The Prevalence and Associated Factors of Non-Commu

RESEARCH ARTICLE
The prevalence and associated factors of non-

communicable disease risk factors among civil
servants in Ibadan, Nigeria
Abisola T. Olawuyi, Ikeola A. Adeoye*
Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University
of Ibadan, Ibadan, Nigeria
* adeoyeikeola@yahoo.com
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Abstract
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a1111111111 Background
a1111111111 Non-communicable diseases (NCDs) have become a global public health problem, which
threatens Sub-Sahara Africa (SSA) including Nigeria. Civil servants are at risk of NCDs
because of the stressful and sedentary nature of their work. The study aimed to determine
the prevalence and associated factors of the major risk factors of NCDs among civil servants
OPEN ACCESS in Ibadan, Nigeria.
Citation: Olawuyi AT, Adeoye IA (2018) The
prevalence and associated factors of non- Methods
communicable disease risk factors among civil
servants in Ibadan, Nigeria. PLoS ONE 13(9): A cross-sectional study was conducted among 606 civil servants in Oyo State using a two-
e0203587. https://doi.org/10.1371/journal. stage cluster sampling technique. The WHO Stepwise approach was used to assess the
pone.0203587 behavioural and metabolic risk factors. Anthropometric (weight, height, waist and hip cir-
Editor: Adewale L. Oyeyemi, University of cumferences), blood pressure and biochemical measurements (fasting blood sugar) were
Maiduguri College of Medical Sciences, NIGERIA obtained. Prevalence rates and 95% confidence intervals were calculated. Multivariate
Received: May 31, 2017 logistic models with adjusted odds ratios and their 95% confidence intervals were used to
Accepted: August 23, 2018 assess the associated factors of NCD risk factors. Multiple Poisson regression was also per-
formed to determine the effects of certain socio-demographic factors on the clustering of
Published: September 13, 2018
NCD risk factors.
Copyright: © 2018 Olawuyi, Adeoye. This is an
open access article distributed under the terms of
the Creative Commons Attribution License, which Results
permits unrestricted use, distribution, and
The mean age of the civil servants was 43.0±10.3 and 53.8% were males. The prevalence
reproduction in any medium, provided the original
author and source are credited. estimates and 95% confidence intervals of the risk factors were 6.5% (95% CI:4.5–8.5) for
current smoking, 7.8% (95% CI:5.1–10.5) for harmful use of alcohol, 62.2% (95% CI:58.2–
Data Availability Statement: All relevant data are
within the paper and its Supporting Information 66.2) for low physical activity, 69.7% (95% CI:66.0–73.4) for insufficient fruit and vegetable
files. intake, 37.1% (95% CI:33.2–41.0) for abdominal obesity, 57.3% (95% CI:53.3–61.3) for
Funding: The authors received no specific funding overweight and obesity, 33.1% (95% CI:29.3–36.8) for raised blood pressure and 7.1%
for this work. (95% CI:5.0–9.1) for raised blood sugar. Over 75% of the population had at least two NCD
Competing interests: The authors have declared risk factors and the study participants had an average of 3 NCD risk factors 3.01 (95% CI:
that no competing interests exist. 2.88–3.14) The female gender was significantly associated with an increased risk for
PLOS ONE | https://doi.org/10.1371/journal.pone.0203587 September 13, 2018 1 / 19

Non-communicable disease risk factors among Nigerian workers
abdominal obesity (AOR 27.9; 95% CI: 12.09–64.6) and being overweight or obese (AOR
6.78; 95% CI: 3.53–13.01), but was protective of smoking (AOR 0.21; 95% CI: 0.07–0.61)
and binge drinking (AOR 0.04; 95% CI: 0.01–0.45). Also, the risk of hypertension increased
with age– 30–39 years (AOR 12.29; 95% CI: 1.06–141.8), 40–49 years (AOR 14.28; 95%
CI: 1.10–181.4) and 50 years and above (AOR 32.43; 95% CI: 2.44–413.7). Raised blood
pressure was a strong correlate for having raised blood sugar (AOR 5.63; 95% CI: 1.48–
21.3). Increasing age (IRR 1.02; 95% CI: 1.01–1.02) and being female (IRR 1.36; 95% CI:
1.23–1.49) were also important predictors of the clustering of risk factors.
Conclusion
The feminization (i.e. the preponderance of risk factors among the females) and clustering
of non-communicable disease risk factors were observed among Oyo State civil servants.
Our findings highlight the high prevalence of cardio-metabolic risk factors among the work-
ing class. Hence the need for targeted preventive and therapeutic interventions among this
population.
Introduction
Non-communicable diseases (NCDs) have become the leading cause of morbidity and mortal-
ity world-wide. In 2012, out of 56 million deaths globally, NCDs accounted for 38 million and
28 million of these NCD deaths occurred in low and medium income countries [1]. These
deaths have been projected to increase from 38 million in 2012 to 52 million by 2030 [1], par-
ticularly in low and middle income countries, which already bear an appreciable burden of
communicable diseases (a double burden of disease). For example, in 2012, NCD mortality for
the African region alone was 28 million [1]. Most African countries are undergoing an epide-
miological transition, which is a shift from a pattern of predominantly infectious diseases to
that of chronic, non-communicable diseases. This is as a result of urbanization, industrializa-
tion, increased life expectancy and the adoption of western lifestyle characterized by reduced
physical activity and dietary changes from foods rich in fruits and vegetables to refined,
energy-dense and fatty foods.
Current evidence shows that four major groups of diseases namely cardiovascular diseases,
cancers, respiratory diseases and diabetes mellitus account for 82% of all NCD deaths, [1].
These diseases share four common behavioural risk factors (tobacco use, excess alcohol con-
sumption, unhealthy diet and physical inactivity) and four metabolic risk factors (elevated
blood pressure, overweight and obesity, hyperglycaemia and hyperlipidaemia). The World
Health Organization (WHO) has recommended the surveillance of NCDs and their risk fac-
tors to inform the implementation of appropriate public health strategies. The WHO Stepwise
approach is a standardized methodology for the surveillance of non-communicable diseases
(STEPS) [2, 3], although, studies using this approach have just begun to emerge in Nigeria [4–
7].
Now it is crucial to pay close attention to NCDs among the working population, because
these health challenges can perhaps lead to economic losses, household poverty and reduction
in productivity [8]. Potentially, the workplace provides a platform for preventive interventions.
This study provides information on the magnitude of the NCD risk factors among civil ser-
vants in Ibadan and a baseline for monitoring the trends, guiding decision making, and imple-
menting appropriate interventions.

Materials and methods

Study design and sampling technique
A cross-sectional survey was conducted among 606 civil servants in Oyo State Secretariat, Iba-
dan, using a two stage cluster sampling technique. Ibadan is the capital city of Oyo State and
the third largest city in Nigeria, after Lagos and Kano (National Population Commission,
2009). It covers an area of 3,080 km2 with coordinates 7˚23’47@N and 3˚550 0@E. Ibadan consists
of 11 Local Government Areas (LGAs).
The Oyo State Secretariat is the administrative headquarters of the State Government
located at Agodi, Ibadan North Local Government Area, with coordinates 7˚24’35@N and 3˚
540 28@E. The Secretariat accommodates the Governor’s office, State House of Assembly, gov-
ernment agencies and 20 state ministries. The civil service lies at the center of public adminis-
trative structure. The study population were the state civil servants in Ibadan. The number of
civil servants in each ministry ranged from 150 to 250 from which an average of 50 civil ser-
vants were selected from each of the 12 ministries randomly selected to participate in the
study. In each ministry, 1–2 study participants were chosen consecutively from the offices
until the sample size was reached. Non-consenting individuals, contract staff, pregnant
women and those absent at the time of the study probably due to ill health.
The sample size was calculated using the sample size determination for prevalence study,
based on a precision of 5%, a Z statistics for the level of confidence of 95% and prevalence of
overweight of 27% [5]. The minimum sample size was 316 and was adjusted to 592 to account
for non-response rate of 20% and design effect.
Data collection
Step 1. The study was conducted using the WHO Stepwise approach for non-communi-
cable diseases, which consists of three steps. Step 1 involves the use of semi structured, pre-
tested, interviewer-administered questionnaires adapted from the WHO NCD risk factor
surveillance questionnaire [3] ] to collect information on socio-demographic characteristics
(age, gender, marital status, level of education, income level and job cadre), behavioral risk fac-
tors (current smoking, harmful use of alcohol, low intake of fruits and vegetables, and low
physical activity) and metabolic risk factors (overweight and obesity, abdominal obesity, ele-
vated blood pressure and fasting blood sugar). The details of the measures of behavioural and
biological risk factors can be found in the attached supplementary file (“S1 File”).
Job cadre: This was based on the salary scale of civil servants, with those between grades
1–6 classified as junior staff, 7–12 as mid-level staff, 13–17 as senior staff.
Tobacco use: This was defined as current use of any tobacco product in either smoked or
smokeless form within 30days prior to study.
Harmful use of Alcohol (Binge drinking): This pertained to any male who reported hav-
ing 5 drinks or to any female having 4 drinks on one or more occasion, within 30days
prior to study. A drink is defined as a bottle or one glass of wine or a shot of any of the spirit,
e.g. gin, red wine.
Unhealthy diet: This was described as the low intake of fruits and vegetables that is less
than 5 servings per week.
Insufficient physical exercise: The physical activity level was assessed using the Interna-
tional Physical Activity Questionnaire (IPAQ) [9]. The International Physical Activity
Questionnaire (IPAQ) was used in this study to substitute the Global Physical Activity Ques-
tionnaire (GPAQ) because IPAQ has better utility in the Nigerian population than the GPAQ.
Besides multiple studies have reported on the reliability and validity of the IPAQ in the

Nigerian population [10–12]. Metabolic equivalent (MET) is the ratio of a person’s working
metabolic rate relative to the resting metabolic rate. The level of physical activity was assessed
using the frequency and the rigor of physical activity per week to arrive at MET-minutes per
week. Insufficient physical activity was considered as less than 600 MET-minutes per week.
Moderate physical activity was 600–3000 MET-minutes per week and vigorous physical activ-
ity was greater than 3000 MET-minutes per week. We also estimated the proportion of study
participants that met the WHO recommendation for physical activity: 75mins or vigorous
or 150 mins moderate physical activity per week.
Step 2—Anthropometric measurements. Height was measured with a calibrated meter
rule and with the participant standing against the wall and facing straight ahead. Weight was
measured using an analogue weighing scale (HANA) placed on a flat hard surface. The
research assistant ensured the pointer of the machine was on zero. After the study participants
had been correctly positioned and the pointer on measuring device became stable, measure-
ment was approximated to the nearest 1kg. Body mass index (BMI) was derived by dividing
weight (kg) by height squared (m2) and categorized based on the WHO classification:
Underweight 18.5 kg/m2, Normal (healthy weight) = 18.5–24.9 kg/m2, Overweight = 25.0–
29.9 kg/m2, Obesity 30 kg/m2 [13]. The waist circumference was determined using a non-
extendable measuring tape, which was wound around the subject, midpoint between the lower
margin of the last rib and the superior border of the iliac crest. The mid axillary line was used
as a reference point. Abdominal obesity was defined as waist circumference (WC) value
greater than 102 cm for men and 88 cm for women [14].
Step 3 –Biological measures. Blood pressure measurements were done using the Omron
digital automatic blood pressure machine (intelli sense M3W). Measurements were taken after
respondents had been sitting for a minimum of 10 minutes and three different readings were
taken each at three minutes interval. An average of the last two readings was used for analysis.
Raised blood pressure was described as systolic BP 140 mmHg or / and diastolic BP 90
mmHg, including respondents who reported that they had been on antihypertensive treatment
[15].
Fasting blood sugar screening was also conducted using the Accu-check Active glucometer.
Capillary blood was obtained by pricking the respondents on their thumbs. Respondents were
informed prior to the day of data collection to fast overnight. Raised blood sugar was defined
as a fasting blood sugar 7.0 mmol/L (126g/dl) or random blood sugar 11.1 mmol/L
(200mg/dl) or being on diabetic medication [16].
Data processing and analysis

Data were inputted and cleaned using SPSS version 17 and Stata version 12 SE was used for
analyses (Data and analytical script are in “S2 and S3 Files”). The dependent variables were
abdominal obesity, overweight and obesity, raised blood pressure and raised blood sugar. The
independent variables were socio-demographic characteristics and behavioural risk factors.
The general characteristics of the study population by socio-demographic and physical param-
eters are presented in “Table 1”. The categorical variables are presented by absolute numbers
and percentages, and means and standard deviation (SD) are used to summarize numeric
variables.
The prevalence of behavioural and biological risk factors are displayed in “Tables 2 and 3”.
The overall prevalence estimates and 95% confidence intervals (CI) of behavioural and meta-
bolic risk factors were determined and were also stratified according to age, gender, marital
status, level of education, income and job cadre. Chi square for trend was performed and their
p-values presented.

Table 1. Characteristics of study participants in Ibadan.

N n Frequency
Socio-demographic factors
Age group 606
20–29 67 11.1
30–39 140 23.1
40–49 191 31.5
50+ 176 29.0
Missing 32 5.3
Gender 606
Male 326 53.8
Female 280 46.2
Marital Status 606
Single 72 12.3
Currently Married 493 84.4
Previously Married 19 3.3
Missing 22 3.6
Level of Education 606
Primary 33 5.5
Secondary 107 17.7
Post-secondary 439 72.8
Missing 27 4.5
Income (Naira ₦) 606
20,999 102 16.8
21,000–60,999 290 47.9
61,000–100,000 98 16.2
>100,000 56 9.2
Missing 60 9.9
Job Cadre 606
Junior 192 31.7
Mid-Level 278 45.9
Senior 102 16.8
Missing 34 5.6
Physical activity per week 606
Adequate 294 48,2
Inadequate 314 51.8
Mean and standard deviation of physical characteristics of study participants.
Weight(kg) 606 71.1 ±12.8
Height (m) 606 1.63 ±0.09
Waist (cm) 606 89.9 ±12.0
SBP 606 124.9 ±19.8
DBP 606 79.3 ±18.2
FBS 477 86.2 ± 30.1

Recommended WHO Physical activity - 75mins or vigorous or 150 mins moderate physical activity per week

includes those with missing data

others were assessed using random blood sugar
https://doi.org/10.1371/journal.pone.0203587.t001
Multivariate logistic regression analyses (Adjusted odds ratios and 95% CI) were performed
to identify the associated factors of overweight and obesity, abdominal obesity, raised blood

Table 2. Prevalence (%) and 95% CI of behavioural risk factors for non-communicable diseases among civil servants in Ibadan.
Characteristics Current Harmful use of alcohol (N) Physical inactivity (N) Insufficient fruit and vegetable (N)
Smoking (N)
Overall prevalence 6.5 (4.5–8.5) 7.8 (5.1.-10.5) 62.2 (58.2–66.2) 69.7 (66.0–73.4)
Age group
20–29 9.1 (2.1–16.1) 9.1 (0.5–17.7) 49.2 (37.0–61.5) 75.0 (64.3–85.7)
30–39 9.2 (4.2–14.1) 7.6 (2.1–13.1) 58.4 (49.9–67.0) 74.6 (67.2–82.0)
40–49 6.1 (2.6–9.7) 5.2 (1.1–9.3) 65.7 (58.7–72.8) 72.1 (65.7–78.5)
50+ 4.2 (1.1–7.3) 11.0 (5.3–16.7) 67.8 (60.8–75.0) 61.4 (54.1–68.7)
P for trend 0.069 0.566 0.005 0.0100
Gender
Male 9.2 (5.9–12.4) 12.6 (8.2–17.0) 63.0 (57.6–68.4) 70.7 (65.6–75.7)
Female 3.3 (1.2–5.6) 1.2 (0.4–3.0) 61.3 (55.3–67.3) 68.6 (63.0–74.1)
P for trend 0.005 <0.001 0.686 0.589
Marital Status
Single 8.6 (1.9–15.1) 10.6 (1.7–19.6) 44.9 (33.0–56.8) 75.7 (65.6–85.9)
Currently Married 6.1 (3.9–8.2) 7.3 (4.5–10.3) 63.5 (59.0–67.9) 69.2 (65.0–73.4)
Previously married 10.5 (3.7–24.7) 8.3 (8.1–24.7) 80.0 (59.0–101.0) 63.1 (40.8–85.5)
P for trend 0.768 0.529 0.001 0.201
Level of Education
Primary 17.2 (3.2–31.3) 18.2(1.6–34.7) 71.8 (56.0–87.7) 64.5 (47.4–81.7)
Secondary 10.8 (4.7–16.8) 7.7 (1.7–13.8) 62.9 (53.2–72.6) 68.6 (59.6–77.5)
Post-secondary 4.8 (2.8–6.9) 6.8 (3.7–9.8) 60.7 (60.0–65.5) 70.0 (65.7–74.4)
P for trend 0.001 0.113 0.244 0.513
Income
< 20,999 13.4 (6.5–20.2) 9.5 (2.7–16.2) 57.0 (46.8–67.1) 78.8 (70.7–86.9)
21,000–60,999 6.2 (3.3–9.1) 5.2 (2.0–8.3) 63.3 (57.6–69.1) 68.1 (62.6–73.6)
61,000–100,000 2.2 (0.8–5.2) 11.5 (2.7–20.3) 61.0 (51.8–71.6) 69.1 (59.8–78.3)
>100,000 5.7 (0.6–12.0) 7.6 (2.8–18.2) 66.0 (52.7–79.3) 55.3 (42.2–68.5)
P for trend 0.016 0.833 0.377 0.007
Job Cadre
Junior 12.0 (7.3–16.8) 9.7 (4.7–14.8) 60.2 (53.0–67.4) 74.7 (68.5–81)
Middle level 3.4 (1.2–5.7) 5.7 (2.3–9.2) 65.1 (59.3–71.0) 67.5 (61.9–73.1)
Senior level 3.1 (0.3–6.6) 11.8 (2.8–20.7) 61.9 (52.1–71.6) 65.0 (55.5–74.4)
P for trend <0.001 0.933 0.627 0.061
pressure and raised blood sugar and to adjust for confounders like the socio-demographic var-
iables and behavioural risk factors in “Tables 4 and 5”. Multiple Poisson regression analyses
(Incidence rate ratios and 95% CI) were performed to determine the effects of certain co-vari-
ates on the clustering of NCD risk factors in “Table 6”.
Ethical consideration
Ethical approval for the study was obtained from the Oyo State Ministry of Health Ethical
Committee. Permission to conduct the study was obtained from the Permanent Secretary of
each Ministry. Informed written consent was obtained from individual respondents before
commencement of the research. The study protocol and conduct adhered to the principles laid
down in the Declaration of Helsinki. All participants were assessed and informed on their indi-
vidual behavioural and cardio-metabolic risk factors with a view to assisting them in taking

Table 3. Prevalence (%) and 95% CI of biological risk factors for non-communicable diseases among civil servants in Ibadan.
Characteristics Abdominal obesity Raised blood pressure Overweight or obesity Raised blood sugar
Overall 37.1 (33.2–40.1) 33.1 (29.3–36.8) 57.3 (53.3–61.3) 7.1 (5.0–9.1)
Prevalence
Age group
20–29 21.2 (11.3–31.2) 9.1 (2.1–16.1) 38.5 (26.5–50.4) 3.0 (-1.1–7.1)
30–39 25.4 (18.1–32.7) 18.8 (12.3–25.4) 47.4 (39.0–55.9) 5.7 (1.8–9.6)
40–49 43.4 (36.3–50.5) 34.7 (27.9–41.5) 68.4 (61.8–75.1) 4.7 (1.7–7.7)
50+ 42.6 (35.3–50.0) 49.7 (42.3–57.1) 59.2 (51.9–66.5) 13.1 (8.0–18.1)
p for trend 0.001 <0.001 0.001 0.011
Gender
Male 10.2 (6.9–13.5) 31.0 (25.9–36.0) 42.4 (37.0–47.8) 7.4 (4.5–10.2)
Female 68.3 (62.8–73.8) 35.6 (30.0–41.3) 74.8 (69.7–80.0) 6.8 (3.8–9.7)
p for trend 0.001 0.219 0.001 0.976
Marital Status
Single 21.1 (11.5–30.7) 12.9 (4.9–20.8) 35.7 (24.4–47.0) 2.8 (- 0.8–19.0)
Currently Married 37.0 (32,7–41.3) 35.1 (30.9–39.3) 59.8 (55.4–64.2) 7.5 (5.2–9.8)
Previously married 63.2 (40.8–85.5) 52.6 (29.5–75.7) 57.9 (35.0–80.7) 5.3 (-5.1–15.6)
p for trend 0.001 0.001 0.001 0.182
Level of Education
Primary 15.1 (2.7–27.6) 59.3 (43.6–77.5) 34.3 (17.6–51.1) 9.1 (-0.8–19.0)
Secondary 43.9 (34.5–53.4) 37.4 (30.9–39.3) 55.2 (45.7–64.8) 9.3 (3.8–14.9)
Post-secondary 36.4 (31.8–41.0) 29.9 (25.6–34.2) 58.3 (53.7–63.0) 6.1 (3.9–8.4)
p for trend 0.340 0.003 0.022 0.715
Income
< 20,999 27.5 (18.7–36.1) 28.4 (19.6–37.2) 42.6 (32.9–52.2) 6.8 (1.9–11.8)
21,000–60,999 39.8 (34.1–45.5) 31.3 (26.0–36.7) 56.3 (50.5–62.1) 6.2 (3.4–9.0)
61,000–100,000 26.8 (17.9–35.7) 42.9 (31.9–51.7) 63.9 (54.3–73.6) 7.1 (2.0–12.3)
>100,000 44.6 (31.5–57.8) 35.7 (23.0–48.4) 69.6 (57.5–81.8) 12.5 (3.7–21.3)
p for trend 0.306 0.078 0.001 0.018
Job Cadre
Junior 30.0 (23.5–36.5) 25.3 (19.1–31.5) 48.4 (41.2–55.6) 6.2 (2.8–9.7)
Middle level 42.4 (36.5–48.2) 31.3 (32.1–43.6) 60.4 (54.6–66.2) 6.1 (3.3–8.9)
Senior level 32.6 (23.5–41.9) 35.3 (25.9–44.6) 67.3 (58.1–76.5) 11.8 (5.5–18.1)
p for trend 0.290 0.095 0.110 0.174
informed decisions on their health. Participants with raised blood pressure and raised blood
sugar were informed and advised to seek medical help.
Results
General characteristics
The socio-demographic and physical characteristics of the study participants are described in
“Table 1”. The mean age was 43.0 ± 10.3 years with more than 60% being 40 years and above.
Also, 53.8% were males, and the majority were currently married (84.4%) and had tertiary
level education (72.5%). The mean and standard deviations of physical parameters were as fol-
lows: weight (71.1 ± 12.8 kg), height (1.63 ± 0.09 m), waist circumference (89.9 ± 12.0 cm), sys-
tolic blood pressure (124.9 ± 19.8 mmHg), and diastolic blood pressure (79.3 ± 18.2 mmHg).

Table 4. Predictors of behavioural risk factors of non-communicable diseases among Oyo State civil servants.
Variables Smoking Binge drinking Low fruit & vegetable intake Physical inactivity
Age group
20–29 1 1 1 1
30–39 1.22 (0.24–6.35) 0.99 (0.12–9.10) 1.73 (0.67–4.45) 0.90 (0.37–2.17)
40–49 1.82 (0.29–11.3) 1–19 (0.09–16.18) 1.44 (0.53–3.93) 1.13 (0.44–2.95)
50+ 0.53 (0.63–4.42) 2.35 (0.16–35.19) 0.99 (0.35–2.81) 1.15 (0.43–3.13)
Gender
Male 1
Female 0.21(0.07–0.61) 0.04 (0.01–0.45) 1.08 (0.70–1.67) 0.88 (0.57–1.34)
Marital status
Single 1 1 1 1
Previously married 4.41 (0.39–50.12) 4.4 (0.14–138.3) 0.98 (0.24–4.04) 3.54 (0.72–17.47)
Level of education
Primary 1 1 1 1
Secondary 0.40 (0.08–1.95) 0.49 (0.09–2.66) 1.08 (0.38–3.07) 0.80 (0.43–1.60)
Post-secondary 0.20 (0.04–1.27) 0.57 (0.08–3.85) 0.96 (0.34–2.75) 0.82 (0.28–2.44)
Income
< 20,999 1 1 1 1
21,000–60,999 0.55 (0.21–1.45) 0.85 (0.24–3.05) 0.59 (0.29–1.18) 0.83 (0.43–1.60)
61,000–100,000 0.20 (0.22–1.77) 2.17 (0.29–16.1) 0.62 (0.24–1.60) 0.71 (0.28–1.77)
>100,000 0.26 (0.02–4.42) 0.63 (0.03–10.56) 0.36 (0.12–1.06) 1.04 (0.35–3.10)
Job cadre
Junior 1 1 1 1
Middle level 0.40 (0.14–1.15) 0.62 (0.17–2.35) 0.85 (0.49–1.48) 1.03(0.62–1.75)
Senior level 0.64 (0.58–6.93) 0.45 (0.50–4.11) 1.06 (0.81–9.59) 0.95(0.39–2.52)

Statistically significantly at p<0.05
Prevalence of behavioural risk factors

Tobacco consumption. The overall prevalence of current smoking was 6.5% (95% CI:
4.5–8.5). The prevalence of smoking among younger civil servants aged less than 40 (9.1%, 95%
CI: 4.2–14.1) was higher than among older civil servants aged 50 and above 4.2% (95% CI: 1.1–
7.3). The prevalence of smoking was also significantly higher (p = 0.005) among males 9.2%
(95% CI: 5.9–12.4) than females 3.3% (95% CI: 1.2–5.6). The prevalence of smoking had an
inverse relationship with the levels of education, income and job cadre the highest occurrence
being among those with lowest level of education 17.2% (95% CI: 3.2–31.2), lowest income
earners (13.4%, 95% CI: 6.5–20.2) and the lowest cadre of staff (12.1%, 95% CI: 7.3–16.8).
Alcohol consumption. The general prevalence of alcohol consumption was 28.6% (95%
CI: 24.8–32.4) among respondents while the occurrence of binge drinking was 7.8% (95% CI:
5.1–10.5). A significantly higher prevalence was also observed among men 12.6% (95% CI:
8.2–17.0) compared to the level among women 1.2% (95% CI: 0.4–3.0).
Physical inactivity. Low physical activity was prevalent 62.2% (95% CI: 58.2–66.2) among
the study participants. Low levels of physical activity significantly increased with age: 49.2%
(95% CI: 37.0–61.5) for 20–29 years, 58.4% (95% CI: 49.9–67.0) for 30–39 years, 65.7% (95%
CI: 58.7–72.8) for 40–49 years, 67.8% (95% CI: 60.8–75.0) for 50 and above. Also, low physical
activity was more common among those currently married 63.5% (95% CI: 59.0–67.9) or pre-
viously married 80.0% (95% CI: 59.0–101.0) compared with the single 44.9% (95% CI: 33.0–

Table 5. Predictors of behavioural risk factors of non-communicable diseases among Oyo State civil servants.
Variables Overweight & obesity Abdominal obesity Raised blood pressure Raised blood sugar
Age group
20–29 1 1 1 1
30–39 1.09 (0.27–4.33) 0.82 (0.14–4.95) 12.29(1.06–141.8) 0.51 (0.04–6.9)

40–49 1.05 (0.28–4.72) 1.42(0.21–9.45) 14.28(1.10–184.4) 0.29 (0.12–5.3)
50+ 0.47 (0.10–2.24) 1.18(0.17–8.08) 32.43 (2.44–413.7) 0. 55 (0.3–10.06)
Gender
Male 1 1 1 1
Female 6.78 (3.53–13.01) 27.9 (12.06–64.60) 0.90 (0.40–2.02) 1.10 (0.22–5.48)
Marital status
Single 1 1 1 1
Previously married 0.31 (0.27–3.45) 3.74 (0.19–72.14) 1.44 (0.10–21.06) -
Level of education
Primary 1 1 1 1
Secondary 0.73 (0.21–2.67) 2.86 (0.35–23.10) 0.21 (0.05–0.87) 3.58 (0.26–49.0)
Post-secondary 0.59 (0.16–2.24) 3.09 (0.37–26.02) 0.14 (0.03–0.63) 2.25 (0.14–36.0)
Income
< 20,999 1 1 1 1
21,000–60,999 1.35 (0.54–3.11) 1.67 (0.53–5.22) 0.58 (0.22–1.51) 0.30 (0.07–1.34)
61,000–100,000 1.94(0.52–7.27) 1.06 (0.20–5.75) 0.96 (0.25–3.72) 0.02 (0.01–0.94)

>100,000 7.90(1.52–41.09) 8.02 (1.18–54.47) 0.75 (0.15–3.60) 0.16 (0.01–3.58)
Job cadre
Junior 1 1 1 1
Middle level 1.70(0.83–3.46) 0.99 (0.40–2.42) 1.46 (0.66–3.27) 0.68 (015–3.03)
Senior level 1.38(0.36–5.31) 0.66 (0.13–3.41) 0.90 (0.22–3.54) 5.04 (0.27–95.7)
Current smoking 1.42(0.53–3.83) 0.40 (0.78–2.42) 0.64 (0.19–2.17) 0.34 (0.03–4.12)
Binge drinking 1.38(0.49–3.68) 0.28 (0.25–3.10) 2.98 (1.00–8.91) 2.52 (0.37–17.19)
Low fruit and vegetables 0.75(0.42–1.37) 0.57 (0.26–1.24) 0.91 (0.48–1.72) 1.51 (0.43–5.27)
Low physical activity 3.82(1.03–3.21) 1.88 (0.90–3.92) 0.78 (0.42–1.44) 2.40(0.70–8.21)
Overweight & obesity - - 1.90 (0.89–4.04) 4.57(0.86–25.70)
Abdominal obesity - - 2.05 (0.82–5.08) 1.09(0.20–6.07)
Raised blood pressure - - - 5.63 (1.48–21.3)

Statistically significantly at p<0.05.
56.8). Low physical activity was commonest among individuals with the highest income 66.0%
(95%: CI 52.1–79.3) compared with the low income group 57.0% (95%: CI 46.8–67.1).
Fruit and vegetable intake. The low intake of fruits and vegetables was high among the
respondents 69.7% (95% CI: 69.7–73.4). Whilst the prevalence was high across all age groups,
it was lowest among those aged 50 and above 61.4% (95% CI: 54.1–68.7). Low intake of fruits
and vegetables significantly decreased by the level of income– 78.8% (95% CI: 70.7–86.9) for
<₦20,999; 68.1% (95% CI: 62.6–73.6) for <₦21,000 - ₦60,999; 69.1% (95% CI: 59.8–78.3) for
<₦61,000 – ₦100,000; and 55.3% (95% CI: 42.2–68.5) for >₦100,000.
Prevalence of biological risk factors

Raised blood pressure. The mean systolic blood pressure was 124.9mmHg ± 19.8, while
the mean diastolic blood pressure was 79.3 ± 18.2. The prevalence of raised blood pressure was

Table 6. Mean number of risk factors for NCDs and the effect of socio-demographic factors on the clustering of
risk factors.
Covariates Mean number of risk factors (95%CI) IRR [95% CI] Robust standard errors
Overall 3.01 (2.88–3.14) - -
Age in years 1.02 (1.01–1.02) 0.003
20–29 2.13 (1.80–2.46)
30–39 2.58 (2.33–2.82)
40–49 3.20 (2.98–2.43)
50+ 3.45 (3.20–3.70)
Gender
Male 2.63 (2.46–2.80) 1 0.065

Female 3.46 (3.28–3.65) 1.36 (1.23–1.49)
Marital Status
Single 2.18 (1.82–2.53) 1
Currently Married 3.09 (2.94–3.65) 1.16 (0.94–1.42) 0.122
Previously married 3.78 (2.81–4.34) 1.05 (0.78–1.41) 0.156
Level of Education
< Primary 3.15 (2.62–3.68) 1
Secondary 3.23 (2.91–3.55) 0.96 (0.77–1.20) 0.107
Post-secondary 2.92 (2.77–3.07) 0.98 (0.79–1.23) 0.110
Income
< 20,999 2.75 (2.47–3.04) 1
21,000–60,999 2.99 (2.80–3.43) 0.95 (0.84–1.08) 0.063
61,000–100,000 3.11 (2.79–3.43) 1.01 (0.85–1.19) 0.086
>100,000 3.25 (2.81–3.68) 1.01 (0.83–1.23) 0.100

Statistically significantly at p<0.05.
33.1% (95% CI: 29.3–36.8) and the prevalence significantly increased with age– 9.1% (95% CI:
2.1–16.1) for 20–29; 18.8% (95% CI: 12.3–25.4) for 30–39; 34.7% (95% CI: 27.9–41.5) for 40–
49; 49.7% (95% CI: 42.3–57.1) for respondents aged 50 and above. We also observed an inverse
relationship between raised blood pressure and the level of education of respondents, with a
higher prevalence among those with primary education 59.3% (95% CI: 43.6–77.5) compared
to those with post-secondary education 29.9% (95% CI: 25.6–34.2).
Abdominal obesity. Overall prevalence of abdominal obesity was 37.1% (95% CI: 33.2–
40.1) and the mean waist circumference was 89.9cm ± 12.0. The prevalence of abdominal obe-
sity was significantly higher among women at 68.3% (95% CI: 62.8–73.8) than among men at
10.2% (95% CI: 6.9–13.5). The prevalence also significantly increased with age– 21.2% (95%
CI: 11.3–31.2) for 20–29; 25.4% (95% CI: 18.1–32.7) for 30–39; 43.4% (95% CI: 36.3–50.5) for
40–49; 42.6% (95% CI: 35.3–50.0) for respondents aged 50 and above.
Overweight and obesity. The prevalence of overweight and obesity among civil servants
in Ibadan was 31.2% and 26.1% respectively. Being overweight or obese had a positive relation-
ship with age, gender, marital status and income. Three-quarters of females were overweight
or obese: 74.8% (95% CI: 69.7–80.0), respondents above 40 years had the highest prevalence,
68.4% (95% CI: 61.7–75.1) and those with the highest income (>₦100,000 monthly) had the
highest prevalence rate 69.6% (95% CI: 57.5–81.8).
Raised blood sugar. The general prevalence of raised blood sugar in the study population
was 7.1% (95% CI: 5.0–9.1). The prevalence among males: 7.4% (95% CI: 4.5–10.2) compares

with the prevalence among females: 6.8% (95% CI: 3.8–9.7). The highest prevalence was noted
among those aged 50 and above: 13.1% (95% CI: 8.0–18.1), among those with the highest
income (>₦100,000 monthly) 12.5% (95% CI: 3.7–21.3), and among those holding senior posi-
tions 11.8% (95% CI: 5.5–18.1).
Associations with non-communicable disease risk factors

The associated factors of behavioural and cardio-metabolic risk factors are represented in
Tables 4 and 5. The odds of smoking and binge drinking were lower among females, as they
were five times less likely to smoke (AOR: 0.21, 95% CI 0.07–0.61) and 25 times less likely to
be involved in binge drinking (AOR:0.04 95% CI 0.003–0.45) than the males. However, being
previously married increased the likelihood of smoking (AOR: 4.41, 95% CI 0.39–50.17) and
binge drinking (AOR: 4.4, 95% CI 0.14–138.3). Contrastingly, being currently married was
protective against smoking (AOR: 0.73, 95% CI 0.16–3.23) and binge drinking (AOR: 0.34,
95% CI 0.04–2.80).
The predictors of overweight and obesity in the study were being female (AOR: 6.78, 95%
CI: 3.53–13.01), low physical activity (AOR: 3.82, 95% CI 1.03–3.21) and high income (AOR:
7.90, 95% CI 1. 52–41.09). Generally, the factors associated with abdominal obesity were older
age, female gender, being currently married, level of education and low physical activity.
Females were almost 30 times more likely than males to have abdominal obesity (AOR: 27.9,
95% CI 12.06–64.6). Likewise, those currently married were twice more likely to have abdomi-
nal obesity than singles (AOR: 2.24, 95% CI: 0.38–13.04). The likelihood of abdominal obesity
also increased as the level of education increased as those with secondary school education
(AOR: 2.86, 95% CI: 0.35–23.10) and post-secondary school education (AOR: 3.09, 95% CI:
0.37–26.02) were three times more likely to have abdominal obesity compared those with only
primary school education. Also, low physical activity increased the odds twice (AOR: 1.88,
95% CI: 0.90–3.92).
The associated factors of raised blood pressure were age, binge drinking and overweight/
obesity. The likelihood of raised blood pressure increased with age: 30–39 years (AOR: 13.08,
95% CI: 1.10–155.3), 40–49 years (AOR: 13.26, 95 CI: 0.99–177.7), 50 years and above (AOR:
36.95, 95% CI: 2.67–510.6). Those with overweight/obesity were twice more at risk of raised
blood pressure (AOR: 2.21, 95% CI: 1.02–4.79). The significant predictors of raised blood
sugar were overweight/obesity (AOR: 4.57, 95% CI: 0.83–25.07) and raised blood pressure
(AOR: 5.75, 95% CI: 1.51–21.9).
Clustering of behavioral and biological risk factors in study participants

The prevalence of multiple NCD risk factors among the civil servants is shown in (Fig 1) and
only a negligible proportion of the civil servants (2.8%) were free of NCD risk factors. Over
75% of the population had at least two NCD risk factors and on average the study participants
had 3 NCD risk factors (95% CI: 2.88–3.14) Table 6.
Table 6 shows the result of the multiple Poisson regression used to predict the effect of
socio-demographic factors on the clustering of risk factors. For every 1 year increase in age
there was a 1.02 (95% CI: 1.01–1.02) times increase in the clustering of risk factors. There was
also a 36% increase in clustering of risk factors among females 1.36 (95% CI: 1.23–1.49) com-
pared with the males.
Discussion
Non-communicable diseases, an ‘epidemic in slow motion’, have been projected to be a lead-
ing cause of morbidity and mortality in Nigeria by 2030 [17]. The surveillance of NCD risk

Fig 1. Prevalence of multiple risk factors among civil servants in Ibadan.

https://doi.org/10.1371/journal.pone.0203587.g001
factors is one of the key strategies advocated to tackle these emerging public health concerns,
particularly in low and middle income countries. Most of the studies assessing the prevalence
and the predictors of NCDs have come from Asian countries [18–21], whereas such studies
have only just begun to emerge in Nigeria [4–7]. Hence our study investigated the prevalence
and associated factors of behavioural risk factors (current smoking, harmful alcohol, physical
inactivity and unhealthy diet) and biological risk factors (overweight/obesity, abdominal obe-
sity, raised blood pressure and raised blood sugar) among civil servants in Oyo State Nigeria
using the WHO Stepwise approach. We found that certain behavioural and biological risk fac-
tors were prevalent among our study population, particularly among women. Notably, physi-
cal inactivity and low fruit and vegetable intake were the most common risk factors in our
study population.
Tobacco use, the leading cause of morbidity and mortality globally that claims about 6 mil-
lion lives annually [22–23], was the least common risk factor (6.4%) in our study. Similarly,
low prevalence rates have been reported among the working class in some other parts of Nige-
ria [5–7]. Generally, smoking is not a common habit among the Nigerian adult population
compared with other African countries–[24–26]. Agaku et al [27] in a study assessing poly-
tobacco use in 44 countries during 2008–2012, reported that Nigeria had the lowest prevalence
of current tobacco use (5.6%) compared with South Africa (20.4%), India (34.4%) and Bangla-
desh (43.2%). One plausible reason for the low prevalence of smoking among the Nigerian
population is the high level of religious involvement that has been shown to influence smoking

behaviour. The inverse relationship between high religious involvements and cigarette smok-
ing have been reported by some researchers [28–29]. Nevertheless, we noted in our study that
the prevalence was higher among the younger worker and among males. This finding suggests
that these groups of persons should be the target for tobacco control interventions, particularly
the young people. The Surgeon General Reports (2012) found that the majority of adult smok-
ers initiated the habit of smoking before the age of 18 years [30]. It is little wonder that young
people have been the target of the tobacco industry through their advertisement and promo-
tional activities, as well as through their emerging tobacco products, which aim at young peo-
ple. For example, flavored cigarettes and mentholated smokeless tobacco product such as ZIP
metholated snus are now available in the Nigerian market [31]. We also noted that the preva-
lence is much higher among males than among females who were about five times less likely
(AOR- 0.21) to indulge in the habit. This pattern has been well documented [24–27]: tobacco
use by females is culturally unacceptable in Nigeria just as the harmful use of alcohol, is also
culturally unacceptable as noted by other researchers in Nigeria [4, 5, 6]. Alcohol consumption
and harmful use of alcohol were reported in more than a quarter of (28.6%) and 7.2% of our
study population respectively. We found that being male was a significant predictor of harmful
alcohol use. Approximately 2.3 million die each year from the harmful use of alcohol, account-
ing for about 3.8% of all deaths in the world. More than half of these deaths occur from NCDs
including cancers, cardiovascular disease and liver cirrhosis [1].
In our study, physical inactivity was high (62.2%), which agrees with previous studies in
Nigeria [5, 6, 32]. We perhaps underestimated the level of physical inactivity in our study
because of the subjective method of assessment in the use of self-reported questionnaires–
(International Physical Activity Questionnaire—IPAQ). For future studies, there is the need to
use more objective means of assessing physical activity like pedometers and accelerometers.
Also, we found that the likelihood of physical inactivity increased with age and income. High
income affords individuals the means for a lifestyle that unduly relies on motorized transport,
labour-saving devices, and indulgence in sedentary pastimes like watching television and
video games. Besides, sedentary occupations like civil service jobs also involve prolonged
hours of sitting. Therefore, workplace interventions that encourage physical activity at work
should be encouraged. For instance, the prohibition of commercial vehicles and motorcycles
within the Oyo State Secretariat encourages some level of physical activity in the workplace.
This may explain why the level of physical inactivity is much lower than that of States’ civil
service, such as that of Kaduna State [5]. Physical inactivity is now a public health concern
hence the WHO recommends that adults should engage in at least 150 minutes of moderate-
intensity aerobic physical activity or at least 75 minutes of vigorous-intensity aerobic physical
activity during the week [33]. We found that less than 50% our study population met this
recommendation.
Daily and sufficient intake of fruits and vegetables protects against NCDs. Currently, 1.7
million deaths worldwide are attributable to low intake of fruits and vegetables [34]. Low
intake of fruits and vegetables was the commonest risk factor of NCDs in the study (69.7%).
This risk factor is also underestimated, because intake of fruits and vegetables in this study was
assessed using at least 5 servings per week instead of the recommended minimum 5 servings
of fruits and vegetables per day. Aryal and coworkers (2015), in their nationwide survey of the
burden of NCD risk factors in Nepal, assessed adequate fruits and vegetables intake as 5 serv-
ings per day and found that almost the entire population (99%) had inadequate intake of fruits
and vegetables [18]. Although, very few researchers have investigated the intake of fruits and
vegetables in Africa, Maimela et al (2016) in the Limpopo Province of South Africa, reported a
high prevalence (86%) of insufficient intake of fruits and vegetables [26]. Also, we noted that
inadequate intake of fruits and vegetables reduced correspondingly with reduced level of

income. Actually, fruits are expensive in the urban areas in Nigeria because fruits and vegeta-
bles are sourced from the rural areas, indicating the need to promote programmes that will
increase the production of fruits and vegetables to make them more available and affordable as
several developed countries (Canada, Japan, Denmark, etc.) have done to implement pro-
grammes that promote fruits and vegetables through mass media campaign and school health
programmes [35–36]. Additionally, Zeba and co-workers (2012) in Burkina Faso have demon-
strated an association between the traditional dietary pattern, which consisted mainly green
leafy vegetables and cereals, had lower risk of cardio metabolic risk factors. [37].
Overweight and obesity were found in more than half of the study population and was asso-
ciated with increasing age and income. The prevalence rate of overweight and obesity among
civil servants in Oyo State (57.3%) is similar to the rates reported among civil servants in
Kaduna [5] and Abakaliki [32] but is much lower than the rate in Lagos (70.7%) which has
higher socio- economic status [38]. The occurrence of overweight and obesity is partly attrib-
utable to the sedentary nature of civil service work [physical inactivity (OR = 3.82)], which is
usually associated with prolonged hours of sitting, minimal energy expenditure, snacking on
energy-dense foods, including sugar-sweetened beverages, and infrequent consumption of
homemade foods. Prolonged hours of sitting has been associated with increased risk of raised
blood sugar, cardiovascular diseases, and cancers [38–40]. Besides, fast food or restaurant pre-
pared meals are usually calorie-dense with high levels of sugar, salt and oils to enhance the
taste and induce people, for profit reasons, to consume portions in excess of their needs.
Hence, there is the need to promote the provision of healthy meals and regulate the services of
canteens. Importantly, gender was a strong predictor of being overweight and obese with the
females having 7 times higher the odds (OR = 6.78) of being overweight and obese than males.
Apart from the factors explained, weight gain from previous pregnancies and postpartum
weight retention in women who have had children may contribute to obesity in these women.
High income (OR = 7.90) was a significant factor of overweight and obesity because it affords
an undue reliance on automated devices like washing machines, dish washers, passive trans-
port and sedentary past times [41–42].
Abdominal obesity, which occurred in close to two-fifths of the study population (37.1%)
was prevalent in our study population. Actually, abdominal obesity is a more ominous sign for
future NCDs, because it is an indicator of visceral obesity, which is associated with higher car-
dio-metabolic risk [13]. Females were about 30 times more likely than the males (AOR = 27.9)
to have abdominal obesity. The other associated issues were physical inactivity, being currently
married and the level of education.
Raised blood pressure (HT) the major risk factor for cardiovascular diseases (CVDs), which
include coronary heart disease, cerebrovascular disease, peripheral vascular disease etc., has
become a global concern. This is because CVDs are the leading cause of death globally with an
estimated 17.5 million deaths yearly [43]. Unfortunately, most of these deaths (>75%) occur
in low and middle income countries. CVDs are also the leading NCD in Nigeria [17]. In our
study, we found that about one-third of the respondents had elevated blood pressure (33.1%).
This finding has been reported by other Nigerian researchers [4, 44– 45]. The factors associ-
ated with raised blood pressure were increasing age, harmful use of alcohol, being overweight
or obese. Increasing age has been shown to be a risk factor for raised blood pressure [5, 46–
47]. This results from changes occurring within the cardiovascular system like thickening of
the arterial wall. Civil servants that were obese and overweight were two times more likely to
have raised blood pressure than those who had normal weight [5, 48]. The relationship
between hypertension and obesity can be explained by deposit of fat causing narrowing or
blockage of the arteries. Thus, the heart does more work in pushing blood against the thick-
ened arterial wall leading to an increase in arterial blood pressure. Additionally, the adipose

tissue also contributes to hypertension by their endocrine and paracrine effects on the endo-
thelial cells by producing substances—cytokines leptin and adiponectin which have detrimen-
tal effects on the vasculature [49– 50]. However, our study did not show any gender difference
in the occurrence of raised blood pressure. Contrariwise, Akinlua and his colleagues (2015) in
a systematic review on the current prevalence and pattern of HT in Nigeria, which estimated a
crude prevalence that ranged between 2.1–47.2%, stated that most studies in Nigeria reported
higher prevalence among males compared to females [51].
Raised blood sugar was the least common biological risk factor in our study with prevalence
of 7.1%. However, this prevalence is slightly higher than rates previously reported by research-
ers in the country [47, 48, 52]. It is important to note that very few studies have assessed the
occurrence of raised blood sugar partly because it was previously uncommon among Nigerians
[52]. Also, the invasive nature of the screening test (fasting blood sugar), which requires an
overnight fast makes the test more difficult to conduct among a healthy study population. Not-
withstanding, it is crucial for researchers to assess the magnitude of raised blood sugar within
the Nigerian population in order to tackle this emerging public health concern. The factors
associated with raised blood sugar included overweight and obesity (AOR = 4.57) and raised
blood pressure (AOR = 5.75). Type 2 raised blood sugar and obesity have been described as
twin epidemics [53] because obesity is a major predictor of raised blood sugar in developed
countries where over 90% of type 2 raised blood sugar patients are either overweight or obese
[54].
Remarkably, while we found that current smoking and harmful alcohol were more among
males, metabolic risk factors (blood pressure, abdominal obesity, overweight and obesity) were
more among females. Finally, a considerable clustering of NCD risk factors was found among
our study population with about four-fifth (80.4%) of our study population having two or
more risk factors and an average of three risk factors per participant. The proportion of clus-
tering is much higher than what was reported by Oluyombo and co-workers [55] in some
semi-urban communities (47.0%) and by Oladapo and colleagues [44] in some rural commu-
nities (12.9%), both in South Western Nigeria. In both studies, clustering was found to increase
with age and was more among females, which corroborates our findings in which age
(IRR = 1.02) and female gender (IRR = 1.36) were the significant predictors for clustering of
NCD risk factors. Even in Kenya, Haregu and co-worker [56] also reported clustering of two
or more risk factors among their urban slum dwellers (19.8%). Although not fully investigated
in this study, metabolic syndrome refers to a cluster of conditions which include increased
blood pressure, high blood sugar, abdominal obesity and abnormal cholesterol or triglyceride
levels increasing the risk of NCDs. Clustering of NCD risk factors is a predictor of poor pro-
gression of disease and premature death. It is also the reason for advocating for an integrated
and comprehensive approach towards the control of NCDs rather than employing the known
modality of managing NCDs, which targets individual diseases.
Strengths and limitations

Our work is an important contribution to the surveillance of NCD risk factors in Nigeria.
Even though it is not a nationally representative survey, an assessment of civil servants in one
of the largest cities in Nigeria can give a minuscular view of the drivers of NCDs within the
larger population until the time when nationally representative surveys, which have begun in a
few African countries like Kenya [57], would be conducted in Nigeria. Currently, the National
response to NCD is just evolving in Nigeria, [17] where most of the indicators like having an
operational national policies for NCDs are yet to be implemented. Although, hyperlipidaemia
is one of the four metabolic risk factors of NCDs, it was not assessed in this study because of

the financial implications. Finally, some of the assessment tools were limited in the level of pre-
cision for instance the level of physical activity was assessed using a subjective rather than
objective method.
Conclusion and implication of the study

In conclusion, our study revealed a high prevalence of NCD risk factors among Nigerian civil
servants. Overall, inadequate fruits and vegetable intake as well as physical inactivity were the
commonest risk factors. We noted that biological risk factors were more common among
females than among males. Hence this phenomenon could be described as the “feminization of
biological risk factors”. There was also a significant level of clustering of NCD risk factors affect-
ing above 75% of our study population. The clustering of NCD risk factors within any popula-
tion is a “bad sign”, because it strongly predicts a huge burden of NCDs and the associated
adverse outcomes like premature deaths in the future. Importantly, our study highlights the high
prevalence of cardio-metabolic risk factors among the working class and thus suggests the need
to provide public health interventions against NCDs, perhaps using the workplace as a platform.
Supporting information
S1 File. Survey Questionnaire on NCD risk factors, Ibadan Nigeria.
(PDF)
S2 File. Raw data of NCD risk factors, Ibadan Nigeria (dta).
(DTA)
S3 File. Analytical script of NCD risk factors, Ibadan Nigeria.
(PDF)
Acknowledgments
The authors wish to thank the Oyo State Civil Service Commission for the permission to con-
duct the study among civil servants, the Permanent Secretary of each of the Ministries for their
support in mobilizing the staff, civil servants in Ibadan for agreeing to participate in this study
and colleagues and research assistants who helped with data collection. We also acknowledge
the input of Mr. Victor Akanmen an editor at Real point Media, Ibadan, Nigeria in editing this
manuscript.
Author Contributions
Conceptualization: Ikeola A. Adeoye.
Data curation: Abisola T. Olawuyi.
Formal analysis: Ikeola A. Adeoye.
Funding acquisition: Abisola T. Olawuyi.
Investigation: Abisola T. Olawuyi.
Methodology: Abisola T. Olawuyi, Ikeola A. Adeoye.
Project administration: Abisola T. Olawuyi.
Resources: Abisola T. Olawuyi.
Supervision: Ikeola A. Adeoye.

Validation: Ikeola A. Adeoye.

Visualization: Ikeola A. Adeoye.
Writing – original draft: Abisola T. Olawuyi, Ikeola A. Adeoye.
Writing – review & editing: Ikeola A. Adeoye.
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RESEARCH ARTICLE

The prevalence and associated factors of non-

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Materials and methods

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Data processing and analysis

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Table 1. Characteristics of study participants in Ibadan.

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Prevalence of behavioural risk factors

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Prevalence of biological risk factors

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Associations with non-communicable disease risk factors

Clustering of behavioral and biological risk factors in study participants

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Fig 1. Prevalence of multiple risk factors among civil servants in Ibadan.

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Strengths and limitations

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Conclusion and implication of the study

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Validation: Ikeola A. Adeoye.

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