Abstract
BACKGROUND: Non-communicable diseases (NCDs) are increasingly prevalent in humanitarian settings, yet modifiable and environmental risk factors among displaced populations remain poorly characterized. Refugees in protracted settlements face elevated exposure to risks such as unhealthy diets, physical inactivity, substance use, and indoor air pollution. This study assessed the prevalence and socio-demographic patterns of key NCD risk factors among adult refugees and asylum seekers in the Kalobeyei Integrated Settlement, northern Kenya. METHODS: A cross-sectional mixed-methods study was conducted with 488 adults selected through multi-stage sampling. Structured household surveys assessed modifiable (tobacco and alcohol use, physical activity, diet, salt intake) and environmental (cooking and lighting fuel) NCD risk factors. Bivariate and multivariate logistic regression identified significant associations. Additionally, 18 key informant interviews and 3 focus group discussions were conducted and analyzed thematically. RESULTS: Nearly all participants (99.6%) reported at least two NCD risk exposures, and 88% had three or more. Lifetime alcohol use was reported by 16.2%, with low education independently associated (OR = 3.51, p = 0.017). Tobacco use (6.1%) occurred only among Christians or those with no religion. Only 33.8% met World Health Organization (WHO) physical activity guidelines, with these same groups more likely to be active (OR = 5.82, p < 0.001). Low fruit and vegetable intake was widespread, while high salt use (22.8%) was more common among Muslims and older adults. Nearly all households (98.2%) relied on polluting cooking fuels, and over half used polluting lighting sources, disproportionately affecting non-Muslims. Compared to national benchmarks (Kenya STEPwise Survey, 2015), refugees in Kalobeyei reported lower substance use but substantially higher physical inactivity, dietary inadequacy, and environmental exposure. Religious affiliation functioned as a contextual marker for broader sociocultural, gendered, and infrastructural dynamics shaping risk profiles. CONCLUSIONS: Refugees in Kalobeyei experience a high burden of overlapping NCD risk factors, shaped by structural inequalities, service access deficits, and sociocultural context. Addressing these risks requires multisectoral, culturally responsive strategies that integrate health, nutrition, energy, and protection systems in protracted humanitarian settings.