Handgrip strength and body mass index among adolescents in Northern Nigeria

Introduction: Normative data on handgrip strength (HGS) and body mass index (BMI) are scarce among adolescents in the Nigerian context. The aims of this study were to evaluate patterns of HGS in relation to gender and age in Nigerian adolescents and its correlation with BMI.Methods: This cross-sectional study involved 1966 participants (1275 males) and (691 females) aged 12–20 years in Northern Nigeria. Body mass and height were measured. HGS was assessed using a dynamometer.Results: The right HGS (RHGS) was significantly higher than the left HGS (LHGS) (t = 21.337, p < 0.05). There were significant age differences in the RHGS and the LHGS (p < 0.05); however, no significant difference occurs at 12–14 years. Males participants aged 16–20 years had significantly higher RHGS values than females of the same age (p < 0.0038). Conversely, males aged 15–20 years had significantly higher LHGS values than females of the same age (p < 0.0038). There was a significant interaction between gender and age for the RHGS (F = 72.2, p < 0.05) and the LHGS (F = 92.1, p < 0.05). There was a significant correlation between the BMI and RHGS (r = 0.480, p < 0.01) and the LHGS (r = 0.465, p < 0.01).Conclusion: There are gender and age difference in the HGS of Nigerian adolescents, with the dominance of the RHGS in both genders. HGS correlated with BMI. This normative data on HGS may serve as baseline data for future comparative studies assessing HGS among the adolescent population in Nigeria

A comparative analysis of teenagers and older pregnant women concerning maternal and neonatal adverse outcomes in Raymond Mhlaba sub-District, South Africa

Teenage pregnancy has become a common global public health issue, associated with increased risk of obstetric complications and adverse neonatal outcomes. Teenagers are more prone to obstetric complications compared to older women. This study examined the maternal and neonatal adverse outcomes among teenagers, and compared them with older pregnant women. This study extracted maternal and neonatal adverse outcomes from 196 medical records of women delivered at Fort Beaufort Hospital from April 2017 to March 2018. Teenagers developed anaemia (13%) and pre-eclampsia (2.1%) during pregnancy as compared to older pregnant women. Most of the women delivered through normal vertex, although the teenagers had the highest percentage of caesarean section (27%) compared to the older women. Few proportions of women developed complications during delivery, however, obstructed labour (14.7%), prolonged labour (11.5%), foetal distress (14.8%) was more prevalent in teenagers. Most neonates were delivered at preterm birth and were alive across all age groups. However, few of the preterm births (23.2%) and very premature neonates (7.4%) occurred among the teenager mothers compared to older women. Few neonates had an Apgar score of less than 7in 1 minute across all age groups. The risk of obstructed labour, prolonged labour, and foetal distress was predominant among teenagers compared to the older women. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. The findings of this study revealed that the teenagers start booking at the second trimester, which may impose the risk of complications if not observed at an early stage. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. Programmes to support early antenatal bookings for teenagers are important to address adverse maternal complications associated with late antenatal bookings. Keywords: Teenage pregnancy, Maternal and neonatal adverse outcomes, Older pregnant women, South Africa La grossesse chez les adolescentes est devenue un problème de santé publique mondial courant, associé à un risque accru de complications obstétricales et d'issues néonatales défavorables. Les adolescentes sont plus sujettes aux complications obstétricales que les femmes plus âgées. Cette étude a examiné les résultats indésirables maternels et néonatals chez les adolescents et les a comparés à ceux des femmes enceintes plus âgées. Cette étude a extrait les résultats indésirables maternels et néonatals de 196 dossiers médicaux de femmes accouchées à l'hôpital de Fort Beaufort d'avril 2017 à mars 2018. Les adolescentes ont développé une anémie (13%) et une pré-éclampsie (2,1%) pendant la grossesse par rapport aux femmes enceintes plus âgées. La plupart des femmes ont accouché par un sommet normal, bien que les adolescentes aient eu le pourcentage le plus élevé de césarienne (27%) par rapport aux femmes plus âgées. Peu de proportions de femmes ont développé des complications lors de l'accouchement, cependant, le travail dystocique (14,7%), le travail prolongé (11,5%) et la détresse fœtale (14,8%) étaient plus fréquents chez lesadolescentes. La plupart des nouveau-nés ont été nés prématurément et étaient vivants dans tous les groupes d'âge. Cependant, peu de naissances prématurées (23,2%) et de nouveau-nés très prématurés (7,4%) sont survenues parmi les mères adolescentes par rapport aux femmes plus âgées. Peu de nouveau-nés avaient un score Apgar inférieur à 7 en 1 minute dans tous les groupes d'âge. Le risque de dystocie, de travail prolongé et de détresse fœtale était prédominant chez les adolescents par rapport aux femmes plus âgées. Il y avait une incidence élevée d'accouchements vaginaux, de bébés prématurés et un faible score d'Apgar chez les adolescents par rapport aux femmes plus âgées. Les résultats de cette étude ont révélé que les adolescents commencent à réserver au deuxième trimestre, ce qui peut entraîner un risque de complications s'il n'est pas observé à un stade précoce. Il y avait une incidence élevée d'accouchements vaginaux, de bébés prématurés et un faible score d'Apgar chez les adolescents par rapport aux femmes plus âgées. Les programmes visant à soutenir les réservations prénatales précoces pour les adolescents sont importants pour lutter contre les complications maternelles indésirables associées aux réservations prénatales tardives. Mots-clés: Grossesse chez les adolescentes, Résultats indésirables maternels et néonatals, Femmes enceintes âgées, Afrique du Su

Central obesity and normal-weight central obesity among adults attending healthcare facilities in Buffalo City Metropolitan Municipality, South Africa: a cross-sectional study

Background: Central obesity (CO) confers a significant threat on the cardio-metabolic health of individuals, independently of overall obesity. Disparities in the measures of fat distribution lead to misclassification of individuals who are at risk of cardio-metabolic diseases. This study sought to determine the prevalence and correlates of central obesity and normal-weight central obesity among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality (BCMM), South Africa, assess their health risk and examine the association between central obesity and cardio-metabolic diseases among adults with normal weight, measured by body mass index (BMI). Methods: A cross-sectional survey of 998 adults was carried out at the three largest outpatient clinics in BCMM. Overall and central obesity were assessed using BMI, waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHTR). The WHO STEPwise questionnaire was used for data collection. Blood pressure and blood glucose were measured. Normal-weight central obesity was defined as CO among individuals with normal weight, as assessed by BMI. Health risk levels were assessed using the National Institute for Health and Clinical Excellence (NICE) BMI-WC composite index. Bivariate and multivariate analyses were used to determine the prevalence of CO, normal-weight central obesity and the predictors of CO. Results: The mean age of participants was 42.6 (\ub1 16.5) years. The prevalence of CO was 67.0, 58.0 and 71.0% by WC, WHR and WHTR, respectively. The prevalence of normal-weight central obesity was 26.9, 36.9 and 29.5% by WC, WHR and WHTR, respectively. About 41% of the participants had a very high health risk, 13% had increased risk or high risk and 33% had no health risk. Central obesity was significantly associated with hypertension but not associated with diabetes among those with normal weight (by BMI). Female sex, age over 30 years, marriage, secondary or tertiary level of education, nonsmoking status, diabetes and hypertension significantly predicted central obesity among the study participants. Conclusion: The prevalence of central obesity among the study participants is high, irrespective of the defining criteria. One in three adults of normal weight had central obesity. Body mass index should therefore not be used alone for clinical assessment by healthcare workers in the study setting

Perceptions of women of reproductive age towards maternal death in Qaukeni sub-District, Eastern Cape Province, South Africa: A qualitative study

Maternal mortality is a global problem, particularly in developing countries. This study explored perceptions, knowledge and attitudes of women of reproductive age concerning maternal deaths in Qaukeni Sub-District, Eastern Cape Province, South Africa. This was a community-based qualitative study using using in-depth interviews among women of reproductive age. Data was analyzed using thematic analysis. The study found some of the mothers knew the causes, signs and symptoms of pregnancy as well as danger signs during pregnancy such as haemorrhage, sepsis, high blood pressure and complications of unsupervised home deliveries, while others had little knowledge about these signs and symptoms. The participants indicated that using herbal medications during pregnancy could result to serious complications and even maternal death. Women do not attend antenatal care because of the long distances, absence of clinics, shortage of nurses and doctors; thus, predisposing women to deliver at homeswith the assistance of traditional birth attendants, who had limited knowledge related to health issues and the Prevention of Motherto-Child-Transmission programme. The findings indicated that some women are knowledgeable about the causes of maternal deaths during pregnancy as well as the signs and symptoms of pregnancy. Health education during pregnancy and provision of better resources would help improve the maternal health of women in this rural setting. Keywords: Mothers, Maternal deaths, Perceptions, Knowledge and attitudes, South AfricaLa mortalité maternelle est un problème mondial, en particulier dans les pays en développement. Cette étude a exploré les perceptions, les connaissances et les attitudes des femmes en âge de procréer concernant les décès maternels dans le sous-district de Qaukeni, province du Cap oriental, Afrique du Sud. Il s'agissait d'une étude qualitative communautaire utilisant des entretiens approfondis auprès de femmes en âge de procréer. Les données ont été analysées à l'aide d'une analyse thématique. L'étude a révélé que certaines mères connaissaient les causes, les signes et les symptômes de la grossesse ainsi que les signes de danger pendant la grossesse tels que l'hémorragie, la septicémie, l'hypertension artérielle et les complications des accouchements à domicile non supervisés, tandis que d'autres avaient peu de connaissances sur ces signes et symptômes. Les participantes ont indiqué que l'utilisation de médicaments à base de plantes pendant la grossesse pouvait entraîner de graves complications et même la mort maternelle. Les femmes ne se rendent pas aux soins prénatals en raison des longues distances, de l’absence de dispensaires, du manque d’infirmières et de médecins; ainsi, prédisposant les femmes à accoucher à domicile avec l'aide des accoucheuses traditionnelles, qui avaient des connaissances limitées sur les problèmes de santé et le programme de prévention de la transmission mère-enfant. Les résultats indiquent que certaines femmes connaissent les causes des décès maternels pendant la grossesse ainsi que les signes et symptômes de la grossesse. L'éducation sanitaire pendant la grossesse et la fourniture de meilleures ressources contribueraient à améliorer la santé maternelle des femmes dans ce milieu rural. Mots-clés: Mères, décès maternels, perceptions, connaissances et attitudes, Afrique du Su

Prevalence, awareness, control and determinants of hypertension among primary health care professional nurses in Eastern Cape, South Africa

Background: Nurses in primary health care settings are key stakeholders in the diagnosis and management of hypertensive patients. Unfortunately, the working conditions of nurses predispose them to stress, long hours of work, shift duties and unhealthy diets, which are drivers of hypertension. Yet nurses are often overlooked in health screening exercises, primarily because they are assumed to be informed and ‘healthy’. Aim: This study examined the prevalence, awareness, control and determinants of hypertension among professional primary health care nurses in the Eastern Cape Province of South Africa. Setting: This was a cross-sectional survey of 203 professional nurses working at 41 primary health care facilities of the Eastern Cape Province. Methods: A modified WHO STEPwise questionnaire was used for data collection during face-to-face interviews. The information obtained included demographic information, behavioural lifestyles, anthropometric and blood pressure (BP) measurements. Hypertension is defined as an average of two BP ≥ 140/90 mmHg or self-reported history of antihypertensive medication use. Results: The prevalence of hypertension was 52%. Of this, 41% were unaware of their hypertension status. Of those who were aware and on treatment, only 38.1% had a controlled blood pressure. After adjusting for confounders (for physical activity, dietary practices, parity, income and alcohol use), only age and duration of practice were independent predictors of hypertension among the study population. Conclusion: There is a high prevalence of hypertension among the study participants. There is an unexpected low rate of awareness and suboptimal control of blood pressure among the participants. Age is the significant predictor of hypertension among professional nurses in Eastern Cape Province, South Africa. There is an urgent need for the implementation of an effective workplace health programme for nurses in the province

Epidemiology of multimorbidity among people living with HIV in sub-Saharan Africa : a systematic review protocol

CITATION: Oladimeji, Kelechi Elizabeth et al. 2020. Epidemiology of multimorbidity among people living with HIV in sub-Saharan Africa : a systematic review protocol. BMJ Open, 10(12):e036988, doi:10.1136/bmjopen-2020-036988.The original publication is avaialble at: https://bmjopen.bmj.comIntroduction Sub-Saharan Africa remains the epicentre of the HIV pandemic, yet enormous knowledge gaps still exist to elicit a comprehensive portrait of multimorbidity and HIV linkage. This study aims to conduct a systematic meta-analysis of peer-reviewed literature to investigate the current status of multimorbidity epidemiology among people living with HIV (PLHIV) in sub-Saharan Africa. Methods and analysis Our review will assess observational studies (ie, cohort, case–control and cross-sectional) on multimorbidity associated with HIV/AIDS between 1 January 2005 and 31 October 2020 from sub-Saharan Africa. Databases to be searched include PubMed/MEDLINE, Scopus, Web of Science, Cochrane library, African Index Medicus and African Journals Online. We will also search the WHO clinical trial registry and databases for systematic reviews. The search strategy will involve the use of medical subject headings and key terms to obtain studies on the phenomena of HIV and multimorbidity at high precision. Quality assessment of eligible studies will be ascertained using a validated quality assessment tool for observational studies and risk of bias through sensitivity analysis to identify publication bias. Further, data on characteristics of the study population, multimorbid conditions, epidemiological rates and spatial distribution of multimorbid conditions in PLHIV will be extracted. Heterogeneity of individual studies will be evaluated using the I2 statistic from combined effect size estimates. The statistical analysis will be performed using STATA statistical software V.15 and results will be graphically represented on a forest plot.Publisher's versio

Beyond health care providers’recommendations: understandinginfluences on infant feeding choices ofwomen with HIV in the Eastern Cape,South Africa

Background: Despite the array of studies on infant feeding practices of HIV-infected women, gaps still exist in the understanding of the underlying reasons for their infant feeding choices. Potential for behavioural change exists, especially in the light of the 2016 updated World Health Organization guideline on HIV and infant feeding. The aim of this paper is to determine the rate of adoption of exclusive breastfeeding in this cohort, examine the determinants of infant feeding choices of HIV-infected women and assess the underlying reasons for these choices. Methods: This was a mixed methods study conducted between September 2015 and May 2016. It analyses the quantitative and qualitative data of 1662 peripartum women enrolled in the East London Prospective Cohort Study across three large maternity services in the Eastern Cape. Women with HIV reported their preferred choices of infant feeding. In addition, participants explained the underlying reasons for their choices. Descriptive and inferential statistics summarised the quantitative data, while thematic content analysis was performed on qualitative data. Results: Of the 1662 women with complete responses, 80.3% opted to exclusively breastfeed their babies. In the adjusted model, up to grade 12 education level (AOR: 1.81; 95% CI: 1.14, 2.86), rural/peri-urban residence (AOR:1.44; 95% CI: 1.05, 1.96), alcohol use (AOR: 1.65; 95% CI: 1.25, 2.18), negative or unknown HIV status at booking (AOR:1.85; 95% CI:1.27, 2.70), currently married (AOR:1.43; 95% CI:1.01, 2.02) and WHO Clinical Stage 2–4 (AOR:1.77; 95% CI: 1.15, 2.72) were significantly associated with the decision to exclusively breastfeed. Health care providers’ recommendations, perceived benefits of breastfeeding, unaffordability of formula feeding, and coercion were the underlying reasons for wanting to breastfeed; while work/school-related demands, breast-related issues, and fear of infecting the baby influenced their decision to formula feed. Conclusion: The majority of HIV-infected women chose to breastfeed their babies in the Eastern Cape. Following up on these women to ensure they breastfeed exclusively, while also addressing their possible concerns, could be an important policy intervention. Future studies should focus on how early infant feeding decisions change over time, as well as the health outcomes for mother and child. Keywords: Exclusive breastfeeding, Infant feeding practice, infant formula feeding, HIV-infected peripartum women, South Africa, WHO guidelin

Diagnostic performance of several biomarkers for identification of cases of non-communicable diseases among Central Africans

Background: This study determined the diagnostic performance of new biomarkers for a composite diagnosis of non-communicable diseases (NCDs) among Central Africans. Methods:  This case-control study was conducted at LOMO Medical Centre, Kinshasa, DR Congo (DRC) between January – December, 2008. The cases comprised 226 participants with concurrent presence of at least 2 or more of NCDs. Anthropometric parameters and blood pressure were measured while blood samples were assayed for biomarkers. The receiver operating characteristics curve and the logistic regression model were applied.Results: Serum selenium (Se) had specificity and sensitivity of 72.4% and 91.1%, respectively with an area under the curve (AUC) of 0.802; Nitric oxide (NO) (specificity: 72.4%; sensitivity: 93.0%) (AUC = 0.800); Thyroid stimulating hormone (TSH) levels > 6 Mu/L (specificity: 75%; sensitivity: 65%) (AUC = 0.0.727); serum calcium levels of ≥ 110g/L (specificity: 76%; sensitivity: 75%) (AUC = 0.822); and daily salt intake of ≥10 g/day (specificity: 75%; sensitivity: 67%) (AUC = 0.653) in the diagnosis of all NCDs, which were all highly significant (<0.0001).  Conclusion: Serum Se, NO, calcium, TSH and daily salt intake had high diagnostic performance as biomarkers for identification of patients with concurrent NCDs in the study population. Keywords: Non-communicable diseases, diet, new biomarkers, Central Africa