The study aimed at determining the prevalence and associated factors of non-communicable diseases among men in Kenya. The study findings revealed that the overall prevalence of NCDs among men in Kenya was 9.4%, with hypertension, depression, and anxiety being the commonest conditions. These findings align with previous studies in other countries Lesotho and Napel, which showed hypertension to be the leading NCDs among men [12, 17]. Although there is a dearth of published data of the overall prevalence in other East African countries, the overall prevalence is lower than that in India of 12.4% and 15.9% of Kenyan women with at least one NCD [13, 18]. This variation in prevalence of NCD across countries could be due to differences in socioeconomic factors, healthcare access, lifestyle habits, and the age distribution of the populations [19].

In this study, hypertension emerged as the most prevalent NCD, with a significant proportion of the population affected being 3.5% which is lower than the 41.4% prevalence of the 2020 Global epidemiology study [20]. However, the low prevalence of cancer (0.1%) in this study contrasts with the increasing global burden of cancer, especially in low and middle income countries [21]. This discrepancy may reflect underreporting and the limited scope of cancer screenings in the study population.

In terms of multiple chronic conditions, the majority of the participants had diabetes and hypertension. The co-existence of diabetes and hypertension as a multimorbidity is supported by literature, as both conditions share several risk factors related to their development such as obesity, poor diet, physical inactivity, and genetic predisposition [22]. The co-occurrence of diabetes and hypertension significantly increases the risk of cardiovascular complications, including stroke, heart failure, and kidney disease [23]. Therefore, stakeholders such as ministry of health of Kenya need to sensitize masses on this multimorbidity, do early screening and treatment, and encourage lifestyle modifications interventions.

We also found a prevalent co-existence of mental and somatic NCDs. The most prevalent combination was hypertension and depression, followed closely by hypertension and anxiety. This is consistent with different studies which have reported that depression and anxiety can negatively impact blood pressure regulation resulting into hypertension [24, 25]. The frequent co-occurrence of mental health conditions with hypertension highlights the interplay between physical and psychological health [24]. Additionally, a combination of arthritis and depression was also notable among participants. The findings are consistent with other studies which reported an association between arthritis and depression [26]. Chronic pain and mobility limitations associated with arthritis often lead to reduced quality of life, social isolation, and emotional distress, making depression a common comorbidity [27]. Therefore, the government of Kenya and SSA countries need to prioritize and integrate mental health screening and support into chronic disease management.

This study also identified several factors associated with the prevalence of NCDs, including increasing age, region, residence, ethnicity, education level, perceived health status, wealth index, religion, media access, living sedentary lifestyle and physical activity. Age was statistically significantly associated with NCDs among men where men aged 25 years and older were more likely experience at least one or multiple, NCDs, including hypertension, diabetes, depression and arthritis compared with the younger participants. This concurs with the existing literature in India and Ghana, which emphasizes that aging is a key risk factor for NCDs [28, 29]. However, the finding is inconsistent with a study in Burkina Faso that reported NCDs tends to be higher in younger populations due to lifestyle factors such as increasing urbanization, sedentary behavior, and dietary shifts towards processed foods [30]. The aging process involves major physiological changes like reduced organ function and inflammation which makes an individual prone to chronic illness [31]. A lot of emphasis should be put on health educating the older population about healthy living, physical exercises and routine medical checkups.

This study found that region was statistically significantly associated with NCDs among men. Unlike anxiety, men from Northeastern, western, Rift Valley, Nairobi, and Nyanza were more likely to experience a heart disease, depression, have at least one NCD and multiple NCDs compared with those from the coastal region of Kenya. The study finding is consistent with findings from a study in Kenya which reported regional differences influence the prevalence of NCDs [7, 32]. Urban areas like Nairobi and the Coast were found to have high NCD rates due to sedentary lifestyles, unhealthy diets, and substance use, especially in informal settlements. However, in our study, less urbanized regions such as Nyanza, North-eastern, and Rift Valley also showed high NCD risk among men, which may be due to smoking, alcohol use, job-related stress, and poor access to healthcare. Even in rural areas, the growing use of processed foods is increasing NCD risk [4]. Therefore, the government should develop and implement region-specific public health policies such as the rural tobacco tax that addressed the root causes of NCDs in high-risk regions of India [33].

Tribe was statistically significantly associated with NCDs among men, as men from the Meru, Kamba, Taita/Taveta, Luhya, and Embu tribes had higher odds of experiencing NCDs like arthritis, anxiety, heart disease, and lung disease compared with the Kikuyu tribe. However, men from some ethnic tribes had lower odds of experiencing hypertension, depression, heart disease, having at least one NCD, and multiple NCDs compared with the Kikuyu tribe. The findings from this study regarding tribal differences in NCDs concur with a study in Kenya which reported the rise in NCDs in certain tribes [7]. This was attributed to increased urbanization and declining proportion of agricultural and forestry wage jobs and unhealthy eating [7]. These ethnic differences may reflect genetic, cultural, or environmental factors that influence disease susceptibility [34]. Therefore, health workers should address ethnic disparities in NCDs using culturally sensitive approaches, like the U.S. REACH program for minority diabetes care [35].

Participants that completed secondary or tertiary education compared with those who had completed primary, or no education had higher odds of having hypertension, diabetes mellitus at least one NCD and multiple NCDs, unlike experiencing anxiety. This finding concurs with previous research in India that showed a strong association between higher education levels and increased NCDs among men [36]. However, the findings are inconsistent with a study in China and a review which reported lower level of education was highly associated with hypertension and diabetes mellitus [37, 38]. Higher education in men may increase NCDs due to lifestyle changes like inactivity which is associated with white-collar jobs [39]. On the other hand, educated individuals tend to have better access to healthcare and coping strategies, which may lower their anxiety [40]. Individuals with higher education should be encouraged by various health sector stakeholders to regularly screen NCD risk factors and recognize or modify the lifestyle NCD risk factors associated with their jobs, such as long hours of inactivity, poor dietary habits, and high stress.

We also found that men with a higher wealth index, when compared with those from the poorest wealth index, had higher odds of having diabetes mellitus and at least one NCD, unlike anxiety. The findings are concur with a study in Bangladesh, which reported that diabetes risk was about 60% higher in adults from wealthy households [41]. Unfortunately, the study findings are contrary to a study in South Africa, which reported a high prevalence of diabetes among the poor [42]. Higher economic status can lead to sedentary lifestyles, stress, and unhealthy eating [43]. Wealthier individuals experience less anxiety due to better access to healthcare, financial security, and lower stress levels [44]. Health workers should prioritize educating men in higher wealth brackets the importance of maintaining a balanced diet and engaging in regular physical activity.

This study also found that participants from the urban setting when compared with those from the rural setting were less likely to have arthritis and at least one NCD. The findings concur with two studies, one in 47 counties of Kenya and another utilized data from 2022 KDHS which reported a high prevalence of cardiovascular diseases in rural areas [13, 32]. However, the study findings contrast with a study in Belagavi which reported that participants in urban areas had a high risk of NCDs and had high rate of smoking [45]. Rural areas have limited access to health care diagnostics, better transport systems, and education about healthy living. Lack of diagnostics and medical professionals delays early detection and treatment. Additionally, poor health literacy and unhealthy behaviors exacerbate NCD risks [46]. Arthritis is less common in urban settings due to better healthcare access, healthier lifestyles, and more opportunities for physical activity [47]. Policy makers in Kenya should focus on improving health awareness and early screening of arthritis in rural areas to ensure timely detection and management.

Men who had access to mass media compared with those who did not have access to it had higher odds of having lung disease, anxiety for those who had access to the radio and having internet access was associated with higher odds of having two NCDs. The findings are consistent with different studies which reported an association between access to media with lung disease, access to radio with anxiety and access to internet with having at least one NCD [18, 48, 49]. Access to radio and the internet may contribute to anxiety and unhealthy behaviors due to information overload, exposure to distressing news, misinformation, and lifestyle influences from digital media [18]. Therefore, the Kenyan government needs emphasize balanced media use and the use of communication strategies that leverage the positive aspects of media while minimizing potential risks.

Participating men who had inadequate weekly exercises compared with those with adequate weekly exercise had a higher likelihood of having hypertension and diabetes. These findings concur with a study that reported Inadequate physical activity in one-fifth of the 420 participants with hypertension [46]. Without interventions to promote regular exercise, the burden of hypertension and diabetes may continue to rise reducing overall quality of life [50]. Stakeholders should prioritize physical activity promotion as part of public health initiatives aimed at reducing the incidence of hypertension and diabetes.

Similarly, participants who lived a sedentary life compared with those who did not; had higher odds of having diabetes. The findings concur with a global study which reported that a sedentary lifestyle is associated with in-activity and poor eating habits that increase the risk type 2 diabetes [51]. This emphasizes that a sedentary lifestyle is a significant risk factor for the development of diabetes, which is a growing global health concern. Individuals should be encouraged to make small, gradual changes to reduce sedentary time and incorporate physical activity into their daily routines.

Religion was significantly associated with NCDs. Men subscribing to the Muslim or other faith compared with the Christians had higher odds of having arthritis and depression. The findings concur with a study which reported a low rate of NCDs in Christian communities in the United States due to counselling and coaching they receive to reduce NCDs [34]. Religious practices may influence health outcomes, as they often have specific health-related behaviors and social support networks that could either mitigate or exacerbate the risk of chronic diseases [52]. Stakeholders should engage minority religious communities in support groups, health education, and collaboration with religious leaders to provide early intervention and reduce stigma.

We found that men who perceived themselves to be in moderate to good health compared with those that thought their health status was bad had lower odds of having hypertension, diabetes, heart disease, arthritis, and having at least one NCD and multiple NCDs, unlike experiencing anxiety. Similar findings were observed in a study which indicated that self-rated health is a strong predictor of physical health outcomes [53]. Improving self-perception of health could lead to better health behaviors and outcomes [54]. Therefore, the government should incorporate health perception assessments into routine health screenings to motivate proactive health management and encourage behavior change.