Body mass index and waist circumference in Mozambique: urban/rural gap during epidemiological transition

Prevalence of Cardiovascular Risk Factors among Young Adults (18-25 Years) in Mozambique

The life course development of cardiovascular diseases (CVDs) and the undergoing epidemiological transition in Mozambique highlight the importance of monitoring the cardiovascular risk profile in young adults. Therefore, this study aims to estimate the prevalence of CVD risk factors in a population aged 18-25 years living in Mozambique. A total of 776 young adults from a nationally representative sample were evaluated in 2014/2015 following the World Health Organization's STEPwise approach to chronic disease risk factor surveillance. Current smoking was the most prevalent among rural men (10.8%, 95%CI: 6.3-17.8), and drinking was most prevalent among urban men (38.6%, 95%CI: 29.3-48.8). The proportion of young adults not engaging in at least 75 min of vigorous physical activity per week ranged between 14.5% in rural men and 61.6% in urban women. The prevalence of being overweight/obese and hypertension were highest among urban women (21.6%, 95%CI: 14.7-30.6) and urban men (25.2%, 95%CI: 15.9-37.6), respectively. Education >8 years (vs. none) was independently associated with lower odds of being a current smoker, and increased monthly household income was associated with increased odds of low levels of physical activity. This study shows that important CVD risk factors are already common in the young adult population of Mozambique.

Global, regional, and national time trends in mortality for stroke, 1990-2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention

BACKGROUND

Despite the fact that stroke is the second leading cause of death globally, a comprehensive and comparable assessment of mortality, and epidemiologic trends has not been conducted for most regions.We estimated the global and regional burden of stroke from 1990 to 2019 using data from the 2019 Global Study of Diseases, Injuries, and Risk Factors.

METHODS

For the period between 1990 and 2019, we used an age-period-cohort model to calculate the annual percentage changes in mortality (net drifts), local drifts, and period and cohort relative risks (period/cohort effects). Meanwhile, to quantify the temporal trends in stroke age-standardised mortality rate (ASMR), Average annual percentage changes (AAPCs) were determined by sex, area. With the potential to uncover disparities and treatment gaps in stroke care, this approach enables the examination and differentiation of age, period, and cohort effects in mortality trends.

FINDINGS

Global stroke deaths in 2019 were 6,552,725 (95% UI 5,995,200 to 7,015,139). Between 1990 and 2019, the ASMR declined globally by 36.43% (95% UI -41.65 to -31.2), with decreases in all SDI quintiles. The net drift in stroke mortality from 1990 to 2019 varied from -2.83% per year (95% confidence interval [CI]:-3.39 to -2.77) in countries with a high Socio-demographic Index (SDI) to -1.21% per year (95% CI: -1.26 to -1.16) in countries with a low SDI. During the past 30 years, favorable mortality reductions were generally found in high-SDI countries (net drift = -3.1% [95% CI: -3.4 to -2.8] per year) and high-middle SDI countries (-2.8% [-3.0 to -2.6]). However, 31 of 204 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥ - 0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high and high-middle SDI countries, with the exceptions of Kuwait, Ukraine, Kazakhstan, Guam, RussianFederation, Lithuania, Turkey, Montenegro, Serbia, Bosnia and Herzegovin, and Bulgaria.

INTERPRETATION

Notwithstanding mortality from stroke has increased globally over the past 30 years, adverse period and cohort effects have been found in many countries, calling into question the adequacy of healthcare for stroke patients of all ages. These lapses have a significant impact on the likelihood of achieving the Sustainable Development Goal (SDG) targets on mortality from age 60+ and NCDs.

Cardiovascular risk factors across different levels of urbanization in Brazilian Afro‐derived communities ( quilombos )

OBJECTIVES

The frequency of cardiovascular diseases has increased throughout the world. People of African descent have been disproportionately affected, particularly if they reside in urban settings. In this work, we evaluate risk factors associated with cardiovascular diseases (CVD) and other chronic diseases in rural and urban Afro-derived communities (quilombo) in Central Brazil. We also determine if there are associations between the frequency of CVD risk factors, sex, and proximity to urban environments.

METHODS

Through a cross-sectional study of participants (n = 347) within three Brazilian Afro-derived communities: Kalunga (a semi-isolated rural community; n = 214), Cocalinho (a non-isolated rural village; n = 70), and Pé do Morro (an urban community; n = 63), we collected data regarding chronic disease (i.e., CVD, diabetes, and hypertension) risk through questionnaires, anthropometrics, blood pressure, and blood samples using standard protocols. Differences between variables were tested by the Chi-square test of Pearson and Fisher's Exact Test, independent sample t-tests, analysis of variances, and Kruskal-Wallis tests (p ≤ .05).

RESULTS

The prevalence of hypertension, overweight, obesity, and other cardiovascular risk factors were higher in the non-isolated rural and urban communities than in the semi-isolated rural community. We found significant sex differences in the distribution of the CVD risk factors, with all occurring at a higher frequency among females.

CONCLUSIONS

Our findings indicate that Brazilian Afro-derived communities are currently going through an epidemiological transition. The urban lifestyle and its environmental factors are likely contributing to an escalation in cardio-metabolic disease risk. However, the magnitude of this transition differentially impacts the sexes, as females suffer a higher frequency of risk factors compared to males.

Factors Associated with Over-Nutrition Among Men 15-54 years in Uganda: A National Survey

Background

Globally and in Sub-Saharan Africa (SSA), the prevalence of overweight and obesity are on the rise. Data on overweight and obesity among men are scarce.

Objective

We aimed to determine the prevalence and factors associated with over-nutrition among men in Uganda.

Methods

We used Uganda Demographic and Health Survey (UDHS) 2016 data of 5,408 men aged 15 to 45 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Multivariable logistic regression was used to determine factors associated with over-nutrition among 15 to 54-year-old men in Uganda.

Results

The prevalence of over nutrition was 9.1%, where that of overweight was 7.9% (95% CI 7.2-8.7 and obesity was1.2% (95% CI 0.9-1.5). Men who were aged 25 to 34 (AOR = 3.28; 95% CI: 1.92-5.59), 35-44 (AOR = 4.51; 95% CI: 2.61-7.82) and 45 to 54 (AOR = 4.28; 95% CI: 2.37-7.74) were more likely to have over-nutrition compared to those aged 15 to 24 years. Married men (AOR=2.44; 95% CI: 1.49-3.99) were 2 times more likely to have over-nutrition than men who were not married. Men in the central region (AOR = 1.78; 95% CI: 1.22-2.60) were 1.78 times more likely to have over-nutrition than men in the northern region. Men who were in the richest wealth index quintiles were 10 times more likely to have over-nutrition compared to those in the poorest wealth index quintile (AOR = 9.38: 95 % CI 5.14-17.10).

Conclusion

The factors associated with over-nutrition among Ugandan men in our study were increasing age, marital status, increasing wealth and region of origin. This shows the need for measures to abate the regional development inequalities, need to promote physical activity among older men and need to improve on the knowledge of nutrition and dietetic practices for married couples and men of different social classes.

Social determinants and behaviors associated with overweight and obesity among youth and adults in a peri-urban area of Maputo City, Mozambique

BACKGROUND

Overweight and obesity are important risk factors for non-communicable diseases (NCDs) such as cardiovascular diseases (CVD), type 2 diabetes and certain cancers. NCDs are responsible for an increased number of deaths worldwide, including in developing countries. We aimed to determine the prevalence of overweight and obesity among youth and adults in a peri-urban area of Maputo city, Mozambique, and to assess their social and behavioral determinants.

METHODS

A cross-sectional study was conducted in a Health and Demographic Surveillance System (HDSS) area in Maputo city. We measured BMI and interviewed 15-64-year-old inhabitants to assess sociodemographic and behavioral characteristics using the STEPwise Approach methodology. A household wealth index was derived through Principal Component Analysis of various household assets and physical activity (PA) was measured using pedometers and accelerometers. Univariable and multivariable analyses were conducted to determine associations between overweight/obesity and social and behavioral determinants.

RESULTS

Among a total of 931 participants, the prevalence of overweight (BMI≥25 kg/m2) and obesity (BMI≥30 kg/m2) was 30.9% (95% confidence interval (CI) = 28.0, 33.9) and 12.6% (95% CI = 10.4, 14.7), respectively; one in every 10 youths and adults were underweight. Being female, older and living in a wealthier household were found to be significantly associated with overweight and obesity. Those with higher levels of education were found to have a reduced risk of being obese compared to those with no or lower levels of education. Behavioral risk factors (diet, alcohol and tobacco consumption and physical activity) did not significantly increase the risk of overweight and obesity.

CONCLUSIONS

Overweight and obesity are highly prevalent in this peri-urban part of the Mozambican capital, where underweight is still present in youth and adults, confirming that the country is facing a double burden of malnutrition. Social determinants of health should be taken into consideration in the design and implementation of NCD prevention programs.

Prevalence and risk factors for overweight and obesity: a cross-sectional countrywide study in Burkina Faso

OBJECTIVE

The objective of this study was to determine the prevalence and predictors of overweight and obesity in Burkina Faso using a population-based countrywide sample. We hypothesise that there is a significant burden related to overweight/obesity in Burkina Faso.

DESIGN

Secondary analysis of a population-based countrywide cross-sectional study.

SETTING

Burkina Faso, all the 13 regions including both rural and urban residential areas.

PARTICIPANTS

4800 participants of both sexes, aged between 25 and 64 years.

MAIN OUTCOMES

Overweight and obesity using body mass index cut-off levels of the WHO.

RESULTS

The prevalence of overweight and obesity in Burkina Faso were 13.82% (95% CI: 12.25 to 15.55) and 4.84% (95% CI: 3.99 to 5.86), respectively. Among men, the proportional odds of overweight/obesity increase with urban residency (p<0.001), greater age (p<0.002), marital status different from single (p≤0.007) and decrease with current smoking (p=0.009). Among women, the proportional odds of overweight/obesity increase with urban residency (p<0.001), primary educational level (p=0.01), high total blood cholesterol level (p<0.001) and high fasting blood glucose level (p=0.02), and decrease with current smoking (p<0.001).

CONCLUSION

Our study showed that nearly one person out of five in the adult population of Burkina has an abnormal weight status with women being more affected than men. Urban residency is a consistent risk factor in both men and women. Alcohol consumption and education were associated with an increased odds in only women. Overnutrition needs to be recognised as an important public health issue in Burkina Faso and nutrition interventions need to be reshaped to account for it.

Reducing the Number of People with Dementia Through Primary Prevention in Mozambique, Brazil, and Portugal: An Analysis of Population-Based Data

Background:

Most people with dementia live in low- and middle-income countries and little is known about the potential for reducing these numbers by reducing key risk factors.

Objective:

To investigate the potential for dementia incidence reduction in Brazil, Mozambique, and Portugal (a culturally related, high-income country).

Methods:

We replicated previously published methods and based on the relative risks from previous studies, we estimated the population-attributable risk (PAR) of dementia in Mozambique, Brazil, and Portugal for seven modifiable risk factors associated with dementia (low educational attainment, physical inactivity, midlife hypertension, midlife obesity, depression, smoking, and diabetes mellitus). The combined PAR was calculated and adjusted for associations between risk factors. The potential for risk factor reduction was assessed by examining the effect of relative reductions of 10% and 20% per decade for each of the risk factors on projections for dementia cases for each decade until 2050.

Results:

After adjusting for non-independence of risk factors, 24.4%, 32.3%, and 40.1% of dementia cases could be related to seven potentially modifiable risk factors in Mozambique, Brazil, and Portugal, respectively. Reducing the prevalence of each risk factor by 20% per decade could, by 2050, potentially reduce the prevalence of dementia in Mozambique, Brazil, and Portugal by 12.9%, 16.2%, and 19.5%, respectively.

Conclusion:

There is a substantial difference between the countries in the percentage of dementia cases that could be attributable to the seven potentially modifiable risk factors. The proportion of cases that could be prevented by 2050 if measures were taken to address these main risk factors was higher in Portugal than in Brazil and Mozambique. Each country or region should consider their unique risk factor profile when developing dementia risk reduction programs.

Estimating energy expenditure of head-hauling water and grain grinding from heart rate monitor measurements in northern Mozambique

OBJECTIVE

Even though sub-Saharan African women spend millions of person-hours per day fetching water and pounding grain, to date, few studies have rigorously assessed the energy expenditure costs of such domestic activities. As a result, most analyses that consider head-hauling water or hand pounding of grain with a mortar and pestle (pilão use) employ energy expenditure values derived from limited research. The current paper compares estimated energy expenditure values from heart rate monitors v. indirect calorimetry in order to understand some of the limitations with using such monitors to measure domestic activities.

DESIGN

This confirmation study estimates the metabolic equivalent of task (MET) value for head-hauling water and hand-pounding grain using both indirect calorimetry and heart rate monitors under laboratory conditions.

SETTING

The study was conducted in Nampula, Mozambique.

PARTICIPANTS

Forty university students in Nampula city who recurrently engaged in water-fetching activities.

RESULTS

Including all participants, the mean MET value for head hauling 20 litres (20·5 kg, including container) of water (2·7 km/h, 0 % slope) was 4·3 (sd 0·9) and 3·7 (sd 1·2) for pilão use. Estimated energy expenditure predictions from a mixed model were found to correlate with observed energy expenditure (r2 0·68, r 0·82). Re-estimating the model with pilão use data excluded improved the fit substantially (r2 0·83, r 0·91).

CONCLUSIONS

The current study finds that heart rate monitors are suitable instruments for providing accurate quantification of energy expenditure for some domestic activities, such as head-hauling water, but are not appropriate for quantifying expenditures of other activities, such as hand-pounding grain.

Cardiovascular risk and D-dimer levels in HIV-infected ART-naïve Africans

Anti-retroviral therapy (ART) has decreased morbidity and mortality in HIV-infected individuals. With the adoption of the 90-90-90 strategy prevention and control of non-communicable disease, particularly knowledge of the burden and profile of cardiovascular disease, will become increasingly important. Our study assessed cardiovascular risk among recently diagnosed HIV-infected ART-naïve patients in a first referral urban hospital in a low-income country in sub-Saharan Africa. HIV-positive ART-naïve patients were submitted to cardiovascular risk assessment, clinical history, physical examination and laboratory workout, including 12-lead electrocardiography, portable transthoracic echocardiography, glycemia, lipidemia, hemogram and D-dimers. Three years after the diagnosis their vital status and occurrence of major cardiovascular events was assessed. We recruited 70 patients, all of black ethnicity (41 females; mean age 37±10.7). CD4 levels were very low (mean 21.3 cells/mL; SD 10.4). Twenty-one (26.6%) were overweight, 13 (16.7%) were obese, 19 (20.5%) had hyperglycemia and 20 patients (25.6%) had hypercholesterolemia. The median blood pressure was 119.5/79 mmHg (IQR 107-141/67-83); 20 patients (25.6%) had hypertension. Four (5.7%) patients had signs of heart failure, and left ventricular ejection fraction was reduced in 17 (25%). High levels of circulating D-dimers were found in 44 (62.8%) patients; the mean levels were 725.9 (SD 555.1). We found high occurrence of cardiovascular risk factors, left ventricular dysfunction and evidence of a pro-coagulant state in these HIV-infected ART-naïve patients. Active cardiovascular risk screening and stratification, as well as management protocols tailored to low-income settings are needed to sustain the gains obtained with increased availability of ART in Africa.

The silent epidemic of obesity in The Gambia: evidence from a nationwide, population-based, cross-sectional health examination survey

OBJECTIVES

Non-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia.

DESIGN

Nationwide cross-sectional health examination survey using the WHO STEPwise survey methods.

SETTING

The Gambia.

PARTICIPANTS

This study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25-64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans).

RESULTS

Two-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women.

CONCLUSION

There is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity.

Prevalence and correlates of objectively measured weight status among urban and rural Mozambican primary schoolchildren: A cross-sectional study

BACKGROUND

The coexistence of undernutrition (thinness) and overnutrition (overweight/obesity) among children and adolescents is a public health concern in low-middle-income countries. Accurate prevalence estimates of thinness and overweight/obesity among children and adolescents are unavailable in many low-middle-income countries due to lack of data. Here we describe the prevalences and examine correlates of objectively measured weight status among urban and rural schoolchildren in Mozambique.

METHODS

A cross-sectional study design was applied to recruit 9-11-year-old schoolchildren (n = 683) from 17 urban and rural primary schools in Mozambique. Body mass index (BMI) was computed from objectively measured height and weight and participants' weight categories were determined using the World Health Organization cut-points. Actigraph GT3X + accelerometers were worn 24 hours per day for 7 days to assess movement behaviours. Multilevel multivariable modelling was conducted to estimate odds ratios and confidence intervals.

RESULTS

Combined prevalence of overweight/obesity (11.4%) was significantly higher among urban participants compared to rural participants (5.7%; χ2 = 7.1; p = 0.008). Conversely, thinness was more prevalent among rural (6.3%) compared to urban (4.2%) participants. Passive school commute, not meeting daily moderate- to vigorous-intensity physical activity (MVPA) guidelines, and maternal BMI >25 kg/m2 were associated with overweight/obesity while possessing one or more functional cars at home, maternal BMI >25 kg/m2 and being an older participant were associated with thinness in the present sample. The proportion of total variance in the prevalences of obesity and/or thinness occurring at the school level was 8.7% and 8.3%, respectively.

CONCLUSION

Prevalences of thinness, overweight/obesity and other key variables differ between urban and rural schoolchildren in Mozambique. MVPA, active transport and mother's BMI are important modifiable correlates of weight status among Mozambican schoolchildren. Results from this study demonstrate important differences between urban and rural schoolchildren that should not be ignored when designing interventions to manage malnutrition, formulating public health strategies, and interpreting findings.

Hypertension in a resource-limited setting: Poor Outcomes on Short-term Follow-up in an Urban Hospital in Maputo, Mozambique

Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short-term outcomes of patients referred to a first referral urban hospital in a low-income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180 mm Hg and/or ≥110 mm Hg, respectively, or any systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5 ± 12.8 years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2 mm Hg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients' risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6-month follow-up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high-risk profile, low hypertension control, and high occurrence of complications during short-term follow-up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.

Body mass index and movement behaviors among schoolchildren from 13 countries across a continuum of human development indices: A multinational cross-sectional study

OBJECTIVE

This study describes the distributions of body mass index (BMI) and movement behaviors among schoolchildren from 13 countries across a continuum of human development.

METHODS

Data were from a cross-sectional study of 9-11-year-old children (n = 8055) recruited from 269 urban schools in 13 countries, and an additional 7 rural schools in one of these countries (Mozambique). BMI was derived from objectively measured heights and weights. Moderate- to vigorous-intensity physical activity (MVPA), sedentary time (SED), and sleep duration were assessed by waist-worn Actigraph GT3X+ accelerometers. Linear models were used to describe the distributions of BMI z-scores, MVPA, SED, and sleep among sites across varying Human Development Indices (HDIs).

RESULTS

Mean MVPA, SED, and sleep duration were 63.1 ± 27.3 minutes/day, 508.7 ± 72.4 minutes/day, and 8.8 ± 0.9 hours/night, respectively. Overall, 2.1% of the sample were thin, 19.5% overweight, and 11.7% were obese. Density curves (BMI z-scores and SED) for urban children in Mozambique showed significantly higher mean values compared with rural children. Boys had significantly higher mean MVPA compared with girls. Mean BMI z-scores were positively associated (β = .02; P = .004) with HDI, mean daily MVPA minutes were negatively associated (β = -.38; P = .025) with HDI, and mean SED time was positively associated with HDI (β = 1.18; P = .049). No significant association (β = .01; P = .29) was observed between sleep duration and HDI.

CONCLUSION

Our findings show distinct differences in BMI and movement behavior profiles between urban and rural children in Mozambique. Mean BMI z-scores, MVPA, and SED differed by country HDI. These findings support the need to include both rural and urban participants in study samples.

Correlation between malnutrition and health-related quality of life (HRQOL) in elderly Iranian adults

Objectives

We aimed to evaluate the association of nutritional status and health-related quality of life (HRQOL) among elderly Iranian residents.

Methods

We used the 36-item Short Form Health Survey (SF-36) to assess HRQOL among participants with normal nutrition status, at risk of malnutrition, and malnourished.

Results

Mean group scores for the Physical Component Summary (PCS) of the SF-36 were 44, 36.5, and 29.0 for normal, at-risk, and malnourished groups, respectively; for the Mental Component Summary (MCS), these were 47.1, 40.7, and 34.8, respectively. The PCS and MCS displayed significant positive correlation with malnutrition in three models: crude (I); age- and sex-adjusted (II); and adjusted for age, sex, education, occupation, marital status, and residence. Standardized beta coefficients of PCS in Models I–III were 1.35, 1.27, and 1.14, respectively; for MCS, these were 1.11 in all three models; all results were statistically significant. Estimated results of logistic regression were −6.023 for malnourished versus well-nourished and −2.652 for malnourished versus at risk of malnutrition.

Conclusion

Our analyses revealed the crucial impact of nutritional status on both mental and physical components of HRQOL.

Prevalence of overweight and obesity in Mozambique in 2005 and 2015

OBJECTIVE

The ongoing demographic, nutritional and epidemiological transitions in sub-Saharan Africa highlight the importance of monitoring overweight and obesity. We aimed to assess the prevalence of overweight and obesity in Mozambique in 2014/2015 and compare the estimates with those obtained in 2005.

DESIGN

Cross-sectional study conducted in 2014/2015, following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95 % CI were computed for different categories of BMI and abdominal obesity, along with age-, education- and income-adjusted OR. The age-standardized prevalence in the age group 25-64 years was compared with results from a STEPS survey conducted in 2005.

SETTING

Mozambique.

PARTICIPANTS

Representative sample of the population aged 18-64 years (n 2595).

RESULTS

Between 2005 and 2014/2015, the prevalence of overweight and obesity increased from 18·3 to 30·5 % (P < 0·001) in women and from 11·7 to 18·2 % (P < 0·001) in men. Abdominal obesity increased among women (from 9·4 to 20·4 %, P < 0·001), but there was no significant difference among men (1·5 v. 2·1 %, P = 0·395). In 2014/2015, the prevalence of overweight and obesity was more than twofold higher in urban areas and in women; in the age group 18-24 years, it was highest in urban women and lowest in rural men.

CONCLUSIONS

In Mozambique, there was a steep increase in the prevalence of overweight and obesity among adults between 2005 and 2014/2015. Overweight and obesity are more prevalent in urban areas and among women, already affecting one in five urban women aged 18-24 years.

Urban and rural dietary patterns are associated with anthropometric and biochemical indicators of nutritional status of adolescent Mozambican girls

OBJECTIVE

The objective of the present study was to explore whether dietary patterns (DP) are associated with nutritional status indicators among adolescent Mozambican girls. Design/Setting/Subjects In this population-based cross-sectional study we used the FFQ data of 547 girls aged 14-19 years from Central Mozambique to derive dietary patterns by means of principal component analysis. We used two-level linear regression models to examine the associations between the DP and anthropometric and biochemical indicators of nutritional status.

RESULTS

We identified three DP: 'Urban bread and fats', 'Rural meat and vegetables' and 'Rural cassava and coconut'. The 'Urban bread and fats' DP was positively associated with BMI-for-age Z-score (BMIZ), mid-upper arm circumference (MUAC), triceps skinfold (P for all<0·001) and blood Hb (P=0·025). A negative association was observed between the 'Urban bread and fats' DP and serum folate (P<0·001). The 'Rural meat and vegetables' DP and the 'Rural cassava and coconut' DP were associated negatively with BMIZ, MUAC and triceps skinfold (P for all<0·05), but the 'Rural meat and vegetables' DP was associated positively with serum ferritin (P=0·007).

CONCLUSIONS

Urban and rural DP were associated with nutritional status indicators. In a low-resource setting, urban diets may promote body fat storage and blood Hb concentrations but compromise serum folate concentration. It is important to continue valuing the traditional, rural foods that are high in folate.

Urinary Sodium and Potassium Excretion and Dietary Sources of Sodium in Maputo, Mozambique

This study aimed to evaluate the urinary excretion of sodium and potassium, and to estimate the main food sources of sodium in Maputo dwellers. A cross-sectional evaluation of a sample of 100 hospital workers was conducted between October 2012 and May 2013. Sodium and potassium urinary excretion was assessed in a 24-h urine sample; creatinine excretion was used to exclude unlikely urine values. Food intake in the same period of urine collection was assessed using a 24-h dietary recall. The Food Processor Plus^® was used to estimate sodium intake corresponding to naturally occurring sodium and sodium added to processed foods (non-discretionary sodium). Salt added during culinary preparations (discretionary sodium) was computed as the difference between urinary sodium excretion and non-discretionary sodium. The mean (standard deviation) urinary sodium excretion was 4220 (1830) mg/day, and 92% of the participants were above the World Health Organization (WHO) recommendations. Discretionary sodium contributed 60.1% of total dietary sodium intake, followed by sodium from processed foods (29.0%) and naturally occurring sodium (10.9%). The mean (standard deviation) urinary potassium excretion was 1909 (778) mg/day, and 96% of the participants were below the WHO potassium intake recommendation. The mean (standard deviation) sodium to potassium molar ratio was 4.2 (2.4). Interventions to decrease sodium and increase potassium intake are needed in Mozambique.

Deficits in anthropometric indices of nutritional status and motor performance among low birth weight children from Maputo City, Mozambique

OBJECTIVE

To evaluate associations between low birth weight (LBW) and anthropometry, body composition, physical fitness, and gross motor coordination among schoolchildren from Maputo, Mozambique.

METHODS

A total of 353 children aged 7 to 10 years old from both genders born in Maputo (Mozambique) were sampled. The sample was divided into two groups: LBW (n = 155) and normal birth weight (NBW, n = 198). Body composition measurements and indices weight-for-age, height-for-age, and weight-for-height were assessed. Physical fitness was assessed by handgrip strength, flexibility, agility, long jump, and running speed. Gross motor coordination was evaluated by using the Korper Koordination Test fur Kinder (KTK) battery.

RESULTS

LBW children were lighter and smaller than NBW children with reduced indices for weight-for-age and height-for-age. They also showed a reduced performance in handgrip strength and sideways movement tests. These differences remained significant even after adjustment for age, gender, body size, and fatness skinfold thickness.

CONCLUSION

LBW seems to be the major factor that influences anthropometry, and is a predictor of low muscle strength and low performance on sideways movement tests. This result suggests that growth faltering in LBW children is associated with adverse health consequences, even after controlling for gender, age, fatness, and body size.

Complex association between rural/urban residence, household wealth and women's overweight: evidence from 30 cross-sectional national household surveys in Africa

BACKGROUND

We sought to demonstrate that the relationship between urban or rural residence and overweight status among women in Sub-Saharan Africa is complex and confounded by wealth status.

METHODS

We applied multilevel logistic regression to data from 30 sub-Saharan African countries which were collected between 2006 and 2012 to examine the association between women's overweight status (body mass index ≥ 25) and household wealth, rural or urban place of residence, and their interaction. Macro-level statistics from United Nations agencies were used as contextual variables to assess the link between progress in globalization and patterns of overweight.

RESULTS

Household wealth was associated with increased odds of being overweight in nearly all of the countries. Urban/rural living and household wealth had a complex association with women's overweight status, shown by 3 patterns. In one group of countries, characterised by low national wealth (median per capita gross national income (GNI) = $660 in 2012) and lower overall prevalence of female overweight (median = 24 per cent in 2010), high household wealth and urban living had independent associations with increased risks of being overweight. In the second group of less poor countries (median per capita GNI = $870) and higher national levels of female overweight (median = 29), there was a cross-over association where rural women had lower risks of overweight than urban women at lower levels of household wealth, but in wealthier households, rural women had higher risks of overweight than urban women. In the final group of countries, household wealth was an important predictor of overweight status, but the association between urban or rural place of residence and overweight status was not statistically significant. The median per capita GNI for this third group was $800 and national prevalence of female overweight was high (median = 32% in 2010).

CONCLUSIONS

As nations develop and household wealth increases, rural African women are at increased or higher risk of being overweight compared with urban women. Programmes and policies to address rising prevalence of overweight are needed in both rural and urban areas to avoid serious epidemics of non-communicable diseases.

Population-based survey of overweight and obesity and the associated factors in peri-urban and rural Eastern Uganda

Background

In sub-Saharan Africa (SSA), the rising prevalence of overweight, obesity and non-communicable diseases co-exists with the high burden of under-nutrition. The paucity of data on adulthood overweight and obesity, disaggregated by socio-demographic characteristics and in rural settings in SSA calls for research. We determined the prevalence of underweight, overweight/obesity and associated factors among adults in peri-urban and rural Uganda.

Methods

A cross-sectional study of 1210 randomly selected adults aged ≥ 18 years was conducted in Iganga-Mayuge Health and Demographic Surveillance Site in eastern Uganda in 2013. Height, weight and socio-demographic variables were assessed. Overweight was defined as BMI = 25.0-29.99 kg/m², obesity ≥ 30 kg/m² and overweight/obesity ≥ 25 kg/m². Logistic regression was used to identify factors associated with overweight/obesity.

Results

Of the participants, 7 % were underweight (8.1 % of men; 5.9 % of women, p = 0.99); 17.8 % were overweight (12.4 % of men; 23.1 % of women, p < 0.001); and 7 % were obese (2.0 % of men; 12.7 % of women, p < 0.001). Overweight prevalence was 15.8 % and 23.8 % among rural and peri-urban adults, respectively (p < 0.001). Obesity prevalence was 3.9 % and 17.8 % among rural and peri-urban adults, respectively (p < 0.001). Factors associated with overweight/obesity were: being female, adjusted odds ratio (AOR) 4.3 (95 % confidence interval (PloS one 8:e75640, 20013) 3.2–5.9); peri-urban residence AOR 2.6 (1.9–3.6); being in age group 35–44, AOR 3.1 (1.8–5.3); 45–54 AOR 4.1 (2.3–7.3); 55–64 AOR 2.6 (1.4–5.0); ≥ 65 years AOR 3.1 (1.6–6.0); and having socio-economic status (SES) in the third AOR 2.8 (1.7–4.6), fourth 2.5 (1.5–4.2) and fifth 2.7 (1.6–4.4) quintile.

Conclusions

Overweight/obesity was prevalent among adults. Overweight/obese was associated with being female, being aged 35 years and older, residing in a peri-urban area and having a higher SES. The time has come to develop interventions to prevent and control overweight/obesity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2506-7) contains supplementary material, which is available to authorized users.

Differing patterns of overweight and obesity among black men and women in Cape Town: the CRIBSA study

Objectives

To ascertain the prevalence and determinants of overweight/obesity in the 25–74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09.

Methods

In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Data were collected by questionnaires, clinical measurements and biochemical analyses. Gender-specific linear regression models evaluated the associations with overweight/obesity.

Results

There were 1099 participants, 392 men and 707 women (response rate 86%) in 2008/09. Mean body mass index (BMI) and waist circumference (WC) were 23.7 kg/m² (95% confidence interval (CI): 23.1–24.2) and 84.2 cm (95% CI: 82.8–85.6) in men, and 33.0 kg/m² (95% CI: 32.3–33.7) and 96.8 cm (95% CI: 95.5–98.1) in women. Prevalence of BMI ≥25 kg/m² and raised WC were 28.9% (95% CI: 24.1–34.3) and 20.1% (95% CI: 15.9–24.9) in men, and 82.8% (95% CI: 79.3–85.9) and 86.0% (95% CI: 82.9–88.6) in women. Among 25–64-year-olds, BMI ≥25 kg/m² decreased between 1990 (37.3%, 95% CI: 31.7–43.1) and 2008/09 (27.7%, 95% CI: 22.7–33.4) in men but increased from 72.7% (95% CI: 67.6–77.2) to 82.6% (95% CI: 78.8–85.8) in women. In the regression models for men and women, higher BMI was directly associated with increasing age, wealth, hypertension and diabetes but inversely related to daily smoking. Also significantly associated with rising BMI were raised low-density lipoprotein cholesterol and being employed compared to unemployed in men, and having >7 years of education in women.

Conclusions

Overweight/obesity, particularly in urban black women, requires urgent action because of the associations with cardiovascular disease risk factors and their serious consequences.

A Cross-Sectional Study on the Diet and Nutritional Status of Adolescent Girls in Zambézia Province, Mozambique (the ZANE Study): Design, Methods, and Population Characteristics

BACKGROUND

There is very little published work on dietary intake and nutritional status of Mozambicans. We conducted a population-based cross-sectional study on the diet and nutritional status of adolescent girls in different types of communities in Zambézia Province, Central Mozambique, in two distinct seasons.

OBJECTIVE

The purpose of this paper is to present the design, methods, and study population characteristics of the Estudo do Estado Nutricional e da Dieta em Raparigas Adolescentes na Zambézia (the ZANE Study).

METHODS

Data was collected in January-February 2010 ("hunger season") and in May-June 2010 ("harvest season"). A total of 551 girls in the age group 14-19 years old were recruited from one urban area and two districts (district towns and rural villages). The study protocol included a background interview, a 24-hour dietary recall interview, a food frequency questionnaire, anthropometric measurements, bioimpedance, hemoglobin measurement, and venous blood, urine, buccal cell, and fecal sampling.

RESULTS

Adolescent motherhood was common in all study regions. Stunting prevalence for the total study population as a weighted percentage was 17.8% (95/549; 95% CI 14.3-22.0) with no regional differences. Overweight was found mainly in the urban area where the prevalence was 12.6% (20/159; 95% CI 7.5-17.6), thinness was rare. There were regional differences in the prevalence of malaria parasitemia and intestinal helminth infestation, but not human immunodeficiency virus.

CONCLUSIONS

The fully analyzed data from the ZANE Study will yield results useful for setting priorities in nutrition policy and further research on the diet and nutritional status in Mozambique and other countries with similar nutritional problems.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01944891; http://www.clinicaltrials.gov/ct2/show/NCT01944891 (Archived by WebCite at http://www.webcitation.org/6L9OUrsq8).

Anthropometric measurements and prevalence of underweight, overweight and obesity in adult Malawians: nationwide population based NCD STEPS survey

INTRODUCTION

Overweight and obesity are significant causes of increased morbidity and premature mortality from non-communicable diseases, particularly in sub-Saharan Africa, although local high quality population-based data to inform policies and strategies are lacking.

METHODS

Using the WHO STEPwise approach to chronic disease risk factor surveillance, population-based nationwide survey was conducted on participants aged 25-64 years in Malawi. A multi-stage cluster sample design and weighting were used to produce a national representative data for that age range.

RESULTS

A total of 4845 participants (65.7% females, 87.6% from rural areas) had complete anthropometric data and included in this analysis. Overall (both sexes) population-based mean body weight, height, systolic blood pressure, diastolic blood pressure, blood glucose and cholesterol were estimated at 58.7 kg, 159.9 cm, 133.4 mmHg, 79.5 mmHg, 4.3 mmol/L, 4.4 mmol/L respectively. Prevalence of underweight, overweight, obesity, overweight and/ or obesity and central adiposity were 6.5%, 17.3%, 4.6%, 21.9% and 28.8% respectively. Overweight, obesity, overweight and/ or obesity and central adiposity were more frequent in females than males (20.7% vs 14.1%, 7.4% vs 2.0%, 28.1% vs 16.1% and 52.8% vs 5.6%), in urban than rural areas (23.2% vs 16.6%, 12.0% vs 3.7%, 35.2% vs 20.2%) respectively.

CONCLUSION

This study demonstrated that overweight and/ or obesity is the major public health problem affecting at least one in five adults in Malawi. The problem is more frequent in females than males and urban than rural. Implementation of primary health care approaches such as WHO package for essential non-communicable diseases could reduce the problem.

Tobacco consumption in Mozambique: use of distinct types of tobacco across urban and rural settings

INTRODUCTION

Monitoring tobacco consumption patterns is essential to define and evaluate strategies to control the tobacco epidemic. We aimed to quantify the use of smoked (manufactured/hand-rolled cigarettes) and smokeless (snuff/chew) tobacco, according to sociodemographic characteristics, in adult Mozambicans.

METHODS

A national representative sample (n = 3,323) of subjects aged 25-64 years was evaluated in 2005 following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS), which included the assessment of tobacco consumption with the quantification of each type of tobacco used daily. We computed prevalences, and age- and education-adjusted prevalence ratios (PRs), with 95% CIs.

RESULTS

Daily smoking was reported by 9.1% (95% CI = 5.0-13.1) of women (manufactured, 3.4%; hand-rolled, 5.6%) and 33.6% (95% CI = 29.3-38.0) of men (manufactured, 18.7%; hand-rolled, 14.8%). Daily manufactured cigarette smoking was significantly more frequent in men (urban: PR = 14.62, 95% CI = 7.59-28.55; rural: PR = 4.32, 95% CI = 2.42-7.71). Daily hand-rolled cigarette smoking was three- to fourfold more frequent among men and nearly 80% less frequent in urban areas, regardless of sex. The prevalence of daily smokeless tobacco use was 7.4% (95% CI = 4.6-10.2) in women (chew, 6.4%; snuff, 1.0%) and 3.4% (95% CI = 1.7-5.2) in men (chew, 1.6%; snuff, 1.8%). Daily smokeless tobacco consumption was significantly less frequent in urban areas only among men (PR = 0.05, 95% CI = 0.01-0.33).

CONCLUSIONS

Despite the relatively low levels of manufactured cigarette smoking, traditional forms of tobacco consumption are frequent, especially among women and in rural settings, showing the need for control measures to target specifically different patterns of consumption.

Non-communicable diseases in Mozambique: risk factors, burden, response and outcomes to date

Mozambique is located on the East Coast of Africa bordering South Africa, Zimbabwe, Zambia, Malawi and Tanzania and is one of the poorest countries in the world. Currently NCDs account for 28% of deaths in Mozambique. Risk factors such as tobacco and alcohol use and poor diet are present in both urban and rural settings. Diseases such as hypertension and diabetes affect large proportions of the population, but people are often unaware of their condition or poorly managed. Data from studies on diabetes highlight the financial burden for NCD management in Mozambique for both the individual and health system. The National Strategic Plan for the prevention and control of NCDs in Mozambique has as its aim to create a positive environment to minimise or eliminate the exposure to risk factors and guarantee access to care. The plan has as its overall objective to reduce exposure to risk factors and morbidity and mortality due to NCDs and has 4 areas of intervention: 1) Prevention and health education with regards to NCDs; 2) Access to quality care, treatment and follow-up; 3) Prevention of disability and premature mortality and 4) Surveillance, research, monitoring and evaluation and advocacy for NCDs. The Ministry of Health developed projects for diabetes and hypertension and used these as key lessons that could then be applied to other NCDs. Mozambique, through political commitment from the Ministry of Health and the dedication of local champions, has been able to garner international support to improve care for people with diabetes and then use this to develop its National Plan for NCDs. Despite this increase in attention resources available do not match the challenge of NCDs in Mozambique. Mozambique’s experience provides a practical example of actions that can be undertaken in a resource poor country to tackle the emerging burden of NCDs.

Physical activity patterns in Mozambique: urban/rural differences during epidemiological transition

OBJECTIVE

To assess the socio-demographic determinants of physical activity, by intensity and domain, across urban and rural areas in Mozambican adults.

METHOD

A national representative sample (n=3323) of subjects aged 25-64 years was evaluated in 2005 following the World Health Organization (WHO) Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS), which includes the Global Physical Activity Questionnaire. We computed prevalences, and age- and education-adjusted prevalence ratios (PR), with 95% confidence intervals (95%CI).

RESULTS

Most of the Mozambicans reported a high physical activity level, according to the WHO criteria (urban women: 83.2%, 95%CI 77.4, 89.0; rural women: 93.2%, 95%CI 89.0, 97.3; urban men: 78.9%, 95%CI 74.7, 83.1; rural men: 91.6%, 95%CI 85.5, 97.6). The prevalences of <75 min/week of vigorous activities were higher in urban settings (women: PR=2.21; men: PR=2.28) and increased with education, regardless of place of residence (PR ranging between 1.75 and 5.72 for more vs. less educated subjects). Work activities were the most important contributor to the overall physical activity, followed by transport.

CONCLUSION

Most of the Mozambicans reported to be physically active. Vigorous activities were less common in urban areas and among the more educated subjects, depicting an ongoing shift to more sedentary behaviours in this setting.

Prevalence of overweight, obesity, and abdominal obesity in a representative sample of Portuguese adults

This study determined the prevalence of overweight, obesity, and abdominal obesity in the Portuguese adults and examined the relationship between above mentioned prevalences and educational level. Body mass, stature, and waist circumference were measured in a representative sample of the Portuguese population aged 18–103 years (n = 9,447; 18–64 years: n = 6,908; ≥65 years: n = 2,539). Overweight and obesity corresponded to a body mass index ranging between 25–29.9 kg/m² and ≥30 kg/m², respectively. Abdominal obesity was assessed as >102 cm for males and >88 cm for females. After adjusting for educational level, the combined prevalences of overweight and obesity were 66.6% in males and 57.9% in females (18–64 years). Respective values in older adults (≥65 years) were 70.4% for males and 74.7% for females. About 19.3% of adult males and 37.9% of adult females presented abdominal obesity. Correspondent values in older adults were 32.1%, for males, and 69.7%, for females. In adults, low educational level was related to an increased risk for overweight (OR = 2.54; 95% CI: 2.08–3.09), obesity (OR = 2.76; 95% CI: 2.20–3.45), and abdominal obesity (OR = 5.48; 95% CI: 4.60–6.52). This reinforces the importance of adjusting public health strategies for educational level.

Manufactured and hand-rolled cigarettes and smokeless tobacco consumption in Mozambique: regional differences at early stages of the tobacco epidemic

BACKGROUND

To describe the use of different types of tobacco (manufactured and hand-rolled cigarettes, and smokeless tobacco) in the adult Mozambican population, across regions.

METHODS

A representative sample of 12,902 Mozambicans aged 25-64 years was evaluated in a national household survey conducted in 2003 using a structured questionnaire. The patterns of tobacco consumption were described to highlight the sex-specific differences by age and between urban and rural settings, and between the north, where most of the country's tobacco production is concentrated, and the south of the country, where the wealthiest provinces, closer to the city capital, are located.

RESULTS

The prevalence of current tobacco consumption was 39.9% in men and 18.0% in women. Women consumed predominantly smokeless tobacco (prevalence: 10.1%), especially in the north. Hand-rolled and manufactured cigarettes were the most frequently consumed among men (prevalences: 18.7% and 17.2%, respectively). Additionally, hand-rolled cigarette consumption predominantly occurred in the northern provinces and rural settings, whereas manufactured cigarette consumption predominated in the south and urban areas.

CONCLUSIONS

The overall tobacco consumption was higher than expected for an African country with scarce economic resources, mostly due to traditional forms of consumption. The gender and regional specific patterns of consumption identified in Mozambique may contribute to the development of culturally adapted and locally grounded actions for tobacco control, and stress the need of locale-specific surveillance data and public health action in this field.

Low fruit and vegetable consumption in Mozambique: results from a WHO STEPwise approach to chronic disease risk factor surveillance

Monitoring food consumption and its determinants over time is essential for defining and implementing health promotion strategies, but surveillance is scarce in Africa. The present study aimed to describe fruit and vegetable consumption in Mozambique according to socio-demographic characteristics and place of residence (urban/rural). A national representative sample (n 3323) of subjects aged 25–64 years was evaluated in 2005 following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance, which included an assessment of usual fruit and vegetable consumption (frequency and quantity). Crude prevalence and age-, education- and family income-adjusted prevalence ratios (PR) with 95 % CI were computed. Less than 5 % of the subjects reported an intake of five or more daily servings of fruits/vegetables. Both fruits and vegetables were more often consumed by women and in rural settings. In urban areas, the prevalence of fruit intake ( ≥ 2 servings/d) increased with education ( ≥ 6 years v. < 1 year: women, adjusted PR = 3·11, 95 % CI 1·27, 7·58; men, adjusted PR = 3·63, 95 % CI 1·22, 10·81), but not with income. Conversely, vegetable consumption ( ≥ 2 servings/d) was less frequent in more educated urban men ( ≥ 6 years v. < 1 year: adjusted PR = 0·30, 95 % CI 0·10, 0·94) and more affluent rural women ( ≥ $801 US dollars (USD) v. $0–64: adjusted PR = 0·32, 95 % CI 0·13, 0·81). The very low intake of these foods in this setting supports the need for fruit and vegetable promotion programmes that target the whole population, despite the different socio-demographic determinants of fruit and vegetable intake.

Alcohol consumption in Mozambique: regular consumption, weekly pattern and binge drinking

This study aimed to describe alcohol consumption in Mozambique, discriminating binge drinking behaviour and the weekday variation in drinking patterns, and to quantify the association between socio-demographic characteristics and alcohol intake. A representative sample of 3265 Mozambicans aged 25-64 years was evaluated in 2005 following the World Health Organization Stepwise approach to Chronic Disease Risk Factor Surveillance (STEPS). The consumption of any type of alcoholic beverage, during life and in the previous year, was recorded. Current drinkers were also asked about the number of standard drinks consumed in each day of the previous week. The overall prevalence of current drinking was 28.9% [95% confidence interval (95% CI): 22.6-35.2] in women and 57.7% (95% CI: 49.8-65.7) in men. Forty percent of the current drinkers reported to have had at least one binge drinking occasion in the previous week. The prevalence of current drinking increased with age and education among women and with income among men. No consistent pattern was observed in binge drinking by education in both genders and by annual income among men, but it was significantly less frequent among the more affluent women. Both drinking and binge drinking peaked at the weekend. Knowing the drinking patterns in Mozambique enables the planning of interventions according to the local needs. Future surveys should also include non-adult populations as risk factors for chronic diseases occurs as early as childhood and adolescence, and are associated with increased risk of disease later in life.

An epidemiological study of stroke hospitalizations in Maputo, Mozambique: a high burden of disease in a resource-poor country

BACKGROUND AND PURPOSE

Already a major cause of death and disability in high-income countries, the burden of stroke in sub-Saharan Africa is also expected to be high. However, specific stroke data are scarce from resource-poor countries. We studied the incidence, characteristics, and short-term consequences of hospitalizations for stroke in Maputo, Mozambique.

METHODS

Over 12 months, comprehensive data from all local patients admitted to any hospital in Maputo with a new stroke event were prospectively captured according to the World Health Organization's STEPwise approach to stroke surveillance program. Disability levels (pre- and posthospital discharge) and short-term case-fatality (in-hospital and 28 days) were also studied.

RESULTS

Overall, 651 new stroke events (mean age 59.1 ± 13.2 years and 53% men) were captured by the registry with 601 confirmed by CT scan (83.4%) or necropsy (8.9%). Crude and adjusted (world reference population) annual incidence rates of stroke were 148.7 per 100,000 and 260.1 per 100,000 aged ≥ 25 years, respectively. Of these, 531 (81.6%) represented a first-ever stroke event comprising 254 ischemic (42.0%) and 217 (36.1%) an intracerebral hemorrhage. Before admission, 561 patients (86.2%) had hypertension and 271 (41.6%) had symptoms for > 24 hours. In-hospital and 28-day case-fatality were 33.3% and 49.6% (72.3% for hemorrhagic stroke), respectively. From almost no preadmission disability, 64.4% of 370 survivors at 28 days had moderate-to-severe disability.

CONCLUSIONS

The burden of disease associated with stroke is high in Maputo, emphasizing the importance of primary prevention and improvement of the standards of care in a developing country under epidemiological transition.