Behavioural risk profiles associated with non-communicable diseases in Tlokweng, South-East District, Botswana

Abstract Background Non-communicable diseases are a growing public health threat in rural Botswana, driven by widespread risk factors, however, evidence on their local distribution and patterns remains limited. This study examined the prevalence of selected risk factors associated with NCDs’ among individuals seeking care in a primary health setting. Methods A facility-based cross-sectional study was conducted among 349 adults attending a primary healthcare facility between 16 September and 4 December 2025. Participants were recruited using systematic random sampling. Data was collected using a culturally adapted questionnaire and analyzed using descriptive statistics and multivariable logistic regression. Results Behavioural risk factors for non-communicable diseases varied across demographic and socioeconomic groups. Adults aged 45–54 years (AOR 0.16, 95% CI: 0.03–0.75; P < 0.021) and ≥ 55 years (AOR 0.15, 95% CI: 0.02–0.99; P < 0.048) had significantly lower adjusted odds of smoking than those aged 18–24 years. Females were significantly less likely than males to consume alcohol (AOR 0.23; 95% CI: 0.14–0.38; P < 0.001) and smoke (AOR 0.15; 95% CI: 0.05–0.12P < 0.001). Compared with participants holding a university diploma or bachelor’s degree, those with junior secondary (AOR 2.87; 95% CI: 1.07–7.70; P < 0.04) and trade/technical/vocational education (AOR 3.13; 95% CI: 1.19–8.27; P < 0.02) had increased odds of smoking, while participants with senior secondary education had higher odds of alcohol consumption (AOR 1.87; 95% CI: 1.05–3.33; P < 0.03). Unemployed participants had over four-fold higher odds of alcohol consumption (AOR 4.45, 95% CI: 1.39–14.26; P < 0.012) and adding salt to served food (AOR 4.16, 95% CI: 1.31–13.19; P < 0.015) than employed participants, while those with a household income of ≥P20,000 (AOR 0.21; 95% CI: 0.05–0.89; P < 0.033) and married participants (AOR 0.33; 95% CI: 0.12–0.86; P < 0.020) had lower adjusted odds of discretionary salt use compared with those earning < P4,000 and those who were single, respectively. Conclusion This study identified a high burden and clustering of non-communicable diseases (NCDs’) risk factors among primary healthcare users, with marked variation across demographic, behavioural, and socioeconomic domains underscoring the need for integrated, gender-responsive, evidence-based primary care, stronger surveillance, and cross-sector action to reduce early NCDs’ deaths and meet global targets.