Effects of training on the WHO package of essential interventions on NCDS prevention and control on the clinical practices of primary health care workers in Benue state

 Corresponding author: Emmanuel Etim Clement Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Effects of training on the WHO package of essential interventions on NCDS prevention and control on the clinical practices of primary health care workers in Benue state ZAR Vershima Daniel 1, Best Ordinioha 1, Gimbason Daniel Mairafi 2, Jibrin M. D 2, UMAR Ibrahim 3 and Bashir Idris 3 1 School of Public Health, University of Port Harcourt. 2 Department of Community Health, Nasarawa State University, Keffi. 3 Community Health Practitioners Registration Board of Nigeria, Abuja. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 Publication history: Received on 09 May 2025; revised on 14 June 2025; accepted on 16 June 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.22.3.0605 Abstract Background: Non-communicable diseases (NCDs) pose a growing health challenge globally, especially in low-resource settings such as Nigeria. Primary healthcare workers (PHCWs) are critical to NCD prevention and control, but often lack adequate knowledge and skills. The World Health Organisation’s Package of Essential Non-Communicable Disease Interventions (WHO PEN) aims to address these gaps. Objective: To evaluate the impact of WHO PEN training on the knowledge, attitudes, and clinical practices of PHCWs in Benue State, Nigeria, and to identify factors associated with these preventive practices. Methods: A quasi-experimental study with 400 PHCWs compared WHO PEN-trained (experimental) and untrained (control) groups using structured questionnaires on NCD knowledge, attitudes, and practices. Chi-square and regression analyses assessed sociodemographic influences. Results: Findings showed that baseline NCD knowledge was high, aligning with national guidelines. Post-training, all participants showed good understanding, with no poor knowledge. Attitudes improved significantly, with 100% positive views on counselling, tobacco cessation, and patient education. Clinical practices varied: patient education improved, but routine BP screening remained low. Older and higher-cadre workers performed better, while sex and experience had no significant impact. Conclusion: WHO PEN training boosted PHCWs' knowledge, attitudes, and clinical practices in NCD prevention in Benue State. While baseline knowledge was strong, the intervention improved confidence and practice consistency, particularly in patient education. Tailoring training for younger, less experienced workers, addressing resource constraints, and sustaining professional development are key to enhancing NCD care. The study recommended that expanding professional development programs in underserved areas is vital to reducing Nigeria's NCD burden. Keywords: WHO PEN (Package of Essential NCD Interventions); NCD Prevention and Control; Clinical Practices; Primary Health Care Workers 1. Introduction Non-communicable diseases (NCDs) pose a growing global health challenge, yet frontline primary healthcare workers often lack the necessary knowledge for effective prevention and control. According to the World Health Organisation World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 313 [WHO] (2024), at least 43 million people died from non-communicable diseases (NCDs) in 2021, which accounted for 75 per cent of mortality worldwide that is not attributable to pandemics. Also, WHO asserted that lowand middleincome nations account for 73 per cent of these fatalities. Additionally, 18 million people died before the age of 70 from an NCD, with lowand middle-income nations accounting for 82 per cent of these premature fatalities. Specifically, WHO (2024) noted that at least 19 million deaths from NCDs are attributable to cardiovascular illnesses, with cancer coming in second with 10 million, chronic respiratory conditions with 4 million, and diabetes with over 2 million deaths, including deaths from kidney disease. Eighty percent of all premature deaths from NCDs are caused by these four disease categories (WHO, 2024). The European Commission (2025) also reported that NCDs such as cardiovascular diseases, diabetes, chronic respiratory diseases, mental disorders, neurological disorders, or cancer are responsible for 80 per cent of the disease burden in the European Union countries and are the leading causes of avoidable premature deaths. Non-communicable diseases are known to affect different populations in other continents and regions, including Africa. The burden of NCDs, both in terms of disease morbidity, mortality and socio-economic impact, is increasing in Africa. According to the African Centre for Diseases Prevention and Control [African CDC] (2022), NCDs constitute a serious impediment to achieving the vision of Agenda 2063 to build an integrated, prosperous, and peaceful Africa driven by its citizens. The burden of NCDs in sub-Saharan Africa alone grew by 67 per cent between 1990 and 2017 (measured as disability adjusted life years–DALYs), reflecting a significant rise in the proportion of total DALYs attributable to NCDs from 18 per cent to 30 per cent (African CDC, 2022). Mohammed et al. (2023) asserted that the burden of NCDs among African Union Member States is higher than the global average. This led to the postulation that Africa has a triple burden of NCDs. The rise of NCDs is projected to accelerate and are estimated to cause more premature deaths on the continent than all ot45 – 65chapter her conditions combined by 2030 and, by far, most death and disability by 2063 (Mohammed et al., 2023). NCDs should no longer be neglected in Africa and must be prioritized on health and development agendas especially by continental, regional and national public health institutes, even in Nigeria. Non-communicable diseases are a significant health problem in Nigeria. The WHO (2018) stated that the risk of premature death from cardiovascular diseases, cancers, respiratory diseases, and diabetes among Nigerians aged 30 to 69 years is quite substantial at 22 per cent. Specifically, cardiovascular diseases as a group now account for approximately 10 per cent of deaths and 3.8 per cent of DALYs (Collaborators and Ärnlöv, 2020). The DALYs lost to NCDs in general increased tremendously by approximately 21.3 per cent from 24,987 in 2010 to 30,306 in 2019, versus 6.5 per cent DALYs lost to infectious diseases over the same period (WHO, 2022). According to the WHO African Region (2023), Nigeria has a high burden of NCDs, making up 27 per cent of deaths in 2019. The mortality rate across four major NCDs (cardiovascular disease, chronic respiratory disease, cancer, diabetes) was 565 per 100,000 in males and 546 in females in 2021 (Oso, 2023; WHO African Region, 2023). Although there is a general increase in the burden of NCDs across states in Nigeria, there is a paucity of studies on NCDs in Benue State. This paucity of studies influences the prevention and control of NCDs in the state. In an optimal healthcare system, primary healthcare workers (PHCWs) should possess comprehensive knowledge and skills for the prevention and control of non-communicable diseases (NCDs). The World Health Organisation Package of Essential Non-Communicable Disease (WHO PEN) interventions were designed to enhance the capacity of PHCWs to detect, manage, and prevent NCDs effectively at the primary healthcare level. Ideally, the full implementation of WHO PEN would equip PHCWs in Benue State, Nigeria, with the necessary expertise to provide early screening, promote lifestyle modifications, and deliver cost-effective treatments, thereby reducing the burden of NCDs and improving overall public health outcomes. However, the reality in Benue State presents a different scenario. NCDs such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer are becoming increasingly prevalent, yet many PHCWs lack the necessary training, knowledge, and resources to implement effective prevention and control measures. The limited awareness and inadequate integration of WHO PEN interventions among PHCWs contribute to poor diagnosis, delayed treatment, and ineffective management of NCDs. Furthermore, systemic challenges such as poor healthcare infrastructure, lack of professional development opportunities, and insufficient policy implementation hinder the capacity of PHCWs to adequately address the growing NCDs burden. Despite the existence of WHO PEN interventions, there is limited empirical evidence on their effectiveness in improving PHCWs' knowledge and practice regarding NCDs prevention and control in Benue State. The extent to which WHO PEN guidelines have been adopted, implemented, and translated into improved knowledge and service delivery among PHCWs remains unclear. Addressing this gap is crucial for strengthening primary healthcare responses to NCDs. Therefore, this study seeks to assess the effects of WHO PEN interventions on PHCWs' knowledge of NCDs prevention and control in primary healthcare settings in Benue State, Nigeria. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 314 1.1. Aim and Objectives of the Study This study aimed to assess the effects of training on the WHO Package of Essential Interventions on NCDs Prevention and Control on the Clinical Practices of Primary Health Care Workers in Benue State. The specific objectives of the study were: • To assess the level of knowledge of preventive practices of NCDs among primary health care workers in Benue State • To assess the attitude towards preventive practices of NCDs among primary health care workers in Benue State • To assess the preventive practices of NCDs among primary health care workers in Benue State 1.2. Research Questions • What is the level of knowledge of preventive practices of NCDs among primary health care workers in Benue State? • What is the attitude towards preventive practices of NCDs among primary health care workers in Benue State? • What are the preventive practices of NCDs among primary health care workers in Benue State? 1.3. Hypotheses The following null hypotheses are postulated to guide the study and will be tested at 0.05 level of significance: • There is no statistically significant difference between the level of knowledge of preventive practices of NCDs in the preand post-intervention stages among the primary health care workers in Benue State. • There is no statistically significant difference between the attitude towards preventive practices of NCDs in the preand post-intervention stages among the primary health care workers in Benue State • There is no statistically significant difference between preventive practices of NCDs in the preand postintervention stages among the primary health care workers in Benue State. 2. Material and methods This study adopted a quasi-experimental research design, involving a pre-test-post-test non-randomised control group design. The study was carried out in Benue State. Benue State, located in north-central Nigeria. The population for the study consisted of primary health care workers (PHCWs), specifically 8 Doctors, 1,561 community health workers (CHWs) comprising 50 community health officers (CHO), 1,138 community health extension workers (CHEW) and 373 junior community health extension workers (JCHEW) employed in Benue State, Nigeria. The study included Health Workers, Doctors, Nurses, Public Health Scientists, Community Health Officers (CHO), Community Health Extension Workers (CHEW), Junior Community Health Extension Workers (JCHEW) and others actively working in primary healthcare facilities in Benue State who have at least six months of work experience in primary healthcare service delivery. Excluded in this study were non-practising Doctors, Nurses, Public Health Scientists, CHO, CHEW JCHEW or other health workers in Benue State at the time of the study. Also excluded were those who declined informed consent or withdrew participation at any stage. For the study, a sample size of 400 PHCWs was determined using the Yamane formula. Thus, n = 𝑁 1+ 𝑁(𝑒2) Where: • n = the required sample size • N = the population size (1,561) • e = the level of precision (0.05) • 1 = unity (a constant) n = 1561 1+ 1.561(0.052) n = 1561 1+ 1.561(0.0025) n = 1561 1+ 3.9025 World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 315 n = 1561 4.9025 n = 318.4 = 318. Computing 1.2 design effect = 318 x 1.2 = 381.6. Hence, the sample size was approximated to 400. The sample size for the study was determined through a two-stage sampling procedure. First, a simple random sampling technique of balloting without replacement was used to select four local government areas (LGAs) from the 23 LGAs in Benue State. At a second stage, a simple random sampling technique of balloting without replacement was used to select 100 PHCWs, comprising 100 primary health care workers from each of the selected LGAs. At the end of the sampling procedure, 100 PHCWs were enrolled for the study in each of the selected four LGAs, giving a total of 400 PHCWs for both control and intervention. A researcher-developed instrument was used for data collection in this study. The instrument was developed in line with the WHO PEN recommended prevention and control of NCDs, such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer. The instrument contained items organised in sections A, B, C and D. Section A comprised the sociodemographic characteristics of the respondents with varied response options. Section B contain items on the knowledge of preventive practices of NCDs. The options were dichotomously scored. This implies that only two scores are possible (True or False). Section C contained questions on attitude towards preventive practices of NCDS, which was on a Likert scale, and Section D contained questions on preventive practices of NCDs. The respondents were asked to place a tick (√) against the correct item. The face validity of the instrument was established by three experts in the fields of public and community health. To establish the construct validity of the instrument, the items of the instrument were subjected to principal component analysis (PCA) using the Statistical Package for Social Science (SPSS) version 26. Before performing the PCA, the suitability of the data for factor analysis was assessed. The items loading .40 and above were retained in the questionnaire. This decision is based on Tabachnik and Fidell's (2007) recommendation that the benchmark for retaining an item in a scale during factor analysis should be .40 and above. The reliability of the instrument was established using Kuder-Richardson-20 (KR-20) and Cronbach's Alpha. According to Cohen et al. (2018), if the correlation coefficient index obtained is 0.70 and above, the instrument was considered reliable for the study. Whereas, when the instrument yields less than .70, it was adjudged not reliable for use. The data collection stage was done in phases. First, the WHO Package of Essential Non-communicable Disease (WHO PEN) Interventions training was designed to aid primary healthcare workers (PHCWs) with essential knowledge and skills for the prevention, early detection, and management of non-communicable diseases (NCDs) at the primary care level. This was followed by the development of the WHO PEN interventions training lesson plan, which covered seven core modules, each focusing on a major NCDs category covered in WHO PEN: Cardiovascular Diseases (CVDs), Diabetes, Chronic Respiratory Diseases (CRDs), and Cancer, as well as integrated NCDs management and monitoring. Before the implementation of the WHO PEN interventions training, the researcher obtained a letter of introduction from the Director, School of Public Health, University of Port-Harcourt. The letter was presented to the Executive Secretary, Benue State Primary Health Care Board, indicating the LGA selected for the study, explaining the purpose of the study and seeking their permission to carry out the study. Furthermore, informed consent was obtained from the PHCWs before they participated in the study. Due to the nature of the study, the researcher employed the services of four research assistants, two with a PhD in Public Health and two with a Master of Science (M.Sc.) in Public Health. The research assistants were briefed on the modalities and the nature of the intervention training. The roles of the research assistants were thoroughly defined. The WHO PEN interventions training was administered to participants in the experimental group once a week for seven days. The control group did not receive any intervention or training. At the end of the intervention, the post-test measure was administered. The instruments were re-administered to the participants in both experimental and control groups within a period of two-week interval. To authenticate the outcome of the study, a one-month follow-up examination was conducted after the post-test. This further facilitated the determination of the effect of WHO PEN interventions training on knowledge of NCDs prevention and control among the participants. Data analysis was performed with Statistical Product and Service Solutions (SPSS) version 25 (IBM, Armonk, New York, USA). A descriptive analysis to report the frequency distributions, percentages, means, and standard deviations was performed. An inferential statistics analysis, such as chi-square and logistics regression, was done to determine factors associated with preventive practices of NCDs among health care workers. All the analyses were performed at 95% confidence intervals, and a p-value ≤0.05 was accepted as statistically significant. Ethical approval was sought from the Ethics Committee of the University of Port Harcourt, while approval had been obtained from the Primary Healthcare Management Board of Benue State. Permission was also sought from the heads of the facilities, and written informed consent was obtained from the primary healthcare workers recruited for the study. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 316 3. Results Table 1 Sociodemographic Characteristics of Respondents Variable Intervention Total X2 p-value Pre Post Age (years) 20-29 187(46.8) 194(48.5) 381(47.6) 30-39 139(34.8) 164(41.0) 303(37.9) 40-49 57(14.2) 36(9.0) 93(11.6) 12.194 0.007* 50 and above 17(4.3) 1(0.5) 23(2.9) Total 400(100.0) 400(100.0) 800(100.0) Sex Male 126(31.5) 126(31.5) 252(31.5) 0.000 1.000 Female 274(68.5) 274(68.5) 548(68.5) Cadre of Health Worker CHEW 253(63.2) 274(68.5) 527(65.9) CHO 77(19.3) 60(15.0) 137(17.1) Dental Therapist 2(0.5) 4(1.0) 6(0.8) Doctors 6(1.5) 8(2.0) 14(1.8) Health Records 4(1.0) 2(0.5) 6(0.8) JCHEW 15(3.8) 14(3.5) 29(3.6) 10.081 0.344 Medical Lab 7(1.8) 12(3.0) 19(2.4) Nurses 28(7.0) 16(4.0) 44(5.5) Pharmacy technician 3(0.8) 2(0.5) 5(0.6) Public Health Scientist 5(1.3) 8(2.0) 13(1.6) Professional training with certificate No 6(1.5) 10(2.5) 16(2.0) 1.020 0.312 Yes 394(98.5) 390(97.5) 784(98.0) Years of working experience 0-4years 226(56.5) 260(65.0) 486(60.8) 5-9years 88(22.0) 88(22.0) 176(22.0) 10-14years 31(7.8) 18(4.5) 49(6.1) 10.786 0.029* 15-19years 32(8.0) 20(5.0) 52(6.5) 20years and above 23(5.8) 14(3.5) 37(4.6) Location of Primary Health Centre Rural 285(71.3) 306(76.5) 591(73.9) 2.856 0.091 Urban 115(28.7) 94(23.5) 209(26.1) World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 317 Table 1 indicates that several 187(46.8%) respondents in pre-phase compared to majority 194(48.5%) of the respondents in post-phase are of ages 20-29 years with a statistically significant difference at p=(0.007). There was found an equal proportion 274(68.5%) of female participants in the pre and post-phases with no statistically significant difference at p=(1.000). Majority 253(63.2%) of the respondents in the pre-phase are CHEW compared to a larger number 274(68.5%) of the respondents in the post-phase with no statistically significant difference at p=(0.344). Most 394(98.5%) of the respondents in the pre-phase have gone through professional trainings with certificate compared to lesser proportion 390(97.5%) of the respondents in the post-phase with a statistically significant difference at p=(0.312). A lesser number 226(56.5%) of the respondent in pre-phase compared to a larger number 260(65.0%) of the participants in the post-phase have 0-4years working experience with a statistically significant difference at p=(0.029). Majority 285(71.3%) of participants in the pre-phase compared to more 306(76.5%) of the participants in the post-phase Primary Healthcare Centres are located in the rural areas with no statistical significance p=(0.091). Table 2a Knowledge of preventive practices of NCDs Variable Intervention Total X2 p-value Pre Post Hypertension cannot be managed effectively with lifestyle changes such as dietary modification and regular exercise. True 16(4.0) 0(0.0) 16(2.0) 16.327 0.00001* False 384(96.0) 400(100.0) 784(98.0) Screening for diabetes should not be conducted annually for individuals over 40 years old True 76(19.0) 2(0.5) 78(9.8) 77.790 0.0001* False 324(81.0) 398(99.5) 722(90.3) The use of tobacco is linked to an increased risk of cardiovascular diseases True 309(77.3) 400(100.0) 709(88.6) 102.680 0.0001* False 91(22.8) 0(0.0) 91(11.4) It is not important to incorporate regular physical activity and balanced nutrition in preventing chronic respiratory diseases True 56(14.0) 0(0.0) 56(7.0) 60.215 0.0001* False 344(86.0) 400(100.0) 744(93.0) Cancer screening for cervical and breast cancer is not a key component of primary healthcare for women. True 61(15.3) 0(0.0) 61(7.6) 66.035 0.0001* False 339(84.8) 400(100.0) 739(92.4) Maintaining a healthy body weight cannot reduce the risk of developing type 2 diabetes. True 20(5.0) 0(0.0) 20(2.5) 20.513 0.0001* False 380(95.0) 400(100.0) 780(97.5) Table 2a shows that 384(96.0%) of the respondents in pre-phase compared to all 400(100.0%) of the respondents in post-phase agree that hypertension can be managed effectively with lifestyle changes such as dietary modification and regular exercise with a statistically significant difference at p=(0.0001). Screening for diabetes should be conducted annually for individuals over 40 years old was seen from the majority 324(81.0%) of the participants in the pre-phase compared to a higher proportion 398(99.5%) of the respondents in the post-phases with a statistically significant difference at p=(0.0001). The use of tobacco is believed to be linked to an increased risk of cardiovascular diseases by 309(77.3%) respondents in the pre-phase compared to all 400(100.0%) of the respondents in the post-phase with a statistically significant difference at p=(0.0001). Most of the respondents 344(86.0%) in the pre-phase accepted that it is important to incorporate regular physical activity and balanced nutrition in preventing chronic respiratory diseases compared to all 400(100.0%) of the respondents in the post-phase with a statistically significant difference at p=(0.0001). Cancer screening for cervical and World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 318 breast cancer is a key component of primary healthcare for women was agreed by majority 339(84.8%) of the respondent in pre-phase compared to all 400(100.0%) of the participants in the post-phase with a statistical significant difference at p=(0.0001). Most 380(95.0%) of the participants in the pre-phase compared to all 400(100.0%) of the participants in the post-phase do accept that maintaining a healthy body weight can reduce the risk of developing type 2 diabetes with a statistical significance at p=(0.0001). Table 2b Knowledge of preventive practices of NCDs Variable Intervention Total X2 p-value Pre Post Controlling blood pressure is important for reducing the risk of stroke. False 6(1.5) 0(0.0) 6(0.8) 6.045 0.014* True 394(98.5) 400(100.0) 794(99.3) Regular handwashing is an effective practice for preventing chronic respiratory diseases False 111(27.8) 100(25.0) 211(26.4) 0.779 0.377 True 289(72.3) 300(75.0) 589(73.6) A high intake of fruits and vegetables is important for reducing the risk of cancers and cardiovascular diseases False 52(13.0) 0(0.0) 52(6.5) 55.615 0.0001* True 348(87.0) 400(100.0) 748(93.5) Metformin is the recommended first-line pharmacological treatment for managing type 2 diabetes when lifestyle modifications alone are insufficient False 27(6.8) 0(0.0) 27(3.4) 27.943 0.0001* True 373(93.3) 400(100.0) 773(96.6) Counseling patients on smoking cessation and avoidance of secondhand smoke exposure is an essential preventive strategy for individuals with both asthma and Chronic Obstructive Pulmonary Disease (COPD). False 5(1.3) 0(0.0) 5(0.6) 5.031 0.025* True 395(98.8) 400(100.0) 795(99.4) Self-care strategies such as medication adherence and monitoring can help manage chronic diseases like hypertension and diabetes False 13(3.3) 0(0.0) 13(1.6) 13.215 0.0001* True 387(96.8) 400(100.0) 787(98.4) Table 2b shows that most 394(98.5%) of the respondents in pre-phase compared to all 400(100.0%) of the respondents in post-phase agreed that controlling blood pressure is important for reducing the risk of stroke with a statistically significant difference at p=(0.014). Regular handwashing is an effective practice for preventing chronic respiratory diseases was agreed by the majority 289(72.3%) of the participants in the pre-phase compared to a higher proportion 300(75.0%) of the respondents in the post-phase with no statistically significant difference at p=(0.377). Most respondents 348 (87.0%) in the pre-phase and all 400 respondents (100.0%) in the post-phase agreed that eating a lot of fruits and vegetables is beneficial for lowering the risk of cardiovascular illnesses and malignancies, with a statistically significant difference at p=0.0001 Metformin is the recommended first-line pharmacological treatment for managing type 2 diabetes when lifestyle modifications alone are insufficient was identified by most 373(93.3%) of the respondents in the pre-phase compared to all 400(100.0%) of the respondents in the post-phase with a statistically significant difference at p=(0.0001). Counseling patients on smoking cessation and avoidance of secondhand smoke exposure is an essential preventive strategy for individuals with both asthma and Chronic Obstructive Pulmonary Disease (COPD) was accepted by majority 395(98.8%) of the respondent in pre-phase compared to all 400(100.0%) of the participants in the post-phase with a statistically significant difference at p=(0.025). Most 380(95.0%) of the participants in the pre-phase compared to all World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 319 400(100.0%) of the participants in the post-phase do accept that Self-care strategies such as medication adherence and monitoring can help manage chronic diseases like hypertension and diabetes with a statistical significance at p=(0.0001). Table 3 Assessment of Knowledge of preventive practices of NCDs Variable Intervention Total X2 p-value Pre Post Assessment of Knowledge Poor 51(12.8) 0(0.0) 51(6.4) Good 349(87.3) 400(100.0) 749(93.6) 54.473 0.0001* Total 400(100.0) 400(100.0) 800(100.0) Table 3 reveals that few 51(12.8%) respondents in pre-phase compared to none 0(0.0%) of the respondents in postphase has poor knowledge of preventive practices of NCDs, while majority 253(63.2%) of the respondents in the prephase compared to all 400(100.0%) of the respondents in the post-phase has good knowledge of preventive practices of NCDs with a statistically significant difference at p=(0.0001). Table 4a Attitude towards preventive practices of NCDs Variable Intervention Total X2 p-value Pre Post Providing lifestyle counseling, such as diet and exercise, are effective in preventing NCDs Agree 107(26.8) 32(8.0) 139(17.4) Disagree 4(1.0) 2(0.5) 6(0.8) Maybe 6(1.5) 4(1.0) 10(1.3) 51.319 0.0001* Strongly Agree 222(55.5) 280(70.0) 502(62.7) Strongly Disagree 61(15.3) 82(20.5) 143(17.9) I feel confident in my ability to educate patients about the risks of smoking and the benefits of quitting Agree 96(24.0) 0(0.0) 96(12.0) Disagree 13(3.3) 0(0.0) 13(1.6) Maybe 7(1.8) 0(0.0) 7(0.9) 203.773 0.0001* Strongly Agree 226(56.5) 394(98.5) 620(77.5) Strongly Disagree 58(14.5) 6(1.5) 64(8.0) Empowering patients with NCDs through self-care education and support significantly improves their health outcomes Agree 155(38.8) 0(0.0) 155(19.4) Disagree 1(0.3) 0(0.0) 1(0.1) Maybe 9(2.3) 0(0.0) 9(1.1) 231.954 0.0001* Strongly Agree 166(41.5) 200(50.0) 366(45.8) Strongly Disagree 69(17.3) 200(50.0) 269(33.6) Following up regularly with patients diagnosed with NCDs is crucial for effective long-term management and prevention of complications World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 320 Agree 126(31.5) 0(0.0) 126(15.8) Disagree 5(1.3) 0(0.0) 5(0.6) Maybe 9(2.3) 0(0.0) 9(1.1) 170.000 0.0001* Strongly Agree 200(50.0) 300(75.0) 500(62.5) Strongly Disagree 60(15.0) 100(25.0) 160(20.0) Table 4a reveals that many 222(55.5%) study respondents in pre-phase compared to majority 280(70.0%) of the respondents in post-phase strongly agree that providing lifestyle counselling, such as diet and exercise, are effective in preventing NCDs with a statistically significant difference at p=(0.0001). Many 226(56.5%) of the participants in the pre-phase compared to a most 394(98.5%) of the respondents in the post-phases strongly agree that they feel confident in their ability to educate patients about the risks of smoking and the benefits of quitting with a statistically significant difference at p=(0.0001). Empowering patients with NCDs through self-care education and support significantly improves their health outcomes was strongly agreed to by fewer 166(41.5%) respondents in the pre-phase compared to a higher proportion 200(50.0%) of the respondents in the post-phase with a statistically significant difference at p=(0.0001). Following up regularly with patients diagnosed with NCDs is crucial for effective long-term management and prevention of complications as strongly agreed by half 200(50.0%) of the respondents in the pre-phase compared to more than half 300(75.0%) of the respondents in the post-phase with a statistically significant difference at p=(0.0001). Table 4b Attitude towards preventive practices of NCDs Variable Intervention Total X2 p-value Pre Post Integrating tobacco cessation counselling into routine primary care consultations is critical for preventing cardiovascular diseases. Agree 138(34.5) 0(0.0) 138(17.3) Disagree 17(4.3) 0(0.0) 17(2.1) Maybe 14(3.5) 0(0.0) 14(1.8) 295.890 0.0001* Strongly Agree 184(46.0) 400(100.0) 584(73.0) Strongly Disagree 47(11.8) 0(0.0) 47(5.9) I am willing to receive further training in NCD prevention strategies to improve my knowledge and practice Agree 121(30.3) 0(0.0) 121(15.1) Disagree 9(2.3) 0(0.0) 9(1.1) Maybe 5(1.3) 0(0.0) 5(0.6) 163.224 0.000* Strongly Agree 207(51.7) 300(75.0) 507(63.4) Strongly Disagree 58(14.5) 100(25.0) 158(19.8) Table 4b indicates that fewer number 184(46.0%) of the respondents in pre-phase compared to majority 300(75.0%) of the respondents in post-phase strongly agree that integrating tobacco cessation counseling into routine primary care consultations is critical for preventing cardiovascular diseases with a statistically significant difference at p=(0.0001). Many 207(51.7%) of the participants in the pre-phase compared to a larger number 300(75.0%) of the respondents in the post-phases strongly agree that they are willing to receive further training in NCD prevention strategies to improve their knowledge and practice with a statistically significant difference at p=(0.0001). World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 327 [11] Farzaei, M., Shahbazi, S., Gilani, N., Ostadrahimi, A., and Gholizadeh, L. (2023). Nurses' knowledge, attitudes, and practices with regards to nutritional management of diabetes mellitus. BMC Medical Education, 23(1), 192. [12] Hyon, C. S., Nam, K. Y., Sun, H. C., Garg, R., Shrestha, S. M., Ok, K. U., and Kumar, R. (2017). Package of essential noncommunicable disease (PEN) interventions in primary health-care settings in the Democratic People's Republic of Korea: A feasibility study. WHO South-East Asia Journal of Public Health, 6(2), 69–73. [13] Kolawole, T. O., Mustapha, A. Y., Mbata, A. O., Tomoh, B. O., Forkuo, A. Y., and Kelvin-Agwu, M. C. (2023). Evaluating the Effectiveness of Community-Based Health Education Programs in Preventing Non-Communicable Diseases. Iconic Research and Engineering Journals, 7(3), 779-793. [14] Maluka, S. (2017). Primary Healthcare Systems (PRIMASYS) Comprehensive Case Study from the United Republic of Tanzania. World Health Organisation. http://apps.who.int/bookorders [15] Miner, C. A., Envuladu, E. A., Afolaranmi, T. O., Okeahialam, B. N., and Zoakah, A. I. (2022). Assessment of primary health care workers' knowledge and skill for COPD and asthma screening and diagnosis in Jos LGA of Plateau State. The Pan African Medical Journal, 41, 21. [16] Mohammed, A., Putnis, N., Kakunze, A., Riches, S. P., Humphreys, E., Eaton, J., Bhatia, T., Dar, O., Raji, T., Walker, I. F., and Ogwell, A. (2023). Non-communicable diseases, injuries, and mental ill-health in Africa: the role of the Africa Centres for Disease Control and Prevention. The Lancet. Global health, 11(4), e495–e496. https://doi.org/10.1016/S2214-109X(23)00054-2 [17] Mutale, W., Bosomprah, S., Shankalala, P., Mweemba, O., Chilengi, R., Kapambwe, S., Chishimba, C., Mukanu, M., Chibutu, D., and Heimburger, D. (2018). Assessing capacity and readiness to manage NCDs in primary care settings: Gaps and opportunities based on the adapted WHO PEN tool in Zambia. PloS One, 13(8), e0200994. [18] Nwankwo, B., and Sambo, M. N. (2020). Effect of Training on Knowledge and Attitude of Health Care Workers towards Health Management Information System in Primary Health Centres in Northwest Nigeria. West African journal of medicine, 37(2), 138–144. [19] Odusanya, O. O., Adeniran, A., Bakare, O. Q., Odugbemi, B. A., Enikuomehin, O. A., Jeje, O. O., and Emechebe, A. C. (2022). Building capacity of primary health care workers and clients on COVID-19: Results from a web-based training. PloS one, 17(10), e0274750. [20] Okoli, R. C. B., Shedul, G., Hirschhorn, L. R., Orji, I. A., Ojo, T. M., Egenti, N., Omitiran, K., Akor, B., Baldridge, A. S., Huffman, M. D., Ojji, D., and Kandula, N. R. (2021). Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centres in the Federal Capital Territory, Nigeria: a qualitative study. Implementation science communications, 2(1), 97. [21] Oladele, D. A., Odusola, A. O., Odubela, O., Nwaozuru, U., Calvin, C., Musa, Z., Idigbe, I., Nwakwo, C., Odejobi, Y., Aifah, A., Kanneh, N., Mishra, S., Onakomaiya, D., Iwelunmor, J., Ogedegbe, O., and Ezechi, O. (2023). Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned. BMC Health Services Research, 23(1), 673. [22] Onagbiye, S. O., Tsolekile, L. P., and Puoane, T. (2020). Knowledge of non-communicable disease risk factors among community health workers in South Africa. Open Public Health Journal, 2020, 13. [23] Oso, A. (2023). Non-communicable Diseases: An Emerging Epidemic in Nigeria. Tropical Journal of Nephrology, 18(1 and 2), 31-37. [24] Otu, A. A., Effa, E. E., Onwusaka, O., Omoyele, C., Arakelyan, S., Okuzu, O., and Walley, J. (2022). mHealth guideline training for non-communicable diseases in primary care facilities in Nigeria: a mixed methods pilot study. BMJ open, 12(8), e060304. [25] Tajudeen, W. A., Adesina, K. A., Fakorede, J. L., Muraina, O. A., Ikotun, B. M., Adesiyan, H. J., Olayinka, A. O., and Omisore, A. G. (2023). Knowledge, Attitudes and Practices of Disease Prevention among Health Talk-Giving Healthcare Workers in Primary Health Centres at Osogbo. Research Journal of Health Sciences, 11(3), 224–237. [26] World Health Organisation [WHO]. (2018). Non-communicable diseases country profiles 2018. Geneva: World Health [27] World Health Organisation [WHO]. (2022). Global health estimates: Leading causes of DALYs. Disease burden, 2000–2021. Available from: https://www.who.int/data/gho/data/them es/mortality-and-global-healthestimates/global-health-estimates-leading-causes-of-dalys World Journal of Biology Pharmacy and Health Sciences, 2025, 22(03), 312-328 328 [28] World Health Organisation [WHO]. (2023d). Increasing fruit and vegetable consumption to reduce the risk of non-communicable diseases. Retrieved from https://ww w.who.int/tools/elena/interventions/fruit-vegetablesncds [29] World Health Organisation [WHO]. (2024). Non-communicable diseases. Retrieved from htt ps://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Non communicable%20diseases%20(NCDs)%20killed%20at,%2D%20and%20middle%2Dincome%20countries. [30] Yenit, M. K., Kolbe-Alexander, T. L., Gelaye, K. A., Gezie, L. D., Tesema, G. A., Abebe, S. M., Azale, T., Shitu, K., and Gyawali, P. (2023). An Evaluation of Community Health Workers’ Knowledge, Attitude and Personal Lifestyle Behaviour in Non-Communicable Disease Health Promotion and Their Association with Self-Efficacy and NCDRisk Perception. International Journal of Environmental Research and Public Health, 20(9), 5642.