Chapter one: Introduction

1.0 Introduction
1.1 Background of the study

Cholesterol is a substance made by animal liver and also supplied in diet through
animal products such as meats, poultry, fish and dairy products. Cholesterol is
needed in the body to insulate nerves, make cell membranes and produce certain
hormones, and it is an important lipid in some membranes. However, the body
makes enough cholesterol, so any dietary cholesterol isn't needed. Cholesterol plays
a major role in human heart health. Cholesterol can be both good and bad. High-
density lipoprotein (HDL) is good cholesterol and low-density lipoprotein (LDL) is
bad cholesterol. High cholesterol in serum is a leading risk factor for human
cardiovascular disease such as coronary heart disease and stroke - America's
number one killer (Tabas, 2002).
In Globally, the raised cholesterol levels increase the risks of heart disease and
stroke. Globally, a third of ischemic heart disease is attributable to high cholesterol.
Overall, raised cholesterol is estimated to cause 2.6 million deaths (4.5% of total)
and 29.7 million DALYS, or 2% of total DALYS. Raised total cholesterol is a major
cause of disease burden in both the developed and developing world as a risk factor
for ischemic heart disease and stroke. In 2008, the global prevalence of raised total
cholesterol among adults was 39% (37% for males and 40% for females).
In Africa the authors reviewed 181 studies involving 309 207 participants from the
community and individuals at high risk of CVD, including patients with hypertension,
diabetes, HIV, and HIV receiving antiretroviral therapy. In the general population,
the pooled prevalence was 41·1% for low HDL cholesterol, 25·7% for elevated LDL
cholesterol, 23·6% for elevated total cholesterol, and 16·5% for
elevated triglyceride concentrations. As expected, dyslipidemia prevalence was
significantly higher in groups at high risk of CVD: prevalence of elevated total
cholesterol concentrations was 38·0% in patients with hypertension, low HDL
cholesterol concentrations was 53·7% in patients with HIV, and elevated triglyceride
concentrations was 35·5% in patients with diabetes. Dyslipidemia prevalence was
higher among urban dwellers than rural dwellers, which is consistent with the nation
that urbanization and adoption of westernized lifestyles among Africans are
underpinning factors of the surge in CVDs. The authors included studies from all
major regions in Africa thus enhancing the generalizability of their findings.
In Somalia the overall population’s mean age was 51.9 ± 12.2 years, with 177
(33.5%) males. Total and atherogenic dyslipidemias were found in 92.8% and
24.8%, respectively. The most common isolated pattern of dyslipidemia was high
non-high-density lipoprotein cholesterol (non-HDL-C) (82.8%), followed by high low-
density lipoprotein cholesterol (LDL-C) (72.6%), high total cholesterol (TC) (54.3%),
and low HDL-C (48.3%). Females were found to have a higher prevalence of high
TC (63.4% vs. 54.2%, p = 0.043) and lower HDL-C (57.4% vs. 46.3%, p = 0.016).
High LDL-C with low HDL-C was the most common pattern among combined type
dyslipidemias (18.1%), followed by high LDL-C with high triglyceride (TG) (17.8%),
as well as low TG with low HDL-C (3.6%). Females had a higher proportion of high
LDL-C with low HDL-C than males (20.3% vs. 13.6%, p = 0.036). Age, gender, body
mass index, central obesity, spot urinary proteinuria, fasting blood glucose, poor
glycemic control, creatinine, and Hs-CRP were all associated with different
dyslipidemia patterns in multivariate logistic regression analysis (Alıcı, 2022).TC
means total cholesterol

Cholesterol is a fat-like substance, found in the blood stream and also in bodily
organs and nerve fibres. While there are different etiological roles for various types
of cholesterol, such as high and low density lipoprotein, the large majority of
descriptive and epidemiological data are available only for total cholesterol levels.
Therefore, in this analysis, cholesterol was defined as total serum cholesterol
expressed in millimoles per litre of blood (mmol/l) a continuous variable with mean
and standard deviation. (World Health Organization, 2004)

This thesis will concrete on Bender Qassim Hospital Bossaso Puntland Somalia
where reported that impact of cholesterol among adults so that why we address for
this study.
1.2 Problem statement.
1.Ideally
Ideally, individuals would maintain optimal cholesterol levels throughout their lives,
reducing their risk of developing cardiovascular diseases (CVDs) and other
associated health conditions. This would involve a balanced diet, regular physical
activity, and lifestyle choices that promote heart health. Healthcare systems would
be equipped to identify individuals at risk of high cholesterol early and provide them
with appropriate interventions to prevent the onset of CVDs.

2. actual
Although the ideal scenario would involve widespread awareness and proactive
management of cholesterol levels, the reality is that many individuals have
suboptimal cholesterol levels. In spite of advances in medical science, a significant
proportion of the population remains unaware of their cholesterol status or lacks
access to effective management strategies. This leads to a higher prevalence of high
cholesterol levels and an increased risk of CVDs
3. consequence
The consequences of high cholesterol levels are profound, with CVDs being the
leading cause of death globally. High cholesterol contributes to the development of
atherosclerosis, narrowing the arteries and increasing the risk of heart attacks and
strokes. Additionally, high cholesterol can lead to other health issues, such as
peripheral artery disease and gallstones. The economic burden of treating CVDs and
related complications is substantial, placing further strain on healthcare systems.

4. gab
Despite the availability of guidelines and treatments for managing cholesterol, there
are significant gaps in the identification and treatment of individuals at risk. Many
people with high cholesterol levels are not adequately diagnosed or treated, leading
to missed opportunities for prevention. There is also a lack of awareness and
understanding of the importance of managing cholesterol levels among the general
population, further contributing to the gap between ideal and actual cholesterol
management practices. Addressing these gaps is essential for reducing the burden
of CVDs and improving overall health outcomes.

purpose of the study 1.3

The purpose of this study is to investigate the impact of cholesterol on health and to
identify strategies for managing cholesterol-related disorders. By examining the
latest research and evidence-based practices, this study aims to provide insights
that can inform clinical practice and public health policies.
Research objective 1.4
1. To review the current literature on cholesterol metabolism and its role in
cardiovascular health in Bender Qassim Hospital Bossaso.
2. To examine the impact of genetic factors, diet, and lifestyle on cholesterol levels
in Bender Qassim Hospital Bossaso.
3. To assess the effectiveness of current interventions for managing cholesterol-
related disorders in Bender Qassim Hospital Bossaso.
4. To identify gaps in knowledge and areas for future research in cholesterol
management in Bender Qassim Hospital Bossaso

Research question 1.5

1. What are the mechanisms by which cholesterol contributes to the development
of cardiovascular diseases in Bender Qassim Hospital Bossaso?
2. How do genetic factors influence cholesterol metabolism and levels in Bender
Qassim Hospital Bossaso?
3. What is the impact of diet and lifestyle on cholesterol levels and cardiovascular
health in Bender Qassim Hospital Bossaso?
4. What are the current guidelines and best practices for managing cholesterol-
related disorders in Bender Qassim Hospital Bossaso?
Scope of the study 1.6
Geographical scope 1.6.1
The geographical scope of this study is focused on the impact of cholesterol among
adults at Bender Qassim Hospital in Bossaso, Puntland, Somalia. The study will
specifically investigate the impact of cholesterol-related conditions, the awareness
and knowledge levels of adults regarding cholesterol, and the management and
treatment practices employed at the hospital.
Theoretical scope 1.6.2
The theoretical scope of this study encompasses various theoretical frameworks
related to cholesterol management and its impact on health outcomes. This includes
theories related to the etiology of cholesterol-related conditions, risk factors
associated with high cholesterol levels, and strategies for cholesterol management
and prevention of related complications.
Time scope 1.6.3
The time scope of this study covers a specified period during which data will be
collected and analyzed. The study will focus on the current status of cholesterol
among adults at Bender Qassim Hospital, with data collection spanning a period of
[March 2024]. This time frame is deemed sufficient to capture relevant data and
trends related to cholesterol levels and associated health outcomes among the adult
population in the study area.
significance of the study 1.7
The study on the impact of cholesterol among adults at Bender Qassim Hospital in
Bossaso, Puntland, Somalia, holds significant importance for several reasons:
Healthcare Planning and Policy Development: The findings of this study can
inform healthcare planning and policy development in Puntland, Somalia.
Understanding the prevalence and impact of cholesterol-related conditions can help
in developing targeted interventions and health programs to improve cholesterol
management and reduce associated health risks.
Clinical Practice Improvement: The study can contribute to improving clinical
practice at Bender Qassim Hospital by providing insights into current practices for
cholesterol management among adults. This can lead to the development of more
effective treatment protocols and guidelines tailored to the local context.
Public Health Awareness: By raising awareness about the importance of
cholesterol management and its impact on health, the study can contribute to
improving public health outcomes. It can empower individuals to make informed
decisions about their health and lifestyle choices.
Research Gap Filling: There is a lack of comprehensive studies on the impact of
cholesterol among adults in Somalia, particularly in the Bossaso region. This study
aims to fill this gap by providing valuable data and insights that can serve as a
foundation for future research in this area.
Community Health Improvement: Ultimately, the study's findings can contribute
to improving the overall health and well-being of the adult population in Bossaso
and beyond. By identifying areas for improvement in cholesterol management and
implementing targeted interventions, the study can help reduce the burden of
cholesterol-related diseases and improve health outcomes.
Operational definitions of the key term 1.8
Cholesterol: For the purpose of this study, cholesterol refers to a waxy, fat-like
substance found in the blood and cells of the body. It includes both high-density
lipoprotein (HDL) cholesterol, often referred to as "good" cholesterol, and low-
density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol. Total
cholesterol levels will be measured to assess the impact on health outcomes.

Impact: The impact of cholesterol among adults at Bender Qassim Hospital will be
assessed based on several factors, including the prevalence of cholesterol-related
conditions (e.g., atherosclerosis, coronary artery disease), the awareness and
knowledge levels of adults regarding cholesterol, and the management and
treatment practices employed at the hospital.

Adults: For the purpose of this study, adults refer to individuals aged 18 years and
older who are receiving healthcare services at Bender Qassim Hospital in Bossaso,
Puntland, Somalia.

Bender Qassim Hospital: This term refers to the healthcare facility located in
Bossaso, Puntland, Somalia, where the study will be conducted. It includes all
departments and services related to adult healthcare.

Bossaso, Puntland, Somalia: This geographical term refers to the specific

location where the study will be conducted. It includes the city of Bossaso and its
surrounding areas within the region of Puntland, Somalia