Double burden of noncommunicable and infectious diseases in developing countries

Changes in disease burden and epidemiological transitions

The epidemiological transition has been characterized by demographic, societal and health changes in societies. Presuming that acute diseases, mostly of communicable etiology, are more important in terms of early-life mortality, whereas chronic diseases are responsible for a greater burden of disease throughout the life course, we attempt to develop an index to measure the stage of the epidemiological transition. Using Global Burden of Diseases, Risk Factors and Injuries (GBD) data available at https://vizhub.healthdata.org/gbd-compare/ on 04/04/2024 to calculate the Epidemiologic Transition Estimate (ETE) index as a ratio of YLD/YLL for the time period of 1990-2019. The values of the index ranged from 0.131 to 1.067 and 0.180 to 2.108 for males and females, respectively, across the 195 included countries. The transition process seems to be faster to females compared to males. The index shows consistently increasing values for five SDI-based country groups, with clear differences among the groups. Although more research and validation studies are needed despite all the uncertainties, the index seems to be robust to assess the progress in epidemiological transition. These findings can help to predict future social care and health system needs to address causes leading to YLD or YLL.

Structural heart disease in the tropics: A comprehensive review

Structural heart disease (SHD) remains a significant global health challenge, disproportionately impacting populations in tropical regions where the burden of infectious diseases, limited healthcare infrastructure, and socio-economic disparities exacerbate the issue. The tropics are uniquely affected by conditions such as rheumatic heart disease (RHD), endomyocardial fibrosis, tropical cardiomyopathies, and pericardial diseases, often resulting from or complicated by endemic infections like malaria, dengue, tuberculosis, and parasitic diseases. Moreover, Human Immunodeficiency Virus-Associated Cardiac Disease (HIVAC) represents an emerging concern in regions with high HIV prevalence, adding complexity to the interplay between infectious and structural cardiac conditions. Despite the significant morbidity and mortality associated with SHD in these areas, research and clinical focus have often been inadequate, underscoring the need for a comprehensive synthesis of available evidence to guide future efforts. This review aims to provide a detailed examination of SHD in the tropics, with a focus on valvular, myocardial, and pericardial diseases linked to tropical infections and conditions. It highlights the epidemiology, pathophysiology, and clinical presentation of key diseases, including RHD, endocarditis, Chagas disease, and HIVAC, as well as other less commonly recognized tropical cardiomyopathies and pericardial disorders. The review also explores diagnostic challenges, advances in imaging and molecular tools, and the role of public health interventions and policy in addressing these conditions. By synthesizing current knowledge and identifying gaps, this review aims to inform research priorities, improve clinical care, and support the development of tailored prevention and management strategies for SHD in resource-constrained tropical settings.

Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India

Hypertension is one of the most prevalent NCDs in the world. Its prevalence is especially high among the elderly, a demographic group on the rise in low and middle income countries. Extant medical literature calls for early detection to prevent aggravation of problems when old. In this paper, we investigate whether diagnosis of hypertension among adults aged 45 and above, is correlated with geographic access to primary public healthcare services, after accounting for a rich set of potentially confounding covariates. Our study focuses on rural India where access to public primary health services is especially poor but hypertension rates are high. Using the first wave of the Longitudinal Ageing Survey of India (LASI) 2017-19, we find that hypertensive adults belonging to poor households, face a distance cost of public primary health facilities and are 8 percent less likely to be aware of their hypertension when Primary Health Centres are 10 km away. Since almost 10 percent of villages in India are at least 10 km away from PHCs, this exclusionary effect is significant. Our analysis suggests that even though public primary facilities are poorly staffed and managed in India, and private care is popular, geographical expansion of public primary facilities can still play an active role in NCDs and public primary health financing should take heed of the need for such expansion.

Medicinal Plants in the Treatment of Respiratory Diseases and their Future Aspects

The utilization of medicinal plants in the treatment of respiratory diseases has a rich history dating back centuries. A vast body of research literature, including review articles, research papers, case studies, patents, and books, provides substantial evidence supporting the use of medicinal plants in the treatment of diseases and injuries. This study delves into the diverse range of plant species known for their therapeutic properties, with a specific focus on their applications in respiratory health. Medicinal plants have played a crucial role as a source of ingredients for medications and the synthesis of drugs. Globally, over 35,000 plant species are employed for medicinal purposes, particularly in emerging countries where traditional medicine, predominantly plant-based pharmaceuticals, serves as a primary healthcare resource. This review highlights the significance of medicinal plants, such as aloe, ginger, turmeric, tulsi, and neem, in treating a wide array of common respiratory ailments. These plants contain bioactive compounds, including tannins, alkaloids, sugars, terpenoids, steroids, and flavonoids, which have diverse therapeutic applications. Some medicinal plants, notably Echinacea purpurea and Zingiber officinale, exhibit potential for adjuvant symptomatic therapy in respiratory conditions, such as chronic obstructive pulmonary disease (COPD), bronchitis, asthma, the common cold, cough, and whooping cough. The leaves of medicinal plants like Acacia torta, Ocimum sanctum, Mentha haplocalyx, Lactuca virosa, Convolvulus pluricaulis, and Acalypha indica are commonly used to address pneumonia, bronchitis, asthma, colds, and cough. This review aims to shed light on specific medicinal plants with therapeutic value, providing valuable insights for researchers in the field of herbal medicine. These plants hold the potential to serve as novel therapeutic agents in the treatment of respiratory diseases.

Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019

BACKGROUND

There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status.

OBJECTIVES

To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda.

METHODOLOGY

Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood.

RESULTS

Between 1999 and 2019, 63082 adults (15-60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33-5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61-12.28) to 3.27 (95% CI: 2.89-3.68) per 1000 pyo between 1999-2004 and 2015-2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively.

CONCLUSION

There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.

Factors associated with hospitalization and mortality in adult and pediatric extrapulmonary tuberculosis at a tertiary care hospital in Central India

BACKGROUND

Comorbidities complicate the management of tuberculosis (TB) and have become an essential part of the end TB strategy to eradicate TB. However, pulmonary TB has received the most attention, and little is known about the impact of comorbidities and other factors on outcomes in patients with extrapulmonary tuberculosis (EPTB).

OBJECTIVES

Our aim was to analyze the factors associated with hospitalization and mortality in EPTB at a hospital in Central India, using non-TB patients with similar clinical presentations as a comparison.

METHODS

Patients with presumptive EPTB were prospectively enrolled and followed up until the end of treatment or for at least 6 months. Detailed demographic and clinical information was collected for all participants, and patients were categorized as TB or non-TB using a composite reference standard. Multivariate logistic regression was used to analyze the impact of various clinical findings and risk factors on hospitalization and mortality.

RESULTS

A total of 276 patients were categorized as TB cases and 175 as non-TB cases. Factors associated with hospitalization in children were younger age and non-adenitis site of disease. In adults, factors associated with mortality were older age, non-adenitis site of disease and HIV infection regardless of TB diagnosis, while diabetes mellitus increased the odds of mortality in EPTB patients.

CONCLUSION

Our results show that comorbidities increase the odds of death in both TB and non-TB patients in low-resource settings. This argues for a shift away from the traditional vertical management of diseases in these areas and supports a continued focus on building robust healthcare systems.

Investigation of non-communicable diseases prevalence, patterns, and patient outcomes in hospitalized populations: a prospective observational study in three tertiary hospitals

BACKGROUND

Non-communicable diseases (NCDs) pose a significant global health challenge, constituting over 80% of mortality and morbidity. This burden is particularly pronounced in low- and middle-income countries (LMICs), including Ethiopia. Despite this, there's limited research on this issue in Africa. This study aims to investigate the prevalence, patterns, and outcomes of NCDs in hospitalized populations across three tertiary hospitals in Ethiopia.

METHODS

A hospital-based cohort study (August 2022 - January 2023) included patients aged 14 and older diagnosed with cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), asthma, or cancer at three Ethiopian hospitals. Data on demographics, socio-economic factors, clinical characteristics, and outcomes were collected through medical records and interviews. Logistic regression identified factors independently associated with in-hospital mortality, with p ≤ 0.05 considered statistically significant.

RESULTS

In the study across three tertiary hospitals involving 2,237 patients, we uncovered the impact of NCDs. About 23.4% of patients struggled with NCDs, with cardiovascular diseases (53.3%), cancer (29.6%), diabetes (6.1%), and respiratory diseases (6.5%) being the most prevalent. Notably, among those affected, women comprised a slight majority (55.1%), with the average patient age being 47.2 years. Unfortunately, 15.3% of patients with NCDs faced in-hospital mortality. Our analysis revealed predictors of mortality, including cancer diagnosis (adjusted odds ratio [AOR]:1.6, 95% CI: 1.2-1.8, p = 0.01), medication adherence ( AOR: 0.36, 95% CI: 0.21-0.64, p < 0.001), concurrent infections (AOR: 0.36, 95% CI: 0.16-0.86, p < 0.001), chronic kidney diseases (CKD) (AOR: 0.35, 95% CI: 0.14-0.85, p = 0.02), and complications during hospitalization (AOR: 6.36, 95% CI: 3.45-11.71, p < 0.001).

CONCLUSION

Our study reveals a substantial prevalence of NCDs among hospitalized patients, affecting approximately one in four individuals, primarily with CVDs and cancer. Alarmingly, a significant proportion of these patients did not survive their hospitalization, emphasizing the urgent need for targeted interventions to enhance outcomes in this population.

Access to essential medicines used in the management of noncommunicable diseases in Southern Ethiopia: Analysis using WHO/HAI methodology

Objectives

This study aims to assess access to essential medicines used in the management of noncommunicable diseases through analysis of the availability, prices, and affordability of these essential medicines in Arba Minch town, Gamo Zone, Southern Ethiopia.

Methods

A cross-sectional design was carried out using the World Health Organization/health action international methodology between 2 March and 2 May 2023, within public and private healthcare facilities located in Arba Minch town, Southern Ethiopia. The median price ratio served as a metric. Statistical tests like the Shapiro-Wilk and Kolmogorov-Smirnov were utilized to assess the normal distribution of price data. The Wilcoxon-Mann-Whitney U test was also employed to compare median buyer's prices (patient prices) between public and private healthcare institutions. Treatment affordability was determined by estimating the number of days' wages required by the lowest-paid government employee in Ethiopia to afford the prescribed medication regimen.

Results

Among 23 health facilities surveyed, the pooled availability of essential medicine used in the management of noncommunicable diseases was 18.7% (range: 0%-30.1%), with the public and private facilities contributing 16.3% and 38.3%, respectively. The overall percentage of availability originator brand versions was 1.1% for overall health sectors, 0.6% for public sectors, and 1.2% for private sectors. The overall percent availability of lowest price generics was 36.2% (range: 0%-26.2%; public: 32.0%; private: 37.1%). Only seven lowest price generics satisfied the World Health Organization target of 80% and above. The overall median price of lowest price generic medicines in private was two times higher than in public sectors. The top five median price scorers were amlodipine, furosemide, insulin, beclomethasone, and salbutamol. The Mann-Whitney U test showed that 11.6% of lowest price generics medicines had a statistically significant median price disparity between the public and private sectors (p < 0.05). The overall percent of unaffordability was found to be 100.0%, (public: 70.4; private: 100.0%).

Conclusions

This study revealed the limited availability and potential financial burdens on patients seeking essential noncommunicable disease medications. Limited availability suggests the need for better supply chain management and consistent stock availability. The price disparities and affordability challenges identified underscore the necessity for policy interventions such as price regulation and subsidized programs to ensure equitable access to essential noncommunicable disease medications in Arba Minch town, Southern Ethiopia.

The Chilean exposome-based system for ecosystems (CHiESS): a framework for national data integration and analytics platform

The double burden of diseases and scarce resources in developing countries highlight the need to change the conceptualization of health problems and translational research. Contrary to the traditional paradigm focused on genetics, the exposome paradigm proposed in 2005 that complements the genome is an innovative theory. It involves a holistic approach to understanding the complexity of the interactions between the human being’s environment throughout their life and health. This paper outlines a scalable framework for exposome research, integrating diverse data sources for comprehensive public health surveillance and policy support. The Chilean exposome-based system for ecosystems (CHiESS) project proposes a conceptual model based on the ecological and One Health approaches, and the development of a technological dynamic platform for exposome research, which leverages available administrative data routinely collected by national agencies, in clinical records, and by biobanks. CHiESS considers a multilevel exposure for exposome operationalization, including the ecosystem, community, population, and individual levels. CHiESS will include four consecutive stages for development into an informatic platform: (1) environmental data integration and harmonization system, (2) clinical and omics data integration, (3) advanced analytical algorithm development, and (4) visualization interface development and targeted population-based cohort recruitment. The CHiESS platform aims to integrate and harmonize available secondary administrative data and provide a complete geospatial mapping of the external exposome. Additionally, it aims to analyze complex interactions between environmental stressors of the ecosystem and molecular processes of the human being and their effect on human health. Moreover, by identifying exposome-based hotspots, CHiESS allows the targeted and efficient recruitment of population-based cohorts for translational research and impact evaluation. Utilizing advanced technologies such as Artificial Intelligence (AI), Internet of Things (IoT), and blockchain, this framework enhances data security, real-time monitoring, and predictive analytics. The CHiESS model is adaptable for international use, promoting global health collaboration and supporting sustainable development goals.

The spectrum of health conditions in community-based cross-sectional surveys in Southeast Asia 2010-21: a scoping review

BACKGROUND

Southeast Asia is undergoing an epidemiological transition with non-communicable illnesses becoming increasingly important, yet infectious diseases (tuberculosis, HIV, hepatitis B, malaria) remain widely prevalent in some populations, while emerging and zoonotic diseases threaten. There are also limited population-level estimates of many important heath conditions. This restricts evidence-based decision-making for disease control and prevention priorities. Cross-sectional surveys can be efficient epidemiological tools to measure the prevalence of a wide range of diseases, but no systematic assessment of their coverage of different health conditions has been produced for the region.

METHODS

We conducted a systematic search in Medline, Embase, Global Health, CINAHL, Scopus, Web of Science Core Collection, and Global Index Medicus, and additionally Google Scholar. Our inclusion criteria were cross-sectional surveys conducted with community-based recruitment, in Bangladesh, Cambodia, Laos, Myanmar, and Thailand, published between January 1, 2010 and January 27, 2021, and reporting the prevalence of any health condition.

RESULTS

542 publications from 337 surveys were included. Non-communicable conditions (n = 205) were reported by more surveys than infectious conditions (n = 124). Disability (n = 49), self-report history of any disease or symptoms (n = 35), and self-perceived health status (n = 34), which reflect a holistic picture of health, were studied by many fewer surveys. In addition, 45 surveys studied symptomatic conditions which overlap between non-communicable and infectious conditions. The most surveyed conditions were undernutrition, obesity, hypertension, diabetes, intestinal parasites, malaria, anemia, diarrhea, fever, and acute respiratory infections. These conditions overlap with the most important causes of death and disability in the Global Burden of Disease study. However, other high-burden conditions (e.g. hearing loss, headache disorder, low back pain, chronic liver and kidney diseases, and cancers) were rarely studied.

CONCLUSION

There were relatively few recent surveys from which to estimate representative prevalences and trends of health conditions beyond those known to be high burden. Expanding the spectrum of health conditions in cross-sectional surveys could improve understanding of evolving disease patterns in the region.

Geographical, sex, and socioeconomic differences in non-communicable disease indicators: A cross-sectional survey in Eastern Uganda

The prevalence of non-communicable diseases (NCDs) is increasing in many low- and middle-income countries (LMICs). This study examined differences in the burden of NCDs and their risk factors according to geographic, sex, and sociodemographic characteristics in a rural and peri-urban community in Eastern Uganda. We compared the prevalence by sex, location, wealth, and education. Unadjusted and adjusted prevalence ratios (PR) were reported. Indicators related to tobacco use, alcohol use, salt consumption, fruit/vegetable consumption, physical activity, body weight, and blood pressure were assessed. Among 3220 people (53.3% males, mean age: 35.3 years), the prevalence of NCD burden differed by sex. Men had significantly higher tobacco (e.g., current smoking: 7.6% vs. 0.7%, adjusted PR (APR): 12.8, 95% CI: 7.4-22.3), alcohol use (e.g., current drinker: 11.1% vs. 4.6%, APR: 13.4, 95% CI: 7.9-22.7), and eat processed food high in salt (13.4% vs. 7.1, APR: 1.8, 95% CI: 1.8, 95% CI: 1.4-2.4) than women; however, the prevalence of overweight (23.1% vs 30.7%, APR: 0.7, 95% CI: 0.6-0.9) and obesity (4.1% vs 14.7%, APR: 0.3, 95% CI: 0.2-0.3) was lower among men than women. Comparing locations, peri-urban residents had a higher prevalence of current alcohol drinking, heavy episodic drinking, always/often adding salt while cooking, always eating processed foods high in salt, poor physical activity, obesity, prehypertension, and hypertension than rural residents (p<0.5). When comparing respondents by wealth and education, we found people who have higher wealth or education had a higher prevalence of always/often adding salt while cooking, poor physical activity, and obesity. Although the findings were inconsistent, we observed significant sociodemographic and socioeconomic differences in the burden of many NCDs, including differences in the distributions of behavioral risk factors. Considering the high burden of many risk factors, we recommend appropriate prevention programs and policies to reduce these risk factors' burden and future negative consequences.

Proportion of cancer cases and deaths attributable to potentially modifiable risk factors in Peru

BACKGROUND

Limited evidence exists on the population attributable fraction (PAF) of cancer cases and deaths in Latin America. In Peru several studies have been published regarding the PAF of various risk factors and their associated diseases. The objective of this study was to estimate the fraction of cancer cases and deaths attributable to potentially modifiable risk factors in Peru in 2018, before the COVID-19 pandemic in the population of 15 years old and older.

METHODS

An ecological study was conducted using the prevalence of exposure of the Peruvian population to modifiable risk factors for cancer, the relative risk associated with each factor, and the number of cancer cases and deaths in 2018 as inputs. We used the Parkin formula with a Montecarlo statistical simulation model to calculate the PAF and confidence intervals. The number of new cancer cases and deaths attributed to each risk factor was determined by multiplying the number of cases and deaths in each gender by the PAF of each risk factor.

FINDINGS

In Peru, 38.5% of new cases (34.5% in men and 42% in women) and 43.4% of cancer-related deaths (43.4% in men and 43.4% in women) were attributable to modifiable risk factors. The number of cancers attributable was 25,308 (10,439 in men and 14,869 in women) and the number of deaths attributable to cancer was 14,839 (6,953 in men and 7,886 in women). The predominant modifiable risk factors contributing to the highest number of cases and deaths were HPV infection (4,563 cases, 2,409 deaths), current tobacco use (3,348 cases, 2,180 deaths), and helicobacter pylori infection (2,677 cases, 1,873 deaths). Among the risk factors, oncogenic infections constituted the group with the highest PAF (16.6% for cases, 19.2% for deaths) followed by other unhealthy lifestyle factors (14.2% for cases, 16.7% for deaths), tobacco (7.2% for cases, 7.2% for deaths) and ultraviolet radiation (0.5% for cases, 0.3% for deaths).

CONCLUSIONS

Prior to the COVID-19 pandemic, 38.5% of cancer cases and 43.4% of cancer-related deaths in Peru were linked to modifiable risk factors in the population of 15 years old and older. Most preventable cancer cases and deaths were related to oncogenic infections, primarily caused by HPV and helicobacter pylori, followed by tobacco and obesity.

COVID-19 impact on blood donor characteristics and seroprevalence of transfusion-transmitted infections in southern Thailand between 2018 and 2022

Blood safety is a critical aspect of healthcare systems worldwide involving rigorous screening, testing, and processing protocols to minimize the risk of transfusion-transmitted infections (TTIs). The present study offers a comprehensive assessment of the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis among blood donors in southern Thailand. It explores the consequences of the COVID-19 pandemic on the blood transfusion service, donor characteristics, and the prevalence of TTIs. A retrospective analysis of 65,511 blood donors between 2018 and 2022 was conducted at Songklanagarind Hospital, Thailand. The socio-demographic characteristics of the donors were examined using the Chi-square test to assess the relationship between TTIs serological positivity and donor characteristics. The donors were divided into pre-COVID-19 (2018-2019) and during COVID-19 (2020-2022) groups to evaluate the impacts of COVID-19. The study found that HBV had the highest overall prevalence at 243 per hundred thousand (pht), followed by syphilis (118 pht), HCV (32 pht), and HIV (31 pht) over a five-year period of study. After COVID-19, the prevalence of HBV decreased by 21.8%; HCV decreased by 2.1%; HIV increased by 36.4%; and syphilis increased by 9.2%. The socio-demographic characteristics and TTIs prevalence were significantly altered over time. This study provides insights into blood donor characteristics and TTIs prevalence in southern Thailand, highlighting the understanding of the impact of COVID-19 on the spread of TTIs.

Defining the hidden burden of disease in rural communities in Bangladesh, Cambodia and Thailand: a cross-sectional household health survey protocol

INTRODUCTION

In low-income and middle-income countries in Southeast Asia, the burden of diseases among rural population remains poorly understood, posing a challenge for effective healthcare prioritisation and resource allocation. Addressing this knowledge gap, the South and Southeast Asia Community-based Trials Network (SEACTN) will undertake a survey that aims to determine the prevalence of a wide range of non-communicable and communicable diseases, as one of the key initiatives of its first project-the Rural Febrile Illness project (RFI). This survey, alongside other RFI studies that explore fever aetiology, leading causes of mortality, and establishing village and health facility maps and profiles, will provide an updated epidemiological background of the rural areas where the network is operational.

METHODS AND ANALYSIS

During 2022-2023, a cross-sectional household survey will be conducted across three SEACTN sites in Bangladesh, Cambodia and Thailand. Using a two-stage cluster-sampling approach, we will employ a probability-proportional-to-size sample method for village, and a simple random sample for household, selection, enrolling all members from the selected households. Approximately 1500 participants will be enrolled per country. Participants will undergo questionnaire interview, physical examination and haemoglobin point-of-care testing. Blood samples will be collected and sent to central laboratories to test for chronic and acute infections, and biomarkers associated with cardiovascular disease, and diabetes. Prevalences will be presented as an overall estimate by country, and stratified and compared across sites and participants' sociodemographic characteristics. Associations between disease status, risk factors and other characteristics will be explored.

ETHICS AND DISSEMINATION

This study protocol has been approved by the Oxford Tropical Research Ethics Committee, National Research Ethics Committee of Bangladesh Medical Research Council, the Cambodian National Ethics Committee for Health Research, the Chiang Rai Provincial Public Health Research Ethical Committee. The results will be disseminated via the local health authorities and partners, peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05389540.

The burden of hypertension, diabetes, and overweight/obesity by sedentary work pattern in Bangladesh: Analysis of Demographic and Health Survey 2017-18

Most low- and middle-income countries, including Bangladesh, are currently undergoing epidemiologic and demographic transitions with an increasing burden of hypertension, diabetes, and overweight/obesity. Inadequate physical activity is a risk factor for these conditions and work-related activities contribute to most of the physical activities in Bangladesh. We investigated the association of the sedentary nature of occupation with hypertension, diabetes, and overweight/obesity in Bangladesh. If a person's systolic/diastolic blood pressure, fasting plasma glucose concentration, and body mass index were ≥130/80 mmHg, ≥7 mmol/l, and ≥23 kg/m2, respectively, they were classified as hypertensive, diabetic, and overweight/obese. The nature of occupation/work was classified into three types: non-sedentary workers (NSW), sedentary workers (SW), and non-workers (NW). After describing the sample according to exposure and outcomes, we performed simple and multivariable logistic regression to investigate the association. Among 10900 participants (60.7% females, mean age: 40.0 years), about 43.2%, 13.2%, and 42.8% were NSW, SW, and NW, respectively. NSW, SW, NW, and overall people, respectively, had 6.7%, 14.5%, 11.7%, and 9.9% prevalence rates for diabetes; 18.0%, 32.9%, 28.3%, and 24.4% prevalence rates for overweight/obesity; and 18.0%, 32.9%, 38.3%, and 28.0% prevalence rate for hypertension. SW had higher odds of diabetes (AOR: 1.44, 95% CI: 1.15-1.81), overweight/obesity (AOR: 1.83, 95% CI: 1.52-2.21), and hypertension (AOR: 1.47, 95% CI: 1.21-1.77) than NSW. NW had higher odds of diabetes (AOR: 1.43, 95% CI: 1.19-1.71) or hypertension (AOR: 1.37, 95% CI: 1.22-1.56) but not higher odds of overweight/obesity (AOR: 1.11, 95% CI: 0.98-1.27) than NSW. We found higher prevalence and odds of the studied conditions among SW than NSW. Workplace physical activity programs may improve the physical activity and health of SW.

Dual burden of infectious and chronic disease in low-resource U.S. communities: examining relationships between infection, adiposity, and inflammation

BACKGROUND

Rising global obesity rates are linked with inflammation and associated morbidities. These negative outcomes are generally more common in low-resource communities within high-income countries; however, it is unclear how frequent infectious disease exposures in these settings may influence the relationship between adiposity and inflammation.

AIM

We test associations between adiposity measures and distinct forms of inflammation among adults (n = 80) living in low-resource U.S. communities experiencing high levels of obesity and pathogen exposure.

SUBJECTS AND METHODS

Adiposity measures included BMI and percent body fat. Inflammation measures included systemic inflammation (C-reactive protein [CRP]) and localised intestinal inflammation (faecal calprotectin [FC]). The relationship between a condition characterised by elevated inflammation (Helicobacter pylori infection) and adiposity was also considered.

RESULTS

Adiposity was not significantly related to FC concentration. However, both adiposity measures were positively related with odds of CRP elevation and H. pylori infection was associated with significantly lower adiposity measures (all p < 0.05).

CONCLUSION

For this disadvantaged U.S. sample, the association between adiposity and inflammation varies by the systemic/localised nature of inflammation and the likely underlying cause of inflammation. Defining these associations will improve understanding of how rising obesity rates shape long-term health inequities, with implications for more effective intervention design.

Autoimmune encephalitis in a resource-limited public health setting: a case series analysis

BACKGROUND

 Autoimmune encephalitis (AE) consists of a group of acquired diseases that affect the central nervous system. A myriad of phenotypes may be present at the onset. Due to the heterogeneity of clinical presentations, it is difficult to achieve uniformity for the diagnostic and therapeutic processes and follow-up strategies.

OBJECTIVE

 To describe a series of patients diagnosed with AE in a resource-limited public hospital in southern Brazil and to analyze therapeutics and outcomes.

METHODS

 We retrospectively reviewed the electronic medical records of patients diagnosed with AE at the Hospital de Clínicas de Porto Alegre from 2014 to 2022. Data collected included clinical presentation, neuroimaging, cerebrospinal fluid testings, electroencephalogram, autoantibodies, treatments, outcomes, follow-up time, degree of neurological impairment, and mortality.

RESULTS

 Data from 17 patients were retrieved. Eleven cases were classified as definite AE and 6 as possible AE. Autoantibodies were identified in 9 patients. Timing for diagnosis was impacted by the high costs associated with autoantibody testing. Most patients became functionally dependent (82.4%) and most survivors remained with autoimmune-associated epilepsy (75%). Five patients died during hospitalization, and one after a 26-month of follow-up.

CONCLUSION

 In this resource-limited hospital, patients with AE had a worse clinical outcome than that previously described in the literature. Development of epilepsy during follow-up and mortality were greater, whilst functional outcome was inferior. Autoantibody testing was initially denied in most patients, which impacted the definitive diagnosis and the use of second-line therapies.

Early user perspectives on using computer-aided detection software for interpreting chest X-ray images to enhance access and quality of care for persons with tuberculosis

Despite 30 years as a public health emergency, tuberculosis (TB) remains one of the world's deadliest diseases. Most deaths are among persons with TB who are not reached with diagnosis and treatment. Thus, timely screening and accurate detection of TB, particularly using sensitive tools such as chest radiography, is crucial for reducing the global burden of this disease. However, lack of qualified human resources represents a common limiting factor in many high TB-burden countries. Artificial intelligence (AI) has emerged as a powerful complement in many facets of life, including for the interpretation of chest X-ray images. However, while AI may serve as a viable alternative to human radiographers and radiologists, there is a high likelihood that those suffering from TB will not reap the benefits of this technological advance without appropriate, clinically effective use and cost-conscious deployment. The World Health Organization recommended the use of AI for TB screening in 2021, and early adopters of the technology have been using the technology in many ways. In this manuscript, we present a compilation of early user experiences from nine high TB-burden countries focused on practical considerations and best practices related to deployment, threshold and use case selection, and scale-up. While we offer technical and operational guidance on the use of AI for interpreting chest X-ray images for TB detection, our aim remains to maximize the benefit that programs, implementers, and ultimately TB-affected individuals can derive from this innovative technology.

Does obesity Kuznets curve exist in developing economies? Evidence from 38 African countries based on heterogeneous panel data analysis on income-level classification

Introduction

The global pandemic disease known as the obesity epidemic has spread throughout the planet. Particularly, Africa is facing a growing problem of obesity, and the trend is rising. This is a result of a ticking time bomb. Given the claim that multiple socio-economic factors significantly affect the diversity in obesity rates between nations, economic development can be seen as a key contributor to this variation.

Methods

Relying on the aforementioned avowal, this extant research examines the relationship between obesity and economic growth using urbanization, trade openness, and unemployment as intermittent variables within the Obesity Kuznets Curve (OKC) framework. Using panel data from 1990 to 2020, a panel of 38 African countries subdivided into income levels (Low income, Lower-middle income, and Upper-middle income) were analyzed. With the presence of residual cross-sectional reliance and slope heterogeneity, the Augmented Mean Group (AMG) econometric approach is employed.

Results

Key outcomes from the mentioned estimation method unveiled that economic growth positively impacts obesity among all the study panels. Variably, unemployment was evidenced to have a palpable positive impact on obesity concerning Low-income economies whereas on the side of the Lower-middle income panel together with Upper-middle income economies and the aggregated panel, a significant negative relationship is observed with obesity. Further, urbanization enhanced obesity in the Low-income panel and the aggregated panel of African nations, whereas an adverse effect is identified in both the Lower-middle and Upper-middle economies in Africa. Moreover, except for Low-income African economies, all the other panels of African nations in terms of income levels were noted to have a significant negative effect on obesity from trade openness.

Discussion

Finally, the long-run coefficients indicated that the OKC is valid among all panels of African countries. The study thus preferably suggests in African economies that addressing the inverted U-shape relationship between obesity and economic growth requires a multifaceted approach that considers the evolving dynamics of both factors. Policy makers should, therefore, aim to balance promoting economic growth and safeguarding public health through targeted interventions and long-term strategies.

Global patterns of cancer transitions: A modelling study

Cancer is a major contributor to global disease burden. Many countries experienced or are experiencing the transition that non-infection-related cancers replace infection-related cancers. We aimed to characterise burden changes for major types of cancers and identify global transition patterns. We focused on 10 most common cancers worldwide and extracted age-standardised incidence and mortality in 204 countries and territories from 1990 to 2019 through the Global Burden of Disease Study. Two-stage modelling design was used. First, we applied growth mixture models (GMMs) to identify distinct trajectories for incidence and mortality of each cancer type. Next, we performed latent class analysis to detect cancer transition patterns based on the categorisation results from GMMs. Kruskal-Wallis H tests were conducted to evaluate associations between transition patterns and socioeconomic indicators. Three distinct patterns were identified as unfavourable, intermediate and favourable stages. Trajectories of lung and breast cancers had the strongest association with transition patterns among men and women. The unfavourable stage was characterised by rapid increases in lung, breast and colorectal cancers alongside stable or decreasing burden of gastric, cervical, oesophageal and liver cancers. In contrast, the favourable stage exhibited rapid declines in most cancers. The unfavourable stage was associated with lower sociodemographic index, health expenditure, gross domestic product per capita and higher maternal mortality ratio (P < .001 for all associations). Our findings suggest that unfavourable, intermediate and favourable transition patterns exist. Countries and territories in the unfavourable stage tend to be socioeconomically disadvantaged, and tailored intervention strategies are needed in these resource-limited settings.

Prevalence and determinants of hypertension among older adults: A comparative analysis of the 6th and 8th national health surveys of Bangladesh

BACKGROUND

Hypertension is a major public health concern in low-and middle-income countries. A nationwide Health, Population, and Nutrition Sector Development Program in Bangladesh has been shown to be effective in resource-poor settings. This article aims to investigate whether the prevalence and determinants of adult hypertension changed from 2011 to 2018.

METHODS

The determinants of adult hypertension were assessed in 2011 and 2018 data of Bangladesh Demographic and Health surveys. These two surveys included both men and women over the age of 34 years and measured their blood pressure, weight, height, and other covariates. For both surveys, we estimated the age-standard prevalence of hypertension and relative, attributable and mediated risk of determinants of hypertension using hierarchical mixed-effects sequential Poisson regression models.

RESULTS

The prevalence of adult hypertension increased by 10.9% from 29.5% in 2011 to 40.4% in 2018. The nationwide awareness program on the Health, Population and Nutrition Sector changed the risks associated with hypertension determinants over the years. During 2011, Socio-economic status (SES) was a major distal determinant of adult hypertension, explaining 21% of population-attributable risk (ART). However, other factors accounted for 90% of risk, mainly by excessive body weight (51%) and awareness of hypertension (39%). In contrast, SES only explained 16% of ART risk, with 97% of the risk mediated by excessive body weight (55%) and awareness of hypertension (41%).

CONCLUSION

The study results highlight that hypertension among older adult was significantly increased over the six-year period. Specially, the socio-economic status, awareness of hypertension and excessive body weight were the significant determinants. Being awareness of hypertension and excessive body weight changed the causal pathways of socio-economic status. The results also highlight the value of studying the effect of non-communicable disease awareness programs to enhance our comprehension of factors influencing health.

Dietary patterns and their socioeconomic factors of adherence among adults in urban Burkina Faso: a cross-sectional study

BACKGROUND

Sub-Saharan African populations undergo a nutrition transition towards diets associated with increased risk for metabolic and cardiovascular diseases. For targeted prevention, we aimed to characterize dietary patterns and determine their sociodemographic factors of adherence.

METHODS

We recruited 1,018 adults aged >  = 25 years from two formal and three informal settlements within the Health and Demographic Surveillance System, Ouagadougou, Burkina Faso, between February and April 2021. In a cross-sectional sample, a culture-specific food-propensity questionnaire with 134 food items and a sociodemographic questionnaire were used to collect the data. Exploratory dietary patterns were derived using principal component analysis, and sociodemographic factors of adherence were calculated using multivariable linear regression models.

RESULTS

In this study population (median age: 42 years, interquartile range 21 years; male: 35.7%), the diet relied on starchy foods and other plant-based staples with rare consumption of animal-based products. We identified three dietary patterns, explaining 10.2%, 9.8%, and 8.9% of variation in food intake, respectively: a meat and egg-based pattern associated with younger age, male sex, better education, and economic situation; a fish-based pattern prevailed among women, higher educational levels, and better economic situation; and a starchy food-based was associated with younger age and sharing a home with other adults.

CONCLUSIONS

This study population is at an early stage of the nutrition transition and shows low intakes of health-beneficial food groups. Yet, progress along the nutrition transition varies according to age, educational attainment, and economic status. Particularly, younger and well-off people seem to adhere more strongly to diets high in animal-based products. These findings can inform strategies in public health nutrition for sub-Saharan African populations.

Developing digital tools for health surveys in low- and middle-income countries: Comparing findings of two mobile phone surveys with a nationally representative in-person survey in Bangladesh

Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are inadequate, mostly due to the cost and burden of collecting in-person population-level estimates. High-income countries regularly use phone-based surveys, and with increasing mobile phone subscription in developing countries, mobile phone surveys (MPS) could complement in-person surveys in LMICs. We compared the representativeness and prevalence estimates of two MPS (i.e., interactive voice response (IVR) and computer-assisted telephone interview (CATI)) with a nationally representative household survey in Bangladesh-the STEPwise approach to NCD risk factor surveillance (STEPs) 2018. This cross-sectional study included 18-69-year-old respondents. CATI and IVR recruitments were done by random digit dialing, while STEPs used multistage cluster sampling design. The prevalence of NCD risk factors related to tobacco, alcohol, diet, and hypertension was reported and compared by prevalence differences (PD) and prevalence ratios (PR). We included 2355 (57% males), 1942 (62% males), and 8185 (47% males) respondents in the CATI, IVR, and STEPs, respectively. CATI (28%) and IVR (52%) had a higher proportion of secondary/above-educated people than STEPs (13%). Most prevalence estimates differed by survey mode; however, CATI estimates were closer to STEPs than IVR. For instance, in CATI, IVR, and STEPs, respectively, the prevalence was 21.4%, 17.9%, and 23.5% for current smoking; and 1.6%, 2.2%, and 1.5% for alcohol drinking in past month. Compared to STEPs, the PD ranged from '-56.6% to 0.4%' in CATI and '-41.0% to 8.4%' in IVR; the PR ranged from '0.3 to 1.1' in CATI and '0.3 to 1.6' in IVR. There were some differences and some similarities in NCD indicators produced by MPS and STEPs with differences likely due to differences in socioeconomic characteristics between survey participants.

Infection with soil-transmitted helminths and their impact on coinfections

The most important soil-transmitted helminths (STHs) affecting humans are roundworms, whipworms, and hookworms, with a large proportion of the world's population infected with one or more of these intestinal parasites. On top of that, concurrent infections with several viruses, bacteria, protozoa, and other helminths such as trematodes are common in STH-endemic areas. STHs are potent immunomodulators, but knowledge about the effects of STH infection on the direction and extent of coinfections with other pathogens and vice versa is incomplete. By focusing on Kenya, a country where STH infections in humans are widespread, we provide an exemplary overview of the current prevalence of STH and co-occurring infections (e.g. with Human Immunodeficiency Virus, Plasmodium falciparum, Giardia duodenalis and Schistosoma mansoni). Using human data and complemented by experimental studies, we outline the immunomechanistic interactions of coinfections in both acutely STH transmigrated and chronically infected tissues, also highlighting their systemic nature. Depending on the coinfecting pathogen and immunological readout, STH infection may restrain, support, or even override the immune response to another pathogen. Furthermore, the timing of the particular infection and host susceptibility are decisive for the immunopathological consequences. Some examples demonstrated positive outcomes of STH coinfections, where the systemic effects of these helminths mitigate the damage caused by other pathogens. Nevertheless, the data available to date are rather unbalanced, as only a few studies have considered the effects of coinfection on the worm's life cycle and associated host immunity. These interactions are complex and depend largely on the context and biology of the coinfection, which can act in either direction, both to the benefit and detriment of the infected host.

Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review

BACKGROUND

Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations.

METHODS

We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively.

RESULTS

Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively.

CONCLUSION

Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.

Non-communicable disease burden among inpatients at a rural district hospital in Malawi

BACKGROUND

The burden of non-communicable diseases (NCDs) is high in Malawi. However, resources and training for NCD care remain scarce, especially in rural hospitals. Current care for NCDs in the developing world focuses on the WHO's traditional 4 × 4 set. However, we do not know the full burden of NCDs outside of that scope, like neurological disease, psychiatric illness, sickle cell disease, and trauma. The goal of this study was to understand the burden of NCDs among inpatients in a rural district hospital in Malawi. We broadened our definition of NCDs beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma.

METHODS

We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. We broke patients down by age, date of admission, type, and number of NCD diagnoses, and HIV status, and constructed multivariate regression models for length of stay and in-hospital mortality.

RESULTS

Of 2239 total visits, 27.5% were patients with NCDs. Patients with NCDs were older (37.6 vs 19.7 years, p < 0.001) and made up 40.2% of total hospital time. We also found two distinct populations of NCD patients. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. We also found significant trauma burden, accounting for 40% of all NCD visits. In multivariate analysis, carrying a medical NCD diagnosis was associated with longer length of stay (coefficient 5.2, p < 0.001) and a higher risk of in-hospital mortality (OR 1.9, p = 0.03). Burn patients also had significantly longer length of stay (coefficient 11.6, p < 0.001).

CONCLUSIONS

There is a significant burden of NCDs in a rural hospital in Malawi, including those outside of the traditional 4 × 4 set. We also found high rates of NCDs in the younger population (under 40 years of age). Hospitals must be equipped with adequate resources and training to meet this burden of disease.

Disease patterns and clinical outcomes of medical admissions at a tertiary hospital in Northern Tanzania: A retrospective observational study

Background and Aims

The burden of noncommunicable diseases is increasing in developing countries and in settings with an existing communicable burden. The study aim was to identify the disease pattern, length of stay, and clinical outcome of medical admissions.

Methods

A retrospective observational study of patients admitted to medical wards between 1st July 2019 and 30th June 2020, excluding those admitted for chemotherapy. The outcome measures were the pattern of disease, length of stay, and clinical outcome.

Results

A total of 3930 patients were analyzed. A total of 53.5% were males, and 42.9% were aged 51-75 years, with a median age of 57 years (IQR 41-71). A total of 41.3% had health insurance, 21.7% died, and the median length of stay was 6 days (IQR 4-9). Cardiovascular diseases were the most common diagnosis (26.8%) on admission and cause of death (27.9%). The common causes of death were stroke (15.1%), chronic kidney disease (11.1%), and heart failure (9.0%). Noninsured patients had a high mortality risk (odds ratios [OR] 1.67, 95% confidence interval [CI] 1.42-1.96), which was also seen among patients aged more than 75 years (OR 1.3, 95% CI 1.08-1.57), patients with communicable diseases (OR 1.44, 95% CI 1.23-1.68), and weekend admissions (OR 1.29, 95% CI 1.08-1.55). The 72-h admission window is critical due to a very high mortality risk (OR 3.03, 95% CI 2.58-3.56).

Conclusion

Cardiovascular diseases are the leading cause of hospital admissions and deaths in a tertiary hospital in Northern Tanzania. Lifestyle modification, health education, and community resources are needed to combat the growing burden of cardiovascular and renal disease.

Implementing and Evaluating Community Health Worker-Led Cardiovascular Disease Risk Screening Intervention in Sub-Saharan Africa Communities: A Participatory Implementation Research Protocol

The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach. The study builds upon a prior community-driven multicentre study conducted by the Collaboration for Evidence-based Health Care and Public Health in Africa (CEBHA+). This is a participatory implementation research. The study will leverage on the CVD risk citizen science pilot studies conducted in the four selected CEBHA+ project countries (viz. Ethiopia, Rwanda, Malawi, and South Africa). Through planned engagements with communities and health system stakeholders, CHWs and lay health worker volunteers will be recruited and trained to screen and identify persons that are at high risk of CVD, provide referral services, and follow-up at designated community health clinics. In each country, we will use a multi-stage random sampling to select and then screen 1000 study participants aged 35-70 years from two communities (one rural and one urban). Screening will be done using a simple validated non-laboratory-based CVD risk assessment mobile application. The RE-AIM model will be used in evaluating the project implementation outcomes, including reach, fidelity, adoption and perceived effectiveness. Developing the capacities of CHWs and lay health worker volunteers in SSA to support population-based, non-invasive population-based CVD risk prevention has the potential to impact on early identification, treatment and secondary prevention of CVDs in often under-resourced communities. Using a participatory research approach to implementing mobile phone-based CHW-led CVD risk screening, referral and follow-up in SSA will provide the evidence needed to determine the effectiveness of CVD risk screening and the potential for scaling up in the wider region.

Mapping national, regional and local prevalence of hypertension and diabetes in Ethiopia using geospatial analysis

OBJECTIVES

This study aimed to map the national, regional and local prevalence of hypertension and diabetes in Ethiopia.

DESIGN AND SETTING

Nationwide cross-sectional survey in Ethiopia combined with georeferenced ecological level data from publicly available sources.

PARTICIPANTS

9801 participants aged between 15 and 69 years.

PRIMARY OUTCOME MEASURES

Prevalence of hypertension and diabetes were collected using the WHO's STEPS survey approach. Bayesian model-based geostatistical techniques were used to estimate hypertension and diabetes prevalence at national, regional and pixel levels (1×1 km²) with corresponding 95% credible intervals (95% CrIs).

RESULTS

The national prevalence was 19.2% (95% CI: 18.4 to 20.0) for hypertension and 2.8% (95% CI: 2.4 to 3.1) for diabetes. Substantial variation was observed in the prevalence of these diseases at subnational levels, with the highest prevalence of hypertension observed in Addis Ababa (30.6%) and diabetes in Somali region (8.7%). Spatial overlap of high hypertension and diabetes prevalence was observed in some regions such as the Southern Nations, Nationalities and People's region and Addis Ababa. Population density (number of people/km²) was positively associated with the prevalence of hypertension (β: 0.015; 95% CrI: 0.003-0.027) and diabetes (β: 0.046; 95% CrI: 0.020-0.069); whereas altitude in kilometres was negatively associated with the prevalence of diabetes (β: -0.374; 95% CrI: -0.711 to -0.044).

CONCLUSIONS

Spatial clustering of hypertension and diabetes was observed at subnational and local levels in Ethiopia, which was significantly associated with population density and altitude. The variation at the subnational level illustrates the need to include environmental drivers in future NCDs burden estimation. Thus, targeted and integrated interventions in high-risk areas might reduce the burden of hypertension and diabetes in Ethiopia.

Cancer Incidence in Merida, Mexico 2015-2018: First Report from the Population-based Cancer Registry

BACKGROUND

Cancer registries are essential for monitoring cancer burden and patterns, and document changes in time for cancer control. Hereby, we present the first results of four years of the Merida population-based cancer registry in Mexico.

METHODS

The registry collects data on all new cancers diagnosed since 2015 using both active and passive methods including a total of 104 information sources. Definitions and coding follow international standards. Using CanReg5 software, age-standardized incidence rates (ASR/100,000 person years) were computed by direct method using the world standard population.

RESULTS

A total of 5684 new cancer cases were registered during 2015-2018, 2321 in males and 3363 in females corresponding to age-adjusted incidence rates (ASR per 100,000) of 128.5, and 153.1, respectively. Most frequent cancers among males were prostate cancer (ASR 29.8), lymphomas (ASR 10.9) and colorectal cancer (ASR 9.7) while among females it was breast cancer (ASR 49.3), cervical cancer (ASR 17.5) and corpus uteri (ASR 11.5). Childhood cancers (0-14 year) represented 2.9% of all cancers, with leukemias accounting for 52% of the new cases. Overall, 87.6% of new cases were microscopically verified.

CONCLUSIONS

The data reported provide information on the cancer profile in Merida. Prostate and breast cancer are the main incident cancers. Cervical cancers present high rates among women, while lymphomas and liver cancer data merit further exploration. Efforts to support the Merida cancer registry as well as other registries in Mexico need to be pursued in order to have locally recorded data to support cancer control measures.

Multifunctional roles and pharmacological potential of β-sitosterol: Emerging evidence toward clinical applications

Currently, available therapeutic medications are both costly as well as not entirely promising in terms of potency. So, new candidates from natural resources are of research interest to find new alternative therapeutics. A well-known combination is a β-sitosterol, a plant-derived nutrient with anticancer properties against breast, prostate, colon, lung, stomach, and leukemia. Studies have shown that β-sitosterol interferes with multiple cell signaling pathways, including cell cycle, apoptosis, proliferation, survival, invasion, angiogenesis, metastasis, anti-inflammatory, anticancer, hepatoprotective, antioxidant, cardioprotective, and antidiabetic effects have been discovered during pharmacological screening without significant toxicity. The pharmacokinetic profile of β-sitosterol has also been extensively investigated. However, a comprehensive review of the pharmacology, phytochemistry and analytical methods of β-sitosterol is desired. Because β-sitosterol is a significant component of most plant materials, humans use it for various reasons, and numerous β-sitosterol-containing products have been commercialized. To offset the low efficacy of β-sitosterol, designing β-sitosterol delivery for "cancer cell-specific" therapy holds great potential. Delivery of β-sitosterol via liposomes is a demonstration that has shown great promise. But further research has not progressed on the drug delivery of β-sitosterol or how it can enhance β-sitosterol mediated anti-inflammatory activity, thus making β-sitosterol an orphan nutraceutical. Therefore, extensive research on β-sitosterol as an anticancer nutraceutical is recommended.

Exploring Enablers and Barriers to Utilize Printed Information, Education, and Communication Materials Among Healthcare Providers of North Shoa Zone, Oromia, Ethiopia

Background

Information, education, and communication (IEC) materials have paramount relevance in primary health care which mainly focused on disease prevention and control. They are a cost-effective approach for achieving better health outcomes in all clinical and public health interventions. This study aimed to explore enablers and barriers to utilize printed IEC materials among healthcare providers of North Shoa Zone, Oromia, Ethiopia, 2020.

Methods

A descriptive, qualitative study was conducted from December 1, 2020, to December 30, 2020, among health care providers. A judgmental sampling technique was used and 20 key informants were recruited considering their educational level, professional categories, working units, work experience, and types of health facilities. The data were collected by using a semi-structured interview guide. The transcribed data were uploaded into ATLAS. ti version 7.5.18 software. Then, the inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. Direct quotations were presented with a thick description of the findings.

Results

The findings of the study were discussed under four themes of enablers and four themes of barriers. The four themes of enablers were availability of printed IEC materials, distribution of printed IEC material, perceived usefulness of printed IEC materials, and support from the non-government organization. The four themes of barriers were printed IEC materials-related factors, patients related factors, health care provider’s related factors, and government-related factors.

Conclusion

In this study, we found that the utilization of IEC materials was influenced by a number of facilitators and barriers. Thus, all concerned bodies need to give due attention to IEC materials and work towards the improvement of the quality of IEC materials, provide training for health care providers, work to increase the availability of IEC materials, and distribute them to the health facilities.

Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial

Background

Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries.

Objective

We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda.

Methods

The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression.

Results

Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%).

Conclusions

Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries.

Trial Registration

ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146

Non-Communicable Disease Risk Factors Among Caregivers of Patients Attending a Tertiary Cardiovascular Hospital in Tanzania

Background

Notwithstanding the ever-present burden of infectious diseases, the sub-Saharan Africa (SSA) region has experienced a 67% rise in the non-communicable disease (NCD) burden in less than three decades. Furthermore, regardless of the increased recognition of NCDs threat in the region, reliable local estimates and associated drivers are generally lacking. We therefore conducted this cross-sectional study to establish the pattern and correlates of the modifiable NCD risk factors among caregivers of patients attending a tertiary cardiovascular centre in Tanzania.

Methods

A cross-sectional survey was conducted at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania. We used a structured questionnaire bearing a modified WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) tool to explore the modifiable behavioral and modifiable biological NCD risk factors.

Results

A total of 1063 caregivers were enrolled in this study. The mean age was 40.5 years, and 55.7% were female. Nearly 80% of participants had a good knowledge regarding NCDs and 85.4% had a positive family history of NCDs. Overall, 1027 (96.6%) participants had at least one modifiable NCD risk factor while 510 (48.0%) had three or more (i.e., clustering). With respect to modifiable behavioral NCD risk factors, 34 (3.2%) were tobacco users, 56 (5.3%) had harmful alcohol consumption, 691 (65%) had unhealthy eating behavior, and 820 (77.1%) were physically inactive. Pertaining to modifiable biological NCD risk factors, 710 (66.8%) had excess body weight, 420 (39.5%) had hypertension and 62 (5.8%) were diabetic.

Conclusion

A vast majority of caregivers of NCD patients in this tertiary setting were found to have modifiable NCD risk factors with a strong tendency of clustering. These findings call for intensification of both population strategies and targeted group interventions for better control of the NCD threat and its correlates.

Cardiovascular Disease Risk Factors in Hypertensive Patients: A Case Study of Jimma University Medical Center

Background

Cardiovascular diseases are a group of disorders of the heart and blood vessels. Globally an estimated 17.9 million people died from cardiovascular diseases, which covers 31% of all global deaths, and the three quarters taking place in developing countries. Hypertension is the major cause of cardiovascular diseases. Its influence is high with other risk factors. This study aimed to determine the major risk factors of cardiovascular disease among hypertensive patients at Jimma University Medical Center.

Methods

Using December to January 2017 hypertension-related report of Jimma University Medical Center (JUMC), a retrospective cohort study type was conducted on purposively selected 343 patients. Three nurses from JUMC participated in the data collection, and the data were fitted using the Cox-Proportional Hazard (Cox-PH) model.

Results

About 138 (40.23%) patients were experienced cardiovascular disease at 28 months median time. From the Cox-PH model, the hazard ratio and 95% CI of age (HR = 1.0495, 95% CI: 1.0250-1.0747), urban (HR = 2.1225, 95% CI: 1.3813-3.2613), diabetes mellitus (HR = 1.702, 95% CI: 1.0082-2.8731), proteinuria (HR = 1.8749, 95% CI: 1.2675-2.7734), two drug users (HR = 0.2533, 95% CI: 0.1376-0.4662), systolic blood pressure (HR = 1.0343, 95% CI: 1.0147-1.0542) and pulse rate (HR = 1.0111, 95% CI: 0.9933-1.0293).

Conclusion

The presence of proteinuria, diabetes mellitus, and being an urban resident had a great impact on the cardiovascular diseases of hypertensive patients.

Health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia: an interpretive description

BACKGROUND

Healthcare providers play a key role in supporting people with chronic low back pain to self-manage their condition. The study aimed at exploring how health care providers understand and conceptualize self-management and how they provide self-management support for people with chronic low back pain in Ethiopia.

METHODS

Health care providers who have supported people with low back pain, including medical doctors and physiotherapists, were approached and recruited from three hospitals in Ethiopia. This study employed an interpretive descriptive approach using semi-structured interviews.

FINDINGS

Twenty-four participants (7 women; 17 men) with a median age of 28 (range 24 to 42) years and a median of 9.5 years (range 1 to 11 years) of helping people with chronic low back pain were interviewed. Seven major themes related to health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia emerged. The findings show that self-management was a new concept to many and health care providers' had a fragmented understanding of self-management. They used or suggested several self-management support strategies to help people with CLBP self-manage their condition without necessarily focusing on enhancing their self-efficacy skills. The participants also discussed several challenges to facilitate self-management support for people with chronic low back pain. Despite the lack of training on the concept, the providers discussed the potential of providing self-management support for people with the condition.

CONCLUSIONS

Self-management was a new concept to health care providers. The providers lack the competencies to provide self-management support for people with chronic low back pain. There is a need to enhance the health care providers' self-management support competencies through training.

The shifting rural-urban gap in mortality over the life course in low- and middle-income countries

Studies have shown that children in rural areas face excess risks of dying, but the little research on spatial inequalities in adult mortality has reached mixed conclusions. We examine rural-urban differences in mortality in 53 low- and middle-income countries. We consider how the rural-urban mortality gap evolves from birth to age 60 by estimating mortality based on birth and sibling histories from 138 Demographic and Health Surveys run between 1992 and 2018. We observe excess rural mortality until age 15, finding the largest differences between urban and rural sectors among 1-59-month-olds. While we cannot claim higher mortality among urban adults than those in rural areas, we find a reduced gap between the sectors over the life course and a diminishing urban advantage in adult mortality with age. This shift over the life course reflects a divergence in the epidemiologic transition between the rural and urban sectors.

Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal

Introduction

Non-Communicable Diseases (NCDs) have become the leading public health problems worldwide and the cardiovascular diseases (CVDs) is one of the major NCDs. Female Community Health Volunteers (FCHVs) in Nepal are the key drivers to implementing frontline health services. We explored the potential for engaging FCHVs for CVD risk screening at the community level in Nepal.

Methods

We used multiple approaches (quantitative and qualitative) for data collection. The trained FCHVs administered CVD risk screening questionnaire among 491 adults in rural and urban areas and calculated the CVD risk scores. To maintain consistency and quality, a registered medical doctor also, using the same risk scoring chart, independently calculated the CVD risk scores. Kappa statistics and concordance coefficient were used to compare these two sets of risk screening results. Sensitivity and specificity analyses were conducted. Two focus group discussions among the FCHVs were conducted to determine their experiences with CVD risk screening and willingness to engage with CVD prevention and control efforts.

Results

The mean level of agreement between two sets of risk screening results was 94.5% (Kappa = 0.77, P<0.05). Sensitivity of FCHV screening was 90.3% (95% CI: 0.801–0.964); and the specificity was 97% (95% CI: 0.948, 0.984). FCHVs who participated in the FGDs expressed a strong enthusiasm and readiness to using the CVD risk screening tools. Despite their busy workload, all FCHVs showed high level of motivation and willingness in using CVD risk screening tools and contribute to the prevention and control efforts of NCDs. The FCHVs recommended needs for providing additional training and capacity building opportunities.

Conclusion

We conclude that there is a potential for engaging FCHVs to use simple CVD risk screening tools at the community level. The findings are promising, however, further studies engaging larger number of FCHVs and larger population would warrant feasibility of such tools within the existing healthcare systems in Nepal.

Building Research Capacity in HIV and Noncommunicable Diseases in Africa: A Mentorship and Leadership Workshop Report

INTRODUCTION

Few structured mentoring programs target early-stage investigators in Africa, creating a gap in mentorship skills where HIV burden is greatest. We describe findings from a Nigeria-based workshop for early-career physician scientists to build mentoring and leadership capacity in HIV and noncommunicable disease research.

METHODS

Baseline surveys captured participant demographics, confidence in implementing mentoring competencies, and perceived importance of workshop training domains. The workshop included didactic presentations, small group activities, and interactive discussions. Daily surveys evaluated sessions, and postworkshop surveys solicited overall course impressions.

RESULTS

Of the 33 participants, most were male (n = 21, 63.6%) and from medicine, laboratory sciences, and surgical specialties. "Building mentees' confidence" and "setting mentees' research goals" were ranked as areas where participants most believed they needed training. Sessions were rated favorably across five areas. Greatest improvements in mean scores were for confidence in identifying personal temperament styles, describing mentoring and leadership theories/frameworks, and developing mentoring plans. Additional identified workshop strengths were content relevance, leadership case series, interactive nature, and collegial atmosphere. All respondents indicated learning something new/useful/helpful in each session. At 6-month postworkshop, most respondents (25 of 26, 96%) had replicated or plan to replicate parts of the workshop in their departments/institutions.

DISCUSSION

Effective mentoring training initiatives targeting future academic leaders have the potential to create skilled academicians who can impart mentoring skills and competencies to their mentees.

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

BACKGROUND

Low- and middle-income countries (LMICs) are facing a combined affliction from both tuberculosis (TB) and noncommunicable diseases (NCDs), which threatens population health and further strains the already stressed health systems. Integrating services for TB and NCDs is advantageous in tackling this joint burden of diseases effectively. Therefore, this systematic review explores the mechanisms for service integration for TB and NCDs and elucidates the facilitators and barriers for implementing integrated service models in LMIC settings.

METHODS AND FINDINGS

A systematic search was conducted in the Cochrane Library, MEDLINE, Embase, PubMed, Bibliography of Asian Studies, and the Global Index Medicus from database inception to November 4, 2021. For our search strategy, the terms "tuberculosis" AND "NCDs" (and their synonyms) AND ("delivery of healthcare, integrated" OR a range of other terms representing integration) were used. Articles were included if they were descriptions or evaluations of a management or organisational change strategy made within LMICs, which aim to increase integration between TB and NCD management at the service delivery level. We performed a comparative analysis of key themes from these studies and organised the themes based on integration of service delivery options for TB and NCD services. Subsequently, these themes were used to reconfigure and update an existing framework for integration of TB and HIV services by Legido-Quigley and colleagues, which categorises the levels of integration according to types of services and location where services were offered. Additionally, we developed themes on the facilitators and barriers facing integrated service delivery models and mapped them to the World Health Organization's (WHO) health systems framework, which comprises the building blocks of service delivery, human resources, medical products, sustainable financing and social protection, information, and leadership and governance. A total of 22 articles published between 2011 and 2021 were used, out of which 13 were cross-sectional studies, 3 cohort studies, 1 case-control study, 1 prospective interventional study, and 4 were mixed methods studies. The studies were conducted in 15 LMICs in Asia, Africa, and the Americas. Our synthesised framework explicates the different levels of service integration of TB and NCD services. We categorised them into 3 levels with entry into the health system based on either TB or NCDs, with level 1 integration offering only testing services for either TB or NCDs, level 2 integration offering testing and referral services to linked care, and level 3 integration providing testing and treatment services at one location. Some facilitators of integrated service include improved accessibility to integrated services, motivated and engaged providers, and low to no cost for additional services for patients. A few barriers identified were poor public awareness of the diseases leading to poor uptake of services, lack of programmatic budget and resources, and additional stress on providers due to increased workload. The limitations include the dearth of data that explores the experiences of patients and providers and evaluates programme effectiveness.

CONCLUSIONS

Integration of TB and NCD services encourages the improvement of health service delivery across disease conditions and levels of care to address the combined burden of diseases in LMICs. This review not only offers recommendations for policy implementation and improvements for similar integrated programmes but also highlights the need for more high-quality TB-NCD research.

Comparing cancer and cardiovascular disease trends in 20 middle- or high-income countries 2000-19: A pointer to national trajectories towards achieving Sustainable Development goal target 3.4

With the 2030 Sustainable Development Goals (SDG) target of a one-third reduction in noncommunicable diseases (NCDs) less than a decade away, it is timely to assess national progress in reducing premature deaths from the two leading causes of mortality worldwide. We examine trends in the probability of dying ages 30-70 from cardiovascular disease (CVD) and cancer 2000-19 in 10 middle-income (MICs) and 10 high-income (HICs) countries with high quality data. We then predict whether the SDG target will be met in each country for CVD, cancer and for the four main NCDs combined. Downward trends were more evident in HICs relative to the MICs, and for CVD relative to cancer. CVD and cancer declines ranged from 30-60% and 20-30% in HICs over the 20-year period, but progress was less uniform among the MICs. Premature deaths from cancer exceeded CVD in nine of the 10 HICs by 2000 and in all 10 by 2019; in contrast, CVD mortality exceeded cancer in all 10 MICs in 2000 and remained the leading cause in eight countries by 2019. Two of the 10 MICs (Colombia and Kazakhstan) and seven of the HICs (Australia, Chile, Italy, New Zealand, Norway, Slovakia, and the U.K.) are predicted to meet the SDG NCDs target. Whether countries are on course to meet the target by 2030 reflects changing risk factor profiles and the extent to which effective preventative and medical care interventions have been implemented. In addition, lessons can be learned given people living with NCDs are more susceptible to severe COVID-19 illness and death.

Environmental risk factors and cardiovascular diseases: a comprehensive review

Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.

The Legislative Approach and System Improvement of China's Compulsory Licensing for Drug Patents

Compulsory licensing for drug patents is of great significance to ensure the accessibility of drugs. Although the development of China’s compulsory licensing system for drug patents has been gradually improved, there are still problems. For example, the scope of the object is not realistic, the setting of the initiating subject is unreasonable, the reasons for issuance are not clear, the duration and scope of the license are not refined, and the provisions on the exploitation fee are missing. Consequently, in order to improve China’s compulsory licensing system for drug patents, it is necessary to expand reasonably the scope of the object, remove the restrictions on the initiating subject, adjust the initiating rights of different subjects, determine the duration and scope of the license and the applicability of the hearing on a case-by-case basis, and determine a reasonable exploitation fee by taking into account the national income, patent cost, market share and other factors, in consideration of the flexibly international norms and the actual situation in China.

Prevalence, awareness, and control of hypertension among Bangladeshi adults: an analysis of demographic and health survey 2017-18

Background

The prevalence of hypertension is increasing in Bangladesh, however, few recent studies investigated the proportion of people and factors associated with prevalence, awareness, and control of this condition in this country. This study investigated these among Bangladeshi adults.

Methods

Using Bangladesh Demographic and Health Survey 2017–18 data, a cross-sectional study was conducted. Multilevel logistic regression analysis was employed after descriptive analysis and prevalence estimation.

Results

Among 12,926 persons (mean age: 40 years, 57% women), the prevalence of hypertension was 27.4% (n = 3551), it was 28.4 and 26.2% among females and males, respectively. Among hypertensive people, about 42.4% (n = 1508) people were aware of having it, 48.7% among females and 33.5% among males. Of the 1313 people who were taking antihypertensive medication, only 33.8% (n = 443) had controlled hypertension, 34.7 and 31.7% among females and males, respectively.

Among the studied factors associated with hypertension, people with older age, female gender, overweight/obesity, diabetes, richer wealth quintiles, and residence in some administrative divisions had higher odds of hypertension (p < 0.05). However, the odds of awareness was lower among younger people, males, and people without overweight/obesity, diabetes, or richer wealth quintiles. Odds of controlled hypertension was also lower among people with older age and higher among college-educated people.

Conclusion

This study identified several important factors associated with prevalence, awareness, and control of hypertension. It is important to address these factors with nationwide prevention and control programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40885-021-00174-2.

Building optimal and sustainable kidney care in low resource settings: The role of healthcare systems

Healthcare systems in low-income and lower-middle income countries (LLMICs) face significant challenges in the provision of health services, for example, kidney care to the population. Although this is linked to several high-level factors such as poor infrastructure, socio-demographic and political factors, healthcare funding has often been cited as the major reason for the wide gap in availability, accessibility and quality of care between LLMICs and rich countries. With the steady rising incidence and prevalence of kidney diseases globally, as well as cost of care, LLMICs are likely to suffer more consequences of these increases than rich countries and may be unable to meet targets of universal health coverage (UHC) for kidney diseases. As health systems in LLMICs continue to adapt in finding ways to provide access to affordable kidney care, various empirical and evidence-based strategies can be applied to assist them. This review uses a framework for healthcare strengthening developed by the World Health Organization (WHO) to assess various challenges that health systems in LLMICs confront in providing optimal kidney care to their population. We also suggest ways to overcome these barriers and strengthen health systems to improve kidney care in LLMICs.

Incidence of chronic obstructive pulmonary disease in people with HIV, their parents and siblings in Denmark

BACKGROUND

People with HIV (PWH) may be at increased risk of several respiratory syndromes including chronic obstructive pulmonary disease (COPD). In matched cohort studies, we examined risk factors for COPD in PWH, their parents and siblings compared with population controls.

METHODS

Using data from national registries, competing risk regression models were constructed and used to calculate adjusted hazard ratios (aHR) for COPD. We evaluated the effect of HIV characteristics, smoking and educational attainment on COPD incidence in PWH.

RESULTS

A total of 226 PWH and 1029 population controls were diagnosed with COPD during 63,661 and 562,171 person years of follow up. PWH had increased risk of being diagnosed with COPD compared to controls (aHR 2.02 [95%CI: 1.75-2.33]). Parents and siblings of PWH were also more likely to be diagnosed with COPD compared to controls. CD4+ T-cell counts were not associated with COPD, but both unsuppressed viral replication, smoking status and educational attainment were associated with COPD in PWH. No COPD diagnoses were registered in PWH with high educational attainment and absence of smoking.

CONCLUSIONS

PWH have an increased risk of being diagnosed with COPD, as have their parents and siblings. This seems to be driven primarily by smoking and low socioeconomic status.

A cost study for mobile phone health surveys using interactive voice response for assessing risk factors of noncommunicable diseases

Background

This is the first study to examine the costs of conducting a mobile phone survey (MPS) through interactive voice response (IVR) to collect information on risk factors for noncommunicable diseases (NCD) in three low- and middle-income countries (LMIC); Bangladesh, Colombia, and Uganda.

Methods

This is a micro-costing study conducted from the perspective of the payer/funder with a 1-year horizon. The study evaluates the fixed costs and variable costs of implementing one nationally representative MPS for NCD risk factors of the adult population. In this costing study, we estimated the sample size of calls required to achieve a population-representative survey and associated incentives. Cost inputs were obtained from direct economic costs incurred by a central study team, from country-specific collaborators, and from platform developers who participated in the deployment of these MPS during 2017. Costs were reported in US dollars (USD). A sensitivity analysis was conducted assessing different scenarios of pricing and incentive strategies. Also, costs were calculated for a survey deployed targeting only adults younger than 45 years.

Results

We estimated the fixed costs ranging between $47,000 USD and $74,000 USD. Variable costs were found to be between $32,000 USD and $129,000 USD per nationally representative survey. The main cost driver was the number of calls required to meet the sample size, and its variability largely depends on the extent of mobile phone coverage and access in the country. Therefore, a larger number of calls were estimated to survey specific harder-to-reach sub-populations.

Conclusion

Mobile phone surveys have the potential to be a relatively less expensive and timely method of collecting survey information than face-to-face surveys, allowing decision-makers to deploy survey-based monitoring or evaluation programs more frequently than it would be possible having only face-to-face contact. The main driver of variable costs is survey time, and most of the variability across countries is attributable to the sampling differences associated to reaching out to population subgroups with low mobile phone ownership or access.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12963-021-00258-z.

Introducing Plant-Based Mediterranean Diet as a Lifestyle Medicine Approach in Latin America: Opportunities Within the Chilean Context

Latin America is experiencing a significant epidemiological and nutritional transition, with a trend toward higher incidence of food-related chronic diseases. In this context, Lifestyle Medicine (LM) is a growing field focused on assisting individuals in adopting healthy behaviors for the prevention and treatment of these chronic diseases, including, among other pillars, a great emphasis on healthy eating. There is also a growing interest worldwide in environmental sustainability of dietary patterns, with increasing concern about their effects on planetary health. In this context, whole-food, plant-based diets -such as the Mediterranean diet (MD)- have emerged as a solution for both healthier eating and lowering environmental impact. Yet in order to be effective at these goals and achieve a high adherence to any nutritional prescription, the sociocultural reality of the community or population where we aim to practice must also be taken into account. In this review, we specifically highlight the plant-based MD as a LM-contextualized dietary pattern that is adaptable, applicable, and sustainable within the Chilean context and has the potential to address the current trend of chronic diseases in our country.