Non-communicable diseases in sub-Saharan Africa: what we know now

The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

Climate change-induced shifts in the food systems and diet-related non-communicable diseases in sub-Saharan Africa: a scoping review and a conceptual framework

OBJECTIVES

To determine the relationship between climate change, food systems and diet-related non-communicable diseases (DR-NCDs) in sub-Saharan Africa (SSA) and propose a conceptual framework for food systems in SSA.

DESIGN

A scoping review.

ELIGIBILITY CRITERIA

Studies included investigated the relationship between climate change and related systemic risks, food systems, DR-NCDs and its risk factors in SSA. Studies focusing on the association between climate change and DR-NCDs unrelated to food systems, such as social inequalities, were excluded.

SOURCES OF EVIDENCE

A comprehensive search was conducted in ProQuest (nine databases), Google Scholar and PubMed in December 2022.

CHARTING METHODS

Data extracted from studies included author, study type, country of study, climate change component, DR-NCD outcomes and risk factors, and impacts of climate change on DR-NCDs. A narrative approach was used to analyse the data. Based on the evidence gathered from SSA, we modified an existing food system conceptual framework.

RESULTS

The search retrieved 19 125 studies, 10 of which were included in the review. Most studies used a cross-sectional design (n=8). Four explored the influence of temperature on liver cancer through food storage while four explored the influence of temperature and rainfall on diabetes and obesity through food production. Cross-sectional evidence suggested that temperature is associated with liver cancer and rainfall with diabetes.

CONCLUSION

The review highlights the vulnerability of SSA's food systems to climate change-induced fluctuations, which in turn affect dietary patterns and DR-NCD outcomes. The evidence is scarce and concentrates mostly on the health effects of temperature through food storage. It proposes a conceptual framework to guide future research addressing climate change and DR-NCDs in SSA.

Burden of cardiovascular disease in Sub-Saharan Africa, 1990-2019: An analysis of the Global Burden of Disease Study

INTRODUCTION

The rise in cardiovascular disease (CVD) in Sub-Saharan Africa (SSA) reflects a major shift from communicable to noncommunicable diseases as primary health challenges. Consequently, this study aims to explore the burden of CVD and associated risk factors in SSA using data from the Global Burden of Disease (GBD) database.

METHODS

This study utilized data from the GBD 1990 to 2019 to examine CVD prevalence in 46 SSA countries. We employed Bayesian regression models, demographic techniques, and mortality-to-incidence ratios to analyze both prevalence and mortality rates. Additionally, disability-adjusted life years (DALYs) were computed, and various risk factors were examined using the GBD's comparative risk assessment framework.

RESULTS

Between 1990 and 2019, CVD raw counts in SSA rose by 131.7 %, with a 2.1 % increase in age-standardized prevalence rates. The most prevalent conditions were ischemic heart disease, stroke, and rheumatic heart disease. During the same period, the age-standardized CVD deaths per 100,000 individuals decreased from 314 (1990) to 269 (2019), reflecting a -14.4 % decline. Age-standardized CVD DALY rates also showed a decrease from 6,755 in 1990 to 5,476 in 2019, with translates to 18.9 % reduction. By 2019, the Central African Republic, Madagascar, and Lesotho were the countries with the highest age-standardized DALY rates for all CVDs.

CONCLUSIONS

The study highlights a contrasting trend in SSA's CVD landscape: a decrease in age-standardized mortality and DALYs contrasts with increasing CVD prevalence, emphasizing the need for targeted public health strategies that balance treatment advancements with intensified prevention and control measures.

Characterization of cell cycle, inflammation, and oxidative stress signaling role in non-communicable diseases: Insights into genetic variants, microRNAs and pathways

Non-Communicable Diseases (NCDs) significantly impact global health, contributing to over 70% of premature deaths, as reported by the World Health Organization (WHO). These diseases have complex and multifactorial origins, involving genetic, epigenetic, environmental and lifestyle factors. While Genome-Wide Association Study (GWAS) is widely recognized as a valuable tool for identifying variants associated with complex phenotypes; the multifactorial nature of NCDs necessitates a more comprehensive exploration, encompassing not only the genetic but also the epigenetic aspect. For this purpose, we employed a bioinformatics-multiomics approach to examine the genetic and epigenetic characteristics of NCDs (i.e. colorectal cancer, coronary atherosclerosis, squamous cell lung cancer, psoriasis, type 2 diabetes, and multiple sclerosis), aiming to identify novel biomarkers for diagnosis and prognosis. Leveraging GWAS summary statistics, we pinpointed Single Nucleotide Polymorphisms (SNPs) independently associated with each NCD. Subsequently, we identified genes linked to cell cycle, inflammation and oxidative stress mechanisms, revealing shared genes across multiple diseases, suggesting common functional pathways. From an epigenetic perspective, we identified microRNAs (miRNAs) with regulatory functions targeting these genes of interest. Our findings underscore critical genetic pathways implicated in these diseases. In colorectal cancer, the dysregulation of the "Cytokine Signaling in Immune System" pathway, involving LAMA5 and SMAD7, regulated by Hsa-miR-21-5p, Hsa-miR-103a-3p, and Hsa-miR-195-5p, emerged as pivotal. In coronary atherosclerosis, the pathway associated with "binding of TCF/LEF:CTNNB1 to target gene promoters" displayed noteworthy implications, with the MYC factor controlled by Hsa-miR-16-5p as a potential regulatory factor. Squamous cell lung carcinoma analysis revealed significant pathways such as "PTK6 promotes HIF1A stabilization," regulated by Hsa-let-7b-5p. In psoriasis, the "Endosomal/Vacuolar pathway," involving HLA-C and Hsa-miR-148a-3p and Hsa-miR-148b-3p, was identified as crucial. Type 2 Diabetes implicated the "Regulation of TP53 Expression" pathway, controlled by Hsa-miR-106a-5p and Hsa-miR-106b-5p. In conclusion, our study elucidates the genetic framework and molecular mechanisms underlying NCDs, offering crucial insights into potential genetic/epigenetic biomarkers for diagnosis and prognosis. The specificity of pathways and related miRNAs in different pathologies highlights promising candidates for further clinical validation, with the potential to advance personalized treatments and alleviate the global burden of NCDs.

Diet changes due to urbanization in South Africa are linked to microbiome and metabolome signatures of Westernization and colorectal cancer

Transition from traditional high-fiber to Western diets in urbanizing communities of Sub-Saharan Africa is associated with increased risk of non-communicable diseases (NCD), exemplified by colorectal cancer (CRC) risk. To investigate how urbanization gives rise to microbial patterns that may be amenable by dietary intervention, we analyzed diet intake, fecal 16 S bacteriome, virome, and metabolome in a cross-sectional study in healthy rural and urban Xhosa people (South Africa). Urban Xhosa individuals had higher intakes of energy (urban: 3,578 ± 455; rural: 2,185 ± 179 kcal/d), fat and animal protein. This was associated with lower fecal bacteriome diversity and a shift from genera favoring degradation of complex carbohydrates (e.g., Prevotella) to taxa previously shown to be associated with bile acid metabolism and CRC. Urban Xhosa individuals had higher fecal levels of deoxycholic acid, shown to be associated with higher CRC risk, but similar short-chain fatty acid concentrations compared with rural individuals. Fecal virome composition was associated with distinct gut bacterial communities across urbanization, characterized by different dominant host bacteria (urban: Bacteriodota; rural: unassigned taxa) and variable correlation with fecal metabolites and dietary nutrients. Food and skin microbiota samples showed compositional differences along the urbanization gradient. Rural-urban dietary transition in South Africa is linked to major changes in the gut microbiome and metabolome. Further studies are needed to prove cause and identify whether restoration of specific components of the traditional diet will arrest the accelerating rise in NCDs in Sub-Saharan Africa.

Residence-based inequalities in overweight/obesity in sub-Saharan Africa: a multivariate non-linear decomposition analysis

BACKGROUND

Overweight/obesity remains a major risk factor for non-communicable diseases and their associated morbidities and mortalities. Yet, limited studies have comprehensively examined factors contributing to the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa. Thus, our study sought to decompose the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa (SSA) using nationally representative datasets.

METHODS

We performed a cross-sectional analysis of data from the Demographic and Health Surveys of 23 sub-Saharan African countries conducted from 2015 to 2022. A sample of 177,329 women was included in the analysis. Percentages with confidence intervals (CIs) were used to summarize the prevalence of overweight/obesity per rural-urban strata and pooled level. A multivariate non-linear decomposition analysis was used to identify the factors contributing to the rural-urban disparities in overweight/obesity. The results were presented using coefficients and percentages.

RESULTS

The pooled prevalence of overweight/obesity among the women was higher in urban areas (38.9%; 95% CI = 38.2-39.6) than rural areas (19.1%; 95% CI = 18.7-19.6). This pattern was observed in all the countries surveyed, except in South Africa, where women in rural areas (53.1%; 95% CI = 50.0-56.4) had a higher prevalence of overweight/obesity than those in urban areas (46.0%; 95% CI = 43.2-48.9). Approximately 54% of the rural-urban disparities in overweight/obesity was attributable to the differences in the women's characteristics or explanatory variables. More than half of the rural-urban disparities in overweight/obesity would be reduced if the disparities in women's characteristics were levelled. Among the women's characteristics, frequency of watching television (29.03%), wealth index (26.59%), and level of education (9.40%) explained approximately 65% of the rural-urban differences in overweight/obesity.

CONCLUSION

The prevalence of overweight/obesity among women in SSA remains high and skewed towards women in urban areas. Increased frequency of watching television, high wealth index, and higher educational attainment contributed largely to the rural-urban disparities in overweight/obesity among women in SSA. Thus, interventions aimed at reducing overweight/obesity among women in SSA could be targeted at reducing the frequency of television watching as well as promoting physical activities among wealthy women and those with higher education, particularly in urban areas.

Mortality from non-communicable diseases and associated risk factors in Zambia; analysis of the sample vital registration with verbal autopsy 2015/2016

BACKGROUND

Non-communicable diseases (NCDs) are the world's growing cause of preventable illness, disability, morbidity, and mortality which account for 71% of deaths. The aim of this study was to determine the factors associated with mortality from NCDs among persons aged 15 years and above in Zambia.

METHODOLOGY

The study used data from Sample Vital Registration with Verbal Autopsy (SAVVY) 2015/16 (Zambia). A total of 3529 Verbal Autopsy were completed in the study, with only 2599 of death where among people aged 15 years and above. Three-level data analysis was applied; univariate analysis, bivariate analysis, and multivariate analysis (binary logistic regression).

FINDINGS

The overall number of deaths from NCDs was 28.81%. Stratified analysis by gender showed that deaths from NCDs were higher among women (32.60%) as compared to men (26.25%). Among all persons, dying from NCDs was associated with tobacco use, age, and education. Tobacco use was negatively associated with mortality from NCDs (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.48-0.98). Age was positively associated with the odds of dying from NCDs among persons aged 45-59 years (aOR = 3.87, 95% CI: 2.13-7.01), 60-74 years (aOR = 12.05, 95% CI: 6.44-22.55), and 75 + years (aOR = 15.16, 95% CI: 7.93-28.97). The likelihood of dying from NCDs was higher among persons with secondary education as compared to those with no education (aOR = 1.93, 95% CI: 1.11-3.33).

CONCLUSION

The findings from this study suggest that public health interventions targeting NCDs need to consider behavioural factors, especially tobacco use which exposes people to second-hand smoke. We also recommend large-scale national-level studies to further examine the contribution of each factor leading to mortality from NCDs.

The impact of environmental conditions on non-communicable diseases in sub-Saharan Africa: A scoping review of epidemiologic evidence

Background

The burden of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA) is increasing. Environmental conditions such as heavy metals and air pollution have been linked with the incidence and mortality of chronic diseases such as cancer, as well as cardiovascular and respiratory diseases. We aimed to scope the current state of evidence on the impact of environmental conditions on NCDs in SSA.

Methods

We conducted a scoping review to identify environmental conditions linked with NCDs in SSA by identifying studies published from January 1986 through February 2023. We searched African Index Medicus, Ovid Medline, Scopus, Web of Science, and Greenfile. Using the PICOS study selection criteria, we identified studies conducted in SSA focussed on physical environmental exposures and incidence, prevalence, and mortality of NCDs. We included only epidemiologic or quantitative studies.

Results

We identified 6754 articles from electronic database searches; only 36 met our inclusion criteria and were qualitatively synthesised. Two studies were conducted in multiple SSA countries, while 34 were conducted across ten countries in SSA. Air pollution (58.3%) was the most common type of environmental exposure reported, followed by exposure to dust (19.4%), meteorological variables (13.8%), heavy metals (2.7%), soil radioactivity (2.7%), and neighbourhood greenness (2.7%). The examined NCDs included respiratory diseases (69.4%), cancer (2.7%), stroke (5.5%), diabetes (2.7%), and two or more chronic diseases (19.4%). The study results suggest an association between environmental exposures and NCDs, particularly for respiratory diseases. Only seven studies found a null association between environmental conditions and chronic diseases.

Conclusions

There is a growing body of research on environmental conditions and chronic diseases in the SSA region. Although some cities in SSA have started implementing environmental monitoring and control measures, there remain high levels of environmental pollution. Investment can focus on improving environmental control measures and disease surveillance.

Chronic obstructive pulmonary disease in East Africa: a systematic review and meta-analysis

Chronic obstructive pulmonary disease (COPD) is a common lung disease that causes restricted airflow and breathing problems. Globally, COPD is the third leading cause of death and low- and middle-income countries account for the majority of these deaths. There is limited information on COPD's prevalence in East Africa. Thus the purpose of this systematic review and meta-analysis is to estimate the pooled prevalence of COPD in East Africa.A computerized systematic search using multiple databases was performed in search of relevant English articles from the inception of the databases to August 2023. All the authors independently extracted the data. R and RStudio software were used for statistical analysis. Forest plots and tables were used to represent the data. The statistical heterogeneity was evaluated using I2 statistics. There was heterogeneity between the included articles. Therefore, a meta-analysis of random effects models was used to estimate the overall pooled prevalence of COPD in East Africa. A funnel plot test was used to examine possible publication bias.The database search produced 512 papers. After checking for inclusion and exclusion criteria, 43 full-text observational studies with 68 553 total participants were found suitable for the review. The overall pooled prevalence of COPD in East Africa was 13.322%. The subgroup analysis found the COPD pooled prevalence in the different countries was 18.994%, 7%, 15.745%, 9.032%, 15.026% and 11.266% in Ethiopia, Uganda, Tanzania, Malawi, Sudan, and Kenya, respectively. Additionally, the subgroup analysis of COPD by study setting among community-based studies was 12.132% and 13.575% for hospital-based studies.According to the study's findings, approximately one of every seven individuals in East Africa has COPD, indicating a notably high prevalence of the disease. Thus governments and other stakeholders working on non-communicable disease control should place an emphasis on preventive measures to minimize the burden of COPD.

Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis

Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.

Factors influencing primary care access, utilisation and quality of management for patients living with hypertension in West Africa: a scoping review protocol

INTRODUCTION

Hypertension, one of the most prevalent non-communicable diseases in West Africa, can be well managed with good primary care. This scoping review will explore what is documented in the literature about factors that influence primary care access, utilisation and quality of management for patients living with hypertension in West Africa.

METHODS AND ANALYSIS

The scoping review will employ the approach described by Arksey and O'Malley (2005) . The approach has five stages: (1) formulating the research questions, (2) identifying relevant studies, (3) selecting eligible studies, (4) charting the data and (5) collating, summarising and reporting the results. This review will employ the Preferred Reporting Items for Systematic review and Meta-Analysis extension for scoping reviews to report the results. PubMed, Embase, Scopus, Cairn Info and Google Scholar will be searched for publications from 1 January 2000 to 31 December 2023. Studies reported in English, French or Portuguese will be considered for inclusion. Research articles, systematic reviews, observational studies and reports that include information on the relevant factors that influence primary care management of hypertension in West Africa will be eligible for inclusion. Study participants should be adults (aged 18 years or older). Clinical case series/case reports, short communications, books, grey literature and conference proceedings will be excluded. Papers on gestational hypertension and pre-eclampsia will be excluded.

ETHICS AND DISSEMINATION

This review does not require ethics approval. Our dissemination strategy includes peer-reviewed publications, policy briefs, presentations at conferences, dissemination to stakeholders and intervention co-production forums.

Sex-specific-evaluation of metabolic syndrome prevalence in Algeria: insights from the 2016-2017 non-communicable diseases risk factors survey

Metabolic syndrome (MetS) is a core driver of cardiovascular diseases (CVD); however, to date, gender differences in MetS prevalence and its components have not been assessed in the Algerian adult general population. This study aimed to determine the gender differences in MetS prevalence and its components, in the general population of Algeria. Secondary analysis was performed on data from the Algerian 2016-2017 non-communicable disease risk factor survey. MetS was determined according to the harmonized Joint Interim Statement criteria. A Poisson regression model based on Generalised Estimating Equations was used to estimate the adjusted prevalence ratios (aPR) for the sex-specific factors associated with MetS. Overall, the prevalence of MetS was 34.0% (95% CI 32.4-35.6). MetS prevalence in women and men was 39.1% (95% CI 37.0-41.3) and 29.1% (95% CI 27.2-31.2), respectively. The most frequent triad was the clustering of abdominal obesity with low HDL-cholesterol and high blood pressure among women (8.9%; 95% CI [8.0-10.0]) and low HDL-cholesterol with high blood pressure and hyperglycaemia among men (5.2%; 95% CI [4.3-6.3]). Increasing age (aPR 3.21 [2.35-4.39] in men and aPR 3.47 [2.86-4.22] in women), cohabitation (aPR 1.14 [1.05-1.24]), women residing in urban areas (aPR 1.13 [1.01-1.26]), men with higher educational levels (aPR 1.39 [1.14-1.70]), and men with insufficient physical activity (aPR 1.16 [1.05-1.30]) were associated with higher risk of MetS. In this population-based study, one in three Algerian adults had MetS, and key components including abdominal obesity, low HDL-cholesterol, and high blood pressure, are very common, especially in women. Reinforcing interventions for weight management targeting married women living in urban areas and improving sufficient physical activity in men with higher socioeconomic status could provide maximal health gains and stem the CVD epidemic in Algeria.

Dietary patterns and their socioeconomic factors of adherence among adults in urban Burkina Faso: a cross-sectional study

BACKGROUND

Sub-Saharan African populations undergo a nutrition transition towards diets associated with increased risk for metabolic and cardiovascular diseases. For targeted prevention, we aimed to characterize dietary patterns and determine their sociodemographic factors of adherence.

METHODS

We recruited 1,018 adults aged >  = 25 years from two formal and three informal settlements within the Health and Demographic Surveillance System, Ouagadougou, Burkina Faso, between February and April 2021. In a cross-sectional sample, a culture-specific food-propensity questionnaire with 134 food items and a sociodemographic questionnaire were used to collect the data. Exploratory dietary patterns were derived using principal component analysis, and sociodemographic factors of adherence were calculated using multivariable linear regression models.

RESULTS

In this study population (median age: 42 years, interquartile range 21 years; male: 35.7%), the diet relied on starchy foods and other plant-based staples with rare consumption of animal-based products. We identified three dietary patterns, explaining 10.2%, 9.8%, and 8.9% of variation in food intake, respectively: a meat and egg-based pattern associated with younger age, male sex, better education, and economic situation; a fish-based pattern prevailed among women, higher educational levels, and better economic situation; and a starchy food-based was associated with younger age and sharing a home with other adults.

CONCLUSIONS

This study population is at an early stage of the nutrition transition and shows low intakes of health-beneficial food groups. Yet, progress along the nutrition transition varies according to age, educational attainment, and economic status. Particularly, younger and well-off people seem to adhere more strongly to diets high in animal-based products. These findings can inform strategies in public health nutrition for sub-Saharan African populations.

Updating the association between socioeconomic status and obesity in low-income and lower-middle-income sub-Saharan African countries: A literature review

Globally, the literature tends to emphasize negative associations between socioeconomic status (SES) and bodyweight in countries improving their economic development. However, little is known about the social distribution of obesity in sub-Saharan Africa (SSA) where economic growth has been highly heterogeneous the last decades. This paper reviews an exhaustive set of recent empirical studies examining its association in low-income and lower-middle-income countries in SSA. Although there is evidence of a positive association between SES and obesity in low-income countries, we found mixed associations in lower-middle-income countries, potentially providing evidence of a social reversal of the obesity burden.

Instrumental variable approach on analyzing risk factors associated with noncommunicable disease prevalence in Tanzania: A nonexperimental design

Background and Aims

Noncommunicable diseases (NCDs) have emerged as a substantial burden in developing countries, representing the leading cause of mortality. Addressing this critical issue necessitates effective interventions and policy measures. Therefore, this study aims to investigate the risk factors associated with NCD prevalence in Tanzania.

Methods

This study employed a nonexperimental research design due to its ability to analyze secondary data without altering variables. The used data set of the study was sourced from National Panel Survey 2020/21 and Household Budget Survey 2017/18. The econometrics analysis applied in the study include two-stage residual inclusion (2SRI) and control function approach due to their ability to suppress endogeneity and enhance the clarity of results.

Results

The findings indicate a significant positive correlation between alcohol consumption (0.4110382, p = 0.02), cigarette smoking (0.3354297, p < 0.001), and NCDs, emphasizing the urgency of targeted interventions to mitigate these behaviors. Conversely, a negative correlation is observed between fruit and vegetable intake (-0.1063375, p < 0.001), physical exercises (-0.3744925, p < 0.001), and NCDs, underscoring the importance of promoting healthy dietary habits and frequent exercises.

Conclusion

These results accentuate the immediate need for targeted interventions and policy measures to address these risk factors and effectively combat the escalating burden of NCDs in Tanzania and similar contexts. Moreover, the need for improved public awareness campaigns and the promotion of healthy life campaigns are vital in the fight to lower the prevalence of NCDs across communities.

Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006-2015

BACKGROUND

Globally, non-communicable diseases (NCD) kill about 40 million people annually, with about three-quarters of the deaths occurring in low- and middle-income countries. This study was carried out to determine the patterns, trends, and causes of in-hospital non-communicable disease (NCD) and injury deaths in Tanzania from 2006-2015.

METHODS

This retrospective study involved primary, secondary, tertiary, and specialized hospitals. Death statistics were extracted from inpatient department registers, death registers, and International Classification of Diseases (ICD) report forms. The ICD-10 coding system was used to assign each death to its underlying cause. The analysis determined leading causes by age, sex, annual trend and calculate hospital-based mortality rates.

RESULTS

Thirty-nine hospitals were involved in this study. A total of 247,976 deaths (all causes) were reported during the 10-year period. Of the total deaths, 67,711 (27.3%) were due to NCD and injuries. The most (53.4%) affected age group was 15-59 years. Cardio-circulatory diseases (31.9%), cancers (18.6%), chronic respiratory diseases (18.4%), and injuries (17.9%) accounted for the largest proportion (86.8%) of NCD and injuries deaths. The overall 10-year hospital-based age-standardized mortality rate (ASMR) for all NCDs and injuries was 559.9 per 100,000 population. It was higher for males (638.8/100,000) than for females (444.6/100,000). The hospital-based annual ASMR significantly increased from 11.0 in 2006 to 62.8 per 100,000 populations in 2015.

CONCLUSIONS

There was a substantial increase in hospital-based ASMR due to NCDs and injuries in Tanzania from 2006 to 2015. Most of the deaths affected the productive young adult group. This burden indicates that families, communities, and the nation at large suffer from premature deaths. The government of Tanzania should invest in early detection and timely management of NCDs and injuries to reduce premature deaths. This should go hand-in-hand with continuous efforts to improve the quality of health data and its utilization.

Measurement of and training for NCD guideline implementation in LMICs: a scoping review protocol

INTRODUCTION

Globally, non-communicable diseases (NCDs) are the leading causes of morbidity and mortality with an estimated 41 million deaths (74% of all global deaths) annually. Despite the WHO's Global Action Plan for the Prevention and Control of NCDs since 2013, progress on implementation of the guidelines has been slow. Although research has shown success of some NCD prevention and treatment interventions, there is a dearth of research on NCD care delivery approaches, cost-effectiveness and larger implementation research, especially in low/middle-income countries (LMICs). The objective of this scoping review is to identify the existing variation in how, why and by whom implementation of NCD guidelines is measured as part of implementation research or non-research programme improvement.

METHODS AND ANALYSIS

Using the methods established by Arksey and O'Malley, the search strategy was developed in consultation with a research librarian together with stakeholder feedback from content experts. We will apply the search to multiple electronic databases and grey literature sources. Two reviewers will independently screen title and abstract for inclusion followed by a full-text screening and all included records will be abstracted using a standardised tool that will be piloted with a sample of articles before application to all records. We will conduct a narrative synthesis of abstracted data and simple quantitative descriptive statistics.

DISSEMINATION

The results will enable stakeholders in LMICs to leverage existing tools and resources for implementation and ongoing evaluation of NCD guidelines, to improve education and capacity building, and ultimately NCD care across the lifespan.

Does engagement in HIV care affect screening, diagnosis, and control of noncommunicable diseases in sub-Saharan Africa? A systematic review and meta-analysis

Objective

Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may also provide opportunities to increase access to NCD services in under-resourced environments. We sought to investigate whether reported use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and/or control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV (PLWH) in sub-Saharan Africa (SSA).

Design

Systematic review and meta-analysis.

Methods

We searched 10 electronic literature databases for studies published between 01 January 2011 and 31 December 2022 using a comprehensive search strategy. We sought studies reporting on screening, diagnosis, treatment, and/or control of NCDs of interest by ART use among non-pregnant adults with HIV ≥16 years of age in SSA. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate.

Results

Twenty-six studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART, were included. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR: 1.07; 95% CI: 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR: 2.10, 95% CI: 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs.

Conclusion

Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.

Undiagnosed hypertension and associated factors among adults in ethiopia: a systematic review and meta-analysis

BACKGROUND

Hypertension is a major public health problem, resulting in 10 million deaths annually. Undiagnosed hypertension affects more people than ever before. It is more likely to be linked to severe hypertension, which can lead to stroke, cardiovascular disease, and ischemic heart disease. Thus, this systematic review and meta-analysis aimed to synthesize the prevalence of undiagnosed hypertension and its associated factors in Ethiopia.

METHODS

Databases, such as Medline/PubMed, Google Scholar, Science Direct, AJOL, and the Cochrane Library, were systematically searched to find potential studies published until December 2022. A Microsoft Excel spreadsheet was used to enter the extracted data. The pooled prevalence of undiagnosed hypertension and its associated factors was estimated using a random effect model. I2 statistics and the Cochrane Q-test were used to assess statistical heterogeneity across the studies. Begg's and Egger's tests were performed to identify possible publication bias.

RESULTS

A total of ten articles with 5,782 study participants were included in this meta-analysis. In the random effects model, the pooled prevalence of undiagnosed hypertension was 18.26% (95% CI = 14.94-21.58). Being older (OR = 3.8, 95% CI = 2.56, 5.66), having a body mass index > 25 kg/m2 (OR = 2.71, 95% CI = 2.1, 3.53), having a family history of hypertension (OR = 2.22, 95% CI = 1.47, 3.36), and having DM comorbidity (OR = 2.44, 95% CI = 1.38, 4.32) were significantly associated with undiagnosed hypertension.

CONCLUSION

In this meta-analysis, the pooled prevalence of undiagnosed hypertension was found to be high in Ethiopia. Being older, having a BMI > 25 kg/m2, having a family history of hypertension, and having DM comorbidity were found to be risk factors for undiagnosed hypertension.

Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study

BACKGROUND

Uncontrolled blood pressure is an important medical and public health problem in developing countries like Ethiopia. Improving the management of hypertension requires a better comprehension of the factors influencing blood pressure control and the application of interventions. But in clinical practice, blood pressure is still not adequately controlled. Thus, this study aimed to assess uncontrolled blood pressure and associated among adult hypertensive patients on follow-up at public health facility ambulatory clinics in Bishoftu, Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted among 398 adult hypertensive patients who were on treatment and follow-up from April to May 31, 2022. Systematic random sampling was used to select study participants. Data were collected using an interviewer-administered, semi-structured questionnaire and chart review. The Eighth Joint National Committee (JNC 8) criteria was applied to define blood pressure control status. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association. Finally, at a p-value < 0.05, statistical significance was proclaimed.

RESULT

Of the total study participants, 249(62.6%) were male. The mean age was 62.26 ± 11.55 years. The overall proportion of uncontrolled blood pressure was 58.8% (95% CI: 54-64). Salt intake (AOR = 2.51; 95% CI: 1.49-4.24), lack of physical activity (AOR = 1.40; 95% CI: 1.10-2.62), habitual coffee consumption (AOR = 4.52; 95% CI: 2.67-7.64), higher BMI (AOR = 2.08; 95% CI: 1.24-3.49), and non-adherence to antihypertensive medications (AOR = 2.31; 95% CI: 1.3-3.89) were independent predictors of uncontrolled blood pressure.

CONCLUSION

More than half of the hypertensive patients in this study had uncontrolled blood pressure. Healthcare providers and other accountable stakeholders should urge patients to follow salt restriction, physical activity, and antihypertensive medication regimes. Reduced coffee consumption and weight maintenance are other crucial blood pressure control measures.

Sedentariness and overweight in relation to mortality in sub-Saharan Africa. A mediation analysis based on the World Health Organization-Global Health Observatory data repository

Background

Globally, noncommunicable diseases (NCDs) have been continuously reported to be the number one leading cause of reduced life expectancy and poor life quality and have thus become a major public health concern.

Objective

This study aimed to investigate the complex mediation analysis between physical inactivity and overweight in relation to mortality.

Methods

The study is based on public data collected by the Global Health Observatory of the World Health Organization.

Results

We showed that the median early mortality attributable to NCDs during the period 2016-2019 in both men and women was 23.2% (5th to 95th range=17.2, 35.6) while that in men alone was 25.1% (16.5, 45.7) and that of women alone was 22.0% (17.0, 27.9). When considering regional early NCDs mortality for both men and women, a systematically high median was observed in Southern Africa [28.7% (22.2, 43.8)] and a low median in Eastern Africa [21.1% (17.15, 27.3)]. The analysis of the overall relation between physical inactivity, overweight and early mortality due to NCDs revealed a statistical significance of the direct association between physical inactivity and early mortality due to NCDs.

Conclusion

Our findings revealed three main epidemiological and public health concerns. First, early mortality attributable to NCDs in a range of about 20 to 30% across the sub-Saharan African regions for both sexes was observed. Second, there was a direct effect between physical inactivity and early NCDs mortality as well as the indirect effect mediated by overweight. Finally, a percentage point decrease in physical inactivity prevalence and overweight could effectively generate a reduction in mortality due to NCDs. Future studies are needed to confirm the scientific evidence observed in this study. Such studies should be based on observation of individual subjects, adopt a longitudinal design, and collect information that evaluates the complex relationship between physical inactivity and early NCDs mortality, along with the role of overweight as a possible mediator.

Trends and disparities in disease burden of age-related macular degeneration from 1990 to 2019: Results from the global burden of disease study 2019

Objectives

This study aims to estimate the trends and disparities in the worldwide burden for health of AMD, overall and by age, sex, socio-demographic index (SDI), region, and nation using prevalence and years lived with disability (YLDs) from Global Burden of Disease (GBD) study 2019.

Methods

This retrospective study presents the prevalent AMD cases and YLDs from 1990-2019, as well as the age-standardized prevalence rate (ASPR) and age-standardized YLD rate (ASYR) of AMD. To measure changes over time, estimated annual percentage changes (EAPCs) of the age-standardized rates (ASRs) were analyzed globally, then studied further by sex, SDI, region, and nation. We included data from the 2019 Global Burden of Disease (GBD) database to examine AMD prevalence and YLDs from 1990-2019 in 204 countries and territories, as well as demographic information such as age, sex, SDI, region, and nation.

Results

Globally, the number of prevalent AMD cases increased from 3,581,329.17 (95% uncertainty interval [UI], 3,025,619.4-4,188,835.7) in 1990 to 7,792,530 (95% UI, 6,526,081.5-9,159,394.9) in 2019, and the number of YLDs increased from 296,771.93 (95% uncertainty interval [UI], 205,462.8-418,699.82) in 1990 to 564,055.1 (95% UI, 392,930.7-789,194.64) in 2019. The ASPR of AMD had a decreased trend with an EAPC of -0.15 (95% confidence interval [CI], -0.2 to -0.11) from 1990 to 2019, and the ASYR of AMD showed a decreased trend with an EAPC of -0.71 (95% confidence interval [CI], -0.78 to -0.65) during this period. The prevalence and YLDs of AMD in adults over 50 years of age showed a significant increase. The prevalence and YLDs of AMD were significantly higher in females than males, overall. The ASPRs and ASYRs in low SDI regions was greater than in high SDI regions from 1990 to 2019. In addition, increases in prevalence and YLDs differed by regions and nations, as well as level of socio-economic development.

Conclusion

The number of prevalent cases and YLDs due to AMD increased over 30 years and were directly linked to age, sex, socio-economic status, and geographic location. These findings can not only guide public health work but also provide an epidemiological basis for global strategy formulation regarding this global health challenge.

Non-communicable disease burden among inpatients at a rural district hospital in Malawi

BACKGROUND

The burden of non-communicable diseases (NCDs) is high in Malawi. However, resources and training for NCD care remain scarce, especially in rural hospitals. Current care for NCDs in the developing world focuses on the WHO's traditional 4 × 4 set. However, we do not know the full burden of NCDs outside of that scope, like neurological disease, psychiatric illness, sickle cell disease, and trauma. The goal of this study was to understand the burden of NCDs among inpatients in a rural district hospital in Malawi. We broadened our definition of NCDs beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma.

METHODS

We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. We broke patients down by age, date of admission, type, and number of NCD diagnoses, and HIV status, and constructed multivariate regression models for length of stay and in-hospital mortality.

RESULTS

Of 2239 total visits, 27.5% were patients with NCDs. Patients with NCDs were older (37.6 vs 19.7 years, p < 0.001) and made up 40.2% of total hospital time. We also found two distinct populations of NCD patients. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. We also found significant trauma burden, accounting for 40% of all NCD visits. In multivariate analysis, carrying a medical NCD diagnosis was associated with longer length of stay (coefficient 5.2, p < 0.001) and a higher risk of in-hospital mortality (OR 1.9, p = 0.03). Burn patients also had significantly longer length of stay (coefficient 11.6, p < 0.001).

CONCLUSIONS

There is a significant burden of NCDs in a rural hospital in Malawi, including those outside of the traditional 4 × 4 set. We also found high rates of NCDs in the younger population (under 40 years of age). Hospitals must be equipped with adequate resources and training to meet this burden of disease.

Cardiovascular risk factors in Sub-Saharan African women

Summary: Background: Cardiovascular risk factors (CVRF) are associated with major cause of death and disability in Sub-Saharan Africa, especially in women. The contribution of obstetrical, psychological, and socio-economic factors in CVRF are not yet well described in Africa. We aimed to compare the prevalence of CVRF between men and women, and to determine the factors associated to these sex-related differences. Patients and methods: A cross-sectional study was conducted on the 2019 data of the TAHES cohort in a geographically defined general population in Benin. A standardized questionnaire adapted from the World Health Organization (WHO) STEPS instrument was used to collect data. Univariate and multivariate analysis has been performed to determine CVRF differences in both sexes. Women-specific logistic regressions have been performed on CVRF previously identified as positively associated to female sex, to assess their association with socio-economic, psychological, and obstetrical factors. Results: We included 1583 patients, with a median age of 39 years [range: 32–53 years]. Prevalence of diabetes (1.2% vs. 3.4%, p=0.0042), abnormal kidney function (15.5% vs. 8.4%, p=0.0002), obesity (12.5% vs. 4.1%, p<0.0001), tobacco-smoking (3.4% vs. 14.1%, p<0.0001) and reduced physical activity (69.9% vs. 50.7%, p<0.0001) differed significantly between women and men, respectively. In multivariate analysis, female sex was independently and significantly associated with obesity, anxiety, depression and reduced physical activity. Number of pregnancies was associated with a reduced physical activity. Hypertension was associated with gestational hypertension. Conclusions: Obesity and reduced physical activity are significantly and independently more frequent in Beninese women than the male counterparts. Hypertension prevalence in Benin is alarming in both sexes. Targeted prevention strategies against obesity, gestational hypertension and sedentary lifestyle are advocated in African women.

Perceptions, facilitators and barriers of physical activity among people living with HIV: a qualitative study

BACKGROUND

People living with HIV (PLWH) have low levels of physical activity. Using the social ecological model to understand perceptions, facilitators and barriers of physical activity in this population is of importance for developing contextualised interventions to improve physical activity in PLWH.

METHOD

This was a qualitative sub-study conducted between august and November 2019 as part of a cohort study on diabetes and associated complications in HIV infected in Mwanza, Tanzania. Sixteen in-depth interviews and three focus groups with nine participants in each were conducted. The interviews and focus groups were audio recorded, transcribed and translated into English. The social ecological model was considered during the coding and interpretation of the results. Transcripts were discussed, coded and analyzed using deductive content analysis.

RESULTS

Forty-three PLWH aged 23-61 years participated in this study. The findings showed that most PLWH perceived physical activity as beneficial to their health. However, their perceptions of physical activity were rooted within existing gender stereotypes and roles in the community. Running and playing football were perceived as activities for men while household chores activities were for women. Further, men were perceived to do more physical activity than women. For women, household chores and income-generating activities were perceived as sufficient physical activity. Social support and engagement of family members and friends in physical activity were reported as facilitators of physical activity. Reported barriers of physical activity were lack of time, money, availability of physical activity facilities and social support groups, and poor information on physical activity from health care providers in HIV clinics. Human-immunodeficiency virus (HIV) HIV infection was not perceived by PLWH as a barrier for doing physical activity but most family members did not support them to do physical activity, fearing that it might worsen their condition.

CONCLUSION

The findings demonstrated differing perceptions, facilitators and barriers of physical activity among PLWH. Interventions addressing awareness, gender stereotypes and roles related to physical activity from individual to community level are needed. Supportive environment and infrastructures are needed to improve physical activity levels in PLWH in Tanzania.

An analysis of the African cancer research ecosystem: tackling disparities

Disparities in cancer research persist around the world. This is especially true in global health research, where high-income countries (HICs) continue to set global health priorities further creating several imbalances in how research is conducted in low and middle-income countries (LMICs). Cancer research disparities in Africa can be attributed to a vicious cycle of challenges in the research ecosystem ranging from who funds research, where research is conducted, who conducts it, what type of research is conducted and where and how it is disseminated. For example, the funding chasm between HICs and LMICs contributes to inequities and parachutism in cancer research. Breaking the current cancer research model necessitates a thorough examination of why current practices and norms exist and the identification of actionable ways to improve them. The cancer research agenda in Africa should be appropriate for the African nations and continent. Empowering African researchers and ensuring local autonomy are two critical steps in moving cancer research towards this new paradigm.

The prevalence and determinants of non-communicable diseases among Ghanaian adults: A survey at a secondary healthcare level

The current epidemiological transition of diseases in Ghana necessitates understanding their burden and the associated context-specific risk factors to inform disease prevention strategies. To determine the prevalence and determinants of selected Non-Communicable Diseases (NCDs) among patients seeking healthcare services in a secondary health facility in Ghana. A facility-based survey was conducted among adult patients 18 years and above between May and July 2021, using a multi-stage sampling approach. Data regarding the prevalence of NCDs, participants' socio-demographics and lifestyle factors of NCDs were obtained using Modified STEPwise Approach to NCD Risk Factor Surveillance (STEPS). The Chi-square test and regression analysis were performed to identify the risk factors of NCDs at P < 0.05. The participants comprised 480 patients with a mean age of 37.7±16.5 years, and 57.7% (277/480) of them were females. The overall prevalence of the selected NCDs was 26.7% (CI = 0.23-0.31), of which hypertension (22.7%) was the most prevalent. More than half (54.2%) of the participants engaged in alcohol consumption and 54% were physically inactive. The odds of developing NCDs were higher in females (CI = 1.32-4.10, P = 0.004), older adults (CI = 4.11-20.68, P <0.001), overweight/obese adults (CI = 1.65-4.70, P < 0.001), family history (CI = 0.15-0.46, P<0.001), and alcohol consumption (CI = 0.12-0.40, P < 0.001). There was an overall high prevalence of NCDs, strongly influenced by the participants' age, sex, BMI, alcohol consumption, and family history. These determinants should be highlighted as part of the campaign for preventive action plans.

Patterns of Medical Admissions and Predictors of Mortality in Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Prospective Observational Study

Background

Previous works show that noncommunicable diseases (NCDs) are on the rise in developing nations, including Ethiopia, in the background of preexisting communicable diseases (CDs). Data on hospital admission in sub-Saharan Africa are scarce, particularly prospectively collected, and hence this study was done to close the gap in acquiring accurate diagnosis usually faced with retrospective data. We aimed to describe medical admission patterns, their outcomes and determinants at Ayder Comprehensive Specialized Hospital (ACSH) in Tigray, Ethiopia.

Methods

Data were collected prospectively from November 1, 2017 to October 31, 2018 for all medical admissions. Sociodemographic profiles, final diagnosis, outcome of hospitalization, and complications were recorded using a data-abstraction checklist. Data were analyzed using SPSS 26.

Results

There were 2084 medical admissions over 1 year. Median age was 45 years (IQR 31). A majority (1107, 53.1%) were male. The age-group 25-34 years had the most admissions (19.0%). NCDs constituted 68.2% of admissions. According to the International Classification of Diseases, patients were admitted most frequently due to disease of the circulatory system (36.7%) followed by infectious or parasitic diseases (24.1%). Of NCDs, cardiovascular diseases contributed to 53.9%, followed by cancers (8.6%). Of CDs, HIV/AIDS contributed to 31.3%, followed by tuberculosis (22.8%). A total of 1375 (66%) were discharged improved, while 311 (14.9%) died. On multivariate analysis, the in-hospital mortality was significantly higher (18.7%) for CDs than NCDs (13.2%, AOR 1.8, 95% CI 1.4-2.3; P<0.001). Bed occupancy of ACSH medical wards and ICU was 54%.

Conclusion

NCDs were leading causes of medical admissions in ACSH. The presence of CDs and the development of complications were associated with higher risk of death. Attention should be given by policy-makers to curb the higher morbidity from NCDs and mortality from CDs.

Stakeholder perspectives on Nigeria's national sodium reduction program: Lessons for implementation and scale-up

BACKGROUND

To reduce excess dietary sodium consumption, Nigeria's 2019 National Multi-sectoral Action Plan (NMSAP) for the Prevention and Control of Non-communicable Diseases includes policies based on the World Health Organization SHAKE package. Priority actions and strategies include mandatory sodium limits in processed foods, advertising restrictions, mass-media campaigns, school-based interventions, and improved front-of-package labeling. We conducted a formative qualitative evaluation of stakeholders' knowledge, and potential barriers as well as effective strategies to implement these NMSAP priority actions.

METHODS

From January 2021 to February 2021, key informant interviews (n = 23) and focus group discussions (n = 5) were conducted with regulators, food producers, consumers, food retailers and restaurant managers, academia, and healthcare workers in Nigeria. Building on RE-AIM and the Consolidated Framework for Implementation Research, we conducted directed content qualitative analysis to identify anticipated implementation outcomes, barriers, and facilitators to implementation of the NMSAP sodium reduction priority actions.

RESULTS

Most stakeholders reported high appropriateness of the NMSAP because excess dietary sodium consumption is common in Nigeria and associated with high hypertension prevalence. Participants identified multiple barriers to adoption and acceptability of implementing the priority actions (e.g., poor population knowledge on the impact of excess salt intake on health, potential profit loss, resistance to change in taste) as well as facilitators to implementation (e.g., learning from favorable existing smoking reduction and advertising strategies). Key strategies to strengthen NMSAP implementation included consumer education, mandatory and improved front-of-package labeling, legislative initiatives to establish maximum sodium content limits in foods and ingredients, strengthening regulation and enforcement of food advertising restrictions, and integrating nutrition education into school curriculum.

CONCLUSION

We found that implementation and scale-up of the Nigeria NMSAP priority actions are feasible and will require several implementation strategies ranging from community-focused education to strengthening current and planned regulation and enforcement, and improvement of front-of-package labeling quality, consistency, and use.

Associations between HIV status and self-reported hypertension in a high HIV prevalence sub-Saharan African population: a cross-sectional study

OBJECTIVES

This study examined whether HIV status and antiretroviral therapy (ART) exposure were associated with self-reported hypertension in Zimbabwe.

DESIGN

Study data were taken from a cross-sectional, general population survey, which included HIV testing (July 2018-December 2019).

SETTING

The data were collected in Manicaland Province, Zimbabwe.

PARTICIPANTS

9780 people aged 15 years and above were included.

OUTCOME MEASURE

Self-reported hypertension was the outcome measure. This was defined as reporting a previous diagnosis of hypertension by a doctor or nurse. After weighting of survey responses by age and sex using household census data, χ² tests and logistic regression were used to explore whether HIV status and ART exposure were associated with self-reported hypertension.

RESULTS

The weighted prevalence of self-reported hypertension was 13.6% (95% CI 12.9% to 14.2%) and the weighted prevalence of HIV was 11.1% (10.4% to 11.7%). In univariable analyses, there was no evidence of a difference in the weighted prevalence of self-reported hypertension between people living with HIV (PLHIV) and HIV-negative people (14.1%, 11.9% to 16.3% vs 13.3%, 12.6% to 14.0%; p=0.503) or between ART-exposed and ART-naive PLHIV (14.8%, 12.0% to 17.7% vs 12.8%, 9.1% to 16.4%,p=0.388). Adjusting for socio-demographic variables in logistic regression did not alter this finding (ORs:HIV status:0.88, 0.70 to 1.10, p=0.261; ART exposure:0.83, 0.53 to 1.30, p=0.411).

CONCLUSIONS

Approximately one in seven PLHIV self-reported having hypertension, highlighting an important burden of disease. However, no associations were found between HIV status or ART exposure and self-reported hypertension, suggesting that it will be valuable to focus on managing other risk factors for hypertension in this population. These findings should be fully accounted for as Zimbabwe reorients its health system towards non-communicable disease control and management.

Understanding perceptions of neighborhood health and non-communicable disease risk in urban contexts in Ghana

Global health surveillance reports show Africa's epidemiologic transition from one dominated by higher burdens of nutritional, maternal, and communicable diseases to one increasingly dominated by non-communicable diseases (NCDs). Debates on the increasing cases of NCDs in the African context have focused on individualistic risk factors to the neglect of other similar important determinants such as the living environment. Drawing on theoretical tenets of the protection motivation theory and using cross-sectional data, we examined neighborhood risk perceptions and self-rated risk of developing NCDs in Ghana. The dependent variable 'self-rated risk of developing NCDs' was measured as a binary outcome and the focal independent variable - perceived neighborhood health risk - as an index. We fitted multivariate multilevel regression models to a sample of 1376 individuals across 9 neighborhoods. Results show that respondents who perceived their neighborhoods as risky were more likely to rate their risk of developing NCDs high. A unit increase in neighborhood violence was associated with 8% likelihood of self-rated risk of developing NCDs. However, a unit increase in the aesthetic quality of respondent's neighborhood was associated with lower likelihood of self-rated risk of developing NCDs. Engaging in regular physical activity, and non-tobacco use were associated with a lower likelihood of perceived NCDs risk. We suggest policy agendas intended for reducing the burden of NCDs in Ghana and other LMICs could incorporate programs that target improving environmental characteristics to minimize risks and offer people the opportunity to make healthy choices.

Bridging the genomic data gap in Africa: implications for global disease burdens

This paper highlights the gap in the use of genomic data of Africans for global research efforts for disease cures. Genomic data represents an important tool used in disease research for understanding how diseases affect several populations and how these differences can be harnessed for the development of effective cures especially vaccines that have an impact at the genetic level e.g., RNA vaccines.This paper then provides a review of global genomic data status where three continents are reported to be the major contributor of genomic data to repositories used for disease research and the development of vaccines and medicines around the world.We reviewed the most recently published information about genetic data inclusiveness of populations, explaining how genomic data of Africans is lacking in global research efforts that cater towards the eradication of pandemics via the development of vaccines and other cures. We also discuss the implication of this non-inclusiveness for global disease burdens and indicate where changes need to be made in the last part of the paper.Lastly, the entire centers on some general policy recommendations to fully include African genomic data in such global genetic repositories. These recommendations can be implemented in African countries to improve genetic data collection, storage, and usage policies.

Foodscapes, finance, and faith: Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbanizing area in Kenya

Introduction

Rapid urbanization (growth of cities) can upset the local population's health and wellbeing by creating obesogenic environments which increase the burden of non-communicable diseases (NCDs). It is important to understand how stakeholders perceive the impact of urbanizing interventions (such as the construction of a new hypermarket) on the health and wellbeing of local populations. Because low- and middle-income countries (LMICs) lack the reliable infrastructure to mitigate the effects of obesogenic environments, so engaging stakeholders who influence dietary habits is one population-level strategy for reducing the burden of NCDs caused by newly built developments.

Methods

We conducted key informant interviews with 36 stakeholders (25 regulatory and 11 local community stakeholders) from Kisumu and Homa Bay Counties of Western Kenya in June 2019. We collected stakeholders' perspectives on the impacts of a new Mall and supermarket in Kisumu, and existing supermarkets in Homa Bay on the health and wellbeing of local populations.

Results

Through thematic discourse analysis, we noted that some stakeholders thought supermarkets enabled access to unhealthy food items despite these outlets being also reliable food sources for discerning shoppers. Others linked the changing physical environment to both an increase in pollution and different types of diseases. Stakeholders were unsure if the pricing and convenience of supermarkets would stop local populations from buying from their usual small-scale food vendors. The key finding of this study was that engaging relevant stakeholders as part of population health impact assessments of new developments in cities are important as it directs focus on health equity and prevention in instances of resource constraints. The findings highlight, also, that community members have a strong awareness of the potential for interventions that would improve the health and wellbeing of local populations.

Risk Factors Attributable to Hypertension among HIV-Infected Patients on Antiretroviral Therapy in Selected Rural Districts of the Eastern Cape Province, South Africa

BACKGROUND

Antiretroviral therapy has improved HIV patients' quality of life and life expectancy. However, complications have emerged in the form of hypertension. In the rural Eastern Cape, there is minimal information about HIV-infected people. The current study intended to evaluate the factors associated with hypertension in HIV-infected individuals receiving antiretroviral therapy in rural areas of South Africa's Eastern Cape.

METHODS

For this cohort study, HIV-positive people taking antiretroviral therapy aged 15 and up were recruited at random from several rural locations in the Eastern Cape. Using Cox univariate and multivariate analyses, the key predictors of hypertension were found.

RESULTS

Of the total participants (n = 361), 53% of individuals had hypertension. In the Cox multivariate model, patients that had hypertension heredity, BMI ≥ 25 kg/m², eGFR < 60 mL/min/1.73 m², advanced and severe CD4 counts, 1TFE and 1T3E regimens, and the male gender were found to be at greater risk of hypertension.

CONCLUSIONS

The findings of this study indicate that hypertension is a prevalent concern among HIV patients receiving antiretroviral therapy. HIV patients should have their blood pressure checked regularly, and they should be screened for high blood pressure and given treatment for it.

Describing and Modeling the Burden of Hospitalization of Patients With Neoplasms in Ghana Using Routine Health Data for 2012-2017

The increasing cancer burden calls for reliable data on current and future associated hospitalizations to enable health care resource planning, especially in low- and middle-income countries. We provide nationwide estimates of the current and future burden of hospitalization because of neoplasms in Ghana.

Other data sets are useful to estimate epidemiologic trends in settings where cancer registries are not available.

Socioeconomic inequalities in intergenerational overweight and obesity transmission from mothers to offsprings in South Africa

This study assesses socioeconomic inequality in the intergenerational transmission of overweight and obesity from mothers to offsprings in South Africa, including the factors contributing to inequality. Data were drawn from the 2017 National Income Dynamic Study, which collected anthropometric and socioeconomic information. Non-pregnant mothers aged 15–49 years and their offsprings 0–14 years were included in the analysis. The dependent variables used in the study were the intergenerational transmission of overweight and obesity. Socioeconomic inequality was assessed using the concentration index. A positive index means that intergenerational overweight and obesity is more likely among the wealthier populations, while a negative index signifies the opposite. The concentration index was decomposed to understand the factors that explain inequalities in the transmission of overweight and obesity from mothers to offsprings. Concentration indices for the intergenerational transmission of overweight and obesity were positive for boys (0.17) and girls (0.23). Thus the intergenerational transmission of overweight and obesity occurs more among wealthier mothers. Although factors explaining socioeconomic inequality in the intergenerational transmission of overweight and obesity differed by offspring sex, mother's marital status (+38%) and socioeconomic status (around +8%) were central determinants of socioeconomic inequalities in intergenerational overweight, while mother's smoking (around +25%), education (about +13%) and employment status (around +12%) contributed to intergenerational obesity inequality. Policies to reduce overweight and obesity burdens and the intergenerational transmission of overweight and obesity in South Africa should target women who bear a significant burden of overweight and obesity and could transmit them to their offsprings. The policies should also recognise the key factors explaining these socioeconomic inequalities. This approach will reduce the future burden of diseases associated with overweight and obesity in South Africa and improve the country's overall health outcomes.

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Intergenerational overweight and obesity occurs more among richer mothers.

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Mother's marital status influenced intergenerational overweight inequality.

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Intergenerational obesity inequality was attributed to mother's smoking status.

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Factors explaining intergenerational health inequalities differed by offspring sex.

Bayesian Spatial Modeling of Diabetes and Hypertension: Results from the South Africa General Household Survey

Determining spatial links between disease risk and socio-demographic characteristics is vital in disease management and policymaking. However, data are subject to complexities caused by heterogeneity across host classes and space epidemic processes. This study aims to implement a spatially varying coefficient (SVC) model to account for non-stationarity in the effect of covariates. Using the South Africa general household survey, we study the provincial variation of people living with diabetes and hypertension risk through the SVC model. The people living with diabetes and hypertension risk are modeled using a logistic model that includes spatially unstructured and spatially structured random effects. Spatial smoothness priors for the spatially structured component are employed in modeling, namely, a Gaussian Markov random field (GMRF), a second-order random walk (RW2), and a conditional autoregressive (CAR) model. The SVC model is used to relax the stationarity assumption in which non-linear effects of age are captured through the RW2 and allow the mean effect to vary spatially using a CAR model. Results highlight a non-linear relationship between age and people living with diabetes and hypertension. The SVC models outperform the stationary models. The results suggest significant provincial differences, and the maps provided can guide policymakers in carefully exploiting the available resources for more cost-effective interventions.

Promoting healthy lifestyles among nurse trainees: Perceptions on enablers and barriers to dietary and physical activity behaviours

Introduction

Promoting healthy lifestyles is important to protect against obesity and non-communicable diseases. However, there is a lack of understanding of the enablers and barriers to healthy lifestyles (dietary and physical activity) among pre-service nursing trainees in Ghana. This study therefore aims to examine the perceived practice, enablers and barriers in adopting healthy dietary and physical activity behaviours.

Materials and methods

Cross-sectional qualitative, one-on-one in-depth interviews with a semi-structured guide were conducted with 16 nursing trainees (public health nursing) (aged: 18–25 years) in the School of Nursing and Midwifery, University of Health and Allied Sciences. Participants were selected based on body mass index (underweight, normal, over-weight, and obesity) classification of the world health organization. The interviews were audio-recorded and transcribed. Data analysis was manually carried out.

Results

Enablers and barriers were grouped into levels of individual (intrapersonal), social environment, physical environment, and university factors based on ecological model initially formulated by Bronfenbrenner’s. Enablers to healthy dietary behaviour were self-discipline, dietary knowledge, social support, and access/availability. Enablers related to physical activity mentioned were body image, social support, and the existence of student societies. Barriers to healthy dietary behaviour included upbringing, preference, accessibility, safety/appearance, and studies/lectures. Barriers mentioned in relation to physical activity include a busy lifestyle, inadequate feeding, studies/academic activity, student societies, upbringing, and social support.

Conclusion

A program to support healthy lifestyles for nursing trainees is needed. Specifically, in terms of developing and implementing interventions to overcome barriers and promote facilitators to adopt healthy dietary and physical activity behaviours whilst in training.

Associations between COVID-19 testing status, non-communicable diseases and HIV status among residents of sub-Saharan Africa during the first wave of the pandemic

BACKGROUND

This study determined if non-communicable disease status, HIV status, COVID-19 status and co-habiting were associated with COVID-19 test status in sub-Saharan Africa.

METHODS

Data of 5945 respondents age 18-years-old and above from 31 countries in sub-Saharan Africa collected through an online survey conducted between June and December 2020, were extracted. The dependent variable was COVID-19 status (testing positive for COVID-19 and having symptoms of COVID-19 but not getting tested). The independent variables were non-communicable disease status (hypertension, diabetes, cancer, heart conditions, respiratory conditions, depression), HIV positive status, COVID-19 status (knowing a close friend who tested positive for COVID-19 and someone who died from COVID-19) and co-habiting (yes/no). Two binary logistic regression models developed to determine associations between the dependent and independent variables were adjusted for age, sex, employment, sub region and educational status.

RESULTS

Having a close friend who tested positive for COVID-19 (AOR:6.747), knowing someone who died from COVID-19 infection (AOR:1.732), and living with other people (AOR:1.512) were significantly associated with higher odds of testing positive for COVID-19 infection, while living with HIV was associated with significantly lower odds of testing positive for COVID-19 infection (AOR:0.284). Also, respondents with respiratory conditions (AOR:2.487), self-reported depression (AOR:1.901), those who had a close friend who tested positive for COVID-19 infection (AOR:2.562) and who knew someone who died from COVID-19 infection (AOR:1.811) had significantly higher odds of having symptoms of COVID-19 infection but not getting tested.

CONCLUSION

Non-communicable diseases seem not to increase the risk for COVID-19 positive test while cohabiting seems to reduce this risk. The likelihood that those who know someone who tested positive to or who died from COVID-19 not getting tested when symptomatic suggests there is poor contact tracing in the region. People with respiratory conditions and depression need support to get tested for COVID-19.

Eating behaviors, attitudes, and beliefs that contribute to overweight and obesity among women in Lilongwe City, Malawi: a qualitative study

Background

Obesity is increasingly a public health concern in low- and middle-income countries, including Malawi where 36% of women have body mass index in overweight/obese categories in urban areas. Eating behaviors, attitudes, and beliefs are associated with body size, but have not been studied in-depth in sub-Saharan African countries. This study therefore, explored eating behaviors, attitudes, and beliefs of women in Lilongwe, Malawi.

Methods

This was a descriptive ancillary qualitative study utilising in-depth interviews with 27 women (13 in normal weight range and 14 in overweight/obesity ranges) puporsively selected in Lilongwe City, Malawi from October to November 2017. The concept of data saturation guided data collection, and it was reached with the 27 interviewed participants when there was no new information coming from the participants. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were analysed manually using thematic content analysis.

Results

Majority of participants perceived overweight as an indication of good health such that with food affordability, women deliberately gain weight to demonstrate their good health. Most normal weight respondents said they ate less food than they wanted to because of financial constraints. Most women in overweight/obese ranges in our sample reported that they eat large portions and eat frequently due to the desire to portray a good image of their marital life since there is a societal expectation that when a woman is married, her weight should increase to show that the marriage is successful. The perceived contributors to weight gain include eating behaviors, feelings about weight gain, and gender roles and social expectations to gain weight.

Conclusion

Beliefs and attitudes related to eating behaviors may have contributed to women being in overweight range and should be considered in designing obesity prevention interventions targeting women in Malawi.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01811-0.

Prevalence of Clinical Cardiovascular Disease Risk Factors Among HIV Infected Patients on Anti-Retroviral Treatment in a Tertiary Hospital in Ethiopia

Background

Anti-retroviral treatment has improved mortality of human immunodeficiency virus (HIV) infected patients, which is offset by an increasing burden of cardiovascular diseases (CVD). Data regarding prevalence of cardiovascular disease risk factors in HIV infected patients in Ethiopia are very scarce. The aim of this study was to determine the prevalence of CVD risks and associated factors in patients with HIV.

Methods

A cross-sectional study was conducted on 333 patients with HIV infection, using a modified World Health Organization’s stepwise approach to surveillance questionnaire. Anthropometric and blood pressure measurement was done along with biochemical studies. Cardiovascular risk was estimated using Framingham risk score. Multivariate logistic regression was used to examine the association between cardiovascular risks and associated factors, with a p-value of <0.05 considered statistically significant.

Results

The mean age of the participants was 45 years, and 69.2% were females. Most (80.9%) of the participants had viral load below 50 copies/mL and the mean CD4 count was 579 cells/mm³. Dyslipidemia was the most common risk factor identified in 69.4%, followed by abnormal fasting blood glucose (≥100 mg/dL) in 36.8%. Hypertension was diagnosed in 23.8%, while 22.8% and 11.1% had metabolic syndrome and obesity, respectively. Framingham risk score was low in 95.9%. Male gender, increasing age, high body mass index and previous ART regimen being tenofovir disoproxil fumarate, lamivudine and nevirapine increased CVD risk factors.

Conclusion

Traditional cardiovascular risk factors were high in the population studied. There is a need to raise awareness about the risk factors, and patients should have timely follow-up and care.

Use of ziv-aflibercept in diabetic macular edema in a Ghanaian population

Aim

To investigate the use of intravitreal ziv-aflibercept (IVZ) in Ghanaian patients with diabetic macular edema (DME).

Methods

A retrospective study of patients with DME, who had been treated with IVZ (1.25 mg/0.05 ml), as part of routine clinical practice, on pro re nata basis between 2016 and 2018 who had a minimum follow-up of 6 months was retrieved and analyzed. The primary outcome measure was change in best-corrected visual acuity (BCVA) at 6 months. Secondary outcome measures are change in BCVA at 12 months and at the last follow-up visit, adverse events and change in central macular thickness (CMT).

Results

Twenty-five eyes of 17 patients (11 males) were included in this study. Their mean age was 60.82 ± 7.70 years and the mean duration of follow-up was 9.52 ± 3.31 months. The mean baseline BCVA (logMAR) of 0.65 ± 0.3 improved to 0.34 ± 0.16 (p < 0.0001) and 0.22 ± 0.15 (p = 0.0004) at 6 and 12 months, respectively. Twelve (48%) eyes had a visual gain of at least three lines at 6 months and 4 of 12 eyes (33.3%) at 1 year. There was a significant reduction in the mean CMT at 6 and 12 months and at the last follow-up visit compared to baseline (p < 0.0001). The adverse events recorded were raised intraocular pressure (four eyes) at 3, 6, and 12 months post injection, increased blood pressure in a patient with known systemic hypertension and transient memory loss in one patient.

Conclusion

IVZ (1.25 mg) was associated with significant improvement in BCVA and reduction in CMT at 6 and 12 months in eyes with DME. A randomized clinical trial is warranted to assess this potentially cost-effective intervention for DME in low-resource settings.

Relationship between tobacco use, alcohol consumption and non-communicable diseases among women in India: evidence from National Family Health Survey-2015-16

BACKGROUND

Based on an increased prevalence of diabetes, asthma and hypertension among women in reproductive age, understanding the risk factors of non-communicable diseases (NCDs) is crucial to inform policy and program interventions to address the problem. In this study, we empirically assessed the associations of behavioural factors such as alcohol consumption and tobacco use and a variety of socioeconomic characteristics with prevalence of NCDs in adult women.

METHODS

The data were derived from the National Family Health Survey conducted in 2015-16. The effective sample size for the present paper was 699,686 women aged 15-49 years in India. Descriptive statistics along with bivariate analysis were conducted to find the preliminary results. Additionally, multivariable logistic regression analysis was conducted to find the relationship between NCDs and behavioural factors such as alcohol consumption and tobacco use. Moreover, population attributable risk was estimated in the present study.

RESULTS

It was revealed that 15.9% of women had any of the NCDs. A proportion of 0.8% of women smoked tobacco whereas 5.5% of women consumed smokeless tobacco. Also, a proportion of 1.2% of women consumed alcohol in the current study. The odds of having NCDs among women who smoked tobacco, consumed smokeless tobacco and consume alcohol were 16, 8 and 20% significantly higher than the odds of having NCDs among women who did not smoke tobacco, consume smokeless tobacco and consume alcohol respectively. The population attributable risk of having NCDs was 1.8% (p < 0.001) for women who smoked, 0.8% (p < 0.001) for women who consumed smokeless tobacco and 2.2% (p < 0.001) for women who consumed alcohol. Besides, the odds of having NCDs among overweight and obese women were 2.25 and 3.60 times greater than the odds of having NCDs among women who were underweight.

CONCLUSION

The findings revealed that smoking and using smokeless tobacco and alcohol consumption were risk factors of NCDs in women. The findings also alarm the focus of maternal and child health programs on NCDs' risk factors like maternal obesity, due to their adverse health consequences on their children too. Also, the coexistence of higher levels of tobacco use and alcohol consumption requires different strategies to address the vulnerability of women towards NCDs, including screening and early detection of NCDs especially among those who smoke or chew tobacco and consume alcohol.

Chronic obstructive pulmonary disease in sub-Saharan Africa

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and an important cause of death in sub-Saharan Africa (SSA). We conducted a systematic review and meta-analysis on the prevalence of and risk factors for COPD in SSA.METHODS: We conducted a protocol-driven systematic literature search in MEDLINE, EMBASE, CINAHL and Global Health, supplemented by a manual search of the abstracts from thoracic conference proceedings from 2017 to 2020. We did a meta-analysis of COPD prevalence and its association with current smoking.RESULTS: We identified 831 titles, of which 27 were eligible for inclusion in the review and meta-analysis. The population prevalence of COPD ranged from 1.7% to 24.8% (pooled prevalence: 8%, 95% CI 6-11). An increased prevalence of COPD was associated with increasing age, smoking and biomass smoke exposure. The pooled odds ratio for the effect of current smoking (vs. never smoked) on COPD was 2.20 (95% CI 1.62-2.99).CONCLUSION: COPD causes morbidity and mortality in adults in SSA. Smoking is an important risk factor for COPD in SSA, and this exposure needs to be reduced through the combined efforts of clinicians, researchers and policymakers to address this debilitating and preventable lung disease.

Prevalence of Mental Disorders in Uganda: a Systematic Review and Meta-Analysis

This systematic review was conducted to determine the prevalence of mental disorders among children and adults in Uganda. A comprehensive systematic search for relevant studies reporting prevalence of mental disorders in children or adults in Uganda was conducted in PubMed, Embase, PsycINFO, Scopus, Web of Science databases and grey literature sources. Study was eligible if, validated instrument based on the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders criteria to assess a mental disorder was used. Eligible studies were critically appraised, prevalence data extracted and pooled using the random-effects model. Certainty in the pooled prevalence estimates was evaluated using the Grading of Recommendation, Assessment, Development and Evaluation approach. A total of 632 records were obtained, of which 26 articles from 24 studies conducted in Uganda were included in the review. Overall and with moderate level of certainty, the prevalence of any mental disorder in Uganda was 22.9% (95% C.I 11.0% - 34.9%) in children and 24.2% (95% C.I 19.8% - 28.6%) in adults. Prevalence of anxiety disorders was 14.4% (95% C.I 4.9% - 24.0%) in children and 20.2% (95% C.I 14.5% - 25.9%) in adults. The prevalence of current depressive disorders was 22.2% (95% C.I 9.2% - 35.2%) in children and 21.2% (95% C.I 16.8% - 25.6%) in adults. Eating disorder and psychotic syndrome disorder were also reported. Our findings suggest that depression and anxiety disorders are common mental disorders in Uganda, affecting approximately one in four persons. The findings provide essential insights for health service planning, clinical practice, and future epidemiological research in Uganda.

Particulate matter pollution at traffic hotspots of Accra, Ghana: levels, exposure experiences of street traders, and associated respiratory and cardiovascular symptoms

BACKGROUND

There are limited studies on the health effects of street trading in spite of common knowledge that individuals engaged in the trade are exposed to high levels of traffic-related air pollution per their mode of operation, and also the fact that the venture is a dominant occupation in cities of Sub-Saharan Africa (SSA) and other developing regions.

OBJECTIVE

We characterized particulate matter (PM) pollution levels at traffic hotspots of Accra, Ghana during the dry and wet seasons, and assessed exposure experiences of street traders.

METHODS

A cross-sectional study was conducted among 236 street traders operating along six selected traffic routes of Accra and a comparison group of 186 office workers. PurpleAir PA-II monitors were used to measure PM levels at the selected traffic routes. We estimated annual PM_2.5 exposure of street traders using assigned seasonal PM_2.5 levels, and information collected in a structured questionnaire on their activity patterns. Outcomes investigated were self-reported respiratory and cardiovascular symptoms.

RESULTS

PM levels at Accra traffic hotspots were high in both seasons. 1 ug/m³ increase in PM_2.5 exposure increased respiratory, cardiovascular, and overall symptoms by a factor of 0.00027 (95% CI: 0.00012, 0.00041), 0.00022 (95% CI: 0.00007, 0.00036), and 0.00048 (95% CI: 0.00023, 0.00073), respectively. Compared to office workers, high PM_2.5 exposure among street traders was associated with increased odds of coughing, catarrh (postnasal drip), sneezing, rapid heart beating, irregular heartbeat, sharp chest pains, fainting spells, headaches, and dizziness. Low and medium PM_2.5 exposure was associated with increased odds of dermatitis, rapid heart beating, and irregular heartbeat, and sharp chest pains, respectively.

CONCLUSIONS

We found consistent evidence that PM_2.5 exposure among street traders increases the occurrence of respiratory and cardiovascular symptoms. We also provide indicative measurements of PM levels at traffic hotspots of a rapidly growing SSA city with heavy vehicular traffic and yet, limited air quality monitoring capacity.

Overweight and obesity in non-pregnant women of childbearing age in South Africa: subgroup regression analyses of survey data from 1998 to 2017

Background

Overweight and obesity in adults are increasing globally and in South Africa (SA), contributing substantially to deaths and disability from non-communicable diseases. Compared to men, women suffer a disproportionate burden of obesity, which adversely affects their health and that of their offspring. This study assessed the changing patterns in prevalence and determinants of overweight and obesity among non-pregnant women in SA aged 15 to 49 years (women of childbearing age (WCBA)) between 1998 and 2017.

Methods

This paper conducts secondary data analysis of seven consecutive nationally representative household surveys—the 1998 and 2016 SA Demographic and Health Surveys, 2008, 2010–2011, 2012, 2014–2015 and 2017 waves of the National Income Dynamics Survey, containing anthropometric and sociodemographic data. The changing patterns of the overweight and obesity prevalence were assessed across key variables. The inferential assessment was based on a standard t-test for the prevalence. Adjusted odds ratios from logistic regression analysis were used to examine the factors associated with overweight and obesity at each time point.

Results

Overweight and obesity prevalence among WCBA in SA increased from 51.3 to 60.0% and 24.7 to 35.2%, respectively, between 1998 and 2017. The urban-rural disparities in overweight and obesity decreased steadily between 1998 and 2017. The prevalence of overweight and obesity among WCBA varied by age, population group, location, current smoking status and socioeconomic status of women. For most women, the prevalence of overweight and/or obesity in 2017 was significantly higher than in 1998. Significant factors associated with being overweight and obese included increased age, self-identifying with the Black African population group, higher educational attainment, urban area residence, and wealthier socioeconomic quintiles. Smoking was inversely related to being overweight and obese.

Conclusions

The increasing trend in overweight and obesity in WCBA in SA demands urgent public health attention. Increased public awareness is needed about obesity and its health consequences for this vulnerable population. Efforts are needed across different sectors to prevent excessive weight gain in WCBA, focusing on older women, self-identified Black African population group, women with higher educational attainment, women residing in urban areas, and wealthy women.

Unmet needs of hypertension care in Nigeria: results of the community action against non-communicable diseases (COMAAND) project preintervention survey

OBJECTIVE

Assessing the state of hypertension care remains the first step towards planning a robust health system needed to tackle the rising burden of hypertension. Prior to the commencement of the Community Action Against Non-Communicable Disease project, we assessed hypertension care using the hypertension care cascade (HCC). This will serve as a baseline to evaluate project performance upon completion.

METHODS

Hypertensive subjects were grouped into a mutually exclusive care cascade of 5 categories including unscreened and undiagnosed; screened but undiagnosed; diagnosed but untreated; treated but uncontrolled and treated with controlled hypertension.

RESULTS

Of the 372 participants, mean age 48.9 years, 161 (43.3%) were hypertensive, of whom only 12.0% had controlled blood pressure (BP). Among the 88.0% with uncontrolled BP,19.0% were unscreened and undiagnosed, 48.5% were screened but undiagnosed, 13.0% were diagnosed but untreated and 7.5% were treated but BP uncontrolled. The HCC demonstrates that 19% of the hypertensive patients were lost at the screening stage, 60% of those who were screened never diagnosed, 40% of those who were diagnosed did not receive treatment and 60% of those who were on treatment did not reach target BP.

CONCLUSION

Unmet need of hypertension care is substantially high, thus underpinning the need for intervention with a multifaceted approach.