Knowledge, Attitudes, Practices and Behaviour on Non-Communicable Diseases, Kosovo 2016

Qamile Ramadani, Elvira Rasimi, Ariana Bytyci

Accessible Quality Healthcare Project

• Funded by:

• Implemented by:O

utc

om

e 1

• Primary Health Care providers in project municipalities deliver quality services that respond better to communities’ needs, including those of vulnerable groups

Ou

tco

me

2

• Health managers in project municipalities improve their performance in guiding service delivery towards continuous quality improvement that responds to communities’ needs

Ou

tco

me

3

• Health awareness and care seeking behavior of the population in project municipalities 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:

Chronic Respiratory Diseases

Salt and Sugar

Tobacco UseAlcohol Consumption

High Blood Pressure

Lifestyle Advice

Physical Activity

Cardiovascular Diseases

Child Diarrhoea

DiabetesDiet Healthcare Seeking

Patients Rights

Results

1) Quantitative Survey

Risk Factors of NCDs

Yes, 20.6%

No, 79.4%

Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Tota

l

Use

rs

No

n-u

sers

Pu

blic

ser

vice

use

rs

Pri

vate

ser

vice

use

rs

Alb

ania

n

RA

E

Mal

e

Fem

ale

Ru

ral f

emal

es

18

-24

yo

25

-34

yo

35

-44

yo

45

-54

yo

55

+ yo

0-1

99

EU

R

20

0-3

99

EU

R

40

0-5

99

EU

R

60

0+

EU

R

Less

th

an p

rim

ary

Pri

mar

y

Seco

nd

ary

Un

iver

sity

an

d h

igh

er

Urb

an

Ru

ral

Total Usage Users Ethnicity Gender Age HH Income Education Residence

Tobacco use among demographic segments

a) Tobacco use

Risk Factors of NCDs

Yes, 15.7%

No, 84.3%

Have you ever consumed any alcohol such as beer, wine or spirits?

0%

10%

20%

30%

40%

50%

Tota

l

Use

rs

No

n-u

sers

Pu

blic

ser

vice

use

rs

Pri

vate

ser

vice

use

rs

Alb

ania

n

RA

E

Mal

e

Fem

ale

Ru

ral f

emal

es

18

-24

yo

25

-34

yo

35

-44

yo

45

-54

yo

55

+ yo

0-1

99

EU

R

20

0-3

99

EU

R

40

0-5

99

EU

R

60

0+

EU

R

Less

th

an p

rim

ary

Pri

mar

y

Seco

nd

ary

Un

iver

sity

an

d h

igh

er

Urb

an

Ru

ral

TotalUsage Users Ethnicity Gender Age HH Income Education Residence

Consumption of alcohol (ever used) among demographic segments

b) Alcohol consumption

Risk Factors of NCDs

0

1

2

3

4

5

6

Tota

l

Use

rs

No

n-u

sers

Pu

blic

ser

vice

use

rs

Pri

vate

ser

vice

use

rs

Alb

ania

n

RA

E

Mal

e

Fem

ale

Ru

ral f

emal

e

18

-24

yo

25

-34

yo

35

-44

yo

45

-54

yo

55

+ yo

0-1

99

EUR

20

0-3

99

EU

R

40

0-5

99

EU

R

60

0+

EU

R

Less

th

an p

rim

ary

Pri

mar

y

Seco

nd

ary

Un

iver

sity

an

d h

igh

er

Urb

an

Ru

ral

Usage Users Ethnicity Gender Age HH Income Education Residence

Consumption of fruits in a typical week

Days a week eating fruit Number of servings per day

c) Diet

Consumption of fruits:

- on average 5 days in a week

- on average2 servings of fruits on those days where they do eat fruits

c) Diet

Usage of food in diet

Several

times a

day

Once a

day

Several

times a

week

Less

oftenNever

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%

15% 9% 5% 3%

Commercially baked goods 2% 8% 40% 33% 14%

3% 11% 26% 13%

Solid fats 2% 18% 30% 15% 5%

Fried food 12% 23% 32% 17% 13%

Frequency of usage of food in diet

21%

32%

65%

40%

Sugar in your tea or coffee

Packaged snack foods

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

39%

52%

46%

0%

10%

20%

30%

40%

50%

60%

Men Women Both sexes

Not meeting WHO recommendations on physical activity for health

Risk Factors of NCDs d) Physical activity

KAPB on NCDs a) Diabetes

Diabetes

Risk factors

Early signs

Preventive measures

• KAPB on NCDs

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Tota

l

Use

rs

No

n-u

sers

Pu

blic

ser

vice

use

rs

Pri

vate

se

rvic

e u

sers

Alb

ania

n

RA

E

Mal

e

Fem

ale

Ru

ral f

emal

es

18

-24

yo

25

-34

yo

35

-44

yo

45

-54

yo

55

+ yo

0-1

99

EU

R

20

0-3

99

EU

R

40

0-5

99

EU

R

60

0+

EUR

Less

th

an p

rim

ary

Pri

mar

y

Seco

nd

ary

Un

iver

sity

an

d h

igh

er

Urb

an

Ru

ral

Total Usage Users Ethnicity Gender Age HH Income Education Residence

Knowledge about diabetes among demographic segments

a) Diabetes

• Knowledge about diabetes higher among users of health services compared to non-users

• Direct correlation between knowledge about diabetes and:- Age - Household

income and- Level of education

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

HH member taking medication

HH member taking insulin

Taking insulin

Glucose measurements

Taking medication

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

• Perception:

– Young people smoke more than others

– Young males smoke more than young females do

• Most smokers smoke in their home environment

• 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: a) Attitudes and practices about smoking

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

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

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

“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)

• 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….

Diet: Eating habits

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

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

Conclusions

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.

Recommendations

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