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Okyere J, Aboagye RG, Ayebeng C, Dosoo AK, Salu S, Dickson KS. Hormonal contraceptive use among women living with hypertension in sub-Saharan Africa: insights from 12 countries. BMC Res Notes 2024; 17:167. [PMID: 38898484 PMCID: PMC11186193 DOI: 10.1186/s13104-024-06830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES Given the well-established link between hormonal contraceptives and hypertension risk, and the paucity of research on hormonal contraceptive use dynamics in this particular demographic, we hypothesize that there is a likelihood of low utilization of high-risk hormonal contraceptives among women living with hypertension in SSA. This study investigates the prevalence and factors associated with hormonal contraceptive use among women living with hypertension in the SSA. RESULTS Only 18.5% of women living with hypertension used hormonal contraceptives. Hormonal contraceptive use was high among women with a higher level of education (aOR = 2.33; 95%CI: 1.73-3.14), those currently working (aOR = 1.38; 95%CI: 1.20-1.59), those who have heard about family planning on the radio (aOR = 1.27, 95%CI: 1.09-1.47), listened to the radio at least once a week (aOR = 1.29, 95%CI: 1.10-1.51), and those residing in rural areas (aOR = 1.32; 95%CI: 1.14-1.54). Conversely, women aged 45-49 exhibited a substantial decrease in the odds of hormonal contraceptive use (aOR = 0.23, 95%CI: 0.14-0.38) compared to younger women (15-19 years). Likewise, the odds of HCU were low among cohabiting (aOR = 0.66; 95%CI: 0.48-0.89) and previously married women (aOR = 0.67; 95%CI: 0.50-0.91) than never married women.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abigail Kabukie Dosoo
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Human Resource Management, School of Business, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Salu
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Hunjan I, Umulisa A, Parati G, Bianchetti MG, Milani GP, Muvunyi B, Ntaganda E, Radovanovic D, Stroppa C, Suter P, Muggli F. Blood pressure screening in Mata Sector, a rural area of Rwanda. J Hum Hypertens 2024:10.1038/s41371-024-00912-7. [PMID: 38658710 DOI: 10.1038/s41371-024-00912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
In rural sub-Saharan Africa, knowledge of non-communicable diseases such as high blood pressure (BP) is rather limited. This report provides information about a BP screening in Mata Sector, a rural region in Southern Province of Rwanda. Community-based, house-to-house screening was performed between February and July 2020 on more than 7000 inhabitants. The screening was conducted by a local team composed by 20 community health care workers, five community health care supervisors, and one nurse with hypertension surveillance training. BP and heart rate were recorded after 5 min of resting, using a validated automated oscillometric OMRON M6 IT-HEM-7322-E monitor with Intelli Wrap Cuff (HEM-FL31-E) technology. The mean of the second and third value was retained. BP was normal (<140/90 mm Hg) in 6340 (88%) and elevated in 863 (12%) participants with 95% of unawareness. Grade 1 (140-159/90-99 mm Hg) hypertensive BP readings were detected in 697 (81%), grade 2 (160-179/100-109 mm Hg) in 134 (16%), and grade 3 (≥180/≥110 mm Hg) in 32 (3.7%) individuals. The prevalence of hypertensive readings was significantly age-dependent. Additionally, a slightly greater proportion of participants with high BP (14% versus 11%) had a body mass index (BMI) ≥ 25.0 kg/m2. Also resting heart rate was higher in individuals with high BP (82 versus 77 beats/min). Although individuals identified with occasionally elevated BP values need further confirmatory measurements to establish the diagnosis of hypertension, these data suggest that high BP represents a noteworthy and preventable reason of concern within sub-Saharan Africa.
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Affiliation(s)
- Isabella Hunjan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alice Umulisa
- Health Care Centre of Nyamyumba, District of Nyaruguru, Nyamyumba, Rwanda
| | - Gianfranco Parati
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy.
| | - Mario G Bianchetti
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Bienvenu Muvunyi
- Medical Specialized Services, King Faisal Hospital, Kigali, Rwanda
| | - Evariste Ntaganda
- Cardiovascular diseases Unit, Non-communicable diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Dragana Radovanovic
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Clara Stroppa
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Paolo Suter
- Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Franco Muggli
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Peniston S, Sivaramakrishnan D, Holloway A. Undiagnosed and uncontrolled hypertension in rural African adults: a scoping review protocol of primary health care interventions. BMJ Open 2024; 14:e081937. [PMID: 38589263 PMCID: PMC11015176 DOI: 10.1136/bmjopen-2023-081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Non-communicable diseases cause 74% of global deaths, with cardiovascular diseases as the major contributor. Hypertension, a primary risk factor for cardiovascular disease, is highly prevalent in Africa. Diagnosis, treatment and control rates are notably limited in rural areas. This limitation results in increased risks of premature mortality and complications such as stroke due to socioeconomic, cultural and geographical challenges. Progress in African countries enhancing hypertension services through primary health care interventions exists. However, a comprehensive review of all primary health care interventions addressing undiagnosed and uncontrolled hypertension in rural African settings is lacking. This scoping review aims to categorise primary health care interventions targeting undiagnosed and uncontrolled hypertension in rural African adults. Intervention components will be mapped to the four stages outlined in the hypertension care cascade to develop a pilot intervention logic model for rural African adults with hypertension. METHOD AND ANALYSIS The scoping review protocol will adhere to the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Studies considered for inclusion will include any intervention delivered by any healthcare provider in a rural African primary care setting targeting any stage of hypertension care. Eight databases will be searched without date restrictions, supplemented by grey literature and reference list searches. A two-stage screening process (title/abstract and full text) will determine evidence source eligibility. All eligible sources of evidence will be extracted, charted and evaluated using the Template for Intervention Description and Replication checklist. A pilot logic model categorising and mapping interventions to the four stages of the hypertension care cascade will be visually presented and analysed using narrative synthesis. ETHICS AND DISSEMINATION No primary data will be collected; therefore, ethics approval is not required. Findings will be disseminated to local health authorities in Ghana and other African Regions and through national and international conferences and publications in peer-reviewed journals.
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Affiliation(s)
- Sandra Peniston
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, UK
- School of Nursing, Faculty of Health, York University, Toronto, ON, Canada
| | - Divya Sivaramakrishnan
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, UK
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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Lamloum D, Fassio F, Osetinsky B, Tediosi F. Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1606428. [PMID: 37901590 PMCID: PMC10600349 DOI: 10.3389/ijph.2023.1606428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objective: High blood pressure is the leading risk factor for cardiovascular disease. The hypertension care cascade (HCC) is increasingly being used to evaluate the effectiveness of interventions. This systematic review aims to examine HCC in low-income settings. Methods: The search strategy included articles published between January 2010 and April 2023. We excluded studies with incomplete HCC, on fragile patients or aged <18 years, reviews. We used the MOOSE guideline. Five researchers retrieved data on the survey year, country, population, HCC and diagnostic methods for hypertension. We used JBI Critical Appraisal Tools for quality assessment. Results: Ninety-five articles were analyzed. Average hypertension prevalence was 33% (95% CI: 31%-34%), lower in LICs than in LMICs (25% vs. 34%). The overall mean awareness of hypertension was 48% (95% CI: 45%-51%), its treatment was 35% (95% IC: 32%-38%) and its control 16% (95% CI: 14%-18%). In almost all steps, percentages were lower in LICs and in Sub-Saharan Africa. Conclusion: Trends in HCC vary between countries, with poorer performance in LICs. This review highlights the need for interventions tailored to low-income settings in order to improve hypertension care.
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Affiliation(s)
- Demetrio Lamloum
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Teshome DF, Balcha SA, Ayele TA, Atnafu A, Gelaye KA. Undiagnosed hypertension and its determinants among hypertensive patients in rural districts of northwest Ethiopia: a mediation analysis. BMC Health Serv Res 2023; 23:222. [PMID: 36882833 PMCID: PMC9990316 DOI: 10.1186/s12913-023-09212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Early detection of hypertension is associated with improved blood pressure control and a reduced risk of cardiovascular diseases. However, in rural areas of Ethiopia, evidence is scarce where access to healthcare services is low. This study aimed to estimate the proportion of undiagnosed hypertension and identify its determinants and mediators among patients with hypertension in rural northwest Ethiopia. METHODS A community-based cross-sectional study was conducted from September to November 2020. A three-stage sampling technique was used to select a total of 2436 study participants. Blood pressure was measured using an aneroid sphygmomanometer two times, 30 min apart. A validated tool was used to assess participants' beliefs and knowledge of hypertension. The proportion, determinants, and mediators of undiagnosed hypertension were determined among patients with hypertension. The regression-based approach used to calculate the direct and indirect effects of determinants of undiagnosed hypertension. Joint significance testing was used to determine the significance of the indirect effect. RESULTS The proportion of undiagnosed hypertension was 84.0% (95% CI: 81.4-86.7%). Participants aged 25-34 years (AOR = 6.03; 95% CI: 2.11, 17.29), who drank alcohol (AOR = 2.40; 95% CI: 1.37, 4.20), were overweight (AOR = 0.41; 95% CI: 0.18, 0.98), had a family history of hypertension (AOR = 0.32; 95% CI: 0.20, 0.53), and had comorbidities (AOR = 0.28; 95% CI: 0.15, 0.54) were significantly associated with undiagnosed hypertension. The mediation analysis revealed that hypertension health information mediated 64.1% and 68.2% of the effect of family history of hypertension and comorbidities on undiagnosed hypertension, respectively. Perceived susceptibility to hypertensive disease mediated 33.3% of the total effect of age on undiagnosed hypertension. Health facility visits also mediated the effect of alcohol drinking (14.2%) and comorbidities (12.3%) on undiagnosed hypertension. CONCLUSION A higher proportion of hypertensive patients remain undiagnosed. Being young, drinking alcohol, being overweight, having a family history of hypertension, and having comorbidities were significant factors. Hypertension health information, knowledge of hypertensive symptoms, and perceived susceptibility to hypertension were identified as important mediators. Public health interventions aimed at providing adequate hypertension health information, particularly to young adults and drinkers, could improve knowledge and perceived susceptibility to hypertensive disease and reduce the burden of undiagnosed hypertension.
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Affiliation(s)
- Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Awareness, treatment, and practices of lifestyle modifications amongst diagnosed hypertensive patients attending the tertiary care hospital of Karachi: A cross-sectional study. Ann Med Surg (Lond) 2022; 82:104587. [PMID: 36268382 PMCID: PMC9577521 DOI: 10.1016/j.amsu.2022.104587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Methods Results Conclusion Data regarding the awareness of lifestyle modifications in the general hypertensive population of Pakistan is scarce. Out of 425 hypertensive patients, 70.7% had uncontrolled hypertension. Age and female gender were the only risk factors significantly associated with uncontrolled hypertension. Most of the patients are on treatment and still not controlled, and thus could be considered under treatment. Interventions should be considered and implemented to potentially increase the control rates.
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Allameh M, Ghanei Gheshlagh R, Rahmani K. Prevalence and Associated Risk Factors of Hypertension for the Middle-Aged Population (30-59 Years) in Iran: A National Cross-Sectional Study. High Blood Press Cardiovasc Prev 2021; 29:75-80. [PMID: 34784009 DOI: 10.1007/s40292-021-00490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/06/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The prevalence of hypertension (HTN) is increasing in the middle-aged population, but few studies have examined the prevalence and risk factors associated with hypertension in this age group. AIM To estimate the prevalence of HTN and its associated demographic risk factors in the middle-aged population (30-59 years) of Iran. METHODS In this cross-sectional study, 4112 middle-aged people from five provinces of the country were selected by multi-stage sampling and entered into the study. HTN or high blood pressure (HBP) was defined as systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg. The relationship between demographic risk factors and the prevalence of HTN was assessed by multivariate logistic regression in Stata software version 14. RESULTS The prevalence of HTN was 17.8% (95% CI 16.5-19.0) and was higher in women than men (19.1% vs. 16.5%). The prevalence of HTN in three studied age groups including 30-39, 40-49 and 50-59 years were 7.2, 18.7 and 38.0%, respectively. The frequency of HTN in urban residents was higher than rural residents (18.4% vs. 15.6%). The chance of developing hypertension in urban residents (OR 1.25), overweight (OR 3.94) and obese persons (OR 7.54) was higher. CONCLUSIONS Hypertension has a relatively high prevalence in the middle-aged Iranian population. According to our results, age, living in urban regions, being illiterate, overweight and obesity are independent risk factors for HBP. It seems that the administration of prevention programs in general population especially in younger ages based on existing risk factors is a necessity.
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Affiliation(s)
| | - Reza Ghanei Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Khaled Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Khamis AG, Senkoro M, Mwanri AW, Kreppel K, Mfinanga SG, Bonfoh B, Kwesigabo G. Prevalence and determinants of hypertension among pastoralists in Monduli District, Arusha region in Tanzania: a cross-sectional study. ACTA ACUST UNITED AC 2020; 78:99. [PMID: 33072318 PMCID: PMC7556965 DOI: 10.1186/s13690-020-00485-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/06/2020] [Indexed: 01/13/2023]
Abstract
Background Hypertension is among the growing non-communicable diseases (NCDs) in developing countries and the leading cause of death worldwide. Pastoral areas have been identified to be at a higher risk of diseases due to challenges in their daily food production, livelihoods or mobility. Unfortunately, the prevalence of hypertension and the risk factors particularly affecting rural and pastoral populations are not fully understood, making intervention efforts challenging. The aim of this study was to determine the prevalence of hypertension and identify the risk factors among adults living in Monduli district in Tanzania. The findings will be useful for the provision of tailored interventions focused on community-specific nutritional and behavioral practices. Methods We conducted a community based cross-sectional study involving a sample of 510 adults aged above 18 years selected using a multistage cluster sampling in the Monduli district of Arusha region, Tanzania. Data were collected by using interviewer-administered questionnaires containing socio-demographic, physical activity, smoking and alcohol consumption. Anthropometry, systolic (SBP) and diastolic blood pressure (DBP) levels were measured. A one-day 24 h diet recall was conducted to evaluate the dietary habits of all participants. Both linear and logistic regression analysis were used to identify the independent predictors for hypertension and blood pressure levels. Results The prevalence of hypertension in this study was 25.7% (n = 131, 95% CI; 22.1–29.7). The odds of hypertension increased with being male (AOR = 1.75, 95%CI, 1.06–2.88), belonging to the older age group of 30–39 year olds (AOR = 3.3, 95%CI, 1.76–6.38), 40–59 year olds (AOR = 3.34, 95%CI, 1.75–6.37) and ≥ 60 year olds (AOR = 4.2, 95%CI, 2.02–8.87), being overweight or obese (AOR = 3.37, 95%CI, 1.18–9.62), have more hours spent sedentary (AOR = 3.19, 95%CI, 1.61–6.32), and consumption of fatty foods (AOR = 2.23, 95%CI, 1.27–3.93). The odds for hypertension was significantly reduced among participants who reported higher income (AOR = 0.47, 95% CI, 0.25–0.91), high level of physical activity (AOR = 0.55, 95%CI, 0.31–0.96) and those reported to consume fruit (AOR = 0.37, 95% CI, 0.18–0.77). Consumption of cereals was negatively associated with levels of SBP (β = − 17.4, 95% CI, − 23.8; − 11.0) and DBP (β = − 6.6, 95% CI, − 11.5,-1.79). Conclusion About one in every four adults living in pastoral communities have been found to have hypertension in this study. Our findings suggest that older age, obesity or overweight, low physical activity, low income, and consumption of fatty foods increase the risk of hypertension among study population. Their diet was dominated by cereals with moderate intake of meat and milk and low fruits. There is a need to promote physical activities and consumption of fruits in the study population in order to fight against hypertension. Further research should be done to confirm the associations.
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Affiliation(s)
- Ahmed Gharib Khamis
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Mbazi Senkoro
- National Institute for Medical Research, Muhimbili Research Centre, Dar-es-Salaam, Tanzania
| | - Akwilina Wendelin Mwanri
- Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Chuo Kikuu Tanzania
| | - Katharina Kreppel
- School of Life Sciences and Bio-Engineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.,Department of Environmental Health and Ecological Sciences, Ifakara Health Institute, Dar-es-salaam, Tanzania
| | | | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Gideon Kwesigabo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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