Prevalence, trends and distribution of lifestyle cancer risk factors in Uganda: a 20-year systematic review

Abstract

Background: Cancer is becoming an important public health problem in Uganda. Cancer control requires surveillance of lifestyle risk factors to inform targeted interventions. However, only one national Non-Communicable Disease (NCD) risk factor survey has been conducted in Uganda. This review assessed the prevalence, trends and distribution of lifestyle risk factors in Uganda.

Methods: The review identified studies up to January 2019 by searching Medline, Embase, CINAL and Cochrane databases. Further literature was identified from relevant websites and journals; scanning reference lists of relevant articles; and citation searching using Google Scholar. To be eligible, studies had to have been conducted in Uganda, and report prevalence estimates for at least one lifestyle cancer risk factor. Narrative and systematic synthesis was used to analyse the data.

Results: Twenty-four studies were included in the review. Overall, unhealthy diet (88%) was the most prevalent lifestyle risk factor for both males and females. This was followed by harmful use of alcohol (range of 14.3% to 26%) for men, and being overweight (range of 9% to 24%) for women. Tobacco use (range of 0.8% to 10.1%) and physical inactivity (range of 3.7% to 4.9%) were shown to be relatively less prevalent in Uganda. Tobacco use and harmful use of alcohol were more common in males and more prevalent in Northern region, while being overweight (BMI > 25 kg/m2) and physical inactivity were more common in females and more prevalent in Central region. Tobacco use was more prevalent among the rural populations compared to urban, while physical inactivity and being overweight were more common in urban than in rural settings. Tobacco use has decreased overtime, while being overweight increased in all regions and for both sexes.

Conclusion: There is limited data about lifestyle risk factors in Uganda. Apart from tobacco use, other lifestyle risk factors seem to be increasing and there is variation in the prevalence of lifestyle risk factors among the different populations in Uganda. Prevention of lifestyle cancer risk factors requires targeted interventions and a multi-sectoral approach. Most importantly, improving the availability, measurement and comparability of cancer risk factor data should be a top priority for future research in Uganda and other low-resource settings.

Keywords: Cancer; Control; Lifestyle; Prevalence; Risk-factors; Surveillance; Trends.

Fig. 1

Study Selection Process: PRISMA Flow Diagram

Fig. 2

Trends of tobacco use by sex, rural, urban and overall populations in Uganda

Fig. 3

Prevalence and trends in tobacco use among Geo-political regions in Uganda

Fig. 4

Factors associated with tobacco use in Uganda BMI Body Mass Index, Ed. Education. * Adjusted odds ratios for sex, age, education, region of residence and BMI, using weighted logistic regression. The bars represent the respective 95% confidence intervals

Fig. 5

Factors associated with harmful use of alcohol in Uganda, as reported by MOH (2016), in Kabwana (2016) *Adjusted odds ratios for sex, age, region of residence and tribe, using weighted logistic regression. The bars represent the respective 95% confidence intervals

Fig. 6

Factors associated with physical inactivity in Uganda according to MOH (2016), in Kirunda (2016) * Adjusted odds ratios for sex, age, residence, BMI, employment and education using weighted logistic regression. The bars represent the respective 95% confidence intervals

Fig. 7

Prevalence of overweight and obesity (> 25 kg/m2) in Uganda NB: "0%" means no data for that year

Fig. 8

Prevalence and trends of overweight among geo-political regions in Uganda

Fig. 9

Prevalence trends of being overweight by education and wealth status among females in Uganda