The aim of this study is to determine the prevalence of overweight/obesity and undiagnosed hypertension and their association with selected sociodemographic variables of military personnel in Maiduguri, Nigeria. To our knowledge, this is the first study which combined prevalence of overweight/obesity and its association with selected sociodemographic variables among military personnel in Nigeria. The study showed a high combined prevalence of overweight/obesity (40.3%) among the military personnel in Maiduguri with 32.5% and 7.8% prevalence of overweight and obesity respectively. The prevalence in overweight/obesity observed in our study is comparable to a recent finding from the cardiovascular (heart) diseases polls conducted in May, 2014 in Nigeria [30
] that revealed 48% of the studied population are either overweight or obese. It is moreover, comparable to a study on the prevalence of obesity in a Nigerian military population that reported 40.4% of Nigerian military personnel to be either overweight or obese [31
]. Prevalence of overweight/obesity was also consistent with those found among young military personnel in Brazil that reported 36% prevalence [27
]. The estimated prevalence of overweight observed among military personnel in this study reported similar findings of 38% prevalence of overweight reported in a study by Al-Asmary et al in a community based screening among military active duty personnel in Saudi-Arabia, however their findings on the prevalence of obesity 28.8% was higher than the one reported in our study [26
], but the combined overall prevalence of overweight/obesity 66.8% among their respondents was higher than the combined prevalence reported in our study. Similarly, a study at a USA Navy medical centre found a prevalence of overweight/obesity of 53% [32
], which was higher than the figure in the present study.
Prevalence of overweight/obesity reported in this study are higher than the 2008 WHO report on Nigeria which gave 26.8% and 6.5% for overweight and obesity, respectively [33
] and the 20% (overweight) and 5% (obesity) reported in two villages in South-Western Nigeria [34
]. However, prevalence of overweight and obesity reported in the present study is lower than the one reported in a Northern city of Nigeria where overweight and obesity prevalence were as high as 53.3% and 21% respectively [35
]. Specifically, in a systematic review, which included only four good-quality community wide studies in Nigeria, Chukwuonye et al., [21
], found that the prevalence of overweight ranged from 20.3% to 35.1%, while the prevalence of obesity ranged from 8.1% to 22.2% which agrees with the present study. The prevalence of obesity as reported by previous studies on other African countries is also higher than those reported in the present study. In the Republic of Benin, Ghana, Tanzania prevalence of obesity is as high as 18% and 13.6%,19.2% respectively [36
]. Similarly, systematic reviews of the literature on overweight and obesity carried out in other parts of the world have also showed a high prevalence of overweight/obesity [39
] showing overweight/obesity as one of the leading global epidemic. In the US, the prevalence of obesity has risen from 22.9% in the late 1980s and early 1990s to 30.5% between 1999 and 2000 [42
The prevalence of overweight/obesity observed among this cohort of Nigerian military personnel corroborates previous studies among the same occupational group [26, 27, 31, 32]. This prevalence observed is high and needs to be of concern in Nigeria, where medical services are not easily accessible for frequent checkups as in the already developed countries. Moreover, overweight and obesity are correlates of poor health and physical fitness. The function of the military personnel to defend and protect the citizenry and the nation at large especially in security challenged region as Maiduguri can never be over-emphasised. Higher prevalence of overweight/obesity among them bares the nation to the consequence of this increasing global epidemic, which can eventually affect the level to which they discharge their duties and performance. According to Athekame, [43
] Functional efficiency required by military personnel to support and defend the constitution of Nigeria against all enemies, foreign and domestic; ensured by timely and effective military action, the security of the country, its territories, and areas vital to its interest; and uphold and advance the national policies and interests of the country depend on strength possessed, which depend upon the physical fitness, endurance and health condition of the individual unit or command in which it is composed [44
Few data exist on the prevalence of undiagnosed hypertension and its association with sociodemographic variables among military personnel in Nigeria with no study among this occupational group in Maiduguri, Nigeria. The study showed a much lower prevalence of undiagnosed hypertension (8.3%) to already existing population based studies of undiagnosed hypertension in Nigeria of 30-40% [45
]. In a similar fashion prevalence observed in the present study was lower than the prevalence of undiagnosed hypertension 17.53% reported in a community based screening for pre-hypertension among military active duty personnel in Saudi-Arabia [26
], and 27% prevalence of hypertension in a study of police forces in Khartoum, Sudan out of which 69.6% were newly diagnosed as hypertensive [28
]. Prevalence of undiagnosed hypertension was however higher than findings from a recent study that reported 4.1% prevalence [50
]. Perhaps the observed variations in prevalence of hypertension can be associated to work environment especially work stress and pressure [51
], lifestyle and dietary habits, which have been documented to increase the incidence of hypertension [52
These prevalence rates of overweight/obesity and undiagnosed hypertension among gender appear to be inconsistent with the prevalence reported in the study by Abu-Aisha [28
].The gender prevalence of undiagnosed hypertension reported in the present study is also lower than that reported by Al-Nozha et al., [53
] in Saudi Arabia that showed the prevalence of hypertension in males as 28.6% and 23.9% in females. The study by [27
] unlike the present study did not stratify the prevalence of obesity and undiagnosed hypertension among military personnel by gender. Females in the present study were less likely to be hypertensive and more likely to be overweight/obese, these disagrees with findings by smith et al., [54
] that indicated women to be less likely than men to be overweight/obese in a 2000 and 2005 survey of health related behaviours among active duty personnel in the United States. However our study has reported a smaller size of the female population in our sample as compared to that of previous studies. However, proportion of female (1/27) and male (31/327) diagnosed with hypertension were comparably low despite the disproportional sample size differences between both genders. Therefore gender prevalence in this study should be interpreted with cautions.
In the present study, the prevalence of overweight/obesity and undiagnosed hypertension tends to be positively associated with age. With those 45 years or older 10 times more likely to be hypertensive and four times more likely to be overweight/obese compared to 30-45 years who were more than twice as likely to be hypertensive and overweight/obese. Affirming that overweight/obesity and undiagnosed hypertension increased with increasing age among the military personnel. This finding is not surprising because evidence indicates that increase in age is a predisposing factor to the development of hypertension and obesity [26
Prevalence of overweight/obesity and undiagnosed hypertension were positively associated with married military personnel. A similar association of prevalence of overweight/obesity and being married was also reported by smith et al., and Desalu et al., [54
]. The higher prevalence and positive associations of overweight/obesity and undiagnosed hypertension among married military personnel in this study could be attributed to the fact that married personnel tend to be older and perhaps more exposed to a combination of family/home and work stress, are less physically active and may engage in unhealthy eating habits.
The prevalence of undiagnosed hypertension was negatively associated with more secondary school education and senior rank among military personnel in the present study this is inconsistent with the finding of Abu-Aisha [28
], where hypertension was positively associated with more secondary school education. The study by Wenzel [27
], also reported lower prevalence of hypertension among military personnel of higher education (19.9%) and senior rank (28.6%) compared to those with lower education and of junior rank. Perhaps, military personnel of senior rank in this study engages in more physical activity, and may have less stressful mental occupational demands than their junior counterparts of lower education and ranks. Overweight/obesity were positively associated with more secondary school education and negatively associated with senior rank. This cannot be explained by the possible confounding effect of the level of education, as this was an independent positive predictor of BMI, Also a higher military rank was a negative independent predictor of BMI [58
]. People in the low socio-economic stratum have been thought to have a higher risk of overweight/obesity. Since a large segment of the military is made up of the junior ranks and their socio-economic status may be rated as low to middle income, this may explain the high rate of overweight/obesity in this group [59
Military personnel from the various countries including Nigeria can be presumed to be exposed to varying levels of stress, pressures from work, family demands, life style and environmental differences which probably result in variations in the prevalence of overweight/obesity and undiagnosed hypertension reported across countries. Occupation-related stress has been considered to be a potentially important cardiovascular risk factor. Consequently, a bulk of investigations has focused on the detection of cardiovascular risk factors and obesity in certain jobs [28
]. However, military personnel are occupational group with special characteristics. Being away from their families for long periods, frequent movement away from their base for military manoeuvres, punctual attendance at their place of work, and work overload may contribute significantly to job strain, and consequently stress-related diseases [60
] like obesity and hypertension.
This study has some limitations even though the cross-sectional study design provides reliable and valid information, longitudinal studies should be carried out in this area. The study was carried out among a small sample of Nigerian military personnel in Maiduguri; there is a need to target a larger sample of this occupational group in Nigeria. Findings from the present study may be difficult to generalize to the general population because the study participants were a unique group. Therefore results should be used with cautions on other sampled population. Despite the above limitations findings from this study has provided an insight into the prevalence of overweight/obesity and undiagnosed hypertension and its association with different Sociodemographic characteristics in a sampled military personnel in Nigeria. Findings from this study have implication for interventional measures among this occupational group in Nigeria.