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Ramalivhana FW, Veldsman T, Moss SJ. Assessment of non-communicable disease risk factors, functional performance, and health-related quality of life in adults: a comparative analysis in low-resourced urban and rural areas of South Africa. BMC Public Health 2024; 24:1580. [PMID: 38867182 PMCID: PMC11170915 DOI: 10.1186/s12889-024-18964-2] [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: 12/04/2023] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Globally, disparities between non-communicable disease (NCD) risk factors, functional performance, and health-related quality of life (HRQoL) exist in people living in rural and low-resourced urban settings. Evidence of these health differences determined with objective NCD risk factors and functional performance measurements in South Africa, is scarce. Therefore, the study aimed to determine the differences in NCD risk factors, functional performance and HRQoL between rural and low-resourced urban areas. METHODS The study recruited 311 adults (35-80 years) presenting with at least one NCD risk factor from low-resourced urban- (n = 183) and rural (n = 128) communities. Objective measurements of physical activity (PA) by means of combined heart rate and accelerometery, body composition employing skinfolds, peripheral lipid and glucose concentrations, blood pressure, functional performance indicators (handgrip, single leg stand, sit-to-stand, timed-up-and-go speed, predicted peak VO2 max); and HRQoL were measured according to standard procedures. Independent t-tests, Mann-Whitney U, and chi-square tests were performed to determine differences between the variables of low-resourced urban and rural settings. RESULTS The participants from the low-resourced urban setting were significantly older than the rural residents (59.1 ± 10.7 years vs. 52.8 ± 11.3 years; p = 0.001). NCD risk factors were significantly more prevalent in the low-resourced urban participants compared to rural participants, in particular for elevated systolic (85.8% vs. 62.5%; p = 0.001), and diastolic blood pressure (88.5% vs. 65.6%; p = 0.001), physical inactivity (95.9% vs. 87.7%; p = 0.026), increased cholesterol concentrations (22.1% vs. 8.7%; p = 0.002), and increased waist circumference (61.9% vs. 49.2%; p = 0.027). Low-resourced urban residents presented with a higher average body fat percentage (27.69% ± 7.65% vs. 12.23% ± 4.67%; p < 0.001), and lower moderate to vigorous PA levels (37.19 ± 49.55 [95% CI = 29.12-45.27] vs. 62.92 ± 60.43 min/week [95% CI = 47.95-77.90]; p = 0.003) compared to rural residents. Rural residents showed significantly better functional performance, including peak VO2 (23.99 ± 9.89 vs. 16.95 ± 7.64 ml/min/kg; p = 0.001) and single leg stand (right leg: 44.96 ± 18.47 vs. 20.87 ± 19.18 s; p = 0.001) as well as higher HRQoL for the physical (51.06 ± 8.14% vs. 45.62 ± 11.13%; p < 0.001) and mental (54.75 ± 8.24% vs. 48.91 ± 12.27%; p < 0.001) component scores compared to participants from the low-resourced urban areas. CONCLUSION NCD risk factors, functional performance, and HRQoL significantly differ in rural communities compared to low-resourced urban communities in South Africa. Urban areas' most prevalent risk factors were elevated blood pressure, physical inactivity, and increased waist circumference. Participants from rural areas demonstrated significantly better functional performance, such as fitness and balance. HRQoL was better in rural settings than in urban settings. Future intervention programmes should be tailored for specific settings.
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Affiliation(s)
- Fhatuwani W Ramalivhana
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Tamrin Veldsman
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Sarah J Moss
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
- North-West University, Private Bag X6001, Potchefstroom, 2531, South Africa.
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Gutiérrez B, Martínez AG, Zuluaga IA. Edentulism and Individual Factors of Active Aging Framework in Colombia. Ann Geriatr Med Res 2024; 28:46-56. [PMID: 38105010 PMCID: PMC10982444 DOI: 10.4235/agmr.23.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND While edentulism remains a serious public health problem for older adults in Colombia, few analyses have been conducted from the framework of active aging as a part of the positive discourse of aging. This study analyzed complete edentulism and its relationship with determinants including personal, behavioral, and health systems and social services. METHODS This study included a total of 19,004 older adults. We used univariate, bivariate, and multivariate logistic regression type scores to investigate the relationships between the variables. The personal determinants included basic (Barthel scale) and instrumental activities of daily living (Lawton scale), public transportation, functional limitations, self-perceived health, and health problems. The behavioral factors included alcohol and tobacco use, mini nutritional tests, and physical activity. The last determinant was the healthcare system, while social services access included dental services. The analysis also included sociodemographic variables. RESULTS The results revealed significant associations for the variables of the three determinants, including the risk of malnutrition (odds ratio [OR]=1.15), functional limitation (OR=1.15), moderate physical activity (OR=1.08), and access to dental services (OR=2.31). Sex, years of education, and race were also risk factors, among other variables. Personal determinants, behavior, and use and access to health services were related to edentulism in older adults. CONCLUSION These findings support the need to include different analyses of edentulism from multicausality and to understand the oral cavity and the living conditions of aging adults.
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Affiliation(s)
- Bruno Gutiérrez
- Faculty of Medicine, School of Dentistry, Universidad del Valle, Cali, Colombia
- Faculty of Health, Universidad El Bosque, Bogota, Colombia
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Pengpid S, Peltzer K. Rural-urban health differences among aging adults in India. Heliyon 2024; 10:e23397. [PMID: 38173538 PMCID: PMC10761573 DOI: 10.1016/j.heliyon.2023.e23397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/08/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Background The aim of this study was to determine the rural-urban health differences among aging adults in India. Methods The national cross-sectional data of 67,489 individuals (≥45 years) in 2017-2018 from 35 states and union territories of India (excluding Sikkim) in 2017-2018 were analysed. Various sociodemographic data, well-being indicators, lifestyle factors and physical conditions were assessed by face-to-face interviews and physical measurement. Univariable and multivariable logistic regression was utilized to assess the predictors between residence status (rural dweller, urban migrant, and urban dweller) and various health indicator outcomes. Results Majority (70.4 %) of the participants lived in rural areas, 10.3 % were urban migrants and 19.3 % urban dwellers. In the multivariable logistic regression analysis, urban migrants and urban dwellers had a higher self-rated health status, cognitive functioning, physical inactivity, overweight or obesity and abdominal obesity than rural dwellers, while urban migrants and/or urban dwellers had lower functional disability, insomnia symptoms, current smokeless tobacco use, current smoking, heavy episodic drinking and underweight than rural dwellers. Furthermore, urban migrants and/or urban dwellers had higher odds of diabetes, hypertension, heart disease, cancer, high cholesterol than rural dwellers, while urban migrants and/or urban dwellers had lower odds of persistent headaches, major injury, recurrent fall, physical pain, periodontal disease, vision impairment, and gastrointestinal problems than rural dwellers. Conclusion Among 30 health indicators assessed, 16 had an urban migrant and/or urban dweller advantage, 8 had urban migrant and/or urban dweller penalty, and 6 did not differ between rural-urban groups. Public health promotion and health care should address differing health care needs of rural and urban middle-aged and older adults.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Zhang J, Zhang Y. Decomposing differences in the chronic disease condition between rural and urban older adults in China: a cross-sectional analysis. Front Public Health 2024; 11:1298657. [PMID: 38249386 PMCID: PMC10797097 DOI: 10.3389/fpubh.2023.1298657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Background With the increasing in aging in China, there has been an increase in older adults suffering from chronic diseases. However, little is known about the differences in chronic disease conditions between rural and urban older adults. The objective of this study is to identify chronic disease conditions and investigate the factors that cause differences in chronic disease conditions between urban and rural older adults. Methods The data are from the fourth wave of the China Health and Retirement Longitudinal Study. The coarsened exact matching (CEM) method was used to reduce the biases for a comparative study. After the CEM method, this study included 5,927 participants aged 60 and above. Chronic disease condition was used as the indicator to measure the health of older adults. Specifically, Fairlie's decomposition analysis was carried out to discover the differences in chronic disease conditions between urban and rural older adults. Results The study showed that the proportion of those suffering from chronic diseases was significantly higher among urban older adults (51.26%) than rural older adults (46.56%). In those suffering from chronic diseases, there were significant differences in gender, education level, minorities, religiosities, duration of sleep, drinking alcohol, social activity, insurance, and socioeconomic status between rural and urban older adults, while in those not suffering from chronic diseases, there were significant differences in age, education level, marital status, drinking alcohol, social activity, insurance, region, and socioeconomic status between rural and urban older adults. For rural older adults, those who were widowers [Odds ratios (OR): 1.267], who drink alcohol (OR: 1.421), and having government medical insurance (OR: 4.869) had higher odds of having chronic diseases. However, those who were in high school and above (OR: 0.802), reporting a duration of sleep of 4-8 h (OR: 0.745) or above 8 h (OR: 0.649), having social activity (OR: 0.778), and having the most affluent socioeconomic status (OR: 0.778) had lower odds of having chronic diseases. As for urban older adults, those who were aged 65-74 years (OR: 1.246) and had government medical insurance (OR: 2.362) had higher odds of having chronic diseases. Fairlie's decomposition analysis indicated that 23.57% of the differences in chronic diseases conditions could be traced to duration of sleep, drinking alcohol, social activity, and region. Conclusion This study illustrated that the proportion of chronic diseases was higher among urban older adults than rural older adults. Considering duration of sleep, drinking alcohol, region, social activity, and region, the study demonstrated health differences between urban and rural older adults and provided evidence for policy-making to narrow the health gap between urban and rural areas.
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Affiliation(s)
- Jian Zhang
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Yuan Zhang
- School of Law and Public Administration, China Three Gorges University, Yichang, China
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Gizamba JM, Davies J, Africa C, Choo-Kang C, Goedecke JH, Madlala H, Lambert EV, Rae DE, Myer L, Luke A, Dugas LR. Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:861. [PMID: 38062372 PMCID: PMC10704741 DOI: 10.1186/s12879-023-08736-5] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. METHODS In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran's Q statistic. RESULTS We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. CONCLUSIONS These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.
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Affiliation(s)
- Jacob M Gizamba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Jess Davies
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Chad Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Julia H Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Hlengiwe Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Estelle V Lambert
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dale E Rae
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
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Perelman NL, Kolosov VP. Differences in the health-related quality of life in patients with asthma living in urban and rural areas in the Amur Region of Russian Federation. PLoS One 2023; 18:e0284683. [PMID: 37963175 PMCID: PMC10645338 DOI: 10.1371/journal.pone.0284683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/05/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Asthma usually arises from an interaction between host and environmental factors. Growing attention has been paid to a place of residence as a factor shaping health-related quality of life (QoL). This study investigated the rural-urban disparity in QoL among adult asthma patients in the Amur region of Russian Federation. MATERIALS AND METHODS This cross-sectional study included 351 randomly selected adults with asthma. We analyzed QoL (SF-36 and AQLQ scores), asthma control (ACT), and anxiety and depression (HADS) depending on the place of residence (urban vs. rural). RESULTS The scale "Role Emotional" (RE) of SF-36 was significantly lower in patients from rural areas compared to urban residents (59.3±3.1 vs. 70.4±2.3 points; p = 0.0042). In the urban group, the correlation analysis demonstrated a clear influence of RE on patients' own assessment of their physical functioning (PF, r = 0.53; p<0.0001). Both groups demonstrated low "Social Functioning" (SF). In the group of urban residents, correlation analysis revealed the presence of positive correlations of SF-36 domains reflecting physical (PF, RP, BP) and social functioning (SF, VT) with most scales of both QoL questionnaires. The domains of the emotional sphere (RE and MH) positively correlated with all scales of both QoL questionnaires among urban residents. In the group of rural residents, a comparative analysis showed the absence of significant correlations between more of the QoL scales. Although Asthma Control Test did not differ between groups, we noted a significantly higher need for β2-agonists in rural areas compared to urban areas (4.2±0.6 vs. 2.7±0.3 inh/day, respectively; p = 0.0221). The frequency of urban residents with a clinically significant level of anxiety (56 persons, or 25.2%) turned out to be lower compared to rural residents (45 persons, or 34.8%; χ2 = 34.08; p<0.001). CONCLUSION The burden of asthma introduces a greater imbalance in the health-related QoL of rural residents compared to urban residents in the Amur region of the Russian Federation. The absence of interrelationships of some QoL domains in rural residents suggested a disunity of the physical, psychological and social aspects of life. The rural residents suppress physical discomfort by the more frequent use of short bronchodilators. They often showed emotional instability with a predominance of anxiety, which affected the decrease in QoL in the psycho-emotional sphere.
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Affiliation(s)
- Natalia L. Perelman
- Laboratory of Prophylaxis of Nonspecific Pulmonary Diseases, Far Eastern Scientific Center of Physiology and Pathology of Respiration, Blagoveshchensk, Russian Federation
| | - Victor P. Kolosov
- Laboratory of Prophylaxis of Nonspecific Pulmonary Diseases, Far Eastern Scientific Center of Physiology and Pathology of Respiration, Blagoveshchensk, Russian Federation
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Hlahla MO, Kunene LA, Mphekgwana PM, Madiba S, Monyeki KD, Modjadji P. Comparison of Malnutrition Indicators and Associated Socio-Demographic Factors among Children in Rural and Urban Public Primary Schools in South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1749. [PMID: 38002840 PMCID: PMC10670259 DOI: 10.3390/children10111749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Most children in South Africa attending public schools are predisposed to malnutrition due to poor infrastructure and social inequality. This is despite the implementation of the National School Nutrition Programme to address barriers to learning associated with hunger and malnutrition and the National Development Plan to reduce child malnutrition through provision of social grants. In view of this, we compared malnutrition indicators and associated socio-demographic factors among children in rural Mpumalanga and urban Gauteng in South African public primary schools selected using a multistage cluster random sampling. A validated researcher-administered questionnaire was used to collect socio-demographic data of caregivers, along with primary school children data collected on age, sex, learning grade, and anthropometric measures. Malnutrition indicators, which are stunting (low height-for-age z-scores), underweight (low weight-for-age z-scores), thinness (low body-mass-index-for-age z-scores), and overweight/obesity (high body mass index) were computed using WHO Anthro Plus 1.0.4 and data were analyzed using Stata 18. A total of 903 children (rural = 390 and urban = 513) with a mean age of 10 ± 2 years in the foundation phase (learning grades one to three) and the intermediate learning phase (learning grades four to seven) participated with their caregivers (mean age: 39 ± 8 years). Significant levels of poor socio-demographic status were observed among caregivers living in the rural setting compared to in the urban setting. Overall, thinness (18%), stunting (12%), underweight (10%), and overweight/obesity (24%) were observed among school children. Children in the rural schools had a significantly higher prevalence of stunting (20% vs. 3%; p < 0.0001), underweight (17% vs. 2%; p < 0.0001) and thinness (28% vs. 7%; p < 0.001) than their urban counterparts. In the urban, the odds of stunting, underweight and thinness were less among school children, while overweight/obesity was twice as likely in the urban setting. The multivariate final model showed lower odds of underweight [adjusted odds ratio (AOR) = 0.16; 95% confidence interval (CI): 0.06-0.42] and stunting [AOR = 0.33; 95% CI: 0.13-0.87] in the urban compared to the rural schools. The association of stunting with sex [AOR =0.53; 95% CI: 0.30-0.94] and the intermediate learning phase [AOR = 7.87; 95% CI: 4.48-13.82] was observed in the rural setting, while thinness was associated with living in households with an income of USD 52.51 to USD 262.60/month [AOR = 2.89; 95% CI: 1.01-8.24] and receiving the child social grant [AOR = 2.49; 0.90-6.86] in the urban setting. Overweight/obesity was associated with living in a household with an income of USD 52.51 to USD 262.60/month [AOR = 1.80; 95% CI: 1.02-3.10]. The findings suggest nutritional intervention approaches that are accustomed to the context of settings to effectively tackle malnutrition.
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Affiliation(s)
- Mosebudi Olga Hlahla
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Lindy Agatha Kunene
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Peter Modupi Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
| | - Kotsedi Dan Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Polokwane 0700, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort, Johannesburg 1709, South Africa
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Steinberg N, Parisi JM, Feger DM, Clay OJ, Willis SL, Ball KK, Marsiske M, Harrell ER, Sisco SM, Rebok GW. Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial. J Aging Health 2023; 35:107S-118S. [PMID: 35604034 DOI: 10.1177/08982643221102718] [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] [Indexed: 11/15/2022]
Abstract
ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.
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Affiliation(s)
- Nessa Steinberg
- Marcus Institute for Aging, Hebrew SeniorLife, Boston, MA, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Danielle M Feger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
- University of Alabama Alzheimer's Disease Research Center, Birmingham, AL, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
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Bhwana D, Siewe Fodjo JN, Amaral LJ, Vandevenne L, Francis F, Challe DP, Mmbando BP, Colebunders R. Disability assessment among persons with epilepsy in Mahenge, an onchocerciasis-endemic area in Tanzania: A cross-sectional study. Epilepsy Behav 2023; 146:109367. [PMID: 37523798 DOI: 10.1016/j.yebeh.2023.109367] [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: 05/02/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND A high prevalence of epilepsy has been observed in the onchocerciasis-endemic focus of Mahenge, Tanzania. This study sought to assess the degree of disability experienced by persons with epilepsy (PWE) in Mahenge and identify associations with sociodemographic and clinical features. METHOD This cross-sectional study was conducted in Mahenge, Tanzania, between February and July 2020. PWE were recruited from the Mahenge epilepsy clinic and four neighbouring rural villages (Mdindo, Mzogezi, Mzelezi and Sali). Data were collected using the 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire for adults. For children aged 5-17 years, we used the Module on Child Functioning developed by UNICEF and the Washington Group. Questionnaires were administered by trained research assistants. Descriptive statistics were performed, and multivariable analyses (gamma and logistic regressions) were conducted. RESULTS A total of 321 adults (45.5% males) and 48 children (55.3% males) with epilepsy participated. The overall median WHODAS 2.0 score was 4.8% (IQR: 0.9-18.9). The most affected disability domain was 'participating in the society' (median score: 12.5%, IQR: 0-29.2). Fifteen (31.3%) of the children with epilepsy had a disability in at least one domain of the child functioning module, with the 'accepting change' domain harbouring the highest proportion of disabled children (12.5%). Higher seizure frequency and longer epilepsy duration were associated with more disability. CONCLUSION PWE in Mahenge experience variable degrees of disability. The affected domains indicate the need for societal rehabilitation of PWE in various community and/or social activities. Peer-support groups were instituted at the study sites to address these needs.
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Affiliation(s)
- Dan Bhwana
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | | | - Luís-Jorge Amaral
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium.
| | - Lauren Vandevenne
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium.
| | - Filbert Francis
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | - Daniel P Challe
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | - Bruno P Mmbando
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
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Das J, Kundu S, Hossain B. Rural-urban difference in meeting the need for healthcare and food among older adults: evidence from India. BMC Public Health 2023; 23:1231. [PMID: 37365536 DOI: 10.1186/s12889-023-16126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Due to changes in demographic and epidemiological scenarios, and the gradual increase in the older population, India is yet to prepare for rising nutrition and health-related issues among older adults in the coming decades. While the process of ageing and its associated aspect has been found to have an urban-rural divide. Thus, this study examines rural/urban differences in unmet needs for food and healthcare among Indian older adults. METHODS A sample of 31,464 older adults aged 60 years and above were considered in the study from the Longitudinal and Ageing Survey of India (LASI). The bivariate analysis was done using the sampling weights. Logistic regression and decomposition analysis was used to explain the rural-urban gap in the unmet needs for food and healthcare among Indian older adults. RESULTS Rural older adults were more vulnerable to meeting the need for health and food than their urban counterparts. While factors that contributed majorly to the difference in unmet need for food between urban and rural were education (34.98%), social group (6.58%), living arrangements (3.34%) and monthly per capita expenditure (MPCE) (2.84%). Similarly, for the unmet need for health, the factors that contributed the most to the rural-urban gap are education (28.2%), household size (2.32%), and MPCE (1.27%). CONCLUSION The study indicates more vulnerability among rural older adults than compared to urban older individuals. The targeted policy-level efforts should be initiated considering the economic and residential vulnerability identified in the study. There is a need for primary care services that can provide targeted help to older adults in rural communities.
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Affiliation(s)
- Jyoti Das
- International Institute for Population Sciences (IIPS), Mumbai, 400088, India
| | - Sampurna Kundu
- Jawaharlal Nehru University (JNU), New Delhi, 110067, India
| | - Babul Hossain
- International Institute for Population Sciences (IIPS), Mumbai, 400088, India.
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11
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Micklesfield LK, Kolkenbeck-Ruh A, Mukoma G, Prioreschi A, Said-Mohamed R, Ware LJ, Motlhatlhedi M, Wrottesley SV, Norris SA. The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women. Cardiovasc J Afr 2022; 33:200-219. [PMID: 35789240 PMCID: PMC9650148 DOI: 10.5830/cvja-2022-015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/14/2022] [Indexed: 10/03/2023] Open
Abstract
Due to the increasing non-communicable disease burden in Africa, several strategies that target the major lifestyle and physiological risk factors have been implemented to combat such diseases. The Healthy Aging Adult South Africa report card systematically reviews national and regional prevalence data of middle-aged South African adults (45-65 years) published between 2013 and 2020 on diet, physical activity, tobacco use and alcohol consumption, obesity, hypertension, dyslipidaemia and diabetes mellitus. Each indicator was assigned two grades, (1) based on the availability of prevalence data, and (2) based on whether policies have been proposed and implemented for the respective indicators. Alcohol consumption, obesity, hypertension and diabetes received an A grade for the availability of prevalence data. Tobacco use and diet received an A grade for policy and implementation. Gaps have been identified that need to be filled by future research focusing on continued surveillance of all indicators in order to inform and implement effective policies.
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Affiliation(s)
- Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gudani Mukoma
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, 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, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Factors associated with active aging in Chinese elderly in rural areas of Xiangtan County, China†. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objectives
To explore the level of active aging and correlates among rural elderly in Xiangtan County, China.
Methods
A cross-sectional survey was conducted from July to November 2019. A total of 945 rural elderly from 3 towns in Xiangtan County, China, were investigated by using the positive aging evaluation questionnaire (PAEQ), the activity of daily living scale (ADL), and the depression in old-age scale (DIA-S).
Results
The average score in the PAEQ among the rural elderly of Xiangtan County was 72.81 (range = 21–105). A moderate negative correlation was found between the score in the PAEQ and those in the ADL (r = −0.361) and DIA-S (r = −0.495). Symptoms of depression (β: −0.321, P = 0.001), number of chronic diseases (β: −0.281, P = 0.001), subjective economic status (β: 0.239, P = 0.001), ADL (β: −0.196, P = 0.001), education (β: 0.126, P = 0.001), number of children (β: 0.097, P = 0.001), and marital status (β: −0.060, P = 0.001) were significantly associated with levels of active aging in rural elderly, whereas gender and age were not independently related to active aging.
Conclusions
The level of active aging is at a moderately high level in the Chinese elderly in rural areas in Xiangtan County. The focus group of active aging in rural areas should be elderly people suffering from chronic diseases, physical decline, poor education and economic conditions, childlessness, and those without partners.
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Pallangyo P, Mkojera ZS, Komba M, Mgopa LR, Bhalia S, Mayala H, Wibonela S, Misidai N, Swai HJ, Millinga J, Chavala E, Kisenge PR, Janabi M. Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study. BMC Neurol 2021; 21:433. [PMID: 34749692 PMCID: PMC8573988 DOI: 10.1186/s12883-021-02467-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. METHODOLOGY A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. RESULTS A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4-5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2-2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1-2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p = 0.04) to have independent association with cognitive impairment. CONCLUSION This present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.
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Affiliation(s)
- Pedro Pallangyo
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | | | - Makrina Komba
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | | | - Jalack Millinga
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Ester Chavala
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Peter R. Kisenge
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Saha S, Behnke A, Oldewage-Theron W, Mubtasim N, Miller M. Prevalence and Factors Associated with Food Insecurity among Older Adults in Sub-Saharan Africa: A Systematic Review. J Nutr Gerontol Geriatr 2021; 40:171-196. [PMID: 34669566 DOI: 10.1080/21551197.2021.1988027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Food insecurity has been undermining the health and well-being of a growing number of older adults in Sub-Saharan Africa. This review aimed to examine the prevalence of food insecurity and the related contributing factors of food insecurity among older adults in Sub-Saharan Africa. We used PubMed, Scopus, ScienceDirect, and Web of Science Core Collection as our search engines and included 22 articles for data extraction. Prevalence of severe and moderate food insecurity in households with older adults ranged from 6.0 to 87.3% and from 8.3 to 48.5%, respectively. Various socio-economic (e.g., low education level, being widowed, low income, lower wealth position of households, living in a rental house, living in rural areas, lack of social grants or pensions), demographic (e.g., female, Black racial group, larger family size), and health and nutrition status-related (e.g., self-reported poor health status, having a functional and mobility-related disability, psychological disorders) factors influence food insecurity in older adults in Sub-Saharan Africa. The findings of this review can help stakeholders to prioritize the issue of food insecurity, design and implement policies and programs to improve food security among older adults in Sub-Saharan Africa.
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Affiliation(s)
- Sanjoy Saha
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Andrew Behnke
- School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA.,Office of the Dean, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Noshin Mubtasim
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA
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Omar SM, Musa IR, Idrees MB, Adam I. Prevalence of depression and associated factors among patients with type 2 diabetes mellitus in eastern Sudan. BMC Psychiatry 2021; 21:336. [PMID: 34229659 PMCID: PMC8259025 DOI: 10.1186/s12888-021-03357-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) represents a global health threat and burden. It is associated with medical and psychological complications, especially depression. Depression among patients with DM may affect the general prognosis. Hence, we conducted a cross-sectional study in Gadarif, eastern Sudan to evaluate the prevalence of depression and its associated factors among patients with type 2 DM (T2DM). METHODS We performed a cross-sectional study. Data on anthropometric parameters, demographic characteristics and blood glucose levels were collected via questionnaire. Depression was assessed using the Patient Health Questionnaire (PHQ-9). RESULTS Three hundred and fifty patients with T2DM were enrolled in the study and 205 (58.6%) were women. The median (interquartile range) age and duration of diabetes were 56.0 (14.0) years and 8 (8) years, respectively. The prevalence of depression in patients with T2DM was 35.6%. Logistic regression analysis showed significant associations between depression and rural residence (adjusted odds ratio [AOR] = 2.11, 95% confidence interval [CI] = 1.20-3.72), non-employee (AOR = 2.32, 95% CI = 1.34-4.00), co-morbidity (AOR = 2.35, 95% CI = 1.43-3.86) and obesity AOR = 2.19, 95% CI = 1.48-4.18). CONCLUSION The prevalence of depression is high among Sudanese patients with T2DM. Rural residence, unemployment, co-morbidity and obesity are significant risk factors for developing depression among patients with T2DM.
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Affiliation(s)
- Saeed M. Omar
- grid.442372.40000 0004 0447 6305Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Imad R. Musa
- Royal Commission Hospital, Al Jubail Industrial City, Al Jubail Kingdom of Saudi Arabia
| | - Maysoon B. Idrees
- grid.442372.40000 0004 0447 6305Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Ishag Adam
- grid.412602.30000 0000 9421 8094Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Banerjee I, Robinson J, Sathian B, van Teijlingen ER. South Africa and its COVID-19 prohibition predilection. Nepal J Epidemiol 2020; 10:874-877. [PMID: 33042590 PMCID: PMC7538013 DOI: 10.3126/nje.v10i3.31543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Indrajit Banerjee
- Department of Pharmacology, Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Mauritius
| | - Jared Robinson
- Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Mauritius
| | - Brijesh Sathian
- Geriatric and long term care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar.,Centre for Midwifery, Maternal and Perinatal Health, Bournemouth University, Bournemouth, United Kingdom
| | - Edwin R van Teijlingen
- Centre for Midwifery, Maternal and Perinatal Health, Bournemouth University, Bournemouth, United Kingdom
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