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Inman EM, Nkala-Dlamini B, Violari A, Kidman R. HIV Stigma, Health, and Violence: A Longitudinal Study among Adolescent Boys with HIV in Soweto, South Africa. AIDS Behav 2024; 28:3197-3204. [PMID: 38856845 DOI: 10.1007/s10461-024-04407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
There are over 1.4 million adolescents living with HIV in sub-Saharan Africa, the majority of whom acquired the virus through perinatal transmission (PHIV). HIV stigma is particularly high among adolescents living with HIV and is associated with several outcomes that worsen health and increase the risk of onward HIV transmission. We tested associations between internalized HIV stigma and four of these outcomes over a one-year period among a sample of adolescent boys living with PHIV in Soweto, South Africa. Participants (N = 241) answered questions about internalized HIV stigma at baseline. They completed weekly mobile surveys over the following year to answer questions about their experiences with depression, binge drinking, medication adherence, and violence victimization. Using generalized linear mixed models, we found that baseline internalized HIV stigma was associated with increased odds of depression (OR 1.74), alcohol misuse (OR 2.09), and violence victimization (OR 1.44) and decreased odds of medication adherence (OR 0.60) over the course of a year. These outcomes negatively impact the health and wellbeing of adolescents living with PHIV and increase their risk of transmitting HIV to their partners in the future. Our findings provide novel, longitudinal evidence for the deleterious effects of HIV stigma. To improve health outcomes for adolescents with PHIV, it will be crucial to develop effective HIV stigma reduction interventions that address specific developmental, gendered, and cultural experiences.
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Affiliation(s)
- Elizabeth M Inman
- Program in Public Health, State University of New York at Stony Brook, Stony Brook, NY, 11794, USA.
| | - Busisiwe Nkala-Dlamini
- Department of Social Work, Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2000, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 1864, South Africa
| | - Rachel Kidman
- Program in Public Health, State University of New York at Stony Brook, Stony Brook, NY, 11794, USA
- Department of Family, Population and Preventive Medicine, State University of New York at Stony Brook, Stony Brook, NY, 11794, USA
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Kalungi A, Kinyanda E, Akena DH, Gelaye B, Ssembajjwe W, Mpango RS, Ongaria T, Mugisha J, Makanga R, Kakande A, Kimono B, Amanyire P, Kirumira F, Lewis CM, McIntosh AM, Kuchenbaecker K, Nyirenda M, Kaleebu P, Fatumo S. Prevalence and correlates of common mental disorders among participants of the Uganda Genome Resource: Opportunities for psychiatric genetics research. Mol Psychiatry 2024:10.1038/s41380-024-02665-8. [PMID: 39003415 DOI: 10.1038/s41380-024-02665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
Genetics research has potential to alleviate the burden of mental disorders in low- and middle-income-countries through identification of new mechanistic pathways which can lead to efficacious drugs or new drug targets. However, there is currently limited genetics data from Africa. The Uganda Genome Resource provides opportunity for psychiatric genetics research among underrepresented people from Africa. We aimed at determining the prevalence and correlates of major depressive disorder (MDD), suicidality, post-traumatic stress disorder (PTSD), alcohol abuse, generalised anxiety disorder (GAD) and probable attention-deficit hyperactivity disorder (ADHD) among participants of the Uganda Genome Resource. Standardised tools assessed for each mental disorder. Prevalence of each disorder was calculated with 95% confidence intervals. Multivariate logistic regression models evaluated the association between each mental disorder and associated demographic and clinical factors. Among 985 participants, prevalence of the disorders were: current MDD 19.3%, life-time MDD 23.3%, suicidality 10.6%, PTSD 3.1%, alcohol abuse 5.7%, GAD 12.9% and probable ADHD 9.2%. This is the first study to determine the prevalence of probable ADHD among adult Ugandans from a general population. We found significant association between sex and alcohol abuse (adjusted odds ratio [AOR] = 0.26 [0.14,0.45], p < 0.001) and GAD (AOR = 1.78 [1.09,2.49], p = 0.019) respectively. We also found significant association between body mass index and suicidality (AOR = 0.85 [0.73,0.99], p = 0.041), alcohol abuse (AOR = 0.86 [0.78,0.94], p = 0.003) and GAD (AOR = 0.93 [0.87,0.98], p = 0.008) respectively. We also found a significant association between high blood pressure and life-time MDD (AOR = 2.87 [1.08,7.66], p = 0.035) and probable ADHD (AOR = 1.99 [1.00,3.97], p = 0.050) respectively. We also found a statistically significant association between tobacco smoking and alcohol abuse (AOR = 3.2 [1.56,6.67], p = 0.002). We also found ever been married to be a risk factor for probable ADHD (AOR = 2.12 [0.88,5.14], p = 0.049). The Uganda Genome Resource presents opportunity for psychiatric genetics research among underrepresented people from Africa.
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Affiliation(s)
- Allan Kalungi
- The African Computational Genomics (TACG) Research Group, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda.
- Department of Medical Biochemistry, College of Health Sciences, Makerere University, Kampala, Uganda.
- The Department of Non-communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK.
| | - Eugene Kinyanda
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dickens Howard Akena
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave Room 505F, Boston, MA, 02115, USA
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Wilber Ssembajjwe
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Richard Steven Mpango
- The African Computational Genomics (TACG) Research Group, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Terry Ongaria
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Joseph Mugisha
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Ronald Makanga
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Ayoub Kakande
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Beatrice Kimono
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Philip Amanyire
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Fred Kirumira
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, de Crespigny Park, London, SE5 8AF, UK
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | | | - Moffat Nyirenda
- The Department of Non-communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda.
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK.
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Agberotimi S, Adekunle O. Enhancing Alcohol-Related Research in Africa: Possibility for a Continental-Wide Alliance. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00794-y. [PMID: 38990474 DOI: 10.1007/s10935-024-00794-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
Alcohol-related harms constitute a major public health concern in Africa, with high rates of alcohol consumption and associated negative health and social consequences. Despite this, there is a lack of comprehensive and coordinated research on alcohol use and related harms across the continent. This paper discusses common factors such as diverse traditions and cultures, prevailing low socioeconomic status, gendered approach, limited policy and weak regulation and compliance to existing alcohol control policies that contribute to alcohol-related problems, and the challenges facing alcohol-related research including limited research, isolated and uncoordinated research, and resource scarcity; it further proposes strategies for advancing a continental-wide alliance to enhance alcohol-related research in Africa. The alliance would bring together researchers, policymakers, and other stakeholders to collaborate on research projects, share data and resources, and develop evidence-based interventions to reduce alcohol-related harms. Furthermore, the paper outlines the potential benefits of such an alliance, including improved data collection and analysis, greater capacity building for researchers, and more effective policy and program development. The paper concludes that a continental-wide alliance on alcohol-related research in Africa has the potential to significantly enhance our understanding of alcohol use and related harms on the continent and to inform effective prevention and intervention strategies.
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Hlahla K, Azizi SC, Simms V, Dziva Chikwari C, Dauya E, Bandason T, Tembo M, Mavodza C, Kranzer K, Ferrand R. Prevalence of substance and hazardous alcohol use and their association with risky sexual behaviour among youth: findings from a population-based survey in Zimbabwe. BMJ Open 2024; 14:e080993. [PMID: 38885985 PMCID: PMC11184200 DOI: 10.1136/bmjopen-2023-080993] [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: 10/17/2023] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES Hazardous drinking (HD) and substance use (SU) can lead to disinhibited behaviour and are both growing public health problems among Southern African youths. We investigated the prevalence of SU and HD and their association with risky sexual behaviour among youth in Zimbabwe. DESIGN Data analysis from a population-based survey conducted between October 2021 and June 2022 to ascertain the outcomes of a cluster randomised trial (CHIEDZA: Trial registration number:NCT03719521). Trial Stage: Post-results. SETTING 24 communities in three provinces in Zimbabwe. PARTICIPANTS Youth aged 18-24 years living in randomly selected households. OUTCOME MEASURES HD was defined as an Alcohol Use Disorders Identification Test score ≥8, SU was defined as ever use of ≥1 commonly used substances in the local setting. RESULTS Of 17 585 participants eligible for this analysis, 61% were women and the median age was 20 (IQR: 19-22) years. Overall, 4.5% and 7.0% of participants reported HD and SU, respectively. Men had a substantially higher prevalence than women of HD (8.2% vs 1.9%) and SU (15.1% vs 1.5%). Among men, after adjusting for socio-demographic factors, we found increased odds of having >1 sexual partner in those who engaged in SU (adjusted OR (aOR)=2.67, 95% CI: 2.21 to 3.22), HD (aOR=3.40, 95% CI: 2.71 to 4.26) and concurrent HD and SU (aOR=4.57,95% CI: 3.59 to 5.81) compared with those who did not engage in HD or SU. Similarly, there were increased odds of receiving/providing transactional sex among men who engaged in SU (aOR=2.51, 95% CI: 1.68 to 3.74), HD (aOR=3.60, 95% CI: 2.24 to 5.79), and concurrent HD and SU (aOR=7.74, 95% CI: 5.44 to 11.0). SU was associated with 22% increased odds of inconsistent condom use in men (aOR=1.22, 95% CI: 1.03 to 1.47). In women, the odds of having >1 sexual partner and having transactional sex were also increased among those who engaged in SU and HD. CONCLUSION SU and HD are associated with sexual behaviours that increase the risk of HIV acquisition in youth. Sexual and reproductive health interventions must consider HD and SU as potential drivers of risky sexual behaviour in youths.
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Affiliation(s)
- Kudzai Hlahla
- Biomedical Research and Training Institute, Harare, Zimbabwe
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Steven Chifundo Azizi
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Chikowore T, Läll K, Micklesfield LK, Lombard Z, Goedecke JH, Fatumo S, Norris SA, Magi R, Ramsay M, Franks PW, Pare G, Morris AP. Variability of polygenic prediction for body mass index in Africa. Genome Med 2024; 16:74. [PMID: 38816834 PMCID: PMC11140909 DOI: 10.1186/s13073-024-01348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/21/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Polygenic prediction studies in continental Africans are scarce. Africa's genetic and environmental diversity pose a challenge that limits the generalizability of polygenic risk scores (PRS) for body mass index (BMI) within the continent. Studies to understand the factors that affect PRS variability within Africa are required. METHODS Using the first multi-ancestry genome-wide association study (GWAS) meta-analysis for BMI involving continental Africans, we derived a multi-ancestry PRS and compared its performance to a European ancestry-specific PRS in continental Africans (AWI-Gen study) and a European cohort (Estonian Biobank). We then evaluated the factors affecting the performance of the PRS in Africans which included fine-mapping resolution, allele frequencies, linkage disequilibrium patterns, and PRS-environment interactions. RESULTS Polygenic prediction of BMI in continental Africans is poor compared to that in European ancestry individuals. However, we show that the multi-ancestry PRS is more predictive than the European ancestry-specific PRS due to its improved fine-mapping resolution. We noted regional variation in polygenic prediction across Africa's East, South, and West regions, which was driven by a complex interplay of the PRS with environmental factors, such as physical activity, smoking, alcohol intake, and socioeconomic status. CONCLUSIONS Our findings highlight the role of gene-environment interactions in PRS prediction variability in Africa. PRS methods that correct for these interactions, coupled with the increased representation of Africans in GWAS, may improve PRS prediction in Africa.
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Affiliation(s)
- Tinashe Chikowore
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Harvard Medical School, Boston, MA, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, USA.
| | - Kristi Läll
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zane Lombard
- Division of Human Genetics, National Health Laboratory Service, and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia H Goedecke
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Segun Fatumo
- NCD Genomics, MRC/UVRI LSHTM Uganda Research Unit, Entebbe, Uganda
- Precision Healthcare University Research Institute (PHURI), Queen Mary University of London, London, UK
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Reedik Magi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul W Franks
- Department of Clinical Sciences, Lund University, Helsingborg, Sweden
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Guillaume Pare
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Andrew P Morris
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
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Mapanga W, Craig A, Mtintsilana A, Dlamini SN, Du Toit J, Ware LJ, Norris SA. The Effects of COVID-19 Pandemic Lockdowns on Alcohol Consumption and Tobacco Smoking Behaviour in South Africa: A National Survey. Eur Addict Res 2023; 29:127-140. [PMID: 36934716 PMCID: PMC10627113 DOI: 10.1159/000528484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/29/2022] [Indexed: 03/21/2023]
Abstract
INTRODUCTION During the first phase of the coronavirus (COVID-19) pandemic lockdowns in South Africa (SA), both alcohol and tobacco were considered non-essential goods and their sales were initially prohibited and further restricted to certain days and timeframes. This study investigates self-reported changes in alcohol consumption and tobacco smoking behaviour in the general population during the COVID-19 pandemic lockdowns in SA. METHODS A cross-sectional national survey was conducted in October 2021 (before the Omicron wave 4 and while SA was in low-level lockdown) among 3,402 nationally representative respondents (weighted to 39,640,674) aged 18 years and older. Alcohol consumption and tobacco use were assessed from the beginning of the lockdown towards the end of March 2020 until October 2021 using the WHO-AUDIT and the US Centre for Disease Control (CDC) Global Adult Tobacco Survey questionnaires, respectively. RESULTS Among those that drank alcohol (33.2%), 31.4% were classified as having a drinking problem that could be hazardous or harmful and 18.9% had severe alcohol use disorder during the COVID-19 lockdowns. Twenty-two per cent (22.0%) of those that reported alcohol consumption reported that the COVID-19 pandemic lockdowns changed their alcohol consumption habits, with 38.1% reporting a decreased intake or quitting altogether. Among the one in five respondents (19.2%) who had ever smoked, most reported smoking at the time of the survey (82.6%) with many classified as light smokers (87.8%; ≤10 cigarettes/day). Almost a third (27.2%) of those smoking reported that the COVID-19 pandemic lockdowns had changed their use of tobacco products or vaping, with 60.0% reporting a reduction/quitting tobacco use. Given that sales were restricted this indicates that people could still get hold of tobacco products. Heavy smoking was associated with older age (p = 0.02), those classified as wealthy (p < 0.001), those who started or increased tobacco smoking during the pandemic lockdowns (p = 0.01) and residential provinces (p = 0.04). CONCLUSION Given restrictions on the sale of alcohol and tobacco in SA between 27 March and August 17, 2020, during the pandemic, respondents reported an overall decline in alcohol consumption and tobacco use which might suggest that the regulatory restrictive strategies on sales had some effect but may be inadequate, especially during times where individuals are likely to experience high-stress levels. These changes in alcohol consumption and tobacco use were different from what was reported in several European countries, possibly due to differences in the restrictions imposed in SA when compared to these European countries.
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Affiliation(s)
- Witness Mapanga
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Asanda Mtintsilana
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siphiwe N. Dlamini
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justin Du Toit
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J. Ware
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
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Micklesfield LK, Munthali R, Agongo G, Asiki G, Boua P, Choma SS, Crowther NJ, Fabian J, Gómez-Olivé FX, Kabudula C, Maimela E, Mohamed SF, Nonterah EA, Raal FJ, Sorgho H, Tluway FD, Wade AN, Norris SA, Ramsay M. Identifying the prevalence and correlates of multimorbidity in middle-aged men and women: a cross-sectional population-based study in four African countries. BMJ Open 2023; 13:e067788. [PMID: 36918238 PMCID: PMC10016250 DOI: 10.1136/bmjopen-2022-067788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES To determine the prevalence of multimorbidity, to identify which chronic conditions cluster together and to identify factors associated with a greater risk for multimorbidity in sub-Saharan Africa (SSA). DESIGN Cross-sectional, multicentre, population-based study. SETTING Six urban and rural communities in four sub-Saharan African countries. PARTICIPANTS Men (n=4808) and women (n=5892) between the ages of 40 and 60 years from the AWI-Gen study. MEASURES Sociodemographic and anthropometric data, and multimorbidity as defined by the presence of two or more of the following conditions: HIV infection, cardiovascular disease, chronic kidney disease, asthma, diabetes, dyslipidaemia, hypertension. RESULTS Multimorbidity prevalence was higher in women compared with men (47.2% vs 35%), and higher in South African men and women compared with their East and West African counterparts. The most common disease combination at all sites was dyslipidaemia and hypertension, with this combination being more prevalent in South African women than any single disease (25% vs 21.6%). Age and body mass index were associated with a higher risk of multimorbidity in men and women; however, lifestyle correlates such as smoking and physical activity were different between the sexes. CONCLUSIONS The high prevalence of multimorbidity in middle-aged adults in SSA is of concern, with women currently at higher risk. This prevalence is expected to increase in men, as well as in the East and West African region with the ongoing epidemiological transition. Identifying common disease clusters and correlates of multimorbidity is critical to providing effective interventions.
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Affiliation(s)
- Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Munthali
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Godfred Agongo
- Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C.K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Palwende Boua
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
- Sydney Brenner Institute of Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Solomon Sr Choma
- Department of Public Health, University of Limpopo, Sovenga, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- South African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa Kabudula
- South African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eric Maimela
- Department of Public Health, University of Limpopo, Sovenga, South Africa
| | - Shukri F Mohamed
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Frederick J Raal
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Furahini D Tluway
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alisha N Wade
- South African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Muti M, Ware LJ, Micklesfield LK, Ramsay M, Agongo G, Boua PR, Kisiangani I, Cook I, Gómez-Olivé FX, Crowther NJ, Kabudula C, Norris SA, Chikowore T. Physical Activity and Its Association With Body Mass Index: A Cross-Sectional Analysis in Middle-Aged Adults From 4 Sub-Saharan African Countries. J Phys Act Health 2023; 20:217-225. [PMID: 36746155 DOI: 10.1123/jpah.2022-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to explore association of self-reported physical activity domains of work, leisure, and transport-related physical activity and body mass index (BMI) in 9388 adult men and women from the Africa-Wits-INDEPTH partnership for Genomic (AWI-Gen) study in Africa. Africa-Wits-INDEPTH partnership for Genomic is a large, population-based cross-sectional cohort with participants from 6 sites from rural and urban areas in 4 sub-Saharan African countries. METHODS A sex-stratified meta-analysis of cross-sectional data from men and women aged 29-82 years was used to assess the association of physical activity with BMI. RESULTS Overall, meeting physical activity guidelines of at least 150 minutes per week was associated with 0.82 kg/m2 lower BMI in men (β = -0.80 kg/m2; 95% confidence interval [CI], -1.14 to -0.47) and 0.68 kg/m2 lower BMI in women (β = -0.68 kg/m2; 95% CI, -1.03 to -0.33). Sex and site-specific differences were observed in the associations between physical activity domains and BMI. Among those who met physical activity guidelines, there was an inverse association between transport-related physical activity and BMI in men from Nanoro (Burkina Faso) (β = -0.79 kg/m2; 95% CI, -1.25 to -0.33) as well as work-related physical activity and BMI in Navrongo men (Ghana) (β = -0.76 kg/m2; 95% CI, -1.25 to -0.27) and Nanoro women (β = -0.90 kg/m2; 95% CI, -1.44 to -0.36). CONCLUSIONS Physical activity may be an effective strategy to curb rising obesity in Africa. More studies are needed to assess the impact of sex and geographic location-specific physical activity interventions on obesity.
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Affiliation(s)
- Monica Muti
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- Food and Nutrition Security Research Institute, Harare,Zimbabwe
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg,South Africa
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Godfred Agongo
- Navrongo Health Research Centre, Ghana Health Service, Navrongo,Ghana
- Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C. K. Tedam University of Technology and Applied Sciences, Navrongo,Ghana
| | - Palwende R Boua
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro,Burkina Faso
| | | | - Ian Cook
- Physical Activity Epidemiology Laboratory (EDST), School of Education, Faculty of Humanities, University of Limpopo, Polokwane,South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- School of Human Development and Health, University of Southampton, Southampton,United Kingdom
| | - Tinashe Chikowore
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
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9
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Mtintsilana A, Craig A, Mapanga W, Dlamini SN, Norris SA. Association between socio-economic status and non-communicable disease risk in young adults from Kenya, South Africa, and the United Kingdom. Sci Rep 2023; 13:728. [PMID: 36639432 PMCID: PMC9839722 DOI: 10.1038/s41598-023-28013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
There is a pressing need for global health preventions to curb the escalating burden of non-communicable diseases (NCDs). Utilising multi-country study designs can improve our understanding of how socio-economic context shapes the aetiology of NCDs, and this has great potential to advance global health interventions. We examined the association between socio-economic status (SES) and NCD risk, and the potential confounding effects of smoking and alcohol intake in young adults (18-35-year-olds) from Kenya, South Africa (SA), and the United Kingdom (UK). Our study was a cross-sectional online survey that included 3000 respondents (n = 1000 per country, 50% women) conducted in April 2022. We utilised information on twelve NCDs to classify respondents as having "no condition", "one condition", and "multimorbidity" (having two or more conditions). A total household asset score was calculated and used as a proxy of SES, and subsequently categorised into quintiles (Q1-Q5; lowest-highest). Ordered logistic regression was used to test the associations between NCD risk and exposure variables. In the UK sample, we found that those in the second lowest SES quintile (Q2) had lower odds of developing NCDs than their lowest SES counterparts (Q1). In contrast, South African and Kenyan youth with a SES score between middle and highest quintiles (Q3-Q5) were more likely to develop NCDs than the lowest SES quintile group. In all countries, smoking and/or alcohol intake were associated with higher odds of developing NCDs, and showed some confounding effects on the SES-NCD relationships. Specifically, in Kenya, the risk of developing NCD was more than two times higher in those in the middle (Q3) SES group (OR 2.493; 95% CI 1.519-4.091; p < 0.001) compared to their lowest (Q1) SES counterparts. After adjusting for smoking and alcohol, the ORs of middle (Q3) SES group changed from 2.493 to 2.241 (1.360-3.721; p = 0.002). Overall, we found that the strength and direction of SES-NCD associations differed within and between countries. This study highlights how different SES contexts shape the risk of NCDs among young adults residing in countries at different levels of economic development.
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Affiliation(s)
- Asanda Mtintsilana
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa.
| | - Ashleigh Craig
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa
| | - Witness Mapanga
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
| | - Siphiwe N Dlamini
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa
| | - Shane A Norris
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
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10
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Goedecke JH, Mendham AE. Pathophysiology of type 2 diabetes in sub-Saharan Africans. Diabetologia 2022; 65:1967-1980. [PMID: 36166072 PMCID: PMC9630207 DOI: 10.1007/s00125-022-05795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 01/11/2023]
Abstract
Sub-Saharan Africa (SSA) is the region with the highest projected rates of increase in type 2 diabetes (129% by 2045), which will exacerbate the already high prevalence of type 2 diabetes complications and comorbidities in SSA. In addition, SSA is grappling with poverty-related health problems and infectious diseases and is also undergoing the most rapid rates of urbanisation globally. These socioenvironmental and lifestyle factors may interact with genetic factors to alter the pathophysiological sequence leading to type 2 diabetes in sub-Saharan African populations. Indeed, current evidence from SSA and the diaspora suggests that the pathophysiology of type 2 diabetes in Black Africans is different from that in their European counterparts. Studies from the diaspora suggest that insulin clearance is the primary defect underlying the development of type 2 diabetes. We propose that, among Black Africans from SSA, hyperinsulinaemia due to a combination of both increased insulin secretion and reduced hepatic insulin clearance is the primary defect, which promotes obesity and insulin resistance, exacerbating the hyperinsulinaemia and eventually leading to beta cell failure and type 2 diabetes. Nonetheless, the current understanding of the pathogenesis of type 2 diabetes and the clinical guidelines for preventing and managing the disease are largely based on studies including participants of predominately White European ancestry. In this review, we summarise the existing knowledge base and data from the only non-pharmacological intervention that explores the pathophysiology of type 2 diabetes in SSA. We also highlight factors that may influence the pathogenesis of type 2 diabetes in SSA, such as social determinants, infectious diseases and genetic and epigenetic influences.
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Affiliation(s)
- Julia H Goedecke
- Biomedical Research and Innovation Platform and Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Amy E Mendham
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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11
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Carney A, Mulei T, Kurao D, Hagstrom C, Sommer M. "When I woke up I was so worried and ashamed, I thought it was a disease": Adolescent boys' transitions through puberty in Kenya. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:956060. [PMID: 36419962 PMCID: PMC9677552 DOI: 10.3389/frph.2022.956060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Growing evidence suggests a need for more focused attention on boys' experiences of puberty in sub-Saharan Africa to assure healthy transitions into young adulthood. Existing research remains limited on the masculinity norms shaping boys' maturation experiences in Kenya. To help fill this gap, we conducted a comparative case study using qualitative methodologies with 16-19-year-old male youth in rural and urban Kenya, and with adults interacting in boys' daily lives. Findings suggest that Kenyan boys experience shame, confusion and silence around changes happening in their bodies; face pressures from new societal expectations as they become young men; and have adolescent lives shaped by minimal supervision, increased peer pressures and engagement in more risky health behaviors. Additional research and targeted interventions on boys transitioning through puberty and early adolescence are needed to better understand their vulnerabilities and prevent or reduce their engagement in unsafe behaviors.
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Affiliation(s)
| | | | | | - Christine Hagstrom
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
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12
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Piga NN, Boua PR, Soremekun C, Shrine N, Coley K, Brandenburg JT, Tobin MD, Ramsay M, Fatumo S, Choudhury A, Batini C. Genetic insights into smoking behaviours in 10,558 men of African ancestry from continental Africa and the UK. Sci Rep 2022; 12:18828. [PMID: 36335192 PMCID: PMC9637114 DOI: 10.1038/s41598-022-22218-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022] Open
Abstract
Smoking is a leading risk factor for many of the top ten causes of death worldwide. Of the 1.3 billion smokers globally, 80% live in low- and middle-income countries, where the number of deaths due to tobacco use is expected to double in the next decade according to the World Health Organization. Genetic studies have helped to identify biological pathways for smoking behaviours, but have mostly focussed on individuals of European ancestry or living in either North America or Europe. We performed a genome-wide association study of two smoking behaviour traits in 10,558 men of African ancestry living in five African countries and the UK. Eight independent variants were associated with either smoking initiation or cessation at P-value < 5 × 10-6, four being monomorphic or rare in European populations. Gene prioritisation strategy highlighted five genes, including SEMA6D, previously described as associated with several smoking behaviour traits. These results confirm the importance of analysing underrepresented populations in genetic epidemiology, and the urgent need for larger genomic studies to boost discovery power to better understand smoking behaviours, as well as many other traits.
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Affiliation(s)
- Noemi-Nicole Piga
- Genetic Epidemiology Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Palwende Romuald Boua
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chisom Soremekun
- Department of Immunology and Molecular Biology, College of Health Science, Makerere University, Kampala, Uganda
- H3Africa Bioinformatics Network (H3ABioNet) Node, Center for Genomics Research and Innovation (CGRI), National Biotechnology Development Agency CGRI/NABDA, Abuja, Nigeria
- The African Computational Genomics (TACG) Research Group, MRC/UVRI LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Nick Shrine
- Genetic Epidemiology Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Kayesha Coley
- Genetic Epidemiology Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jean-Tristan Brandenburg
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin D Tobin
- Genetic Epidemiology Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Segun Fatumo
- H3Africa Bioinformatics Network (H3ABioNet) Node, Center for Genomics Research and Innovation (CGRI), National Biotechnology Development Agency CGRI/NABDA, Abuja, Nigeria
- The African Computational Genomics (TACG) Research Group, MRC/UVRI LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Non-Communicable Disease Epidemiology (NCDE), London School of Hygiene and Tropical Medicine, London, UK
| | - Ananyo Choudhury
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chiara Batini
- Genetic Epidemiology Group, Department of Population Health Sciences, University of Leicester, Leicester, UK.
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13
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Alves D, Delgado AP, Amado M, Craveiro I, Santos Z, Goggins A, Gasparinho C, Correia A, Gonçalves L. Recreation and Alcohol Consumption in Sub-Saharan Africa: Addressing Gender and Age Differences in Urban Areas-Praia, Cabo Verde. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11175. [PMID: 36141447 PMCID: PMC9517591 DOI: 10.3390/ijerph191811175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Reducing alcohol consumption and improving urban planning in African cities are public health priorities. The aim of this study was to explore gender and age differences in recreational activity participation and its link with self-reported alcohol consumption in three urban areas of Praia. METHODS A questionnaire was applied to a probabilistic sample of 1912 adults, with a median age of 35.0 (IQR: 26.0-48.8) years, living in informal, transition, and formal areas of the capital of Cabo Verde. RESULTS More than 80% of the participants reported rarely or never participating in recreational activities. Going daily or weekly to the café was the most reported recreational activity, regardless of the urban area. Participation in recreational activities was higher in men than women, decreasing with age in both cases. Alcohol consumption was significantly higher in men than women (72.4% versus 47.4%, p < 0.001). Multiple logistic regression models showed that going at least once to the bar/nightclub (for men and women) and going to the café (for women) were associated with alcohol consumption. Furthermore, age (for women), in a protective way, and having children (for men) appeared to be associated with alcohol consumption. CONCLUSIONS This study provides new data on the recreational environment in Praia and can contribute to the development of local and national public health policies and interventions in line with several SDGs to reduce alcohol consumption, enhance healthy leisure/recreation practices, and promote better living conditions for its inhabitants.
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Affiliation(s)
- Daniela Alves
- Unidade de Saúde Pública Global, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine, IHMT-NOVA, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - António Pedro Delgado
- Global Health and Tropical Medicine, IHMT-NOVA, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
- Universidade de Cabo Verde, Zona K do Palmarejo Grande, Praia 7943-010, Capo Verde
| | - Miguel Amado
- Civil Engineering Research and Inovation for Sustainability, CERis, Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Isabel Craveiro
- Unidade de Saúde Pública Global, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine, IHMT-NOVA, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Zélia Santos
- Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa (IPL), Av. D. João II, 1990-096 Lisboa, Portugal
| | - Alexander Goggins
- Unidade de Saúde Pública Global, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Carolina Gasparinho
- Unidade de Saúde Pública Global, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine, IHMT-NOVA, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Artur Correia
- Universidade Intercontinental de Cabo Verde, n 1 Palmarejo, Praia, Capo Verde
| | - Luzia Gonçalves
- Unidade de Saúde Pública Global, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine, IHMT-NOVA, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências da Universidade de Lisboa, 1749-016 Lisboa, Portugal
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14
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Shaikh MA, Lule H, Bärnighausen T, Lowery Wilson M, Abio A. Self-reported involvement in road traffic crashes in Kenya: A cross-sectional survey of a nationally representative sample. Health Sci Rep 2022; 5:e809. [PMID: 36177397 PMCID: PMC9475121 DOI: 10.1002/hsr2.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022] Open
Abstract
Background Road traffic crashes (RTCs) are a global public health burden whose resulting morbidity and mortality disproportionately impact low- and middle-income countries with stressed health systems. There is a paucity of published studies that evaluate the sociodemographic distribution of RTCs using nationally representative samples from the African region. Aim To examine population-wide associations between sociodemographic factors and involvement in RTCs in Kenya. Methods Data were obtained from the 2014 Kenyan Demographic Health Survey, representing all 47 counties in Kenya, from May to October of 2014. We estimated the prevalence of RTCs and utilized logistic regression for bivariate and multivariable analyses to determine the sociodemographic factors associated with RTCs. Study variables included age, place of residence, household wealth index, educational attainment, and history of alcohol consumption. We computed odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results A higher prevalence was reported among men (8.76%) versus women (3.22%). The risk factors among men included being 20-34 years of age, living in a rural area (OR 1.38, 95% CI 1.09, 1.74), drinking alcohol (OR 1.33, 95% CI 1.11, 1.59), and having not higher than a primary (OR 1.90, 95% CI 1.19, 3.03) or secondary (OR 1.68, 95% CI 1.04, 2.71) education. The strongest risk factors for women included the being aged 45-49 (OR 2.30, 95% CI 1.44, 3.67) and 20-24 years (OR 1.81, 95% 1.17, 2.79) as well as being in the fourth wealth quintile (OR 1.83, 95% CI 1.15, 2.91). Conclusion Men and the most economically productive age groups were more likely to report being involved in RTCs. Strategies to reduce the occurrences of RTCs should prioritize the most vulnerable sociodemographic groups.
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Affiliation(s)
- Masood Ali Shaikh
- Injury Epidemiology and Prevention (IEP) Research Group, Department of Clinical Neurosciences, Turku Brain Injury CenterTurku University Hospital and University of TurkuTurkuFinland
| | - Herman Lule
- Injury Epidemiology and Prevention (IEP) Research Group, Department of Clinical Neurosciences, Turku Brain Injury CenterTurku University Hospital and University of TurkuTurkuFinland
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH)University Hospital and University of HeidelbergHeidelbergGermany
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH)University Hospital and University of HeidelbergHeidelbergGermany
| | - Anne Abio
- Injury Epidemiology and Prevention (IEP) Research Group, Department of Clinical Neurosciences, Turku Brain Injury CenterTurku University Hospital and University of TurkuTurkuFinland
- Heidelberg Institute of Global Health (HIGH)University Hospital and University of HeidelbergHeidelbergGermany
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15
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Alcohol Consumption Patterns: A Systematic Review of Demographic and Sociocultural Influencing Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138103. [PMID: 35805782 PMCID: PMC9265892 DOI: 10.3390/ijerph19138103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
Background: Excessive alcohol consumption has negative effects not only on the drinkers’ health but also on others around them. Previous studies suggest that excessive alcohol consumption can be related to a combination of factors such as age, family background, religiosity, etc. Investigating and clarifying these roots of alcohol consumption is crucial so that the right type of interventions can be designed in a specific and targeted manner. Objectives: This work was conducted as a systematic review to reveal the factors associated with alcohol consumption and to heighten the understanding of the differences among various communities and segments of the population regarding their usage of alcohol. Data sources: A systematic search of Web of Science, PubMed, ScienceDirect, and Google Scholar was performed. Results: Forty-five studies were included in the review after excluding irrelevant records and duplicates. Conclusions: Alcohol consumption patterns can be associated with several factors related to communities and individuals, and our review revealed demographic factors, including age and proximity to alcohol outlets, as well as social factors, including family background, socioeconomic background, and religious influence. These findings can be used to establish a guideline for further studies in understanding alcohol consumption patterns among individuals according to their personal characteristics and sociocultural backgrounds.
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16
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Nonterah EA, Boateng D, Crowther NJ, Klipstein-Grobusch K, Oduro AR, Agongo G, Mohamed SF, Boua PR, Choma SSR, Norris SA, Tollman SM, Bots ML, Ramsay M, Grobbee D. Carotid Atherosclerosis, Microalbuminuria, and Estimated 10-Year Atherosclerotic Cardiovascular Disease Risk in Sub-Saharan Africa. JAMA Netw Open 2022; 5:e227559. [PMID: 35471573 PMCID: PMC9044117 DOI: 10.1001/jamanetworkopen.2022.7559] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Carotid atherosclerosis and microalbuminuria are associated with atherosclerotic cardiovascular disease (ASCVD) but are understudied in sub-Saharan Africa. OBJECTIVE To evaluate the association of carotid atherosclerosis and microalbuminuria with 10-year ASCVD risk in middle-aged sub-Saharan African individuals. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study conducted analyses of baseline data from the African-Wits-INDEPTH (International Network for the Demographic Evaluation of Populations and Their Health in Low- and Middle-Income Countries) genomic study (AWI-Gen). Women and men aged 40 to 60 years without baseline CVD and drawn from Burkina Faso, Ghana, Kenya, and South Africa were included. MAIN OUTCOMES AND MEASURES Hypotheses for the analyses were formulated after data collection. The main exposures were carotid atherosclerosis, assessed using carotid intima-media thickness (CIMT) using B-mode ultrasonography, and microalbuminuria, measured using spot urine albumin (SUA) and urine albumin-creatinine ratio (uACR). The main outcome was high ASCVD risk, defined as a 2018 Pooled Cohort Equations score of 7.5% or greater. Associations were estimated using adjusted multivariable logistic regression analyses. FINDINGS A total of 9010 participants with a mean (SD) age of 50 (6) years and 4533 (50.3%) women were included. High CIMT, SUA, and uACR were each associated with older age (eg, mean [SD] age of participants with high vs reference range CIMT: 55 [5] years vs 50 [6] years; P < .001) and high prevalence of both diabetes and hypertension (eg, hypertension among those with high vs reference range SUA: 213 of 1117 [19.1%] vs 356 of 2549 [14.0%]; P < .001). Smokers were likely to have higher vs reference range SUA (210 [18.8%] vs 407 [16.0%]) and uACR (138 of 707 [19.5%] vs 456 of 2797 [16.3%]). Carotid atherosclerosis was common in Burkina Faso (82 of 262 [31.3%]) and Ghana (91 [34.7%]), while microalbuminuria, measured by SUA, was common in Kenya (272 [24.4%]) and South Africa (519 [46.5%]). SUA was associated with higher odds of carotid atherosclerosis (odds ratio [OR], 1.77; 95% CI, 1.04-3.01) compared with uACR (OR, 0.51; 95% CI, 0.27-0.95). Common CIMT, SUA, and uACR were associated with 10-year ASCVD risk, with CIMT having a stronger association with 10-year ASCVD risk in both women (OR, 1.95; 95% CI, 1.78-2.14) and men (OR, 1.73; 95% CI, 1.55-1.93) than SUA (women: OR, 1.29; 95% CI, 1.12-1.43; men: OR, 1.46; 95% CI, 1.26-1.55) and uACR (women: OR, 1.32; 95% CI, 1.10-1.54; men: OR, 1.35; 95% CI, 1.15-1.46). CONCLUSIONS AND RELEVANCE The presence of microalbuminuria measured by SUA may indicate risk of subclinical carotid atherosclerosis and high 10-year ASCVD risk in middle-aged residents of sub-Saharan Africa. These data should be confirmed in longitudinal studies of cardiovascular events.
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Affiliation(s)
- Engelbert A. Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Laboratory Health Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abraham R. Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Godfred Agongo
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C.K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | | | - Palwendé R. Boua
- Institut de Recherché en Sciences de la Santé, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Solomon S. R. Choma
- DIMAMO Health Demographic Surveillance Site, Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Shane A. Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M. Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michiel L. Bots
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michèle Ramsay
- Sydney Brenner Institute of Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Lipenga T, Matumba L, Vidal A, Herceg Z, McCormack V, De Saeger S, De Boevre M. A concise review towards defining the exposome of oesophageal cancer in sub-Saharan Africa. ENVIRONMENT INTERNATIONAL 2021; 157:106880. [PMID: 34543937 DOI: 10.1016/j.envint.2021.106880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Oesophageal cancer (EC) is among the common causes of illness and death among all cancers worldwide. Advanced EC has a poor prognosis, with worse outcomes observed in low-income settings. Oesophageal squamous cell carcinoma (ESCC) is the most common EC histology reported globally, with the highest ESCC incidence rates in the 'Asian Belt' and the African EC corridor. While the aetiology of ESCC is well-documented in the 'Asian belt', data for the African EC corridor and the entirety of sub-Saharan Africa (SSA) are fewer. OBJECTIVE To help address gaps in ESCC aetiology in SSA, we critically evaluated evidence of lifestyle, environmental, and epigenetic factors associated with ESCC risk and discussed prospects of defining ESCC exposome. DATA INCLUSION Unlimited English and non-English articles search were made on PubMed Central and Web of Science databases from January 1970 to August 2021. In total, we retrieved 999 articles and considered meta-analyses, case-control, and cohort studies. The quality of individual studies was assessed using the Newcastle-Ottawa scale. DATA EXTRACTION Details extracted include the year of publication, country of origin, sample size, comparators, outcomes, study subjects, and designs. DATA ANALYSIS Together, we assessed 13 case-control studies and two meta-analyses for the effect of lifestyle or environmental exposures on ESCC risk. Again, we evaluated seven case-control studies and one meta-analysis regarding the role of epigenetics in ESCC tumorigenesis. RESULTS In general, evidence of ESCC aetiology points to essential contributions of alcohol, tobacco, hot beverages, biomass fuel, and poor oral health/hygiene, although more precise risk characterisation remains necessary. CONCLUSION We conclude that ESCC in SSA is a multifactorial disease initiated by several external exposures that may induce aberrant epigenetic changes. The expanding aetiological research in this domain will be enhanced by evidence synthesis from classical and molecular epidemiological studies spanning the external and internal exposome.
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Affiliation(s)
- Trancizeo Lipenga
- Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; Department of Pathology, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent, Belgium.
| | - Limbikani Matumba
- MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; Food Technology and Nutrition Research Group-NRC, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Arnau Vidal
- Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium
| | - Zdenko Herceg
- Epigenomics and Mechanism Branch, International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - Sarah De Saeger
- Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent, Belgium; Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng, South Africa
| | - Marthe De Boevre
- Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent, Belgium
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