There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The actual burden of ...disease is poorly understood and awareness and treatment to control it is often suboptimal.
The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension.
A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive medication.
The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites.
Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations.
•Stark differences in hypertension prevalence, awareness, and control across Africa.•Hypertension prevalence ranges between 15.1% and 54.1% in sub-Saharan Africans.•Only 47.7% of hypertensive individuals knew their blood pressure status.•Levels of blood pressure control ranged from 30.0% to 61.1%.•Urgent need for localized monitoring and treatment of blood pressure.
Abstract Background There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The ...actual burden of disease is poorly understood and awareness and treatment to control it is often suboptimal. Objectives The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension. Methods A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive medication. Results The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites. Conclusions Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations.
Background
The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP ...incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.
Methods
A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.
Results
Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136). Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality adj. OR = 0·72 (0·44–1·17; P = 0·180) or likelihood of requiring ventilatory support adj. OR = 1·17 (0·71–1·92; P = 0·537), but early treatment versus later significantly reduced mortality adj. OR = 0·70 (0·55–0·88; P = 0·003) and likelihood of requiring ventilatory support adj. OR = 0·68 (0·54–0·85; P = 0·001).
Conclusions
Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.
Childhood violence and mental health remain concerning public health issues globally yet there is limited evidence on the associations between experiences of such violence and mental health in ...refugee settings.
To assess the association between experiences of childhood violence (sexual, physical, and emotional violence) and mental health (severe mental distress, self-harm, suicidal ideation and/or attempted suicide) in refugee settings in Uganda.
Data are from the 2022 Uganda Humanitarian Violence against Children and Youth Survey (HVACS) conducted among 1338 females and 927 males aged 13–24 years between March and April 2022. Cross-tabulation with chi-square tests and multivariate logistic regression analysis were used to assess the association between experiencing childhood violence and mental health.
The results show a high prevalence of experiencing childhood violence (females 40.8% vs males 55.2%) and mental distress (45% for both males and females). Females who experienced childhood sexual violence had significantly higher odds of reporting severe mental distress (aOR = 1.989; CI = 1.216–3.255), suicidal ideation and/or attempted suicide (aOR = 4.119; CI = 2.157–7.864) and self-harm (aOR = 3.734; CI = 1.619–8.609) compared to those who did not experience such violence. Experiencing childhood physical or emotional violence was also significantly associated with increased odds of reporting suicidal ideation and/or attempts and self-harm among females. Among males, childhood emotional violence was significantly associated with increased odds of reporting suicidal ideation and/or attempts (aOR = 9.233; CI = 2.293–37.177) or severe mental distress (aOR = 2.823; CI = 1.115–7.148).
Childhood exposure to violence was associated with poor mental health, with a higher risk observed among females. The findings of this paper provide critical insights to facilitate the development or strengthening of violence prevention and response interventions on violence against children in refugee settings.
•The prevalence of violence in childhood was high among both females and males.•Female survivors of sexual, physical, or emotional violence had increased odds of experiencing mental health issues.•Among males, experience of emotional violence was associated with increased odds of experiencing mental health issues.
There is limited evidence regarding the associations between disability, childhood experiences of violence, and associated health outcomes in humanitarian settings.
We examined the prevalence of ...childhood sexual, physical, and emotional violence by disability status, explored associations between childhood violence and type of disability (limitation), perpetrator types, and the negative health outcomes associated with experiencing childhood violence by disability status.
Participants included 1338 females and 927 males aged 13–24 years living in refugee settings in Uganda.
Data were from a cross-sectional Humanitarian Violence against Children and Youth Survey (HVACS) conducted between March and April 2022 in Uganda. Analysis entailed cross-tabulation with a chi-square test and estimation of bivariate and multivariate logistic regression models.
For both females and males, the prevalence of sexual violence in childhood was higher among those with disabilities compared to those without disabilities (23.2% vs. 11.5% for females; and 15.7% vs. 7.6% for males). The odds of experiencing sexual violence were higher among females with physical limitations (self-care AOR:2.1; 95%CI-1.0-4.3 and task performance AOR:2.5; 95%CI = 1.3–5.2) and males with both physical AOR:4.4; 95%CI = 1.4–13.7 and communication AOR:4.1; 95%CI = 1.3–12.9 limitations compared to those without such limitations. Experiencing violence and having disabilities increased the odds of reporting negative health outcomes including severe mental distress and symptoms or being diagnosed with STI among females by three times.
In Uganda's refugee settings, the prevalence of childhood violence is higher among children and youth with disabilities compared to those without disabilities. Females with disabilities and who had experienced childhood violence were considerably more susceptible to negative health outcomes. These findings underscore the need for targeted child protection and response interventions to address the vulnerabilities of children and youth, and particularly for those with disabilities and female children.
Background Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income ...countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts. Objective This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa. Methods Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included. Results A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status. Conclusions This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions. PROSPERO Registration Number CRD42013004399
In recent years, physical activity and fitness transitions, described as declines in physical activity and aerobic fitness, coupled with increased sedentary behaviour, have been observed among ...school-aged children. Consequently, the prevalence of childhood overweight/obesity has also increased considerably. While there is a wealth of evidence supporting such behavioural transitions in higher income countries, there exists a paucity of data on the situation in lower income countries, such as those in Sub-Saharan Africa (SSA). The premise of this thesis was to investigate the robustness of these relationships in other global regions.
The first objective was to investigate the evidence for an overweight/obesity, physical activity, and fitness transition among SSA’s school-aged children. Systematic review methodology was used to examine temporal trends and correlates of overweight/obesity, physical activity, fitness, and sedentary behaviour in apparently healthy or population based samples of children (5 - 17 years). The second objective of this thesis was to determine the prevalence and correlates of overweight/obesity and physical activity among Kenyan children aged 9 to 11 years, having contextualised Kenya within the broader situation in SSA. Further, the relationships between self-reported and directly assessed measures of physical activity and sedentary time by weight status in Kenyan children were investigated. The third objective was to examine moderate-to-vigorous physical activity (MVPA) patterns accrued by time of day among Kenyan children using the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)-Kenya data. Activity patterns in the Kenyan setting were then compared to similar ISCOLE-Canada data from Canadian children, revealing differences and similarities in the accumulation of MVPA, light physical activity, and sedentary time.
Systematic review data syntheses revealed a trend towards increasing proportions of overweight/obesity among Sub-Saharan Africa’s school-aged children. Further, urbanization and higher socioeconomic status (SES) were associated with decreased physical activity and aerobic fitness, and increased sedentary behaviours and body composition measures. ISCOLE-Kenya data analyses found a prevalence of childhood overweight/obesity of 20.8% in Nairobi, with few children meeting global physical activity guidelines (12.6%). Mean daily sedentary time was 398 minutes, time spent in light physical activity was 463 minutes, and time spent in MVPA was 36 minutes. Higher SES and parental education attainment were associated with a higher likelihood of children being overweight/obese and a lower likelihood of children meeting the physical activity recommendations. Data analyses also revealed considerable discrepancies in both self-report and direct measures of physical activity by weight status, and weak to moderate correlations between self-report and direct measures of physical activity. Under/healthy weight children had significantly higher directly measured mean daily minutes of MVPA compared to overweight/obese children (39 verses 20 minutes); had lower mean weekend-day minutes of sedentary time (346 verses 365 minutes); and had a higher proportion who met physical activity guidelines (15.5% versus 2.6%). Lastly, while MVPA patterns among urban Kenyan children were largely similar to those of urban Canadian children with regard to relationships by sex, BMI category, and weekday/weekend days; in the Kenyan sample, much unlike many higher income countries, lower SES was associated with higher MVPA.
PDF
