Assessment of non-communicable diseases screening practices among university lecturers in Ghana – a cross sectional single centre study [version 1; peer review: awaiting peer review

Background: Non-communicable diseases (NCDs) are a major cause of morbidity and mortality globally. In low-income settings, some NCDs are without symptoms so regular screening for early detection is key. However, routine screening for NCDs is limited in the general public and even among the elite. We therefore set


Introduction
Non-communicable diseases (NCDs) are a major cause of morbidity and mortality globally (Pan American Health Organization, 2021;Ouyang et al. 2022;Brenyah et al., 2023a). In low-income settings, some NCDs are without symptoms and hence regular screening for early detection is key to reduce its burden (Budreviciute et al., 2020;National Health Mission;undated). Early detection with appropriate management especially in high-risk individuals may be cost effective (Ghana Ministry of Health, 2012). By lowering common risk factors like tobacco use, hazardous alcohol use, physical inactivity and eating healthily, many NCDs can be avoided (Ghana Ministry of Health, 2012;Pan American Health Organization, 2021). NCDs account for 41 million annual deaths worldwide, or 71% of all fatalities (Pan American Health Organization & WHO, 2022). The prevalence of NCDs is on the rise in low-and middle-income countries (Ndubuisi, 2021;WHO, 2022). Preventive strategies are required, and immediate action must be made to reduce risk factors for NCD development. NCDs not only result in death, but also economic damages for a nation. This is a result of high dependency rates, poor work productivity, and restricted access to production resources, all of which contribute to poverty and low economic growth (Ummi et al., 2021).
As part of the modern approaches to healthcare in identifying and managing NCDs, anticipatory care including general and preventative health screenings have formed a fundamental component. For health to improve and health inequities to be avoided, it is crucial to guarantee a high and equitable uptake of general health check-ups (Watt et al., 2011;Dryden et al., 2012). Lecturers and teaching staff are among the body of professionals that need to undertake regular health checks due to heavy workloads in recent times. However, empirical data on health check practices among lecturers and teaching staff is lacking. We therefore set out to evaluate the health screening practices among lecturers at tertiary institutions in Ghana, using Kwame Nkrumah University of Science and Technology as a test case.
General health checks are a standard part of medical care. It includes a number of tests in a healthy individual with the intention of detecting illness early, preventing illness from occurring, or giving assurance of absence of illness (Scottish Government Report, 2008;Watt et al., 2011;Krogsboll et al., 2012). It is therefore important that individuals have general health checks every year to aid in the identification of, and early management of some possible diseases. However, according to Krogsboll et al. (2012), and Ummi et al. (2021), some people believe these health checks do more harm than good. This is due to the diagnosis of new and unexpected diseases which causes fear in individuals, as well as the rush to treat these conditions that may result in unnecessary regimen that could further harm the body. In either way, general health checks are very vital in the early detection of non-communicable diseases.
Many professions are characterized by huge workload, stress, bad eating habits, and considerably long periods of sitting (Sharma & Majumdar, 2009;Dixon et al. 2014;Gareth et al., 2022). These are all modifiable risk factors of NCDs. Lecturers are a vital group of the society who contribute immensely to the educational system. However, to be a lecturer, means to carry upon oneself a great responsibility encompassing teaching, mentorship, research, community services and leadership roles. University lecturing is implicated in unhealthy modifiable behavior and as such lecturers may be predisposed to risk factors of non-communicable diseases. Available reports in the rise in mortality caused by noncommunicable disease poses a great concern (Ummi et al., 2021;Pan American Health Organization, 2021;WHO, 2022) and needs to be address as a matter of urgency.
Studies have reported that, over the years, there have been several community and professional based studies conducted to assess screening practices (Maindal et al., 2014;Alzahrani et al., 2021;AL-Kahil et al., 2020). Our search in the literature did not reveal the conduct of any study on health check practices among Lecturers or teaching staff. As a result, not much is known about the health check practices of lecturers in Ghana. This study therefore aimed at assessing health check practices among lecturers in the Kwame Nkrumah University of Science and Technology in Ghana. It is hoped that the outcome of this study would inform policy on health care issues not only among lecturers but also other professions in general.

Methods
This section highlights the various methods used for this study. It covers study setting, study design, study approach, study population, sampling techniques, sample size calculation, inclusion and exclusion criteria, ethical consideration, data collection, data management and data analysis.

Study setting
The study was carried out at Kwame Nkrumah University of Science and Technology (KNUST), Kumasi between February to August, 2022. The study covered all the six (6) Colleges in the University.

Study design
This was a cross sectional study to ascertain health check practices among university lecturers. The study therefore captured sex of lecturers who self-reported they were males or females. Therefore we did not inquire into socially constructed roles, behaviors, expressions and identities of individual participants. The implication is that, no external or internal examination of body characteristics or genetic testing, or other means were conducted on study participants.

Study approach
The study employed a quantitative approach in which data was collected using questionnaires with both closed-and openended questions.

Study population
The study population involved 838 Lecturers across the six Colleges at Kwame Nkrumah University of Science and Technology (KNUST), Kumasi. A study of the lecturer population per college revealed that Colleges of Health Sciences (highest) and Agricultural/Natural resources (lowest) were the outliers (Quality Assurance and Planning Office, 2020).

Sampling technique
Simple probability technique was used to select the name of a college and the day/date to visit. Two sets of papers were folded with names of colleges (set 1) and day/date of visit (set 2). A picker picked one folded paper from each set and the name of the college and the day/date to visit was matched. In this case, the ordering of date and visit gave 1 st , College of Humanities & Social Sciences (COHSS), 2 nd College of Agriculture and Natural Resources (CANR), 3 rd College of Art & Built Environment (CABE), 4 th College of Engineering (COE), 5 th College of Science (COS) and 6 th College of Health Sciences (COHS). We then used the 'walk-in' system to select the study participants. By 'walk in', the date and time of visit to the Colleges were not announced to avoid possible biases in terms of lecturer modifiable lifestyle behaviors. Within the days to visit a college, any lecturer we meet in his/her office was a potential study participant. All lecturers who consented to participate in the study were assessed instantly in their offices face to face (see details under data collection procedure and tools).

Sample size calculation
The sample size was obtained using Yamane's (1967) formulae as shown below: However, due to logistical constraints, 205 participants were contacted across the 6 Colleges at Kwame Nkrumah University of Science and Technology. The logistical constraints centered on consumables for the biochemical parameters and anthropometric measurements assessment; gloves, sanitizers, methylated spirits, glucometer strips, cotton wool, batteries (BP apparatus, weighing scales, glucometer gadgets) and among others. We then applied simple proportions to get the number of lecturers to be consulted in each College.

Inclusion and exclusions criteria
Inclusion criteria was made up of all Lecturers on KNUST campus who are in active service and consented to participate. All other staff not within this category were excluded from this research.

Ethical considerations
Ethical approval was sought from the CHRPE, KNUST with approval reference no: CHRPE/AP/581/21 granted on 8 th December, 2021. The aim of the research was explained to participants. Those who consented to participate in the research were given consent forms to sign and date. Again, participants were assured of confidentiality. Participants were told that, they were free to withdraw from the study in the cause of time. In other words, study participants were not coerced into the study.

Data collection procedures and tool
Data was collected using standardized structured questionnaires formulated for the current study based on guidelines of Boynton and Greenhalgh (2004). The questionnaires were pretested at Akenteng Appiah-Menka University of Skills Training and Entrepreneurial Development in Kumasi, Ghana. Questions found to be uncomfortable to respondents or biased were amended and incorporated into the final set of questionnaires (see Extended data, Brenyah et al., 2023b). The questionnaires covered socio-demographic characteristics of respondents, dietary intake, alcohol intake, issues on physical inactivity and tobacco use. Aside these four main risk factors of NCDs, the questionnaire also captured frequency of blood pressure checks, blood pressure outcome anytime it is checked (systolic and diastolic), frequency of general body check-up, frequency of anthropometric measurement checks (weight and height), an assessment of impressions about the outcome of weight and height checks, an assessment of intended measures to be taken depending on the outcomes of weight and health checked. Lecturers were also asked to identify if the content of their jobs have negative effects on their health status. With the assistance of two (2) State Registered Nurses, the research team and research assistants, lecturers were assessed on blood sugar status using glucometers, blood pressure using digital sphygmomanometer, weight and height using weighting scale and stadiometer. Questionnaires were administered using google-forms and submitted before the research team leaves the lecturers office. All these assessments were done in the offices of the lecturers. Instant results of blood sugar status, body mass index and blood pressure were released and interpreted to the respondents.

Data management
Only the Research Team had access to data. Data was kept confidential. The researchers had planned of disposing data from the storage 5 years after the publication of this research. Collected data was entered and cleaned using Microsoft Excel spread sheet, and then imported into STATA version 14.0 (Stata Corp LP, College Station, Texas, USA) for statistical analysis and results presentation.

Data analysis
Descriptive statistics were used to summarize the characteristics of the study population by employing frequencies and percentages for categorical data. In addition, the degree of relatedness (association) was evaluated using Chi-square (χ 2 ) or Fisher's exact tests where appropriate with a p ≤ 0.05 assumed to be statistically significant. Both bivariate and multivariate logistic regression analyses were performed and adjusted for colleges' effect to identify associations among the variables of interest. Variables having significant association in the logistic regression models were set at p ≤ 0.05 with 95% confidence interval (95% CI) for both odd and adjusted odds ratios (OR, AOR).

Variables
Blood pressure (BP) was selected as the dependent variable, and in turn define as Normal: ≤ 120/80 mmHg; Elevated: Systolic between 120-129 and diastolic ≤ 80 mmHg; Hypertensive: Systolic ≥ 130 or diastolic ≥ 80 mmHg. Then dichotomized into Normal blood pressure: ≤ 120/80 mmHg and high blood pressure (Hypertension): ≥ 130/90 mmHg for logistic regression analyses. Independent variables were socio-demographics characteristics; sex status (male/female), age, marital status, staff rank and lecturer's colleges (categorized into binary variable; COHS/COS/COE and CABE/ CANR/COHSS), family history of NCDs and health check status. In this study, the variable "very often" denotes (doing the activity in question more than 4 times a month), "often" denotes (doing the activity in question at least twice a month), and "not often" denotes (doing the activity in question once a month).

Socio-demographic characteristics of university lecturers
The study involved 205 participants including 176 (85.9%) men and 29 (14.15%) women based on their self-declaration of identity (Brenyah et al., 2023b). The mean age of participants was 46.3 AE 9.4 SD years with 39.02% aged 50 years and above as shown together with other variables in Table 1. The only disaggregated variable relating to sex (male and female) were the number and sex identity of study participants per their reported responses and the male/female risk ratio of developing hypertension. Family history of non-communicable diseases among university lecturers Participants with a self-reported NCD were 28.2%. The highest prevalence of the NCDs indicated was hypertension (66.8%) among the lecturers. Additionally, 50.1% of the Lecturers reported a family history of NCD, with hypertension accounting for 70.7% as shown on Table 2.
Distribution of health checks status by blood pressure among university lecturers Table 3 shows that among the lecturers with hypertension, 59 (50.86%) often check their BP each month, whereas 22 (18.97%) reported not doing so often. Thus, there is statistical association (p = 0.049) between the frequency of monthly BP checks and blood pressure. However, no associations were found between BP and nature of BP results (p = 0.475), frequency of medical check-ups (p = 0.737) or BMI (p = 0.094).

Distribution of health checks status by blood sugar status among lecturers
The study found that 68.3% of lecturers undertake health checks by doing a blood sugar test twice a month. Again, 11.7% do the blood sugar test more than 3 times a month. Out of the 164 (80%) that took the test, 107 (65.3%) used the fasting blood sugar (FBS) and 57 (34.7%) used the Random Blood Sugar (RBS). Among those who took the test, 78 (47.5%) are not happy with their blood sugar status. The study found that, 61 (78.2%) claim their blood sugar status is mostly high (100 to 125 mg/dL (5.6 to 6.9 mmol/L) signifying prediabetes as shown on Table 4. Table 5 shows bivariate and multivariate analyses for BP on socio-demographic characteristics and health checks status. Lecturers in the age bracket 40 to 49 years were found to be associated (p = 0.036) with BP in the bivariate analysis, but not in the multivariate analysis (p = 0.114). Additionally, in the bivariate analyses, female lecturers were found to have a higher risk (OR 1.35; 95% CI 0.29-6.21) of developing BP (hypertension) compared to male lecturers. Lecturers in the colleges; COHS/COS/COE were found to be significantly associated (p = 0.016) with BP and were four times more likely  Although there was no association between blood pressure and any of the factors in the multivariate model, the analysis also revealed that lecturers who rarely check their weight (check monthly/yearly) were 91% more likely (AOR: 1.91, 95% CI: 0.09-41.98) to have BP than those who frequently check. Moreover, those with higher BMI (obese) had increase odds of BP that were more than six folds (AOR: 6.89, 95% CI: 0.61-77.9) compared with those with healthy weight. However, there were greater uncertainties surrounding the estimates of these odds.

Factors associated with BP among lecturers adjusting for colleges' effect
The study also assessed if the variables assume different statistically significant associations if the logistics regression analyses were adjusted for effects from the colleges. It was noticed in Table 6 that strong statistical significance was found between BP checks and age ("40-49" p < 0.001, "50+" p = 0.05) and also with BMI ("overweight" p < 0.001, "obese" p < 0.001) in the bivariate analysis. The multivariate analysis showed several statistical associations were found between BP and its predicting factors including age: 40-49 (p < 0.001), the frequency of lecturers' BP checks (with the categories "not often" p < 0.001, "Often" p < 0.001), job influence on lecturers BP (p = 0.037), the frequency of weight checks (with the category "never checked" p < 0.001) and BMI ("obese" p < 0.001) as shown on Table 6.

Discussion
The study reported on socio-demographic characteristics (sex) by only disaggregating the self-identify of respondents based on their self-declaration into male and female. These two categories of respondents (males and females) lecturing at the universities are classified as university lecturers in this research.
The study revealed a high prevalence of NCDs among university lecturers. Hypertension was revealed to be the most prevalent NCD (66.8%) which is not surprising because cardiovascular diseases have been reported to be the most prevalent NCD that accounts for most deaths (World Helath Organization, 2022). Individuals, irrespective of their sex (male or female) with a family history of chronic NCDs are at risk of developing similar conditions later in their lives (Downing et al., 2020;Alemi et al., 2021). This risk factor could add up to the presence of the chronic conditions observed among lecturers.
The prevalence of hypertension among the lecturers could be the occupational stress since there is vast evidence linking hypertension to occupational stress (Djindjic et al., 2012;Rosenthal & Alter, 2012;Owolabi et al., 2012). The current study revealed that lecturers in the age bracket of 40 to 49 years are more predisposed to developing hypertension than the other age groups. The European University Institute (2018) published that most lecturers obtain a PhD by age 37 and very few of them become full professors before the age of 40. This means that extra work is done in the academic pursuit of becoming a professor after the age of 40. Fulfilling occupational duties and that of the academic responsibilities compounds the stress that predisposes lecturers to developing high blood pressure. This situation makes frequent health checks by lecturers very important.
Our study found that, female lecturers were more at risk of developing hypertension than male lecturers. This finding is inconsistent with other studies (Doumas et al., 2013;Everett & Zajacova, 2015;Kalibal et al., 2020;Alemi et al., 2021), that have suggested that hypertension is less likely to occur in women than in men. This inconsistency may be as a result of the age groups because prior studies focused on the youth unlike this current study that focused on older adults. Also, a healthy lifestyle of the female lecturers in this study could be a possible reason, however, it is not absolute. Further studies are needed to explore if the risk of developing hypertension in female lecturers increases as a result of the profession.
However, our study outcome is consistent with the study outcome of Alemi et al. (2021), who reports that, female teachers had a higher prevalence of increased serum low-density lipoprotein (LDL) cholesterol and overweight/obesity than male teachers. The level of awareness of a chronic disease is important in its management. The study revealed that lecturers who had regular medical assessment and checked their blood pressure regularly stood a better chance of identifying hypertension and related conditions such as diabetes and managing them. This finding is consistent with studies conducted by Everett & Zajacova (2015) who found out that participants who were aware of their chronic conditions were better managers of the disease than those who were unaware.
We also found that, among the lecturers with normal BP and those with hypertensive conditions, those who mentioned that they checked their BP often were high accounting for 53.85% and 40.68%, respectively. The implication is that many lecturers are aware of the need for frequent BP monitoring. Whiles those with normal BP are monitoring the possibility of onset of hypertension and other related conditions, those with hypertensive conditions are monitoring the control of their BP.
In addition, we realized that the BMI was biased towards lectures with hypertensive condition. It was found among them that, 51.87% and 43.22% were overweight and obese, respectively. This result is consistent with other studies that have reported that, overweight and obesity are associated with hypertension and diabetes (Jiang et al., 2016;Aronow, 2017). The outcomes of the health check variables translate to various activities as an effort to control it. For instance, according to our study, the lecturers with hypertension exercised more because they were not happy about their weight, unlike those with normal blood pressure who exercised less frequently.
Moreover, our study found that only few lecturers among the normal BP category and those in the hypertensive condition category check their BP's daily accounting for 11.11% and 5.95%, respectively. However, it was noticed that majority of the lecturers in the above categories checked their BP monthly accounting for 55.56% and 45.95% respectively. Under normal circumstances, people with hypertensive conditions should check their BP frequently. However, our study found a contrary practice where lecturers with hypertensive condition were the least in checking their BP in both daily and monthly regimen accounting for 5.95% and 45.95%, respectively. The implication is that BP check practices are poor among lecturers especially those with hypertensive conditions.
The study found that, majority (80 %) of lecturers undertake health checks by doing blood sugar test more than twice a month. Majority of them (107, 65.3 %) do the fasting blood sugar (FBS) and 78 (47.5%) of them are not happy with their blood sugar status. Among those who are not happy with their blood sugar level, 61 (78.2%) have high blood sugar level between 100 to 125 mg/dL (5.6 to 6.9 mmol/L)] which signifies prediabetes.
Awareness means an individual may adopt lifestyle activities that will reduce the risk of developing diabetes and hypertension such as healthy eating and exercising. The regular visits to the hospital for routine examination was found to be higher among lecturers who were hypertensive. The general public has been reported to underutilize general healthcare checkups (Krogsboll et al., 2012) and this study reiterate that findings. This indicates a poor health check among the lecturers because it is indicating that they only go to the hospital when they are aware that they have an onset of a disease.
However, these health checks are reliable means, through which chronic conditions are detected earlier and managed for an improved quality of life. Hence, the need for university lecturers to make it a habit of visiting the hospital for health checks.

Conclusions
The study has revealed that university lecturers, just like the general population have poor health check habits. The need for the setup of occupational health check units in all universities is overdue. The health promotion units of universities and hospitals should also scale up their activities to encourage university lecturers to improve their health check practices.