Prevalence of cardiovascular risk factors among adults without obvious cardiovascular disease in a rural community in Ekiti State, Southwest Nigeria

Co-occurrence of Modifiable Risk Factors for Cardiovascular Disease amongst Diabetic Patients in Lagos State, Nigeria

BACKGROUND

Diabetes significantly increases the likelihood of developing cardiovascular disease (CVD). This risk can be reduced by addressing modifiable risk factors. The objectives of this study were to assess the modifiable risks for CVD amongst persons with diabetes and identify the factors associated with multiple risk factors.

METHODS

This cross-sectional study was conducted amongst 357 diabetic patients attending a large tertiary hospital in Southwest Nigeria. Eligible patients were recruited consecutively on clinic days till the minimum sample size was reached. An interviewer-administered survey tool adapted from the World Health Organization STEPS was used to obtain information from study participants. The following risk factors were assessed: tobacco use, obesity, high blood pressure, physical activity, sedentary time and hours of sleep. Data were analysed using the STATA version 15.0 (Stata Corp.) statistical programme.

RESULTS

The mean age of the participants was 61.7 ± 12.6 years, and they were mostly females (63.9%). Of the risk factors assessed, the most prevalent modifiable risk factors amongst the respondents were inadequate sleep - <8 h on average (91.6%), abdominal obesity (82.6%) and high blood pressure (72%). Others were inadequate physical activity (56%) and lifetime tobacco use (21%). Up to 40.3% of the diabetic persons had three or more co-existing CVD risk factors. Age, gender, work and marital status (P ≤ 0.01) were statistically associated with multiple CVD risk factors. Being male, unmarried and increasing age were predictors of multiple CVD risk factors amongst the diabetic patients.

CONCLUSION

A significant proportion of the diabetic patients have multiple co-existing modifiable CVD risks. Abdominal obesity and poor sleep were the most prevalent. Older men who are unmarried were more likely to have multiple risks. Primary and secondary preventive measures to address CVD risks amongst diabetic patients are warranted and should target older unmarried men.

Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study

INTRODUCTION

Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State.

MATERIALS AND METHODS

A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis.

RESULTS

There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM.

CONCLUSION

The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Cardiovascular event risk estimation among residents of a rural setting in Bayelsa state, Nigeria

Cardiovascular diseases (CVD) are a leading cause of death worldwide. There is a rising prevalence of CVDs in Nigeria, including in rural communities. The present study assessed the total CVD risk among two rural communities in Bayelsa State, South-south Nigeria. Adults aged ≥ 40 years in 264 randomly selected households in two rural communities in Bayelsa State were interviewed in this descriptive cross-sectional survey. Using a structured questionnaire, data on socio-demographic characteristics, anthropometry, blood pressure (BP) and random blood sugar measurements were obtained. The WHO/ISH risk assessment chart for the African sub-region was used to estimate the 10-year total risk of fatal or non-fatal CVD events using five predictor variables: age, gender, smoking, systolic BP, and coexistence of diabetes mellitus (DM). Of the 264 participants, majority was men (70.1%) and married (93.2%). Mean age was 50.9±8.1 years. Most participants were overweight (53.4%), add salt to food on table (97.0%), lead a sedentary lifestyle (79.2%) and greater than a third of participants (36.7%) were known hypertensive patients. Using the WHO/ISH risk prediction chart for Africa, 90.0% and 10.0% of the study population had low and moderate risk, respectively of developing cardiovascular events in 10 years. As the age of participants increases, the 10-year risk of a cardiovascular event increased (X 2-48.9; P-0.001). History of hypertension (X 2-20.0; P-0.001), DM (X 2-5.87; P-0.016) and smoking (X 2-23.42; P-0.001) were significantly related to the level of 10-year cardiovascular event risk. Sex showed no significant relationship. There is a high prevalence of several cardiovascular risk factors in this rural population, though the 10-year risk of CV event is still low. CVD risk in rural communities requires awareness, monitoring and an integrated approach in their prevention, detection, and treatment.

High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative

BACKGROUND

The prevalence of hypertension in Nigeria is high and growing. The burden and risk factor distribution also vary by geographical zone. Information about prevalence, risk factors and disease status awareness are needed to guide evidence based public health response at the national and sub- national levels.

PURPOSE

This paper describes the prevalence of hypertension and its correlates, as well as hypertension status awareness among men in North Central, Nigeria.

METHODS

A cross sectional survey was administered to male partners of pregnant women participating in the Healthy Beginning Initiative program from 2016-2018. Information on socio-demographic characteristics, risk factors, physical measurement and blood pressure readings were collected using a standardized protocol. Data was analyzed with simple and multiple logistic regression.

RESULTS

The 6,538 men had a median age of 31 years [IQR: 26-37]. The prevalence of hypertension was 23.3% (95% CI: 22.3%-24.4%), while 46.7% had prehypertension. The odds of hypertension was associated with increasing age (OR:1.02, CI:1.01-1.03), being overweight (aOR:1.5,CI:1.3-1.8), being obese (aOR:2.6,CI:2.0-3.3), living in an urban area (aOR:1.6,CI:1.2-2.1), and alcohol use in the 30 days prior (aOR:1.2,CI:1.1-1.4). Overall, 4.5% (297/6,528) of participants had ever been told they have hypertension. Among the 23.3% (1,527/6,528) with hypertension, 7.1% (109/1,527) were aware of their disease status. Men aged 41-50 years (aOR: 1.8, CI: 1.0-3.3), and > 50 years (aOR: 2.2, CI: 1.1-4.3), had higher odds disease status awareness. Living in an urban area was associated with lower odds (aOR: 0.2, CI: 0.03-0.7) of hypertension status awareness.

CONCLUSION

This study showed that hypertension is already a significant public health burden in this population and that disease awareness level is very low. Alcohol use and obesity were associated with hypertension, highlighting some modifiable cardiovascular disease risk factors that are prevalent in the study population. Taken together, these findings can inform the design of interventions for primary and secondary cardiovascular disease prevention in Nigeria and similar settings.

Unlocking community capabilities for addressing social norms/practices: behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria

BACKGROUND

Maternal mortality is attributed to combination of contextual factors that cause delay in seeking care, leading to poor utilization of skilled health services. Community participation is one of the acknowledged strategies to improve health services utilization amongst the poor and rural communities. The study aimed at assessing the potentials of improving birth preparedness and complication readiness (BP/CR) using community-driven behavioural change intervention among pregnant women in rural Nigeria.

METHODS

A pre-post intervention study was conducted from June 2018 to October 2019 on 158 pregnant women selected through multi-stage sampling technique from 10 villages. Data on knowledge and practices of birth preparedness and utilization of facility health services were collected through interviewer-administered pre-tested structured questionnaire. Behavioural change intervention comprising of stakeholders' engagement, health education, facilitation of emergency transport and fund saving system, and distribution of educational leaflets/posters were delivered by twenty trained volunteer community health workers. The intervention activities focused on sensitization on danger signs of pregnancy, birth preparedness and complication readiness practices and emergency response. Means, standard deviations, and percentages were calculated for descriptive statistics; and T-test and Chi square statistical tests were carried out to determine associations between variables. Statistical significance was set at p-value < 0.05.

RESULTS

The result showed that after the intervention, mean knowledge score of danger signs of pregnancy increased by 0.37 from baseline value of 3.94 (p < 0.001), and BP/CR elements increased by 0.27 from baseline value of 4.00 (p < 0.001). Mean score for BP/CR practices increased significantly by 0.22 for saving money. The proportion that had antenatal care (76.6%) and had facility delivery (60.0%) increased significantly by 8.2 and 8.3% respectively. Participation in Community-related BP/CR activities increased by 11.6% (p = 0.012).

CONCLUSION

With the improvements recorded in the community-participatory intervention, birth preparedness and complication readiness should be promoted through community, household and male-partner inclusive strategies. Further evaluation will be required to ascertain the sustainability and impact of the programme.

Cardiovascular risk factors among high-risk individuals attending the general practice at king Abdulaziz University hospital: a cross-sectional study

Background

Cardiovascular disease (CVD) is the primary cause of death worldwide, accounting for 31.0% of all deaths and more than 18 million deaths annually. The 2008 World Health Report indicated that 144 (35%) of the 413 deaths per 100,000 in 2002 in the Kingdom of Saudi Arabia (KSA) were due to CVD. Primary prevention is an important focus of most of the cardiovascular prevention guidelines around the world. In this study, we aimed to describe the prevalence of extrinsic risk factors for CVDs in a high-risk population attending general practice in Jeddah, KSA.

Methods

We conducted a cross-sectional survey at King Abdulaziz University Hospital in Jeddah. Patients started on lipid-lowering and/or antihypertensive and/or antidiabetes treatments without a history of established cardiovascular disease were interviewed. The questionnaire was adopted from the EUROASPIRE III study.

Results

Two hundred and fifty high-risk individuals (80.0% female) were interviewed. Overall, 72% of the patients had been diagnosed with hypertension, 61.2% of patients had dyslipidemia, and approximately two-thirds of patients had diabetes mellitus. Most of the patients (88%) were non-smokers. The mean waist circumference of patients was 101.6 ± 14.1 cm, which suggests most were clinically obese. About 54.8% of the patients followed an unhealthy diet and 52.0% were physically inactive. There were significant differences between women and men in relation to dyslipidemia (p = 0.007), unhealthy diet (p = 0.034), being overweight (p = 0.018), and high blood cholesterol (p = 0.002). We observed significantly greater prevalence of hypertension (p = 0.073), unhealthy diet (p = 0.015), being overweight (p = 0.018), and high blood cholesterol (p = 0.000) in those patients with dyslipidemia.

Conclusion

Our study presents novel findings in the KSA. Women were more likely to have high-risk CVD risk factors compared with their male counterparts in this sample. Gender-specific prevention programs in the KSA should be considered to more appropriately target at-risk individuals, to reduce preventable morbidity and mortality associated with CVDs.

Prevalence of obesity in rural and urban areas in Brazil: National Health Survey, 2013

OBJECTIVE

To investigate the role of the domiciliary situation in the prevalence of general and abdominal obesity through the National Health Survey of 2013.

METHODOLOGY

General obesity (body mass index ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 102 cm in men and ≥ 88 cm in women) in rural and urban areas were described according to sex and macroregion. Crude and adjusted Poisson regression models were used to test the association between obesity and household situation, with the significance level of 5%.

RESULTS

The study included 59,226 individuals. Out of these, 20.7% presented general obesity and 38% abdominal obesity (higher in women: 24.3 and 52%, respectively). The highest prevalences of general obesity were observed in southern urban areas, for both sexes (20.8% in men and 26.5% in women). In rural areas, the highest prevalences were observed for the central-west region (17.2%) in men and in the south region (27.4%) in women. In males, after adjusting for demographic variables, living in rural areas was associated with lower prevalences of general obesity in the North (prevalence ratios - PR = 0.60; confidence interval of 95% - 95%CI 0.40 - 0.89) and Northeast (PR = 0.47, 95%CI 0,38 - 0.59), and for abdominal obesity in all regions. For women in the Midwest, the rural household situation was associated with lower prevalences of obesity. (PR = 1.11, 95%CI 1.01 - 1.23).

CONCLUSIONS

The results evidenced the role of the domiciliary situation among outcomes at the national level, with lower prevalence of general and abdominal obesity in men living in rural areas. However, higher prevalences were found among women, especially for abdominal obesity.

The burden of dyslipidaemia and factors associated with lipid levels among adults in rural northern Ghana: An AWI-Gen sub-study

Dyslipidaemia is a primary risk factor for cardiometabolic disease, causing over 17 million deaths globally in 2015. However, the burden of dyslipidaemia and factors associated with lipid levels remain unknown in many rural African populations. Therefore, this study evaluated the association of socio-demographic, anthropometric and behavioural factors with lipid levels in rural Ghana. The prevalence of hypercholesterolaemia, hypertriglyceridaemia and elevated LDL-C in the total population of 1839 (846 men and 993 women) was 4.02%, 2.12%, and 5.55% respectively and did not differ between genders. The prevalence of low HDL-C levels was 60.30% and differed (p = 0.005) between men (56.86%) and women (63.24%). Subcutaneous abdominal fat was associated with TC (β = 0.067, p = 0.015) and TG (β = 0.137, p<0.001) among women and LDL-C (β = 0.139, p = 0.006) and TC (β = 0.071, p = 0.048) among men. Body mass index was associated with TC (β = 0.010, p = 0.043) among men while waist circumference was associated with LDL-C (β = 0.116, p<0.001) and TG (β = 0.094, p<0.001) among women. Hip circumference was negatively associated (β = -0.053, p = 0.043) while visceral fat was positively associated with TG (β = 0.033, p = 0.022) among women. Socioeconomic status, education, being unmarried and employment were associated with HDL-C (β = 0.081, p = 0.004), LDL-C (β = 0.095, p = 0.004) and TG (β = 0.095, p = 0.001) all among women, and TC (β = 0.070, p = 0.010) among men, respectively. Nankana women had lower TC (β = -0.069, p = 0.001), and men lower TG levels (β = -0.084, p = 0.008) than the other ethnic groups. Tobacco smoking (β = 0.066, p = 0.024) and alcohol intake (β = 0.084, p = 0.001) were associated with HDL-C levels among men and women respectively. Further studies are required to investigate whether high prevalence of low HDL-C levels in this population presents with any adverse cardiovascular disease outcomes. Associations of education, employment and adiposity with lipid levels suggest that future societal advances and increases in the prevalence of obesity may lead to associated adverse health consequences. Monitoring and interventions are required to limit these effects.

Prevalence of cardiovascular disease risk factors: A community-based cross-sectional study in a peri-urban community of Kathmandu, Nepal

Background

As a low-income country, Nepal is experiencing cardiovascular diseases as an emerging health problem. However, studies are lacking on the risk factors of cardiovascular diseases in peri-urban communities; where the socio-demographical transition is in progress. Therefore, this study aimed to identify the prevalence and socio-demographic distribution of cardiovascular disease risk factors in one of the peri-urban communities in Kathmandu, Nepal.

Methods

We conducted a cross-sectional study in Sitapaila Village Development Committee, Kathmandu from February 2014 to February 2015. Altogether, 347 adults from 18 to 70 years of age were selected randomly. Data were collected through modified WHO STEPS questionnaire for non-communicable disease (NCD) risk factors survey and analyzed in SPSS V.16.0 software.

Results

Mean age of the participant was 42.5 ± 13.2 years. Majority of them were female (n = 206; 59.4%), one-third (34%) represented Brahman and Chetri, and over a quarter (29.1%) did not attend school. Cardiovascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%), and high triglyceride levels (10.8%). They were significantly associated with different socio-demographic characteristics: smoking with gender, age groups and education level; alcohol consumption was with gender, age groups, ethnicity and occupation; insufficient physical activity with gender, age groups and occupation; hypertension with gender, age groups, ethnicity, education level and occupation.

Conclusion

A high prevalence of cardiovascular disease risk factors and their disproportional distribution among the study population indicated an inevitable risk of cardiovascular events in near future.

Validation of the Friedewald formula for the estimation of low density lipoprotein cholesterol in a sub-Saharan African population

BACKGROUND

Low density lipoprotein cholesterol (LDL-C) levels are used to estimate cardiovascular disease (CVD) risk and to guide prescriptions. To circumvent the challenges of direct LDL-C measurement, guidelines recommend the use of Friedewald formula derived LDL-C levels. Despite reported limitations of this formula, its validity in sub-Saharan Africans has not been adequately investigated.

OBJECTIVE

To assess the validity of the Friedewald formula derived against directly (homogeneous) measured LDL-C in adult Cameroonians.

METHODS

We reviewed the fasting lipid profiles of 2500 patients, performed between March 2012 and January 2016 using enzymatic colorimetric method (reference), at the Douala General Hospital laboratory. The Friedewald formula was used to calculate LDL-C from total cholesterol, high density lipoprotein cholesterol and triglyceride levels. Calculated LDL-C values were compared to the reference values, and clinical significance of differences between the two methods was assessed using total error allowable (TEa).

RESULTS

The difference between means of calculated and the reference LDL-C values was neither statistically nor clinically significant (3.33±1.51 vs. 3.33±1.25mmol/l; p=0.704). The calculated LDL-C correlated positively with the measured LDL-C value (r=0.749) and both methods showed a good agreement on Bland-Altman plot. Conversely, there was only moderate agreement (kappa=0.478, 95% CI: 0.455-0.502) between the two values in the stratification of cardiovascular risk according to the National Cholesterol Education Program/Adult Treatment Panel III. Consequently, 40.6% of the participants were misclassified.

CONCLUSION

Friedewald formula is technically accurate but has a modest clinical accuracy which can translate into a substantial misclassification of patients' cardiovascular risk and subsequent inappropriate therapeutic decisions.

The prevalence of type 2 diabetes in urban Bo, Sierra Leone, and in the 16 countries of the West Africa region

BACKGROUND

The goal of this study was to measure the prevalence of diabetes among adults in urban Bo, Sierra Leone, and to compare the new results to the diabetes prevalence rates reported from studies across West Africa.

METHODS

A total of 694 outpatients ages 18 and older at Bo Government Hospital were tested for diabetes between January 2012 and December 2014. Diabetes was defined as a fasting blood sugar level of ≥126 mg/dL (≥7.0 mmol/L).

RESULTS

The overall prevalence of diabetes was 6.2% (43/694). Diabetes prevalence increased from 0.8% (2/256) among patients ages 18 to 29 years to 3.9% (8/204) among patients ages 30 to 39, 8.4% (11/131) among patients ages 40 to 49, 19.0% (12/63) among patients ages 50 to 59, and 25.0% (10/40) among patients ages 60 and older. The prevalence of diabetes was 5.2% among females and 7.4% among males. After adjusting the study population to the age and sex distribution of the national population, the standardized prevalence of diabetes was 7.0%. The only previously published study of diabetes in Sierra Leone found a much lower 2.4% prevalence rate in 1997. A comprehensive literature search identified studies from across West Africa (including Benin, Burkina Faso, Cabo Verde, Côte d'Ivoire, the Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo) that illustrate an increasing rate of diabetes and impaired glucose tolerance in the region.

CONCLUSIONS

It is important for hospitals and clinics across West Africa to increase their ability to diagnose, monitor, and treat type 2 diabetes in urban and rural areas.

Estimating the prevalence, hospitalisation and mortality from type 2 diabetes mellitus in Nigeria: a systematic review and meta-analysis

BACKGROUND

There is not yet a comprehensive evidence-based epidemiological report on type 2 diabetes mellitus (T2DM) in Nigeria. We aimed to estimate country-wide and zonal prevalence, hospitalisation and mortality rates of T2DM in Nigeria.

METHODS

We searched MEDLINE, EMBASE, Global Health, Africa Journals Online (AJOL) and Google Scholar for population and hospital-based studies on T2DM in Nigeria. We conducted a random-effects meta-analysis on extracted crude estimates, and applied a meta-regression epidemiological model, using the United Nations demographics for Nigeria in 1990 and 2015 to determine estimates of diabetes in Nigeria for the two years.

RESULTS

42 studies, with a total population of 91 320, met our selection criteria. Most of the studies selected were of medium quality (90.5%). The age-adjusted prevalence rates of T2DM in Nigeria among persons aged 20-79 years increased from 2.0% (95% CI 1.9% to 2.1%) in 1990 to 5.7% (95% CI 5.5% to 5.8%) in 2015, accounting for over 874 000 and 4.7 million cases, respectively. The pooled prevalence rate of impaired glucose tolerance was 10.0% (95% CI 4.5% to 15.6%), while impaired fasting glucose was 5.8% (95% CI 3.8% to 7.8%). Hospital admission rate for T2DM was 222.6 (95% CI 133.1 to 312.1) per 100 000 population with hyperglycaemic emergencies, diabetic foot and cardiovascular diseases being most common complications. The overall mortality rate was 30.2 (95% CI 14.6 to 45.8) per 100 000 population, with a case fatality rate of 22.0% (95% CI 8.0% to 36.0%).

CONCLUSION

Our findings suggest an increasing burden of T2DM in Nigeria with many persons currently undiagnosed, and few known cases on treatment.

Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.

Contribution of modifiable risk factors for hypertension and type-2 diabetes in Peruvian resource-limited settings

Background

It is important to understand the local burden of non-communicable diseases including within-country heterogeneity. The aim of this study was to characterise hypertension and type-2 diabetes profiles across different Peruvian geographical settings emphasising the assessment of modifiable risk factors.

Methods

Analysis of the CRONICAS Cohort Study baseline assessment was conducted. Cardiometabolic outcomes were blood pressure categories (hypertension, prehypertension, normal) and glucose metabolism disorder status (diabetes, prediabetes, normal). Exposures were study setting and six modifiable factors (smoking, alcohol drinking, leisure time and transport-related physical activity levels, TV watching, fruit/vegetables intake and obesity). Poisson regression models were used to report prevalence ratios (PR). Population attributable risks (PAR) were also estimated.

Results

Data from 3238 participants, 48.3% male, mean age 45.3 years, were analysed. Age-standardised (WHO population) prevalence of prehypertension and hypertension was 24% and 16%, whereas for prediabetes and type-2 diabetes it was 18% and 6%, respectively. Outcomes varied according to study setting (p<0.001). In multivariable model, hypertension was higher among daily smokers (PR 1.76), heavy alcohol drinkers (PR 1.61) and the obese (PR 2.06); whereas only obesity (PR 2.26) increased the prevalence of diabetes. PAR showed that obesity was an important determinant for hypertension (15.7%) and type-2 diabetes (23.9%).

Conclusions

There is an evident heterogeneity in the prevalence of and risk factors for hypertension and diabetes within Peru. Prehypertension and prediabetes are highly prevalent across settings. Our results emphasise the need of understanding the epidemiology of cardiometabolic conditions to appropriately implement interventions to tackle the burden of non-communicable diseases.

Prevalence of cardiovascular disease risk factors among a Nigerian adult population: relationship with income level and accessibility to CVD risks screening

BACKGROUND

In Nigeria, reports on the prevalence of modifiable cardiovascular disease (CVD) risk factors are scarce. In addition, socio-economic status (SES), an important component of the socioeconomic gradient in CVD and its risk factors has not been clearly elucidated. This study sought to assess the prevalence of CVD risk factors and how the difference in prevalence and accessibility to CVD risk screening across income levels and educational backgrounds contributes to disease diagnosis in rural and urban Nigerian adults.

METHODS

A cross sectional study was carried out on a sociocultural ethnic group of persons living in rural and urban settings. All participants were aged ≥ 18 years. The WHO STEPS questionnaire was used to document the demographics, history of previous medical check-up or screening, anthropometric and biochemical measurements of the participants. Average income level and educational status were indicators used to assess the impact of SES. Multivariate analyses were performed to assess any difference between the geographical locations and SES indicators, and prevalence of CVD risk factors and access to CVD risk screening.

RESULTS

The 422 participants (273 females and 149 males) [corrected] had mean age (± standard deviation) of 38.3 ± 20.5 and 42.9 ± 20.7 years, respectively. Only total cholesterol (p = 0.001), triglyceride (p = 0.005), high density lipoprotein cholesterol (HDL) (p < 0.0001), body mass index (BMI) (p = 0.03) and average income rate (p = 0.01) showed significant difference between gender groups. Overall prevalence of prediabetes (4.9%), diabetes (5.4%), hypertension (35.7%), low HDL (17.8%), hypertriglyceridemia (23.2%), hypercholesterolemia (38.1%) and central obesity of 52.2% was recorded. Except between total cholesterol (p = 0.042) and HDL (p = 0.017), other CVD risk factors did not show a statistical significance across income levels. Participants with 'university and postgraduate education' had higher access to blood pressure and blood glucose screening compared to other educational groups; and this showed a statistical significance.

CONCLUSION

This study has shown that a significant number of modifiable CVD risk factors exist in the rural and urban migrants of an adult Nigerian population. While income level did not affect the CVD risk factor prevalence, it did affect accessibility to CVD risk screening. There is a need for access to diagnosis of modifiable risk factors at all levels of society.

Modifiable Risk factors of Hypertension and Socio-demographic Profile in Oghara, Delta State; Prevalence and Correlates

BACKGROUND

Factors associated with the development of hypertension can be categorized into modifiable and non-modifiable risk factors. The modifiable risk factors include obesity, physical inactivity, high salt diet, smoking alcohol consumption and others.

AIM

This study was aimed to determine the prevalence of modifiable risk factors of hypertension in a rural community; Oghara and to ascertain if any association exists with these risk factors and socio-demographic variables.

SUBJECTS AND METHODS

Descriptive cross-sectional study design was utilized for the study and it was carried out over a period of 6 months (Feburary 2012 to August 2012). Cluster sampling was utilized to select a total of 272 respondents for the study. An interviewer administered questionnaire was used to collect data and data analysis was performed by SPSS version 16.0 (Chicago II, USA).

RESULTS

The prevalence of hypertension is 21.0% (57/272), while the prevalence of modifiable risk factors of hypertension such as smoking, alcohol consumption and obesity are 15.8% (43/272), 43.4% (118/272) and 18.8% (51/272) respectively. There is a statistical significant association between hypertension and smoking (P < 0.001), as well as hypertension and alcohol. (P < 0.001), on the other hand socio-demographic variables were significantly associated with smoking (P < 0.001).

CONCLUSION

The study showed high prevalence of modifiable risk factors of hypertension. This underscores the need for preventive efforts to encourage changes in life style pattern in order to reverse the impending epidemic of hypertension and other non-communicable diseases.

Cardiovascular risk factors in semi-urban communities in southwest Nigeria: Patterns and prevalence

Introduction: Over 80% of cardiovascular deaths take place in low- and middle-income countries; most of these deaths are due to modifiable risk factors. The study aimed at estimating the prevalence and pattern of major cardiovascular risk factors in both men and women older than 18 years.

Methods: This is a cross-sectional study of cardiovascular risk factors among semi-urban dwellers in Ekiti State, south-western, Nigeria. 750 participants were drawn from 10 communities. The instrument used was the standard WHO STEPS (II) questionnaire, while blood samples were obtained for analysis.

Results: There were 750 participants with 529 (70.53%) females. The mean age of participants was 61.7 ± 18.50 years and participants’ ⩾65 years comprised 38.3%. There were 0.8%, 24.9% and 12.4%, who at the time of this study smoked cigarettes, consumed alcohol, and ate a high salt diet, respectively. The prevalence of hypertension, diabetes, generalized and abdominal obesity was 47.2%, 6.8%, 8.5% and 32.0%, respectively, with only 48.9% receiving hypertension treatment. Elevated total cholesterol, LDL-cholesterol, and low HDL was seen in 4.4%, 16.7% and 56.3% respectively.

Conclusion: High prevalence of cardiovascular risk factors call for an urgent need for more public health attention and reinforcement of primary preventive strategies to curb its menace.

The wits appraisal using three reference planes and its interaction with the ANB angle among a sub-set of Nigerians"

AIMS

Conjoint analysis of orthodontic patients using the Subspinale (A-point) Nasion-Supramentale (B point) (ANB) angle and the Wits appraisal is popular in many practices. This study aimed to present reference values for the Wits appraisal among Nigerians using three horizontal reference planes namely the bisected occlusal plane (BOP), the functional occlusal plane (FOP) and the maxillomandibular angle bisector (MM° bisector) plane. It also assessed the relationship of the Wits appraisal with the ANB angle and its interaction with clinical measures of sagittal skeletal relations among subjects with malocclusion.

METHODOLOGY

One hundred participants with normal occlusion and 120 with malocclusion were recruited in the study. Cephalometric radiographs were taken for all participants. Each radiograph was manually traced on a 0.003 matted cellulose acetate tracing paper using a sharpened 2H pencil. The Wits appraisal and ANB angle were determined. Data was analyzed using SPSS version 19.

RESULTS

The mean age was 20.7 ± 4.9 years for those with normal occlusion and 18.8 ± 6.5 years in the malocclusion group. There were 91 (41.4%) males and 129 (58.6%) females. Mean values for the Wits appraisal using the BOP as reference, was--1.27 ± 2.91mm, with the FOP, it was -3.54 ± 3.24mm, while with the MM° bisector plane, it was--.75? ± .94mm. The ANB angle showed highest correlation with the MM'°bisector plane Wits value(P< 0 .001). CCONCLUSION: hen the clinical and angular cephalometric findings are at variance, the ANB angle is best moderated by the MM'° isector plane Wits appraisal.

Prevalence of cardiovascular health risk behaviors in a remote rural community of Sindhuli district, Nepal

BACKGROUND

Cardiovascular disease (CVD) is emerging as a public health menace among low and middle income countries. It has particularly affected the poorest. However, there is paucity of information about CVD risk factors profile among Nepalese rural communities where the majority of people live in poverty. Therefore, this study aimed to identify the prevalence of cardiovascular health risk behaviors in an outback community of Nepal.

METHODS

We conducted a descriptive cross-sectional study in Tinkanya Village Development Committee (VDC), Sindhuli between January and March, 2014. Total 406 participants of age 20 to 50 years were selected randomly. Data were collected using WHO-NCD STEPwise approach questionnaires and analyzed with SPSS V.16.0 and R i386 2.15.3 software.

RESULT

The mean age of participants was 36.2 ± 9 years. Majority of participants (76.3%) were from lower socio-economic class, Adibasi/Janajati (63.1%), and without formal schooling (46.3%). Smoking was present in 28.6%, alcohol consumption in 47.8%, insufficient fruits and vegetables intake in 96.6%, insufficient physical activity in 48.8%; 25.6% had high waist circumference, 37.4% had overweight and obesity. Average daily salt intake per capita was 14.4 grams ±4.89 grams. Hypertension was detected in 12.3%. It had an inverse relationship with education and socio-economic status. In binary logistic regression analysis, age, smoking, body mass index (BMI) and daily salt intake were identified as significant predictors of hypertension.

CONCLUSION

Present study showed high prevalence of smoking, alcohol consumption, insufficient fruit and vegetable intake, daily salt intake, overweight and obesity and hypertension among remote rural population suggesting higher risk for developing CVD in future. Nepalese rural communities, therefore, are in need of population-wide comprehensive intervention approaches for reducing CVD health risk behaviors.

Association of hypertension and obesity with HIV and antiretroviral therapy in a rural tertiary health center in Nigeria: a cross-sectional cohort study

Background

There are few studies from Nigeria and Africa regarding the contribution of obesity and hypertension to cardiovascular risk in HIV-infected patients. This study investigates the prevalence of hypertension and obesity and their association with HIV infection and antiretroviral treatment (ART).

Methods

We conducted a cross-sectional cohort study in a rural tertiary health center in Nigeria. The data collected included demographic variables, blood pressure, body mass index (BMI), monthly income, educational attainment, HIV status and ART treatment, duration of treatment, and CD4 T-lymphocyte count.

Results

A total of 403 participants met the inclusion criteria. There were 153 (38.0%) HIV-negative subjects (42.5% male, 57.5% female; mean age: 35.5±7.6 years), 120 (29.8%) HIV-positive drug-naïve subjects (42.5% male, 57.5% female; mean age: 36.5±9.1 years), and 130 (32.2%) HIV-positive subjects taking antiretroviral drugs (33.1% male, 66.9% female; mean age: 38.6±8.0 years). The prevalence of hypertension was 13.7% in HIV-negative subjects, 19.0% in HIV-positive drug-naïve subjects, and 12.3% in HIV-positive ART subjects. The prevalence of obesity was 15.9% in the HIV-negative group, 3% in the HIV-positive drug-naïve group, and 8% in the HIV-positive ART group. Multivariate regression analysis showed no relationship between hypertension and HIV status (P=0.293) or ART status (P=0.587). In contrast, BMI showed a strong relationship with HIV status (odds ratio: 0.281; 95% confidence interval: 0.089–0.884; P=0.030) but not with ART status (P=0.593). BMI was a significant predictor of hypertension.

Conclusion

HIV or ART status was not associated with hypertension. HIV infection was associated with a lower BMI, and a lower prevalence of obesity compared with HIV-negative subjects.