Project – Assessing the prevalence and risk factors of non-communicable diseases among urban slum populations in Nigeria

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Non-communicable diseases (NCDs) such as hypertension, diabetes mellitus, cardiovascular diseases, cancers, and chronic respiratory diseases are increasingly recognized as major contributors to global morbidity and mortality (World Health Organization [WHO], 2023). In Nigeria, NCDs now account for nearly one-third of all deaths, reflecting a clear shift from infectious to chronic diseases (Odunyemi et al., 2023). This growing burden is particularly concerning among urban poor populations, where living conditions and limited access to health care exacerbate vulnerability (Akinwale et al., 2013).

Urban slums are characterized by overcrowding, poor sanitation, food insecurity, and limited access to quality health services. These conditions foster risk behaviors such as unhealthy diets, physical inactivity, harmful alcohol use, and tobacco consumption, which are major modifiable risk factors for NCDs (Uthman et al., 2022). Studies conducted in Nigerian slums—such as Makoko, Ajegunle, and Ijora-Oloye in Lagos—have reported high rates of hypertension (20%–40%) and growing prevalence of diabetes and pre-diabetes (Akinwale et al., 2013; Daniel et al., 2013). Many of these cases remain undiagnosed or poorly controlled due to limited access to screening and treatment services (Olamoyegun et al., 2024).

Globally, systematic reviews confirm that hypertension and diabetes are increasingly prevalent in slum populations compared with non-slum urban settings (Uthman et al., 2022). Factors such as poverty, chronic stress, sedentary lifestyles, and dietary transitions toward processed foods contribute to this rise (WHO, 2023). Within Nigeria, socio-economic inequalities, poor health literacy, and fragmented health systems further amplify the risk (Odunyemi et al., 2023).

Understanding the prevalence and determinants of NCDs among slum dwellers is crucial for designing equitable health interventions. Data from such studies will help inform community-based health promotion, early screening programs, and chronic disease management models tailored to the realities of slum communities.

1.2 Statement of the Problem

Although Nigeria has made progress in infectious disease control, NCDs are emerging as a silent epidemic in marginalized communities. Urban slums, which house a significant portion of Nigeria’s rapidly growing urban population, experience limited access to preventive and curative health services (Uthman et al., 2022). Previous research indicates that many slum residents are unaware of their hypertensive or diabetic status until complications arise (Daniel et al., 2013). Poor health-seeking behavior, low income, high stress, and limited awareness about healthy lifestyles further worsen the situation (Akinwale et al., 2013).

Despite numerous policy frameworks targeting NCD prevention—such as the National Multi-Sectoral Action Plan for the Prevention and Control of NCDs (Federal Ministry of Health [FMOH], 2019)—implementation remains weak at the community level. Most available data on NCDs in Nigeria derive from urban hospitals or regional surveys, with little focus on slum populations. Therefore, there is a pressing need to assess the prevalence of and risk factors for NCDs among urban slum residents to inform targeted interventions and reduce the growing burden of chronic diseases.

1.3 Objectives of the Study

General Objective

To assess the prevalence and risk factors of non-communicable diseases—specifically hypertension and diabetes—among urban slum populations in Nigeria.

Specific Objectives

1. To determine the prevalence of hypertension among adults living in selected urban slums in Nigeria.

2. To determine the prevalence of diabetes and pre-diabetes in these populations.

3. To identify the socio-demographic, behavioral, and environmental risk factors associated with hypertension and diabetes among slum dwellers.

4. To assess awareness, treatment, and control rates of hypertension and diabetes among the study population.

5. To explore barriers to screening, diagnosis, and management of NCDs in urban slum settings.

1.4 Research Hypothesis

• Null Hypothesis (H₀): There is no significant association between selected risk factors (e.g., age, BMI, tobacco use, alcohol consumption, physical inactivity, and diet) and the occurrence of hypertension or diabetes among urban slum residents in Nigeria.

• Alternative Hypothesis (H₁): There is a significant association between selected risk factors (e.g., age, BMI, tobacco use, alcohol consumption, physical inactivity, and diet) and the occurrence of hypertension or diabetes among urban slum residents in Nigeria.

1.5 Significance of the Study

This study is significant for several reasons:

1. Policy Implications: Findings will support government agencies and stakeholders in designing evidence-based health policies to address NCDs among underserved populations (Odunyemi et al., 2023).

2. Public Health Impact: The study will help identify modifiable risk factors and guide preventive interventions such as lifestyle education, community-based screening, and treatment programs (WHO, 2023).

3. Equity and Advocacy: Documenting the NCD burden in slums highlights health inequities, strengthening advocacy for equitable resource distribution (Uthman et al., 2022).

4. Academic Contribution: This research adds to the existing literature on NCD epidemiology and health disparities in low-income urban populations (Olamoyegun et al., 2024).

5. Community Empowerment: Understanding barriers to care can empower communities to demand improved health services and adopt healthier behaviors (Daniel et al., 2013).

1.6 Scope and Limitation of the Study

This study focuses on selected urban slums in Nigeria, such as those located in Lagos and other major cities. It will assess adults aged 18 years and above, focusing primarily on hypertension and diabetes as representative NCDs. Data collection will include anthropometric measurements, blood pressure, blood glucose levels, and questionnaires on lifestyle and socio-demographic characteristics.

Limitations:

• Cross-sectional design limits the ability to infer causality.

• Limited funding and logistics may restrict sample size and geographic coverage.

• Self-reported data on lifestyle behaviors may be prone to recall bias.

• Variations among slums may affect the generalizability of findings.

1.7 Definition of Terms

• Non-Communicable Diseases (NCDs): Chronic diseases not transmitted from person to person, such as hypertension, diabetes, and cardiovascular diseases.

• Hypertension: Persistent elevation of blood pressure above 140/90 mmHg or current use of antihypertensive medication.

• Diabetes Mellitus: A metabolic disorder characterized by elevated blood glucose levels (fasting glucose ≥7.0 mmol/L or random glucose ≥11.1 mmol/L).

• Urban Slum: An area characterized by overcrowding, poor housing, inadequate sanitation, and limited access to social and health services.

• Risk Factor: Any attribute, behavior, or exposure that increases the likelihood of developing a disease.

• Prevalence: The proportion of a population found to have a condition at a given time.

1.8 Organization of the Study

This study is organized into five chapters:

• Chapter One: Introduction, which includes the background, problem statement, objectives, hypothesis, significance, and scope of the study.

• Chapter Two: Literature review, covering theoretical and empirical studies on NCDs in slum populations.

• Chapter Three: Methodology, detailing research design, population, sampling, data collection, and analysis techniques.

• Chapter Four: Results and discussion, presenting data analysis and interpretation of findings.

• Chapter Five: Summary, conclusions, and recommendations for policy and practice.

Project – Assessing the prevalence and risk factors of non-communicable diseases among urban slum populations in Nigeria