Developmental origins of health and disease in Africa-influencing early life

Children born during the hunger season are at a higher risk of severe acute malnutrition: Findings from a Guinea Sahelian ecological zone in Northern Ghana

Heightened food insecurity in the hunger season increases the risk of severe acute malnutrition (SAM) in childhood. This study examined the association of season of birth with SAM in a Guinean Sahelian ecological zone. We analyzed routine health and sociodemographic surveillance data from the Navrongo Health and Socio-demographic Surveillance System collected between 2011 and 2018. January-June, the period of highest food insecurity, was defined as the hunger season. We defined moderate acute malnutrition as child mid-upper arm circumference (MUAC) between 115 mm and 135 mm and SAM as MAUC ≤ 115 mm. We used adjusted logistic regression to quantify the association between the season of birth and SAM in children aged 6-35 months. From the 29,452 children studied, 24% had moderate acute malnutrition. Overall, 1.4% had SAM, with a higher prevalence (1.8%) in the hunger season of birth. Compared with those born October-December, adjusted odds ratios (aOR) and 95% confidence interval (95% CI) for SAM were increased for children born in the hunger season: January-March (1.77 [1.31-2.39]) and April-June (1.92 [1.44-2.56]). Low birth weight, age at an assessment of nutritional status, and ethno-linguistic group were also significantly associated with SAM in adjusted analyses. Our study established that being born in the hunger season is associated with a higher risk of severe acute malnutrition. The result implies improvement in the food supply to pregnant and lactating mothers through sustainable agriculture or food system change targeting the hunger season may reduce the burden of severe acute malnutrition.

Physical Activity Levels, Food Insecurity and Dietary Behaviours in Women from Soweto, South Africa

Women in Soweto in their prime reproductive years (18-25 years) report being exposed to an obesogenic environment that makes it difficult to lead a healthy lifestyle. This study aimed to determine individual and community level predictors of these behaviours, as well as whether these behaviours were related to obesity status. Women (n = 1698) were recruited from their households as part of a survey study. Physical activity and sitting time was assessed using the Global Physical Activity Questionnaire (GPAQ). Participants were asked how frequently they used street vendors in a normal month, and dietary practices in the home and food insecurity were assessed using a questionnaire. Height and weight were measured. Individual and community level predictors were included in a series of linear regressions with either activity behaviours, or dietary practices as the outcomes. BMI was then treated as the outcome in a multinomial logistics regression. The majority of participants were normal weight, yet 44% were overweight or obese. Most participants were meeting the physical activity guidelines, yet less than half participated in leisure time physical activity. Most participants were meeting the sitting time guidelines, yet TV time was high. Age was positively associated with being overweight (ß = 0.145, p < 0.01) or obese (ß = 0.179, p < 0.01). Street vendor use was negatively associated with being obese (ß = - 0.236, p < 0.05), as was the community area in which women lived (ß = - 0.1098, p < 0.05). Both physical activity and sedentary behaviours were positively associated with higher socioeconomic status. Socioeconomic status was also negatively related to food insecurity and dietary behaviours. The environment in which young women live plays a significant role in the development of certain health behaviours, as well as in obesity prevalence.

Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle-Income Countries

OBJECTIVE

The prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are not well understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes and may inform how adverse environmental conditions in early life affect diabetes risk. We therefore systematically analyzed the association of adult height and diabetes across LMICs, where such conditions are prominent.

RESEARCH DESIGN AND METHODS

We pooled individual-level data from nationally representative surveys in LMICs that included anthropometric measurements and diabetes biomarkers. We calculated odds ratios (ORs) for the relationship between attained adult height and diabetes using multilevel mixed-effects logistic regression models. We estimated ORs for the pooled sample, major world regions, and individual countries, in addition to stratifying all analyses by sex. We examined heterogeneity by individual-level characteristics.

RESULTS

Our sample included 554,122 individuals across 25 population-based surveys. Average height was 161.7 cm (95% CI 161.2-162.3), and the crude prevalence of diabetes was 7.5% (95% CI 6.9-8.2). We found no relationship between adult height and diabetes across LMICs globally or in most world regions. When stratifying our sample by country and sex, we found an inverse association between adult height and diabetes in 5% of analyses (2 out of 50). Results were robust to alternative model specifications.

CONCLUSIONS

Adult height is not associated with diabetes across LMICs. Environmental factors in early life reflected in attained adult height likely differ from those predisposing individuals for diabetes.

Investigating associations between rural-to-urban migration and cardiometabolic disease in Malawi: a population-level study

Background

The extent to which rural-to-urban migration affects risk for cardiometabolic diseases (CMD) in Africa is not well understood. We investigated prevalence and risk for obesity, diabetes, hypertension and precursor conditions by migration status.

Methods

In a cross-sectional survey in Malawi (February 2013–March 2017), 13 903 rural, 9929 rural-to-urban migrant and 6741 urban residents (≥18 years old) participated. We interviewed participants, measured blood pressure and collected anthropometric data and fasting blood samples to estimate population prevalences and odds ratios, using negative binomial regression, for CMD, by migration status. In a sub-cohort of 131 rural–urban siblings-sets, migration-associated CMD risk was explored using conditional Poisson regression.

Results

In rural, rural-to-urban migrant and urban residents, prevalence estimates were; 8.9, 20.9 and 15.2% in men and 25.4, 43.9 and 39.3% in women for overweight/obesity; 1.4, 2.9 and 1.9% in men and 1.5, 2.8 and 1.7% in women for diabetes; and 13.4, 18.8 and 12.2% in men and 13.7, 15.8 and 10.2% in women for hypertension. Rural-to-urban migrants had the greatest risk for hypertension (adjusted relative risk for men 1.18; 95% confidence interval 1.04–1.34 and women 1.17: 95% confidence interval 1.05–1.29) and were the most screened, diagnosed and treated for CMD, compared with urban residents. Within sibling sets, rural-to-urban migrant siblings had a higher risk for overweight and pre-hypertension, with no evidence for differences by duration of stay.

Conclusions

Rural-to-urban migration is associated with increased CMD risk in Malawi. In a poor country experiencing rapid urbanization, interventions for the prevention and management of CMD, which reach migrant populations, are needed.

Does economic growth reduce childhood stunting? A multicountry analysis of 89 Demographic and Health Surveys in sub-Saharan Africa

Background

There is mixed evidence and lack of consensus on the impact of economic development on stunting, and likewise there is a dearth of empirical studies on this relationship in the case of sub-Saharan Africa. Thus, this paper examines whether economic growth is associated with childhood stunting in low-income and middle-income sub-Saharan African countries.

Methods

We analysed data from 89 Demographic and Health Surveys conducted between 1987 and 2016 available as of October 2018 using multivariable multilevel logistic regression models to show the association between gross domestic product (GDP) per capita and stunting. We adjusted the models for child's age, survey year, child's sex, birth order and country random effect, and presented adjusted and unadjusted ORs.

Results

We included data from 490 526 children. We found that the prevalence of stunting decreased with increasing GDP per capita (correlation coefficient=-0.606, p<0.0001). In the unadjusted model for full sample, for every US$1000 increase in GDP per capita, the odds of stunting decreased by 23% (OR=0.77, 95% CI 0.76 to 0.78). The magnitude of the association between GDP per capita and stunting was stronger among children in the richest quintile. After adjustment was made, the association was not significant among children from the poorest quintile. However, the magnitude of the association was more pronounced among children from low-income countries, such that, in the model adjusted for child's age, survey year, child's sex, birth order and country random effect, the association between GDP per capita and stunting remained statistically significant; for every US$1000 increase in GDP per capita, the odds of stunting decreased by 12% (OR=0.88, 95% CI 0.87 to 0.90).

Conclusion

There was no significant association between economic growth and child nutritional status. The prevalence of stunting decreased with increasing GDP per capita. This was more pronounced among children from the richest quintile. The magnitude of the association was higher among children from low-income countries, suggesting that households in the poorest quintile were typically the least likely to benefit from economic gains. The findings could serve as a building block needed to modify current policy as per child nutrition-related programmes in Africa.

Prevalence and determinants of type 2 diabetes among lean African migrants and non-migrants: the RODAM study

Background

Exposure to adverse conditions earlier in life-course can predispose to type 2 diabetes in adulthood, irrespective of body mass index (BMI). However, the burden of type 2 diabetes in lean Africans is not well understood despite higher exposure to adverse early life conditions. Mirroring ongoing epidemiological transition, we assessed the burden and determinants of type 2 diabetes in a homogenous group of lean Ghanaians residing in rural and urban Ghana, and as migrants in Europe.

Methods

Baseline data from 2179 RODAM study participants with BMI<25kg/m² (25-70 years) were analyzed. Prevalence and determinants of type 2 diabetes were estimated using logistic regression analysis. Adjustments were made for socio-demographic and lifestyle factors, use of anti-diabetic medication and optimal blood glucose control.

Results

Prevalence of type 2 diabetes in rural, urban and migrant lean participants were 3.5%, 8.9% and 7.5% respectively, representing 55.4%, 35.6%, 13.2% of all participants with type 2 diabetes. Compared with lean rural participants, the odds of type 2 diabetes were higher in lean urban participants (adjusted OR = 8.81, 95% CI = 6.56-11.06), followed by migrants (5.27, 95% CI = 3.51-6.91). Irrespective of site, determinants of type 2 diabetes in lean participants include; presence of hypertension, physical inactivity, hypercholesterolemia and age (>45 years).

Conclusions

Our study shows a high prevalence of type 2 diabetes among lean African populations in different geographical settings. Future studies are needed in-order to examine how contextual differences are related to the pathophysiology of type 2 diabetes in lean individuals.

Landscape and opportunities for active pharmaceutical ingredient manufacturing in developing African economies

This review will highlight the opportunities that exist in the localization of cutting-edge manufacturing technologies within an African context.

Celebrity endorsed music videos: innovation to foster youth health promotion

There are calls for innovation in health promotion and for current issues to be presented in new and exciting ways; in addition to creating engaging messages, novel ways to deliver health messaging are needed, especially where youth are the key target audience. When pupils in WHO Health Promoting Schools were asked what health messages would resonate with them, they also identified celebrities as the ‘messengers’ they would be particularly likely to listen to. Expanding on these discussions, the pupils quoted celebrity-recorded music videos containing health and lifestyle messaging as an example of where they had learned from celebrities. Their ability to sing phrases from the songs and repeat key health messages they contained indicated the videos had commanded attention and provided knowledge and perspectives that had been retained. We located on YouTube the video titles the pupils identified and evaluated the content, messaging and production concepts these celebrity-recorded music videos incorporated. All are good examples of the health promotion genre known as education entertainment, where educational content is intentionally included in professionally produced entertainment media to impart knowledge, create favorable attitudes and impact future behaviors. The importance of this genre is growing in parallel with the burgeoning influence of social media. Music videos resonate with youth, and celebrity recordings combine young people’s love of music with their fascination for the aura of celebrity. Hence, producing videos that combine an effective health message with celebrity endorsement offers potential as an innovative conduit for health promotion messaging among youth.