Drivers of cardiovascular disease risk factors in slums in Kampala, Uganda: a qualitative study

ABSTRACT

Background

Cardiovascular disease (CVD) risk factors are increasing in many sub-Saharan African countries and disproportionately affecting communities in urban slums. Despite this, the contextual factors that influence CVD risk among slum communities have not been fully documented to guide interventions to prevent and control the disease.

Objective

This study explored the drivers of CVD risk factors in slums in Kampala, Uganda.

Methods

This qualitative study employed focus group discussions (FGDs) to collect data among slum residents. A total of 10 FGDs separate for gender and age group were held in community public places. Discussions were audio-recorded, transcribed, and transcripts analysed thematically with the aid of Atlas ti 7.0. Study themes and sub-themes are presented supported by participant quotations.

Results

Five themes highlighted the drivers of CVD risk factors in slum communities. (1) Poverty: a critical underlying factor which impacted access and choice of food, work, and housing. (2) Poverty-induced stress: a key intermediate factor that led to precarious living with smoking and alcohol use as coping measures. (3) The social environment which included socialisation through drinking and smoking, and family and peers modelling behaviours. (4) The physical environment such as the high availability of affordable alcohol and access to amenities for physical activity and healthy foods. (5) Knowledge and information about CVD risk factors which included understanding of a healthy diet and the dangers of smoking and alcohol consumption.

Conclusion

To address CVD risk in slums, broad-ranging multisectoral interventions are required, including economic empowerment of the slum population, stress reduction and coping interventions, and alcohol legislation. Also, there is a need for community CVD sensitisation and screening as well as increasing access to physical activity amenities and healthy foods within slums.

KEYWORDS:

• Alcohol
• diet
• physical activity
• smoking
• slums

Responsible Editor

Maria Emmelin

Responsible Editor

Maria Emmelin

Acknowledgements

The authors wish to thank the study participants for sharing information that led to this publication and the local leaders for their support in conducting the study. We also thank the funders for supporting this study.

Authors’ contributions

RN conceived the study. RN, PM, DB, RKW, DM, and GM contributed to the design of the study. RN, PM, DB, and LNN collected the data. RN, PM, DB, LNN, RKW, DM, and GM contributed to data analysis. RN, PM, DB, and LNN drafted the manuscript. RKW, DM, and GM critically reviewed the draft manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical approval for this study was obtained from the Makerere University School of Public Health Higher Degrees Research and Ethics Committee (Protocol 965). The study was registered by the Uganda National Council for Science and Technology (HS 1661ES) and permission was also obtained from local authorities at different levels in Kampala city. All study participants provided written informed consent before participating in the study.

Paper context

Cardiovascular disease (CVD) risk factors are on the rise in many low-income contexts disproportionately impacting urban communities. However, gaps exist in understanding the drivers of CVD risk factors, especially in informal settlements to inform potential response interventions. Through focus group discussions among slum communities, we have uncovered the potential drivers of CVD risk factors and their interconnectedness and highlight the need for multisectoral strategies to effectively deal with them.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author [RN]. The data are not publicly available so as not to compromise the privacy of research participants.

Additional information

Funding

This study was funded by Makerere University School of Public Health under the Small Grants Programme (Grant Reference Number: MakSPH-GRCB/20-21/02). The funder had no role in the design, decision to publish, or preparation of the manuscript