Project – Knowledge and Practice of Cardiovascular Disease Prevention among Civil Servants.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Cardiovascular diseases (CVDs) constitute a major public-health challenge and comprise disorders affecting the heart and blood vessels, including coronary heart disease, cerebrovascular disease, heart failure and other vascular conditions. They remain the leading cause of death globally, accounting for an estimated 19.8 million deaths in 2022, representing about 32% of all deaths worldwide, with approximately 85% of these deaths attributable to heart attacks and strokes. More than three-quarters of cardiovascular deaths occur in low- and middle-income countries, making CVD prevention particularly important in countries such as Nigeria. The World Health Organization (WHO) identifies unhealthy diet, physical inactivity, tobacco use and harmful alcohol consumption as major behavioural risk factors, while hypertension, raised blood glucose, abnormal blood lipids and overweight/obesity constitute important intermediate risk factors (World Health Organization [WHO], 2025).

The burden of cardiovascular disease is particularly significant because many of its major risk factors are preventable or controllable through appropriate health behaviours and early intervention. WHO (2025) indicates that cessation of tobacco use, reduction of dietary salt, increased consumption of fruits and vegetables, regular physical activity, avoidance of harmful alcohol use and appropriate management of hypertension, diabetes and abnormal blood lipids can substantially reduce cardiovascular risk. However, prevention requires more than the availability of medical services; individuals need sufficient knowledge to recognise risk factors and translate that knowledge into appropriate preventive practices. The WHO STEPwise approach to non-communicable disease surveillance consequently places emphasis on assessing behavioural risk factors such as tobacco use, alcohol consumption, unhealthy diet and physical inactivity alongside biological factors such as raised blood pressure, overweight, raised blood glucose and abnormal blood lipids (WHO, 2025).

Nigeria is experiencing an increasing burden of cardiovascular and other non-communicable diseases alongside its continuing burden of communicable diseases. National evidence from a WHO STEPwise-based survey involving 4,192 Nigerian adults reported an age-standardised hypertension prevalence of 38.1%, with the South-West geopolitical zone recording a prevalence of 42.1%. Hypertension is particularly important because it is one of the most important modifiable risk factors for cardiovascular events such as stroke and heart disease. The same national evidence demonstrated substantial variation in hypertension according to age, with prevalence increasing markedly among older adults (Akinkugbe et al., 2020). These findings demonstrate that cardiovascular risk is already substantial among Nigerian adults and reinforce the need for prevention strategies that identify and address risk factors before serious cardiovascular events occur.

The workplace represents an important setting for cardiovascular disease prevention because adults spend a substantial proportion of their productive years at work and occupational environments can influence physical activity, dietary behaviour, stress, smoking, alcohol consumption and access to health information. Civil servants constitute an important component of the formal workforce, and many administrative occupations involve prolonged sitting, computer-based work and limited occupational physical activity. A study among 305 senior civil servants in Lagos State found that 43.3% of participants were physically inactive, although 56.7% were classified as active according to the study’s physical-activity assessment. The study further found that educational status and occupational cadre were significantly associated with physical-activity levels and recommended workplace strategies to improve physical activity among Lagos State civil servants (Owoeye et al., 2013). This evidence makes civil servants an important population for examining cardiovascular disease prevention practices in Lagos State.

Evidence from Southwestern Nigeria further demonstrates the presence of multiple cardiovascular risk factors among government employees. A study of 260 local government civil servants in Oyo State found that 57.7% had good knowledge of cardiovascular risk factors, while substantial proportions had physical inactivity, visceral obesity, hypertension, diabetes, elevated cholesterol and other cardiovascular risk factors. Specifically, physical inactivity was observed among 84.6% of participants, obesity among 24.6%, systolic hypertension among 29.6%, and elevated total cholesterol among 55.4%. The study also found that age of 40 years or more, management cadre, obesity, abnormal waist circumference and physical inactivity were associated with higher likelihood of cardiovascular risk. These findings demonstrate that having some knowledge of cardiovascular risk factors does not necessarily mean that workers practise behaviours that reduce their cardiovascular risk (Adebiyi et al., 2020).

Knowledge is an important component of cardiovascular disease prevention because individuals who understand the causes, warning signs and risk factors of CVD may be better positioned to adopt preventive behaviours and seek appropriate medical care. However, evidence from Nigeria suggests that knowledge can be incomplete even among educated working populations. In a study involving secondary school teachers and civil-servant controls in Oyo State, hypertension and heart attack were among the cardiovascular conditions most commonly recognised, but knowledge of several other cardiovascular diseases and risk factors was inadequate. The study identified gaps in knowledge concerning factors such as sedentary living, stress, smoking and advanced age and concluded that cardiovascular health knowledge required improvement (Awosan et al., 2012). Similarly, Omoronyia (2017) reported that baseline knowledge and practices of cardiovascular disease prevention among civil servants in Cross River State were generally poor, while a structured educational intervention subsequently improved knowledge, risk perception and selected preventive practices. These findings indicate that knowledge should be examined together with actual preventive practices rather than treated as an outcome sufficient on its own.

The relationship between knowledge and practice is especially important in the context of civil servants working in Alausa, Lagos State. Alausa is a major administrative and government-service environment in Lagos, where employees may experience occupational demands associated with sedentary work, commuting, work-related stress and limited opportunities for structured physical activity during working hours. Although previous studies have documented cardiovascular risk among Lagos civil servants and public servants in Southwestern Nigeria, the available evidence does not necessarily describe the current knowledge and preventive practices of workers across selected ministries in Alausa. Existing research among Lagos senior civil servants has focused particularly on physical-activity profiles, while studies elsewhere in Southwestern Nigeria have examined cardiovascular risk profiles and knowledge. A focused assessment among selected ministries in Alausa can therefore provide institution-specific evidence concerning what civil servants know about CVD prevention and the extent to which they practise recommended preventive behaviours (Owoeye et al., 2013; Adebiyi et al., 2020).

Cardiovascular disease prevention among civil servants is also important because workplace health practices may influence productivity, absenteeism, healthcare utilisation and long-term workforce health. Cardiovascular events occurring during economically productive years can have consequences not only for affected individuals and their families but also for institutions that depend on a healthy workforce. Nigerian research among local government civil servants found that approximately one-sixth of respondents had a high predicted 10-year cardiovascular risk, while physical inactivity, obesity and abnormal waist circumference were associated with increased cardiovascular risk (Adebiyi et al., 2020). WHO similarly emphasises that early identification and management of cardiovascular risk factors can prevent heart attacks, strokes and premature deaths. Therefore, assessing knowledge and actual preventive practices among civil servants in selected ministries in Alausa can provide useful evidence for workplace health promotion, routine screening, lifestyle modification and institutional cardiovascular disease prevention programmes (WHO, 2025; Adebiyi et al., 2020).

1.2 Statement of the Problem

Cardiovascular diseases remain a major cause of morbidity and mortality globally, with approximately 19.8 million deaths attributed to CVDs in 2022. The burden is particularly concerning in low- and middle-income countries, which account for more than three-quarters of cardiovascular deaths. Nigeria is similarly affected, with national evidence showing a substantial prevalence of hypertension, one of the principal modifiable risk factors for cardiovascular disease. The high burden of cardiovascular risk factors indicates that prevention must become an important component of public-health practice rather than focusing solely on the treatment of established cardiovascular disease (WHO, 2025; Akinkugbe et al., 2020).

The problem is particularly relevant among civil servants because the nature of administrative employment can encourage sedentary behaviour and other lifestyle practices associated with cardiovascular risk. Evidence from Lagos State showed that 43.3% of senior civil servants included in a study were physically inactive, while evidence from Oyo State demonstrated even higher levels of physical inactivity among local government civil servants alongside obesity, hypertension, diabetes and abnormal cholesterol levels. These findings suggest that workers may be exposed to multiple cardiovascular risk factors during their productive years. However, the existence of risk factors alone does not establish whether workers understand cardiovascular disease prevention or whether they regularly practise behaviours such as healthy eating, physical activity, smoking avoidance, moderation of alcohol consumption and routine health screening (Owoeye et al., 2013; Adebiyi et al., 2020).

Another concern is the possible gap between knowledge and practice. Evidence among Nigerian civil servants has shown that knowledge of cardiovascular risk factors may be moderate or good while important behavioural risk factors remain prevalent. In Oyo State, 57.7% of local government civil servants demonstrated good knowledge of CVD risk factors, yet 84.6% were physically inactive, while obesity, hypertension, diabetes and elevated cholesterol were also observed. Similarly, an educational intervention among Nigerian civil servants demonstrated that knowledge and selected preventive practices could improve following structured cardiovascular health education (Adebiyi et al., 2020; Omoronyia, 2017). This suggests that merely providing health information may not automatically translate into healthy behaviour and that assessing both knowledge and practice is necessary to understand the effectiveness and limitations of cardiovascular disease prevention among workers.

Despite existing evidence from Lagos and other parts of Southwestern Nigeria, there is a need for current, setting-specific information concerning cardiovascular disease prevention among civil servants working in selected ministries in Alausa, Lagos State. Previous studies have examined physical activity among Lagos senior civil servants and cardiovascular risk among civil servants in Oyo State, but these studies do not directly provide a comprehensive assessment of knowledge and preventive practices among workers in selected Alausa ministries. Without such information, it may be difficult to determine whether civil servants possess adequate knowledge of cardiovascular disease prevention and whether this knowledge is reflected in their everyday health practices. Therefore, this study seeks to assess the knowledge and practice of cardiovascular disease prevention among civil servants in selected ministries in Alausa, Lagos State, with particular attention to knowledge of risk factors, healthy lifestyle practices, physical activity, dietary practices, smoking and alcohol-related behaviours, health screening and other preventive measures (Owoeye et al., 2013; Adebiyi et al., 2020; WHO, 2025).

1.3 Purpose of the Study

The main purpose of this study is to assess the knowledge and practice of cardiovascular disease prevention among civil servants in selected ministries in Alausa, Lagos State.

Specific Objectives

The study seeks to:

1. assess the level of knowledge of cardiovascular disease and its risk factors among civil servants in selected ministries in Alausa;
2. determine the level of knowledge of recommended cardiovascular disease preventive measures among the respondents;
3. assess the cardiovascular disease prevention practices of civil servants in the selected ministries;
4. determine the extent to which civil servants practise healthy dietary behaviours for cardiovascular disease prevention

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of cardiovascular disease and its risk factors among civil servants in selected ministries in Alausa?
2. What is the level of knowledge of recommended cardiovascular disease preventive measures among the respondents?
3. What cardiovascular disease prevention practices are adopted by civil servants in the selected ministries?
4. To what extent do civil servants practise healthy dietary behaviours for cardiovascular disease prevention?

1.5 Research Hypothesis

The following null hypothesis will be tested at 0.05 level of significance:

H₀: There is no statistically significant relationship between knowledge of cardiovascular disease prevention and preventive practices among civil servants in selected ministries in Alausa, Lagos State.

1.6 Significance of the Study

Civil Servants

The study will be beneficial to civil servants because it will provide information about cardiovascular disease, its risk factors and practical measures for prevention. The findings may encourage workers to pay greater attention to physical activity, dietary practices, weight management, blood-pressure monitoring, smoking avoidance and appropriate alcohol consumption.

Ministry Management

The study will provide management of the selected ministries with evidence concerning the cardiovascular health knowledge and preventive practices of their workforce. Such information may assist ministries in considering workplace wellness activities, health education programmes and opportunities for periodic health screening.

Public-Health Practitioners

The findings will be useful to public-health professionals by providing information on cardiovascular disease prevention within an occupational population. The findings may assist in designing targeted workplace interventions addressing modifiable risk factors such as physical inactivity, unhealthy diet, obesity, tobacco use and harmful alcohol consumption.

Occupational Health Services

The study will be useful to occupational health personnel and healthcare providers responsible for workers’ health. Evidence from the study may support routine screening for blood pressure, body weight and other cardiovascular risk indicators, as well as counselling and referral of workers identified as being at increased risk.

Lagos State Government

The study may provide the Lagos State Government with evidence that can inform workplace non-communicable disease prevention strategies. Since civil servants constitute a substantial part of the formal workforce, strengthening cardiovascular health promotion among them may form part of broader strategies for reducing preventable NCD risk.

Researchers and Students

The study will contribute to the existing body of knowledge on cardiovascular disease prevention among Nigerian workers. It may also provide baseline information for subsequent researchers investigating knowledge, attitudes, practices and cardiovascular risk among civil servants and other occupational groups.

1.7 Scope of the Study

The study will focus on the knowledge and practice of cardiovascular disease prevention among civil servants in selected ministries in Alausa, Lagos State.

The geographical scope will be restricted to selected ministries located in the Alausa administrative area of Lagos State.

The population scope will consist of civil servants working in the selected ministries who meet the inclusion criteria established for the study.

The content scope will cover knowledge of cardiovascular disease, knowledge of cardiovascular disease risk factors and knowledge of preventive measures. The study will also examine preventive practices, including dietary practices, physical activity, smoking-related behaviour, alcohol consumption, weight management, blood-pressure monitoring, routine health screening and health-seeking behaviour.

The study will focus primarily on prevention rather than clinical diagnosis or treatment of established cardiovascular disease. However, selected cardiovascular risk indicators may be assessed where appropriate to provide contextual information about the respondents’ preventive health practices.

1.8 Operational Definition of Terms

Cardiovascular Disease (CVD): A group of disorders affecting the heart and blood vessels, including coronary heart disease, cerebrovascular disease, heart failure and other diseases of the circulatory system.

Cardiovascular Disease Prevention: Actions undertaken by individuals or health systems to reduce the occurrence or progression of cardiovascular disease through risk-factor modification, healthy lifestyle practices, screening and appropriate management.

Knowledge: The level of accurate information and understanding possessed by respondents concerning cardiovascular disease, its risk factors, warning signs and preventive measures.

Practice: The actual behaviours and actions undertaken by respondents to prevent cardiovascular disease, including healthy eating, physical activity, avoidance of tobacco, appropriate alcohol use and routine health checks.

Civil Servant: An employee of the government working within a ministry or government department and receiving remuneration from the public service.

Risk Factor: A characteristic, behaviour or condition that increases the likelihood of developing cardiovascular disease. Examples include hypertension, physical inactivity, unhealthy diet, obesity, smoking, harmful alcohol use, diabetes and abnormal blood lipids.

Physical Activity: Any bodily movement produced by skeletal muscles that requires energy expenditure, including walking, exercise, sports, occupational activity and other forms of active movement.

Healthy Dietary Practice: Regular consumption of foods consistent with cardiovascular health, including fruits, vegetables and other nutrient-dense foods, while limiting excessive salt, unhealthy fats, added sugars and highly processed foods.

Health Screening: The process of checking individuals who may not have obvious symptoms for cardiovascular risk indicators such as raised blood pressure, obesity, elevated blood glucose or abnormal blood lipids.

Project – Knowledge and Practice of Cardiovascular Disease Prevention among Civil Servants.