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A section of the Nairobi Central Business District (CBD).

A section of the Nairobi Central Business District (CBD).

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Rapid urbanization in Africa has been linked to the growing burden of non-communicable diseases (NCDs). Urbanization processes have amplified lifestyle risk factors for NCDs (including unhealthy diets, tobacco use, harmful alcohol intake, and physical inactivity), especially among individuals of low and middle social economic status. Nevertheless,...

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... is estimated that up to 62 percent of SSA's urban population live in informal settlements characterized by pervasive poverty and overcrowding [19]. While the poor in the cities continue to suffer marginalization and experience excess social and economic vulnerability from unstable employment, external shocks such as natural disasters, the affluent section of cities are much more planned and with significant policy attention, and development that ensures healthy living such as presence of walk ways, parks and playing fields (Figure 2) [20,21]. Therefore, the divide between the rich and poor urban dwellers remains wide in African cities, and the extent of inequality reduces access to healthy living as well as essential and quality health services particularly for the poor. ...

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... This suggests that these individuals' "unhealthy" BMIs have been steadily rising. According to the most recent studies [63][64][65][66], this number indicates that the number of overweight and obese women has rapidly increased. Table 3 examines the empirical distributional impact of the HFD diet diversity measure along with the effects of the other explanatory factors for women, such as wealth, education, age, and region. ...
... As a result, these families may experience lower risks of obesity and overweight, not only due to dietary diversity but also because of the broader benefits associated with their socioeconomic status [43]. In sub-Saharan Africa, including Kenya, higher income levels are linked to access to more diverse diets [57,66], but this diversity has been linked to an increase in the risk of obesity and overweight due to a shift towards processed, calorie-dense foods. Studies, i.e., refs. ...
... Studies, i.e., refs. [11,43,57,64,66], show that urbanisation and rising incomes contribute to these unhealthy dietary changes, particularly in urban areas, leading to higher obesity rates. While dietary diversity is generally seen as beneficial, it does not always result in better nutritional outcomes if the variety includes unhealthy food options. ...
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The study examines the link between dietary diversity and BMI using data from Kenyan women aged 15–49. By exploring how dietary diversity affects BMI across various BMI categories, the study examines the demand for diet diversity and its impact on BMI. The results reveal a positive relationship between food diversity and BMI at all quantiles, suggesting that a more varied diet is associated with increased BMI levels among underweight, overweight, and obese individuals. This indicates that the correlation between dietary diversity and health outcomes in higher BMI categories may be ‘unfavourable’, with increased food diversity linked to a higher risk of ‘unfavourable’ BMI categories, i.e., overweight and obesity. This may be attributed to higher caloric intake and/or higher consumption of saturated fats and cholesterol from a more diverse diet, which can contribute to increased BMI. These findings highlight the need to consider moderation and balance in energy intake and the overall nutritional quality of diets when considering and evaluating diets and dietary diversity and in formulating and shaping food policies.
... We report only the marginal effect results because they provide helpful insight into the direction and magnitude of the relationship between the dependent and the explanatory variables. Although the multinomial logit regression helps quantify the relationship between the outcome variable and a set of independent variables, it cannot be used to determine the effects of the independent variables on the variable outcome [63,64]. The results reported in Table 8 show that the models are significant, with P-values < 0.000. ...
... These results are consistent with previous studies that found that urbanisation in many countries including Nigeria, Sierra Leone, Cameroon, DR Congo, Guinea-Bissau (mostly belonging to the final convergence clubs with the worse health outcomes) is chaotic, characterised by high rates of poverty, unemployment, and inequality due to the lack of massive social, economic and infrastructural transformations. There are significant health crises resulting from inadequate safe water supply, poor sanitation, and high prevalence of infectious and non-infectious diseases [45,64]. ...
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Progress in health outcomes across Africa has been uneven, marked by significant disparities among countries, which not only challenges the global health security but impede progress towards achieving the United Nations’ Sustainable Development Goals 3 and 10 (SDG 3 and SDG 10) and Universal Health Coverage (UHC). This paper examines the progress of African countries in reducing intra-country health outcome disparities between 2000 and 2019. In other words, the paper investigates the convergence hypothesis in health outcome using a panel data from 40 African countries. Data were sourced from the World Development Indicators, the World Governance Indicators, and the World Health Organization database. Employing a non-linear dynamic factor model, the study focused on three health outcomes: infant mortality rate, under-5 mortality rate, and life expectancy at birth. The findings indicate that while the hypothesis of convergence is not supported for the selected countries, evidence of convergence clubs is observed for the three health outcome variables. The paper further examine the factors contributing to club formation by using the marginal effects of the ordered logit regression model. The findings indicate that the overall impact of the control variables aligns with existing research. Moreover, governance quality and domestic government health expenditure emerge as significant determinants influencing the probability of membership in specific clubs for the child mortality rate models. In the life expectancy model, governance quality significantly drives club formation. The results suggest that there is a need for common health policies for the different convergence clubs, while country-specific policies should be implemented for the divergent countries. For instance, policies and strategies promoting health prioritization in national budget allocation and reallocation should be encouraged within each final club. Efforts to promote good governance policies by emphasizing anti-corruption measures and government effectiveness should also be encouraged. Moreover, there is a need to implement regional monitoring mechanisms to ensure progress in meeting health commitments, while prioritizing urbanization plans in countries with poorer health outcomes to enhance sanitation access.
... 9 Risk factors for NCDs among adolescents in the region include tobacco and alcohol use, unhealthy diets, sedentary lifestyles (SL), reduced PA, and increasing rates of overweight and obesity. [45][46][47][48][49] South Africa, like many other countries in sub-Saharan Africa, faces a high burden of NCDs, with cardiovascular diseases being a significant contributor to mortality. 47 NCDs have surpassed injuries and communicable diseases as a major cause of disability-adjusted life years (DALYs) among adolescents, highlighting the urgent need for intervention programs targeting this population group. ...
... [45][46][47][48][49] South Africa, like many other countries in sub-Saharan Africa, faces a high burden of NCDs, with cardiovascular diseases being a significant contributor to mortality. 47 NCDs have surpassed injuries and communicable diseases as a major cause of disability-adjusted life years (DALYs) among adolescents, highlighting the urgent need for intervention programs targeting this population group. 16,50 The prevalence of overweight and obesity among adolescents is rising, posing significant health risks and increasing the likelihood of developing cardiovascular diseases and metabolic syndrome. ...
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Background The Nyakaza-Move-for-Health intervention program was developed in response to the alarming rise in non-communicable diseases (NCDs) globally, in sub-Saharan Africa and South Africa. The rise in NCDs is attributed to the low levels of participation in physical activity (PA) among adolescents. Therefore, this study aimed to design a culturally tailored PA intervention for adolescents, guided by the Intervention Mapping (IM) protocol. The intervention program aims to address the multifaceted determinants of physical activity behavior, promote healthy lifestyles and improve adolescent fitness levels. Methods The Intervention Mapping protocol was applied to design the intervention program. The IM has 6 steps: (1) Needs assessment, (2) developing a logic model of the problem (LMP), (3) Formulating program outcomes and objectives, (4) Program design and production, (5) Generating implementation plan, and (6) Generating intervention evaluation plan. Participants included (n = 48) adolescent learners recruited from 8 (n = 8) participating schools. Adolescent learners participated in focus group discussions (FGD) to identify personal, interpersonal and environmental determinants of physical inactivity. Twenty-six (n = 26) key informant stakeholders participated in a stakeholder engagement workshop (SEW) to determine the motivators and constraints in implementing physical activity interventions. Results The Nyakaza intervention program’s process development involved extensive stakeholder engagement, capacity development training, and integration of community feedback into the design. The intervention included a social marketing campaign and structured after-school physical activity sessions based on the Health Belief Model (HBM) and Transtheoretical Model (TTM). Implementation and evaluation plans were created, emphasizing real-time monitoring and adaptations. Strategies to enhance parental and community support were developed to address participation barriers. Although not tested in this study, these plans laid a robust foundation for fostering sustainable behavior change and improving physical activity among adolescents in resource-constrained settings. Conclusion The Nyakaza-Move-for-Health intervention demonstrates a promising framework for promoting adolescent physical activity and addressing Non-Communicable Diseases in a culturally relevant manner. The systematic approach, grounded in the intervention mapping protocol, ensured a robust and replicable intervention design. Future research should focus on long-term follow-up, integrating objective physical activity measures, and expanding the program to include nutrition education. Addressing identified barriers, such as parental involvement, is crucial for enhancing the intervention’s effectiveness and sustainability.
... Existing literature supports this, highlighting how urbanisation and rural-urban migration influence dietary patterns and physical activity levels, thereby affecting nutritional health (69)(70)(71)(72). Studies have shown that urban areas, while offering better access to healthcare and diversified food options, often expose residents to unhealthy dietary practises and sedentary lifestyles, contributing to rising obesity rates (73)(74)(75)(76)(77)(78)(79). Conversely, rural areas, despite being traditionally associated with undernutrition, are now experiencing the dual challenges of food insecurity and increasing prevalence of overweight/obesity due to limited access to healthy foods and healthcare services (80)(81)(82). ...
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Background The double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure. Methods This study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010–2011 and 2015, which provided information on women’s and children’s health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010–2011 and 2015. Results The average age of mothers was approximately 31 years, and children’s ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women. Conclusion The growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban–rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO’s Double Duty Actions, are essential to improve the nutritional health of Zimbabwe’s population.
... The reasons for the increase of metabolic syndrome prevalence in Africa are thought to be due to a shift from traditional African to western lifestyles or the rise in the use of risk behaviors, such as consumption of unhealthy diet, reduced physical activity, harmful alcohol consumption and tobacco use, as well as due to the increment of urbanizations and increasing life expectancies [9,10]. Globalization has also contributed a significant impact on the incidence of metabolic syndrome in sub-Saharan Africa via contributing to the availability of unhealthy diet, the expansion of urbanization, racial and cultural tensions, political upheaval and stress over time [11]. ...
... The answers will either be recorded as a correct answer (1), an incorrect answer, or I don't know (0). The maximum possible score is 20, and the knowledge levels will break down into Poor knowledge score (1-7), Average knowledge score (8)(9)(10)(11)(12)(13)(14), and good knowledge score (15)(16)(17)(18)(19)(20) [12]. ...
... The answers will be recorded on a 0-2 Likert scale as disagree (0), agree (1), and strongly agree (2). The highest score is 26, and the categories for attitude will: Poor attitude (scores of 0-9), Average attitude (scores of [10][11][12][13][14][15][16][17][18], and good attitude (scores of 19-26) [12]. ...
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Background Nowadays, metabolic syndrome has become a major health threat, and affects over one billion people globally. It also plays a great role in the growth of diseases like type 2 diabetes, coronary diseases, stroke, and other chronicity. It increases the risk of cardiovascular disorder and stroke by three to ten times and diabetic mellitus by ten times. The prevalence of metabolic syndrome is increasing globally as a result of epidemiological shift. Low and middle-income countries are facing an increasing burden of metabolic syndrome. There is a need for concerted efforts to modify behavioral risk factors that significantly contribute to the prevalence of the syndrome. This can be done by developing and implementing appropriate interventions that can bring behavior change after testing for effectiveness, feasibility, and acceptability. Thus, this study aims to develop and test the effectiveness, feasibility and acceptability of an education intervention promoting healthy lifestyle to reduce risk factors for metabolic syndrome, among office workers in Ethiopia. Methods and analysis This randomized controlled trial will be implemented with 226 bank employees (age ≥18 years) with metabolic syndrome from government and private banks in Bahir Dar City, Ethiopia. Participants will be randomized to intervention (education) and control (general health advice) groups. The intervention group will be given one-on -one base education about healthy diets, physical exercise, stress management, avoidance of harmful alcohol consumption and smoking cessation by experts on health promotion. Text messages will be sent every two weeks and reading materials will also be provided. Additionally, a review meeting will be held at the 3rd and 6th month of the intervention. The primary outcomes of interest will be change in metabolic parameters (obesity levels, blood pressure, fasting blood glucose, total cholesterol, high density lipoprotein, low density lipoprotein, and triglycerides). Secondary outcomes will be knowledge, attitudes and practice of the participants towards lifestyle and cardiovascular risk factors, feasibility, acceptability, implementation fidelity, and cost-effectiveness of the intervention. Data will be collected at three time points: at baseline, at the 6th month of the intervention and at the end of the intervention (9 months). Generalized linear mixed models will be utilized to compare the desired outcome between the trial arms, after accounting for baseline variations. Cost-benefit analysis and a qualitative process evaluation of the intervention will also be conducted. Discussion This randomized control trial study will provide information on the effectiveness, feasibility, and acceptability of an education intervention promoting healthy lifestyle to reduce risk factors for metabolic syndrome, among office workers in Ethiopia, where the burden of metabolic syndrome is high among office workers. Clinical trial registration This trial has been prospectively registered at the Australian New Zealand Clinical Trials Registry: ACTRN12623000409673p.
... The large increases in prevalence of NCDs in LMICs have been attributed to economic development and urbanization that have resulted in dramatic changes in where and how people live [6] with consequent changes in living conditions, diet, physical activity, and exposures to psychosocial stressors [7]. The emergence of the NCD epidemic in LMICs is having a major impact on utilization of scarce health care resources and poses a significant hurdle to achieving sustainable development goal targets for poverty reduction and prevention of premature death and disability [5]. ...
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Background There is a growing epidemic of chronic non-communicable diseases in low and middle-income countries, often attributed to urbanization, although there are limited data from marginalized rural populations. This study aimed to estimate prevalence of cardiometabolic diseases and associated risk factors in transitional rural communities. Methods A cross-sectional study of Montubio adults aged 18–94 years living in agricultural communities in a tropical coastal region of Ecuador. Data were collected by questionnaires and anthropometry, and fasting blood was analyzed for glucose, glycosylated hemoglobin, insulin, and lipid profiles. Population-weighted prevalences of diabetes, hypertension, and metabolic syndrome were estimated. Associations between potential risk factors and outcomes were estimated using multilevel regression techniques adjusted for age and sex. Results Out of 1,010 adults recruited, 931 were included in the analysis. Weighted prevalences were estimated for diabetes (20.4%, 95% CI 18.3–22.5%), hypertension (35.6%, 95% CI 29.0–42.1%), and metabolic syndrome (54.2%. 95% CI 47.0–61.5%) with higher prevalence observed in women. Hypertension prevalence increased with age while diabetes and metabolic syndrome peaked in the 6th and 7th decades of life, declining thereafter. Adiposity indicators were associated with diabetes, hypertension, and metabolic syndrome. Conclusion We observed an unexpectedly high prevalence of diabetes, hypertension, and metabolic syndrome in these marginalized agricultural communities. Transitional rural communities are increasingly vulnerable to the development of cardiometabolic risk factors and diseases. There is a need for targeted primary health strategies to reduce the burden of premature disability and death in these communities.
... On the other hand, children residing in cities may also have a high prevalence of ECC for different reasons [8]. In the cities, there is ready access to unhealthy food options and unhealthy lifestyles, which may contribute to the adoption of unhealthy dietary behaviours such as inadequate fruit and vegetable consumption and increased energy intake [9][10][11][12]. For children living in cities and urban slums, the urban environment can increase their exposure to air pollution, which may also contribute to ECC [13]. ...
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Background Early childhood caries (ECC) is a multifactorial disease in which environmental factors could play a role. The purpose of this scoping review was to map the published literature that assessed the association between the Sustainable Development Goal (SDG) 11, which tried to make cities and human settlements safe, inclusive, resilient and sustainable, and ECC. Methods This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to housing, urbanization, waste management practices, and ECC. Studies that solely examined ECC prevalence without reference to SDG11 goals were excluded. Of those that met the inclusion criteria, a summary highlighting the countries and regions where the studies were conducted, the study designs employed, and the findings were done. In addition, the studies were also linked to relevant SDG11 targets. Results Ten studies met the inclusion criteria with none from the African Region. Six studies assessed the association between housing and ECC, with findings suggesting that children whose parents owned a house had lower ECC prevalence and severity. Other house related parameters explored were size, number of rooms, cost and building materials used. The only study on the relationship between the prevalence of ECC and waste management modalities at the household showed no statistically significant association. Five studies identified a relationship between urbanization and ECC (urbanization, size, and remoteness of the residential) with results suggesting that there was no significant link between ECC and urbanization in high-income countries contrary to observations in low and middle-income countries. No study assessed the relationship between living in slums, natural disasters and ECC. We identified links between ECC and SDG11.1 and SDG 11.3. The analysis of the findings suggests a plausible link between ECC and SDG11C (Supporting least developed countries to build resilient buildings). Conclusion There are few studies identifying links between ECC and SDG11, with the findings suggesting the possible differences in the impact of urbanization on ECC by country income-level and home ownership as a protective factor from ECC. Further research is needed to explore measures of sustainable cities and their links with ECC within the context of the SDG11.
... 25 People's lack of awareness about NCDs and risk factors especially HPT and T2D is not uncommon in SA and globally. 6,30,45 The lack of knowledge about NCDs and their risk factors among the women and the general population makes it challenging to reduce the burden of NCDs. Adopting of a multisectoral approach such as community health workers raising NCD awareness through health education, and integration of NCD education in school curriculum could assist in behaviour change, increased knowledge about NCD risk factors and care available among women. ...
Article
Background Non-communicable diseases (NCDs) such as obesity, hypertension (HPT), and type II diabetes (T2D) are of increasing concern in South Africa (SA), with women being more at risk. Authors conducted a scoping review to identify and map the evidence available about the barriers of access to obesity, HPT, and T2D care among women in SA. Methods Arksey and O'Malley's framework for scoping review was used. The search of the literature was completed in the Scopus, Web of Science, and PubMed databases between April and May 2022. Only studies conducted among women in SA were eligible for inclusion. Identified barriers were mapped onto Levesque’s framework of access to health care to determine which points along the chain of accessing NCD health care among women are mostly impacted. Results Seven articles were included in the review: qualitative (n=2), quantitative (n=2), mixed methods (n=2), and grey literature (n=1). The included studies reported barriers of access to HPT and T2D care only, and no study reported barriers to obesity care. Supply-side barriers included lack of knowledge about available services, physician heavy workloads, medicine stock-outs, limited availability of testing equipment, travelling long distances, long waiting times, and delayed referral. Demand-side barriers included women having low self-awareness of NCD status, concerns about confidentiality, perceived discrimination, and poverty. Conclusions The study highlighted barriers related to the availability and accessibility dimension of access to health care, indicating that care for HPT and T2D is often inaccessible, with women often unable to reach health facilities or service providers. There is a pressing need for further research on access to healthcare for obesity, T2D, and HPT for women in South Africa, particularly among women who bear a disproportionately high burden of these conditions.
... One of the factors influencing the rise in the prevalence of chronic diseases as a result of lifestyle changes is urbanization (1). Sedentary lifestyles and restricted availability to fresh meals are frequently associated with urbanization, particularly in less developed nations (25)(26)(27). ...
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Background: Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases. Methods: The current study was conducted in Mashhad’s Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study’s objectives, and partial least square structural equation modeling (PLS-SEM) was utilized. Results: The chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity. Conclusion: Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.
... Research has shown that the use of green spaces is influenced by sociodemographic characteristics and an understanding of their health benefits (23)(24)(25)(26). However, physicians did not consider their role in prescribing park use or physical activity, in contrast to healthcare practitioners globally who promote the use of green spaces through initiatives like park prescriptions (27)(28)(29)(30)(31)(32). ...
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Background: Noncommunicable diseases (NCDs) such as diabetes, hypertension, and cardiovascular diseases are major global health concerns, surpassing the mortality rates of communicable diseases. These conditions pose significant challenges to global development, particularly in low- and middle-income countries where two-thirds of NCD-related deaths occur. In Pakistan, NCDs account for nearly 25% of all fatalities. The prevention of NCDs requires continuous lifestyle modifications, and evidence suggests that the physical environment and urban design play crucial roles in influencing health behaviors and outcomes. Objective: This study aimed to assess doctors' perspectives on the role of cities in the prevention and management of NCDs in Pakistan, and to identify barriers and enablers to the development of healthy city policies. Methods: This descriptive exploratory study employed a qualitative approach, conducted at various private hospitals in the Twin Cities. A purposive sample of approximately 20 doctors from medical units and outpatient departments participated in focus group discussions (FGDs). Data were collected using a semi-structured interview guide, and the FGDs were audio-recorded with participants' consent. Thematic analysis was performed to identify major themes and subthemes related to the role of urban environments in NCD prevention and management. Results: Participants recognized the importance of physical activity, healthy environments, and lifestyle modifications in preventing NCDs. Key barriers to physical activity included socio-cultural norms, environmental limitations, and political/legislative challenges. Facilitators included individual willpower, health-seeking behavior, supportive policies, and perceived benefits. Poor air quality and the lack of green spaces were significant contributors to the increased prevalence of NCDs. Participants emphasized the need for government intervention to improve urban infrastructure, promote physical activity, and enhance public health initiatives. Conclusion: Well-planned cities can significantly reduce the burden of NCDs by addressing modifiable risk factors. Governments must prioritize the development of infrastructure that promotes physical activity, improves air quality, and increases access to green spaces. Comprehensive multisectoral strategies are essential to combat the rising threat of NCDs, particularly in rapidly urbanizing areas.