Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 22  |  Issue : 1  |  Page : 65-72

Public knowledge and perception of heart disease: A cross-sectional study of two communities in Delta State, Nigeria


Department of Medicine, Delta State University, Abraka; Delta State University Teaching Hospital, Oghara, Nigeria

Date of Submission26-Jan-2020
Date of Decision19-Feb-2020
Date of Acceptance12-Mar-2020
Date of Web Publication20-May-2020

Correspondence Address:
Dr. Ejiroghene M Umuerri
Department of Medicine, Delta State University Teaching Hospital, P.M.B 07 Oghara
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomt.jomt_3_20

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  Abstract 


Background: Knowledge gaps and misperception of heart disease and its risk factors are significant roadblocks to effective prevention and control of cardiovascular diseases (CVD). This study aims to assess the knowledge and perception of heart disease and its risk factors among adults in Delta State, Nigeria. Method: Cross-sectional study of adults recruited from Jesse and Warri, Delta State, Nigeria. The study questionnaire was adapted from the heart disease fact questionnaire (HDFQ). Respondents with knowledge scores <50%, 50–69.9%, and ≥70% were assigned poor, moderate, and good knowledge, respectively. Ethical approval was obtained from the DELSUTH Health Research Ethics Committee. Result: Eight hundred and sixty-six adults with a mean age of 42.6 years were recruited for the study. Majority (56.0%) of the respondents were females and urban dwellers. Knowledge score ranged between 0.0% and 95.7% with a mean score of 39.8(±22.5) %. Majority (65.1%) had poor knowledge of heart disease. Knowledge of heart disease was significantly associated with place of residence [OR (95%CI) = 0.544 (0.408–0.727); P < 0.001], age group [OR (95%CI) = 0.437 (0.314–0.607); P < 0.001], duration of formal education [OR (95%CI) = 3.805 (2.755–5.255); P < 0.001] but not sex (P = 0.871). Majority (75.2%) perceived heart disease to be an extremely serious condition. However, 74.7% of the respondents were not concerned at all about getting heart disease. Conclusion: Although majority of the respondents in this study perceived that heart disease was a serious condition, the overall knowledge of heart disease was poor. There is need to scale-up heart health education among the general populace in Nigeria.

Keywords: Adults, heart disease, Knowledge, Nigeria, perception


How to cite this article:
Umuerri EM. Public knowledge and perception of heart disease: A cross-sectional study of two communities in Delta State, Nigeria. J Med Trop 2020;22:65-72

How to cite this URL:
Umuerri EM. Public knowledge and perception of heart disease: A cross-sectional study of two communities in Delta State, Nigeria. J Med Trop [serial online] 2020 [cited 2020 May 29];22:65-72. Available from: http://www.jmedtropics.org/text.asp?2020/22/1/65/284638




  Introduction Top


Atherosclerotic cardiovascular disease (CVD) is a significant contributor to non-communicable diseases and its consequent morbidity, disability and mortality; chiefly from stroke and coronary heart disease.[1],[2] By the year 2030, the estimated number of CVD-related death per annum is expected to be well over 23 million.[2] The distribution of CVD-burden is skewed; three-quarters of CVD-related deaths occur in economically disadvantaged countries. Whereas, CVD-related deaths have dramatically declined in high-income countries over the past few decades. The gains recorded by the high-income countries are traceable to the effective implementation of preventive strategies at various ecological levels and availability of improved treatment and rehabilitation services for acute cardiovascular events.[3]

The development of CVD is linked to behavioral risk factors such as physical inactivity, tobacco smoking, consumption of excessive alcohol and unhealthy diet. Knowledge and perception influence behavior; attitude and practice.[4] Indeed, gaps in knowledge and misperception of heart disease and its risk factors are significant roadblocks to effective prevention and control of CVD. For successful implementation of cardiovascular disease prevention, it is expedient to evaluate the knowledge base and perception of the target population. Data on public knowledge and perception of heart disease in Nigeria are limited. This study, therefore, aims to assess the knowledge-base and perception of heart disease and its risk factors among adults living in Delta State, Nigeria.


  Methodology Top


This was a cross-sectional population-based study of two communities in Delta State, Nigeria. Delta State is in the Niger-Delta region of Nigeria, located between longitude 5°00 and 6°.45’ East and latitude 5°00 and 6°.30’ North with an estimated population of over four million persons.[5] It is one of the major oil-producing states in Nigeria. Aside from oil-related activities, other contributors to the revenue of the state are agricultural activities and taxation. The State is administratively divided into three senatorial districts.

The study participants were selected using a multi-stage sampling method. Firstly, two of the three senatorial districts were selected using random sampling method by balloting; Delta Central and Delta South senatorial districts. After that, one study site was purposively chosen from each of the randomly selected senatorial districts. The study sites are Jesse, a rural community in Delta Central senatorial district and Warri, a metropolitan city in Delta South senatorial district. Finally, using cluster sampling method, apparently healthy adults aged 18 years and above were recruited for the study from households in the study sites. Only consenting adults who had lived at least one (1) year continuously in the study sites were eligible for enrolment in the study. Pregnant women, visiting adults as well as adult residents who had lived less than one year in the study sites, and persons not willing to participate in the study were not recruited. Using a pooled prevalence of hypertension of 22.5% between the year 2000 and 2009,[6] and assuming a 95% confidence interval, an error margin of 5% and allowing for a 10% non-response rate, the calculated minimum sample size for each study site was 295 persons.

Data on socio-demographic profile, personal and family history of hypertension, diabetes mellitus and dyslipidemia, and knowledge and perception of heart disease were obtained using a structured interviewer-administered questionnaire. The knowledge section of the questionnaire was adapted from the heart disease fact questionnaire (HDFQ).[7] The HDFQ has been validated and used by other researchers.[8],[9],[10] The adapted HDFQ had twenty-three questions and tested knowledge in these domains; risk factors (modifiable and non-modifiable), symptomatology/prognosis, and lifestyle-related prevention and control measures. For each question, the respondent had the option of choosing ‘true,’ ‘false,’ or ‘don’t know.’ A correctly answered question was scored as one (1). An incorrect or neutral answer was scored zero (0). The total percentage score for each respondent was computed. A respondent had good knowledge if the total score is at least 70%. Total scores of less than 50% were regarded as poor knowledge, while knowledge was moderate if the score was between 50% and 69.9%.

Perception of heart disease was tested using five questions. Self-perceived seriousness of and susceptibility to heart disease were tested using one and four questions, respectively.

The physical measurements of height, weight, and blood pressure of all respondents were taken and documented. Respondents were asked to remove their footwear, head dressings, and empty their pockets. Each respondent was then made to stand erect with feet together and looking straight-on. The height (in centimeters) and weight (in kilograms) were noted. The body mass index (in kilogram per square meters) was thereafter calculated. Furthermore, body mass index was categorized using the WHO classification as underweight, normal, overweight, and obese.[11] Using an Omron sphygmomanometer, the blood pressure of each respondent was measured while sitting comfortably from the right arm thrice at an interval of one minute. The average blood pressure reading was after that computed and recorded in mmHg.


  Results Top


Eight hundred and sixty-six adults with a median age of 40 years were enrolled in the study. [Table 1] shows the socio-demographic profile of the study population. About two-fifth (381) of the respondents were males and rural dwellers. Majority of the respondents were married (56.0%), had received more than 12 years of formal education (62.2%), were self-employed (65.0%), and practice Christianity (83.9%).
Table 1: Sociodemographic profile of the study population

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Among the respondents, 107 (12.4), 66 (7.6) and 7 (0.8) reported they had hypertension, diabetes mellitus, and dyslipidemia, respectively. Less than one-fifth of the respondents with a self-reported diagnosis of hypertension and diabetes were rural dwellers [Table 2]. In the same vein, none of the respondents with dyslipidemia were rural dwellers. A majority (63.7%) of the respondents were not aware of a family history of chronic diseases [Table 2].
Table 2: Biophysical characteristics of study population

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Urban dwellers had significantly higher mean body mass index and mean systolic and diastolic blood pressures [Table 2].

[Table 3] shows the questions that tested the knowledge base of the study population and their responses. Of the twenty-three knowledge-based questions, eight items were correctly answered by more than half of the respondents. More than half of the respondents reported ‘don’t know’ to 14 of the 23 items on knowledge of heart disease [Table 3]. The total percentage score of the respondents ranged from 0.0% to 95.7%, with an average score of 39.8% (±22.5). Overall, 564 (65.1%), 225 (26.0%), and 77 (8.9%) of the respondents had poor, moderate, and good knowledge of heart disease, respectively.
Table 3: Responses to questions on heart disease

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The association between knowledge of heart disease and place of residence, age group, sex, duration of formal education, and marital status is as shown in [Table 4]. The associations were statistically significant, except for sex where there were no observed differences in knowledge.
Table 4: Socio-demographic characteristics and knowledge of heart disease

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Knowledge of heart disease did not differ based on the category of body mass index [Table 5]. A significantly higher proportion of respondents with poor knowledge were either normotensive or prehypertensive [Table 5].
Table 5: Association between knowledge of heart disease and cardiometabolic risk factors (measured and self-reported)

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[Table 5] also shows the association between level of knowledge and self-reported personal history of hypertension, diabetes, and dyslipidemia. The association was significant only for those with self-reported diabetes.

A majority (92.0%) of the respondents reported that heart disease was a serious condition [Figure 1].
Figure 1: Perceived seriousness of heart disease.

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A majority (74.7%) of the respondents were not concerned at all about getting heart disease. Of the 219 who were concerned, 85 (38.8%) were extremely concerned. Among the respondents who were not concerned about getting heart disease, 445 (68.9%) had poor knowledge of heart disease. The association between knowledge of heart disease and self-perceived concern of getting heart disease was statistically significant (χ2 = 15.024; OR, 95% confidence interval: 1.851, 1.353–2.533; P < 0.001).

Seven hundred and fifty-two (86.8%) respondents did not perceive any likelihood of getting heart disease. Of the 114 respondents who perceived they were likely to get heart disease, 87 (76.3%) reported an extreme likelihood. Among the respondents who perceived a likelihood of getting heart disease, 85 (74.6%) had poor knowledge of heart disease. The association between the perceived likelihood of getting heart disease and the knowledge of heart disease was statistically significant (χ2 = 5.145; OR, 95% confidence interval: 0.599, 0.383–0.936; P = 0.023).

One hundred and nine (12.6%) of the respondents thought they were responsible for getting heart disease. Among the respondents who did not think they were responsible for getting heart disease, 536 (70.8%) had poor knowledge of heart disease. The association between knowledge of heart disease and perceived responsibility of getting heart disease was statistically significant (χ2 = 85.398; OR, 95% confidence interval: 7.016, 4.441–11.085; P < 0.001).

Compared to their peers, 221 (25.5%) perceived that their chances of getting heart disease were the same, while 637 (73.6%) and 8 (0.9%) were perceived to be lower and higher respectively. A higher proportion of respondents with much lower (60.3%) and same (80.1%) chance of getting heart disease compared to peers had poor knowledge of heart disease. On the other hand, 62.5% of those who perceived a higher chance had good knowledge. The observed differences were statistically significant (χ2 = 31.058; P < 0.001).


  Discussion Top


Findings from this study revealed poor public knowledge of heart disease among adults in Delta State, Nigeria. This is against the backdrop of the growing prevalence of traditional and emerging cardiovascular risk factors in Nigeria.[2],[12] In this study, only 45% of the respondents knew the chronic nature of heart disease. More than 70% of the respondents did not know if heart disease is always apparent to the sufferer. This is worrisome as heart disease can often go unnoticed, especially in the early phase of the disease. In the same vein, symptoms when present may be confused with other diagnoses. Although knowledge of specific symptoms of heart disease was not sought for in this study, previous reports have shown poor knowledge of the symptomatology of heart disease. In a survey of civil servants in Ilorin, Nigeria, Kolo et al. noted a low knowledge of symptoms of a heart attack.[13] Although more than 60% of their study population knew that chest pain or discomfort and shortness of breath were symptoms of heart attack, only 44.4% could discriminate constellations of symptoms of a heart attack from other conditions.[13] This observation is however not peculiar to Nigeria. Similar low-level knowledge of symptoms of heart attack was reported among Kuwaiti adults.[14]

Non-modifiable cardiovascular risk factors although not amenable to preventive measures, nonetheless, contribute to an individual’s total cardiovascular risk. The knowledge of non-modifiable risk factors was variable in this study. While 58.1% of the study population correctly identified that having a family history of heart disease puts them at increased cardiovascular risk, only 45.7% of the respondents knew that advancing age increases the risk. An even less proportion (32%) of the respondents knew men and post-menopausal women had a higher cardiovascular risk. In another household survey in Kathmandu, a metropolis in Nepal, similarly poor but variable knowledge of non-modifiable cardiovascular risk factors were noted among adult respondents: sex (13.8%), hereditary (39.8%), and age (46.9%).[15]

Of the seven questions that assessed modifiable cardiovascular risk factors, only three were correctly answered by more than half of the respondents. These factors were smoking (56.8%), hypercholesterolemia (52.7%), and hypertension (50.1%) in descending order. In Nigeria, cigarettes advertisement is accompanied by warning to consumers on the health risk of smoking. Akintunde et al. in a study of University workers in South-West Nigeria reported a similar pattern though at higher frequencies: smoking (79.6%), hypercholesterolemia (66.5%) and hypertension (64.6%).[9] Pandey et al.[15] also reported smoking and hypertension as commonly known cardiovascular risk factors among adults in Kathmandu; 70.4% and 59.0% respectively. Although, more than half of the respondents in this study correctly identified high serum cholesterol as a cardiovascular risk factor, 81.6%, and 74.8% were unaware of the respective roles of HDL and LDL in the development of heart disease. In contrast, Akintunde et al. reported a lower proportion of respondents who were unaware of the roles of HDL and LDL; 52.4% and 56.3% respectively.[9] Only 34.5% and 42.8% of the respondents in this study correctly identified diabetes and overweight as cardiovascular risk factors. This also contrasts with the higher frequencies (46.1% and 58.3% for diabetes and overweight respectively) reported by Akintunde et al.[9]

Given that cardiovascular risk factors are commonly behavioral, the identified knowledge gaps can act as significant barriers to effective prevention and control of heart disease. Variable levels of knowledge of preventive measures were noted in this study. Less than 50% of the respondents had correct knowledge about measures such as maintaining blood pressure within the target. Although greater than half of the respondents agreed that regular exercise was beneficial, only 37.9% recognized walking and gardening as forms of exercise that improve heart health. It was not surprising that three-quarters of the respondents agreed that quitting smoking reduces the risk of heart disease.

Overall, 65% of the study population had poor knowledge of heart disease with aggregate knowledge score of less than 50. This is far worse than the 49.0% reported by Akintunde et al.[9] even though both studies used the heart disease fact questionnaire[7] to assess knowledge among adult Nigerians. The observed differences in aggregate knowledge score may be due to the variations in the socio-demographic profile of both study populations. While their study[9] was among University workers in an urban location, the index study was among the general population living in both rural and urban locations. Indeed, the socio-demographic profile of the respondents was associated with the observed knowledge levels. Respondents who were rural dwellers, aged 50 years and above, had less than 12 years of formal education and were ever married or cohabiting had significantly higher proportions of respondents with poor knowledge. This pattern is not peculiar to this study. Akin to this study, age, educational and marital status but not sex was found to be predictors of knowledge of heart disease among a cohort of Filipino Americans living in Southern Nevada.[16] There are limited studies on rural-urban differences in knowledge of heart disease in Nigeria. However, like the index study, studies assessing the knowledge of heart disease among adults in the United States revealed lower knowledge scores among rural dwellers compared to their non-rural counterparts.[17],[18] On the other hand, no rural-urban difference was observed in the knowledge of heart attack among adults in Northern Tanzania.[19] Unlike the index study, Akintunde et al. reported no statistically significant association between age, educational status, and knowledge of heart disease.[9] Sex was not significantly associated with knowledge of heart disease in this study. Existing literature review shows inconsistent relationship between sex and knowledge of heart disease with many of them showing no difference in knowledge as was the case with the index study.[20]Although the majority of the respondents perceived the seriousness of heart disease, only 4.8% knew that heart disease has worse mortality than breast cancers among women. Heart failure, a final common pathway for many atherosclerotic heart diseases, has a worse prognosis than many cancers, breast inclusive.[21] Perceived susceptibility to heart disease was assessed in this study using concern, likelihood, personal responsibility, and a peer-comparative chance of getting heart disease. Akin to the level of knowledge of heart disease in this study, most of the respondents had a negative self-perceived susceptibility to heart disease. The significant association between knowledge levels and the domains of perceived susceptibility to heart disease in this study supports the fact that negative self-perception can also be a cog in the wheel of effective prevention of lifestyle-related cardiovascular risk factors and heart disease.


  Conclusion Top


Although almost all the respondents in this study perceived that heart disease was a serious condition, overall poor knowledge of heart disease was rife. The odds were against rural dwellers, respondents with less than 12 years of formal education and those aged 50 years and above as they tended to have poor knowledge of heart disease. Negative self-perceived susceptibility to heart disease was also common.

From the foregoing, the urgent need to re-strategize and scale-up health education and health promotion activities targeted at achieving and maintaining good heart health cannot be over-emphasized. Although socio-demographic variations in knowledge of heart disease were identified in this study, educational interventions should be for all; without prejudice and inequity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Cardiovascular disease. Available at: https://www.who.int/cardiovascular_diseases/en/  Back to cited text no. 1
    
2.
Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G et al. Global regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017;70:1-25. Doi: 10.1016/j.jacc.2017.04.052  Back to cited text no. 2
    
3.
O’Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart 2013;99:159-62  Back to cited text no. 3
    
4.
Ferrer RA, Klein WMP. Risk perceptions and health behavior. Curr Opin Psychol 2015;5:85-89. Doi: 10.1016/j.copsyc.2015.03.012  Back to cited text no. 4
    
5.
Federal Republic of Nigeria, Official Gazette, No. 24, vol, 94, 2007.  Back to cited text no. 5
    
6.
Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJC, Falase AO et al. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol 2012;4:327-40  Back to cited text no. 6
    
7.
Wagner J, Lacey K, Chyun D, Abbott G. Development of a questionnaire to measure heart disease risk knowledge in people with diabetes: the Heart Disease Facts Questionnaire. Patient Educ Couns 2005;58:82-87  Back to cited text no. 7
    
8.
Zehirlioglu L, Mert H. Validity and reliability of the Heart Disease Fact Questionnaire (HDFQ): a Rasch measurement model approach. Prim Care Diabetes 2019. Doi: 10.1016/j.pcd.2019.06.006  Back to cited text no. 8
    
9.
Akintunde AA, Akintunde TS, Opadijo OG. Knowledge of heart disease risk factors among workers in a Nigerian University: a call for concern. Niger Med J 2015;56:91-95. Doi: 10.4103/ 0300-1652. 150688  Back to cited text no. 9
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10.
Amadi CE, Lawal FO, Mbakwem AC, Ajuluchukwu JN, Oke DA. Knowledge of cardiovascular disease risk factors and practice of primary prevention of cardiovascular disease by community pharmacists in Nigeria: a cross-sectional study. Int J Clin Pharm 2018;40:1587-95. Doi: 10.1007/s11096-018-0744-3  Back to cited text no. 10
    
11.
Seidell JC, Flegal KM. Assessing obesity: classification and epidemiology. Br Med Bull 1997;53:238-52  Back to cited text no. 11
    
12.
Ogunmola OJ, Olaifa AO, Oladapo OO, Babatunde OA. Prevalence of cardiovascular risk factors among adults without obvious cardiovascular disease in a rural community in Ekiti State, Southwest Nigeria. BMC Cardiovasc Disord 2013;13:89. Doi: 10.1186/1471-2261-13-89  Back to cited text no. 12
    
13.
Kolo PM, Ogunmodede JA, Sanya EO, Bello HS, Gbadamosi MS, Dele-Ojo BF et al. Public knowledge of heart attack symptoms and prevalence of self-reported cardiovascular risk factors in Ilorin, Nigeria. Nig J Cardiol 2015;12:95-100. Doi: 10.4103/0189-7969.152022  Back to cited text no. 13
  [Full text]  
14.
Awad A, Al-Nafisi H. Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional study. BMC Public Health 2014;14:1131. Doi: 10.1186/1471-2458-14-1131  Back to cited text no. 14
    
15.
Pandey RA, Khadka I. Knowledge regarding preventive measures of heart disease among the adult population in Kathmandu. Health 2012;4:23053, 4 pages. Doi: 10.4236/health.2012.49094  Back to cited text no. 15
    
16.
Angosta AD, Speck KE. Assessment of heart disease knowledge and risk factors among first generation Filipino Americans residing in Southern Nevada: a cross-sectional survey. Clin Nurs Studies 2014;2:123-32. Doi: 10.5430/cns.v2n2p123  Back to cited text no. 16
    
17.
Villablanca AC, Slee C, Lianov L, Tancredi D. Outcomes of a clinic-based educational intervention for cardiovascular disease prevention by race, ethnicity, and urban/rural status. J. Womens Health. 2016;25:1174-86. doi: 10.1089/jwh.2015.5387  Back to cited text no. 17
    
18.
Swanoski MT, Lutfiyya MN, Amaro ML, Akers MF, Huot K. Knowledge of heart attack and stroke symptomatology: a cross-sectional comparison of rural and non-rural US adults. BMC Public Health 2012;12:283-90. doi: 10.1186/1471-2458- 12-283.  Back to cited text no. 18
    
19.
Hertz JT, Madut DB, Tesha RA, William G, Simmons RA, Galson SW et al. Knowledge of myocardial infarction symptoms and perceptions of self-risk in Tanzania. Am Heart J 2019;210:69-74. Doi: 10.1016/j.ahj.2019.01.003  Back to cited text no. 19
    
20.
Jensen LA, Moser DK. Gender differences in knowledge, attitude and beliefs about heart disease. Nurs Clin North Am 2008;43:77-104. Doi: 10.1016/.jcnur.2007.10.005  Back to cited text no. 20
    
21.
Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S et al. Cardiovascular disease and breast cancer: where these entities intersect: a scientific statement from the American Heart Association. Circulation 2018;137:e30-e66. Doi: 10.1161/CIR. 0000000000000556  Back to cited text no. 21
    


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