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Ekem-Ferguson G, Tetteh J, Malm K, Yawson AO, Biritwum R, Mensah G, Yawson AE. Determinants of semantic and episodic memory decline among older adults in Ghana: Evidence from the WHO study on global AGEing and adult health Ghana wave 2. DIALOGUES IN HEALTH 2023; 2:100118. [PMID: 38515495 PMCID: PMC10953951 DOI: 10.1016/j.dialog.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/14/2023] [Accepted: 02/20/2023] [Indexed: 03/23/2024]
Abstract
Objective Determined factors associated with semantic (SM) and episodic memory (EM) among older adults aged 50 years and older in Ghana. Methods Data from WHO Study on Global AGEing and Adult Health (SAGE) Ghana Wave 2 was used for this study. Semantic memory (SM) and Episodic memory (EM) were the main study outcomes separately. The study employed Nested Ordinary Least Square regression analysis by sequentially adding 6 blocks of variables and comparison tests between the nested models. Results The study involved 3575 adult Ghanaians aged 50 years and older with a mean ± standard deviation of 62.6 ± 18.4 years. The overall mean ± SD of EM and SM were 5.86 ± 2.51 and 11.69 ± 8.59 respectively. Overall, analysis from block 6 showed a significant variation in SM by approximately 16.9%(ΔR2 = 1.17%) where increasing age, never married (β = -1.55; 95% CI = -2.41-0.69), being resident in Greater Accra (regional disparity) (β = -3.45; 95% CI = -4.73-2.20), underweight (β = -0.81;95% CI = -1.34-0.27), and moderate self-rated health (SRH) (β = -0.98; 95% CI = -1.52-0.45) significantly decreased SM. Similarly, increasing age, separated/divorced (β = -0.22; 95% CI = -0.35-0.87), being resident in Greater Accra (β = -0.53; 95% CI = -0.80-0.26), and moderate SRH (β = -0.20; 95% CI = -0.36--0.04) significantly decrease EM with an overall significant variation of approximately 22.9%(ΔR2 = 2.7%). Conclusions Increasing age, sex, marital status, regional disparity, and poor SRH significantly decreased both Semantic memory and Episodic memory. Higher educational attainment and life satisfaction significantly influenced SM and EM. These provide pointers to important socio-demographic determinants of SM and EM with implications for the implementation of the Ghana national ageing policy 2010, 'ageing with security and dignity', and as a key consideration for healthy ageing towards 2030.
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Affiliation(s)
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Keziah Malm
- National Malaria Control Programme, Ghana Health Service, Ghana
| | - Anita Ohenewa Yawson
- Ground Floor Surgical Intensive Care Unit, Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard Biritwum
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - George Mensah
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Otieno P, Asiki G, Wilunda C, Wami W, Agyemang C. Cardiometabolic multimorbidity and associated patterns of healthcare utilization and quality of life: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002215. [PMID: 37585386 PMCID: PMC10431646 DOI: 10.1371/journal.pgph.0002215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023]
Abstract
Understanding the patterns of multimorbidity, defined as the co-occurrence of more than one chronic condition, is important for planning health system capacity and response. This study assessed the association of different cardiometabolic multimorbidity combinations with healthcare utilization and quality of life (QoL). Data were from the World Health Organization (WHO) study on global AGEing and adult health Wave 2 (2015) conducted in Ghana. We analysed the clustering of cardiometabolic diseases including angina, stroke, type 2 diabetes, and hypertension with unrelated conditions such as asthma, chronic lung disease, arthritis, cataract and depression. The clusters of adults with cardiometabolic multimorbidity were identified using latent class analysis and agglomerative hierarchical clustering algorithms. We used negative binomial regression to determine the association of multimorbidity combinations with outpatient visits. The association of multimorbidity clusters with hospitalization and QoL were assessed using multivariable logistic and linear regressions. Data from 3,128 adults aged over 50 years were analysed. We identified four distinct classes of multimorbidity: relatively "healthy class" with no multimorbidity (47.9%): abdominal obesity only (40.7%): cardiometabolic and arthritis class comprising participants with hypertension, type 2 diabetes, stroke, abdominal and general obesity, arthritis and cataract (5.7%); and cardiopulmonary and depression class including participants with angina, chronic lung disease, asthma, and depression (5.7%). Relative to the class with no multimorbidity, the cardiopulmonary and depression class was associated with a higher frequency of outpatient visits [β = 0.3; 95% CI 0.1 to 0.6] and higher odds of hospitalization [aOR = 1.9; 95% CI 1.0 to 3.7]. However, cardiometabolic and arthritis class was associated with a higher frequency of outpatient visits [β = 0.8; 95% CI 0.3 to 1.2] and not hospitalization [aOR = 1.1; 95% CI 0.5 to 2.9]. The mean QoL scores was lowest among participants in the cardiopulmonary and depression class [β = -4.8; 95% CI -7.3 to -2.3] followed by the cardiometabolic and arthritis class [β = -3.9; 95% CI -6.4 to -1.4]. Our findings show that cardiometabolic multimorbidity among older persons in Ghana cluster together in distinct patterns that differ in healthcare utilization. This evidence may be used in healthcare planning to optimize treatment and care.
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Affiliation(s)
- Peter Otieno
- African Population and Health Research Center, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Welcome Wami
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Awuviry-Newton K, Amponsah M, Amoah D, Dintrans PV, Afram AA, Byles J, Mugumbate JR, Kowal P, Asiamah N. Physical activity and functional disability among older adults in Ghana: The moderating role of multi-morbidity. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001014. [PMID: 36963038 PMCID: PMC10021534 DOI: 10.1371/journal.pgph.0001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 02/08/2023] [Indexed: 03/26/2023]
Abstract
Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults' care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries-many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO's Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana.
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Affiliation(s)
- Kofi Awuviry-Newton
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- College of Health and Biomedicine, Victoria University, Victoria, Australia
| | - Mary Amponsah
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- Centre for African Research, Engagement and Partnerships (CARE-P), The University of Newcastle, Newcastle, Australia
| | - Dinah Amoah
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Pablo Villalobos Dintrans
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile
- Millennium Institute for Caregiving Research (MICARE), Chile
| | | | - Julie Byles
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- Centre for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Newcastle, Australia
| | - Jacob Rugare Mugumbate
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Paul Kowal
- International Health Transitions, Canberra, Australia
| | - Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Essex, United Kingdom
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Aheto JMK, Dagne GA. Multilevel modeling, prevalence, and predictors of hypertension in Ghana: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health. Health Sci Rep 2021; 4:e453. [PMID: 34938897 PMCID: PMC8661999 DOI: 10.1002/hsr2.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/22/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Hypertension is a major public health issue, an important risk factor for cardiovascular diseases and stroke, especially in developing countries where the rates remain unacceptably high. In Africa, hypertension is the leading driver of cardiovascular disease and stroke deaths. Identification of critical risk factors of hypertension can help formulate targeted public health programs and policies aimed at reducing the prevalence and its associated morbidity, disability, and mortality. This study attempts to develop multilevel regression, an in-depth statistical model to identify critical risk factors of hypertension. METHODS This study used data on 4667 individuals aged ≥18 years from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 conducted in 2014/2015. Multilevel regression modeling was employed to identify critical risk factors for hypertension based on systolic blood pressure (SBP) (ie, SBP > 140 mmHg). Of the 4667, 27.3% were hypertensive. Final data on 4381 individuals residing in 3790 households were analyzed using multilevel models, and results were presented as adjusted odds ratios (aOR) and their associated 95% confidence intervals (CI). RESULTS Risk factors for hypertension identified were age (aOR) = 5.4, 95% CI: 4.11-7.09), obesity (aOR = 1.51, 95% CI: 1.19-1.91), marital status (aOR = 0.75, 95% CI: 0.64-0.89), perceived health state (moderate; aOR = 1.38, 95% CI: 1.15-1.65 and bad/very bad; aOR = 1.35, 95% CI: 1.0-1.83), and difficulty with self-care (aOR = 1.64, 95% CI: 1.1-2.44). We found unobserved significant differences in the likelihood of hypertension prevalence between different households. CONCLUSION Addressing the problem of obesity, targeting specific interventions to those aged over 50 years, and improvement in the general health of Ghanaians are paramount to reducing the prevalence and its associated morbidity, disability, and mortality. Lifestyle modification in the form of dietary intake, knowledge provision supported with strong public health message, and political will could be beneficial to the management and prevention of hypertension.
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Affiliation(s)
- Justice Moses K. Aheto
- Department of BiostatisticsSchool of Public Health, College of Health Sciences, University of GhanaAccraGhana
- College of Public Health, University of South FloridaTampaFloridaUSA
| | - Getachew A. Dagne
- College of Public Health, University of South FloridaTampaFloridaUSA
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Iacone R, Iaccarino Idelson P, Russo O, Donfrancesco C, Krogh V, Sieri S, Macchia PE, Formisano P, Lo Noce C, Palmieri L, Galeone D, Rendina D, Galletti F, Di Lenarda A, Giampaoli S, Strazzullo P. Iodine Intake from Food and Iodized Salt as Related to Dietary Salt Consumption in the Italian Adult General Population. Nutrients 2021; 13:nu13103486. [PMID: 34684487 PMCID: PMC8537510 DOI: 10.3390/nu13103486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Since the Italian iodoprophylaxis strategy is based on the use of iodized salt, we assessed the relationship between dietary salt consumption and iodine intake in the Italian adult population. We estimated the relative contribution given by the use of iodized salt and by the iodine introduced by foods to the total iodine intake. The study population included 2219 adults aged 25-79 years (1138 men and 1081 women) from all Italian regions, participating to the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008-2012 (OEC/HES), and examined for sodium and iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary sodium and total iodine intake were assessed by the measurement of 24 h urinary excretion, while the EPIC questionnaire was used to evaluate the iodine intake from food. Sodium and iodine intake were significantly and directly associated, upon accounting for age, sex, and BMI (Spearman rho = 0.298; p < 0.001). The iodine intake increased gradually across quintiles of salt consumption in both men and women (p < 0.001). The European Food Safety Authority (EFSA) adequacy level for iodine intake was met by men, but not women, only in the highest quintile of salt consumption. We estimated that approximately 57% of the iodine intake is derived from food and 43% from salt. Iodized salt contributed 24% of the total salt intake, including both discretionary and non-discretionary salt consumption. In conclusion, in this random sample of the Italian general adult population examined in 2008-2012, the total iodine intake secured by iodized salt and the iodine provision by food was insufficient to meet the EFSA adequate iodine intake.
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Affiliation(s)
- Roberto Iacone
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
- Correspondence: (R.I.); (P.I.I.)
| | - Paola Iaccarino Idelson
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
- Correspondence: (R.I.); (P.I.I.)
| | - Ornella Russo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (V.K.); (S.S.)
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (V.K.); (S.S.)
| | - Paolo Emidio Macchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Pietro Formisano
- Department of Translational Medical Science, Federico II University of Naples Medical School, 80131 Naples, Italy;
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Daniela Galeone
- Italian Ministry of Health, Center for Disease Prevention and Control, 00161 Rome, Italy;
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Andrea Di Lenarda
- ANMCO, Italian Association of Hospital Cardiology, 50121 Florence, Italy;
- Cardiovascular Center, University Hospital and Health Services, 34122 Trieste, Italy
| | - Simona Giampaoli
- Former Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
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Charlton KE, Corso B, Ware L, Schutte AE, Wepener L, Minicuci N, Naidoo N, Kowal P. Effect of South Africa's interim mandatory salt reduction programme on urinary sodium excretion and blood pressure. Prev Med Rep 2021; 23:101469. [PMID: 34381665 PMCID: PMC8333157 DOI: 10.1016/j.pmedr.2021.101469] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/26/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
Thirty percent reduction in population salt intake by 2025 is recommended by WHO. South Africa introduced mandatory maximum sodium limits in processed foods in 2016. A countrywide impact evaluation assessed change in salt intake after two years. Salt intake measured using 24hr Na excretion dropped by 1.15 g per day. Ongoing evaluation is necessary as more stringent targets were implemented in 2019.
South Africa implemented legislation in June 2016 mandating maximum sodium (Na) levels in processed foods. A pre-post impact evaluation assessed whether the interim legislative approach reduced salt intake and blood pressure. Baseline Na intake was assessed in a nested cohort of the WHO Study on global AGEing and adult health (WHO-SAGE) Wave 2 (Aug-Dec 2015). 24-hour urine samples were collected in a random subsample (n = 1,299; of which n = 750 were considered valid (volume ≥ 300 mL and creatinine ≥ 4 mmol/day (women) or ≥ 6 mmol/day (men))). Follow-up urine samples were collected in Wave 3 (Jun 2018-Jun 2019), with replacements included for those lost to follow-up (n = 1,189; n = 548 valid). In those aged 18 − 49y, median salt intake was 7.8 (4.7, 12.0) g/day in W2 (n = 274), remaining similar in the W3 sample (7.7 (4.9, 11.3) g salt/day (n = 92); P = 0.569). In older adults (50 + y), median salt intake was 5.8 (4.0, 8.5) g/day (n = 467) in W2, and 6.0 (4.0, 8.6) g/day (n = 455) in W3 (P = 0.721). Controlling for differences in background characteristics, overall salt intake dropped by 1.15 g/day (P = 0.028). 24hr urinary Na concentrations from a countrywide South African sample suggest that salt intakes have dropped during the interim phase of mandatory sodium legislation. Further measurement of population level salt intake following stricter Na targets, enforced from June 2019, is necessary.
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Affiliation(s)
- Karen E. Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Corresponding author.
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Lisa Ware
- DSI-NRF Centre of Excellence in Human Development and SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Aletta E. Schutte
- School of Population Health , University of New South Wales; The George Institute for Global Health, Sydney, NSW 2052, Australia
- Hypertension in Africa Research Team, MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom 2520, South Africa
| | - Leanda Wepener
- Hypertension in Africa Research Team, MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom 2520, South Africa
| | - Nadia Minicuci
- Neuroscience Institute, National Research Council, Padova, Italy
| | | | - Paul Kowal
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
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Aheto JMK, Udofia EA, Kallson E, Mensah G, Nadia M, Nirmala N, Chatterji S, Kowal P, Biritwum R, Yawson AE. Prevalence, socio-demographic and environmental determinants of asthma in 4621 Ghanaian adults: Evidence from Wave 2 of the World Health Organization's study on global AGEing and adult health. PLoS One 2020; 15:e0243642. [PMID: 33296442 PMCID: PMC7725342 DOI: 10.1371/journal.pone.0243642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
Background A previous multi-site study involving lower- and middle-income countries demonstrated that asthma in older adults is associated with long-term exposure to particulate matter, male gender and smoking. However, variations may occur within individual countries, which are relevant to inform health promoting policies as populations live longer. The present study estimates asthma prevalence and examines the sociodemographic characteristics and environmental determinants associated with asthma in older adults in Ghana. Methods This study utilised data from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2. A final sample of 4621 individuals residing in 3970 households was used in analytical modelling. Factors associated with asthma were investigated using single level and multilevel binary logistic regression models. Results Asthma was reported by 102 (2.2%) respondents. Factors associated with asthma in the univariate model were: those aged 60–69 (OR = 5.22, 95% CI: 1.24, 21.95) and 70 or more (OR = 5.56, 95% CI: 1.33, 23.26) years, Ga-Adangbe dialect group (OR = 1.65, 95% CI: 1.01, 2.71), no religion (OR = 3.59, 95% CI: 1.77, 7.28), having moderate (OR = 1.76, 95% CI: 1.13, 2.75) and bad/very bad (OR = 2.75, 95% CI: 1.58, 4.80) health state, and severe/extreme difficulty with self-care (OR = 3.49, 95% CI: 1.23, 9.88) and non-flush toilet facility (OR = 0.62, 95% CI: 0.39, 0.99). Factors independently associated with asthma in the adjusted models were: those aged 60–69 (OR = 4.49, 95% CI: 1.03, 19.55) years, father with primary education or less (OR = 0.40, 95% CI: 0.17, 0.94), no religion (OR = 2.52, 95% CI: 1.18, 5.41), and households with non-flush toilet facility (OR = 0.58, 95% CI: 0.35, 0.96). Significant residual household-level variation in asthma was observed. Over 40% of variance in asthma episodes could be attributable to residual household-level variations. Conclusion Individual as well as household factors were seen to influence the prevalence of asthma in this national survey. Clinical management of these patients in health facilities should consider household factors in addition to individual level factors.
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Affiliation(s)
- Justice Moses K. Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Emilia A. Udofia
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Eugene Kallson
- Deloitte Consulting, West Africa Deloitte & Touche, Accra, Ghana
| | - George Mensah
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Minicuci Nadia
- National Research Council, Institute of Neuroscience, Padova, Italy
| | - Naidoo Nirmala
- World Health Organization HIS/HIS/MCS, Geneva, Switzerland
| | | | - Paul Kowal
- World Health Organization HIS/HIS/MCS, Geneva, Switzerland
- University of Newcastle Research Centre for Gender, Health and Ageing, Newcastle, Australia
| | - Richard Biritwum
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred E. Yawson
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Calys-Tagoe B, Nuertey BD, Tetteh J, Yawson AE. Individual awareness and treatment effectiveness of hypertension among older adults in Ghana: evidence from the World Health Organization study of global ageing and adult health wave 2. Pan Afr Med J 2020; 37:264. [PMID: 33598079 PMCID: PMC7864259 DOI: 10.11604/pamj.2020.37.264.24526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/30/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the aim of this study was to report the prevalence of hypertension, its awareness and treatment effectiveness among older adults (aged 50 years and above) in Ghana. METHODS the Ghana World Health Organization´s (WHO) Study on Global Aging and Adult Health (SAGE) wave 2 dataset was used in this study. The study adopted a cross-sectional study design. Information on self-reported hypertension as well as measured hypertension was analyzed. The level of awareness regarding hypertension and the effectiveness of treatment was determined using descriptive statistics. Factors associated with an individual´s awareness of their hypertensive status were determined using Rao-Scott Chi square test statistic and the predictors of unawareness of hypertension were determined using adjusted logistic regression analysis. A p-value of ≤0.05 was deemed significant. RESULTS information on 3,575 adults in Ghana aged 50 years or older was included in this analysis. The mean age of study participants was 65.1 ± 10.7 years with 59% being female. The prevalence of measured hypertension was 50.7% [95%CI=48.3-53.2]. The overall prevalence of hypertension among older adults in Ghana who were hypertensive but were not aware of it was 35.0% [95%CI=31.6-38.5]. Of the 332 individuals who self-reported being hypertensive, only 74 (22.2%) were on any form of treatment, with only 17 (5.1%) having their blood pressures well controlled. CONCLUSION approximately half of all older adults in Ghana have elevated blood pressures. Most of these are not aware of their elevated blood pressure and for those who are aware, very few are on treatment and even fewer have their blood pressure well controlled. Structured national population level screening and health promotion for elevated blood pressure by Ministry of Health/ Ghana Health Service is worthy of consideration.
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Affiliation(s)
- Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Benjamin D Nuertey
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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9
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Menyanu E, Corso B, Minicuci N, Rocco I, Zandberg L, Baumgartner J, Russell J, Naidoo N, Biritwum R, Schutte AE, Kowal P, Charlton K. Salt-reduction strategies may compromise salt iodization programs: Learnings from South Africa and Ghana. Nutrition 2020; 84:111065. [PMID: 33450677 DOI: 10.1016/j.nut.2020.111065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Universal salt iodization has been adopted by many countries to address iodine deficiency. More recently, salt-reduction strategies have been widely implemented to meet global salt intake targets of <5 g/d. Compatibility of the two policies has yet to be demonstrated. This study compares urinary iodine excretion (UIE) according to 24-h urinary sodium excretion, between South Africa (SA) and Ghana; both countries have implemented universal salt iodization, but in Ghana no salt-reduction legislation has been implemented. METHODS Participants from the World Health Organization's Study on Global Ageing and Adult Health Wave 3, with survey and valid 24-h urinary data (Ghana, n = 495; SA, n = 707), comprised the sample. Median 24-h UIE was compared across salt intake categories of <5, 5-9 and >9 g/d. RESULTS In Ghana, median sodium excretion indicated a salt intake of 10.7 g/d (interquartile range [IQR] = 7.6), and median UIE was 182.4 µg/L (IQR = 162.5). In SA, both values were lower: median salt = 5.6 g/d (IQR = 5.0), median UIE = 100.2 µg/L (IQR = 129.6). UIE differed significantly across salt intake categories (P < 0.001) in both countries, with positive correlations observed in both-Ghana: r = 0.1501, P < 0.0011; South Africa: r = 0.4050, P < 0.0001. Participants with salt intakes <9 g/d in SA did not meet the World Health Organization's recommended iodine intake of 150 µg/d, but this was not the case in Ghana. CONCLUSIONS Monitoring and surveillance of iodine status is recommended in countries that have introduced salt-reduction strategies, in order to prevent reemergence of iodine deficiency.
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Affiliation(s)
- Elias Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Ilaria Rocco
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Lizelle Zandberg
- Centre for Excellence in Nutrition, North West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre for Excellence in Nutrition, North West University, Potchefstroom, South Africa; Human Nutrition Laboratory, Department of Health Sciences and Technology, Institute of Food, Nutrition and Health, Zurich, Switzerland
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nirmala Naidoo
- World Health Organization, Data, Analytics and Delivery for Impact Division, Geneva, Switzerland
| | | | - Aletta E Schutte
- School of Public Health and Community Medicine, University of New South Wales; The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Paul Kowal
- Chiang Mai University, Research Institute for Health Sciences, Chiang Mai, Thailand; World Health Organization, SAGE, Geneva, Switzerland
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.
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10
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Iacone R, Iaccarino Idelson P, Campanozzi A, Rutigliano I, Russo O, Formisano P, Galeone D, Macchia PE, Strazzullo P. Relationship between salt consumption and iodine intake in a pediatric population. Eur J Nutr 2020; 60:2193-2202. [PMID: 33084957 PMCID: PMC8137629 DOI: 10.1007/s00394-020-02407-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022]
Abstract
Purpose The World Health Organization recommends reduction of salt intake to < 5 g/day and the use of iodized salt to prevent iodine deficiency states. A high prevalence of excess salt consumption and an inadequate iodine intake has been previously shown in an Italian pediatric population. It was appropriate, therefore, to analyse in the same population the relationship occurring between salt consumption and iodine intake. Methods The study population was made of 1270 children and adolescents. Estimates of salt consumption and iodine intake were obtained by measuring 24 h urinary sodium and iodine excretion. Results The iodine intake increased gradually across quartiles of salt consumption independently of sex, age and body weight (p < 0.001). Median iodine intake met the European Food Safety Authority adequacy level only in teenagers in the highest quartile of salt consumption (salt intake > 10.2 g/day). We estimated that approximately 65–73% of the total iodine intake was derived from food and 27–35% from iodized salt and that iodized salt made actually only 20% of the total salt intake. Conclusion In this pediatric population, in face of an elevated average salt consumption, the use of iodized salt was still insufficient to ensure an adequate iodine intake, in particular among teenagers. In the perspective of a progressive reduction of total salt intake, the health institutions should continue to support iodoprophylaxis, in the context of the national strategies for salt reduction. In order for these policies to be successful, in addition to educational campaigns, it is needed that the prescriptions contained in the current legislation on iodoprophylaxis are made compelling through specific enforcement measures for all the involved stakeholders. Electronic supplementary material The online version of this article (10.1007/s00394-020-02407-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roberto Iacone
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy.
| | - Paola Iaccarino Idelson
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia, Italy.
| | - Irene Rutigliano
- Pediatrics, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Ornella Russo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Pietro Formisano
- Translational Medical Science, Federico II University of Naples Medical School, Naples, Italy
| | - Daniela Galeone
- Italian Ministry of Health, Center for Disease Prevention and Control, Rome, Italy
| | - Paolo Emidio Macchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
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11
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Menyanu EK, Corso B, Minicuci N, Rocco I, Russell J, Ware LJ, Biritwum R, Kowal P, Schutte AE, Charlton KE. Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3. BMC Nutr 2020; 6:54. [PMID: 33005430 PMCID: PMC7523323 DOI: 10.1186/s40795-020-00379-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Though Ghana has high hypertension prevalence, the country lacks current national salt consumption data required to build and enhance advocacy for salt reduction. We explored the characteristics of a randomly selected sub sample that had valid urine collection, along with matched survey, anthropometric and BP data (n = 839, mean age = 60y), from the World Health Organization's Study on global AGEing and adult health (WHO-SAGE), Ghana Wave 3, n = 3053). We also investigated the relationship between salt intake and blood pressure (BP) among the cohort. BP was measured in triplicate and 24 h urine was collected for the determination of urinary sodium (Na), potassium (K), creatinine (Cr) and iodine levels. Hypertension prevalence was 44.3%. Median salt intake was 8.3 g/day, higher in women compared to men (8.6, interquartile range (IQR) 7.5 g/day vs 7.5, IQR 7.4 g/day, p < 0.01), younger participants (18-49 y) compared to older ones (50+ y) (9.7, IQR 7.9 g/day vs 8.1, IQR 7.1 g/day, p < 0.01) and those with higher Body Mass Index (BMI) (> 30 kg/m2) compared to a healthy BMI (18.5-24.9 kg/m2) (10.04, IQR 5.1 g/day vs 6.2, IQR 5.6 g/day, p < 0.01). More than three quarters (77%, n = 647) of participants had salt intakes above the WHO maximum recommendation of 5 g/d, and nearly two thirds (65%, n = 548) had daily K intakes below the recommended level of 90 mmol. Dietary sodium to potassium (Na: K) ratios above 2 mmol/mmol were positively associated with increasing BP with age. Population-based interventions to reduce salt intake and increase K consumption are needed.
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Affiliation(s)
- Elias K. Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Ilaria Rocco
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Lisa J. Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Biritwum
- Department of Community Health, University of Ghana, Accra, Ghana
| | - Paul Kowal
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
- World Health Organization (WHO), Geneva, Switzerland
| | - Aletta E. Schutte
- School of Public Health and Community Medicine, University of New South Wales; The George Institute for Global Health, Sydney, NSW 2052 Australia
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520 South Africa
| | - Karen E. Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522 Australia
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12
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Menyanu E, Baatiema L, Charlton K, Wilson M, Aikins ADG, Russell J. Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction. Curr Dev Nutr 2020; 4:nzaa084. [PMID: 32851200 PMCID: PMC7438700 DOI: 10.1093/cdn/nzaa084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 01/29/2023] Open
Abstract
Although population salt reduction is considered a "best buy" in addressing hypertension and cardiovascular disease, Ghana shares a high hypertension burden with a seemingly high salt consumption. This article discusses best practices in reducing population salt intake and provides preliminary data on salt and potassium intake, as well as the process to develop a road map and identification of actions needed to support the development of a strategic national document towards salt reduction in Ghana. In February 2019, a 2-d stakeholder meeting was held with government agencies, researchers, nongovernmental organizations, civil society organizations, and international partners to deliberate on salt reduction strategies and interventions needed in the face of rising hypertension and other noncommunicable diseases (NCDs) in Ghana. Recommendations were developed from the stakeholder meeting and are being considered for inclusion in the revision of Ghana's national NCD policy.
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Affiliation(s)
- Elias Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leonard Baatiema
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Michael Wilson
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama De-Graft Aikins
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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13
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Charlton KE, Schutte AE, Wepener L, Corso B, Kowal P, Ware LJ. Correcting for Intra-Individual Variability in Sodium Excretion in Spot Urine Samples Does Not Improve the Ability to Predict 24 h Urinary Sodium Excretion. Nutrients 2020; 12:nu12072026. [PMID: 32650384 PMCID: PMC7400094 DOI: 10.3390/nu12072026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 01/11/2023] Open
Abstract
Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-individual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine samples results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine samples over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated samples for spot and 24 h samples were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day; 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-individual variation were used. Sensitivity of equations to detect salt intake equivalent values of ≤5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-individual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot samples for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine samples are not appropriate to detect participants with salt intakes below the recommended 5 g/day.
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Affiliation(s)
- Karen Elizabeth Charlton
- School of Medicine, University of Wollongong, Wollongong 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia
- Correspondence: ; Tel.: +61-2-42214754
| | - Aletta Elisabeth Schutte
- School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney 2052, Australia;
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2520, South Africa;
| | - Leanda Wepener
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2520, South Africa;
| | - Barbara Corso
- Neuroscience Institute, National Research Council, 35121 Padova, Italy;
| | - Paul Kowal
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
- World Health Organization (WHO), CH-1211 Geneva 27, Switzerland
| | - Lisa Jayne Ware
- SA MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg 2013, South Africa;
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14
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Tetteh J, Fordjour G, Ekem-Ferguson G, Yawson AO, Boima V, Entsuah-Mensah K, Biritwum R, Essuman A, Mensah G, Yawson AE. Visual impairment and social isolation, depression and life satisfaction among older adults in Ghana: analysis of the WHO's Study on global AGEing and adult health (SAGE) Wave 2. BMJ Open Ophthalmol 2020; 5:e000492. [PMID: 32626826 PMCID: PMC7326267 DOI: 10.1136/bmjophth-2020-000492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 12/17/2022] Open
Abstract
AIM To estimate the prevalence of visual impairment (VI) and associated factors and further quantify its association with social isolation, depression and life satisfaction among older adults in Ghana. METHODS WHO Study on Global AGEing and Adult Health Ghana dataset for older adults 50 years and above was used for this study. Social isolation, depression and life satisfaction were our primary outcomes with VI being our secondary outcome. We employed negative binomial, Poisson and generalised negative binomial regression models individually modified with Coarsened Exact Matching method of analysis. All analysis was performed by adopting robust SE estimation using Stata V.15. RESULTS The prevalence of VI was 17.1% (95% CI14.3 to 20.2) and the factors associated include age groups, educational level, religion, region, where the participant was born, and difficulty in work/households activity (p<0.05). The inferential analysis shows that the significant log-likelihood score of social isolation and life satisfaction for older adults with VI was 0.25 more (95% CI 0.03 to 0.47) and 0.04 less (95% CI -0.08 to -0.01), respectively, compared with those without VI. The prevalence of depression among older adults with VI was significantly 90% higher compared with non-VI (adjusted prevalence ratio (95% CI) = 1.90 (1.17 to 3.09), p<0.001). CONCLUSION The prevalence of VI is associated with increasing age, educational level and self-rated health. VI was identified to be associated with social isolation, depression and diminishing life satisfaction. In order to achieve sustainable development goal #3, a national focus on geriatric care as part of the implementation of the National Ageing Policy will garner improvement in the quality of life of older adults with visual VI in Ghana. Eye health practitioners at all levels of the health systems should consider the psychosocial consequences of VI for the optimum care of the older adult client.
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Affiliation(s)
- John Tetteh
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Gladys Fordjour
- Ophthalmology Unit, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - George Ekem-Ferguson
- Psychiatry Unit, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | | | - Vincent Boima
- Medicine and Therapeutics, School of Medicine, University of Ghana College of Health Sciences, Accra, Greater Accra, Ghana
| | - Kow Entsuah-Mensah
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Richard Biritwum
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Akye Essuman
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - George Mensah
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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15
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Calys-Tagoe BNL, Aheto JMK, Mensah G, Biritwum RB, Yawson AE. Cervical cancer screening practices among women in Ghana: evidence from wave 2 of the WHO study on global AGEing and adult health. BMC Womens Health 2020; 20:49. [PMID: 32138737 PMCID: PMC7059370 DOI: 10.1186/s12905-020-00915-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 02/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cervical cancer is the third most common cancer that affects women worldwide. It has been and remains the leading cause of cancer mortality among women in Ghana. Despite the fact that cervical cancer is preventable through early detection and treatment of precancerous lesions, anecdotal evidence from gynaecological clinics in Ghana indicates that most patients present with a late stage of the disease. This study assesses the cervical cancer screening practices among women in Ghana. METHODS Data from the World Health Organization's (WHO) multi-country Study on AGEing and adult health (SAGE) wave 2 conducted between 2014 and 2015 in Ghana was used. We employed binary logistic regression models to analyse data on 2711 women to examine factors associated with having pelvic examination among women aged ≥18 years. Among those who had pelvic examination, we applied binary logistic regression models to analyse factors associated with receiving Pap smear test as a subgroup analysis. RESULTS Of the 2711 women aged 18 years or older surveyed, 225 (8.3%) had ever had a pelvic examination and only 66 (2.4%) of them reported ever having done a Pap smear test. For those who had pelvic examination, only 26.94% had Pap smear test. Ethnic group, marital status, father's educational level and difficulty with self-care were independently associated with undergoing pelvic examination. Only age and healthcare involvement were independently associated with pelvic examination within the past 5 years to the survey. Marital status, satisfaction with healthcare and healthcare involvement were independently associated with Pap smear test. CONCLUSION Even though cervical cancer is preventable through early detection of precancerous lesions using Pap smear test, the patronage of this screening test is still very low in Ghana. Factors influencing the low patronage in Ghana include the marital status of women, their level of satisfaction with healthcare as well as their level of involvement with healthcare. These may be the consequences of a weak health system and the lack of a national policy on cervical cancer screening.
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Affiliation(s)
- Benedict N L Calys-Tagoe
- Department of Community Health, School of Public Health,College of Health Sciences, University of Ghana, Accra, Ghana
| | - Justice M K Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - George Mensah
- Department of Community Health, School of Public Health,College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard B Biritwum
- Department of Community Health, School of Public Health,College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, School of Public Health,College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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16
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Lartey ST, Si L, Otahal P, de Graaff B, Boateng GO, Biritwum RB, Minicuci N, Kowal P, Magnussen CG, Palmer AJ. Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health. Soc Sci Med 2020; 247:112821. [PMID: 32018114 DOI: 10.1016/j.socscimed.2020.112821] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 12/02/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
Overweight/obesity is becoming increasingly prevalent in sub-Saharan Africa including Ghana. However, transition probabilities, an essential component to develop cost-effective measures for weight management is lacking in this population. We estimated annual transition probabilities between three body mass index (BMI) categories: normal weight (BMI ≥18.5 and <25.0 kg/m2), overweight (BMI ≥25.0 and <30.0 kg/m2), and obesity (BMI ≥30.0 kg/m2), among older adults aged ≥50 years in Ghana. Data were used from a nationally representative, multistage sample of 1496 (44.3% females) older adults in both Waves 1 (2007/8) and 2 (2014/15) of the Ghana WHO SAGE. A multistage Markov model was used to estimate annual transition probabilities. We further examined the impact of specific socio-economic factors on the transition probabilities. At baseline, 22.8% were overweight and 11.1% were obese. The annual transition probability was 4.0% (95% CI: 3.4%, 4.8%) from normal weight to overweight, 11.1% (95% CI: 9.5%, 13.0%) from overweight to normal weight and 4.9% (95% CI: 3.8%, 6.2%) from overweight to obesity. For obese individuals, the probability of remaining obese, transitioning to overweight and completely reverting to normal weight was 90.2% (95% CI: 87.7%, 92.3%), 9.2% (95% CI: 7.2%, 11.6%) and 0.6% (95% CI: 0.4%, 0.8%) respectively. Being female, aged 50-65 years, urban residence, having high education and high wealth were associated with increased probability of transitioning into the overweight or obese categories. Our findings highlight the difficulty in transitioning away from obesity, especially among females. The estimated transition probabilities will be essential in health economic simulation models to determine sustainable weight management interventions.
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Affiliation(s)
- Stella T Lartey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; The George Institute for Global Health, University of New South Wales, Kensington, NSW, 2042, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Godfred O Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Geneva, Switzerland; University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
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17
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Calys-Tagoe BNL, Aheto JMK, Mensah G, Biritwum RB, Yawson AE. Mammography examination among women aged 40 years or older in Ghana: evidence from wave 2 of the World Health Organization's study on global AGEing and adult health multicountry longitudinal study. Public Health 2020; 181:40-45. [PMID: 31940503 DOI: 10.1016/j.puhe.2019.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/07/2019] [Accepted: 11/23/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the uptake of mammography among Ghanaian women aged 40 years or older and to examine critical risk factors that influence the uptake. STUDY DESIGN A cross-sectional survey. METHODS A nationally representative sample of 2787 women and 1948 men aged ≥18 years were surveyed in the Wave 2 (2014-2015) of the World Health Organization's multicountry study on AGEing and adult health in Ghana. Of the 2787 women aged ≥18 years, data on a total of 2301 women aged ≥40 years were included in this study. Univariable and multivariable logistic regression models were applied to examine critical risk factors for mammogram examination. RESULTS Of the 2301 women sampled, only 83 (3.61%) ever had mammogram. The odds of mammogram examination were lower for women aged ≥70 years (odds ratio [OR] 0.42, 95% confidence interval [CI]: 0.19, 0.93), being self-employed (OR = 0.21, 95% CI: 0.11, 0.42) and being informal sector employee (OR = 0.26, 95% CI: 0.12, 0.57) in the multivariable analyses. Belonging to the Ewe ethnic group (OR=3.41, 95% CI:1.88, 6.16) compared to the Akan group was associated with increased odds of mammogram examination in the multivariable analysis. Women aged ≥70 years, being self-employed, being an informal employee and belonging to the Ewe ethnic group were independently associated with mammography examination. CONCLUSION The prevalence of screening for breast cancer using mammography among Ghanaian women aged 40 years and older was 3.6%. Age, type of employer and ethnicity were associated with an older adult woman's likelihood to access mammography screening. Overall, our study provided critical data to encourage and promote good health-seeking behaviour in terms of breast cancer screening among older adult women. Further qualitative studies are warranted to explore why some of these factors influence mammography.
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Affiliation(s)
- B N L Calys-Tagoe
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana
| | - J M K Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Ghana.
| | - G Mensah
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana
| | - R B Biritwum
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana
| | - A E Yawson
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana; Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Ghana
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Lartey ST, de Graaff B, Magnussen CG, Boateng GO, Aikins M, Minicuci N, Kowal P, Si L, Palmer AJ. Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana. Health Policy Plan 2019; 35:199-209. [DOI: 10.1093/heapol/czz147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and <30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.
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Affiliation(s)
- Stella T Lartey
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku FI-20014, Finland
| | - Godfred O Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Moses Aikins
- School of Public Health, University of Ghana, Accra LG 13, Ghana
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Via Giustiniani, 2 35128 Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Avenue Appia 20, 1211 Genève, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales 2305, Australia
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Kensington, NSW 2042, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3053, Australia
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Large artery stiffness is associated with marinobufagenin in young adults: the African-PREDICT study. J Hypertens 2019; 36:2333-2339. [PMID: 30382957 DOI: 10.1097/hjh.0000000000001866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The cardiotonic steroid, marinobufagenin (MBG), has been shown to play a physiological natriuretic role in response to salt intake. However, recent studies in clinical and animal models demonstrated possible links between elevated levels of endogenous MBG and increased arterial stiffness. Large artery stiffness is a known predictor of future cardiovascular disease. We, therefore, investigated whether large artery stiffness relates to 24-h urinary MBG excretion in young apparently healthy black and white adults. METHODS This study included data of 711 participants (black 51%, men 42%, mean age 24.8 ± 3.02 years). We measured the carotid-femoral pulse wave velocity (cfPWV), 24-h urinary MBG and sodium excretion. RESULTS In single, partial and multivariable adjusted (Adj.) regression analyses, we found a persistent positive association between cfPWV and MBG excretion in women [Adj. R = 0.23; standardized (std.) β = 0.15; P = 0.002], but not men (Adj. R = 0.17; std. β = 0.06; P = 0.31). Multiple regression models were adjusted for ethnicity, age, waist-to-height ratio, mean arterial pressure, high-density lipoprotein cholesterol, C-reactive protein, γ-glutamyl transferase and glucose. CONCLUSION In conclusion, already at a young age heightened endogenous MBG levels may contribute to large artery stiffness in women via pressure-independent mechanisms, increasing their risk for future cardiovascular disease.
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Udofia E, Aheto J, Mensah G, Biritwum R, Yawson A. Prevalence and risk factors associated with non-traffic related injury in the older population in Ghana: Wave 2 of the WHO Study on Global AGEing and adult health (SAGE). Prev Med Rep 2019; 15:100934. [PMID: 31333998 PMCID: PMC6617348 DOI: 10.1016/j.pmedr.2019.100934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 11/23/2022] Open
Abstract
Injuries are a significant cause of hospitalization in the older population, leading to a decline in physical activity and greater dependence on others. Compared to traffic related injury, relatively fewer studies have been conducted on non-traffic related injury in the older population in Ghana. This analysis provides a nationwide baseline prevalence and associated factors of non-traffic related injuries among older adults in Ghana. Data from the 2014–2015 nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 was used. A final sample of 3461 older adults living in 2827 households was used in the statistical modelling. Predictors of injury were examined using both single-level and multilevel binary logistic regression models. The prevalence of non-traffic related injury found in this study was 3.74%. The odds of being injured decreased among females (OR = 0.66, 95% CI: 0.46, 0.95) compared to their male counterparts and those who rated their heath state as moderate (OR = 0.59, 95% CI: 0.38, 0.94). Depression was the only risk factor identified in the multivariable model (OR = 2.55, 95%CI: 1.38, 4.71). The study did not observe significant residual household-level variation in injury status. The role of depression as a risk factor suggests that interventions that aim to reduce non-traffic related injury in older adults should consider improving mental health. Sex, self-reported health and depression predicted non-traffic related injury Depression increases the odds of non-traffic related injury in older adults Interventions that improve mental health might have potential benefits
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Affiliation(s)
- E.A. Udofia
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana
| | - J.M. Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Ghana
- Corresponding author at: Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Accra, Ghana.
| | - G. Mensah
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana
| | - R. Biritwum
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana
| | - A.E. Yawson
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Ghana
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Ghana
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21
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Prediction of 24-hour sodium excretion from spot urine samples in South African adults: a comparison of four equations. J Hum Hypertens 2019; 34:24-33. [PMID: 31076654 DOI: 10.1038/s41371-019-0210-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 01/29/2023]
Abstract
Repeated 24-hour urine collection is considered to be the gold standard for assessing salt intake. This is often impractical in large-population studies, especially in low-middle-income countries. Equations to estimate 24-hour urinary salt excretion from a spot urine sample have been developed, but have not been widely validated in African populations. This study aimed to systematically assess the validity of four existing equations to predict 24-hour urinary sodium excretion (24UNa) from spot urine samples in a nationally representative sample of South Africans. Spot and 24-hour urine samples were collected in a subsample (n = 438) of participants from the World Health Organisation Study on global AGEing and adult health (SAGE) Wave 2 in South Africa in 2015. Measured 24UNa values were compared with predicted 24UNa values from the Kawasaki, Tanaka, INTERSALT and Mage equations using Bland-Altman plots. In this subsample (mean age 52.8 ± 16.4 years; body mass index 30.2 ± 8.2 kg/m2; 76% female; 73% black African; 42% hypertensive), all four equations produced a significantly different population estimate compared with the measured median value of 6.7 g salt/day (IQR 4.4-10.5). Although INTERSALT underestimated salt intake (-3.77 g/d; -1.64 to -7.09), the other equations overestimated by 1.28 g/d (-3.52; 1.97), 6.24 g/d (2.22; 9.45), and 17.18 g/d (8.42; 31.96) for Tanaka, Kawasaki, and Mage, respectively. Bland-Altman curves indicated unacceptably wide levels of agreement. Use of these equations to estimate population level salt intake from spot urine samples in South Africans is not recommended.
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22
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Ware LJ, Charlton K, Kruger R, Breet Y, van Rooyen J, Huisman H, Botha S, Uys AS, Rennie KL, Naidoo N, Kowal P, Schutte AE. Assessing tobacco use in an African population: Serum and urine cotinine cut-offs from South Africa. Drug Alcohol Depend 2019; 195:82-89. [PMID: 30593984 PMCID: PMC6424978 DOI: 10.1016/j.drugalcdep.2018.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cotinine, a nicotine metabolite, is used to measure tobacco use and exposure, but recommended cut-offs to differentiate tobacco users from those exposed through the environment range from 3 to 58 ng/ml in serum, and 2.5 to 550 ng/ml in urine. Cut-offs may differ by ethnicity, sex and age. As data from adults in Africa are scarce, our aim was to evaluate cut-offs for serum and urine cotinine that best predict self-reported tobacco use in South African adults. METHODS Two datasets were explored: African-PREDICT (n = 941 black and white healthy young adults, 20-30 years, serum cotinine); and WHO SAGE Wave 2 (n = 604 adults, 18-102 years, urine cotinine). Population specific cut-offs (ROC analyses) were compared with published cut-offs and self-reported tobacco use. RESULTS Overall, 19% (293 of 1545) reported current tobacco use. The following cotinine cut-offs showed the highest sensitivity and specificity: serum ≥15 ng/ml in black and white men, and white women; serum ≥10 ng/ml in black women; urine ≥300 ng/ml for black, mixed ancestry, and older adults (50-plus years); urine ≥500 ng/ml for younger adults (18-49 years). Specificity was lower for urine than for serum cotinine. CONCLUSION Our study suggests that a serum cotinine level of ≥15 ng/ml and a urine cotinine level of ≥300 ng/ml best distinguish current tobacco users from non-users generally in the South African adult population.
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Affiliation(s)
- Lisa J. Ware
- South African MRC Developmental Pathways for Health
Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University
of the Witwatersrand, Johannesburg, South Africa;
,Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa; ;
; ;
; ;
| | - Karen Charlton
- School of Medicine, University of Wollongong, and Illawarra Health and Medical Research Institute, New South Wales, Australia.
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Johannes van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Hugo Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Shani Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.
| | - Aletta S. Uys
- Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa; ;
; ;
; ;
| | - Kirsten L. Rennie
- Centre for Lifespan and Chronic Illness Research,
University of Hertfordshire, United Kingdom;
| | | | - Paul Kowal
- World Health Organization (WHO), Geneva, Switzerland; University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, Australia.
| | - Aletta E. Schutte
- Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa; ;
; ;
; ;
,MRC Research Unit for Hypertension and Cardiovascular
Disease, North-West University, South Africa
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Predictors of hypertension awareness, treatment and control in South Africa: results from the WHO-SAGE population survey (Wave 2). J Hum Hypertens 2018; 33:157-166. [PMID: 30382179 DOI: 10.1038/s41371-018-0125-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/16/2018] [Accepted: 09/27/2018] [Indexed: 11/08/2022]
Abstract
South Africa has one of the highest levels of hypertension globally, coupled with poor rates of diagnosis, treatment and control. Risk factors that predict hypertension in high income countries may perform differently in the African context, where communicable disease, obesity and malnutrition co-exist. This study investigated traditional risk factors alongside other health and sociodemographic indicators to determine predictors of hypertension prevalence and management. Participants were recruited from households across South Africa as part of WHO's Study on global AGEing and adult health (WHO SAGE) Wave 2 (2015). Blood pressure (BP) was measured in triplicate and sociodemographic and health data collected by survey (n = 1847; 30% 18-39 years, 39% 40-59 years, 31% 60 years+; median age 51 years; 68% female). Of all adults, 43% were hypertensive (n = 802), of which 58% (n = 398) were unaware, 33% (n = 267) were on medication, with only 18% (n = 141) controlled on medication (BP < 140/90 mmHg). Multivariate logistic regression showed waist-to-height ratio > 0.5 and diabetes comorbidity were the most significant predictors of hypertension presence, awareness and treatment. Individuals with diabetes were twice as likely to have hypertension, 7.0 times more likely to be aware, 3.3 times more likely to be on antihypertensive medication, and 2.4 times more likely to be controlled on medication. Women and individuals reporting lower salt use were more likely to be aware and treated for hypertension. Applying the 2017 AHA/ACC hypertension guidelines showed only 1 in 4 adults had normal BP. As with HIV, similarly intensive efforts are now needed in the region to improve non-communicable disease diagnosis and management.
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Harris RM, Rose AMC, Hambleton IR, Howitt C, Forouhi NG, Hennis AJM, Samuels TA, Unwin N. Sodium and potassium excretion in an adult Caribbean population of African descent with a high burden of cardiovascular disease. BMC Public Health 2018; 18:998. [PMID: 30092782 PMCID: PMC6085702 DOI: 10.1186/s12889-018-5694-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022] Open
Abstract
Background High sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated levels with recommended intakes and to identify the main food sources of sodium in Barbadian adults. Methods A sub-sample (n = 364; 25–64 years) was randomly selected from the representative population-based Health of the Nation cross-sectional study (n = 1234), in 2012–13. A single 24-h urine sample was collected from each participant, following a strictly applied protocol designed to reject incomplete samples, for the measurement of sodium and potassium excretion (in mg), which were used as proxy estimates of dietary intake. In addition, sensitivity analyses based on estimated completeness of urine collection from urine creatinine values were undertaken. Multiple linear regression was used to examine differences in sodium and potassium excretion, and the sodium-to-potassium ratio, by age, sex and educational level. Two 24-h recalls were used to identify the main dietary sources of sodium. All analyses were weighted for the survey design. Results Mean sodium excretion was 2656 (2488–2824) mg/day, with 67% (62–73%) exceeding the World Health Organization (WHO) recommended limit of 2000 mg/d. Mean potassium excretion was 1469 (1395–1542) mg/d; < 0.5% met recommended minimum intake levels. Mean sodium-to-potassium ratio was 2.0 (1.9–2.1); not one participant had a ratio that met WHO recommendations. Higher potassium intake and lower sodium-to-potassium ratio were independently associated with age and tertiary education. Sensitivity analyses based on urine creatinine values did not notably alter these findings. Conclusions In this first nationally representative study with objective assessment of sodium and potassium excretion in a Caribbean population in over 20 years, levels of sodium intake were high, and potassium intake was low. Younger age and lower educational level were associated with the highest sodium-to-potassium ratios. These findings provide baseline values for planning future policy interventions for non-communicable disease prevention.
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Affiliation(s)
- Rachel M Harris
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Angela M C Rose
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Ian R Hambleton
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Christina Howitt
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anselm J M Hennis
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - T Alafia Samuels
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Strauss M, Smith W, Kruger R, van der Westhuizen B, Schutte AE. Large artery stiffness is associated with salt intake in young healthy black but not white adults: the African-PREDICT study. Eur J Nutr 2018; 57:2649-2656. [PMID: 30032457 DOI: 10.1007/s00394-018-1791-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/17/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE There is global consensus on the benefits of reducing excessive salt intake. Indeed, lower salt intake associates with reduced arterial stiffness, a well-established predictor of cardiovascular risk, in older populations. Whether high habitual salt intake in healthy normotensive youth may already contribute to increased arterial stiffness is unknown. We, therefore, determined whether estimated salt intake is associated with large artery stiffness in young healthy black and white adults. METHODS We included 693 black and white adults (51% black; 42% men), aged 20-30 years. Participants were normotensive based on clinic blood pressure, and no previous diagnosed chronic illnesses. We measured carotid femoral pulse wave velocity (cfPWV) and determined estimated salt intake based on 24 h urinary sodium excretion. RESULTS We found estimated salt consumption of > 5 g/day in 47% of our population, whereas 21% consumed > 10 g/day. In multivariable-adjusted regression analyses a positive association existed between estimated salt intake and cfPWV in the total group (Adj. R2 = 0.32; std. β = 0.10; p = 0.007), and black adults (Adj. R2 = 0.37; std. β = 0.12; p = 0.029). This was independent of age, sex, mean arterial pressure, and other covariates. No association was evident in white individuals (p = 0.19). CONCLUSION Excessive salt intake is positively associated with large artery stiffness-independent of blood pressure-in young adults, especially in black individuals. Our results suggest a potential contributory role of salt consumption towards early vascular aging.
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Affiliation(s)
- Michél Strauss
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.,MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.,MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Bianca van der Westhuizen
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa. .,MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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26
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Charlton KE, Ware LJ, Baumgartner J, Cockeran M, Schutte AE, Naidoo N, Kowal P. Iodine Status Assessment in South African Adults According to Spot Urinary Iodine Concentrations, Prediction Equations, and Measured 24-h Iodine Excretion. Nutrients 2018; 10:E736. [PMID: 29880734 PMCID: PMC6024758 DOI: 10.3390/nu10060736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/15/2022] Open
Abstract
The iodine status of populations is conventionally assessed using spot urinary samples to obtain a median urinary iodine concentration (UIC) value, which is assessed against standard reference cut-offs. The assumption that spot UIC reflects daily iodine intake may be flawed because of high day-to-day variability and variable urinary volume outputs. This study aimed to compare iodine status in a sample of South African adults when determined by different approaches using a spot urine sample (median UIC (MUIC), predicted 24 h urinary iodine excretion (PrUIE) using different prediction equations) against measured 24 h urinary iodine excretion (mUIE). Both 24 h and spot urine samples were collected in a subsample of participants (n = 457; median age 55 year; range 18⁻90 year) in the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 in South Africa, in 2015. Kawasaki, Tanaka, and Mage equations were applied to assess PrUIE from predicted urinary creatinine (PrCr) and spot UIC values. Adequacy of iodine intake was assessed by comparing PrUIE and mUIE to the Estimated Average Requirement of 95 µg/day, while the MUIC cut-off was.
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Affiliation(s)
- Karen E Charlton
- School of Medicine, University of Wollongong, Wollongong 2500, New South Wales, Australia.
- Illawarra Health and Medical Institute, University of Wollongong, Wollongong 2500, New South Wales, Australia.
| | - Lisa J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2531, North West Province, South Africa.
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa.
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2531, North West Province, South Africa.
| | - Marike Cockeran
- Statistical Consultation Services, North-West University, 11 Hoffman Street, Potchefstroom; Private Bag X6001, Potchefstroom 2520, North West Province, South Africa.
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2531, North West Province, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom 2531, North West Province, South Africa.
| | - Nirmala Naidoo
- World Health Organization (WHO), Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
| | - Paul Kowal
- World Health Organization (WHO), Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle 2308, New South Wales, Australia.
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Charlton K, Ware LJ, Baumgartner J, Cockeran M, Schutte AE, Naidoo N, Kowal P. How will South Africa's mandatory salt reduction policy affect its salt iodisation programme? A cross-sectional analysis from the WHO-SAGE Wave 2 Salt & Tobacco study. BMJ Open 2018; 8:e020404. [PMID: 29602855 PMCID: PMC5884349 DOI: 10.1136/bmjopen-2017-020404] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/05/2018] [Accepted: 02/09/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The WHO's global targets for non-communicable disease reduction recommend consumption of<5 g salt/day. In 2016, South Africa was the first country to legislate maximum salt levels in processed foods. South Africa's salt iodisation fortification programme has successfully addressed iodine deficiency but information is dated. Simultaneous monitoring of sodium reduction and iodine status is required to ensure compatibility of the two public health interventions. DESIGN/SETTING/PARTICIPANTS A nested cohort design within WHO's 2015 Study on global AGEing and adult health (n=2887) including individuals from households across South Africa. Randomly selected adults (n=875) provided 24-hour and spot urine samples for sodium and iodine concentration analysis (the primary and secondary outcome measures, respectively). Median 24-hour urinary iodine excretion (UIE) and spot urinary iodine concentrations (UIC) were compared by salt intakes of <5g/day, 5-9g/dayand >9 g/day. RESULTS Median daily sodium excretion was equivalent to 6.3 g salt/day (range 1-43 g/day); 35% had urinary sodium excretion values within the desirable range (<5 g salt/day), 37% had high values (5-9 g salt/day) and 28% had very high values (>9 g salt/day). Median UIC was 130 µg/L (IQR=58-202), indicating population iodine sufficiency (≥100 µg/L). Both UIC and UIE differed across salt intake categories (p<0.001) and were positively correlated with estimated salt intake (r=0.166 and 0.552, respectively; both p<0.001). Participants with salt intakes of <5 g/day were not meeting the Estimated Average Requirement for iodine intake (95 µg/day). CONCLUSIONS In a nationally representative sample of South African adults, the association between indicators of population iodine status (UIC and UIE) and salt intake, estimated using 24-hour urinary sodium excretion, indicate that low salt intakes may compromise adequacy of iodine intakes in a country with mandatory iodisation of table salt. The iodine status of populations undergoing salt reduction strategies needs to be closely monitored to prevent re-emergence of iodine deficiency.
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Affiliation(s)
- Karen Charlton
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- Research Fellow, Illawarra Health and Medical Institute, Wollongong, New South Wales, Australia
| | - Lisa Jayne Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence in Nutrition, North-West University, Potchefstroom, South Africa
| | - Marike Cockeran
- Statistical Consultation Services, North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Nirmala Naidoo
- WHO Multi-Country Studies Unit, World Health Organization (WHO), Geneva, Switzerland
| | - Paul Kowal
- WHO Multi-Country Studies Unit, World Health Organization (WHO), Geneva, Switzerland
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
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Salt Use Behaviours of Ghanaians and South Africans: A Comparative Study of Knowledge, Attitudes and Practices. Nutrients 2017; 9:nu9090939. [PMID: 28846641 PMCID: PMC5622699 DOI: 10.3390/nu9090939] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/30/2022] Open
Abstract
Salt consumption is high in Africa and the continent also shares the greatest burden of hypertension. This study examines salt-related knowledge, attitude and self-reported behaviours (KAB) amongst adults from two African countries—Ghana and South Africa—which have distributed different public health messages related to salt. KAB was assessed in the multinational longitudinal World Health Organisation (WHO) study on global AGEing and adult health (WHO-SAGE) Wave 2 (2014–2015). Respondents were randomly selected across both countries—Ghana (n = 6746; mean age 58 years old; SD 17; 41% men; 31% hypertensive) and South Africa (n = 3776, mean age 54 years old; SD 17; 32% men; 45% hypertensive). South Africans were more likely than Ghanaians to add salt to food at the table (OR 4.80, CI 4.071–5.611, p < 0.001) but less likely to add salt to food during cooking (OR 0.16, CI 0.130–0.197, p < 0.001). South Africans were also less likely to take action to control their salt intake (OR 0.436, CI 0.379–0.488, p < 0.001). Considering the various salt reduction initiatives of South Africa that have been largely absent in Ghana, this study supports additional efforts to raise consumer awareness on discretionary salt use and behaviour change in both countries.
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Peters SAE, Dunford E, Ware LJ, Harris T, Walker A, Wicks M, van Zyl T, Swanepoel B, Charlton KE, Woodward M, Webster J, Neal B. The Sodium Content of Processed Foods in South Africa during the Introduction of Mandatory Sodium Limits. Nutrients 2017; 9:nu9040404. [PMID: 28425938 PMCID: PMC5409743 DOI: 10.3390/nu9040404] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/07/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background: In June 2016, the Republic of South Africa introduced legislation for mandatory limits for the upper sodium content permitted in a wide range of processed foods. We assessed the sodium levels of packaged foods in South Africa during the one-year period leading up to the mandatory implementation date of the legislation. Methods: Data on the nutritional composition of packaged foods was obtained from nutrition information panels on food labels through both in-store surveys and crowdsourcing by users of the HealthyFood Switch mobile phone app between June 2015 and August 2016. Summary sodium levels were calculated for 15 food categories, including the 13 categories covered by the sodium legislation. The percentage of foods that met the government’s 2016 sodium limits was also calculated. Results: 11,065 processed food items were included in the analyses; 1851 of these were subject to the sodium legislation. Overall, 67% of targeted foods had a sodium level at or below the legislated limit. Categories with the lowest percentage of foods that met legislated limits were bread (27%), potato crisps (41%), salt and vinegar flavoured snacks (42%), and raw processed sausages (45%). About half (49%) of targeted foods not meeting the legislated limits were less than 25% above the maximum sodium level. Conclusion: Sodium levels in two-thirds of foods covered by the South African sodium legislation were at or below the permitted upper levels at the mandatory implementation date of the legislation and many more were close to the limit. The South African food industry has an excellent opportunity to rapidly meet the legislated requirements.
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Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford OX1 3QX, UK.
| | - Elizabeth Dunford
- Carolina Population Center, University of North Carolina, Chapel Hill, NC 27516, USA.
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
| | - Lisa J Ware
- Hypertension in Africa Research Team, North West University, Potchefstroom 2520, South Africa.
| | | | | | - Mariaan Wicks
- Center of Excellence for Nutrition, North West University, Potchefstroom 2520, South Africa.
| | - Tertia van Zyl
- Center of Excellence for Nutrition, North West University, Potchefstroom 2520, South Africa.
| | - Bianca Swanepoel
- Center of Excellence for Nutrition, North West University, Potchefstroom 2520, South Africa.
| | - Karen E Charlton
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford OX1 3QX, UK.
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Jacqui Webster
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
- The Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
- Imperial College London, London SW7 2AZ, UK.
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Schutte AE, Botha S, Fourie CMT, Gafane-Matemane LF, Kruger R, Lammertyn L, Malan L, Mels CMC, Schutte R, Smith W, van Rooyen JM, Ware LJ, Huisman HW. Recent advances in understanding hypertension development in sub-Saharan Africa. J Hum Hypertens 2017; 31:491-500. [PMID: 28332510 DOI: 10.1038/jhh.2017.18] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/16/2017] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and
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Affiliation(s)
- A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Department of Medicine and Healthcare Science, Anglia Ruskin University, Chelmsford, UK
| | - W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - H W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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