Migration and hypertension in Dakar, Senegal

Rural-urban difference in the prevalence of hypertension in West Africa: a systematic review and meta-analysis

Urbanisation is considered a major contributor to the rising prevalence of hypertension in West Africa, yet the evidence regarding rural-urban differences in the prevalence of hypertension in the region has been mixed. A systematic literature search of four electronic databases: PubMed, Embase, African Journals Online, and WHO's African Index Medicus; and reference lists of eligible studies was carried out. Original quantitative studies describing the rural-urban difference in the prevalence of hypertension in one or more countries in West Africa, and published in English language from the year 2000 to 2021 were included. A random effects meta-analysis model was used to estimate the odds ratio of hypertension in rural compared to urban locations. A limited sex-based random effects meta-analysis was conducted with 16 studies that provided sex-disaggregated data. Of the 377 studies screened, 22 met the inclusion criteria (n = 62,907). The prevalence of hypertension was high in both rural, and urban areas, ranging from 9.7% to 60% in the rural areas with a pooled prevalence of 27.4%; and 15.5% to 59.2% in the urban areas with a pooled prevalence of 33.9%. The odd of hypertension were lower in rural compared to urban dwellers [OR 0.74, 95% CI: 0.66-0.83; p < 0.001]. The pooled prevalence of hypertension was 32.6% in males, and 30.0% in females, with no significant difference in the odds of hypertension between the sexes [OR 0.91, 95% CI: 0.8-1.05, p = 0.196]. Comprehensive hypertension control policies are needed for both rural, and urban areas in West Africa, and for both sexes.

Lifestyle risk factors and metabolic markers of cardiovascular diseases in Bangladeshi rural-to-urban male migrants compared with their non-migrant siblings: A sibling-pair comparative study

Background

The increasing prevalence of cardiovascular diseases (CVDs) in developing countries like Bangladesh has been linked to progressive urbanisation. Comparisons of rural and urban populations often find a higher prevalence of CVD risk factors in the urban population, but rural-to-urban migrants might have different CVD risk profiles than either rural or urban residents. This study aimed to describe differences in CVD risk factors between migrants and non-migrants siblings and to determine whether acculturation factors were associated with CVD risk factors among migrants.

Methods

Using a sibling-pair comparative study, 164 male migrant who migrated from Pirganj rural areas to Dhaka City and their rural siblings (total N = 328) were assessed by interview, anthropometric measurement, blood pressure and blood samples. Comparisons were made using linear or logistic mixed effects models.

Findings

Physical inactivity, inadequate intake of fruit and vegetables and possible existence of a mental health disorder had 3.3 (1.73; 6.16), 4.3 (2.32; 7.92) and 2.9 (1.37; 6.27) times higher odds among migrants than their rural siblings, respectively. Migrants watched television on average 20 minutes (95% CI 6.17–35.08 min/day) more per day than the rural sibling group whereas PUFA intake, fruit and vegetable and fish intake of the migrants were -5.3 gm/day (-6.91; -3.70), -21.6 serving/week (-28.20; -15.09), -14.1 serving/week (-18.32; -9.87), respectively, lower than that of the rural siblings. No significant difference was observed for other variables. After adjusting, the risk of physical inactivity, inadequate fruit and vegetable intake, a mental health disorder and low HDL were significantly higher in migrants than in rural siblings and tended to be higher for each increasing tertile of urban life exposure.

Conclusion

The findings suggest that migration from rural-to-urban environment increases CVD risk which exacerbate with time spent in urban area due to acculturation. This study gives new insights into the increased CVD risk related with migration and urbanization in Bangladesh.

Assessing health impacts of an environmental pan-African development project: A migration perspective

The general objective of this article is to analyze to what extent the implementation of the Great Green Wall project is likely to disrupt migratory movements towards the rural environment and, consequently, the socio-economic structures and health status of local populations. This study was carried out in 2015 on a population sample of 500 individuals living in the municipality of Tessekere, constructed using the quota method. Socioeconomic and demographic characteristics, migratory status and self-rated health of individuals were collected during face-to-face interviews. Statistical analyses used were Chi-square tests, student and binary logistic regressions. Results show that internal migrants in the municipality of Tessekere represent 13.40% of the study population. Migrants more often work as civil servants, artisans, craft workers or traders than the region's native population, who are generally livestock breeders or jobless. While place of birth does not play a significant role, it appears that the length of residence of migrants in rural areas influences health status: migrants residing in the municipality of Tessekere for less than 10 years are less likely to report poor health, regardless of their sex, age, occupation, material well-being and perceived stress. In conclusion, an environmental requirement (combating desertification), addressed by an international political project - the Great Green Wall - and then applied at the national level, has transformed the demographic, economic and health structure of a local population. In conclusion, our study showed that (1) an examination of migration can offer a means of interpreting the impact of development projects and the local changes they entail, and (2) migration is a unique prism through which one can study how exposure to a new physical and social environment influences the health of populations.

Biocultural determinants of overweight and obesity in the context of nutrition transition in Senegal: a holistic anthropological approach

Senegal is experiencing a rising obesity epidemic, due to the nutrition transition occurring in most African countries, and driven by sedentary behaviour and high-calorie dietary intake. In addition, the anthropological local drivers of the social valorization of processed high-calorie food and large body sizes could expose the population to obesity risk. This study aimed to determine the impact of these biocultural factors on the nutritional status of Senegalese adults. A mixed methods approach was used, including qualitative and quantitative studies. Between 2011 and 2013, fourteen focus group discussions (n=84) and a cross-sectional quantitative survey (n=313 women;n=284 men) of adults in three different socio-ecological areas of Senegal (rural:n=204; suburban:n=206; urban:n=187) were conducted. Dietary intake (Dietary Diversity Scores), physical activity (International Physical Activity Questionnaire), body weight norms (Body Size Scale), weight and health statuses (anthropometric measures and blood pressure) were measured. Middle-aged and older Senegalese women were found to value overweight/obesity more than younger Senegalese in all regions. In addition, young urban/suburban adults had a tendency for daily snacking whilst urban/suburban adults tended to be less physically active and had higher anthropometric means. A binary logistic regression model showed that being female, older, living in urban/suburban areas and valuing larger body size were independently associated with being overweight/obese, but not high-calorie diet. Univariate analyses showed that lower physical activity and higher socioeconomic status were associated with being overweight/obese. Finally, overweight/obesity, which is low in men, is associated with hypertension in the total sample. The nutrition transition is currently underway in Senegal’s urban/suburban areas, with older women being more affected. Since several specific biocultural factors jointly contribute to this phenomenon, the study’s findings suggest the need for local public health interventions that target women and which account for the anthropological specificities of the Senegalese population.

Impact of acculturation on depression, perceived stress and self-esteem in young Middle Eastern American adults

BACKGROUND

Human biologists have a longstanding interest in understanding the biological and health impacts of migration. Acculturation, the cultural adjustment that a group or individual experiences when previously separate cultures interact, has been found to be one pathway through which migration may impact human biology and health, not only for the migrants themselves, but also their descendants.

AIM

The authors conducted a pilot study to examine the relationship between acculturation and perceived stress, self-esteem and depression among young Middle-Eastern American adults.

SUBJECT AND METHODS

Survey data were collected from 48 young Middle-Eastern American adults. Participants were divided into one of two acculturation categories, integrated (American and Middle Eastern culture oriented) and assimilated (American culture oriented). Health measures were compared between these acculturation categories.

RESULTS

Integrated individuals had significantly lower stress (F = 8.1, p < 0.01) and depression (F = 10.8, p < 0.01) than assimilated individuals. Integrated individuals had lower self-esteem than assimilated individuals (F = 5.0, p < 0.05). Generational status, a proxy used for acculturation, was only significantly associated with self-esteem (F = 3.15, p = 0.05).

CONCLUSION

This pilot study furthers understanding of the effects acculturation can have on perceived stress and mental health among young Middle-Eastern Americans. Future research should incorporate biological measures of stress to determine the physiological impacts of acculturation.

A Concept Mapping Study of Physicians' Perceptions of Factors Influencing Management and Control of Hypertension in Sub-Saharan Africa

Hypertension, once a rare problem in Sub-Saharan Africa (SSA), is predicted to be a major cause of death by 2020 with mortality rates as high as 75%. However, comprehensive knowledge of provider-level factors that influence optimal management is limited. The objective of the current study was to discover physicians' perceptions of factors influencing optimal management and control of hypertension in SSA. Twelve physicians attending the Cardiovascular Research Training (CaRT) Institute at the University of Ghana, College of Health Sciences, were invited to complete a concept mapping process that included brainstorming the factors influencing optimal management and control of hypertension in patients, sorting and organizing the factors into similar domains, and rating the importance and feasibility of efforts to address these factors. The highest ranked important and feasible factors include helping patients accept their condition and availability of adequate equipment to enable the provision of needed care. The findings suggest that patient self-efficacy and support, physician-related factors, policy factors, and economic factors are important aspects that must be addressed to achieve optimal hypertension management. Given the work demands identified by physicians, future research should investigate cost-effective strategies of shifting physician responsibilities to well-trained no-physician clinicians in order to improve hypertension management.

Differences in hypertension between informal and formal areas of Ouagadougou, a sub-Saharan African city

Background

Countries of sub-Saharan Africa are increasingly confronted with hypertension and urbanization is considered to favor its emergence. This study aims to assess the difference in the prevalence of hypertension between formal and informal urban areas of Ouagadougou and to determine the risk factors associated with hypertension in these urban populations of sub-Saharan Africa.

Methods

A cross-sectional survey was conducted in 2010 on 2041 adults aged 18 years and older in formal and informal areas of Ouagadougou. Data was collected through personal interviews conducted at home. Blood pressure and anthropometric measurements were taken by trained interviewers. Logistic regressions were fitted to identify factors associated with hypertension.

Results

The overall prevalence of hypertension was 18.6% (95% confidence interval [CI], 16.9-20.3) and its detection was 27.4% (95% CI, 22.9-31.9). Prevalence of hypertension in formal settings was 21.4% (95% CI, 19.0-23.8), significantly higher than prevalence in informal settings: 15.3% (95% CI, 13.0-17.6). However, this difference disappeared after adjusting for age. In addition to age, being an unmarried woman (odds ratio [OR] = 1.7; 95% CI, 1.1-2.4), recent rural-to-urban migration (OR = 1.8; 95% CI, 1.2-2.8), obesity (OR = 1.8; 95% CI, 1.1-3.1) and physical inactivity (OR = 1.9; 95% CI, 1.2-3.0), were independent risk factors for hypertension.

Conclusions

Hypertension is common among the adult population of Ouagadougou but its detection is low. While there are no differences between formal and informal areas of the city, rural-to-urban migration emerges as an independent risk factor. Known risk factors as obesity and physical inactivity are confirmed while the vulnerability of unmarried women and rural-to-urban migrants maybe specific to this west African population.

Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa

BACKGROUND

In West Africa, hypertension, once rare, has now emerged as a critical health concern and the trajectory is upward and factors are complex. The true magnitude of hypertension in some West African countries, including in-depth knowledge of underlying risk factors is not completely understood. There is also a paucity of research on adequate systems-level approaches designed to mitigate the growing burden of hypertension in the region.

AIMS

In this review, we thematically synthesize available literature pertaining to the prevalence of hypertension in West Africa and discuss factors that influence its diagnosis, treatment and control. We aimed to address the social and structural determinants influencing hypertension in the sub-region including the effects of urbanization, health infrastructure and healthcare workforce.

FINDINGS

The prevalence of hypertension in West Africa has increased over the past decade and is rising rapidly with an urban-rural gradient that places higher hypertension prevalence on urban settings compared to rural settings. Overall levels of awareness of one's hypertension status remain consistently low in West African. Structural and economic determinants related to conditions of poverty such as insufficient finances have a direct impact on adherence to prescribed antihypertensive medications. Urbanization contributes to the increasing incidence of hypertension in the sub-region and available evidence indicates that inadequate health infrastructure may act as a barrier to optimal hypertension control in West Africa.

CONCLUSION

Given that optimal hypertension control in West Africa depends on multiple factors that go beyond simply modifying the behaviors of the individuals alone, we conclude by discussing the potential role systems-thinking approaches can play to achieve optimal control in the sub-region. In the context of recent advances in hypertension management including new therapeutic options and innovative solutions to expand health workforce so as to meet the high demand for healthcare, the success of these strategies will rely on a new understanding of the complexity of human behaviors and interactions most aptly framed from a systems-thinking perspective.