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Hassen HY, Abrams S, Musinguzi G, Rogers I, Dusabimana A, Mphekgwana PM, Bastiaens H. Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: analysis from the SPICES multi-country project. Eur Heart J Open 2023; 3:oead131. [PMID: 38130418 PMCID: PMC10733186 DOI: 10.1093/ehjopen/oead131] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
Aims Accurate prediction of a person's risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries. Methods and results We used data from a multi-country study involving 9309 participants, i.e. 4941 in Europe, 3371 in South Africa, and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score were investigated. The variation in the adjusted total and component scores was compared across contexts using analysis of variance. The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2), and the difference was statistically significant (P < 0.001). The prevalence and per cent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score, respectively. Contribution of behavioural factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas, contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%). Conclusion The total risk score, subcomponents, categories, and their contribution to total score greatly vary across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource-limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings are recommended.
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Affiliation(s)
- Hamid Y Hassen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, Wilrijk 2610, Belgium
| | - Steven Abrams
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, Wilrijk 2610, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Diepenbeek 3590, Belgium
| | - Geofrey Musinguzi
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, Wilrijk 2610, Belgium
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Alfred Dusabimana
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, Wilrijk 2610, Belgium
| | - Peter M Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, Wilrijk 2610, Belgium
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Hassen HY, Sisay BG, Van Geertruyden JP, Le Goff D, Ndejjo R, Musinguzi G, Abrams S, Bastiaens H. Dietary outcomes of community-based CVD preventive interventions: a systematic review and meta-analysis. Public Health Nutr 2023; 26:2480-2491. [PMID: 37191001 DOI: 10.1017/s1368980023000976] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE We aimed to synthesise available evidence on the effects of community-based interventions in improving various dietary outcome measures. DESIGN Systematic review and meta-analysis. SETTING We searched databases including Medline, EMBASE, PSYCINFO, CINAHL and the Cochrane registry for studies reported between January 2000 and June 2022. The methodological quality of the included studies was evaluated using the Cochrane risk of bias tools for each study type. For some of the outcomes, we pooled the effect size using a random-effects meta-analysis. PARTICIPANTS A total of fifty-one studies, thirty-three randomised and eighteen non-randomised, involving 100 746 participants were included. RESULTS Overall, thirty-seven studies found a statistically significant difference in at least one dietary outcome measure favouring the intervention group, whereas fourteen studies found no statistically significant difference. Our meta-analyses indicated that, compared with controls, interventions were effective in decreasing daily energy intake (MJ/d) (mean difference (MD): -0·25; 95 % CI: -0·37, -0·14), fat % of energy (MD: -1·01; 95 % CI: -1·76, -0·25) and saturated fat % of energy (MD: -1·54; 95 % CI: -2·01, -1·07). Furthermore, the interventions were effective in improving fibre intake (g/d) (MD: 1·08; 95 % CI: 0·39, 1·77). Effective interventions use various strategies including tailored individual lifestyle coaching, health education, health promotion activities, community engagement activities and/or structural changes. CONCLUSION This review shows the potential of improving dietary patterns through community-based CVD preventive interventions. Thus, development and implementation of context-specific preventive interventions could help to minimise dietary risk factors, which in turn decrease morbidity and mortality due to CVD and other non-communicable diseases.
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Affiliation(s)
- Hamid Y Hassen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp2610, Belgium
| | - Binyam G Sisay
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jean-Pierre Van Geertruyden
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp2610, Belgium
| | - Delphine Le Goff
- Department of General Practice, University of Western Brittany, Brest, France
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Steven Abrams
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp2610, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp2610, Belgium
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Hassen HY, Hussien FM, Hassen AM, Dewau R, Amsalu ET, Limenih MA, Berhe NM, Kassaw NA, Sisay BG, Manzar MD. Survival pattern of colorectal cancer in Sub-Saharan Africa: A systematic review and meta-analysis. Cancer Epidemiol 2022; 81:102276. [PMID: 36257176 DOI: 10.1016/j.canep.2022.102276] [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] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region.
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Affiliation(s)
- Hamid Y Hassen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium.
| | - Foziya M Hussien
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anissa M Hassen
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Erkihun T Amsalu
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Miteku A Limenih
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Neamin M Berhe
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Nigussie A Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Binyam G Sisay
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
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Jima BR, Hassen HY, Getnet Y, Bahwere P, Gebreyesus SH. Diagnostic performance of midupper arm circumference for detecting severe wasting among infants aged 1-6 months in Ethiopia. Am J Clin Nutr 2021; 113:55-62. [PMID: 33184640 DOI: 10.1093/ajcn/nqaa294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/30/2020] [Accepted: 09/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6-59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1-6 mo. OBJECTIVE The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1-6 mo. METHODS We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1-6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of -3 SDs from the median as per the WHO 2006 child growth standards. Receiver operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs. RESULTS The median age, MUAC, and WLZ were 100 d (IQR: 69-145 d), 119 mm (IQR: 103-130 mm), and -1.27 (IQR: -2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n = 101 (21.6%) and n = 61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI: 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI: 76.7%, 91.4%) and a specificity of 76.0% (95% CI: 71.2%, 80.2%). CONCLUSIONS A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1-6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo.
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Affiliation(s)
- Beshada R Jima
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hamid Y Hassen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Yalemwork Getnet
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Paluku Bahwere
- Centre of Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Free University of Brussels, Brussels, Belgium
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Hassen HY, Gebreyesus SH, Endris BS, Roro MA, Van Geertruyden JP. Development and Validation of a Risk Score to Predict Low Birthweight Using Characteristics of the Mother: Analysis from BUNMAP Cohort in Ethiopia. J Clin Med 2020; 9:jcm9051587. [PMID: 32456155 PMCID: PMC7290279 DOI: 10.3390/jcm9051587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 01/13/2023] Open
Abstract
At least one ultrasound is recommended to predict fetal growth restriction and low birthweight earlier in pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. Hence, we developed and validated a model and risk score to predict low birthweight using maternal characteristics during pregnancy, for use in resource limited settings. We developed the model using a prospective cohort of 379 pregnant women in South Ethiopia. A stepwise multivariable analysis was done to develop the prediction model. To improve the clinical utility, we developed a simplified risk score to classify pregnant women at high- or low-risk of low birthweight. The accuracy of the model was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plot. All accuracy measures were internally validated using the bootstrapping technique. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. Age at pregnancy, underweight, anemia, height, gravidity, and presence of comorbidity remained in the final multivariable prediction model. The AUC of the model was 0.83 (95% confidence interval: 0.78 to 0.88). The decision curve analysis indicated the model provides a higher net benefit across ranges of threshold probabilities. In general, this study showed the possibility of predicting low birthweight using maternal characteristics during pregnancy. The model could help to identify pregnant women at higher risk of having a low birthweight baby. This feasible prediction model would offer an opportunity to reduce obstetric-related complications, thus improving the overall maternal and child healthcare in low- and middle-income countries.
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Affiliation(s)
- Hamid Y. Hassen
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, 2160 Antwerp, Belgium;
- Correspondence: ; Tel.: +32-466298748
| | - Seifu H. Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa 1000, Ethiopia; (S.H.G.); (B.S.E.)
| | - Bilal S. Endris
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa 1000, Ethiopia; (S.H.G.); (B.S.E.)
| | - Meselech A. Roro
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa 1000, Ethiopia;
| | - Jean-Pierre Van Geertruyden
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, 2160 Antwerp, Belgium;
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