Prevalence, determinants, and association of overweight/obesity with non-communicable disease-related biomedical indicators: A cross-sectional study in schoolteachers in Kabul, Afghanistan.

Overweight/obesity constitutes a major risk factor for non-communicable diseases (NCDs), whose global prevalence is growing rapidly, including in Afghanistan. However, the effects of risk factors on NCDs have rarely been studied in the educator workforce. Therefore, the objective of this study is to determine the prevalence, determinants, and association of overweight/obesity with NCD-related biomedical indicators among schoolteachers in Afghanistan. The sample comprised 600 schoolteachers aged 18 years and above. We conducted questionnaire interviews, anthropometric measurements, and blood biochemistry tests. The main explanatory variable was overweight/obesity (body mass index ≥ 25.0 kg/m2). NCD-related biomedical indicators were the outcome variables. Poisson regression models were applied to investigate the association between overweight/obesity and outcome variables. The prevalence of overweight/obesity was 58.2%, which was significantly higher in women, those aged 41-50 years, married participants, and those with 10-20 years of working experience than in their counterparts. After adjusting for sociodemographic variables and lifestyle behaviors, overweight/obesity was significantly associated with hypertension (adjusted prevalence ratio [aPR] = 1.83, 95% confidence interval [CI]: 1.33-2.51); elevated levels of glycosylated hemoglobin (HbA1c) (aPR = 1.35, 95% CI: 1.01-1.79), total cholesterol (aPR = 1.67, 95% CI:1.14-2.44), low-density lipoprotein cholesterol (LDL-C) (aPR = 1.29, 95% CI: 1.10-1.50), and triglycerides (aPR = 1.98, 95% CI: 1.57-2.50), and having three or more comorbidities (aPR = 1.90, 95% CI: 1.47-2.47). Our findings demonstrated a high prevalence of overweight/obesity among schoolteachers. In addition, we found significant associations of overweight/obesity with a higher prevalence of hypertension; elevated serum levels of HbA1c, total cholesterol, LDL-C, and triglycerides; and comorbid conditions in schoolteachers. The findings highlight the need for worksite interventions that promote weight control among schoolteachers with overweight/obesity to reduce the burden of NCDs.

Gender-Specific Prevalence of Risk Factors for Non-Communicable Diseases by Health Service Use among Schoolteachers in Afghanistan.

Objectives of this study were: (1) to examine gender differences in biomedical indicators, lifestyle behaviors, self-health check practices, receipt of professional non-communicable disease (NCD)-related lifestyle advice, and the use of health services among teachers in Afghanistan; and (2) to seek the patterns of these indicators among users and non-users of health services among both male and female teachers. This cross-sectional study was carried out among 600 schoolteachers in Kabul city in February 2017. Gender differences in percentage distributions of abnormal biomedical indicators, lifestyle behaviors, self-health check practices, and receipt of professional lifestyle advice were examined. These patterns were further analyzed according to the use of health services in the previous 12 months by both genders. The results showed that male teachers had a higher prevalence of hypertension, increased serum triglycerides, physically active lifestyle, and tobacco use than female teachers (28.2/20.4, p = 0.038; 47.0/37.9, p = 0.040; 54.3/40.9, p = 0.002; 15.8/0.7, p < 0.001, respectively); female teachers had a higher prevalence of increased serum LDL cholesterol, overweight/obesity, and frequent consumption of fruits/vegetables than male teachers (61.3/50.8, p = 0.018; 64.7/43.5, p < 0.001; 71.4/53.8, p < 0.001, respectively). Female teachers were more likely to receive professional lifestyle advice related to NCDs than male teachers. Although users of health services practiced self-health checks and received professional lifestyle advice more frequently than non-users, abnormal biomedical indicators were similarly shown among users and non-users of health services in both genders. In conclusion, high prevalence of abnormal biomedical indicators was indicated in both male and female teachers, although the specific abnormal biomedical indicators differed by gender. Users and non-users of health services presented a similar prevalence of these abnormal indicators. Understanding the differences in patterns of NCD risk factors is essential when developing gender-informed policies.

Factors associated with antenatal care visits in Afghanistan: secondary analysis of Afghanistan Demographic and Health Survey 2015.

Afghanistan is one of the countries with the poorest maternal mortality ratio in the world. Inadequate utilization of antenatal care (ANC) services increases the risk of maternal mortality. This study aimed to identify the factors associated with ANC visits in Afghanistan. The dataset of the Afghanistan Demographic and Health Survey (AfDHS) 2015 were used for taking the socio-demographic factors, cultural factors, and the number of ANC visits. The subjects of this study were 18,790 women who had at least one live birth in the last five years, and 10,554 women (56.2%) had availed of at least one ANC visit. Most women were 20-29 years old (53.3%), poor (41.7%), had 2-4 children (43.9%), lived in rural areas (76.1%), and had no education (85.0%) or no job (86.7%). Most women answered that husbands made a decision about their healthcare and that getting permission from their husbands was a major challenge. Multivariate analysis showed that age, ethnicity, area of residence, parity, women's education, husband's education, literacy, having a job, wealth, the decision maker for healthcare, and difficulty in getting permission from the husband were significantly correlated with availing of the ANC visits. This study showed that not only the socio-demographic factors but also the cultural factors were associated with ANC visits. The Afghanistan government should improve the education programs at schools and healthcare facilities, for both men and women. To augment women's propensity to take a decision, the programs for women's empowerment need to be supported and extended across the country.