Obesity and Cardio-Metabolic Risk Factors in an Urban and Rural Population in the Ashanti Region-Ghana: A Comparative Cross-Sectional Study.

There is a surge in chronic diseases in the developing world, driven by a high prevalence of cardio-metabolic risk factors. This study described differences in prevalence of obesity and cardio-metabolic risk factors between urban and rural settlements in the Ashanti Region of Ghana. This comparative cross-sectional study included 672 participants (median age 50 years), of which 312 were from Kumasi (urban) and 360 from Jachie-Pramso (rural). Demographic, anthropometric and other cardio-metabolic risk factors were gathered and venous blood samples were drawn for biochemical assays. Results suggested significant differences in diastolic blood pressure (80.0 mmHg vs 79.5 mmHg; p = 0.0078), and fasting blood sugar (5.0 mmo/l vs 4.5 mmol/l; p < 0.0001) between the two groups. Further differences in anthropometric measures suggested greater adiposity amongst participants in the urban area. Participants in the urban area were more likely than rural participants, to have high total cholesterol and LDL-c (p < 0.0001 respectively). Risk factors including BMI ≥ 25 (p < 0.0001), BMI ≥ 30 (p < 0.0001), high waist circumference (p < 0.0001), high waist-to-height ratio (p < 0.0001) and alcohol consumption (p = 0.0186) were more prevalent amongst participants in the urban area. Markers of adiposity were higher amongst females than males in both areas (p < 0.05). In the urban area, hypertension, diabetes and lifestyle risk factors were more prevalent amongst males than females. Differences in risk factors by urban/rural residence remained significant after adjusting for gender and age. Obesity and cardio-metabolic risk factors are more prevalent amongst urban settlers, highlighting an urgent need to avert the rise of diet and lifestyle-related chronic diseases

Odds Ratios associated with selected cardio-metabolic factors amongst the urban population (reference: rural population).

<p>OR: Odds ratio. Adj: adjusted. Compared using Multivariate logistic regression. p < 0.05 was considered significant.</p><p>Odds Ratios associated with selected cardio-metabolic factors amongst the urban population (reference: rural population).</p

Socio-demographic characteristics of the study population.

<p>Data is presented as median (IQR); Mann-Whitney test or n (%); Chi-square or Fisher’s test. p < 0.05 was considered significant for rural vs urban. n: number, IQR: Interquartile range. GHS: Ghana Cedi.</p><p>Socio-demographic characteristics of the study population.</p

Spearman’s rho correlation coefficients between selected cardio-metabolic variables for rural (Lower Left-Hand Side) and urban (Upper Right-Hand Side).

<p>** Correlation is significant at the 0.01 level (2-tailed).</p><p>* Correlation is significant at the 0.05 level (2-tailed). SBP: Systolic Blood Pressure. DBP: Diastolic blood Pressure. FBS: Fasting Blood Sugar. WC: Waist circumference. WHR: Waist-to-hip ratio. WHtR: Waist-to-height ratio. BF%: percentage Body Fat. TCHL: Total Cholesterol. HDL-c: High Density Lipoprotein cholesterol. LDL-c: Low Density Lipoprotein Cholesterol. TG: triglycerides.</p><p>Spearman’s rho correlation coefficients between selected cardio-metabolic variables for rural (Lower Left-Hand Side) and urban (Upper Right-Hand Side).</p

Cardio-metabolic risk factors amongst study population stratified by type of community.

<p>Data is presented as n (%); compared using Fischer’s test. p < 0.05 was considered significant for rural vs urban. BMI: Body mass index. WC: Waist Circumference. WHR: Waist-to hip Ratio. WHtR: Waist-to height Ratio. BF%: Percentage body fat. HDL-c: High Density Lipoprotein cholesterol. LDL-c: Low Density Lipoprotein Cholesterol.</p><p>Cardio-metabolic risk factors amongst study population stratified by type of community.</p

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways