Perception and Screening Practices for NonCommunicable Diseases among Pentecostals in a Semi-Urban Community: A Divergence from Paradigm

Obiebi IP*

Delta State University Teaching Hospital, PMB 07, Oghara, Delta state, Nigeria

*Corresponding Author:
Obiebi IP
Delta State University Teaching Hospital
PMB 07, Oghara, Delta state, Nigeria
Tel: +234 (0) 8067315468
E-mail: [email protected]

Received Date: April 02, 2018; Accepted Date: April 22, 2018; Published Date: April 30, 2018

Citation: Obiebi IP (2018) Perception and Screening Practices for Non-Communicable Diseases among Pentecostals in a Semi-Urban Community: A Divergence from Paradigm. Glob J Res Rev Vol.5 No.1:5

 
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Abstract

Background: Anecdotal evidence suggests a rising incidence of noncommunicable diseases (NCDs) and a common attitude of “spiritualizing” diseases among Pentecostals. Some risk factors are modifiable and/or preventable thus understanding the level awareness of risk factors, causes, features of and screening practices for common NCDs among Pentecostals in Sapele, Delta state has become imperative so as to provide a premise for instituting interventions that will tackle NCDs in our locality. Methodology: This study was conducted among Pentecostals in Sapele, Delta state by adopting a descriptive cross-sectional design. A two-stage sampling involving firstly a simple random technique and then a stratified sampling method with proportionate allocation was applied to select study participants. The study instrument was a pre-tested semi-structured self-administered questionnaire. Data generated was analyzed with SPSS software version 22. Results: Males were marginally more than females (53.1% vs. 46.9%). Age group 40-49 years was most frequent (40.6%) with a mean age of 38.15 years for all participants. All participants were aware of diabetes mellitus, kidney failure (disease) and hypertension. Significant proportion of the respondents opined that diabetes (68.8%), hypertension (93.8%) and kidney failure (96.9%) can be prevented; and 62.5% agreed that a healthy lifestyle was important for preventing these diseases. Majority (71.9%) identified dietary control as a means of cure but more than three-fifth did not know drugs or herbal concoction could be applied in treating diabetes. Over three-fifth (62.5%) did not know dialysis was a renal replacement therapy. A sizeable proportion of all participants had never checked their weight, blood pressure, fasting blood sugar, lipid profile, HIV and HBV status. Conclusion: All participants were aware of diabetes; hypertension and kidney disease and all knew what hypertension represented. Nonetheless, the significant disparity in their screening practices indicates that health promotion based on health belief model is required to change their poor screening practice.

Keywords

Screening practices; Spiritualizing; Non-communicable diseases; Divergence from paradigm; Pentecostals

Background

Non-communicable diseases (NCDs) are usually long-standing non-infectious medical conditions and health states or events, with slow, often unnoticeable progression though some NCDs occur suddenly and rapidly e.g., road traffic accidents, rapes, burn etc. Underlying most NCDs are bio-psychosocial factors which are generally known as modifiable and non-modifiable risk factors [1]. Extraneous factors such as sedentary living, unsafe reproductive and/or sexual behaviour, tobacco exposure, harmful alcohol ingestion etc., all constitute changeable (adjustable or modifiable) risk factors. Exposure to these factors interact with unchangeable (fixed) factors such as genetics, age, ethnicity or race, gender and family history and induces changes in the homeostasis of the body to amplify the risk for initiating and developing NCDs [2].

Globally, non-communicable diseases are becoming an epidemic accounting for most deaths annually. Developing countries like Nigeria with very poor socio-economic and infrastructural development are among the worst hit due to inadequate and unequal access to facilities and services for prevention, early diagnosis and treatment of non-communicable diseases [3,4]. The burdens of NCDs borne by the population are enormous and more profound among low and middle-income countries in which majority of mortalities are recorded [4].

NCDs are the most important cause of death, representing over 60% of deaths and killing over 36 million people globally each year. In 2015, WHO estimated 15.0 million deaths from noncommunicable diseases among people aged 30 to 69 years; over 80% of these untimely deaths, were due to cardiovascular disease, cancer, diabetes and chronic respiratory disease [5].

Tobacco smoking was estimated to account for over 70% of lungs cancer, over three-fifth of chronic respiratory disorders and nearly one-tenth of cardiovascular disease [6]. The probability of dying prematurely is higher among people who do not engage in regular physical exercise by 20-30%; and over 3 million people die each year due to insufficient physical exercise. Alcohol intake contributed about 3.8% of the yearly deaths [7]. Similarly, poor dietary habit/obesity contributes over 4% of these deaths, with the risk of heart diseases, strokes and diabetes soaring progressively with expanding body mass index (BMI) [7].

Nigeria contributes one-fifth of the overall deaths from NCDs with major inputs from cardiovascular, endocrine, respiratory and renal diseases. It is forecasted that by 2020, 70% of the global burden of disease from NCDs will occur in developing countries thus economically productive young people that incidentally are less able to afford early detection and treatment would not be spared. Diabetes mellitus and hypertension ranked topmost in the causes of kidney failure. Diabetes mellitus is one of leading causes of mortality globally; and within the next two decades there will be a projected rise of 64% if the present trend continues [4].

Anecdotal evidence suggests a surge in the incidence of noncommunicable diseases (NCDs) in the general population and a common attitude of “spiritualizing” causes of diseases among Pentecostals which often undesirably influence their health seeking behavior [8,9]. However, there is a probability that the level of awareness of non-communicable diseases such as diabetes mellitus, hypertension and chronic kidney disease is low and a strong indication that hypertension and diabetes mellitus will invariably lead to chronic kidney disease if not adequately managed. The likelihood that the burden of NCDs will increase is high and World Health Organization predicted in 2009 that by 2020, there will be a 17% surge in the burden of NCDs with lowand middle-income countries having more than a quarter of the rise (27% upsurge) [4]. Considering this extrapolation and the fact that most of the risk factors such as tobacco intake, sedentary lifestyle, westernization of diet and others are modifiable and/ or preventable it has become progressively vital to understand the level of awareness of the risk factors, causes, features of and screening practices for common non-communicable diseases among Pentecostals in Sapele, Delta state has become imperative so as to provide a premise for instituting interventions that will tackle NCDs in our locality.

Methodology

Study location

The study was conducted in Sapele, Delta state. The major tribe in Sapele is Okpe (a part of the Urhobos) and the foremost occupations of the people of Sapele include trading, sustenance farming and civil service. There are different religious groups in Sapele; Christians, Muslims, traditional worshippers, atheists etc.

Study population

Christian Worshippers in Pentecostal churches in Sapele, Delta state who willingly give their consent.

Sampling technique

From a list of all Pentecostal churches (obtained from the leader of Sapele branch of Pentecostal Fellowship of Nigeria) eleven churches was selected with a simple random technique by balloting. Then, with stratified sampling method with proportionate allocation a minimum of 30 members was selected from each of the chosen churches.

Data collection

The study instrument was a pre-tested semi-structured selfadministered questionnaire. Participants’ information was not recorded on the questionnaire to ensure strict confidentiality of their responses.

Data analysis

Data generated was entered into spread sheet of SPSS software version 22 for analysis. Descriptive data was displayed in frequency tables.

Ethical Clearance

Ethical clearance was obtained from Health Research Ethics Committee in Delta State University Teaching Hospital. Written informed consent was sought and obtained from the participants before recruiting them for this study. Permission was sought from the head of each church be commencement of the survey.

Results

Males were marginally more than females (53.1% vs. 46.9%). The 40-49 years age group was most frequent (40.6%) with a mean age of 38.15 years for all participants. Most participants were married (75.0%) and had tertiary education (96.9%), however their job types varied among them with only two-fifth (40.6%) being teachers (Table 1).

Age group    
  <20 20 (6.3)
  20-29 30 (9.4)
  30-39 50  (15.6)
  40-49 130 (40.6)
  50-59 20 (6.3)
  ≥60 10 (3.1)
Mean ± SD    
  38.15 ± 10.20years  
Sex    
  Male 170 (53.1)
  Female 150 (46.9)
 Occupation    
  Teaching 130 (40.6)
  Engineer 20 (6.3)
  Trader 100 (31.3)
  Civil servant 30 (9.4)
  Student 20 (6.3)
  Nursing 10 (3.1)
Education  
  None 10 (3.1)
  Tertiary 310 (96.9)
Marital status  
  Single 40 (12.5)
  Living with a partner 10 (3.1)
  Married 240 (75.0)
  Separated 10 (3.1)
  Widowed 20 (6.3)

Table 1 Socio-demographic characteristics of respondents.

All participants were aware of diabetes mellitus, most having heard through electronic and print media (68.7%), perceived genetics and risky lifestyle (82.8%) as possible causes and identified excess sugar intake (92.9%) as a predisposing factor. Nonetheless, about three-fifth factor (59.3%) identified family history as risk (Table 2).

Awareness of DM 320 (100.0)
Source of Information about DM  
Newspapers 180 (56.2)
Media 40 (12.5)
Relatives 100 (31.3)
Perception on causes of DM  
High sugar intake 20 (6.2)
Genetics & risky lifestyle 300 (82.8)
Identified Predisposing factor  
Food poisoning 10 (3.1)
Excess sugar intake 310 (92.9)
Risk factors of DM  
Family history 190 (59.4)
Sedentary lifestyle 80 (25.0)
Nutritional habit 40 (12.5)
I don’t know 10 (3.1)

Table 2 Awareness and knowledge of diabetes.

All participants were aware of hypertension, more than half having heard from relatives, friends and colleagues (54.2%), and all thought hypertension referred to high blood pressure. While slightly less than a third (31.2%) identified excess salt intake as a predisposing factor, family history, sedentary living were both identified by almost three-fifth (59.4%) of the respondents as risk factors (Table 3).

Awareness of Hypertension 320 (100.0)
Source of Information about Hypertension  
Newspapers 20 (6.2)
Media 120 (37.5)
Relatives 90 (28.1)
Friends/colleagues 90 (28.1)
Knowledge of Hypertension  
High blood pressure 320 (100.0)
Identified Predisposing factor  
Excess Salt intake 100 (31.2)
Low carbohydrate diet 90 (28.1)
I don’t know 130 (40.6)
Risk factors of Hypertension  
Family history 110 (34.4)
Sedentary lifestyle 80 (25.0)
Nutritional habit 10 (3.1)
Obesity 20 (6.2)
Aging 100 (31.2)

Table 3 Awareness and knowledge of hypertension.

No participants was unaware of kidney disease, majority of whom heard from print media (71.9%), and thought kidney disease meant inability to excrete salt or toxic substances from the body (96.9%) referred to high blood pressure. While 65.6% were ignorant of predisposing factors to kidney disease, 34.4% identified nutritional habit and only 3.1% thought family history was a risk factor (Table 4).

Awareness of CKD 320 (100.0)
Source of Information about kidney disease  
Newspapers 230 (71.9)
Media 90 (28.1)
Knowledge of kidney disease  
Inability of the body to excrete salt 200 (62.5)
Inability of the kidney to excrete toxic substances properly 110 (34.4)
I don’t know 10 (3.1)
Identified Predisposing factor  
Excess Sugar intake 10 (3.1)
Food poisoning 90 (28.1))
I don’t know 210 (65.6)
Risk factors of kidney disease  
Family history 10 (3.1)
Sedentary lifestyle 80 (25.0)
Nutritional habit 110 (34.4)
I don’t know 120 (37.5)

Table 4 Awareness and Knowledge of kidney disease.

A significant proportion (68.8%) of the respondents opined that diabetes can be prevented and agreed that a healthy lifestyle was important for preventing DM but less than two-fifth (37.5%) disagreed with eating processed sugar as a its preventive measure. Majority (71.9%) identified dietary control as a means of cure but more than three-fifth did not know drugs or herbal concoction could be applied in treating diabetes (Table 5).

Variables Category Frequency (%)
Do you think DM can be prevented? Yes 220 (68.8)
  I don’t know 70 (21.9)
  N/A 30   (9.3)
DM can be prevented by eating processed sugar Agree 90 (28.1)
  Undecided 90 (28.1)
  Disagree 120 (37.5)
  N/A 20 (6.3)
DM can be prevented by leading a healthy lifestyle Agree 220 (68.8)
  Undecided 10 (3.1)
  Disagree 10 (3.1)
  N/A 80 (25.0)
How DM can be cured?    
Through dietary control Yes 230 (71.9)
  No 10 (3.1)
  IDK 80 (25.0)
Through Drug use Yes 110 (34.4)
  No 10 (3.1)
  IDK 200 (62.5)
Through Herbal concoctions Yes 10 (3.1)
  No 110 (34.4)
  IDK 200 (62.5)

Table 5 Perception of prevention, causes and cure for diabetes.

Almost all respondents (93.8%) opined that hypertension can be prevented and agreed that a healthy lifestyle was important for preventing hypertension while the same proportion disagreed that eating processed sugar can cause hypertension. About the same proportions (68.8% and 65.6%) of respondents identified dietary control and drug therapy respectively as treatment options for hypertensions (Table 6).

Variables Category Frequency (%)
Do you think HTN can be prevented? Yes 300 (93.8)
  I don’t know 10 (3.1)
  N/A 10 (3.1)
Eating processed sugar can cause hypertension Agree 0 (0.0)
  Undecided 0 (0.0)
  Disagree 300 (93.8)
  N/A 20 (6.2)
Healthy lifestyle can prevent hypertension Agree 300 (93.8)
  Undecided 0 (0.0)
  Disagree 10 (3.1)
  N/A 10 (3.1)
Ways of curing Hypertension include:
Dietary control Yes 210 (65.6)
  No 100 (31.3)
  IDK 10 (3.1)
Drug use Yes 220 (68.8)
  No 90 (28.1)
  IDK 10 (3.1)
Herbal concoctions Yes 0 (0.0)
  No 120 (37.5)
  IDK 200 (62.5)
Prayers only Yes 20 (6.2)
  No 100 (31.3)
  IDK 200 (62.5)

Table 6 Perception of prevention, causes and cures for hypertension.

Only 3.1% felt kidney cannot be prevented, 62.5% disagreed that kidney disease can be prevented by exercise, vegetable intake, dietary control but over three-fifth (65.6%) were undecided about intake of excess protein, canned food or concoction causing or worsening kidney failure. Only a little over one-third (34.4%) knew dialysis to be a treatment modality for kidney failure whereas over three-fifth did not know if dialysis can treat the condition; almost a majority (62.5%) identified renal transplant a cure for kidney failure (Table 7).

Variables Category Frequency (%)
Do you think Kidney failure can be prevented? Yes 310 (96.9)
  No 10 (3.1)
Herbs, pain killer, antiseptic can cause kidney failure  Agree 0 (0.0)
  Undecided 110 (0.0)
  Disagree 200 (62.5)
  N/A 10 (6.3)
Kidney failure can be prevented by drinking plenty of water, regular medical check-up, prompt treatment of infection Agree 220 (68.7)
  Undecided 100 (31.3)
  Disagree 0 (0.0)
  N/A 0 (0.0)
Exercise, vegetable intake,  dietary control can prevent kidney failure Agree 0 (0.0)
  Undecided 110 (34.4)
  Disagree 200 (62.5)
  N/A 10 (3.1)
Intake of excess protein, canned food or concoction can cause/worsen kidney failure Agree 0 (0.0)
  Undecided 210 (65.6)
  Disagree 110 (34.4)
  N/A  
Do you think dietary control can treat or cure kidney disease Yes 10 (3.1)
  No 10 (3.1)
  IDK 300 (93.8)
Do you think appropriate drugs use can treat or cure kidney disease Yes 30 (9.3)
  No 0 (0.0)
  IDK 290 (90.7)
Do you think Herbal concoctions  can treat or cure kidney disease Yes 0 (0.0)
  No 100 (31.3)
  IDK 220 (68.7)
Do you think prayers can cure kidney disease Yes 120 (37.5)
  No 0 (0.0)
  IDK 200 (62.5)
Do you think Dialysis can treat or cure kidney disease Yes 110 (34.4)
  No 10 (3.1)
  IDK 200 (62.5)
Do you think renal transplant can cure kidney disease Yes 200 (62.5)
  No 0 (0.0)
  IDK 120 (37.5)

Table 7 Perception of prevention, causes and cure for kidney disease.

A sizeable proportion of all participants had never checked their weight, blood pressure, fasting blood sugar, lipid profile, HIV and HBV status; while a minute fraction (3.1%) did check in the year preceding the study. More than a quarter checked their weight within 6 months prior to the study while less one-tenth (6.3%) did so within the previous year (Table 8).

Last check Weight Blood pressure FBS LP HIV HBV
Never 190 (59.4) 290  (90.7) 210 (65.6) 210 (65.6) 300 (93.8) 300 (93.8)
<6months ago 90 (28.1) 10 (3.1) 10 (3.1) 0 (0.0) 0 (0.0) 0 (0.0)
<1year ago 20 (6.3) 10 (3.1) 10 (3.1) 10 (3.1) 10 (3.1) 10 (3.1)
<2years ago 10 (3.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
2years ago 10 (3.1) 0 (0.0) 0 (0.0) 0 (0.0) 10 (3.1) 10 (3.1)
<3years ago 0 (0.0) 0 (0.0) 0 (0.0) 10 (3.1) 0 (0.0) 0 (0.0)
3 years ago 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
5 years ago 0 (0.0) 10 (3.1) 90 (28.2) 0 (0.0) 0 (0.0) 0 (0.0)

Table 8 Screening Practices among respondents.

Discussion

The mean age and predominant age group identified in this study seemingly represents the middle-age group among whom a surge in the incidence of non-communicable diseases has been reported [10]. Thus they require regular health promotional activities to make them mindful of this fact, since diseases which used to be prevalent only among the frail and old have become popular amongst younger ages [11]. In addition, contrary to common belief that females tend to be more religious than males [12] this study showed a higher male to female ratio probably because men were more willingly to participate in this study.

While most participants had heard of diabetes, hypertension and kidney disease and understand what they connoted some still lack knowledge of the causes and risk factors of these diseases. For instance, some participants considered food poisoning a predisposing factor for diabetes and kidney disease while over a quarter identified low carbohydrate diet and two-fifth were oblivious of predisposing factor for hypertension. On the other hand, it is commendable that most participants correctly identified risk factors of non-communicable diseases; though surmising that they therefore will avoid these risk factors may be preposterous since the bulk of them have neither checked their weight nor blood pressures in their entire life. Nonetheless, addressing these misconceptions through timely and properly organized health campaigns could equip them with the appropriate information regarding their health [13].

Most respondents had good perception about prevention, cause and treatment of diabetes and hypertension. This finding is remarkably positive for promoting activities to ensure they safeguard their health and could stimulate policy drive for sustaining health-related SDGs in the general population [14]. Perception about causes of kidney failure appeared adequate but their perception about likely preventive measures was poor as over three-fifth disagreed that exercise, vegetable intake, dietary control were important aspects of prevention. Knowledge of a cure for kidney failure seemed high but over three-fifth did not know dialysis was a renal replacement therapy. People need the right information to seek healthcare when they are ill. Thus, this level of ignorance about dialysis as a viable option for renal therapy exemplified in this study may be a reflection of discriminatory access to accurate health-related information rather than a religious inclination [15]. Moreover, even among patients with chronic kidney disease perception about treatment modalities was poor due to a failure on the part of their attending physicians to educate them appropriately [16].

Screening practices among these religious worshippers appeared low, especially as at least three-fifth of the study participants had never checked their weight. It is not impossible that some of the participants may have undetected diseases such as diabetes; hypertension and dyslipidemia, as a greater proportion of them have not been screened for these conditions. The negative impact for not screening at all or regularly may have long-term implications for these participants, particularly because NCDs have likely complications affecting vital organs in the body which often remain asymptomatic until irreversible damage becomes inevitable [17]. This observation not only highlights a disparity from what is expected but also indicates a significant gap in the application of simple and useful measures for looking after one’s own health and wellbeing. A possible reason that may be adduced for this finding may well be related to their belief in divine healing and health often demonstrated with a regular confession of “I cannot be sick”, commonly observed among various religious sects in Nigeria [18]. Nevertheless, this abysmal void in screening practice among these participants likely reflects their knowledge of non-communicable disease. Thus, the inevitability for planning educational and preventive interventional programs for this group of participants has become obviously apparent if they are to lead and maintain a healthy lifestyle.

One may want to excuse them for not screening for noncommunicable diseases on the ground that, they have poor knowledge of these diseases. Nevertheless, it is noteworthy that most of them have never screened for HIV, an infection for which there is intensified awareness, free counseling, testing and treatment. Their spiritual belief in divine immunity against all forms of diseases may also have influenced this poor practice especially because some Pentecostals maintain that prayers from their spiritual leaders are often sufficient to keep HIV at bay [19]. Their poor screening practice might have been ingrained in their attitude such that without a change in behavior no meaningful progress can be made with only public enlightenment. Even HIV/ AIDS prevention messages have been contradicted by Pentecostal groups in Mozambique [20]. Consequently, they may benefit from the application of health belief model of health promotion because their poor practice may not be independent of their belief. Moreover, religion can be an avenue for stimulating social change, [21] thus awareness campaigns and health promotion activities can be targeted towards this Pentecostal group using their well-respected leaders as arrow heads. The screening for hepatitis B as observed for HIV was poor; almost all respondents have never screened for this infection. While religious persons may have low sexual risk behavior [22] other means of transmitting the diseases such as sharing of sharp objects and blood transfusion cannot be completely excluded among Pentecostals. Thus, their risk of contracting hepatitis B is not absolutely insignificant and they may need proper education in this regard.

As alarming as the foregoing seems it might not be out of place to explore deeply the socio-behavioral components underlying the low screening uptake which is a clear divergence from an exemplar. Therefore, it can posit that future studies among these participants should include qualitative investigation, simply because religious, socio-cultural as well as personal factors crisscross in an individual’s daily life [23].

Conclusion

All participants were aware of diabetes; hypertension and kidney disease and all knew what hypertension represented; though gaps in their knowledge and misconceptions about predisposing factors also existed. Most participants correctly identified risk factors of non-communicable diseases; nevertheless it is uncertain if they would avoid such risks given their poor practice of simple screening tests (weight and blood pressure check). The significant disparity in their screening practices requires health promotion approaches based on health belief model because their poor practice may not be independent of their belief.

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