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Hachey D, van Woerden I, Shiluama R, Singu BS. Weight gain in Namibians with HIV switching from efavirenz to dolutegravir. Int J STD AIDS 2023; 34:854-859. [PMID: 37309139 DOI: 10.1177/09564624231179767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research suggests that integrase strand transferase inhibitor use can lead to weight gain, and data from sub-Saharan countries are limited. This study investigated changes in weight in Namibians switched from tenofovir DF/emtricitabine/efavirenz (TEE) to tenofovir DF/lamivudine/dolutegravir (TLD). METHODS Longitudinal, retrospective, and quantitative study from outpatient records of Namibians living with HIV/AIDS switched from efavirenz-to dolutegravir-based regimen at four clinics. A linear mixed effects model predicting weight 6 months prior to the switch, time of the switch, and at 6, 12-, and 18-months post-switch was run. A second analysis comparing change in weights between males and females was also run. RESULTS 242 patients switched from TEE to TLD. Compared to patient weight at the time of the switch, weights were significantly higher at 6 (+0.9 kg, p = 0.004), 12 (+1.7 kg, p < 0.001), and 18 months (+1.4 kg, p < 0.001) post-switch. There was no significant weight change for males, but females had a significant weight gain at 12 (+1.58 kg, p = 0.012) and 18 months (+1.49 kg, p = 0.024) post switch. CONCLUSIONS Females living with HIV in Namibia gain weight when switched from TEE to TLD. Clinical implications on the development of cardiometabolic complications is unclear and mechanisms by which the weight gain occurs are unknown.
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Affiliation(s)
- David Hachey
- Department of Family Medicine, Idaho State University, Pocatello, ID, United States
- Department of Pharmacology and Therapeutics, University of Namibia, Windhoek, Namibia
| | - Irene van Woerden
- Department of Community and Public Health, Idaho State University, Pocatello, ID, United States
| | - Roselli Shiluama
- Department of Pharmacology and Therapeutics, University of Namibia, Windhoek, Namibia
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Tatah L, Bain LE, Kongnyuy E, Assah F, Mbanya JC. Shared correlates of maternal and childhood overweight in Cameroon: a cross-sectional analysis of demographic and health survey data. BMC Public Health 2023; 23:1265. [PMID: 37386386 PMCID: PMC10311895 DOI: 10.1186/s12889-023-16164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Overweight parents are likelier to bear overweight babies, who are likelier to grow into overweight adults. Understanding the shared risks of being overweight between the mother-child dyad is essential for targeted life course interventions. In this study, we aimed to identify such risk factors in Cameroon. METHODS We conducted secondary data analysis using Cameroon's 2018 Demographic and Health Surveys. We used weighted multilevel binary logistic regressions to examine individual, household, and community correlates of maternal (15-49 years) and child (under five years) overweight. RESULTS We retained 4511 complete records for childhood and 4644 for maternal analysis. We found that 37% [95%CI:36-38%] of mothers and 12% [95%CI:11-13%] of children were overweight or obese. Many environmental and sociodemographic factors were positively associated with maternal overweight, namely urban residence, wealthier households, higher education, parity and being a Christian. Childhood overweight was positively associated with a child being older and a mother being overweight, a worker, or a Christian. Therefore, only religion affected both mothers overweight (aOR: 0.71[95%CI:0.56-0.91]) and childhood overweight (aOR 0.67[95%CI: 0.5-0.91]). Most of the potentially shared factors only indirectly affected childhood overweight through maternal overweight. CONCLUSION Besides religion, which affects both mothers and childhood overweight (with the Muslim faith being protective), much of childhood overweight is not directly explained by many of the observed determinants of maternal overweight. These determinants are likely to influence childhood overweight indirectly through maternal overweight. Extending this analysis to include unobserved correlates such as physical activity, dietary, and genetic characteristics would produce a more comprehensive picture of shared mother-child overweight correlates.
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Affiliation(s)
- Lambed Tatah
- Health of Populations in Transition Research Group (HoPiT), University of Yaoundé I, 8046, Yaoundé, Cameroon
- Medical Research Council Epidemiology Unit, University of Cambridge, CB2 0QQ, Cambridge, UK
| | - Luchuo Engelbert Bain
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- International Development Research Centre, IDRC, Ottawa, ON, Canada
| | | | - Felix Assah
- Health of Populations in Transition Research Group (HoPiT), University of Yaoundé I, 8046, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Health of Populations in Transition Research Group (HoPiT), University of Yaoundé I, 8046, Yaoundé, Cameroon
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Anyasodor AE, Nwose EU, Bwititi PT, Richards RS. Cost-effectiveness of community diabetes screening: Application of Akaike information criterion in rural communities of Nigeria. Front Public Health 2022; 10:932631. [PMID: 35958851 PMCID: PMC9357922 DOI: 10.3389/fpubh.2022.932631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of diabetes mellitus (DM) is increasing globally, and this requires several approaches to screening. There are reports of alternative indices for prediction of DM, besides fasting blood glucose (FBG) level. This study, investigated the ability of combination of biochemical and anthropometric parameters and orodental disease indicators (ODIs) to generate models for DM prediction, using Akaike information criterion (AIC) to substantiate health economics of diabetes screening. Methods Four hundred and thirty-three subjects were enrolled in the study in Ndokwa communities, Delta State, Nigeria, and their glycaemic status was determined, using the CardioChek analyser® and previous data from the Prediabetes and Cardiovascular Complications Study were also used. The cost of screening for diabetes (NGN 300 = $0.72) in a not-for-profit organization/hospital was used as basis to calculate the health economics of number of individuals with DM in 1,000 participants. Data on the subjects' anthropometric, biochemical and ODI parameters were used to generate different models, using R statistical software (version 4.0.0). The different models were evaluated for their AIC values. Lowest AIC was considered as best model. Microsoft Excel software (version 2020) was used in preliminary analysis. Result The cost of identifying <2 new subjects with hyperglycemia, in 1,000 people was ≥NGN 300,000 ($ 716). A total of 4,125 models were generated. AIC modeling indicates FBG test as the best model (AIC = 4), and the least being combination of random blood sugar + waist circumference + hip circumference (AIC ≈ 34). Models containing ODI parameters had AIC values >34, hence considered as not recommendable. Conclusion The cost of general screening for diabetes in rural communities may appear high and burdensome in terms of health economics. However, the use of prediction models involving AIC is of value in terms of cost-benefit and cost-effectiveness to the healthcare consumers, which favors health economics.
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Affiliation(s)
- Anayochukwu Edward Anyasodor
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, NSW, Australia
- *Correspondence: Anayochukwu Edward Anyasodor
| | - Ezekiel Uba Nwose
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, NSW, Australia
- Department of Public and Community Health, Novena University, Kwale, Nigeria
| | | | - Ross Stuart Richards
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, NSW, Australia
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Alathari BE, Nyakotey DA, Bawah AM, Lovegrove JA, Annan RA, Ellahi B, Vimaleswaran KS. Interactions between Vitamin D Genetic Risk and Dietary Factors on Metabolic Disease-Related Outcomes in Ghanaian Adults. Nutrients 2022; 14:2763. [PMID: 35807945 PMCID: PMC9269445 DOI: 10.3390/nu14132763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
The Ghanaian population is experiencing an upsurge in obesity and type 2 diabetes (T2D) due to rapid urbanization. Besides dietary factors, vitamin D-related genetic determinants have also been shown to contribute to the development of obesity and T2D. Hence, we aimed to examine the interactions between dietary factors and vitamin D-related genetic variants on obesity and T2D related outcomes in a Ghanaian population. Three hundred and two healthy Ghanaian adults (25-60 years old) from Oforikrom, Municipality in Kumasi, Ghana were randomly recruited and had genetic tests, dietary consumption analysis, and anthropometric and biochemical measurements of glucose, HbA1c, insulin, cholesterol, and triglycerides taken. A significant interaction was identified between vitamin D-GRS and fiber intake (g/day) on BMI (pinteraction = 0.020) where those who were consuming low fiber (≤16.19 g/d) and carrying more than two risk alleles for vitamin D deficiency (p = 0.01) had a significantly higher BMI. In addition, an interaction between vitamin D-GRS and fat intake (g/day) on HbA1c (total fat, pinteraction = 0.029) was found, where participants who had a lower total fat intake (≤36.5 g/d), despite carrying more than two risk alleles, had significantly lower HbA1c (p = 0.049). In summary, our study has identified novel gene-diet interactions of vitamin D-GRS with dietary fiber and fat intakes on metabolic traits in Ghanaian adults.
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Affiliation(s)
- Buthaina E. Alathari
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Harry Nursten Building, Pepper Lane, University of Reading, Reading RG6 6DZ, UK; (B.E.A.); (J.A.L.)
- Department of Food Science and Nutrition, Faculty of Health Sciences, The Public Authority for Applied Education and Training, P.O. Box 14281, AlFaiha 72853, Kuwait
| | - David A. Nyakotey
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi GH233, Ghana; (D.A.N.); (A.-M.B.); (R.A.A.)
- Liggins Institute, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Abdul-Malik Bawah
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi GH233, Ghana; (D.A.N.); (A.-M.B.); (R.A.A.)
| | - Julie A. Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Harry Nursten Building, Pepper Lane, University of Reading, Reading RG6 6DZ, UK; (B.E.A.); (J.A.L.)
- Institute of Cardiovascular and Metabolic Research, Harry Nursten Building, Pepper Lane, University of Reading, Reading RG6 6DZ, UK
| | - Reginald A. Annan
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi GH233, Ghana; (D.A.N.); (A.-M.B.); (R.A.A.)
| | - Basma Ellahi
- Faculty of Health and Social Care, University of Chester, Riverside Campus, Chester CH1 4BJ, UK;
| | - Karani S. Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, Harry Nursten Building, Pepper Lane, University of Reading, Reading RG6 6DZ, UK; (B.E.A.); (J.A.L.)
- Institute of Cardiovascular and Metabolic Research, Harry Nursten Building, Pepper Lane, University of Reading, Reading RG6 6DZ, UK
- Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AH, UK
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Knowledge, Attitude and Consumption Pattern of Sugar Sweetened Beverages Among Somali Students in Turkey. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.861149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Oladeji O, Zhang C, Moradi T, Tarapore D, Stokes AC, Marivate V, Sengeh MD, Nsoesie EO. Monitoring Information-Seeking Patterns and Obesity Prevalence in Africa With Internet Search Data: Observational Study. JMIR Public Health Surveill 2021; 7:e24348. [PMID: 33913815 PMCID: PMC8120431 DOI: 10.2196/24348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of chronic conditions such as obesity, hypertension, and diabetes is increasing in African countries. Many chronic diseases have been linked to risk factors such as poor diet and physical inactivity. Data for these behavioral risk factors are usually obtained from surveys, which can be delayed by years. Behavioral data from digital sources, including social media and search engines, could be used for timely monitoring of behavioral risk factors. OBJECTIVE The objective of our study was to propose the use of digital data from internet sources for monitoring changes in behavioral risk factors in Africa. METHODS We obtained the adjusted volume of search queries submitted to Google for 108 terms related to diet, exercise, and disease from 2010 to 2016. We also obtained the obesity and overweight prevalence for 52 African countries from the World Health Organization (WHO) for the same period. Machine learning algorithms (ie, random forest, support vector machine, Bayes generalized linear model, gradient boosting, and an ensemble of the individual methods) were used to identify search terms and patterns that correlate with changes in obesity and overweight prevalence across Africa. Out-of-sample predictions were used to assess and validate the model performance. RESULTS The study included 52 African countries. In 2016, the WHO reported an overweight prevalence ranging from 20.9% (95% credible interval [CI] 17.1%-25.0%) to 66.8% (95% CI 62.4%-71.0%) and an obesity prevalence ranging from 4.5% (95% CI 2.9%-6.5%) to 32.5% (95% CI 27.2%-38.1%) in Africa. The highest obesity and overweight prevalence were noted in the northern and southern regions. Google searches for diet-, exercise-, and obesity-related terms explained 97.3% (root-mean-square error [RMSE] 1.15) of the variation in obesity prevalence across all 52 countries. Similarly, the search data explained 96.6% (RMSE 2.26) of the variation in the overweight prevalence. The search terms yoga, exercise, and gym were most correlated with changes in obesity and overweight prevalence in countries with the highest prevalence. CONCLUSIONS Information-seeking patterns for diet- and exercise-related terms could indicate changes in attitudes toward and engagement in risk factors or healthy behaviors. These trends could capture population changes in risk factor prevalence, inform digital and physical interventions, and supplement official data from surveys.
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Affiliation(s)
- Olubusola Oladeji
- Department of Global Health, School of Public Health, Boston University, Boston, MA, United States
| | - Chi Zhang
- Department of Computer Science, Boston University, Boston, MA, United States
| | - Tiam Moradi
- Department of Computer Science, Boston University, Boston, MA, United States
| | - Dharmesh Tarapore
- Department of Computer Science, Boston University, Boston, MA, United States
| | - Andrew C Stokes
- Department of Global Health, School of Public Health, Boston University, Boston, MA, United States
| | - Vukosi Marivate
- Department of Computer Science, University of Pretoria, Pretoria, South Africa
| | - Moinina D Sengeh
- Directorate of Science, Technology and Innovation, Freetown, Sierra Leone
| | - Elaine O Nsoesie
- Department of Global Health, School of Public Health, Boston University, Boston, MA, United States
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7
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Chetty L, Govender N, Govender GM, Reddy P. Demographic stratification of Type 2 diabetes and comorbidities in district healthcare in KwaZulu-Natal. S Afr Fam Pract (2004) 2021; 63:e1-e9. [PMID: 33881328 PMCID: PMC8377998 DOI: 10.4102/safp.v63i1.5218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/08/2022] Open
Abstract
Background Diabetes has been reported as the second leading cause of death and the top leading cause of death amongst women in South Africa; it is important to evaluate any epidemiological or demographic transition related to diabetes. This study evaluated the demographically stratified prevalence of type 2 diabetes mellitus (T2DM) and existing comorbidities amongst an outpatient population in a district healthcare facility in Kwazulu-Natal (KZN). Methods This retrospective cross-sectional study was conducted at a district hospital, and a retrospective record review of all outpatients who reported to the hospital to be treated for T2DM between the period, August 2018–January 2019, was used. Data, such as age, sex, ethnicity and any coexisting morbidity, were collected from outpatient hospital registers and electronically captured using a record review tool. Results There were significantly more female patients (3072) compared to male patients (1050) (p < 0.001) with a mean age of 59.21 years. Hypertension (77.9%) and cardiovascular problems (11.16%) were most frequent. Approximately 84% of women presented with T2DM and either one or two morbidities simultaneously. Female patients were at significantly higher risk of presenting with hypertension (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.20;1.71), whilst their risk for cardiovascular problems was significantly lower compared to male patients (OR = 0.67, 95% CI: 0.54;0.83). Conclusion The prevalence of T2DM and comorbidities differed by demographic factors, such as sex, ethnicity and age. There is a need for flexible and adaptive approaches for the prevention and management of T2DM cases in order to allocate medical resources efficiently and according to the true burden of disease because of T2DM complications.
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Affiliation(s)
- Lauren Chetty
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban.
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8
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Byberg S, Bundesen C, Rudolf F, Haraldsdottir TL, Indjai L, Barai R, Beck-Nielsen H, Sodemann M, Jensen DM, Bjerregaard-Andersen M. Diabetes in urban Guinea-Bissau; patient characteristics, mortality and prevalence of undiagnosed dysglycemia. Glob Health Action 2021; 13:1802136. [PMID: 32814520 PMCID: PMC7480585 DOI: 10.1080/16549716.2020.1802136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The burden of diabetes mellitus in Sub-Saharan Africa is growing rapidly, and yet the prevalence and patient characteristics are still largely unknown. Objectives We analyzed clinical and demographic characteristics of Type 2 diabetes (T2DM) patients attending a diabetes clinic in Guinea-Bissau from February 2008 to April 2014, and estimated the prevalence and risk factors of unknown-impaired fasting plasma glucose (FPG) and diabetes, as well as excess mortality associated with T2DM. Methods We characterized T2DM patients attending the national diabetes clinic in Bissau. Diabetes was diagnosed based on FPG. We matched T2DM patients 1:1 with non-diabetes community controls on age and sex to determine relevant risk factors for T2DM using logistic regression. Furthermore, we matched patients 1:6 with community controls to assess long-term survival (until February 2019) in a Cox regression using calendar time as the underlying timescale. Verbal autopsies determined the cause of death among T2DM patients and controls. Results The mean age among T2DM was 50.6 (SD 11.1), and the mean FPG at first consultation was high (13.2 mmol/L (SD 5.1)). Ethnicity, family history of diabetes, hypertension, and anthropometrics differed among T2DM patients, community controls with impaired FPG, and healthy controls. Family history of diabetes (OR = 5.65, 95% CI: 3.10–10.3) and elevated waist circumference (2.33, 1.26–4.29) were significant risk factors for T2DM. 20.4% (59/289) of community controls had abnormal FPG. T2DM patients had an excess mortality hazard ratio of 3.53 (95%CI: 1.92–6.52). Deaths caused by bacterial infections, including foot ulcers, were more common among T2DM patients, compared with community controls (54% (7/13) vs. 19% (5/27) (P = 0.02)). Conclusion Several risk factors including were associated with T2DM in Guinea-Bissau. We found a high prevalence of elevated FPG among randomly selected community controls. In combination with higher mortality among T2DM patients, an urgent need for better treatment options and increased awareness.
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Affiliation(s)
- Stine Byberg
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute , Copenhagen, Denmark.,Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen , Gentofte, Denmark
| | - Camilla Bundesen
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Odense University Hospital , Odense, Denmark
| | - Frauke Rudolf
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital Skejby , Aarhus, Denmark
| | - Thorny Linda Haraldsdottir
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital Skejby , Aarhus, Denmark
| | - Lamine Indjai
- The Diabetes Clinic, The National Diabetes Association (ANDD) , Bissau, Guinea-Bissau
| | - Rui Barai
- The Diabetes Clinic, The National Diabetes Association (ANDD) , Bissau, Guinea-Bissau
| | | | - Morten Sodemann
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Odense University Hospital , Odense, Denmark
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital , Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital , Odense, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute , Copenhagen, Denmark.,Steno Diabetes Center Odense, Odense University Hospital , Odense, Denmark.,Department of Endocrinology, Hospital of Southwest Denmark , Esbjerg, Denmark
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Correia JC, Lopes A, Nhabali A, Madrigal V, Errasti CR, Brady E, Hadjiconstantinou M, Perolini MC. Implementation and evaluation of a specialized diabetes clinic in Guinea-Bissau: lessons learnt from the field. Pan Afr Med J 2021; 37:126. [PMID: 33425159 PMCID: PMC7755353 DOI: 10.11604/pamj.2020.37.126.26127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction diabetes care in Guinea-Bissau (GB) is characterized by a lack of properly trained healthcare professionals (HCPs) and guidelines for diagnosis, treatment and follow up of patients. To address these issues, this project was launched with the objective to train HCPs in the management of diabetic patients and establish a specialized diabetes clinic in the Hospital Nacional Simão Mendes, a public tertiary care hospital in Bissau, capital of GB. This project is led by the Geneva University Hospitals (HUG) in collaboration with the Swiss Association for the Aid to Diabetic People in Guinea-Bissau, with the support of the International Solidairty Office (SSI) of the State of Geneva, and AIDA (Ayuda, Intercambio y Desarrollo). Methods specialists from the HUG in collaboration with local experts in GB developed and delivered a culturally and contextually adapted training course pertaining to diabetes care to HCPs in this hospital. Pre and post training tests were conducted to assess differences in knowledge and practices. Following the training program, a diabetes clinic was set up and an audit was conducted to assess its performance. Results a total of 24 HCP attended the training program and exhibited statistically significant improvements in their knowledge pertaining to diabetes care (mean difference between pre and post-test = 14.53, SD 11.60, t=-4.8, p < 0.001). The diabetes clinic was established and provided consultations 2 days per week. A total of 63 patients consulted at this clinic, of which 49 had type two diabetes treated with oral antidiabetic drugs and 14 were type 1 diabetics treated with insulin. Patients had blood glucose measurements and received therapeutic, dietary and physical activity counselling. Several barriers leading to occasional interruptions of service were encountered, including a political instability in the country and strikes of healthcare staff demanding better wages and working conditions. Conclusion: this study delineates the feasibility of setting up a diabetes consultation clinic in GB despite important barriers. To ensure successful running of such consultation clinics, continued buy-in and support from stakeholders should be ensured. Diabetes training should be incorporated in pre-and post-graduate training curriculums of all HCP to help shape a better workforce.
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Affiliation(s)
- Jorge César Correia
- Unit of Patient Education, Division of Endocrinology, Diabetology, Nutrition and Patient Education, WHO Collaborating Center, Department of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Adalgisa Lopes
- Association Suisse d´Aide aux Personnes Diabétiques en Guiné-Bissau, Geneva, Switzerland
| | - Adramane Nhabali
- Department of Internal Medicine, Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau
| | - Victor Madrigal
- Aida Ayuda Intercambio y Desarrollo (AIDA), Bissau, Guinea-Bissau
| | | | - Emer Brady
- Leicester Diabetes Centre, University Hospitals of Leicester, NHS Trust, UK
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Wu Y, Fu R, Lei C, Deng Y, Lou W, Wang L, Zheng Y, Deng X, Yang S, Wang M, Zhai Z, Zhu Y, Xiang D, Hu J, Dai Z, Gao J. Estimates of Type 2 Diabetes Mellitus Burden Attributable to Particulate Matter Pollution and Its 30-Year Change Patterns: A Systematic Analysis of Data From the Global Burden of Disease Study 2019. Front Endocrinol (Lausanne) 2021; 12:689079. [PMID: 34484113 PMCID: PMC8414895 DOI: 10.3389/fendo.2021.689079] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epidemiological trends of type 2 diabetes mellitus attributable to fine particulate matter (PM2.5) pollution remain unclear. Here, we estimated spatiotemporal trends of type 2 diabetes mellitus burden attributable to PM2.5 pollution, including ambient particulate matter pollution (APMP) and household air pollution (HAP), from 1990-2019. METHODS Data were obtained from the Global Burden of Disease Study 2019 and were analyzed by age, sex, year, and location. Joinpoint regression analysis was applied in the analysis of temporal trends in type 2 diabetes mellitus burden over the 30 years. RESULTS Globally, PM2.5 pollution contributed to 292.5 thousand deaths and 13 million disability-adjusted life-years (DALYs) in 2019. APMP ranked third among all risk factors, causing an increase in type 2 diabetes mellitus burden from 1990, whereas the impact of HAP significantly fell during the same period. Both APMP and HAP contributed the most to deaths and DALYs of type 2 diabetes mellitus among older people. However, the age-standardized death and DALY rates of type 2 diabetes mellitus attributable to APMP were greater among males and people in the middle socio-demographic index countries, especially in Southern Sub-Saharan Africa. For HAP, type 2 diabetes mellitus burden was modestly higher in females and was highest in Oceania, which was the only region with an increase from 1990. CONCLUSIONS PM2.5 pollution resulted in substantial and increasing type 2 diabetes mellitus burden worldwide. Hence, governments and health systems should take steps to reduce air pollution to mitigate this increasing burden.
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Affiliation(s)
- Ying Wu
- Department of Nephrology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Rongguo Fu
- Department of Nephrology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chen Lei
- Department of Endocrinology, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yujiao Deng
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Weiyang Lou
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Li Wang
- Department of Nephrology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yi Zheng
- Department of Nephrology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xinyue Deng
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Si Yang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Meng Wang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhen Zhai
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuyao Zhu
- Department of Nephrology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dong Xiang
- Celilo Cancer Center, Oregon Health Science Center affiliated Mid-Columbia Medical Center, The Dalles, OR, United States
| | - Jingjing Hu
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Zhijun Dai
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Jie Gao, ; Zhijun Dai,
| | - Jie Gao
- Department of Nephrology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Jie Gao, ; Zhijun Dai,
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11
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Mbanya JC, Lamptey R, Uloko AE, Ankotche A, Moleele G, Mohamed GA, Ramracheya I, Ramaiya K, Ndiweni M, Mbaye MN, Bahendeka S, Kalra S. African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus. Diabetes Ther 2021; 12:37-54. [PMID: 33169346 PMCID: PMC7843662 DOI: 10.1007/s13300-020-00958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 12/17/2022] Open
Abstract
The prevalence of diabetes in sub-Saharan Africa (SSA) is growing rapidly, and a steadily increasing number of adults are estimated to be living with type 2 diabetes mellitus (T2DM). Insulin therapy is the treatment of choice in patients who present with severe hyperglycaemia and in most of those who do not achieve target goals on oral hypoglycaemic agents. Initiating treatment with the appropriate type of insulin based on the meal patterns and lifestyle of the individual patient is a strategy that is more likely than others to improve glycaemic control and adherence. African cuisine typically has a high carbohydrate load. Given these predominantly carbohydrate-rich food habits, it is essential to modify this dietary pattern whilst at the same time ensuring that insulin therapy is initiated, titrated and maintained in a timely manner, as needed to suit the patient's habits. To date, there are no published clinical guidelines to guide practitioners and patients on tailoring insulin to match the high carbohydrate content in African cuisine. To address this gap, we have reviewed current insulin therapy practices and propose a patient-centric guide to insulin therapy based on African cuisine. A literature search was conducted for studies published in English up to November 2019 that focused on the choice of insulin and its dosing in relation to African foods. All articles extracted were reviewed by an expert group. The recommendation of the expert group was that basal-bolus and premix insulin regimens are best suited to manage post-meal glycaemia in African cuisine. The timing and constituents of the meal, portion sizes, glycaemic load and glycaemic index of meals should be considered when choosing the type of insulin and insulin regimen. Assessment of individual preferences and comorbidities should be prioritised and form an integral part of diabetes management.
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Affiliation(s)
- Jean Claude Mbanya
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé, Yaoundé, Cameroon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Roberta Lamptey
- Department of Family Medicine, Korle Bu Teaching Hospital–University of Ghana, Accra, Ghana
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Andrew E. Uloko
- Department of Medicine, Bayero University Kano / Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Amos Ankotche
- Department of Internal Medicine, Enocrinology and Geriatrics, Unit of Training and Research, Medical Science of Abidjan, University of Côte D’Ivoire, Abidjan, Ivory Coast
| | - Gontle Moleele
- Department of Endocrinology, Bokamoso Private Hospital, Mmopane, Botswana
| | | | | | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Chusi Street, Dar es Salaam, Tanzania
| | | | | | - Silver Bahendeka
- Department of Internal Medicine, Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala, Uganda
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
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12
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Pinchoff J, Mills CW, Balk D. Urbanization and health: The effects of the built environment on chronic disease risk factors among women in Tanzania. PLoS One 2020; 15:e0241810. [PMID: 33141863 PMCID: PMC7608895 DOI: 10.1371/journal.pone.0241810] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
Sub-Saharan Africa is experiencing rapid urban growth. Cities enable greater access to health services and improved water and sanitation infrastructure, leading to some improvements in health. However, urban settings may also be associated with more sedentary, stressful lifestyles and consumption of less nutritious food. C-reactive protein (CRP) is a measure of chronic inflammation predictive of cardiovascular disease, and high body mass index (BMI), a ratio of weight to height, indicates overweight or obesity and is associated with an increased risk of many chronic diseases. To explore the association between urbanicity and these two markers, we overlaid data from the 2010 Tanzania Demographic and Health Survey (DHS) with a satellite-derived measure of built environment. Linear regression models were constructed for the outcomes of BMI and CRP, by 1) administratively defined urban/rural categorization from the DHS, 2) satellite derived built environment, and 3) built environment stratified by urban/rural. A total of 2,212 women were included; 23% had elevated CRP, 21% were overweight or obese. A third (33%) lived in a highly built up area and 29% lived in an area classified as urban. A strong positive association between both CRP and BMI and built environment was detected; log CRP increased 0.43 in the highest built up areas compared to not built up (p<0.05); log BMI increased 0.02 in the most built up areas compared to not built up (p<0.05). However, comparing urban to rural category was only significant in unadjusted models. Models stratified by urban/rural category highlight that the variation in CRP and BMI by built environment is mainly driven by rural areas; within urban areas there is less variation. Our findings highlight the potential negative effects of urbanicity on chronic disease markers, with potentially more change detected for those transitioning from rural to urban lifestyles. Satellite-derived urbanicity measures are reproducible and provide more nuanced understanding of effects of built environment on health.
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Affiliation(s)
- Jessie Pinchoff
- Department of Poverty Gender and Youth, Population Council, New York, NY, United States of America
| | - Carrie W. Mills
- CUNY Institute for Demographic Research, City University of New York, New York, NY, United States of America
| | - Deborah Balk
- CUNY Institute for Demographic Research, City University of New York, New York, NY, United States of America
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13
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Green MA, Pradeilles R, Laar A, Osei-Kwasi H, Bricas N, Coleman N, Klomegah S, Wanjohi MN, Tandoh A, Akparibo R, Aryeetey RNO, Griffiths P, Kimani-Murage EW, Mensah K, Muthuri S, Zotor F, Holdsworth M. Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study. BMJ Open 2020; 10:e035680. [PMID: 32595155 PMCID: PMC7322322 DOI: 10.1136/bmjopen-2019-035680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. DESIGN Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability. SETTING Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya). MAIN OUTCOME MEASURE Types of foods and beverages sold and/or advertised. RESULTS Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets. CONCLUSION Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.
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Affiliation(s)
- Mark Alan Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Nathaniel Coleman
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Milka Njeri Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Kobby Mensah
- Business School, University of Ghana, Legon, Ghana
| | | | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Michelle Holdsworth
- NUTRIPASS Unit, French Research Institute for Sustainable Development (IRD), Montpellier, France
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14
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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15
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Lygidakis C, Uwizihiwe JP, Kallestrup P, Bia M, Condo J, Vögele C. Community- and mHealth-based integrated management of diabetes in primary healthcare in Rwanda (D²Rwanda): the protocol of a mixed-methods study including a cluster randomised controlled trial. BMJ Open 2019; 9:e028427. [PMID: 31345971 PMCID: PMC6661689 DOI: 10.1136/bmjopen-2018-028427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In Rwanda, diabetes mellitus prevalence is estimated between 3.1% and 4.3%. To address non-communicable diseases and the shortage of health workforce, the Rwandan Ministry of Health has introduced the home-based care practitioners (HBCPs) programme: laypeople provide longitudinal care to chronic patients after receiving a six-month training. Leveraging technological mobile solutions may also help improve health and healthcare. The D²Rwanda study aims at: (a) determining the efficacy of an integrated programme for the management of diabetes in Rwanda, which will provide monthly patient assessments by HBCPs, and an educational and self-management mHealth patient tool, and; (b) exploring qualitatively the ways the interventions will have been enacted, their challenges and effects, and changes in the patients' health behaviours and HBCPs' work satisfaction. METHODS AND ANALYSIS This is a mixed-methods sequential explanatory study. First, there will be a one-year cluster randomised controlled trial including two interventions ((1) HBCPs' programme; (2) HBCPs' programme + mobile health application) and usual care (control). Currently, nine hospitals run the HBCPs' programme. Under each hospital, administrative areas implementing the HBCPs' programme will be randomised to receive intervention 1 or 2. Eligible patients from each area will receive the same intervention. Areas without the HBCPs' programme will be assigned to the control group. The primary outcome will be changes in glycated haemoglobin. Secondary outcomes include medication adherence, mortality, complications, health-related quality of life, diabetes-related distress and health literacy. Second, at the end of the trial, focus group discussions will be conducted with patients and HBCPs. Financial support was received from the Karen Elise Jensens Fond, and the Universities of Aarhus and Luxembourg. ETHICS AND DISSEMINATION Ethics approval was obtained from the Rwanda National Ethics Committee and the Ethics Review Panel of the University of Luxembourg. Findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03376607; Pre-results.
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Affiliation(s)
- Charilaos Lygidakis
- Institute for Health and Behaviour – Research Unit INSIDE, Universite du Luxembourg, Esch-sur-Alzette, Luxembourg
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Jean Paul Uwizihiwe
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
- Centre for Global Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Michela Bia
- Labor Market, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Jeanine Condo
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
| | - Claus Vögele
- Institute for Health and Behaviour – Research Unit INSIDE, Universite du Luxembourg, Esch-sur-Alzette, Luxembourg
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16
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Sugar-sweetened beverage consumption in the early years and implications for type-2 diabetes: a sub-Saharan Africa context. Proc Nutr Soc 2019; 78:547-553. [PMID: 30816084 DOI: 10.1017/s0029665118002860] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This review aims to explore trends of early consumption of sugar-sweetened beverages (SSB) in sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSB, including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases (NCD). SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSB already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Public health efforts in many high income and some middle-income countries address increasing prevalence of obesity and type-2 diabetes by focusing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of NCD, particularly when contextualised with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSB are necessary to help address this issue.
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17
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Davids SF, Matsha TE, Peer N, Erasmus RT, Kengne AP. Changes in Obesity Phenotype Distribution in Mixed-ancestry South Africans in Cape Town Between 2008/09 and 2014/16. Front Endocrinol (Lausanne) 2019; 10:753. [PMID: 31781031 PMCID: PMC6851026 DOI: 10.3389/fendo.2019.00753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The concept of obesity phenotypes encompasses a different approach to evaluating the relationship between obesity and cardiometabolic diseases. Considering the minimal research on obesity phenotypes in Africa, we investigated these changes from 2008/09 to 2014/16 in the mixed ancestry population in Cape Town, South Africa. Methods: In all, 928 (2008/09) and 1969 (2014/16) ≥20 year old participants were included in two community-based cross-sectional studies. For obesity phenotype classification, a combination of body mass index (BMI) categories and prevalent cardiometabolic disease risk factors were used, with the presence of ≥2 cardiometabolic abnormalities defining abnormal metabolic status. Interaction tests were used to investigate changes in their distribution across the years of study. Results: Distribution of BMI categories differed significantly between the 2 years; normal weight, overweight and obese: 27.4, 27.4, and 45.3% in 2008/09 vs. 34.2, 23.6, and 42.2% in 2014/16 (p = 0.001). There was no differential effect in the distribution of obesity phenotypes pattern across the two time-points (interaction p = 0.126). Across BMI categories, levels of cardiometabolic risk factors linearly deteriorated in both metabolically healthy and abnormal participants (all p ≤ 0.018 for linear trends). Findings were not sensitive to the number of metabolic abnormalities included in the definition of obesity phenotypes. Conclusions: Our study showed negligible differences in obesity phenotypes over time, but a high burden of metabolic abnormalities among normal weight participants, and a significant proportion of metabolically health obese individuals. Further investigation is needed to improve risk stratification and cost-effective identification of individuals at high risk for cardiometabolic diseases.
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Affiliation(s)
- Saarah Fatoma Davids
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
| | - Tandi Edith Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
| | - Nasheeta Peer
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rajiv Timothy Erasmus
- Department of Chemical Pathology, Faculty of Medicine and Health Sciences, and National Health Laboratory Service (NHLS), Stellenbosch University, Cape Town, South Africa
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- *Correspondence: Andre Pascal Kengne
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18
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Tateyama Y, Techasrivichien T, Musumari PM, Suguimoto SP, Zulu R, Macwan’gi M, Dube C, Ono-Kihara M, Kihara M. Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia. PLoS One 2018; 13:e0208176. [PMID: 30496252 PMCID: PMC6264511 DOI: 10.1371/journal.pone.0208176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 11/13/2018] [Indexed: 01/12/2023] Open
Abstract
Background Sub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context. Methods In this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25–64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) ≥25 kg/m2 and underestimation of body weight were assessed using multiple logistic regression. Results Of the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI ≥25 kg/m2. In multivariate analyses, female gender, age 45–64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c ≥5.7% were significantly associated with BMI ≥25 kg/m2. Among participants with BMI ≥25 kg/m2, 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45–64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m2 and BMI≥25 kg/m2, respectively; “looks attractive” and “fear of being perceived as HIV-positive” were the main reasons. Conclusion In rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI ≥25 kg/m2 underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia.
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Affiliation(s)
- Yukiko Tateyama
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Teeranee Techasrivichien
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Patou Masika Musumari
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S. Pilar Suguimoto
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Richard Zulu
- Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
| | - Mubiana Macwan’gi
- Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
| | | | - Masako Ono-Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Gowshall M, Taylor-Robinson SD. The increasing prevalence of non-communicable diseases in low-middle income countries: the view from Malawi. Int J Gen Med 2018; 11:255-264. [PMID: 29988742 PMCID: PMC6029598 DOI: 10.2147/ijgm.s157987] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Non-communicable diseases (NCDs) are the leading cause of death globally, the majority of these being due to cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Mortality from many NCDs continues to increase worldwide, with a disproportionately larger impact in low-middle income countries (LMIs), where almost 75% of global deaths occur from these causes. As a low-income African country that consistently ranks amongst the world's poorest nations, Malawi as a case study demonstrates how transition due to societal change and increasing urbanization is often accompanied by a rise in the rate of NCDs. Other factors apart from changing lifestyle factors can explain at least some of this increase, such as the complex relationship between communicable and NCD and growing environmental, occupational, and cultural pressures. Malawi and other LMIs are struggling to manage the increasing challenge of NCDs, in addition to an already high communicable disease burden. However, health care policy implementation, specific health promotion campaigns, and further epidemiological research may be key to attenuating this impending health crisis, both in Malawi and elsewhere. This review aims to examine the effects of the major NCDs in Malawi to help inform future public health care policy in the region.
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Affiliation(s)
- Matthew Gowshall
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, London, UK, ,
- Barts and the London School of Medicine and Dentistry, London, UK,
| | - Simon D Taylor-Robinson
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, London, UK, ,
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Mahajan R. Oxidative Stress in Diabetic Patients with Sickle-Cell Anemia: A Warning Call for Endemic Areas. Int J Appl Basic Med Res 2018; 8:65-66. [PMID: 29744315 PMCID: PMC5932925 DOI: 10.4103/ijabmr.ijabmr_104_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Rajiv Mahajan
- Department of Pharmacology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
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Herbal medicine use among Type 2 diabetes mellitus patients in Nigeria: understanding the magnitude and predictors of use. Int J Clin Pharm 2018; 40:580-588. [PMID: 29721742 DOI: 10.1007/s11096-018-0648-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/27/2018] [Indexed: 01/28/2023]
Abstract
Background Patients with chronic diseases exploit complementary and alternative treatment options to manage their conditions better and improve well-being. Objective To determine the prevalence and predictors of herbal medicine use among Type 2 Diabetes patients in Lagos, Nigeria. Setting Secondary healthcare facilities in Lagos state, Nigeria. Method The study design was a cross sectional survey. A two-stage sampling approach was used to select the health facilities and patients were recruited consecutively to attain the sample size. Data was collected using a structured and standardized interviewer-administered questionnaire. Characteristics, prevalence and predictors of herbal medicine use were assessed using descriptive statistics and multivariate regression analyses. Main outcome measure Herbal medicine use among Type 2 diabetes mellitus patients. Results 453 patients were surveyed, 305 (67.3%) reported herbal medicine use, among whom 108 (35.4%) used herbal and conventional medicines concurrently; 206 (67.5%) did not disclose use to their physician. Herbal medicine use was significantly associated with age (p = 0.045), educational level (p = 0.044), occupation (p = 0.013), duration of diabetes disease (p = 0.007), mode of diabetes management (p = 0.02), a positive history of diabetes (p = 0.011) and presence of diabetes complication (p = 0.033). Formulations or whole herbs of Vernonia amygdalina, Moringa oleifera, Ocimum gratissimum, Picralima nitida, and herbal mixtures were the commonest herbal medicine. Beliefs and perceptions about herbal medicine varied between the users and non-users. Conclusion The use of herbal medicine among Type 2 diabetes mellitus patients in Lagos, Nigeria is high. There is dire need for health care practitioners to frequently probe patients for herbal medicine use and be aware of their health behaviour and choices, with a view to manage the disease better.
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Ahmed MH, Ali YA, Awadalla H, Elmadhoun WM, Noor SK, Almobarak AO. Prevalence and trends of obesity among adult Sudanese individuals: Population based study. Diabetes Metab Syndr 2017; 11 Suppl 2:S963-S967. [PMID: 28736258 DOI: 10.1016/j.dsx.2017.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
AIM The prevalence of obesity has increased across the globe in particular in Africa. The aim of this study was to determine the prevalence of obesity in Sudan. MATERIAL AND METHODS Descriptive, cross sectional study recruited 7239 individuals. Demographic and clinical data were collected by an interview using a pretested standardised questionnaire. Anthropometric measurements including body weight, height and waist circumference have been taken using standardized techniques and calibrated equipment. Body mass index (BMI) has been calculated. RESULTS Total of 7239 persons completed the questionnaires; the results showed that prevalence of obesity was found to be 21.2%, with a higher rate of obesity in females than males (26.3% versus 13.8%). The prevalence of central obesity was also higher in women (36.7%) than men (17.6%).The prevalence of overweight was 34.9%. The overall prevalence of overweight/obesity was 56.1%. Obesity determined by BMI was associated with hypertension and diabetes. While central obesity was associated with an increase in age, female, diabetes and hypertension. CONCLUSION The prevalence of obesity was 21.2%. Obesity and central obesity have a higher prevalence among Sudanese women. Obesity and central obesity were associated with diabetes and hypertension.
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Affiliation(s)
- Mohamed H Ahmed
- Department of Medicine and HIV Metabolic clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK.
| | - Yasmeen A Ali
- Public and Tropical Health Program, University of Medical Sciences and Technology, Khartoum, Sudan.
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | - Wadie M Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Sudan,.
| | - Sufian K Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atabra, Sudan.
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan.
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Bornman MS, Aneck-Hahn NH, de Jager C, Wagenaar GM, Bouwman H, Barnhoorn IEJ, Patrick SM, Vandenberg LN, Kortenkamp A, Blumberg B, Kimmins S, Jegou B, Auger J, DiGangi J, Heindel JJ. Endocrine Disruptors and Health Effects in Africa: A Call for Action. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:085005. [PMID: 28935616 PMCID: PMC5783641 DOI: 10.1289/ehp1774] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND Africa faces a number of unique environmental challenges. Unfortunately, it lacks the infrastructure needed to support the comprehensive environmental studies that could provide the scientific basis to inform environmental policies. There are a number of known sources of endocrine-disrupting chemicals (EDCs) and other hazardous chemicals in Africa. However, a coordinated approach to identify and monitor these contaminants and to develop strategies for public health interventions has not yet been made. OBJECTIVES This commentary summarizes the scientific evidence presented by experts at the First African Endocrine Disruptors meeting. We describe a "call to action" to utilize the available scientific knowledge to address the impact of EDCs on human and wildlife health in Africa. DISCUSSION We identify existing knowledge gaps about exposures to EDCs in Africa and describe how well-designed research strategies are needed to address these gaps. A lack of resources for research and a lag in policy implementation slows down intervention strategies and poses a challenge to advancing future health in Africa. CONCLUSION To address the many challenges posed by EDCs, we argue that Africans should take the lead in prioritization and evaluation of environmental hazards, including EDCs. We recommend the institution of education and training programs for chemical users, adoption of the precautionary principle, establishment of biomonitoring programs, and funding of community-based epidemiology and wildlife research programs led and funded by African institutes and private companies. https://doi.org/10.1289/EHP1774.
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Affiliation(s)
- Maria S Bornman
- Environmental and Occupational Health, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Environmental Chemical Pollution and Health Research Unit, University of Pretoria, Pretoria, South Africa
| | - Natalie H Aneck-Hahn
- Environmental and Occupational Health, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Environmental Chemical Pollution and Health Research Unit, University of Pretoria, Pretoria, South Africa
- Department of Urology, University of Pretoria , Pretoria, South Africa
| | - Christiaan de Jager
- Environmental and Occupational Health, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Environmental Chemical Pollution and Health Research Unit, University of Pretoria, Pretoria, South Africa
| | - Gesina M Wagenaar
- Department of Zoology, University of Johannesburg , Johannesburg, South Africa
| | - Hindrik Bouwman
- Unit for Environmental Sciences and Management, North-West University , Potchefstroom, South Africa
| | | | - Sean M Patrick
- Environmental and Occupational Health, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Environmental Chemical Pollution and Health Research Unit, University of Pretoria, Pretoria, South Africa
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, University of Massachusetts Amherst School of Public Health and Health Sciences , Amherst, Massachusetts, USA
| | - Andreas Kortenkamp
- Institute of Environment, Health and Societies, Brunel University London , Uxbridge, UK
| | - Bruce Blumberg
- Department of Developmental and Cell Biology, University of California, Irvine , Irvine, California, USA
| | - Sarah Kimmins
- Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University , Montreal, Canada
- Department of Animal Science, Faculty of Agricultural and Environmental Sciences, McGill University , Montreal, Canada
| | - Bernard Jegou
- Institut de Recherche en Santé, Environnement et Travail (IRSET-INSERM UMR 1085 ), Institut national de la santé et de la recherche médicale (INSERM) , Rennes, France
- Ecole des Hautes Études en Santé Publique (EHESP) , Rennes, France
| | - Jacques Auger
- INSERM U1016, Equipe Génomique, Epigénétique et Physiologie de la Reproduction, Institut Cochin, Université Paris Descartes , Paris, France
| | - Joseph DiGangi
- International POPs Elimination Network (IPEN) , Gothenburg, Sweden
| | - Jerrold J Heindel
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services , Research Triangle Park, North Carolina, USA
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Ali YA, Almobarak AO, Awadalla H, Elmadhoun WM, Ahmed MH. Obesity among Sudanese adults with diabetes: a population-based survey. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:252. [PMID: 28706920 DOI: 10.21037/atm.2017.05.11] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to determine the prevalence of obesity among Sudanese individuals with diabetes. METHODS Demographic and clinical data from 1,337 individuals with type 2 diabetes were collected using a pretested, standardized, interviewer administered questionnaire. Subjects were recruited from three states namely Khartoum, Northern and River Nile States. Anthropometric measurements including body weight, height and waist circumference were determined using standardized techniques and calibrated equipment. RESULTS Total of 1,337 subjects with type 2 diabetes from Khartoum and North of Sudan were enrolled in this study and completed the questionnaires; the results showed that prevalence of obesity among individuals with diabetes was found to be 24.5%, with a higher rate of obesity in females than males (29.2% versus 18.1%). The prevalence of central obesity was also higher in women (43.6%) than men (21.8%). The prevalence of overweight was 39.9%. The overall prevalence of overweight and obesity was 64.4%. Obesity was associated with age, sex and blood pressure. While central obesity was associated with an increase in age, female sex and hypertension. Logistic regression analysis showed that female sex and hypertension are absolute risk factors for both obesity and central obesity. CONCLUSIONS The prevalence of obesity was 24.5% and overweight was 39.9% among Sudanese individuals with diabetes and more among women than men. Obesity and central obesity were significantly associated with female sex and hypertension.
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Affiliation(s)
- Yasmeen A Ali
- Public and Tropical Heath Program, Graduate College, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Wadie M Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
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Abstract
Noncommunicable disease (NCD), principally cardiovascular diseases, cancer, chronic lung disease, and diabetes, constitutes the major cause of death worldwide. Evidence of a continuing increase in the global burden of these diseases has generated recent urgent calls for global action to tackle and reduce related death and disability. Because the majority of NCD deaths occur in low- and middle-income countries, increased attention has been focused on this group of countries. However, in sub-Saharan Africa, where all countries are members of the low- and middle-income grouping, NCDs are not the leading causes of death or potential life years lost. Thus, strategies to tackle NCDs in sub-Saharan Africa are best conceived and executed in alignment with existing strategies for the prevention, treatment, and control of the actual leading causes of death in this region. This commentary addresses caveats to be considered as strategies are developed to tackle NCDs in sub-Saharan Africa as part of the global effort to prevent, treat, and control NCDs.
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Affiliation(s)
- George A Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Aminde LN, Atem JA, Kengne AP, Dzudie A, Veerman JL. Body mass index-measured adiposity and population attributability of associated factors: a population-based study from Buea, Cameroon. BMC OBESITY 2017; 4:1. [PMID: 28078091 PMCID: PMC5219758 DOI: 10.1186/s40608-016-0139-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/19/2016] [Indexed: 12/21/2022]
Abstract
Background Obesity is currently a global health challenge driven by a mix of behavioural, environmental and genetic factors. Up to date population-based disease burden estimates are needed to guide successful prevention and control efforts in African countries. We investigated the prevalence and population attributable fractions of overweight and obesity in Buea, the Southwest region of Cameroon. Methods Data are from a community-based cross-sectional study involving randomly selected adults conducted in 2016. Body mass index (BMI) was categorized according to the WHO classification. Multivariable logistic regressions were used to investigate factors independently associated with obesity. Corresponding population attributable fractions were estimated. Results Among the 1,139 participants, age-standardized prevalence (95% CI) of overweight and obesity were; 36.5 (33.7–39.3) and 11.1 (9.3–12.9) percent respectively. Mean BMI was 25.3 ± 4.3 kg/m2; women were heavier than men (25.8 vs. 24.4 kg/m2; p <0.0001). Factors associated with obesity were; female gender [odds ratio 3.20 (95% CI: 1.93–5.59)], age > 31 years [3.21 (1.86–5.28)] and being married [2.10 (1.60–3.51)]. At the population level; older age, being married, low level of education, high monthly income and physical inactivity accounted respectively for 11.9%, 21.8%, 11.6%, 6.4% and 8.7% of overweight and obesity among the women, while older age and being married explained 9.2% and 28.3% of overweight and obesity in men. Conclusion The prevalence of overweight and obesity in this semi-urban Cameroonian population is high, affecting over a third of individuals. Community-based interventions to control weight would need to take into account gender specificities and socio-economic status.
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Affiliation(s)
- Leopold Ndemnge Aminde
- The University of Queensland, School of Public Health, Herston, QLD 4006 Australia ; Non-communicable Diseases Unit, Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Jeannine A Atem
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Andre Pascal Kengne
- Non-communicable Diseases Unit, Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon ; South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - Anastase Dzudie
- Non-communicable Diseases Unit, Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon ; Faculty of Health Sciences, University of Buea, Buea, Cameroon ; Department of Medicine, Douala General Hospital and Faculty of Medicine & Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - J Lennert Veerman
- The University of Queensland, School of Public Health, Herston, QLD 4006 Australia
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Goedecke JH, Mtintsilana A, Dlamini SN, Kengne AP. Type 2 diabetes mellitus in African women. Diabetes Res Clin Pract 2017; 123:87-96. [PMID: 28006698 DOI: 10.1016/j.diabres.2016.11.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023]
Abstract
Compared to global estimates, Sub-Saharan Africa (SSA) has the highest projected rates of increase in type 2 diabetes (T2D) over the next 25years. This is attributed to the ageing population, increasing urbanisation and the associated lifestyle changes. Although the prevalence does not differ by gender, deaths attributable to T2D in SSA are greater in women, likely due to differences in beliefs and access to care. Women in SSA also have greater risk factor burden for T2D than men, in particular obesity, which is explained in part by sociocultural factors. The pathogenesis of diabetes differs between African and Caucasian women, with implications for risk assessment. African women are more insulin resistant than their Caucasian counterparts, despite a more 'favourable' body fat distribution. Notably, women in SSA face the dual burden of T2D and HIV/AIDS. HIV positive women in SSA are typically young and obese, with the latter being exacerbated by anti-retroviral therapy (ART). Cultural perceptions regarding weight loss and limited financial resources are the major limitations to the management of T2D. Hence prevention is vital. However, there is a paucity of studies examining the effectiveness and sustainability of interventions to reduce T2D in SSA.
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Affiliation(s)
- Julia H Goedecke
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Asanda Mtintsilana
- Medical Research Council/University of Witwatersrand, Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siphiwe N Dlamini
- Medical Research Council/University of Witwatersrand, Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Gatimu SM, Milimo BW, Sebastian MS. Prevalence and determinants of diabetes among older adults in Ghana. BMC Public Health 2016; 16:1174. [PMID: 27871259 PMCID: PMC5117548 DOI: 10.1186/s12889-016-3845-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/15/2016] [Indexed: 02/05/2023] Open
Abstract
Background Diabetes is one of the leading non-communicable diseases in Africa, contributing to the increasing disease burden among the old adults. Thus, the aim of this study was to determine the prevalence and determinants of diabetes among adults aged 50 years and above in Ghana. Methods A cross sectional study based on data collected from Study of Ageing and Adult Health (SAGE) Wave 1 from 2007 to 2008. Data was collected from 5565 respondents of whom 4135 were aged 50+ years identified using a multistage stratified clusters design. Bivariate and hierarchical multivariable logistic regression models were used to examine the association of the determinants and diabetes. Results The weighted prevalence of diabetes among the adults aged 50 years and above in Ghana was 3.95% (95% Confidence Interval: 3.35–4.55) with the prevalence being insignificantly higher in females than males (2.16%, 95% CI: 1.69–2.76 vs. 1.73%, 95% CI: 1.28–2.33). Low level of physical activity (Adjusted Odds Ratio [AOR] 2.11, 95% CI: 1.21–3.69) and obesity (AOR 4.81, 95% CI: 1.92–12.0) were associated with increased odds of diabetes among women while old age (AOR 2.58, 95% CI: 1.29–5.18) and university (AOR 12.8, 95% CI: 4.20–39.1), secondary (AOR 3.61, 95% CI: 1.38–9.47) and primary education (AOR 2.71, 95% CI: 1.02–7.19) were associated with increased the odds of diabetes among men. Conclusion The prevalence of diabetes among old adults shows a similar trend with that of the general population. However, the prevalence may have been underestimated due to self-reporting and a high rate of undiagnosed diabetes. In addition, the determinants of diabetes among older adults are a clear indication of the need for diabetes prevention programme targeting the young people and that are gender specific to reduce the burden of diabetes at old age. Physical activity and nutrition should be emphasised in any prevention strategy.
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Affiliation(s)
- Samwel Maina Gatimu
- Department of Midwifery and Gender, School of Nursing, Moi University, P.O. Box 4606, 30100, Eldoret, Kenya. .,School of Nursing, Moi University, PO. Box 4606, 30100, Eldoret, Kenya.
| | - Benson Williesham Milimo
- Department of Midwifery and Gender, School of Nursing, Moi University, P.O. Box 4606, 30100, Eldoret, Kenya.,School of Nursing, Moi University, PO. Box 4606, 30100, Eldoret, Kenya
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Umeå International School of Public Health, Umeå University, SE-90 185, Umeå, Sweden.,Department of Nursing I, University of the Basque country, Bilbao, Spain
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Elmadhoun WM, Noor SK, Ibrahim AAA, Bushara SO, Ahmed MH. Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: Population-based study. J Diabetes 2016; 8:839-846. [PMID: 26663723 DOI: 10.1111/1753-0407.12364] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/10/2015] [Accepted: 12/06/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a major health problem in Africa and worldwide. The prevalence of diabetes is expected to increase at alarming rate in Africa. Its estimated that around 20 million Africans are now living with diabetes, comprising a challenge for health systems at present and in the future. The aim of the present study was to determine the prevalence of undiagnosed and diagnosed DM and impaired glucose tolerance (IGT) in adult urban communities of the River Nile State (RNS), north Sudan. METHODS The present study was a cross-sectional community-based study in which participants were randomly selected from the four main cities of the RNS, on a house-to-house basis. Blood glucose was tested and all participants completed a questionnaire to obtain demographic, clinical and social data. Blood pressure and anthropometric measures were also recorded. RESULTS In all, 954 adults (518 females; 54.3%; mean [±SD] age 39.5 ± 16.7 years; range 18-90 years) participated in the survey. The overall prevalence of DM was 19.1% (182/954), whereas that of IGT was 9.5% (91/954). Among the diabetic group, 125 (68.7%) had known diabetes, whereas 57 (31.3%) were newly diagnosed during the study. Increasing age, a family history of diabetes, central obesity, abnormal body mass index, and hypertension were significant risk factors for DM. CONCLUSIONS There is high prevalence of DM and glucose intolerance in the urban population of the RNS. Screening for diabetes in individuals with any feature of metabolic syndrome is recommended.
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Affiliation(s)
- Wadie M Elmadhoun
- Department of Pathology and Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Sufian K Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | | | - Sarra O Bushara
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Mohamed H Ahmed
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK.
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Vieira WA, Sadie-Van Gijsen H, Ferris WF. Free fatty acid G-protein coupled receptor signaling in M1 skewed white adipose tissue macrophages. Cell Mol Life Sci 2016; 73:3665-76. [PMID: 27173059 PMCID: PMC11108433 DOI: 10.1007/s00018-016-2263-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 12/13/2022]
Abstract
Obesity is associated with the establishment and maintenance of a low grade, chronically inflamed state in the white adipose tissue (WAT) of the body. The WAT macrophage population is a major cellular participant in this inflammatory process that significantly contributes to the pathophysiology of the disease, with the adipose depots of obese individuals, relative to lean counterparts, having an elevated number of macrophages that are skewed towards a pro-inflammatory phenotype. Alterations in the WAT lipid micro-environment, and specifically the availability of free fatty acids, are believed to contribute towards the obesity-related quantitative and functional changes observed in these cells. This review specifically addresses the involvement of the five G-protein coupled free fatty acid receptors which bind exogenous FFAs and signal in macrophages. Particular focus is placed on the involvement of these receptors in macrophage migration and cytokine production, two important aspects that modulate inflammation.
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Affiliation(s)
- Warren Antonio Vieira
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Hanél Sadie-Van Gijsen
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - William Frank Ferris
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
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Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nat Rev Nephrol 2015; 12:73-81. [DOI: 10.1038/nrneph.2015.173] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Diaw M, Pialoux V, Martin C, Samb A, Diop S, Faes C, Mury P, Sall Diop N, Diop SN, Ranque B, Mbaye MN, Key NS, Connes P. Sickle Cell Trait Worsens Oxidative Stress, Abnormal Blood Rheology, and Vascular Dysfunction in Type 2 Diabetes. Diabetes Care 2015; 38:2120-7. [PMID: 26324331 PMCID: PMC4613921 DOI: 10.2337/dc15-0699] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/04/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It is predicted that Africa will have the greatest increase in the number of patients with type 2 diabetes mellitus (T2DM) within the next decade. T2DM patients are at risk for cardiovascular disorders. In Sub-Saharan African countries, sickle cell trait (SCT) is frequent. Despite the presence of modest abnormalities in hemorheology and oxidative stress, SCT is generally considered a benign condition. Little is known about vascular function in SCT, although recent studies demonstrated an increased risk of cardiovascular disorders, including venous thromboembolism, stroke, and chronic kidney disease. We hypothesized that SCT could accentuate the vascular dysfunction observed in T2DM. RESEARCH DESIGN AND METHODS The current study, conducted in Senegal, compared vascular function, hemorheological profile, and biomarkers of oxidative stress, inflammation, and nitric oxide metabolism in healthy individuals (CONT), subjects with T2DM or SCT, and patients with both T2DM and SCT (T2DM-SCT). RESULTS Flow-mediated dilation was blunted in individuals with T2DM, SCT, and T2DM-SCT compared with CONT, with vascular dysfunction being most pronounced in the latter group. Carotid-femoral pulse wave velocity measurements demonstrated increased arterial stiffness in T2DM-SCT. Oxidative stress, advanced glycation end products, and inflammation (interleukin-1β) were greater in patients with T2DM-SCT compared with the other groups. Blood viscosity was higher in individuals with TD2M, SCT carriers, and individuals with T2DM-SCT, and the values were further increased in the latter group. CONCLUSIONS Our results demonstrate severe biological abnormalities and marked vascular dysfunction in patients with both T2DM and SCT. SCT should be viewed as a risk factor for further cardiovascular disorders in individuals with T2DM.
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Affiliation(s)
- Mor Diaw
- Laboratoire de Physiologie et Explorations Fonctionnelles, FMPO, Université Cheikh Anta Diop de Dakar (UCAD), Dakar, Senegal
| | - Vincent Pialoux
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Institut Universitaire de France, Paris, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Cyril Martin
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Abdoulaye Samb
- Laboratoire de Physiologie et Explorations Fonctionnelles, FMPO, Université Cheikh Anta Diop de Dakar (UCAD), Dakar, Senegal UMI 3189, Environnement, Sante, Sociétés, CNRS, CNRST, Université Bamako-UCAD, Dakar, Senegal
| | - Saliou Diop
- Laboratoire d'Hémato-Immunologie, FMPO, UCAD, Dakar, Senegal
| | - Camille Faes
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Pauline Mury
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Niama Sall Diop
- Laboratoire de Biochimie et de Biologie Moléculaire, FMPO, UCAD, Dakar, Senegal
| | - Saïd-Norou Diop
- Clinique Médicale II, Centre Hospitalier Abass Ndao, Dakar, Senegal
| | - Brigitte Ranque
- Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France UMR INSERM 970, Université Paris Descartes, Paris, France Service de Médecine Interne, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Nigel S Key
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Philippe Connes
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Institut Universitaire de France, Paris, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
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Katchunga PB, Mirindi PN, Kishabongo AS, Cikomola JC, Bwanamdogo S, Philippé J, Speeckaert MM, Delanghe JR. Glycated nail proteins as a new biomarker in management of the South Kivu Congolese diabetics. Biochem Med (Zagreb) 2015; 25:469-73. [PMID: 26526975 PMCID: PMC4622194 DOI: 10.11613/bm.2015.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/23/2015] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Diagnosis and monitoring of diabetes mellitus in sub-Saharan Africa, based on blood analyses, are hampered by infrastructural and cultural reasons. The first aim of this study was to evaluate the diagnostic accuracy of glycated nail proteins for diabetes mellitus. The second aim was to compare the course of short- and long-term glycemic biomarkers after 6 months of antidiabetic treatment. These objectives should support our hypothesis that glycated nail proteins could be used as an alternative glycemic biomarker. MATERIALS AND METHODS This case-control study consisted of 163 black diabetics and 67 non-diabetics of the South Kivu (Democratic Republic of Congo). Diagnostic accuracy of glycated nail proteins was evaluated using ROC curve analysis. At the start of the study, glycated nail protein concentrations were compared between diabetics and non-diabetics, using a nitro blue tetrazolium (NBT) colorimetric method. In a subgroup of 30 diabetics, concentrations of glycated nail proteins, fasting glucose (Accu-Chek® Aviva), serum fructosamine (NBT) and HbA1c (DCA-2000+®) were measured at start and after 6 months. RESULTS ROC analysis yielded an AUC of 0.71 (95% confidence interval (CI): 0.65-0.76) and a cut-off point of 3.83 μmol/g nail. Concentration of glycated nail proteins was significantly higher (P<0.001) in diabetics in comparison with non-diabetics. After 6 months of antidiabetic treatment, a significant drop in the fasting glucose concentration (P=0.017) and concentration of glycated nail proteins (P=0.008) was observed in contrast to serum fructosamine and HbA1c. CONCLUSIONS Measurement of glycated nail proteins could be used to diagnose and monitor diabetes mellitus in sub-Saharan Africa.
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Affiliation(s)
- Philippe B Katchunga
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Division of Endocrinology and Diabetology, Department of Internal Medicine, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Patrick N Mirindi
- Regional School of Public Health (ERSP), Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Antoine S Kishabongo
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Biology, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Justin C Cikomola
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Division of Endocrinology and Diabetology, Department of Internal Medicine, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Socrate Bwanamdogo
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Biology, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Jan Philippé
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | | | - Joris R Delanghe
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
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Frank LK, Jannasch F, Kröger J, Bedu-Addo G, Mockenhaupt FP, Schulze MB, Danquah I. A Dietary Pattern Derived by Reduced Rank Regression is Associated with Type 2 Diabetes in An Urban Ghanaian Population. Nutrients 2015. [PMID: 26198248 PMCID: PMC4517010 DOI: 10.3390/nu7075233] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reduced rank regression (RRR) is an innovative technique to establish dietary patterns related to biochemical risk factors for type 2 diabetes, but has not been applied in sub-Saharan Africa. In a hospital-based case-control study for type 2 diabetes in Kumasi (diabetes cases, 538; controls, 668) dietary intake was assessed by a specific food frequency questionnaire. After random split of our study population, we derived a dietary pattern in the training set using RRR with adiponectin, HDL-cholesterol and triglycerides as responses and 35 food items as predictors. This pattern score was applied to the validation set, and its association with type 2 diabetes was examined by logistic regression. The dietary pattern was characterized by a high consumption of plantain, cassava, and garden egg, and a low intake of rice, juice, vegetable oil, eggs, chocolate drink, sweets, and red meat; the score correlated positively with serum triglycerides and negatively with adiponectin. The multivariate-adjusted odds ratio of type 2 diabetes for the highest quintile compared to the lowest was 4.43 (95% confidence interval: 1.87–10.50, p for trend < 0.001). The identified dietary pattern increases the odds of type 2 diabetes in urban Ghanaians, which is mainly attributed to increased serum triglycerides.
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Affiliation(s)
- Laura K Frank
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Franziska Jannasch
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Janine Kröger
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - George Bedu-Addo
- Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
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Metta E, Haisma H, Kessy F, Geubbels E, Hutter I, Bailey A. "It is the medicines that keep us alive": lived experiences of diabetes medication use and continuity among adults in Southeastern Tanzania. BMC Health Serv Res 2015; 15:111. [PMID: 25890162 PMCID: PMC4364569 DOI: 10.1186/s12913-015-0768-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes is a chronic condition which requires many patients to use medications for the remainder of their lives. While this regimen is demanding, little research has been done on the experiences individuals have with diabetes medication use and the continuity of use, especially patients from rural areas of Tanzania. This study explores the lived experiences of diabetes medication use and the continuity of use among adult diabetes patients from rural communities with limited access to diabetes medicines. METHODS We conducted 19 in-depth interviews to explore patients' experiences with diabetes medication use and the continuity of use. We employed the 5As of access to care to situate the behavioral practices surrounding diabetes medication use in the study settings. The data analysis followed grounded theory principles, and was conducted with the help of NVivo 9. RESULTS Study participants expressed positive attitudes toward the use of diabetes medicines, but also concerns about affordability. The patients employed two main strategies for dealing with the cost. The first was to increase their available funds by spending less money on family needs, selling household property, asking family and friends for money, or borrowing cash. They also reported sourcing medicines from pharmacies to save on consultation and laboratory costs. Second, participants reported using less than the recommended dosage or skipping doses, and sharing medicines. The geographic accessibility of diabetes service providers, the availability of medication, and the organization of the diabetes services were also cited as barriers to taking medications and to using them continuously. CONCLUSIONS The strategies employed by the people in this study illustrate their resilience in the face of poverty and failing health care systems. More comprehensive strategies are therefore needed to encourage consistent medication use among people with chronic conditions. These strategies could include the reduction of prices by pharmaceuticals, the strengthening of community risk-pooling mechanisms and sustained health campaigns aimed at patients and the community.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania. .,Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Hinke Haisma
- Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Flora Kessy
- Mzumbe University, P.O. Box 20226, Dar es Salaam, Tanzania.
| | - Eveline Geubbels
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.
| | - Inge Hutter
- Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Ajay Bailey
- Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
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