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Uthman OA, Ayorinde A, Oyebode O, Sartori J, Gill P, Lilford RJ. Global prevalence and trends in hypertension and type 2 diabetes mellitus among slum residents: a systematic review and meta-analysis. BMJ Open 2022; 12:e052393. [PMID: 35210339 PMCID: PMC8883228 DOI: 10.1136/bmjopen-2021-052393] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE First, to obtain regional estimates of prevalence of hypertension and type 2 diabetes in urban slums; and second, to compare these with those in urban and rural areas. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA Studies that reported hypertension prevalence using the definition of blood pressure ≥140/90 mm Hg and/or prevalence of type 2 diabetes. INFORMATION SOURCES Ovid MEDLINE, Cochrane CENTRAL and EMBASE from inception to December 2020. RISK OF BIAS Two authors extracted relevant data and assessed risk of bias independently using the Strengthening the Reporting of Observational Studies in Epidemiology guideline. SYNTHESIS OF RESULTS We used random-effects meta-analyses to pool prevalence estimates. We examined time trends in the prevalence estimates using meta-regression regression models with the prevalence estimates as the outcome variable and the calendar year of the publication as the predictor. RESULTS A total of 62 studies involving 108 110 participants met the inclusion criteria. Prevalence of hypertension and type 2 diabetes in slum populations ranged from 4.2% to 52.5% and 0.9% to 25.0%, respectively. In six studies presenting comparator data, all from the Indian subcontinent, slum residents were 35% more likely to be hypertensive than those living in comparator rural areas and 30% less likely to be hypertensive than those from comparator non-slum urban areas. LIMITATIONS OF EVIDENCE Of the included studies, only few studies from India compared the slum prevalence estimates with those living in non-slum urban and rural areas; this limits the generalisability of the finding. INTERPRETATION The burden of hypertension and type 2 diabetes varied widely between countries and regions and, to some degree, also within countries. PROSPERO REGISTRATION NUMBER CRD42017077381.
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Affiliation(s)
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Oyinlola Oyebode
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - R J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Mkuu RS, Gilreath TD, Barry AE, Nafukho FM, Rahman J, Chowdhury MAB, Wekullo C, Harvey IS. Identifying individuals with multiple non-communicable disease risk factors in Kenya: a latent class analysis. Public Health 2021; 198:180-186. [PMID: 34461453 DOI: 10.1016/j.puhe.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Non-communicable diseases (NCDs) are the leading causes of death globally. In Kenya, the number of deaths resulting from NCDs is projected to surpass malaria and tuberculosis by 2030. Studies in Kenya show increasing NCDs; the aim of the present study is to examine the clustering of NCDs and risk factors in Kenya. STUDY DESIGN This is a cross-sectional study using data from the 2015 Kenya STEPwise Survey. METHODS This study examined relationships between NCDs (e.g. obesity, hypertension and diabetes) and health behaviours (e.g. sedentary activity, and fruit and vegetable consumption). Survey probability weights, which estimated the sampling design effect, were applied to consider the sampling units, and stratifications were used during sampling so that the results could be generalisable to the national adult Kenyan population. In total, 4350 adults were included in the study sample. RESULTS Overall, 24.43% of participants were classified as having hypertension, 1.88% as having type 2 diabetes, and 27.94% were classified as being overweight or obese. The best-fit model was a four-class solution. Class 1 is best described as 'young with high NCD risk' and had the highest sedentary activity. Class 2 is best described as 'poor rural with lower NCD risk' with a high chance of smoking and alcohol consumption. Class 3 is best described as 'rural with high NCD risk' and had the highest fruit and vegetable consumption. Class 4 is best described as 'wealthy young urban dwellers with high NCD risk' with a high chance of alcohol consumption and smoking. Individuals in Class 4 had the highest chance (40%) of being overweight/obese, a 2% chance of type 2 diabetes and a 23% chance of having hypertension. CONCLUSIONS NCDs are clustered in groups with high-risk behaviours. The group with the highest chance of having NCDs also had the highest chance of engaging in high-risk behaviours. The findings of this study suggest that smoking and alcohol consumption increase NCD risk in rural areas. Tailored and targeted interventions are needed to curb the increasing NCD prevalence in Kenya.
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Affiliation(s)
- R S Mkuu
- University of Florida, College of Medicine, Gainesville, FL, USA.
| | - T D Gilreath
- Texas A&M University, Transdisciplinary Center for Health Equity Research, College Station, TX, USA.
| | - A E Barry
- Texas A&M University, Department of Health and Kinesiology, College Station, TX, USA.
| | - F M Nafukho
- Texas A&M University, College of Education and Human Development, College Station, TX, USA.
| | - J Rahman
- BRAC University, Dhaka, Bangladesh.
| | - M A B Chowdhury
- University of Florida, College of Medicine, Gainesville, FL, USA.
| | - C Wekullo
- Masinde Muliro University of Science and Technology, Kakamega, Kenya.
| | - I S Harvey
- Texas A&M University, Department of Health and Kinesiology, College Station, TX, USA.
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Cheung JTK, Yu R, Woo J. Is polypharmacy beneficial or detrimental for older adults with cardiometabolic multimorbidity? Pooled analysis of studies from Hong Kong and Europe. Fam Pract 2020; 37:793-800. [PMID: 32596732 PMCID: PMC7699312 DOI: 10.1093/fampra/cmaa062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physicians often prescribe high numbers of medications for managing multiple cardiometabolic diseases. It is questionable whether polypharmacy (concurrent use of five or more medications) is beneficial or detrimental for older adults with cardiometabolic multimorbidity (co-occurrence of two or more diseases). OBJECTIVE To examine combined effects of multimorbidity and polypharmacy on hospitalization and frailty and to determine whether effect sizes of polypharmacy vary with numbers of cardiometabolic diseases. METHODS We pooled longitudinal data of community-dwelling older adults in Hong Kong, Israel, and 17 European countries. They completed questionnaires for baseline assessment from 2015 to 2018 and reassessment at 1-2-year follow-up. We performed regression analyses to address the objective. RESULTS Among 44 818 participants (mean age: 69.6 years), 28.3% had polypharmacy and 34.8% suffered from cardiometabolic multimorbidity. Increased risks of hospitalization and worsening frailty were found in participants with 'multimorbidity alone' [adjusted odds ratio (AOR) 1.10 and 1.26] and 'polypharmacy alone' (AOR 1.57 and 1.68). With 'multimorbidity and 'polypharmacy' combined, participants were not at additive risks (AOR 1.53 and 1.47). In stratified analysis, with increasing numbers of cardiometabolic diseases, associations of polypharmacy with hospitalization and frailty were attenuated but remained statistically significant. CONCLUSION Polypharmacy is less detrimental, yet still detrimental, for older adults living with cardiometabolic multimorbidity. Physicians should optimize prescription regardless of the number of diseases. Health policymakers and researchers need to consider their interrelationship in hospitalization risk predictions and in developing frailty scales.
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Affiliation(s)
- Johnny T K Cheung
- Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ruby Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean Woo
- Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Smit M, Perez-Guzman PN, Mutai KK, Cassidy R, Kibachio J, Kilonzo N, Hallett TB. Mapping the Current and Future Noncommunicable Disease Burden in Kenya by Human Immunodeficiency Virus Status: A Modeling Study. Clin Infect Dis 2020; 71:1864-1873. [PMID: 31734688 PMCID: PMC8240998 DOI: 10.1093/cid/ciz1103] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The noncommunicable disease (NCD) burden in Kenya is not well characterized, despite estimates needed to identify future health priorities. We aimed to quantify current and future NCD burden in Kenya by human immunodeficiency virus (HIV) status. METHODS Original systematic reviews and meta-analyses of prevalence/incidence of cardiovascular disease (CVD), chronic kidney disease, depression, diabetes, high total cholesterol, hypertension, human papillomavirus infection, and related precancerous stages in Kenya were carried out. An individual-based model was developed, simulating births, deaths, HIV disease and treatment, aforementioned NCDs, and cancers. The model was parameterized using systematic reviews and epidemiological national and regional surveillance data. NCD burden was quantified for 2018-2035 by HIV status among adults. RESULTS Systematic reviews identified prevalence/incidence data for each NCD except ischemic heart disease. The model estimates that 51% of Kenyan adults currently suffer from ≥1 NCD, with a higher burden in people living with HIV (PLWH) compared to persons not living with HIV (62% vs 51%), driven by their higher age profile and partly by HIV-related risk for NCDs. Hypertension and high total cholesterol are the main NCD drivers (adult prevalence of 20.5% [5.3 million] and 9.0% [2.3 million]), with CVD and cancers the main causes of death. The burden is projected to increase by 2035 (56% in persons not living with HIV; 71% in PLWH), with population growth doubling the number of people needing services (15.4 million to 28.1 million) by 2035. CONCLUSIONS NCD services will need to be expanded in Kenya. Guidelines in Kenya already support provision of these among both the general and populations living with HIV; however, coverage remains low.
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Affiliation(s)
- Mikaela Smit
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Pablo N Perez-Guzman
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | | | - Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joseph Kibachio
- Division of Noncommunicable Diseases, Ministry of Health, Nairobi, Kenya
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Timothy B Hallett
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Wekesah FM, Klipstein-Grobusch K, Grobbee DE, Kadengye D, Asiki G, Kyobutungi CK. Determinants of Mortality from Cardiovascular Disease in the Slums of Nairobi, Kenya. Glob Heart 2020; 15:33. [PMID: 32489806 PMCID: PMC7218782 DOI: 10.5334/gh.787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular diseases (CVD) comprise eighty percent of non-communicable disease (NCD) burden in low- and middle-income countries and are increasingly impacting the poor inequitably. Traditional and socioeconomic factors were analyzed for their association with CVD mortality over 10 years of baseline assessment in an urban slum of Nairobi, Kenya. Methods and results A 2008 survey on CVD risk factors was linked to cause of death data collected between 2008 and 2018. Cox proportional hazards on relative risk of dying from CVD over a 10-year period following the assessment of cardiovascular disease risk factors were computed. Population attributable fraction (PAF) of incident CVD death was estimated for key risk factors. In total, 4,290 individuals, 44.0% female, mean age 48.4 years in 2008 were included in the analysis. Diabetes and hypertension were 7.8% and 24.9% respectively in 2008. Of 385 deaths recorded between 2008 and 2018, 101 (26%) were caused by CVD. Age (hazard ratio (HR) 1.11; 95% confidence interval (CI) 1.03-1.20, p = 0.005) and hypertension (HR 2.19, 95% CI 1.44-3.33, p <0.001) were positively associated with CVD mortality. Primary school education and higher (HR 0.57, 95% CI 0.33-0.99, p = 0.044) and formal employment (HR 0.22, 95% CI 0.06-0.75, p = 0.015) were negatively associated with CVD mortality. Controlling hypertension would avert 27% (95% CI 9%-42%, p = 0.004) CVD deaths, while if every member of the community attained primary school education and unemployment was eradicated, 39% (95% CI 5% - 60%, p = 0.026), and 17% (95% CI 5%-27%, p = 0.030) of CVD deaths, would be averted respectively. Conclusions A holistic approach in addressing socioeconomic factors in the broader context of social determinants of health at the policy, population and individual level will enhance prevention and treatment-adherence for CVD in underserved settings.
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Affiliation(s)
- Frederick M. Wekesah
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, NL
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, US
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, NL
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, ZA
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, NL
| | - Damazo Kadengye
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
| | - Gershim Asiki
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
| | - Catherine K. Kyobutungi
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
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Abstract
Introduction Overweight and obesity are associated with increased rates of chronic disease
and death globally. In Kenya, the prevalence of overweight and obesity among
women is high and may be growing. This study aimed to determine the national
prevalence and predictors of overweight and obesity among women in
Kenya. Methods We used cross-sectional data from the 2014 Kenya Demographic and Health
Survey (KDHS). Data on body mass index for 13,048 women (aged 15–49
y) were analyzed by using multivariable logistic regression models.
Overweight and obesity were classified by using World Health Organization
categories (normal weight, 18.5 to <24.9; overweight, 25.0 to <29.9;
and obese, ≥30.0). Results The prevalence of overweight was 20.5%, and the prevalence of obesity, 9.1%.
Women aged 35 to 44 (odds ratio [OR] = 3.14; 95% confidence interval [CI],
2.58−3.81), with more than a secondary education (OR = 1.43; 95% CI,
1.05–1.95), married or living with a partner (OR = 1.73; 95% CI,
1.42−2.08), not working (OR = 1.27; 95% CI, 1.10–1.48), in the
richest category (OR = 6.50; 95% CI, 5.08–8.30), and who used
hormonal contraception (OR = 1.24; 95% CI, 1.07–1.43) were
significantly more likely to be overweight or obese. Conclusion A high proportion of women in Kenya are overweight or obese. Our study
indicates that women from urban areas and women with high socioeconomic
status make up the largest proportion of women who are overweight or obese.
Targeted and tailored studies and interventions are needed to identify
evidence-based obesity prevention strategies for high-risk women in
Kenya.
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Affiliation(s)
- Rahma S Mkuu
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas
| | | | - Muhammad Abdul Baker Chowdhury
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida.,PO Box 100186, Gainesville, FL 32610-0186.
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