SOUTH EASTERN KENYA UNIVERSITY

RISK FACTORS TO CARDIOVASCULAR DISEASE AMONG

STAFF IN SEKU

CHARO CHARITY HURUMA

H129/1611/2016

A PROPOSAL SUBMITTED FOR THE PARTIAL FULFILLMENT

FOR THE AWARD OF BSC. POPULATION HEALTH

AUGUST 2020
DECLARATION OF ORIGINALITY
This research project proposal is my original work and has not been presented to any university
for award. I declare that this work is entirely my own work and that any additional sources of
information have duly cited.
I declared that any internet sources, published or unpublished work from which I have quoted or
drawn reference have been fully referenced in the text. I understand that failure to do this result
in failure of this proposal due to plagiarism.

Signature............................. Date.....................
Charo Charity Huruma
SUPERVISORS APPROVAL
This research proposal report has been submitted for examination with my approval as the
university supervisor.
.
Signature............................... Date ........................
DEDICATION
First I thank God for his guidance and enabling me to work on this project. Secondly, I thank my
beloved parents and my academic mentor Dr. Josphert Kimatu and Miss Rissy Makhoha.
Tremendous thanks to my supervisor and the dean of school. Lastly, I express my gratitude to all
my friends for their support, advice and encouragement.
ABBREVIATION
Non-communicable disease NCD

Cardiovascular disease CVD

Coronary heart disease CHD

Low middle income countries LMCM

Health Belief Model HBM

World Health Organization WHO

ABSTRACT SUMMARY
The risk factors to cardiovascular disease are rising in sub-Saharan African. Kenya, like many
other lower-middle income countries, is undergoing epidemiological transition from infectious
diseases to non-communicable diseases whose leading contributor is cardiovascular. This study
is designed to assess the risk factors of cardiovascular disease, its awareness level and lifestyle
practices towards prevention among South Eastern Kenya University staff.

Suggested strategies for the management and prevention of cardiovascular disease and other non-
communicable diseases are aimed at increasing the life expectancy among staffs. This can be
achieved by: Cessation of tobacco use, reduction of salt in the diet, consuming fruits and
vegetables, regular physical activity and avoiding harmful use of alcohol to reduce the risk of
cardiovascular disease.

The study uses Health Belief Model to explain how staff shall adopt a healthy life practice
towards cardiovascular disease prevention. HBM explains how clients undergo
perceived susceptibility, severity, benefits, barrier, cue to action and maintenance of the new
behavior.

The researcher will perform a descriptive cross-sectional study among selected subordinate staff
using convenience sampling. Cardiovascular risk factors, its awareness level and lifestyle
practices towards CVD prevention will be assessed using a structured self-report questionnaire.
Measurements of participants’ height, weight, BMI and blood pressure will be taken. The
researcher will anticipate collecting the data for about two months. Data collection will involve
questionnaire via face-to-face, phone and/or online platform. The interview schedule will be both
open and closed ended questions. The results will be expressed using the Bliar E and Blair
(2015) formula. The quantitative data will be coded, entered in a computer, cleared and analyzed
using SPSS software. Descriptive analysis will be done and analyzed data presented in
frequencies, percentages and measure of central tendency.

TABLE OF CONTENT
Table of content
DECLARATION OF ORIGINALITY....................................................................................................2
SUPERVISORS APPROVAL..................................................................................................................3
DEDICATION...........................................................................................................................................4
ABBREVIATION......................................................................................................................................5
ABSTRACT SUMMARY.........................................................................................................................6
TABLE OF CONTENT............................................................................................................................7
INTRODUCTION.....................................................................................................................................9
Background information.......................................................................................................................9
Problem statement...............................................................................................................................10
Justification of the study.....................................................................................................................11
Objectives of the study........................................................................................................................11
Main objective..................................................................................................................................11
Specific objectives............................................................................................................................11
Research questions..........................................................................................................................11
Possible limitation of the study...........................................................................................................11
Theoretical model................................................................................................................................12
Health belief model..........................................................................................................................12
Conceptual framework.......................................................................................................................14
LITERATURE REVIEW.......................................................................................................................15
1. AWARENESS LEVEL OF RISK FACTORS TO CVD...............................................................15
2. HEALTHY LIFESTYLE PRACTICES TOWARDS CVD...............................................................16
3. THE COMMON CARDIOVASCULAR RISK FACTORS..............................................................17
Age....................................................................................................................................................17
Tobacco use......................................................................................................................................18
Physical activity...............................................................................................................................18
Overweight and obesity...................................................................................................................19
Unhealthy diets................................................................................................................................20
STUDY METHODOLOGY....................................................................................................................21
Research design...................................................................................................................................21
Study area............................................................................................................................................21
Study population and target population............................................................................................21
Inclusion...............................................................................................................................................21
 Exclusion..............................................................................................................................................21
Study variables....................................................................................................................................21
Sampling techniques............................................................................................................................21
Sample size determination..................................................................................................................21
Data collection tools and methods......................................................................................................22
Data validity and reliability................................................................................................................22
Data management and analysis..........................................................................................................22
Ethical consideration...........................................................................................................................23
REFERENCES........................................................................................................................................23
APPENDIXES.........................................................................................................................................25
APPENDIX 1: SAMPLE QUESTAINNAIRE...................................................................................25
APPENDIX 2: WORK PLAN............................................................................................................27
APPENDIX 3: BUDGET....................................................................................................................28
 INTRODUCTION
Background information
Cardiovascular diseases are the leading cause of death globally and their risk factors are rising in
sub-Saharan African. CVD caused approximately 17.8 million deaths worldwide, corresponding
to 330 years of life lost and another 35.6 million lived with disability. Nearly 80% of global
CVD deaths occur in low and middle income-countries (LMIC) where CVD and risk factor
burden are on the rise as a result of an ongoing epidemiological transition. (According to George
A. Mensah, Gregory Roth and Valentine 2019)

Kenya, like many other lower-middle income countries, is undergoing epidemiological

transition-from infectious diseases to non-communicable diseases which its leading contributor is
cardiovascular disease. In Kenya approximately 25% of hospital admissions and 13% of deaths
are due to CVDs. In addition, 13% of Kenyans consume alcohol and tobacco products, and 94%
eat less than 5 servings of fruits and vegetables per day. It is estimated that coronary artery
disease and stroke account for 80% in males and 75% in female CVD deaths, hypertension
accounts for 13%, tobacco accounts for 9%, diabetes 6% and lack of exercise 6%. In SEKU
several staff are suffering from cardiovascular diseases among other metabolic risk factors such
as raised blood glucose, raised blood pressure, raised blood lipids, and overweight and obesity.
Therefore, addressing risk factors to health at individual level behaviors will reverse or prevent
these diseases.

Cardiovascular disease is a class of disease that affects the heart and blood vessels. It is usually
associated with a buildup of fatty deposits inside arteries and an increased risk of blood clots.
Narrowed, blocked and stuffy blood vessels from fatty deposits and blood clots prevent the heart
and lungs from being supplied with oxygen. CVD include coronary heart disease,
cerebrovascular disease, peripheral arterial disease, aortic disease and congenital heart disease.

The risk factors for CVDs are aspects of personal behaviors/lifestyles, environmental exposure
or hereditary characteristics that are associated with an increase of development of the disease.
Risk factors can be classified into two categories: modifiable and non-modifiable risk factors.
Modifiable risk factors are those that can be reduced or controlled with altered behaviors but
non-modifiable ones cannot be changed. Modifiable risk factors include: tobacco use and/or
exposure to tobacco smoke, unhealthy diet, overweight/obesity, physical inactivity, alcohol use,
hypertension, diabetes. Non-modifiable factors include sex, age, race and family history.
Fortunately, most CVD sufferings are the results of modifiable risk factors; therefore, this
disease is preventable and manageable.

Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular
physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of
cardiovascular disease. In addition, drug treatment of diabetes, hypertension and high blood
lipids may be necessary to reduce cardiovascular risk and prevent heart attacks and strokes.
Health policies that create conducive environments for making healthy choices affordable and
available are essential for motivating people to adopt and sustain healthy behavior. (WHO,2017)

Problem statement
90% of SEKU staff are highly exposed to the development of cardiovascular disease due to their
job settings. Most of them spend their working time while sitting in their offices and they do not
participate in physical exercises, even after the university has a sports field with able trained
sport officers to facilitate and promote physical activities within the university. In addition, the
university is located in a semi-arid area with limited diversity of healthy meals hence staff are
forced to take the available unhealthy diets found in cafeterias thereby, exposing risks to
cardiovascular disease. Population based studies show that with this continuous rise in risk
factors, by 2030 over 23 million people will die from CVDs each year.

Contemporary studies and research show that up to 90% of CVDs may be preventable and
treatable by addressing behavioral risk factors using population wide-strategies and with initial
treatment primarily focused on diet and lifestyle interventions respectively. The effects of
behavioral risk factors among SEKU staffs show up as raised blood glucose, raised blood
pressure, raised blood lipids and overweight and obesity. These risk factors can lead to metabolic
changes, which can then alter genetic expression for the same condition leading to future
inheritance to the changes. In order to stem the rising burden of CVDs risk factors among SEKU
staff, education and awareness to prevent or reverse this disease must be taken.
Justification of the study
Cardiovascular disease threatens progress towards the 2030 Agenda for Sustainable
Development which includes a target of reducing premature deaths from NCDs by one-third by
2030 and eradicating poverty hence, threatens the entire life of SEKU community. CVD impedes
poverty reduction initiatives, since they are life-long and expensive to treat, causing loss of
breadwinner, forcing millions of people into poverty. In addition, SEKU staff are highly exposed
to the major risk factors to cardiovascular disease due to environmental setting. It is therefore
hoped that the findings of this study will provide impetus on policy discussion in the institution
about health risk factors especially with regard to healthy diet and lifestyle intervention.

Objectives of the study

Main objective
To study the main risk factors to cardiovascular disease among staff in South Eastern Kenya
University.

Specific objectives
To determine the awareness level of risk factors to cardiovascular diseases among staff in SEKU

To examine the common risk factors amongst staffs

To determine the practices of behaviors/ healthy lifestyle towards CVD prevention

Research questions
Are staff in SEKU aware of the risk factors to cardiovascular diseases?

What are the common risk factors amongst the staff?

Are staff in SEKU practicing a healthy lifestyle?

Possible limitation of the study

Unwillingness of the staff to participate fully

Sincerity in providing information about their lifestyle practices

Difficulties in accessing the staff

Theoretical model
Health belief model
The Health Belief Model (HBM) was developed in the early 1950s by social scientists at the U.S.
Public Health Service in order to understand the failure of people to adopt disease prevention
strategies or screening tests for the early detection of disease. Later uses of HBM were for
patients' responses to symptoms and compliance with medical treatments. The HBM suggests
that a person's belief in a personal threat of an illness or disease together with a person's belief in
the effectiveness of the recommended health behavior or action will predict the likelihood the
person will adopt the behavior.

The HBM derives from psychological and behavioral theory with the foundation that the two
components of health-related behavior are 1) the desire to avoid illness, or conversely get well if
already ill; and, 2) the belief that a specific health action will prevent, or cure, illness. Ultimately,
an individual's course of action often depends on the person's perceptions of the benefits and
barriers related to health behavior. There are six constructs of the HBM. The first four constructs
were developed as the original tenets of the HBM. The last two were added as research about the
HBM evolved.

1. Perceived susceptibility - This refers to a person's subjective perception of the risk of

acquiring an illness or disease. There is wide variation in a person's feelings of personal
vulnerability to an illness or disease.

2. Perceived severity - This refers to a person's feelings on the seriousness of contracting an

illness or disease (or leaving the illness or disease untreated). There is wide variation in a
person's feelings of severity, and often a person considers the medical consequences (e.g
death, disability) and social consequences (e.g., family life, social relationships) when
evaluating the severity

3. Perceived benefits - This refers to a person's perception of the effectiveness of various

actions available to reduce the threat of illness or disease (or to cure illness or disease). The
course of action a person takes in preventing (or curing) illness or disease relies on
consideration and evaluation of both perceived susceptibility and perceived benefit, such that
the person would accept the recommended health action if it was perceived as beneficial.
 4. Perceived barriers - This refers to a person's feelings on the obstacles to performing a
recommended health action. There is wide variation in a person's feelings of barriers, or
impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness of
the actions against the perceptions that it may be expensive, dangerous (e.g., side effects),
unpleasant (e.g., painful), time-consuming, or inconvenient.

5. Cue to action - This is the stimulus needed to trigger the decision-making process to
accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing,
etc.) or external (e.g., advice from others, illness of family member, newspaper article, etc.).

6. Self-efficacy - This refers to the level of a person's confidence in his or her ability to
successfully perform a behavior. This construct was added to the model most recently in
mid-1980. Self-efficacy is a construct in many behavioral theories as it directly relates to
whether a person performs the desired behavior.

Therefore, HBM can significantly be applied in the prevention and management of

cardiovascular disease risk factors, especially the modifiable risk factors.
Conceptual framework

INDEPENDENT VARIABLES DEPENDENT VARIABLES

Awareness level on CVD

risk

 knowledge

● Attitude

● Education

Common risk factors to CVD

● Age CVD risk factors

among SEKU staff
● Physical activity

● Nutrition/diet

● Tobacco use and/ alcohol use

● Obesity and overweight

Healthy lifestyle
behaviors

● Adherence

● Behavioral factors

● Cardio-protective diet

● primordial prevention
LITERATURE REVIEW
This chapter outlines literature review on studies across the world related to risk factors to
cardiovascular disease.

1. AWARENESS LEVEL OF RISK FACTORS TO CVD

According to (Tareq L, Mohd shara and Anan s. Rajab, 2012) a study conducted to assess the
public knowledge and awareness of CVD and its risk factors Jordan, indicated a low level of
CVD knowledge and limited public awareness as a global issue. The participants in this study
were more likely to have better CVD knowledge scores if they were non-smokers, always or
often paid attention to their diets, reported having right weight, occupied a very high
socioeconomic level, held a university degree and had a positive family history.

A systematic review on knowledge and awareness of and perception towards CVD risk in sub-
Saharan Africa in 2017 records a general low-level knowledge and awareness, coupled with poor
perception. The proportion of participants who were unable to identify a single risk factor and
clinical symptoms for CVDs ranged from 1.8% in a study among hospital staff in Nigeria to a
high of 73% in a population-based survey in Uganda and 7%among university staff in Nigeria to
75.1% in a general population in Uganda respectively.

([Link]

A study conducted in western Kenya on cardiovascular health knowledge and prevention

practices in people living with HIV outlines participants knowledge of risk factors was low with
a mean (SD) score of 1.3 out of 10 possible and 77.7% could not identify any warning signs for
heart attack. (BMC Infectious diseases, 2015)

An investigation on prevalence, awareness treatment and hypertension according to a national

survey in Kenya, presents an overall of 24.5% of hypertension. Among individuals with
hypertension, only 15.6% were aware of their elevated blood pressure. Among those aware only
26.9% were on treatment and 51.7% among those on treatment had achieved blood pressure
control. Similar factors associated with awareness were older age (p= 0.013) and being male
(p<0-001). (BMC public health, 2018).
2. HEALTHY LIFESTYLE PRACTICES TOWARDS CVD
According to WHO recommendation on prevention of cardiovascular disease (2007) recommend
that, behaviors such as stopping smoking, taking regular physical activity and eating a healthy
diet promote health and have no known harmful effects. They also improve the sense of
wellbeing and are usually less expensive to the healthcare system than drug treatment, which
may also have adverse effects. Moreover, a cardioprotective diet should consist of a variety of
foods and should aim to achieve three major goals; a healthy body weight, a desirable lipid
profile, and a desirable blood pressure.

A healthy lifestyle behavior is much more important to the attaining optimal CVD health.
([Link]-Gutierrez, 2018). According to Steven A Claas [Link] (2016) study on the role of healthy
lifestyle in the primordial prevention of CVD revealed that appropriate dietary intake, including
limiting salt and saturated fat consumption, can reduce the risk of developing hypertension and
hyslipidemins. Regular activity is associated with lower blood pressure and healthier lipid
profiles. Behavioral factors such as stress management, sleep duration, portion control, and meal
timing may play a role in weight management and offer additional routes of intervention.

By living a healthy lifestyle, you can help keep your blood pressure, cholesterol, and blood sugar
levels normal and lower your risks for heart disease and heart attack. (Center for Disease Control
and Prevention, 2020).

According to a study in the United States on healthy factors in the primary prevention of
coronary heart disease among men found that, a majority of CHD events among US men may be
preventable through adherence to healthy practices, even among those taking medications for
hypertension or hypercholesterolemia. (SE Chieve.2006). In addition, adherence to healthy
lifestyle patterns may substantially lower the burden of CVD. (JunLV.2017)

According to Jennifer S LIn [Link] (2014) reviewed behavioral counselling to promote a healthy
lifestyle for CVD prevention in persons with cardiovascular risk factors studied that medium-
and high intensity diet and physical activity behavioral counselling in the overweight or obese
persons with CVD risk factors resulted in the consistent improvement across a variety of
important cardiovascular intermediate health outcome up to 2 years. High intensity combined
lifestyle counselling reduced diabetes incidence in the longer term

3. THE COMMON CARDIOVASCULAR RISK FACTORS

Age
It is not by the gray of the hair that one knows the age of the heart. (Edward Bulwer-Lytton).
According to Ravi Dhingoa, study on age as a cardiovascular risk factor found that age can be
classified as a modifiable factor partly by the modification of traditional co-existing CVD risk
factors through individualized subsequent management of the risk factors.

Age plays a vital role in the deterioration of cardiovascular functionally, resulting in an

increased risk of CVD in order adults, and these correspond to an overall decline in sex
hormones and their associated receptors. It is highly linked to a number of factors including
increased oxidative stress, inflammation, apoptosis and overall myocardial deterioration, and
degeneration (Jennifer L. Rudgers [Link], 2019). In the American Heart Association(AHA) 2019
Heart disease and stroke Statistical update, the incidence of CVD was reported to be 77.2% in
males and 78.2% in females, from ages 60-79 years.

Conventional clinical measures of cardiovascular function may underestimate the effects of age
on the cardiovascular system, explaining in part why age remains such a dominant factor. Age is
associated with increased comorbidity too and may itself influence behavioral risk factors (e.g.
creating barriers to exercise. There are also implications for pharmacological risk factor
management, due to altered pharmacokinetics and pharmacodynamics and a lack of drug trials in
the elderly. (Rupert A Payne [Link], 2012). According to Elisio Costa [Link] (2015) on aging and
cardiovascular risk said that the normal process of aging is highly associated with progressive
deterioration in structure and function of the heart and vasculature that likely contribute to the
development of CVD.

According to Dirk L Christensen (2016) blood pressure and plasma cholesterol levels increase
According to Dirk L Christensen (2016) blood pressure and plasma cholesterol levels increase
with age at a similar gradient in men and women, but absolute level of the majority of the risk
factors were higher in men. Therefore, fundamental mechanisms that dictate the pace of aging
could lead to significant advancement into both preventive and therapeutic treatment of CVD
(Brain J. North and David A. Sinclair)
Tobacco use
Tobacco use increases the risk for heart disease and heart attack. Tobacco smoke contains
nicotine that raises blood pressure and carbon monoxide which reduces the amount of oxygen in
the bloodstream. (CDC, 2019). In addition, smoking damages the endothelium, increases fatty
deposits in the arteries, increases clotting, raises low-density lipoprotein cholesterol, reduces
high-density lipoprotein and promotes coronary artery spasm. Moreover, it is estimated that
smoking increases the risk of stroke, coronary heart disease and impotence by 100%. Smoking
increases the risk of deaths from undiagnosed CHD by 300%

Nicotine is a dangerous and highly addictive chemical. It can cause an increase in blood
pressure, heart rate, flow of blood to the heart and a narrowing of the arteries (vessels that carry
blood). Nicotine may also contribute to the hardening of the arterial walls, which in turn, may
lead to heart attack.

Carbon monoxide decreases the amount of oxygen that is carried in the red blood cells. It also
increases the amount of cholesterol that is deposited into the inner lining of the arteries which,
over time, can cause the arteries to harden. This leads to heart disease, artery disease and
possibly heart attack. (Rupent A Payne)

Physical activity
More than 60% of the global population is not sufficiently active (WHO, 2019). Physical activity
protects you by regulating your weight and improving your body's use of insulin. Studies show
that doing 150 minutes of moderate physical activity every week or an hour of vigorous physical
activity every day will reduce your risk of coronary heart disease by 30%. Evidence suggests that
keeping active even if you have a risk factor for CVD may lower your risk of premature death
compared to inactive people with no risk factors for CVD (World Heart Federation, 2017).

According to THUSA study (Salome Krudger [Link] 2003) suggested that habitual physical
activity contributes to the low prevalence of coronary heart disease and a number of CVD risk
factors were significantly associated with physical inactivity, especially in overweight subjects.
Irrefutable evidence regarding health benefits of physical activity effectiveness is overwhelming
and plays a vital role in both the primary and secondary prevention of coronary artery disease
and have additional improvement in health status (DS. Prasad, 2009)
Overweight and obesity
According to cleve land clinic ( obesity and heart disease, 2019) show that Obesity and
overweight are linked to several factors that increase one's risk for cardiovascular disease
(coronary artery disease and stroke): High blood lipids, especially high triglycerides, LDL
cholesterol, and total cholesterol and low HDL cholesterol, High blood pressure, Impaired
glucose tolerance or type-2 (also called adult onset) diabetes and Metabolic syndrome

According to L Akil [Link] 2011 study on the relationship between obesity and CVD, Obesity was
found to be a major risk factor for the development of type-2 diabetes, asthma, hypertension,
stroke, coronary artery disease, cancer and cancer-related mortality, liver and gallbladder
diseases, sleep apnea, osteoarthritis, and gynecological complications. Obesity is associated with
elevated blood pressure, blood lipids, and blood glucose; changes in body weight are coincident
with changes in these risk factors for disease.

Cardiovascular disease (CVD) mortality and morbidity has been shown to be elevated in
individuals who are overweight, particularly with central deposition of adipose tissues.4
Abdominal obesity has been shown to be a risk factor for CVD worldwide.8 Obesity may be
associated with hypertension, dyslipidemia, diabetes, or insulin resistance, and elevated levels of
fibrinogen and C-reactive protein, all of which increase the risk of CVD events( L Akil [Link],
20119). In addition to CVD, obesity has been shown to increase the risk of high blood pressure.
According to the obesity paradox in CVD (S Carbone, 2019) show that Overweight and obesity
are strong risk factors for the development of CVD, particularly heart failure and coronary heart
disease. Although the exact mechanisms connecting obesity and the development of these
conditions are not completely understood, the ability of the adipose tissue to expand and produce
pro-inflammatory cytokines that can directly impair cardiac systolic and diastolic function as
well as the formation of atherosclerotic plaques plays a major role. Similarly, other body
composition changes typical of obesity can also lead to initial hemodynamic and structural
changes of heart.
Unhealthy diets
An unhealthy diet is one of the major risk factors for a range of chronic diseases, including
cardiovascular diseases, cancer, diabetes and other conditions linked to obesity. Specific
recommendations for a healthy diet include: eating more fruit, vegetables, legumes, nuts and
grains; cutting down on salt, sugar and fats. It is also advisable to choose unsaturated fats,
instead of saturated fats (WHO, 2019)

According to American Heart Association, 2017 reports that eating more heart healthy foods,
and less foods with high amounts of salt and trans fats, could save tens of thousands of lives.
And a low intake of healthy foods such as nuts, vegetables, whole grains and fruits combined
with higher intake of unhealthy dietary components, such as salt and trans-fat, is a major
contributor to deaths from cardiovascular disease.
STUDY METHODOLOGY
Research design
This study will use a descriptive cross-sectional study design among approximately 1200 staff in
SEKU faculty. The researcher anticipates collecting the data for about 3 weeks in the month of
November2020.

Study area
The study will be conducted at South Eastern Kenya University located in eastern province,
Yatta division, Kwa Vonza location. It is 13 kilometers from Kwa-vonza market along Kitui-
Machakos road in a serene environment conducive for studying. Its immediate neighbours
include Kenyatta university Kitui campus, the goat and sheep project (GASP) and Nyumbani
Village Children’s Home.

Study population and target population

The study population will be staff working in SEKU while study population will be staff aged
between 25 to 65 years of age. Both staff must have been working in the institution for the last 3
months prior to the study.

Inclusion
The study will include all staff aged 25-65 who have been working in SEKU past 3 months prior
to the study.

Exclusion
The study will exclude all staff below 25 and above 65 of aged and who have not been in SEKU
past 3 months prior to the study.

Study variables
The independent variables in the study are awareness level, knowledge coverage, common risk
factors, adherence and healthy behaviors while dependent variable is cardiovascular among staff.

Sampling techniques
The study design will use sample random sampling, probability sampling method where
participants are selected among SEKU staff.

Sample size determination

The sample size will be determined from all eligible staff using the Bliar E and Blair J (2015)
formula indicated below:
 N
n=
1+ N ( e ) 2

Where n= the desired sample size of population

N=the population size staff age 25 to 65 as at August)

e=the level of precision

N
n=
1+ N ( 0.05 ) 2

1200
n=
1+ 1200 ( 0.05 ) 2

1200
n=
4

n=300

n=300

The desired sample size(n) will therefore be 300 respondents.

Data collection tools and methods

An interview schedule with both open and closed ended questions will be used to collect
quantitative data from the sampled staff. The researcher will conduct face to face interviews
during data collection period. Data collection will involve questionnaire presented to the staff via
online platform and face-to-face.

Data validity and reliability

A pre-test will be conducted in Kenyatta university Kitui, where 10% of total sample size
interview schedules will be filled. Any noted difficulties in understanding the question, language
barrier and/or gaps in the interview schedule will appropriately be amended. The researcher shall
ensure completeness and consistency of the filled interview schedules.

Data management and analysis

The completed interview schedule will be numbered and packed in envelops marked with date of
data collection. The quantitative data will be coded, entered in a computer, cleared and analyzed
using statistical package for social science(SPSS) version 22 computer software. Descriptive
analysis will be done and analyzed data will be presented in frequency, percentages and measure
of central tendency.

Ethical consideration
The proposal will be approved by the school of nursing sciences and public health as well as
SEKU Research and Ethic Committee. The researcher will also request all sampled respondents
who consent in the participation of the study to sign a consent form in order to get their informed
consent. To maintain anonymity, no name or any identification details will be requested from the
respondents. Respondents will be assured of confidentiality which will be maintained throughout
the study period and beyond.
REFERENCES

Akil, L and others. (2011). Relationship between obesity and CVD.

[Link]

Anand, SS. (2015). Food consumption ad its impact on cardiovascular disease.

[Link]

Center for Disease Control and Prevention. (2020). [Link]

Cercato, C. (2019). [Link]>articles

Chieve, S. (2006) Adherence to healthy lifestyle practices among US men.

[Link]

Christensen, DL. (2016). Age-annuals of human biology 43(1), 42-49, 2016

Cleveland clinic. (2019). Obesity and Heart Disease. 2019-my-

[Link]>health>articles>17038-obesity-heartdisease

Costa, e. and others. (2015). Aging and cardiovascular risk. [Link]

Haregu, T. N, Oti, S, Engondi, T and Kyobutungi, C. (2015) cooccurrence of behavioral risk

factors of common non-communicable disease. Nairobi. Kenya.
[Link]

Https://[Link]/tobacco/data. Statistics/sgr/ 50th-aniversary. Pdfs-smoking. CVD.508 pdf.

[Link]

[Link]

[Link] org. risk-factors-CVD

Joshi, MD and others. (2014). Prevalence of hypertension and associated cardiovascular risk
factors: a population-based survey. Nairobi. Kenya.

Jun LV. (2017). Journal of the American college of cardiology. Adherence to healthy lifestyle
and CVD in Chinese. [Link]
Kruger, S H. Ventur, C S and Voster, H H. (2003). The THUSA study: cardiovascular topics.
South Africa.

Niem, NH. Miicunpalo, S. Pasanen, M. Vuori, I. Oja P and Malmberg, S. (200). International
journal of obesity 24 (11), 1465-1474,2000

Payne, R.A. (2012). Cardiovascular risk. Cambridge, UK.

[Link]

Prasad, DS. (2009). Physical activity: a cardiovascular risk factor. Indian journal of medical
sciences 63(1)2009

Rigolti, N.A. and Clair, C. ( November2013). Managing tobacco use: the neglected
cardiovascular disease risk factor. [Link]

Rudgers, JL and others. (2019). Cardiovascular risks associated with Gender and Aging. A
review on journal of cardiovascular development and disease.

Warbutune, D. (2006). Health benefits of physical activity: the evidence.

WHO. (2007). Prevention of cardiovascular disease.

WHO. World Health Report 2002: reducing risks, promoting healthly life. Genera:WHO;2002

World Heart Federation. (20 May 2017). Risk factors. [Link]-heart-federation-org.

APPENDIXES
APPENDIX 1: SAMPLE QUESTAINNAIRE
The purpose of this study is purely academic and more so to contribute to the understanding of
the constraints of risk factors to the exposure or/and containment of cardiovascular disease
among SEKU staff. Respondents are requested to voluntarily participate in answering this
questionnaire and are assured that any information shared would strictly be confidential.

Date of interview.

Name of enumerator

SECTION A: demographic profile

1 Gender: male [ ] female [ ]

2 Age bracket: [25-35] [36-46] [47-57 ] [Above 58]

3 Highest level of education

1 University/collage 2 secondary
3 primary 4 none

4 How long have you been in this institution?

5 What position do you hold in your job?

SECTION B: risk factors profile

1 Have you ever heard of any risk factors to cardiovascular disease? Yes, or no
2 If yes, what was the source of your information? Television, radio, newspapers, internet,
health professionals, friends
3 Could you tell if someone is having cardiovascular disease? If yes what are the warning
signs or symptoms?
4 Can you tell me what are the major causes of heart disease or heart problems?

5 Do you know the difference between good fats and bad fats in food?

6 Which of these behaviors can help reduce the risk of a heart attack or stroke?
 No smoking---------------
 Reduce salt in food------------
 To control weight--------------
 Reduce stress-----------------------
 Not drink alcohol heavily---------------
 Eat more fresh vegetables and fruits-------------
7 Have you ever had heart attack, heart pain or stroke? Yes--------------- No------------------
8 Do you have a cardiovascular family history? Yes----------------- No-----------------
9 Are you hypertensive? Yes---------No------------
10 Are you diabetic Yes------------ No--------------
11 How often do you usually eat fried food?
12 How many teaspoons of sugar do you consume in a day?
13 How many serves of vegetables and fruits do you usually eat per day?
14 Are you practicing any health promotion and prevention intervention? Yes---- No-----
15 Smoking
  Never smoked--------------------- Ex-smoker-----------------------
 Current smoker less than 20 cigarettes/day --------------------
 Current smoker more than 20 cigarettes/day --------------------
 Passive smoking (a non-smoker exposed to smoke most days at home or work)-----
16 Alcohol
 Average 0 drinks daily--------------------------- Average 1 drink daily or 7 units per
week ----
 Average 2 drinks daily or 14 units per week---------------- Average 3 or more
drinks daily---

17 Exercise. Moderate exercise is brisk walking, jogging, cycling, swimming, playing sports
or any exercise that increases breathing and heart rate continuously for at least 20 minute
 Sedentary – moderate exercise less than once a week-----------
 Moderate exercise (average once per week) -----------------------
 Moderate exercise (average 2 – 3 times per week) --------------
 Moderate exercise (average 4 – 5 times per week) ------------
 Moderate exercise (average 5 or more times per week) ---------

SECTION C: Clinical parameter profile

18 Weight of the respondent

19 Height of the respondent
20 BMI measurement
21 Blood

APPENDIX 2: WORK PLAN

ACTIVITY MONTH
Writing of proposal February to August 2020
 Starting study, data collection, analysis and September to November 2020
interpretation
Writing up and presentation of final report November

APPENDIX 3: BUDGET
ITEM UNITS REQUIRED UNIT COST (KSH) TOTAL COST
(KSH)
Personal daily 500 times 30 days 15000
subsistence
Transport to and from 60 ksh 60 times30 days 1800
Data forms 50 5 times 50 250
Pens and pencil 5 5 times 25 125
miscellaneous 350
Grand total 17525

APPENDIX 4: Informed Consent

My name is Charo Charity Huruma, a student at SEKU pursuing BSC. Population health and
undertaking a research study on cardiovascular risk factor among SEKU staff. This study is
voluntary and does not pose any risk to anyone. The information given is private and confidential
and will be used for academic purpose and for health policies and efficient education
intervention in the institution. I therefore request you to participate in answering questionnaire
honestly and frankly.

Date ………………………………….. Signature of the respondent…………………………..