Prevalence of Overweight and Obesity among Primary School Children Aged 8-13 Years in Dar es Salaam City, Tanzania

Background. The understanding of obesity as a growing health problem in Africa and Tanzania in particular is hampered by lack of data as well as sociocultural beliefs in which overweight and obesity are revered. This study sought to determine the prevalence of overweight and obesity among primary school children aged 8-13 years in Dar es Salaam, Tanzania. Method. A cross-sectional analytical research design was used to study overweight and obesity in primary schools in Dar es Salaam, Tanzania. The target population was 150,000 children aged 8-13 years. Stratified random sampling was used to select 1781 children. Weight and height were taken and WHO standards for children were used to determine weight status. Results. Findings showed that the prevalence of overweight and obesity was 15.9% and 6.7%, respectively ( = 1781). However, 6.2% of the children were underweight. There were significant differences in mean BMI between children in private and public schools ( = 0.021), between male and female ( < 0.001), and across age groups of 8-10 and 11-13 years ( < 0.001). Conclusion. The prevalence of overweight and obesity among primary school children is significant and requires management and prevention strategies

Personal NO2 and volatile organic compounds exposure levels are associated with markers of cardiovascular risk in women in the Cape Town region of South Africa

CITATION: Everson, F., et al. 2019. Personal NO2 and volatile organic compounds exposure levels are associated with markers of cardiovascular risk in women in the Cape Town region of South Africa. International Journal of Environmental Research and Public Health, 16(13):2284, doi:10.3390/ijerph16132284.The original publication is available at http://www.mdpi.comENGLISH ABSTRACT: Exposure to ambient NO2 and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO2 was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region.https://www.mdpi.com/1660-4601/16/13/2284Publisher's versio

People living with HIV display increased anti-apolipoprotein A1 auto-antibodies, inflammation, and kynurenine metabolites: a case–control study

ObjectiveThis study aimed to study the relationship between auto-antibodies against apolipoprotein A1 (anti-apoA1 IgG), human immunodeficiency virus (HIV) infection, anti-retroviral therapy (ART), and the tryptophan pathways in HIV-related cardiovascular disease.DesignThis case–control study conducted in South Africa consisted of control volunteers (n = 50), people living with HIV (PLWH) on ART (n = 50), and untreated PLWH (n = 44). Cardiovascular risk scores were determined, vascular measures were performed, and an extensive biochemical characterisation (routine, metabolomic, and inflammatory systemic profiles) was performed.MethodsAnti-apoA1 IgG levels were assessed by an in-house ELISA. Inflammatory biomarkers were measured with the Meso Scale Discovery® platform, and kynurenine pathway metabolites were assessed using targeted metabolomic profiling conducted by liquid chromatography-multiple reaction monitoring/mass spectrometry (LC-MRM/MS).ResultsCardiovascular risk scores and vascular measures exhibited similarities across the three groups, while important differences were observed in systemic inflammatory and tryptophan pathways. Anti-apoA1 IgG seropositivity rates were 15%, 40%, and 70% in control volunteers, PLWH ART-treated, and PLWH ART-naïve, respectively. Circulating anti-apoA1 IgG levels were significantly negatively associated with CD4+ cell counts and positively associated with viremia and pro-inflammatory biomarkers (IFNγ, TNFα, MIPα, ICAM-1, VCAM-1). While circulating anti-apoA1 IgG levels were associated with increased levels of kynurenine in both control volunteers and PLWH, the kynurenine/tryptophan ratio was significantly increased in PLWH ART-treated.ConclusionHIV infection increases the humoral response against apoA1, which is associated with established HIV severity criteria and kynurenine pathway activation

Contribution of highly active anti-retroviral therapy to the development of non-alcoholic fatty liver disease with concomitant cardiovascular dysfunction in an obese rat model

Thesis (PhD)--Stellenbosch University, 2018.Introduction: HIV/AIDS mortality is declining due to successful highly active anti-retroviral therapy (HAART). However, obesity, non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) in treated HIV-infected populations are rising. Impaired peroxisome proliferator-activated receptor (PPARα/γ) activity is partly implicated. Aims: To assess the contribution of a protease inhibitor (Lopinavir/Ritonavir (LPV/r) and nucleoside reverse transcriptase inhibitor (Azidothymidine (AZT)/lamivudine (3TC)) HAART regimen in the development of NAFLD and CVD in rats with high caloric diet (HCD)-induced obesity, and to investigate dual PPARα/γ stimulation in limiting HAART-induced NAFLD and CVD. Methods: Wistar rats were randomised into rat chow and HCD groups (n=88/group; 16 weeks). From week 10, each group was further sub-divided into: vehicle/control, HAART, HAART+PPARα/γ agonist (Saroglitazar) and Saroglitazar only (n=22/group) administered via oral gavage. Endpoints: Daily food/water consumption, weekly total body mass (TBM), random+fasting blood glucose measurements (n=8/group); hearts exposed to either 20min global ischaemia/10min reperfusion for Western blot (WB) analysis (n=6/group) or 35min regional ischaemia/60min reperfusion (n=8/group) for haemodynamic and infarct size (IS) determinations. Liver samples were histologically assessed (n=12/group) and analysed by WB. Intraperitoneal (IP) fat was weighed. Fasting serum lipids, insulin and oxidative stress markers were measured (n=8/group). WB analyses of important signalling proteins in pre/post-cardiac ischaemia, liver and aorta tissues. Thoracic aorta (n=8/group) segments were subjected to isometric tension studies. Results: The HCD resulted in obesity (increased: TBM, %IP fat (HCD control 6.50±0.40% vs. lean control 3.60±0.3%; p<0.0001), liver mass, insulin and triglycerides (TGs). Additionally, HCD induced insulin resistance (IR). HAART+Saroglitazar led to reduced %IP fat in lean and HCD groups. HAART-induced IR, elevated cardiac mass and insulin in obese rats were limited by Saroglitazar co-treatment. HCD+HAART-induced oxidative stress (elevated conjugated dienes), was limited in combined HAART+Saroglitazar. Liver histology: HAART induced moderate hepatic steatosis in ~67% of obese rats and moderate inflammation in ~25% of cases. Combined HAART+Saroglitazar limited these changes and upregulated adenosine monophosphate-activated protein kinase (AMPK) and protein kinase B (PKB/Akt) activity, which were downregulated by HAART in HCD. Heart/aorta studies: Untreated obese rats had smaller %IS compared to lean control rats (19.1±1.6 vs. 26.1±1.6, respectively; p<0.05). IS for HCD+HAART animals were smaller (despite poor cardiac performance) compared to untreated obese rats. Post-ischaemia activity of extracellular-signal-regulated kinase (Erk1/2), PKB/Akt, AMPK and endothelial nitric oxide synthase (eNOS) was downregulated, whereas expression of p22-phox and caspase-3 was accentuated. HAART+Saroglitazar upregulated (1.5-fold) the expression of Erk1/2, PKB/Akt, AMPK and eNOS, and downregulated caspase-3 and p22-phox. Obese+HAART rats demonstrated poor aortic relaxation accompanied by downregulated eNOS and PKB/Akt, and upregulated p22-phox. However, Saroglitazar+HAART in obese animals improved aortic relaxation by ~30%, accompanied by upregulation of eNOS, and PKB/Akt, and downregulated p22-phox. Discussion and conclusion: HAART-induced NAFLD and CVD in obesity were limited by PPARα/γ agonist co-administration. HAART treatment for six weeks was not a cardiovascular risk factor per se, but it potentiated HCD-induced cardiovascular effects. Monitoring cardiovascular risk factors in obese+HAART patients is crucial, and our findings suggest that there is therapeutic potential in co-treatment with PPARα/γ agonists. The metabolic, functional and signalling disturbances in the liver, heart and aorta tissues in obese+HAART rats are interlinked, and partially limited by co-treatment with a dual PPARα/γ agonist.Inleiding: Daar is ‘n daling in die HIV/VIGS sterftesyfer a.g.v. suksesvolle hoogs-aktiewe antiretrovirale terapie (HAART). Vetsug, nie-alkoholiese vetterige lewersiekte (NAFLD) en kardiovaskulêre siekte (KVS) in behandelde HIV-geïnfekteerde populasies is aan die styg. Ingekorte peroksisoom proliferator-geaktiveerde reseptor (PPARα/γ) funksie is deels hiervoor verantwoordelik. Doelwitte: Om die bydraes van ‘n protease inhibitor (Lopinavir/Ritonavir (LPV/r) en nukleosied omgekeerde transkriptase inhibitor (Azidothymidine (AZT)/lamivudine (3TC)) as deel van HAART in die ontwikkeling van NAFLD en KVS in rotte met ’n hoë kaloriedieet (HCD)-geïnduseerde vetsug te bepaal, asook tweeledige PPARα/γ-stimulasie in die vermindering van HAART-geïnduseerde NAFLD en KVS te bepaal. Metodes: Wistar rotte is lukraak in ‘n gewone rot-dieet en ‘n HCD groep (n=88/groep; 16 weke) ingedeel. Vanaf Week 10 is elke groep verder onderverdeel in: oplosmiddel/kontrole, HAART, HAART+PPARα/γ agonis (Saroglitazar) en slegs Saroglitazar (n=22/groep) wat via ‘n gastriese buis toegedien was. Eindpunte: Daaglikse kos/water verbruik, weeklikse totale liggaamsgewig (TBM), lukrake+vastende bloedglukose (n=8/groep); harte wat blootgestel is aan óf 20min globale isgemie/10min herperfusie, wat vir Western blot (WB) ontleding aangewend is, of 35min streeksisgemie/60min herperfusie (n=8/groep), wat vir hemodinamiese en infarktgrootte (IS) bepalings aangewend is. Lewermonsters is histologies ondersoek (n=12/groep) en ontleed deur WB. Intraperitoneale (IP) vet is geweeg. Vastende serumlipiede, oksidatiewe spanningsmerkers en insulien is gemeet (n=8/groep). WB ontledings van belangrike seintransduksieproteïene in pre/post-isgemiese hart-, lewer- en aortaweefsel uitgevoer. Torakale aortasegmente (n=8/groep) is aan isometriese spanningstudies blootgestel. Resultate: Die HCD het tot vetsug gelei (verhoogde: TBM, %IP vet (HCD kontrole 6.50±0.40% vs. gewone-dieet kontrole 3.60±0.3%; p<0.0001), lewermassa, insulien en trigliseriedes). Verder het HCD tot insulienweerstandigheid (IR) gelei. HAART+Saroglitazar het tot verlaagde %IP vet in kontrole en HCD groepe gelei. HAART het IR veroorsaak, terwyl verhoogde hartmassa en insulien in vetsugtige rotte deur kobehandeling met Saroglitazar verlaag is. HCD+HAART het vrye-vetsuur-oksidasie (verhoogde gekonjugeerde diëne) geïnduseer, wat deur gekombineerde HAART+Saroglitazar verminder is. Lewerhistologie: HAART het matige lewersteatose in ~67% van vetsugtige rotte en matige inflammasie in ~25% veroorsaak. Hierdie veranderinge is deur gekombineerde HAART+Saroglitazar verlig en AMPK en PKB/Akt aktiwiteit is opgereguleer, wat deur HAART afgereguleer is. Hart/aorta studies: Onbehandelde vetsugtige rotte het kleiner IS as kontrole gehad (19.1±1.6 vs. 26.1±1.6, onderskeidelik; p<0.05). Die IS vir rotte op HAART+HCD was kleiner (ondanks swak hartfunksie) vs. hul onbehandelde eweknieë. Die post-isgemiese aktiwiteit van Erk1/2, PKB/Akt, AMPK en eNOS is afgereguleer, terwyl uitdrukking van p22-phox en kaspase-3 verhoog is. Die uitdrukking van Erk1/2, PKB/Akt, AMPK en eNOS is deur HAART+Saroglitazar opgereguleer (1.5-voudig) en PKB/Akt en p22-phox is afgereguleer. Vetsugtige+HAART rotte het swak aortiese verslapping getoon ~30%, wat met afgereguleerde eNOS en PKB/Akt en opgereguleerde p22-phox geassosieer was. Tog het Saroglitazar+HAART in vetsugtige rotte tot verbeterde aortiese verslapping, gepaard met opgereguleerde eNOS en PKB/Akt, asook afgereguleerde p22-phox gelei. Bespreking en gevolgtrekking: HAART-geïnduseerde lewersteatose en KVS in vetsugtige rotte is deur ko-behandeling met ʼn PPARα/γ agonis verlig. HAART per se was nie ‘n kardiovaskulêre risikofaktor nie, maar het die HCD-geïnduseerde kardiovaskulêre effekte vererger. Dis noodsaaklik om die kardiovaskulêre risikofaktore in vetsugtige+HAART pasiënte te monitor, en ons bevindinge toon dat ko-behandeling met PPARα/γ agoniste terapeutiese potensiaal het. Die metaboliese, funksionele en seintransduksieversteurings in die lewer, hart en aortaweefsel in vetsugtige+HAART rotte is ineengeskakel en word gedeeltelik verlaag deur ko-behandeling met ‘n tweeledige PPARα/γ agonis

Enhancing Ecologically Resilient Food Security through Innovative Farming Systems in the Semi-Arid Midlands of Kenya : final technical report (March 2011 - August 2014)

Technologies were selected, evaluated and prioritized by farmers (high-value traditional crops, indigenous chickens and a range of farm management practices), resulting in increased dietary diversity, consumption of foods of high micro-nutrient content, and farmers’, especially women farmers’ access to markets. The farmer-led approach catalyzed both horizontal and vertical scaling-up of adoption of resilience-building technologies and practices. The approach was also scaled-up vertically through adoption by Ministry of Agriculture sub-county officials in new areas. The farmer-led approach, builds on strengths of collective action, learning networks, participatory process, social capital and established peer extension practices

HIV and antiretroviral therapy are independently associated with cardiometabolic variables and cardiac electrical activity in adults from the Western Cape Region of South Africa

Cardiovascular-related complications are on the rise in people with HIV/AIDS (PWH); however, the relationship among HIV and antiretroviral therapy (ART)-related parameters, cardiovascular risk, and cardiac electrical activity in PWH remain poorly studied, especially in sub-Saharan African populations. We investigated whether HIV and ART are associated with cardiometabolic and cardiac electrical activity in PWH from Worcester in the Western Cape Province, South Africa. This was a cross-sectional study with HIV-negative (HIV−, n = 24) and HIV-positive on ART (HIV+/ART+, n = 63) participants. We obtained demographic, lifestyle, and medical history data and performed anthropometric, clinical assessments, and blood/urine biochemistry. We performed multiple stepwise linear regression analyses to determine independent associations among HIV, ART, cardiometabolic, and electrocardiographic (ECG) variables. HIV+/ART+ independently associated with a lower body mass index (p = 0.004), elevated gamma-glutamyl transferase levels (β: 0.333 (0.130–0.573); p = 0.002), and elevated alanine aminotransferase levels (β: 0.427 (0.224–0.629); p p = 0.002). Although ECG parameters did not differ between HIV− and HIV+/ART+, viral load positively associated with p-wave duration (0.306 (0.018–0.594); p = 0.038), and longer HIV duration (≥5 years) with ST-interval (0.270 (0.003–0.537); p = 0.047) after adjusting for confounding factors. Our findings suggest that HIV and ART are associated with mixed effects on this population’s cardiometabolic profile and cardiac electrical activity, underpinning the importance of cardiovascular risk monitoring in PWH

Concentrations of Efavirenz, Tenofovir, and Emtricitabine in Obesity: A Cross-Sectional Study

BackgroundObesity is increasing worldwide including in people living with HIV (PLWH). Antiretroviral pharmacokinetic data in obesity are limited.ObjectivesTo measure antiretroviral drug concentrations in obese and nonobese PLWH treated with the fixed-dose combination of efavirenz-tenofovir-emtricitabine. To determine pharmacokinetic differences across indicators of obesity and their associated immunovirological outcomes.MethodsWe conducted a cross-sectional sample analysis of 2 cohort studies. We measured mid-dose efavirenz, 8-hydroxy-efavirenz, tenofovir, and emtricitabine concentrations. Antiretroviral drug concentrations were analyzed by body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR).ResultsWe performed a study of 213 participants: General obesity was detected in 20.4% using BMI and abdominal obesity in 53.6% using WC and 62.4% using WHR, respectively. The median concentrations of all antiretroviral drugs were lower among obese participants determined by BMI and WC, with efavirenz showing greater differences than tenofovir or emtricitabine. For BMI, results were most striking for efavirenz (1752.3 vs 2342.9 ng/mL, P = 0.002) with lower concentrations in obese participants. Using WC, efavirenz (1845.8 vs 2571.2 ng/mL, P ConclusionWe found lower antiretroviral concentrations in all obese groups, most strikingly in participants with abdominal obesity determined by WC. Lower drug concentrations had no immunovirological associations

People living with HIV display increased anti-apolipoprotein A1 auto-antibodies, inflammation, and kynurenine metabolites : a case–control study

Objective This study aimed to study the relationship between auto-antibodies against apolipoprotein A1 (anti-apoA1 IgG), human immunodeficiency virus (HIV) infection, anti-retroviral therapy (ART), and the tryptophan pathways in HIV-related cardiovascular disease. Design This case–control study conducted in South Africa consisted of control volunteers ( n  = 50), people living with HIV (PLWH) on ART ( n  = 50), and untreated PLWH ( n  = 44). Cardiovascular risk scores were determined, vascular measures were performed, and an extensive biochemical characterisation (routine, metabolomic, and inflammatory systemic profiles) was performed. Methods Anti-apoA1 IgG levels were assessed by an in-house ELISA. Inflammatory biomarkers were measured with the Meso Scale Discovery® platform, and kynurenine pathway metabolites were assessed using targeted metabolomic profiling conducted by liquid chromatography-multiple reaction monitoring/mass spectrometry (LC-MRM/MS). Results Cardiovascular risk scores and vascular measures exhibited similarities across the three groups, while important differences were observed in systemic inflammatory and tryptophan pathways. Anti-apoA1 IgG seropositivity rates were 15%, 40%, and 70% in control volunteers, PLWH ART-treated, and PLWH ART-naïve, respectively. Circulating anti-apoA1 IgG levels were significantly negatively associated with CD4+ cell counts and positively associated with viremia and pro-inflammatory biomarkers (IFNγ, TNFα, MIPα, ICAM-1, VCAM-1). While circulating anti-apoA1 IgG levels were associated with increased levels of kynurenine in both control volunteers and PLWH, the kynurenine/tryptophan ratio was significantly increased in PLWH ART-treated. Conclusion HIV infection increases the humoral response against apoA1, which is associated with established HIV severity criteria and kynurenine pathway activation.</p

A field bioassay for assessing ivermectin bio-efficacy in wild malaria vectors

Abstract Background Ivermectin (IVM) mass drug administration is a candidate complementary malaria vector control tool. Ingestion of blood from IVM treated hosts results in reduced survival in mosquitoes. Estimating bio-efficacy of IVM on wild-caught mosquitoes requires they ingest the drug in a blood meal either through a membrane or direct feeding on a treated host. The latter, has ethical implications, and the former results in low feeding rates. Therefore, there is a need to develop a safe and effective method for IVM bio-efficacy monitoring in wild mosquitoes. Methods Insectary-reared Anopheles gambiae s.s. were exposed to four IVM doses: 85, 64, 43, 21 ng/ml, and control group (0 ng/ml) in three different solutions: (i) blood, (ii) 10% glucose, (iii) four ratios (1:1, 1:2, 1:4, 1:8) of blood in 10% glucose, and fed through filter paper. Wild-caught An. gambiae s.l. were exposed to 85, 43 and 21 ng/ml IVM in blood and 1:4 ratio of blood-10% glucose mixture. Survival was monitored for 28 days and a pool of mosquitoes from each cohort sacrificed immediately after feeding and weighed to determine mean weight of each meal type. Results When administered in glucose solution, mosquitocidal effect of IVM was not comparable to the observed effects when similar concentrations were administered in blood. Equal concentrations of IVM administered in blood resulted in pronounced reductions in mosquito survival compared to glucose solution only. However, by adding small amounts of blood to glucose solution, mosquito mortality rates increased resulting in similar effects to what was observed during blood feeding. Conclusion Bio-efficacy of ivermectin is strongly dependent on mode of drug delivery to the mosquito and likely influenced by digestive processes. The assay developed in this study is a good candidate for field-based bio-efficacy monitoring: wild mosquitoes readily feed on the solution, the assay can be standardized using pre-selected concentrations and by not involving treated blood hosts (human or animal) variation in individual pharmacokinetic profiles as well as ethical issues are bypassed. Meal volumes did not explain the difference in the lethality of IVM across the different meal types necessitating further research on the underlying mechanisms