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Bendera A, Nakamura K, Seino K, Alemi S. Performance of the non-laboratory based 2019 WHO cardiovascular disease risk prediction chart in Eastern Sub-Saharan Africa. Nutr Metab Cardiovasc Dis 2024; 34:1448-1455. [PMID: 38499452 DOI: 10.1016/j.numecd.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND AND AIMS The World Health Organization (WHO) updated its cardiovascular disease (CVD) risk prediction charts in 2019 to cover 21 global regions. We aimed to assess the performance of an updated non-lab-based risk chart for people with normoglycaemia, impaired fasting glucose (IFG), and diabetes in Eastern Sub-Saharan Africa. METHODS AND RESULTS We used data from six WHO STEPS surveys conducted in Eastern Sub-Saharan Africa between 2012 and 2017. We included 9857 participants aged 40-69 years with no CVD history. The agreement between lab- and non-lab-based charts was assessed using Bland-Altman plots and Cohen's kappa. The median age of the participants was 50 years (25-75th percentile: 44-57). The pooled median 10-year CVD risk was 3 % (25-75th percentile: 2-5) using either chart. According to the estimation, 7.5 % and 8.4 % of the participants showed an estimated CVD risk ≥10 % using the non-lab-based chart or the lab-based chart, respectively. The concordance between the two charts was 91.3 %. The non-lab-based chart underestimated the CVD risk in 57.6 % of people with diabetes. In the Bland-Altman plots, the limits of agreement between the two charts were widest among people with diabetes (-0.57-7.54) compared to IFG (-1.75-1.22) and normoglycaemia (-1.74-1.06). Kappa values of 0.79 (substantial agreement), 0.78 (substantial agreement), and 0.43 (moderate agreement) were obtained among people with normoglycaemia, IFG, and diabetes, respectively. CONCLUSIONS Given limited healthcare resources, the updated non-lab-based chart is suitable for CVD risk estimation in the general population without diabetes. Lab-based risk estimation is suitable for individuals with diabetes to avoid risk underestimation.
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Affiliation(s)
- Anderson Bendera
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Sharifullah Alemi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
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Mekonene M, Gebremedhin S, Bikila D, Ashebir G, Baye K. Association of fruit and vegetable intake with predicted 10-year cardiovascular disease risk among hypertensive patients in Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e075893. [PMID: 37640463 PMCID: PMC10462971 DOI: 10.1136/bmjopen-2023-075893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE In low-income countries, such as Ethiopia, few studies have evaluated the risk of cardiovascular disease (CVD) among hypertensive patients. We assessed the 10-year CVD risk of hypertensive patients. DESIGN This cross-sectional study was part of a larger survey conducted in Addis Ababa. The 10-year CVD risk was calculated using the Framingham Risk Score (FRS) algorithm based on seven sex-specific risk factors as well as a country-specific Globorisk score. Fruits and vegetables (FV) consumption, salt intake and stress levels were measured with 24-hour dietary recall, INTERSALT equation and Cohen's Perceived Stress Scale, respectively. A multiple linear regression model was fitted to explore the association. SETTING Addis Ababa, Ethiopia, 2021. PARTICIPANTS A sample of 191 patients diagnosed with hypertension. OUTCOME MEASURES Predicted 10-year cardiovascular risk of hypertensive patients. RESULTS A total of 42.4%, 27.7% and 29.8% of hypertensive patients were at low, moderate and high CVD risks, respectively. The majority (80.1%) of patients consumed inadequate FV, 95.7% consumed salt >5 g/day and 58.1% had moderate to high-stress levels. There was a substantial agreement between the FRS and Globorisk prediction models (weighted kappa 0.77). In the unadjusted model, FV consumption (>450 g/day) and total fruit intake in the highest tertile were associated with 14.2% and 6.7% lower CVD risk, respectively. After adjusting for lifestyle factors, increasing FV intake from 120 to 450 g/day was significantly related to 11.1%-15.2% lower CVD risk in a dose-response manner. Additionally, total fruit, but not total vegetable intake in the highest tertile, was significantly associated with decreased CVD risk. CONCLUSION We found a high prevalence of CVD risk among hypertensive patients. High FV consumption was inversely associated with CVD risk. This suggests that patients should be advised to increase FV intake to minimise CVD risk.
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Affiliation(s)
- Mulugeta Mekonene
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Sport Science Academy, Wollo University, Dessie, Ethiopia
| | - Samson Gebremedhin
- School of Public Health, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Demiraw Bikila
- National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Genet Ashebir
- National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
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Brindley C, Van Ourti T, Capuno J, Kraft A, Kudymowa J, O'Donnell O. Risk factor contributions to socioeconomic inequality in cardiovascular risk in the Philippines: a cross-sectional study of nationally representative survey data. BMC Public Health 2023; 23:689. [PMID: 37046247 PMCID: PMC10092926 DOI: 10.1186/s12889-023-15517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Primary prevention of cardiovascular diseases (CVD) increasingly relies on monitoring global CVD risk scores. Lack of evidence on socioeconomic inequality in these scores and the contributions that specific risk factors make to this inequality impedes effective targeting of CVD prevention. We aimed to address this evidence gap by measuring and decomposing socioeconomic inequality in CVD risk in the Philippines. METHODS We used data on 8462 individuals aged 40-74 years from the Philippines National Nutrition Survey and the laboratory-based Globorisk equation to predict 10-year risk of a CVD event from sex, age, systolic blood pressure, total cholesterol, high blood glucose, and smoking. We used a household wealth index to proxy socioeconomic status and measured socioeconomic inequality with a concentration index that we decomposed into contributions of the risk factors used to predict CVD risk. We measured socioeconomic inequalities in these risk factors and decomposed them into contributions of more distal risk factors: body mass index, fat share of energy intake, low physical activity, and drinking alcohol. We stratified by sex. RESULTS Wealthier individuals, particularly males, had greater exposure to all risk factors, with the exception of smoking, and had higher CVD risks. Total cholesterol and high blood glucose accounted for 58% and 34%, respectively, of the socioeconomic inequality in CVD risk among males. For females, the respective estimates were 63% and 69%. Systolic blood pressure accounted for 26% of the higher CVD risk of wealthier males but did not contribute to inequality among females. If smoking prevalence had not been higher among poorer individuals, then the inequality in CVD risk would have been 35% higher for males and 75% higher for females. Among distal risk factors, body mass index and fat intake contributed most to inequalities in total cholesterol, high blood sugar, and, for males, systolic blood pressure. CONCLUSIONS Wealthier Filipinos have higher predicted CVD risks and greater exposure to all risk factors, except smoking. There is need for a nuanced approach to CVD prevention that targets anti-smoking programmes on the poorer population while targeting diet and exercise interventions on the wealthier.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands.
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Tom Van Ourti
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
| | - Joseph Capuno
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Aleli Kraft
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Jenny Kudymowa
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Rethink Priorities, Frankfurt, Germany
| | - Owen O'Donnell
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
- Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
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Osei-Yeboah J, Moll van Charante EP, Kengne AP, Owusu-Dabo E, van den Born BJH, Galenkamp-van der Ploeg H, Chilunga FP, Boateng D, Motazedi E, Agyemang C. Cardiovascular Risk Estimation Based on Country-of-Birth- and Country-of-Residence-Specific Scores among Migrants in the Netherlands: The HELIUS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5148. [PMID: 36982057 PMCID: PMC10048928 DOI: 10.3390/ijerph20065148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Regional and country-specific cardiovascular risk algorithms have been developed to improve CVD risk prediction. But it is unclear whether migrants' country-of-residence or country-of-birth algorithms agree in stratifying the CVD risk of these populations. We evaluated the risk stratification by the different algorithms, by comparing migrant country-of-residence-specific scores to migrant country-of-birth-specific scores for ethnic minority populations in the Netherlands. METHOD data from the HELIUS study was used in estimating the CVD risk scores for participants using five laboratory-based (Framingham, Globorisk, Pool Cohort Equation II, SCORE II, and WHO II) and three nonlaboratory-based (Framingham, Globorisk, and WHO II) risk scores with the risk chart for the Netherlands. For the Globorisk, WHO II, and SCORE II risk scores, we also computed the risk scores using risk charts specified for the migrant home country. Risk categorization was first done according to the specification of the risk algorithm and then simplified to low (green), moderate (yellow and orange), and high risk (red). RESULTS we observed differences in risk categorization for different risk algorithms ranging from 0% (Globorisk) to 13% (Framingham) for the high-risk category, as well as differences in the country-of-residence- and country-of-birth-specific scores. Agreement between different scores ranged from none to moderate. We observed a moderate agreement between the Netherlands-specific SCORE II and the country-of-birth SCORE II for the Turkish and a nonagreement for the Dutch Moroccan population. CONCLUSION disparities exist in the use of the country-of-residence-specific, as compared to the country-of-birth, risk algorithms among ethnic minorities living in the Netherlands. Hence, there is a need for further validation of country-of-residence- and country-of-birth-adjusted scores to ascertain appropriateness and reliability.
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Affiliation(s)
- James Osei-Yeboah
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, PMB KNUST, Kumasi GPS AK-448-4944, Ghana
| | - Eric P. Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
| | - Andre-Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Ellis Owusu-Dabo
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, PMB KNUST, Kumasi GPS AK-448-4944, Ghana
| | - Bert-Jan H. van den Born
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Henrike Galenkamp-van der Ploeg
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
| | - Felix P. Chilunga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
| | - Daniel Boateng
- Department of Epidemiology & Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, PMB KNUST, Kumasi GPS AK-448-4944, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, 3584 CX Utrecht, The Netherlands
| | - Ehsan Motazedi
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
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Odland ML, Gassama K, Bockarie T, Wurie H, Ansumana R, Witham MD, Oyebode O, Hirschhorn LR, Davies JI. Cardiovascular disease risk profile and management among people 40 years of age and above in Bo, Sierra Leone: A cross-sectional study. PLoS One 2022; 17:e0274242. [PMID: 36084117 PMCID: PMC9462708 DOI: 10.1371/journal.pone.0274242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Access to care for cardiovascular disease risk factors (CVDRFs) in low- and middle-income countries is limited. We aimed to describe the need and access to care for people with CVDRF and the preparedness of the health system to treat these in Bo, Sierra Leone.
Methods
Data from a 2018 household survey conducted in Bo, Sierra Leone, was analysed. Demographic, anthropometric and clinical data on CVDRF (hypertension, diabetes mellitus or dyslipidaemia) from randomly sampled individuals 40 years of age and above were collected. Future risk of CVD was calculated using the World Health Organisation–International Society of Hypertension (WHO-ISH) calculator with high risk defined as >20% risk over 10 years. Requirement for treatment was based on WHO package of essential non-communicable (PEN) disease guidelines (which use a risk-based approach) or requiring treatment for individual CVDRF; whether participants were on treatment was used to determine whether care needs were met. Multivariable regression was used to test associations between individual characteristics and outcomes. Data from the most recent WHO Service Availability and Readiness Assessment (SARA) were used to create a score reflecting health system preparedness to treat CVDRF, and compared to that for HIV.
Results
2071 individual participants were included. Most participants (n = 1715 [94.0%]) had low CVD risk; 423 (20.6%) and 431 (52.3%) required treatment based upon WHO PEN guidelines or individual CVDRF, respectively. Sixty-eight (15.8%) had met-need for treatment determined by WHO guidelines, whilst 84 (19.3%) for individual CVDRF. Living in urban areas, having education, being older, single/widowed/divorced, or wealthy were independently associated with met need. Overall facility readiness scores for CVD/CVDRF care for all facilities in Bo district was 16.8%, compared to 41% for HIV.
Conclusion
The number of people who require treatment for CVDRF in Sierra Leone is substantially lower based on WHO guidelines compared to CVDRF. CVDRF care needs are not met equitably, and facility readiness to provide care is low.
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Affiliation(s)
- Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Department of Obstetrics and Gynecology, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Khadija Gassama
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Tahir Bockarie
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Rashid Ansumana
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Clinicians' Perceptions towards Precision Medicine Tools for Cardiovascular Disease Risk Stratification in South Africa. J Pers Med 2022; 12:jpm12091360. [PMID: 36143145 PMCID: PMC9505828 DOI: 10.3390/jpm12091360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of mortality and morbidity in South Africa. Risk stratification is the preferred approach to disease prevention, but identifying patients at high risk for CVD remains challenging. Assessing genetic risk could improve stratification and inform a clinically relevant precision medicine (PM) approach. Clinicians are critical to PM adoption, thus, this study explores practicing clinicians’ perceptions of PM-based CVD risk stratification in South Africa’s public health setting. Practicing clinicians (n = 109) at four teaching hospitals in Johannesburg, South Africa, completed an electronic self-administered survey. The effect of demographic and professional characteristics on PM-based CVD risk stratification perceptions was assessed. Fewer than 25% of respondents used clinical genetic testing, and 14% had formal genetics training. 78% had a low mean knowledge score, with higher scores associated with genetic training (p < 0.0005) and research involvement (p < 0.05). Despite limited knowledge and resources, 84% perceived PM approaches positively. 57% felt confident in applying the PM-based approach, with those already undertaking CVD risk stratification more confident (p < 0.001). High cost and limited access to genetics services are key barriers. Integrating genetic information into established clinical tools will likely increase confidence in using PM approaches. Addressing the genetics training gap and investment into the country’s genomics capacity is needed to advance PM in South Africa.
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Goldberg EM, Bountogo M, Harling G, Baernighausen T, Davies JI, Hirschhorn LR. Older persons experiences of healthcare in rural Burkina Faso: Results of a cross sectional household survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000193. [PMID: 36962344 PMCID: PMC10021992 DOI: 10.1371/journal.pgph.0000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022]
Abstract
Ensuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality. We performed a cross-sectional household survey including socio-demographic; morbidities; and patient-reported health system utilization, responsiveness, and quality outcomes in individuals 40 and older in northwestern Burkina Faso. We describe results and use exploratory factor analysis to derive a contextually appropriate grouping of health system responsiveness (HSR) variables. We used linear or logistic regression to explore associations between socio-demographics, morbidities, and the grouped-variable, then between these variables and health system quality outcomes. Of 2,639 eligible respondents, 26.8% had least one NCD, 56.3% were frail or pre-frail and 23.9% had a recent healthcare visit, including only 1/3 of those with an NCD. Highest ratings of care experience (excellent/very good) included ease of following instructions (86.1%) and trust in provider skills (81.1%). The HSR grouping with the greatest factor loading included involvement in decision-making, clarity in communication, trust in the provider, and confidence in providers' skills, labelled Shared Understanding and Decision Making (SUDM). In multivariable analysis, higher quality of life (OR 1.02,95%CI 1.01-1.04), frailty (OR 1.47,95%CI 1.00-2.16), and SUDM (OR 1.06,95%CI 1.05-1.09) were associated with greater health system trust and confidence. SUDM was associated with overall positive assessment of the healthcare system (OR 1.02,95%CI 1.01-1.03) and met healthcare needs (OR 1.09,95%CI 1.08-1.11). Younger age and highest wealth quintile were also associated with higher met needs. Recent healthcare access was low for people with existing NCDs, and SUDM was the most consistent factor associated with higher health system quality outcomes. Results highlight the need to increase continuity of care for aging populations with NCDs and explore strengthening SUDM to achieve this goal.
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Affiliation(s)
- Ellen M. Goldberg
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | | | - Guy Harling
- Institute for Global Health, University College London, London, United Kingdom
| | - Till Baernighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Justine I. Davies
- Institute of Applied Health Research, Birmingham University, Birmingham, United Kingdom
| | - Lisa R. Hirschhorn
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Bockarie T, Odland ML, Wurie H, Ansumana R, Lamin J, Witham M, Oyebode O, Davies J. Prevalence and socio-demographic associations of diet and physical activity risk-factors for cardiovascular disease in Bo, Sierra Leone. BMC Public Health 2021; 21:1530. [PMID: 34376163 PMCID: PMC8353867 DOI: 10.1186/s12889-021-11422-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little is known about modifiable dietary and physical activity risk factors for cardiovascular diseases (CVDs) in Sierra Leone. This information is critical to the development of health improvement interventions to reduce the prevalence of these diseases. This cross-sectional study investigated the prevalence and socio-demographic correlates of dietary and physical activity risk behaviours amongst adults in Bo District, Sierra Leone. METHODS Adults aged 40+ were recruited from 10 urban and 30 rural sub-districts in Bo. We examined risk factors including: ≤150 min of moderate or vigorous-intensity physical activity (MVPA) weekly, physical inactivity for ≥3 h daily, ≤5 daily portions of fruit and vegetables, and salt consumption (during cooking, at the table, and in salty snacks). We used logistic regression to investigate the relationship between these outcomes and participants' socio-demographic characteristics. RESULTS 1978 eligible participants (39.1% urban, 55.6% female) were included in the study. The prevalence of behavioural risk factors was 83.6% for ≤5 daily portions of fruit and vegetables; 41.4 and 91.6% for adding salt at the table or during cooking, respectively and 31.1% for eating salty snacks; 26.1% for MVPA ≤150 min weekly, and 45.6% for being physically inactive ≥3 h daily. Most MVPA was accrued at work (nearly 24 h weekly). Multivariable analysis showed that urban individuals were more likely than rural individuals to consume ≤5 daily portions of fruit and vegetables (Odds Ratio (OR) 1.09, 95% Confidence Interval (1.04-1.15)), add salt at the Table (OR 1.88 (1.82-1.94)), eat salty snacks (OR 2.00 (1.94-2.07)), and do MVPA ≤150 min weekly (OR 1.16 (1.12-1.21)). Male individuals were more likely to add salt at the Table (OR 1.23 (1.20-1.27)) or consume salty snacks (OR 1.35 (1.31-1.40)) than female individuals but were less likely to report the other behavioural risk-factors examined. Generally, people in lower wealth quintiles had lower odds of each risk factor than those in the higher wealth quintiles. CONCLUSION Dietary risk factors for CVD are highly prevalent, particularly among urban residents, of Bo District, Sierra Leone. Our findings highlight that forthcoming policies in Sierra Leone need to consider modifiable risk factors for CVD in the context of urbanisation.
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Affiliation(s)
- Tahir Bockarie
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Maria Lisa Odland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area Sierra Leone
| | - Rashid Ansumana
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Joseph Lamin
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
- Mercy Hospital Research Laboratory, Bo, Sierra Leone
| | - Miles Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Justine Davies
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Department for Global Health, Centre for Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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