Vermaak, Kerry.Tseole, Nkeka Peter.2020-04-082020-04-0820182018https://researchspace.ukzn.ac.za/handle/10413/17818Doctoral Degree.University of KwaZulu-Natal, Durban.Background A large body of scholarship describes escalating mortality caused by Non-Communicable Diseases (NCDs) is in Africa. Disease forecasts also anticipate further increases in the prevalence of NCDs in the region. However, there is little work focusing on NCDs in some African countries such as Lesotho. Studies on gender differences in mortality caused by NCDs (linked to NCDs modifiable risk factors) have observed higher death rates in men than in women. There are fewer investigations directed to gendered effects of modifiable risk factors for NCDs in Lesotho. Objectives In order to bridge the existing knowledge gap, this study explores the prevalence and effects of modifiable risk factors for NCDs on adult men’s health. Men are the only subjects in the study owing to reports that mortality caused by NCDs is high in men compared to women, yet men are generally the least researched gender in Lesotho. The study objectives comprised an investigation of the relationship between demographic and socioeconomic factors and lifestyle risk behaviours for NCDs. The study further explored men’s perceptions and attitudes to modifiable risk factors for NCDs. Given the effect that masculinity has on health, the current study has also studied how adult men in Maseru define masculinity. It has also evaluated masculinity’s effects on modifiable risk factors for NCDs. Lastly, the study investigated gender norms in order to better understand how dominant notions of masculinity influence the prevalence of modifiable risk factors for NCDs in men. Methods The study used sequential explanatory mixed methods research design which prioritises and begins with collecting and analysing quantitative and then qualitative data. The methodology process was guided by the Health Belief Model (HBM) and the Health, Illness, Men and Masculinity Model (HIMM) to provide different perspectives on the study. The study went through three phases. The first phase was a pilot study that provided a background understanding of the masculinity scales and prevalence of NCDs risks in a small population sample of 227 respondents. The second phase involved the analysis of the 2014 Lesotho Demographic Health Survey’s secondary data. This phase was meant to provide a larger picture of the prevalence of the NCD’s risk factors among adult men in Lesotho. The third phase involved collection of qualitative data using eight focus group discussions with a total of 54 adult men. This stage was informed by the second stage and this qualitative research assisted the researcher to deep-dive into the reasons behind the estimates and patterns seen from the pilot and the LDHS data analysis, and the potential health preventative measures. Results The prevalence of smoking The final analysis of the data collected by and large shows a low but increasing prevalence of smoking, especially among younger adult men in Maseru, Lesotho. Between 2009 and 2014, there was about seven percent increase in the prevalence of smoking in men. The prevalence of smoking fluctuates among middle age men and eventually declines as men grow older. The prevalence of smoking decreases as the men’s level of education increases. A positive change in marital status, e.g. getting married, and/ cohabiting with a woman leads to increased smoking cessation, while a negative change, e.g. death, divorce and separation leads to an increased prevalence of smoking among adult men. Men who did not practice any religious practices reported higher prevalence of smoking than men who practiced any religion. Stressful occupations led to higher prevalence of smoking. Unskilled labour also reported higher prevalence of smoking. Increases in wealth was found to lead to declines in the prevalence of smoking. Harmful use of alcohol The study findings shows harmful alcohol use as the most prevalent NCDs risk factor in Maseru, Lesotho. Binge alcohol consumption is the most prevalent especially among younger adult men compared to older adult men. Similar to the prevalence of smoking, the prevalence of harmful alcohol use declines as men get older. Binge drinking prevails mostly during men’s leisure time, which is commonly on weekends and at social gatherings. The study shows that excessive and harmful use of alcohol is associated with manliness. Men who do not consume alcohol excessively are perceived as weak and feminine. Men who had the highest level of education showed the highest prevalence of harmful use of alcohol compared to men who reported lower levels of education. Again, similar to smoking, the prevalence of harmful use of alcohol varies across different marital statuses. The married men and men cohabiting with women have lower prevalence of harmful use of alcohol compared to men who are widowers, divorced and separated. Poor dietary The prevalence of poor dietary patterns contribute greatly to the high prevalence of NCDs. Men’s reported behaviours and rationales shows that men commonly abdicated responsibility for their health to women, particularly for healthy eating. The study findings indicate high prevalence of poor dietary patterns among adult men in Lesotho mainly owing to men’s dependency on women for healthy food preparation. Most men reported buying convenient meals as a common practice especially when their wives/partners are not around. In addition to men’s dependency on women for healthy meals preparation, a high prevalence of poor reported higher prevalence of smoking. Increases in wealth was found to lead to declines in the prevalence of smoking. Harmful use of alcohol. The study findings shows harmful alcohol use as the most prevalent NCDs risk factor in Maseru, Lesotho. Binge alcohol consumption is the most prevalent especially among younger adult men compared to older adult men. Similar to the prevalence of smoking, the prevalence of harmful alcohol use declines as men get older. Binge drinking prevails mostly during men’s leisure time, which is commonly on weekends and at social gatherings. The study shows that excessive and harmful use of alcohol is associated with manliness. Men who do not consume alcohol excessively are perceived as weak and feminine. Men who had the highest level of education showed the highest prevalence of harmful use of alcohol compared to men who reported lower levels of education. Again, similar to smoking, the prevalence of harmful use of alcohol varies across different marital statuses. The married men and men cohabiting with women have lower prevalence of harmful use of alcohol compared to men who are widowers, divorced and separated. Poor dietary The prevalence of poor dietary patterns contribute greatly to the high prevalence of NCDs. Men’s reported behaviours and rationales shows that men commonly abdicated responsibility for their health to women, particularly for healthy eating. The study findings indicate high prevalence of poor dietary patterns among adult men in Lesotho mainly owing to men’s dependency on women for healthy food preparation. Most men reported buying convenient meals as a common practice especially when their wives/partners are not around. In addition to men’s dependency on women for healthy meals preparation, a high prevalence of poor dietary patterns in men exists because the negative effects of poor diet seem to develop over a ‘long’ period of time. Physical inactivity Physical inactivity, especially leisure time physical inactivity is reportedly prevalent in Maseru, Lesotho. Reasons for the high prevalence of leisure time physical inactivity include modernisation, which has resulted in sedentary jobs, especially in urban areas like Maseru. Ignorance is another reason described in the study for physical inactivity. This stems from undermining some activities and not perceiving them as physical activities. Another finding of interest is that some adult men perceive leisure time physical inactivity as an activity for the working class members of society. Conclusion Masculinity is one of the principal health determinants that contribute greatly to the risky lifestyle practiced by men. This avoidable risky lifestyle increases men’s exposure to NCDs. It is of critical importance that high-risk members of society, e.g. men, to commit to and adopt lifestyle changes that mitigate the negative effect associated with modifiable risk factors for NCDs.enNon-Communicable Diseases.Health Belief Model.Thesis