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

Lifestyle Factors, Sociodemographic Characteristics and Incident Hypertension: A Prospective Analysis of the Korean National Health Insurance Service Sample Cohort

BACKGROUND

Hypertension is a significant chronic disease globally, and lifestyle modifications are crucial for the prevention of this disease. We conducted a longitudinal analysis of the associations between lifestyle factors and the incidence of hypertension, stratified by sociodemographic characteristics.

METHODS

We analyzed 113,022 adults (65,315 men), aged 20 years or older from the Korean National Health Insurance Service-National Sample Cohort 2.0 who participated in health screening between 2002 and 2003. Lifestyle factors (smoking, drinking, physical activity) were assessed at baseline using self reports, and incident hypertension was defined based on physician diagnoses. Cox proportional hazards regression models were used to assess associations.

RESULTS

During an 11.6-year follow-up, 26,812 new cases of hypertension were identified. The risk of hypertension was high among men and women who smoked over 20 cigarettes daily (men: hazard ratio [HR]: 1.15; 95% confidence interval [CI], 1.08-1.21; women: HR: 1.62; 95% CI 1.17-2.25) and those who drank over 1.5 bottles of alcohol daily (men, HR: 1.18; 95% CI, 1.12-1.24; women, HR: 1.23; 95% CI 1.02-1.47). These associations tended to be high in high-income men (HR: 1.09; 95% CI, 1.04-1.14), low-income women (HR: 1.19; 95% CI, 1.05-1.35) and non-obese women (HR: 1.13; 95% CI, 1.01-1.27) who currently smoked. Physical activity was inversely associated with incident hypertension in men (HR: 0.96; 95% CI, 0.93-0.99).

CONCLUSIONS

Unhealthy lifestyle factors, such as heavy smoking and drinking, was associated with an increased risk of hypertension, with variations by income, BMI, and sex. These findings underscore the importance of tailored, population-specific prevention strategies to address hypertension disparities.

Delivering effective, comprehensive, multi-exercise component cardiac rehabilitation (CR) for chronic heart failure patients in low resource settings in sub-Saharan Africa: Queen Elizabeth Central Hospital-(QECH-CR) randomised CR study, Malawi

BACKGROUND

The delivery of Cardiac Rehabilitation (CR) and attaining evidence-based treatment goals are challenging in developing countries, such as Malawi. The aims of this study were to (i) assess the effects of exercise training/ CR programme on cardiorespiratory and functional capacity of patients with chronic heart failure (CHF), and (ii) examine the effectiveness of a novel, hybrid CR delivery using integrated supervised hospital- and home-based caregiver approaches.

METHODS

A pre-registered (UMIN000045380), randomised controlled trial of CR exercise therapy in patients with CHF was conducted between September 2021 and May 2022. Sixty CHF participants were randomly assigned into a parallel design-exercise therapy (ET) (n = 30) or standard of care (n = 30) groups. Resting hemodynamics, oxygen saturation, distance walked in six-minutes (6MWD) and estimated peak oxygen consumption (VO2 peak) constituted the outcome measures. The exercise group received supervised, group, circuit-based ET once weekly within the hospital setting and prescribed home-based exercise twice weekly for 12 weeks. Participants in both arms received a group-based, health behaviour change targeted education (usual care) at baseline, 8-, 12- and 16-weeks.

RESULTS

Most of the participants were female (57%) with a mean age of 51.9 ±15.7 years. Sixty-five percent (65%) were in New York Heart Association class III, mostly with preserved left ventricular ejection fraction (HFpEF) (mean Left Ventricular Ejection Fraction 52.9 ±10.6%). The 12-weeks ET led to significant reductions in resting haemodynamic measures (all P <0.05). The ET showed significantly higher improvements in the 6MWD (103.6 versus 13.9 m, p<0.001) and VO2 peak (3.0 versus 0.4 ml·kg-1·min-1, p <0.001). Significant improvements in 6MWD and VO2 peak (both p<0.001), in favour of ET, were also observed across all follow-up timepoints.

CONCLUSION

This novel, randomised, hybrid ET-based CR, delivered to mainly HFpEF patients using an integrated hospital- and home-based approach effectively improved exercise tolerance, cardiorespiratory fitness capacities and reduced perceived exertion in a resource-limited setting.

Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi

BACKGROUND

Little is known about the burden or management of distal radius fractures (DRFs) in low- and middle-income countries. The purpose of this study was to describe the care of DRFs in Malawi.

METHODS

We retrospectively reviewed a registry of all patients with fractures who presented to the orthopaedic departments at four public hospitals in Malawi.

RESULTS

Totally, 1,440 patients (14.5%) were with a DRF. Average age was 40, and 888 (62.0%) were male. Surgery was done for 122 patients (9.5%). Patients presenting to Queen Elizabeth Hospital, patients presenting after a fall, and patients initially evaluated by an orthopaedic registrar or orthopaedic clinical officer had lower odds of receiving surgical treatment. Meanwhile, open injuries had the greatest odds of receiving surgery.

CONCLUSION

The most common musculoskeletal injury among patients in the Malawi Fracture Registry was fractures of the distal radius. These most affected young adult male patients may benefit from surgery; however, the majority were managed nonsurgically. Lack of access to surgical fixation and conservative follow-up may have long-term functional consequences in a predominantly agrarian society. Outcomes-based research is needed to help guide management decisions and standardize patient care and referral protocols.

Association of migration and family planning use among women in Malawi: Evidence from 2019/2020 Malawi Multiple Indicators Survey

BACKGROUND

Family planning (FP) is known to bring multiple benefits to people both individually and collectively. Individually, FP has been associated with reduction in risk of unintended pregnancy which also correlates with low child mortality rates. Child mortality rates in women with child spacing of less than two years are 45% higher compared to their counterparts with child spacing of more than two years. Several factors that predict FP utilisation among women of childbearing age have been identified but there is limited literature on how migration impacts FP utilisation in Malawi. Our current study aimed at assessing the association between migration and modern contraceptive use among women of childbearing age in Malawi.

METHODS

Data for this study came from a nationally representative 2019/20 Malawi multiple cluster indicator survey (MICS). At total of 24,543 women aged 15 to 49 participated in the survey. Contraceptive prevalence rate (CPR) analyses were conducted separately on all women of childbearing age and married women. The data was analysed using the complex survey data approach by applying sampling weights to correct unequal representation of participants at cluster, district, and regional level. We used binary logistic regression to assess association between migration status and modern contraceptive use among all women of childbearing age and married women separately. We included age, age at first sex, age at marriage, region of residence, education, residence wealth index and presence of disability as confounders in our final multivariable models.

RESULTS

The overall CPRs for married women and for all women of childbearing age were 64.7% and 40.5% respectively. The CPRs for all women of childbearing age were 40.5% for non-migrants and 33.0% for migrant women. For married women, CPRs were 51.5% for migrant women and 65.5% for non-migrant women. The fully adjusted odds ratios for the association between migration status and modern contraceptive use were 0.62 (0.49-0.78) for married women and 0.65 (0.52-0.80) for all women of childbearing age.

CONCLUSIONS

We conclude from our findings that migrant women were significantly less likely to utilize modern contraceptive methods for both married women and all women of childbearing age. Deliberate efforts are required to ensure that migrant women of childbearing age have equal access to sexual and reproductive health services which includes family planning.

Urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old: evidence from a cross-sectional study in Tibet

OBJECTIVE

To assess urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old.

DESIGN

A three-stage, stratified, cluster sampling was used to randomly select eligible individuals from July to October 2020. The data of participants, including demographic characteristics, altitude of residence, and nutritional status, were collected via questionnaire and physical examination.

SETTING

Tibet, China.

PARTICIPANTS

Children under 5 years old in Tibet.

RESULTS

Totally, 1975 children under 5 years old were included in this study. We found that an additional 1000 m increase in altitude was associated with decreased Z-scores of height-for-age (β = -0·23, 95 % CI: -0·38, -0·08), Z-scores of weight-for-age (β = -0·24, 95 % CI: -0·39, -0·10). The OR for stunting and underweight were 2·03 (95 % CI: 1·51 to 2·73) and 2·04 (95 % CI: 1·38 to 3·02) per 1000 m increase in altitude, respectively; and OR increased rapidly at an altitude above 3500 m. The effects of long-term exposure to high altitudes on the prevalence of underweight in rural children were higher than that in urban children (P < 0·05).

CONCLUSIONS

High-altitude exposure is tightly associated with malnutrition among children under 5 years old. Improving children's nutrition is urgently needed in areas above 3500 m, especially in rural ones.

Urban-rural differences in the association between long-term exposure to ambient air pollution and obesity in China

INTRODUCTION

Ambient air pollution might increase the risk of obesity; however, the evidence regarding the relationship between air pollution and obesity in comparable urban and rural areas is limited. Therefore, our aim was to contrast the effect estimates of varying air pollution particulate matter on obesity between urban and rural areas.

METHODS

Four obesity indicators were evaluated in this study, namely, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Exposure to ambient air pollution (e.g., particulate matter with aerodynamic diameters 1.0 μm [PM₁], PM_2.5, and PM₁₀) was estimated using satellite-based random forest models. Linear regression and logistic regression models were used to assess the associations between air pollution particulate matter and obesity. Furthermore, the effect estimates of different air pollution particulates were contrasted between urban and rural areas.

RESULTS

A total of 36,998 participants in urban areas and 31, 256 in rural areas were included. We found positive associations between long-term exposure to PM₁, PM_2.5, and PM₁₀ and obesity. Of these air pollutants, PM_2.5 had the strongest association. The results showed that the odds ratios (ORs) for general obesity were 1.8 (95% CI, 1.64 to 1.98) per interquartile range (IQR) μg/m³ increase in PM₁, 1.89 (95% CI, 1.71 to 2.1) per IQR μg/m³ increase in PM_2.5, and 1.74 (95% CI, 1.58 to 1.9) per IQR μg/m³ increase in PM₁₀. The concentrations of air pollutants were lower in rural areas, but the effects of air pollution on obesity of rural residents were higher than those of urban residents.

CONCLUSION

Long-term (3 years average) exposure to ambient air pollution was associated with an increased risk of obesity. We observed regional disparities in the effects of particulate matter exposure from air pollution on the risk of obesity, with higher effect estimates found in rural areas. Air quality interventions should be prioritized not only in urban areas but also in rural areas to reduce the risk of obesity.