18 (0.5)	7	33.5 [12.3,64.3]		47.3 [41.1, 53.4]		33.5 [12.3, 64.5]
Kikuyu	612 (16)	258	45.5 [40.2,51.0]		49.0 [43.7, 54.4]		43.8 [35.3, 52.6]
Luhya	476 (12.5)	200	43.9 [37.2,50.9]		56.5 [42.5, 69.5]		34.8 [26.0, 44.9]
Luo	414 (10.8)	224	53.7 [44.7,62.5]		54.3 [42.0, 66.1]		50.7 [39.7, 61.5]
Maasai	60 (1.6)	27	52.9 [40.7,64.7]		46.5 [38.6, 54.6]		40.0 [10.3, 79.5]
Meru	221 (5.8)	88	43.3 [35.9,51.2]		41.6 [24.3, 61.3]		26.0 [14.9, 41.3]
Mijikenda	143 (3.8)	53	37.7 [24.8,52.6]		51.8 [43.8, 59.7]		28.8 [17.9, 42.9]
Somali	186 (4.9)	79	47.5 [40.2,55.0]		25.4 [14.9, 39.8]		27.8 [16.2, 43.4]
Turkana	82 (2.2)	24	26.2 [17.2,37.9]		55.1 [38.0, 71.1]		30.1 [21.7, 40.1]
Other	334 (8.8)	142	50.8 [38.4,63.1]	0.0013	48.7 [45.3, 52.1]	0.0034	43.3 [27.3, 60.9]	0.2455

Distribution of CVH metrics by sex (Statistically significant difference at p < 0.001 ***, p < 0.01**, p < 0.05*).

Distribution of CVH metrics by place of residence (Statistically significant difference at p < 0.001 ***, p < 0.01**, p < 0.05*).

Distribution of CVH metrics by alcohol intake (Statistically significant difference at p < 0.001 ***, p < 0.01**, p < 0.05*).

Table 3

Distribution of mean CVH metrics by sample characteristics.

CHARACTERISTIC	FRUIT AND VEGETABLEINTAKE	NICOTINE	PHYSICAL ACTIVITY	BODY MASS INDEX	BLOOD PRESSURE	FASTING BLOOD GLUCOSE	NON-HDL CHOLESTEROL	OVERALL CVH SCORE
CHARACTERISTIC	%	%	%	%	%	%	%	%
Wealth
Quintile 5	20.3	75.2	99.5	95.8	69.2	94.1	93.5	78.2
Quintile 4	27.8	82.7	99.2	91.1	62.5	96.5	94.5	79.2
Quintile 3	29.0	88.0	99.3	87.2	63.3	94.8	92.2	79.1
Quintile 2	30.9	88.3	98.5	84.9	59.4	95.4	92.2	78.5
Quintile 1	35.0	86.4	98.6	80.4	59.5	94.8	90.0	77.8
Education
No formal	23.7	79.0	99.1	91.4	64.9	94.7	93.3	78.0
Primary	31.3	85.8	99.1	87.2	62.0	95.8	92.9	79.2
Secondary+	31.5	88.2	98.8	84.6	61.1	94.9	91.1	78.6
Region
Rift Valley	26.5	84.7	98.8	90.3	63.1	96.7	94.2	79.2
Eastern	27.4	77.4	99.0	89.2	59.9	93.8	92.0	76.9
Nyanza	45.2	93.3	99.7	88.6	68.8	96.1	91.3	83.3
Coast	27.0	75.2	98.1	88.7	64.0	93.3	93.3	77.1
Nairobi	20.5	81.6	98.9	81.6	60.2	95.6	93.8	76.0
Western	30.5	88.2	99.7	90.6	63.2	94.3	95.6	80.3
North Eastern	1.8	98.5	97.7	94.4	76.0	91.4	91.0	78.7
Central	35.4	82.4	99.3	80.8	55.8	95.4	86.7	76.5
Ethnicity
Kisii	44.0	88.1	99.3	85.3	56.3	98.2	94.1	80.8
Embu	26.6	77.4	99.9	85.7	64.6	90.1	90.3	76.4
Kalenjin	25.5	89.3	99.1	88.7	61.5	96.2	92.7	79.0
Kamba	23.4	80.8	99.3	87.2	56.9	93.9	90.6	76.0
Borana	32.2	53.3	99.1	84.9	67.5	92.9	91.1	74.4
Kikuyu	35.8	81.2	98.3	82.2	59.2	95.3	92.0	77.7
Luhya	29.0	87.6	99.7	89.3	61.3	95.4	95.2	79.6
Luo	37.4	93.1	99.6	87.2	69.7	94.1	89.9	81.6
Maasai	19.2	93.2	96.5	92.2	69.8	98.8	94.5	80.6
Meru	30.2	74.2	98.9	89.6	62.2	94.7	91.5	77.3
Mijikenda	21.5	67.9	98.0	91.2	62.8	97.2	93.9	76.1
Somali	1.3	97.5	97.8	91.6	73.8	88.7	90.9	77.4
Turkana	8.9	49.0	99.1	99.6	77.7	96.4	95.0	75.1
Other	25.6	73.7	99.1	92.6	69.0	96.2	93.0	78.4

Table 4

Factors associated with ideal CVH in Kenya (Unadjusted and Multivariable binary logistic regression analyses results for complete case analysis (n = 3818).

	COMPLETE CASE ANALYSIS (N = 3818)
	VARIABLE/CATEGORY	CRUDE OR (95% CI)	P-VALUE	ADJUSTED OR (95% CI)	P-VALUE	ADJUSTED OR (95% CI)	P-VALUE	ADJUSTED OR (95% CI)	P-VALUE
	Sex
Female	1		1		1		1
Male	0.9 (0.7, 1.0)	0.123	1.0 (0.8, 1.3)	0.847	1.1 (0.9, 1.5)	0.373	0.9 (0.7, 1.3)	0.72
Age group (years)
18–29	1		1		1		1
30–39	0.6 (0.4, 0.8)	<0.001	0.5 (0.4, 0.7)	<0.001	0.5 (0.4, 0.7)	<0.001	0.6 (0.3, 1.1)	0.093
40–49	0.4 (0.3, 0.6)	<0.001	0.4 (0.3, 0.5)	<0.001	0.4 (0.3, 0.6)	<0.001	0.3 (0.1, 0.6)	0.001
50+	0.3 (0.2, 0.3)	<0.001	0.2 (0.2, 0.3)	<0.001	0.2 (0.2, 0.3)	<0.001	0.3 (0.2, 0.4)	<0.001
Marital Status
In a union	1		1		1		1
Not in a union	1.2 (1.0, 1.4)	0.02	1.0 (0.8, 1.2)	0.987	0.8 (0.7, 1.0)	0.063	1.3 (0.9, 2.0)	0.169
Education
No formal	1		1		1		1
Primary	1.0 (0.8, 1.3)	0.747	0.8 (0.6, 1.1)	0.172	0.8 (0.6, 1.1)	0.26	0.8 (0.4, 1.3)	0.325
Secondary +	1.3 (1.0, 1.8)	0.064	1.4 (1.0, 2.0)	0.067	1.1 (0.8, 1.6)	0.661	2.0 (1.0, 3.9)	0.055
Occupation
Unemployed/Unpaid	1		1		1		1
Self-Employed	1.3 (1.0, 1.8)	0.097	1.2 (0.9, 1.6)	0.195	1.0 (0.8, 1.4)	0.72	1.6 (0.8, 3.1)	0.146
Employed/Salaried	1.4 (1.0, 1.9)	0.06	0.9 (0.6, 1.2)	0.462	1.0 (0.6, 1.6)	0.969	0.9 (0.5, 1.6)	0.698
Wealth quintile
Quintile 5	1		1		1		1
Quintile 4	1.0 (0.8, 1.4)	0.907	0.9 (0.7, 1.2)	0.547	1.0 (0.8, 1.3)	0.954	0.8 (0.4, 1.5)	0.508
Quintile 3	1.1 (0.8, 1.5)	0.576	1.0 (0.8, 1.4)	0.83	1.2 (0.8, 1.7)	0.296	0.8 (0.5, 1.3)	0.363
Quintile 2	0.9 (0.6, 1.3)	0.573	0.9 (0.6, 1.3)	0.501	0.9 (0.6, 1.4)	0.721	0.8 (0.5, 1.4)	0.477
Quintile 1	1.1 (0.8, 1.5)	0.66	1.3 (0.9, 2.1)	0.173	1.3 (0.9, 2.0)	0.215	1.3 (0.6, 2.6)	0.481
Alcohol intake
Never/Past drinker	1		1		1		1
Current user	0.5 (0.4, 0.6)	0.002	0.5 (0.3, 0.6)	<0.001	0.5 (0.3, 0.7)	<0.001	0.4 (0.2, 0.6)	<0.001
Residence
Rural	1		1		1		1
Urban	0.7 (0.5, 0.9)	0.004	0.6 (0.5, 0.8)	<0.001	-	-	-	-
Region
Rift Valley	1		1		1		1
Eastern	0.7 (0.5, 1.0)	0.024	0.7 (0.4–1.2)	0.171	0.8 (0.3, 2.2)	0.609	0.5 (0.3, 1.0)	0.054
Nyanza	1.9 (1.2, 2.9)	0.003	1.5 (0.8–2.7)	0.176	3.0 (1.1, 8.0)	0.03	0.8 (0.4, 1.8)	0.657
Coast	0.8 (0.5, 1.2)	0.217	0.6 (0.3–1.1)	0.118	0.6 (0.2, 2.1)	0.426	0.4 (0.2, 0.9)	0.025
Nairobi	0.6 (0.4, 0.9)	0.015	0.4 (0.2–0.8)	0.01	-	-	0.3 (0.1, 0.6)	0.001
Western	1.2 (0.9, 1.6)	0.23	1.4 (0.9–1.9)	0.097	2.1 (1.5, 2.9)	<0.001	0.7 (0.4, 1.3)	0.242
North Eastern	1.1 (0.8, 1.5)	0.62	1.3 (0.4–5.1)	0.664	1.9 (0.3, 12.1)	0.483	1.1 (0.3, 4.4)	0.844
Central	0.7 (0.5, 1.0)	0.081	0.6 (0.4–0.8)	0.006	0.6 (0.4, 1.0)	0.073	0.3 (0.2, 0.6)	0.001
Ethnicity
Kisii	1		1		1		1
Embu	0.4 (0.1, 1.3)	0.116	0.8 (0.2–2.5)	0.669	1.1 (0.2–4.6)	0.947	0.8 (0.1–5.4)	0.787
Kalenjin	0.4 (0.3, 0.7)	0.002	0.5 (0.3–0.9)	0.027	0.7 (0.3–1.6)	0.394	0.5 (0.2–1.4)	0.215
Kamba	0.3 (0.2, 0.5)	<0.001	0.5 (0.2–1.2)	0.112	0.7 (0.2–2.3)	0.053	0.7 (0.2–1.8)	0.4
Borana	0.3 (0.1, 1.2)	0.084	0.4 (0.1–2.4)	0.297	-	-	0.5 (0.1–4.1)	0.477
Kikuyu	0.5 (0.3, 0.9)	0.031	0.8 (0.3–1.9)	0.64	1.2 (0.5–2.8)	0.617	0.8 (0.2–2.8)	0.729
Luhya	0.5 (0.2, 0.9)	0.014	0.5 (0.2–1.1)	0.073	0.5 (0.2–1.1)	0.09	0.7 (0.2–2.6)	0.629
Luo	0.7 (0.4, 1.3)	0.266	0.7 (0.4–1.3)	0.212	0.4 (0.2-1)	0.053	1.3 (0.5–3.2)	0.621
Maasai	0.7 (0.3, 1.4)	0.278	0.5 (0.2–1.2)	0.111	0.7 (0.3–2.1)	0.581	0.5 (0.1–2.6)	0.438
Meru	0.5 (0.2, 0.8)	0.012	0.7 (0.3–1.7)	0.489	1 (0.3–3.6)	0.949	0.5 (0.2–1.9)	0.335
Mijikenda	0.3 (0.2, 0.8)	0.01	0.5 (0.2–1.5)	0.227	0.9 (0.2–3.5)	0.85	0.7 (0.2–2.5)	0.602
Somali	0.5 (0.3, 1.0)	0.054	0.3 (0.1–1.4)	0.13	0.4 (0.1–2.4)	0.286	0.3 (0–1.8)	0.186
Turkana	0.2 (0.1, 0.5)	<0.001	0.3 (0.1–0.6)	0.002	0.3 (0.1-1)	0.054	0.4 (0.1–1.3)	0.122
Other	0.6 (0.3, 1.2)	0.164	0.9 (0.4–2.1)	0.773	1 (0.4–2.7)	0.93	1.2 (0.3–5.2)	0.82

Articles in this issue

DOI: https://doi.org/10.5334/gh.1363 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Jun 12, 2024

Accepted on: Sep 21, 2024

Published on: Oct 23, 2024

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Ideal cardiovascular health,

cardiovascular disease,

prevalence,

determinants,

Kenya,

cardiovascular disease risk factors

© 2024 James Odhiambo Oguta, Penny Breeze, Elvis Wambiya, Catherine Akoth, Grace Mbuthia, Peter Otieno, Oren Ombiro, Yvette Kisaka, Lilian Mbau, Elizabeth Onyango, Gladwell Gathecha, Pete R. J. Dodd, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 19 (2024): Issue 1

Prevalence and Determinants of Ideal Cardiovascular Health in Kenya: A Cross-Sectional Study Using Data From the 2015 Kenya STEPwise Survey

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