Incidence of HIV in Windhoek, Namibia: Demographic and Socio-Economic Associations

To estimate HIV incidence and prevalence in Windhoek, Namibia and to analyze socio-economic factors related to HIV infection. In 2006/7, baseline surveys were performed with 1,753 private households living in the greater Windhoek area; follow-up visits took place in 2008 and 2009. Face-to-face socio-economic questionnaires were administrated by trained interviewers; biomedical markers were collected by nurses; GPS codes of household residences were recorded. The HIV prevalence in the population (aged>12 years) was 11.8% in 2006/7 and 14.6% in 2009. HIV incidence between 2007 and 2009 was 2.4 per 100 person year (95%CI = 1.9-2.9). HIV incidence and prevalence were higher in female populations. HIV incidence appeared non-associated with any socioeconomic factor, indicating universal risk for the population. For women a positive trend was found between low per-capita consumption and HIV acquisition. A HIV knowledge score was strongly associated with HIV incidence for both men and women. High HIV prevalence and incidence was concentrated in the north-western part of the city, an area with lower HIV knowledge, higher HIV risk perception and lower per-capita consumption. The HIV incidence and prevalence figures do not suggest a declining epidemic in Windhoek. Higher vulnerability of women is recorded, most likely related to economic dependency and increasing transactional sex in Namibia. The lack of relation between HIV incidence and socio-economic factors confirms HIV risks for the overall urban community. Appropriate knowledge is strongly associated to lower HIV incidence and prevalence, underscoring the importance of continuous information and education activities for prevention of infection. Geographical areas were identified that would require prioritized HIV campaignin

Hypertension in Sub-Saharan Africa: Cross-Sectional Surveys in Four Rural and Urban Communities

Background: Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania. Methods and Findings: We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009-2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study. The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3-21.3) in rural Nigeria, 21.4% (19.8-23.0) in rural Kenya, 23.7% (21.3-26.2) in urban Tanzania, and 38.0% (35.9-40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥160/100 mmHg) or grade 3 hypertension (≥180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania). Conclusion: Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed

Individual social capital of entrepreneurs: a multidimensional measurement approach

Social network embeddedness lowers the transaction costs for firms’ entrepreneurs and enables them to obtain access to information and resources at a price below market-costs. We argue that the access to and use of this entrepreneurial social capital entails a complex interplay of structural, relational and mobilization dimensions both at the local and extended level. By grouping types of entrepreneurs based on these multiple dimensions we show the unequal distribution of social capital across entrepreneurial populations and identify distinct social capital configurations to affect specific entrepreneurial outcomes

Characteristics of the study populations.

†<p>NP  =  Not Performed;</p>*<p>Consumption per capita per year in USD corrected for purchasing power parity (PPP), 2009 conversion rate World bank (<a href="http://www.worldbank.org/" target="_blank">http://www.worldbank.org/</a>).</p

Awareness, treatment and blood pressure control in patients with hypertension.

<p>Definitions: Aware  =  respondents who self report to have hypertension, Treated  =  respondents who self report to have hypertension, and who indicate to take drug treatment for hypertension, Controlled  =  respondents who self report to have hypertension, and who have a blood pressure below 140/90 (patients who use drug treatment or for whom treatment status is unknown).</p

Hypertension prevalence and distribution of blood pressure.

<p>2A: Age-standardized and age stratified hypertension prevalence. 2B: Distribution of blood pressure in patients with hypertension (treated and untreated cases). Optimal  =  systolic blood pressure (SBP) <120 and diastolic blood pressure (DBP) <80; Normal  =  SBP 120–129 and/or DBP 80–84; Pre-HT (hypertension)  =  SBP 130–139 and/or DBP 85–89; Grade 1 =  SBP 140–159 and/or DBP 90–99; Grade 2 =  SBP 160–179 and/or DBP 100–109; Grade 3 =  SBP> = 180 and/or DBP> = 110.</p

Prevalence of Hypertension and other CVD risk factors.

*<p>HT  =  hypertension;</p>†<p>In those with untreated or inadequately treated hypertension;</p>¶<p>WHO CVD risk charts start at age 40 years and older;</p>¶¶<p>Those with blood pressure ≥160/100 mmHg or 140/90 and 10 year CVD risk of ≥20%;</p>**<p>SBP  =  systolic blood pressure, DBP  =  diastolic blood pressure;</p>∥|<p>NP =  not performed;</p>††<p>BMI  =  Body Mass Index;</p>‡<p>WC  =  waist circumference, M  =  male, F  =  female;</p>&par<p>DM  = Diabetes Mellitus (non-fasting blood glucose of ≥11.1 mmol/L, or a fasting blood glucose of ≥7.0 mmol/L, or self reported use of drug treatment for DM);</p>§<p>High cholesterol ≥6.2 mmol/L;</p>§§<p>U = 1 standard unit of alcohol containing approximately 10 g of ethanol;</p>***<p>Reported parent with hypertension, diabetes or heart disease.</p

Participation in the 4 surveys (household and individual level).

<p>*HH  =  households, **Repeating sampling done because household were difficult to locate due to poor registries used for sampling, ^†BP =  blood pressure.</p