Chronic Diseases in North-West Tanzania and Southern Uganda. Public Perceptions of Terminologies, Aetiologies, Symptoms and Preferred Management

Research outputs produced to support a quantitative population survey, quantitative health facility survey, focus groups and in-depth interviews performed by the projec

Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa

Prevalence and factors associated with dysglycemia among girls in selected boarding secondary schools in Wakiso District, Uganda

Rhoda Nakiriba,1,* Roy William Mayega,2,* Thereza Piloya,1 Nicolette Nabukeera-Barungi,1 Richard Idro1 1Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda *These authors contributed equally to this work Background: There is limited information on dysglycemia in adolescents in low-income countries. The objective of this study was to determine the prevalence and factors associated with dysglycemia among boarding secondary school adolescent girls in a peri-urban district.Methods: The design was a cross-sectional survey. A total of 688 adolescents from four randomly selected girls-only boarding secondary schools in Wakiso District, Uganda, participated in this study. Fasting plasma glucose, body mass index (BMI), and blood pressure (BP) were measured. A questionnaire was used to assess demographic and lifestyle factors. Suspected dysglycemia was defined using the American Diabetes Association cutoff of fasting glucose ≥5.6 mmol/L. Overweight and hypertension were defined being above two SDs or the 95th percentile of the WHO BMI for age and BP for age reference charts, respectively. Logistic regression was used to determine the factors independently associated with dysglycemia.Results: The mean age of the participants was 15.4 years (SD=1.7 years). Probable dysglycemia was found in 44 of 688 (6.4%) participants, ranging from 3.5% in the least affluent school to 9.8% in the most affluent school. No case of type 2 diabetes was found. 11.6% of the participants were found to have probable hypertension. Dysglycemia was higher in adolescents who were overweight (adjusted OR [AOR] 2.3; 95% CI 1.22–4.48), those with hypertension (AOR 4.0; 95% CI 1.86–8.45), and those who frequently stocked biscuits (AOR 3.0; 95% CI 1.21–7.28). Dysglycemia was lower in older adolescents (AOR 0.3; 95% CI 0.10–0.86) and those who took water with meals (AOR 3.0; 95% CI 1.21–7.28).Conclusion: In these predominantly peri-urban boarding secondary schools, 6.4% of the adolescent girls have probable dysglycemia. As Africa undergoes the epidemiological transition, there is a need for closer surveillance for diabetes and hypertension in peri-urban schools and school health measures against lifestyle diseases. Keywords: dysglycemia, secondary school, peri-urban, adolescent girl

Pattern and correlates of obesity among public service workers in Ondo State, Nigeria: a cross-sectional study

Background: Obesity is the third leading cause of mortality and has become a global epidemic. There is a continuous increase in its prevalence both in the developed and in developing countries. Obesity is closely associated with chronic health conditions, thus increasing the overall burden of disease and disability at the population level. Several factors have been identified as contributors to the obesity epidemic, and may include the work environment and lifestyle behaviours. This study sought to determine the correlates of obesity among public service workers in Akure, Ondo State, Nigeria. Method: This was a cross-sectional study involving 4 828 public civil service workers across 47 ministries, departments and agencies in Ondo State, Nigeria. Relevant demographic and lifestyle measures were obtained using the World Health Organization (WHO) STEPwise Questionnaire. Height and weight were measured using standardised procedures. Obesity and overweight were defined according to the WHO Criteria as a body mass index (BMI) of ≥ 30 kg/m2 and 25–29.9 kg/m2, respectively. Bivariate and multivariate (logistic regression models) analyses were used to determine the significant predictors of obesity. Results: Of the total participants (n = 4828), there was a male to female ratio of 1:1 (male = 2 299 and female = 2 529). One in every five participants was found to be obese with 55% of the participants having a BMI ≥ 25 kg/m2. In the bivariate analysis, female sex (p < 0.000), age above 41 years (p < 0.000), post-primary education level (p < 0.001), marriage (p < 0.000), no alcohol consumption (p < 0.001), diabetes (p < 0.000) as well as hypertension (p < 0.000) were significantly associated with obesity. In the multivariate analysis, after adjusting for confounders, only female sex (AOR = 5.7, CI = 4.7–6.9), age (AOR = 1.4, CI = 1.1–1.8), level of education (AOR = 0.8, CI = 0.7–0.9), marital status (AOR = 2.1, CI = 1.7–2.), alcohol consumption (AOR = 0.7, CI = 0.5–0.9), diabetes mellitus (AOR = 0.7, CI = 0.5–0.9) and hypertension (AOR = 0.5, CI = 0.4–0.6) were the significant and independent predictors of obesity. Conclusion: This study found a high prevalence of obesity among public service workers in Akure, Nigeria, possibly attributed to ageing, being of female gender, being married, and having other non-communicable diseases. A well-implemented workplace policy focusing on integrated screening for obesity and non-communicable diseases should be prioritised in Nigeria. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.133378