Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Jeremy I. Schwartz

Second Advisor

Drew Cameron

Abstract

Background: Cardiovascular disease (CVD) accounts for 10% of all deaths in Uganda, making it the leading cause of death among non-communicable diseases (NCDs) in the country. Across sub-Saharan Africa, urban market vendors serve as key participants in the informal workforce. Research from West Africa suggests that vendors, many of whom are women, are a vulnerable population with high prevalence of CVD risk factors and structural barriers to healthcare access. However, limited research has examined this population in East Africa, and the present study is the first to characterize 10-year CVD risk and assess healthcare barriers among market vendors in Uganda.Methods: We enrolled 360 vendors (73.9% women) from Nakawa Market, Kampala (n=180) and Mbarara Central Market, Mbarara (n=180) using simple random sampling. We adapted the WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) covering behavioral risk factors, anthropometrics, blood pressure, psychological distress (PHQ-4), social support (OSSS-3), and healthcare access. 10-year CVD risk was estimated for 202 participants aged 40–74 using the 2019 WHO CVD risk non-laboratory-based chart for Eastern Sub-Saharan Africa. Results: Among the 202 participants eligible for 10-year CVD risk estimation, 9.4% had an estimated 10-year CVD risk ≥10%, with men (23.3% vs. 5.7%) and Kampala vendors (14.7% vs. 4.0%) disproportionately affected. In the full sample, 55.2% had elevated blood pressure (≥120/80 mmHg). 23.7% had a blood pressure reading at or above the hypertension threshold, Stage 1 or higher (≥140/90 mmHg), and 49.4% of those affected were previously unaware of their condition. Prior screening was limited: 77.5% reported ever having their blood pressure measured, 49.4% their blood sugar tested, and 10.8% their cholesterol tested. Overall, 75.2% were overweight or obese, only 6.4% met the WHO fruit and vegetable recommendation, 26.7% had moderate-to-severe psychological distress, and 41.7% reported poor social support. More than half (51.4%) reported unmet healthcare need, defined as having ever needed healthcare but not seeking it or being unable to seek it, with cost (58.7%), long waiting times (39.1%), and work hours (26.1%) as the primary barriers. In multivariable logistic regression, female sex (aOR 1.94; 95% CI 1.11–3.37), each additional hour worked per day (1.17; 1.05–1.31), and greater PHQ-4 mental distress (1.10; 1.03–1.17) were independently associated with higher odds of unmet healthcare need, whereas higher individual monthly income (0.70 per log-USD; 0.53–0.91) and completed secondary education or higher (0.48; 0.25–0.93, vs. no schooling) were associated with lower odds of unmet healthcare need. Conclusions: Ugandan market vendors represent a vulnerable population with a high burden of modifiable CVD risk factors, psychological distress, poor social support, and unmet healthcare needs. Low screening coverage, combined with frequent prior diagnosis among those screened, suggests that chronic disease may be underdetected in this population. These findings highlight the need for market-embedded CVD prevention and care strategies that address the full continuum of care, from screening and early detection to linkage to care and sustained treatment follow-up among market vendors in Uganda.

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This is an Open Access Thesis.

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