Community-based Lifestyle Intervention for the Management and Control of Metabolic Syndrome Among Adults Attending St. Mary’s Mission Hospital, Nairobi, Kenya

Abstract

Background: Metabolic Syndrome (MetS) is a major risk factor for cardiovascular disease and type-2 diabetes. Implementation of interventions targeting risk factors associated with lifestyle could significantly control MetS and reduce the burden of cardiovascular diseases. However, the effectiveness of such interventions implemented through a community-based approach has not been reported in Kenya. Objective: Determine the effect of a 15-month community-based lifestyle intervention in adults with metabolic syndrome attending St. Mary’s hospital, Nairobi, Kenya. Methods: A two-arm randomized controlled trial involving 352 adults with MetS was conducted for 15-months. The participants were recruited from the outpatient clinic of St. Mary’s Mission Hospital in Nairobi and randomly assigned into control and intervention groups equally. MetS was difined using the International Diabetes Federation diagnostic criteria. The intervention group was exposed to comprehensive lifestyle intervention that entailed detailed verbal and written recommendations focused on the main modifiable cardiovascular risk factors. While the control group received conventional lifestyle advice, which is the routine care provided in the hospital by health care providers according to the usual clinical practice. A questionnaire adopted from the WHO STEPS was used to collect the lifestyle characteristics of the participants. Knowledge of risks and preventive measures of CVDs and behavioural patterns were measured at baseline and end-line. The trans-theoretical model stages of change towards a healthy lifestyle were assessed before and after the intervention. Physical, clinical and biochemical markers were measured at baseline, midline, and end-line. Analysis with chi-square test and binary logistic regression for categorical and independent t-test and paired t-test for continuous variables were employed. Results: The anthropometric/clinical/biochemical, lifestyle characteristic, knowledge of CVDs were similar across the two groups at baseline. The consumption of recommended dietary intake patterns and physical activity significantly improved in the intervention compared to the control group at the end-line. There was a significant (p < 0.001) decline in the proportion of MetS in the intervention (45.5%) relative to the control group (15.9%) at the endline. There was also a significant (p < 0.05) improvement in all the components of MetS in the intervention relative to control group at the endline. The level of knowledge of the major risk factors and preventive measures of CVDs significantly (p < 0.001) improved in the intervention relative to the control group at the end-line. Additionally, most participants in the intervention group proceeded to the maintenance stage of lifestyle change as per the TTM-based health education intervention. Conclusions: A community-based lifestyle intervention showed effectiveness in modifying lifestyle goals that resulted in improved metabolic outcomes. One in three adults with MetS exposed to a community-based lifestyle intervention experienced improvement - an indication of the efficacy of the model. The findings have major implications for CVDs prevention through early indentification and management of cardiometabolic abnormalities. Integration of community approach into the health system can greatly improve early identification of those at risk for timely intervention, better outcome and protection against CVDs. The approach could leverage on nurses and CHWs who are the main human resource for health at the primary level health facilities to promote community wellbeing through universal health care model.