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Davidson SL, Emmence L, Motraghi-Nobes SM, Bickerstaff E, Rayers G, Lyimo G, Kilasara J, Chuwa M, Kisheo F, Kisaruni E, Urasa S, Mitchell E, Dotchin CL, Walker RW. Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania. BMC Geriatr 2024; 24:190. [PMID: 38408948 PMCID: PMC10898155 DOI: 10.1186/s12877-024-04789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 02/06/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Populations are ageing globally and Low- and Middle-Income Countries (LMICs) are experiencing the fastest rates of demographic change. Few studies have explored the burden of frailty amongst older people in hospital in LMICs, where healthcare services are having to rapidly adapt to align with the needs of older people. This study aimed to measure the prevalence of frailty amongst older people admitted to hospital in Tanzania and to explore their demographic and clinical characteristics. METHODS This study had a prospective observational design. Over a six-month period, all adults ≥ 60 years old admitted to medical wards in four hospitals in northern Tanzania were invited to participate. They were screened for frailty using the Clinical Frailty Scale (CFS) and the Frailty Phenotype (FP). Demographic and clinical characteristics of interest were recorded in a structured questionnaire. These included the Barthel Index, the Identification of Elderly Africans Instrumental Activities of Daily Living (IADEA-IADL) and Cognitive (IDEA-Cog) screens, the EURO-D depression scale and Confusion Assessment Method. RESULTS 540 adults aged ≥ 60 were admitted, and 308 completed assessment. Frailty was present in 66.6% using the CFS and participants with frailty were significantly older, with lower levels of education and literacy, greater disability, greater comorbidity, poorer cognition and higher levels of delirium. Using the FP, 57.0% of participants were classed as frail though a majority of participants (n = 159, 51.6%) could not be classified due to a high proportion of missing data. CONCLUSIONS This study indicates that the prevalence of frailty on medical wards in northern Tanzania is high according to the CFS. However, the challenges in operationalising the FP in this setting highlight the need for future work to adapt frailty screening tools for an African context. Future investigations should also seek to correlate frailty status with long-term clinical outcomes after admission in this setting.
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Affiliation(s)
- Sean L Davidson
- Newcastle University, Newcastle Upon Tyne, UK.
- Northumbria Healthcare NHS Foundation Trust, Morpeth, UK.
| | | | | | | | | | - Godrule Lyimo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joseph Kilasara
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mary Chuwa
- Mawenzi Regional Referral Hospital, Moshi, Tanzania
| | | | | | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Catherine L Dotchin
- Newcastle University, Newcastle Upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Morpeth, UK
| | - Richard W Walker
- Newcastle University, Newcastle Upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Morpeth, UK
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Mwangala PN, Nasambu C, Wagner RG, Newton CR, Abubakar A. Prevalence and Factors Associated With Frailty Among Older Adults Living With HIV Compared to Their Uninfected Peers From the Kenyan Coast. Int J Public Health 2024; 69:1606284. [PMID: 38426187 PMCID: PMC10901986 DOI: 10.3389/ijph.2024.1606284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives: a) To document the prevalence and correlates of frailty among older adults living with HIV (OALWH) and their uninfected peers, and b) Investigate HIV status as an independent predictor of frailty. Methods: This cross-sectional study was conducted between 2020 and 2021 at the Kenyan coast among 440 older adults aged ≥50 years (257 OALWH). Frailty was assessed using the Reported Edmonton Frail Scale. Logistic regression was used to examine the correlates of frailty. Results: The prevalence of frailty was significantly higher among OALWH (24%) than their uninfected peers (13%). HIV seropositivity was not independently associated with frailty. Sleeping difficulties, ageism, higher waist/hip ratio, visiting traditional healers, HIV treatment change/interruption, prolonged illness following HIV diagnosis, and self-reported diabetes were significantly associated with higher odds of frailty. Residing in larger households, having higher income, having friends, being male and light physical activities were significantly associated with reduced odds of frailty. Conclusion: The prevalence of frailty is elevated among OALWH; however, factors other than HIV are predominant, particularly psychosocial factors. Multicomponent interventions are needed to prevent/delay and manage frailty in this setting.
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Affiliation(s)
- Patrick N. Mwangala
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Carophine Nasambu
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles R. Newton
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
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Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital. J Clin Med 2023; 12:jcm12093103. [PMID: 37176544 PMCID: PMC10179017 DOI: 10.3390/jcm12093103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. MATERIALS Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. METHODS Kaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. RESULTS Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)). CONCLUSIONS Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
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Affiliation(s)
- Guillermo Cano-Escalera
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Manuel Graña
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain
- BioCruces Health Research Institute, 48903 Barakaldo, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain
| | - Ana Gonzalez-Pinto
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
| | - Ariadna Besga
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
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Abstract
OBJECTIVE To summarise available evidence and estimate the pooled prevalence of malnutrition among old people in Africa. DESIGN Systematic review and meta-analysis. SETTING Any healthcare or community research reporting the prevalence or incidence of malnutrition in Africa from January 2000 to October 2021. PARTICIPANTS Old people, aged above 60 years. OUTCOME MEASURES Malnutrition, either undernutrition or overnutrition. RESULTS A total of 1442 studies were retrieved based on the search strategy, where only 36 studies (n=15 266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2% to 77.3% across the continent. Overall, the pooled prevalence rates of undernutrition and overnutrition were 18% (95% CI: 15% to 22%; I2=98.1; p<0.001) and 33% (95% CI: 22% to 44%; p<0. 001), respectively. CONCLUSION The prevalence of malnutrition in old African people is high and differs by setting, assessment tool and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable and simple screening tool should be thought of.
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Affiliation(s)
- Ahmed Muhye Seid
- Department of Public Health, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia
- Department of Public Health, Dire Dawa University, College of Medicine and Health Sciences, Dire Dawa, Ethiopia
| | - Netsanet Fentahun
- Department of Nutrition and Dietetics, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia
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Seid AM, Babbel NF. Prevalence of malnutrition among old age people in Africa. FRONTIERS IN AGING 2022; 3:1002367. [PMID: 36439677 PMCID: PMC9686835 DOI: 10.3389/fragi.2022.1002367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/10/2022] [Indexed: 04/14/2024]
Abstract
Background: Improved health care and rising life expectancy are creating a growing pool of old age people all over the world, including Africa. Malnutrition in the old age people is associated with both short- and long-term negative health outcomes. However, the reported burdens of malnutrition are fragmented and inconsistent, where more compiled evidence is warranted to aid decision-makers. Hence, this paper is aimed to estimate the pooled prevalence of malnutrition among old age people in Africa. Methods: A systematic search for research reporting the prevalence of malnutrition among old age people (aged above 60 years) was conducted from HINARI/PubMed and Google Scholar databases using combination keywords. Published articles in English language starting from January 2000 to October 2021 were screened. We presented the results based on the standard for reporting systematic review and meta-analysis of observational studies. A random-effect meta-analysis was done to estimate the prevalence of malnutrition along with the 95% confidence intervals. The publication bias was assessed using the funnel plot. Results: A total of 1,442 studies were retrieved based on the search strategy, where only 36 studies (n = 15,266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2 to 77.3% across Africa. Overall, the pooled prevalence of malnutrition was 18% (95% CI: 15-22; I2 = 98.1; p < 0.001). The prevalence is higher in the Central Africa (3.8%; 95% CI: 3.2-4.4), in the community (3.1%; 95% CI: 2.7-3.7), and among advanced age (3.5%; 95% CI: 2.3-5.4). Conclusion: The prevalence of malnutrition in African old age people is high and differs by setting, assessment tool, and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable, and simple screening tool should be thought of.
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Affiliation(s)
- Ahmed Muhye Seid
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Netsanet Fentahun Babbel
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Lekan D, McCoy TP, Jenkins M, Mohanty S, Manda P. Frailty and In-Hospital Mortality Risk Using EHR Nursing Data. Biol Res Nurs 2021; 24:186-201. [PMID: 34967685 DOI: 10.1177/10998004211060541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study was to evaluate four definitions of a Frailty Risk Score (FRS) derived from EHR data that includes combinations of biopsychosocial risk factors using nursing flowsheet data or International Classification of Disease, 10th revision (ICD-10) codes and blood biomarkers and its predictive properties for in-hospital mortality in adults ≥50 years admitted to medical-surgical units. Methods In this retrospective observational study and secondary analysis of an EHR dataset, survival analysis and Cox regression models were performed with sociodemographic and clinical covariates. Integrated area under the ROC curve (iAUC) across follow-up time based on Cox modeling was estimated. Results The 46,645 patients averaged 1.5 hospitalizations (SD = 1.1) over the study period and 63.3% were emergent admissions. The average age was 70.4 years (SD = 11.4), 55.3% were female, 73.0% were non-Hispanic White (73.0%), mean comorbidity score was 3.9 (SD = 2.9), 80.5% were taking 1.5 high risk medications, and 42% recorded polypharmacy. The best performing FRS-NF-26-LABS included nursing flowsheet data and blood biomarkers (Adj. HR = 1.30, 95% CI [1.28, 1.33]), with good accuracy (iAUC = .794); the reduced model with age, sex, and FRS only demonstrated similar accuracy. The poorest performance was the ICD-10 code-based FRS. Conclusion The FRS captures information about the patient that increases risk for in-hospital mortality not accounted for by other factors. Identification of frailty enables providers to enhance various aspects of care, including increased monitoring, applying more intensive, individualized resources, and initiating more informed discussions about treatments and discharge planning.
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Affiliation(s)
- Deborah Lekan
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Thomas P McCoy
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Somya Mohanty
- Department of Computer Science, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Prashanti Manda
- Informatics and Analytics, University of North Carolina at Greensboro, Greensboro, NC, USA
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Vecchio A, Nakigozi G, Nakasujja N, Kisakye A, Batte J, Mayanja R, Anok A, Robertson K, Wawer MJ, Sacktor N, Rubin LH, Saylor D. Assessment, prevalence, and correlates of frailty among middle-aged adults with HIV in rural Uganda. J Neurovirol 2021; 27:487-492. [PMID: 33788138 DOI: 10.1007/s13365-021-00969-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
We investigated the prevalence and risk factors for frailty among people with HIV (PWH) in rural Uganda (n = 55, 47% male, mean age 44 years). Frailty was defined according to the Fried criteria with self-reported physical activity level replacing the Minnesota Leisure Time Activity Questionnaire. Alternate classifications for physical activity utilized were the sub-Saharan Africa Activity Questionnaire and the International Physical Activity Questionnaire. Eleven participants (19%) were frail. Frail participants were older (p < 0.001), less likely to be on antiretroviral therapy (p = 0.03), and had higher rates of depression (p < .001) and HIV-associated neurocognitive disorder (p = 0.003). Agreement between physical activity measures was sub-optimal. Prevalence of frailty was high among PWH in rural Uganda, but larger sample sizes and local normative data are needed.
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Affiliation(s)
- Alyssa Vecchio
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | | | | | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Kevin Robertson
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Maria J Wawer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ned Sacktor
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Leah H Rubin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Deanna Saylor
- Johns Hopkins University School of Medicine, Baltimore, USA
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Gbeasor-Komlanvi FA, Tchankoni MK, Bakoubayi AW, Lokossou MY, Sadio A, Zida-Compaore WIC, Djibril M, Belo M, Agbonon A, Ekouevi DK. Predictors of three-month mortality among hospitalized older adults in Togo. BMC Geriatr 2020; 20:507. [PMID: 33243161 PMCID: PMC7690011 DOI: 10.1186/s12877-020-01907-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo. Methods We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality. Results The median age of the 650 older adults included in the study period was 61 years, IQR: [55–70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4–20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5 and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases. Conclusion Togolese health system needs to adjust its response to an aging population in order to provide the most effective care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01907-y.
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Affiliation(s)
- Fifonsi Adjidossi Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo. .,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo.
| | | | | | | | - Arnold Sadio
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo
| | | | - Mohaman Djibril
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Centre Hospitalier Universitaire Sylvanus Olympio, Pavillon Militaire, Lomé, Togo
| | - Mofou Belo
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Programme National de Lutte contre les Maladies Chroniques, Lomé, Togo
| | - Amegnona Agbonon
- Université de Lomé, Laboratoire de Physiologie-Pharmacologie, Lomé, Togo
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo
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