Prevalence and Determinants of Non-Communicable Disease (NCD) Risk Factors among Indigenous Adults in Khagrachari , Chittagong Hill Tract Area

Abstract

Background Non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, cancers, and chronic respiratory illnesses, are the foremost causes of morbidity and mortality globally, responsible for approximately 74% of all deaths each year. Low- and middle-income countries bear the greatest burden, accounting for nearly 77% of these deaths. Key behavioral risk factors such as tobacco use, physical inactivity, unhealthy diets, and harmful alcohol consumption play a significant role in the development and progression of NCDs. Indigenous populations, particularly those residing in geographically isolated and socioeconomically disadvantaged regions like the Chittagong Hill Tracts (CHT) of Bangladesh, are especially vulnerable. Factors such as poverty, limited healthcare access, cultural marginalization, and rapid shifts from traditional to modern lifestyles contribute to a higher prevalence of NCD risk factors and poorer health outcomes in these communities compared to the general population. However, there is a notable gap in research specifically addressing the prevalence and determinants of NCD risk factors among Indigenous adults in Khagrachari district, CHT. Understanding these determinants is essential to inform targeted, culturally sensitive interventions that address existing health disparities and improve community health outcomes. Therefore, this study aims to identify the prevalence and determinants of NCD risk factors among Indigenous adults in Khagrachari, with a focus on socioeconomic, behavioral, and environmental influences.

Methodology: This study employed a cross-sectional quantitative research design to assess the prevalence and determinants of non-communicable disease (NCD) risk factors among Indigenous adults in Khagrachari, a district within the Chittagong Hill Tracts of Bangladesh. A total of 378 Indigenous participants aged 18 years and above were selected using a multistage random sampling technique to ensure diverse representation across ethnic groups and geographic areas. Data collection was conducted using a semi-structured, interviewer-administered questionnaire adapted from the WHO STEPwise approach to NCD risk factor surveillance. The questionnaire captured demographic, socioeconomic, behavioral, and environmental variables, alongside anthropometric and physiological measurements such as blood pressure and body mass index

(BMI).Before starting the main survey, the questionnaire was tested on a few people to make sure it was clear and easy to understand. Informed consent either written or verbal was obtained from each participant, ensuring voluntary participation and ethical compliance. Participants were also informed that they could withdraw from the study at any point during the data collection process without any consequences. Data were entered and cleaned using SPSS software, with subsequent statistical analyses including descriptive statistics and multivariate logistic regression to identify significant associations between risk factors and potential determinants. Result: The study found a high prevalence of non-communicable disease (NCD) risk factors among Indigenous adults in Khagrachari. 44.7% of participants were current smokers, and 50.5% used smokeless tobacco products. Physical inactivity was reported by 48.4% of respondents, with only 8.5% engaging in daily exercise. Dietary assessments revealed that 17.2% of participants consumed no fruits or vegetables daily, and only 10.1% met the recommended intake of more than five servings per day. Processed and high-sugar diets were common, with 48.4% and 43.9% reporting high intake, respectively. Regarding body weight, 27% of respondents were overweight, 24% were obese, and 7% were underweight. Hypertension was present in 43% of the population and was significantly associated with increasing age (p < 0.005). Notably, there were strong gender differences in smoking prevalence (74.1% among men vs. 8.2% among women), while other NCD risk factors were more evenly distributed between genders. Awareness about NCDs was limited, especially among those who believed they had sufficient access to healthcare. Conclusion: The results indicate that Indigenous adults in Khagrachari are increasingly vulnerable to non-communicable diseases due to a combination of behavioral, socioeconomic, and environmental factors. The shift from traditional to more sedentary and processed-lifestyle patterns, compounded by limited health literacy and access to care, has contributed to a growing health burden in these communities. The findings emphasize the urgent need for targeted, culturally appropriate interventions focused on tobacco cessation, improved nutrition, physical activity promotion, and routine screening.

Beyond the statistics, this study reflects the deeper story of a population often left behind in national health priorities. Many participants continue to face barriers to healthcare access, lack of awareness, and limited opportunities to adopt healthier behaviors. Yet, their participation in this research also shows a willingness to engage and be part of the solution. Prioritizing Indigenous voices and local context in health policies is essential to reduce disparities and improve long-term health outcomes in these underserved communities.