Background Little is known about modifiable dietary and physical activity risk factors for non-communicable diseases (NCDs) in Sierra Leone. This information is critical to the development of health improvement interventions to reduce the prevalence of these diseases.

Methods Adults aged 40+ were recruited from 10 urban and 30 rural sub-districts in Bo. We examined risk factors including: <150 minutes of moderate and vigorous-intensity physical activity (MVPA) weekly, physical inactivity for >3 hours daily, <5 daily portions of fruit and vegetables, and salt consumption (during cooking, at the table, and in salty snacks). We used logistic regression to investigate the relationship between these outcomes and participants’ socio-demographic characteristics.

Results 1,966 eligible participants were included in the study. The prevalence of behavioural risk factors was 83.1% for <5 daily portions of fruit and vegetables; 40.8% and 91.9% for adding salt at the table or during cooking, respectively and 30.6% for eating salty snacks; 22.4% for MVPA <150 minutes weekly, and 43.9% for being physically inactive >3 hours daily. Multivariable analysis showed that urban individuals were more likely than rural individuals to consume <5 daily portions of fruit and vegetables (Odds Ratio (OR) 1.06, 95% Confidence Interval (1.00–1.11)), add salt at the table (OR 1.86 (1.80–1.92)), eat salty snacks (OR 2.03 (1.97–2.11)) and do MVPA <150 minutes weekly (OR 1.17 (1.13–1.22)). Male individuals were more likely to add salt at the table (OR 1.25 (1.21–1.29) and consume salty snacks (OR 1.36 (1.32–1.41)) than female individuals but were less likely to report the other behavioural risk-factors examined). Increasing age was associated with higher odds of eating <5 daily portions of fruit and vegetables daily; adding salt at the table; eating salty snacks; doing <150 minutes of MVPA per week and physical inactivity >3hours. Generally, people in lower wealth quintiles had higher odds of any of the risk factors than those in the highest wealth quintile.

Conclusion Dietary risk factors for NCDs are highly prevalent, particularly among urban residents in Sierra Leone. Our findings show that forthcoming policies in Sierra Leone need to consider modifiable risk factors for NCDs in the context of urbanisation.

This study used data from Cardiovascular Disease (CVD) Risk Factors in Sierra Leone, which was supported by a Small Grant from the Wellcome Trust, grant number 209921/Z/17/Z.