Knowledge, Attitudes, Practices and Behaviour on Non-Communicable Diseases, Kosovo 2016 Qamile Ramadani, Elvira Rasimi, Ariana Bytyci
Outcome 1 Outcome 2 Outcome 3 Accessible Quality Healthcare Project Funded by: Implemented by: Primary Health Care providers in project municipalities deliver quality services that respond better to communities needs, including those of vulnerable groups Health managers in project municipalities improve their performance in guiding service delivery towards continuous quality improvement that responds to communities needs Health awareness and care seeking behavior of the population in project municipaliti es improves (in particular of vulnerable groups)
Purpose of KAPB study Assess the knowledge, attitude, practice and behaviour of general population, particularly focusing on vulnerable groups regarding selected non-communicable diseases (NCDs), and citizens rights to health.
Methodology 1) Quantitative survey Quantitative questionnaire Face-to-face interviews In-home 1200 respondents, 18+ Urban and rural areas Multi-staged random probability sampling 2) Qualitative research 12 focus group discussion Each group 4-5 participants 18+ Urban and rural areas Random selection with criteria of the target group
Sampling 1) Quantitative survey 1200 respondents 100 respondents per Municipality 30-50 respondents in the small Municipalities 48% males and 52% females Albanian sub-sample: 950 effective interviews RAE sub-sample: 250 effective interviews 2) Qualitative research 12 focus group discussions 9 Albanian community (6 with women, 3 with men) 3 RAE community (1 with women, 3 with men) 5 Urban 7 Rural
Methodology The questionnaire for the quantitative stage had the following sections: Tobacco Use Alcohol Consumption High Blood Pressure Salt and Sugar Physical Activity Lifestyle Advice Chronic Respiratory Diseases Cardiovascular Diseases Diet Diabetes Child Diarrhoea Healthcare Seeking Patients Rights
Results 1) Quantitative Survey
Total Users Non-users Public service users Private service users Albanian RAE Male Female Rural females 18-24 yo 25-34 yo 35-44 yo 45-54 yo 55+ yo 0-199 EUR 200-399 EUR 400-599 EUR 600+ EUR Less than primary Primary Secondary University and higher Urban Rural Risk Factors of NCDs a) Tobacco use Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes? Yes, 20.6% 50.0% 40.0% 30.0% Tobacco use among demographic segments 20.0% 10.0% 0.0% No, 79.4% Total Usage Users Ethnicity Gender Age HH Income Education Residence
Total Users Non-users Public service users Private service users Albanian RAE Male Female Rural females 18-24 yo 25-34 yo 35-44 yo 45-54 yo 55+ yo 0-199 EUR 200-399 EUR 400-599 EUR 600+ EUR Less than primary Primary Secondary University and higher Urban Rural Risk Factors of NCDs b) Alcohol consumption Have you ever consumed any alcohol such as beer, wine or spirits? 50% Consumption of alcohol (ever used) among demographic segments Yes, 15.7% 40% 30% 20% 10% 0% No, 84.3% Total Usage Users Ethnicity Gender Age HH Income Education Residence
Total Users Non-users Public service users Private service users Risk Factors of NCDs Albanian RAE Male Female Rural female 18-24 yo 25-34 yo 35-44 yo 45-54 yo 55+ yo 0-199 EUR c) Diet 200-399 EUR 400-599 EUR 600+ EUR Less than primary Primary Secondary University and higher Urban Rural 6 5 4 Consumption of fruits in a typical week Days a week eating fruit Number of servings per day Consumption of fruits: - on average 5 days in a week 3 2 1 0 - on average 2 servings of fruits on those days where they do eat fruits Usage Users Ethnicity Gender Age HH Income Education Residence
c) Diet Frequency of usage of food in diet Usage of food in diet Several times a day Once a day Several times a week Less often Never Salt or a salty sauce to your food right before you eat it or as you are eating it Salt, salty seasoning or a salty sauce used in cooking or preparing foods in your household 21% 32% 22% 29% 18% 7% 24% 28% 12% 3% Cakes, sweets, chocolate or biscuits 5% 18% 35% 25% 12% Soft drinks, such as Coca Cola, Fanta, energy drinks 16% 22% 28% 21% 8% Sugar in your tea or coffee 65% 15% 9% 5% 3% Commercially baked goods 2% 8% 40% 33% 14% Packaged snack foods 3% 11% 40% 26% 13% Solid fats 2% 18% 30% 15% 5% Fried food 12% 23% 32% 17% 13%
Risk Factors of NCDs d) Physical activity 60% 50% 40% Not meeting WHO recommendations on physical activity for health 52% 46% 39% 30% 20% 10% 0% Men Women Both sexes
KAPB on NCDs a) Diabetes Diabetes Risk factors Early signs Preventive measures
Total Users KAPB on NCDs Non-users Public service users Private service users Albanian RAE Male Female Rural females 18-24 yo 25-34 yo a) Diabetes 35-44 yo 45-54 yo 55+ yo 0-199 EUR 200-399 EUR 400-599 EUR 600+ EUR Less than primary Primary Secondary University and higher Urban Rural 100.0% 90.0% 80.0% 70.0% 60.0% Knowledge about diabetes among demographic segments Knowledge about diabetes higher among users of health services compared to nonusers 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Direct correlation between knowledge about diabetes and: - Age - Household income and - Level of education Total Usage Users Ethnicity Gender Age HH Income Education Residence
KAPB on NCDs a) Diabetes Seeking treatment Confidence among diabetics Informed about prob. associated with diabetes Willingness to be informed
KAPB on NCDs a) Diabetes Glucose measurements Taking medication Taking insulin HH member taking medication HH member taking insulin
KAPB on NCDs b) Hypertension Hypertension Complications
KAPB on NCDs b) Hypertension Confidence Informed about prob. associated with hypertension Willingness to be informed
Results 2) Qualitative Research
Risk Factors: a) Attitudes and practices about smoking Perception: Young people smoke more than others Young males smoke more than young females do Most smokers smoke in their home environment 70% of smokers smoke inside their houses and that 21% of smokers that declared that they smoke inside their houses have children under 18 years old in their household They believe smoking within enclosed spaces affects the health of other family members BUT they would only stop smoking inside the house, when they have guests that do not smoke, otherwise they will not stop. I can t imagine what would it would be like, if I couldn t smoke inside. It has never occurred to me to stop smoking inside the house, I am used to this. (Group with female, Gjakove, urban)
Risk Factors: b) Attitudes and practices about physical activity Rural areas Have limited opportunities for physical activity See as an obstacle the mind-set that still prevails in these rural areas A doctor advised me that housework is not enough, I have to walk. But where can I walk here in the village, people will start talking! (Group with female, Malisheva, rural) Urban areas Youth is more physically active because they have lots of sport centres and gyms nearby Elderly and mothers with children are less active because there is a lack of walking trails or parks
Diet: Eating habits Usually have two main meals per day Lunch and dinner are most important The types of foods for breakfast, lunch and dinner - almost the same. Breakfast Dairy products Fried eggs Dough products Milk Children: Processed meat (salami, sausage) Chocolate cream Butter Lunch Usually: Meat products Dinner Pasta Bread Corn bread etc
Conclusions High knowledge about NCDs, but a very low level of knowledge about risk factors, early signs and preventive measures General lack of understanding about smoking as a risk factor for NCDs Significant portion of the population lacks the recommended physical activity RAE community shows far riskier behaviours especially towards smoking Women are more knowledgeable about NCDs than men, especially when it comes to risk factors, early signs and preventive measures
Recommendations Raise awareness particularly of the RAE community, on risk factors, early signs and preventive measures of NCDs Inform public on the associated problems with NCDs through healthcare professionals Increase understanding that smoking is a risk factor related to NCDs Inform public about the importance of a healthy diet and physical activity Raise awareness about the importance of seeking medical treatment in cases people have NCDs.
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