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Ramadhar A, Miller PN, Muchengeti M, Kagura J, Chu K, Gaskill C. Gastric cancer in Sub-Saharan Africa - a systematic review of primary data. Ecancermedicalscience 2024; 18:1680. [PMID: 38566758 PMCID: PMC10984845 DOI: 10.3332/ecancer.2024.1680] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 04/04/2024] Open
Abstract
Introduction Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data regarding incidence, treatment, and outcomes in these settings are sparse. The primary aim of this systematic review was to aggregate all available data on GC in sub-Saharan Africa (SSA) to describe the variability in incidence across the region. Methods Studies reporting population-based primary data on GC in SSA were considered. The inclusion was limited to primary studies published between January 1995 and March 2022 which comprised of adult patients in SSA with GC. Studies without accessible full text in either French or English language were excluded. Unadjusted GC incidence rates with their standard errors for each study were recalculated from the crude numerators and denominators provided in individual studies. Results A total of 5,626 articles were identified in the initial search, of which, 69 studies were retained. Reported incidence rates ranged from a high of 5.56 GC cases per 100,000 in Greater Meru Kenya to a low of 0.04 GC cases per 100,000 people in Benin City Nigeria. The overall crude pooled incidence was 1.20 GC cases per 100, 000 (95%CI 1.15-1.26) with a variability of 99.83% (I2 p < 0.001). From the 29 high-quality population-based registry studies the crude pooled incidence was 1.71 GC cases per 100,000 people (95%CI 1.56-21.88) with a variability of 99.60%. Conclusion This systemic review demonstrates that GC incidence is highly variable across SSA. The limited data on GC treatment, mortality, and survival presents a significant challenge to providing a complete epidemiologic description of the burden of GC in SSA. There is a need for further robust data collection, exploration, and research studies on cancer care in SSA, with continued assessment of primary data availability.
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Affiliation(s)
- Anishka Ramadhar
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Phoebe N Miller
- University of California San Francisco, San Francisco, CA, USA
| | - Mazvita Muchengeti
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn Chu
- Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Ntamatungiro AJ, Eichenberger A, Okuma J, Vanobberghen F, Ndege R, Kimera N, Francis JM, Kagura J, Weisser M. Transitioning to Dolutegravir in a Programmatic Setting: Virological Outcomes and Associated Factors Among Treatment-Naive Patients With HIV-1 in the Kilombero and Ulanga Antiretroviral Cohort in Rural Tanzania. Open Forum Infect Dis 2023; 10:ofad321. [PMID: 37520425 PMCID: PMC10375425 DOI: 10.1093/ofid/ofad321] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Background Virological outcome data after programmatic transition from non-nucleoside reverse transcriptase inhibitor (NNRTI)-based to dolutegravir (DTG)-based antiretroviral therapy (ART) regimens in sub-Saharan Africa (SSA) outside of clinical trials are scarce. We compared viral suppression and associated factors in treatment-naïve people living with HIV (PLHIV) starting DTG- based versus NNRTI-based ART. Methods We compared virological suppression at 12 months, after treatment initiation in the two cohorts of participants aged ≥15 years, initiating DTG- and NNRTI-based ART. Drug resistance was assessed among participants with viremia ≥50 copies/mL on DTG. Results Viral suppression was achieved for 165/195 (85%) and 154/211 (73%) participants in the DTG- and NNRTI- cohorts, respectively (P = 0.003). DTG-based ART was associated with >2 times the odds of viral suppression versus NNRTI-based ART (adjusted odds ratio, 2.10 [95% confidence interval {CI}, 1.12-3.94]; adjusted risk ratio, 1.11 [95% CI, 1.00-1.24]). HIV-1 genotypic resistance testing (GRT) before ART initiation was done in 14 of 30 viremic participants on DTG, among whom nucleoside reverse transcriptase inhibitor (NRTI), NNRTI, and protease inhibitors resistance was detected in 0 (0%), 2 (14%) and 1 (7%), respectively. No resistance was found in the 2 of 30 participants with available GRT at the time of viremia ≥50 copies/mL. Conclusions Virological suppression at 1 year was higher in participants initiating DTG- versus NNRTI-based ART. In those with viremia ≥50 copies/mL on DTG-based ART, there was no pretreatment or acquired resistance to the DTG co-administered NRTIs, although the number of samples tested was small.
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Affiliation(s)
- Alex J Ntamatungiro
- Correspondence: Alex J. Ntamatungiro, MS, Department of Interventions and Clinical Trials, Ifakara Health Institute, 5 Ifakara St, Plot 463 Mikocheni, PO Box 78373, Dar es Salaam, Tanzania (); Anna Eichenberger, MS, Department of Infectious Diseases, Bern University Hospital, Freiburgstrasse 16, 3010 Bern, Switzerland ()
| | - Anna Eichenberger
- Correspondence: Alex J. Ntamatungiro, MS, Department of Interventions and Clinical Trials, Ifakara Health Institute, 5 Ifakara St, Plot 463 Mikocheni, PO Box 78373, Dar es Salaam, Tanzania (); Anna Eichenberger, MS, Department of Infectious Diseases, Bern University Hospital, Freiburgstrasse 16, 3010 Bern, Switzerland ()
| | - James Okuma
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fiona Vanobberghen
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Namvua Kimera
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
| | - Joel M Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Kagura J, Khamisa N, Matsena Zingoni Z, Dulaze N, Awuku-Larbi Y, Tshuma N. Patient satisfaction with chronic disease care and its associated factors in primary health care facilities in Johannesburg, South Africa. Front Health Serv 2023; 3:967199. [PMID: 37304754 PMCID: PMC10254081 DOI: 10.3389/frhs.2023.967199] [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] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 04/04/2023] [Indexed: 06/13/2023]
Abstract
Background Patient satisfaction is a widely used indicator of assessing health care quality and has been used by policymakers to consider the needs of patients when developing suitable strategies for safe and high-quality care. However, in South Africa, the dual burden of HIV and NCDs has implications for the health system, whereby the factors influencing the quality of care and patient satisfaction may be unique to this context. Thus, this study examined the predictors affecting chronic disease patients' levels of satisfaction with care in Johannesburg, South Africa. Methods A cross-sectional study was conducted among 2,429 chronic disease patients at 80 primary healthcare facilities in Johannesburg, South Africa. A questionnaire derived from existing literature and patient satisfaction frameworks was used to measure the level of satisfaction of patients when receiving care. Patients' overall satisfaction was categorized into not satisfied and satisfied. Cronbach's alpha was used to assess scale reliability. Factor analysis was used as a data dimension reduction approach and the Kaiser-Meyer-Olkin and the Bartlett test of sphericity were used to test the sampling adequacy and to examine the inter-independence of the items. Logistic regression was used to determine factors associated with being satisfied. Significance was set at 5%. Results The majority of chronic disease patients 65.5% (n = 1,592) were aged 18-30 years; 63.8% (n = 1,549) were females, 55.1% (n = 1,339) were married and 2,032 (83.7%) were satisfied with care. The factor analysis results were in five sub-scales namely improving values and attitudes, cleanliness of the clinic, safe and effective care, infection control, and on the availability of medicines. In adjusted models, patients aged >51years had an increased odds of 3.18 (95% CI:1.31-7.75) of being satisfied compared to those aged 18-30 years and patients who had visited the clinic at least 6 times had 51% increased odds of being satisfied (AOR = 1.51,95% CI:1.13-2.03). The odds of being satisfied increased by 28% (AOR = 1.28,95% CI:1.07-1.53), 45% (AOR = 1.45,95% CI:1.2-1.75), 34% (AOR = 1.34,95% CI:1.13-1.59) and 4.31 (95% CI:3.55-5.23) for every score increase in the factors like improving values and attitudes, cleanliness of clinic safe and effective care and availability of medicine, respectively. Conclusions Key predictors of patient satisfaction were found to be sociodemographic factors including age, distance to the clinic, number of visits and waiting times as well as factors such as improving values and attitudes, cleanliness of the clinic, waiting time, safety and effective care and availability of medicines. Adjustment of existing frameworks for addressing context-specific improvement of patient experiences such as security and safety is recommended to ensure healthcare quality and service utilization for better chronic disease outcomes in South Africa.
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Affiliation(s)
- Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Natasha Khamisa
- Division of Health and Society, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Zvifadzo Matsena Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Neo Dulaze
- Division of Bioethics and Health Law, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Yaw Awuku-Larbi
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kalu GO, Francis JM, Ibisomi L, Chirwa T, Kagura J. Factors associated with the uptake of Intermittent Preventive Treatment (IPTp-SP) for malaria in pregnancy: Further analysis of the 2018 Nigeria Demographic and Health Survey. PLOS Glob Public Health 2023; 3:e0000771. [PMID: 36962778 PMCID: PMC10021516 DOI: 10.1371/journal.pgph.0000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023]
Abstract
Pregnancy-associated malaria is preventable and curable with intermittent preventive treatment with Sulfodoxine-Pyrimethamine (IPTp-SP). However, despite the effectiveness of IPTp-SP against malaria in pregnancy, the uptake among pregnant women in Nigeria remains very low. Thus, this study aimed to establish the factors associated with the uptake of at least one dose and optimal doses of IPTp-SP among pregnant women aged 15 to 49 years living in Nigeria in 2018. The study included 12,742 women aged 15 to 49 years with live births two years before or during the 2018 Nigeria Demographic Health Survey (NDHS) in the analysis. Descriptive analysis was carried out to determine the prevalence of IPTp-SP uptake. Multivariable logistic regression was used to establish the factors associated with receiving IPTp-SP during pregnancy, adjusting for possible confounding factors. Given the complex survey design, all analyses are adjusted for sampling weight, stratification, and clustering. The p-value of <0.05 was considered significant. In 2018, the prevalence of at least one dose of IPTp-SP was 63.6% (95% CI:62.0-65.1), and optimal doses of IPTp-SP were 16.8% (95% CI:15.8-17.8) during pregnancy. After the multivariable analysis, age group, region, frequency of ANC visits, belief in IPTp-SP effectiveness, and morbidity caused by malaria predicted the uptake of at least one IPTp-SP dose. Similar maternal characteristics, including household wealth index, spouse's educational level, and media exposure were significantly associated with taking optimal IPTp-SP doses. For instance, women in the wealthiest households whose husbands had secondary education predicted a four-fold increase in uptake of at least one IPTp-SP dose (aOR:4.17; 95% CI:1.11-8.85). The low prevalence and regional variations of IPTp-SP uptake in the study area imply that most pregnant women in Nigeria are at substantial risk of pregnancy-associated malaria. Therefore, stakeholders should explore context-specific strategies to improve the IPTp-SP coverage across the regions in Nigeria.
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Affiliation(s)
- Godwin Okeke Kalu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary care, School of Clinical Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Latifat Ibisomi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Juliana Kagura
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Kagura J, Meer R, Boateng D, Klipstein-Grobusch K, Norris SA. S-43-6: HYPERTENSION FROM CHILDHOOD TO ADULTHOOD: THE BT20+ STUDY. J Hypertens 2023. [DOI: 10.1097/01.hjh.0000913664.62214.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mkubwa B, Kagura J, Chirwa T, Ibisomi L, Kinyanjui S. Determinants of utilization of malaria preventive measures during pregnancy among women aged 15 to 49 years in Kenya: an analysis of the Malaria Indicator Survey 2020. Malar J 2022; 21:398. [PMID: 36581863 PMCID: PMC9798621 DOI: 10.1186/s12936-022-04425-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria is a significant cause of morbidity and mortality. Malaria infection in pregnancy can have severe consequences for the fetus and the mother. To fight against malaria infection in pregnancy, Kenya integrated the issuance of an insecticide-treated net (ITN) and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTpSP) with antenatal care (ANC) for pregnant women. However, the uptake of the ITN and IPTpSP is still low. Individual, social, or structural factors may influence the low uptake. It is, therefore, important to identify the determinants associated with the uptake of ITN and IPTpSP during pregnancy in Kenya. METHODS Data were from the 2020 Kenya Malaria Indicator Survey (MIS). A total of 1779 women between the ages of 15 to 49 years who had a history of either being pregnant or having given birth within 5 years before the MIS survey were included. Survey-adjusted multinomial logistic regression was used in the analysis. RESULTS During pregnancy, ITN use was more than half (54.9%). The use of at least one dose of IPTpSP was 43.5%, three or more doses of IPTpSP was 27.2%, and only 28.2% of the participants used both ITN and IPTpSP during pregnancy. The significant determinants of combined use of ITN and IPTpSP during pregnancy were maternal age (RR 3.57, CI 1.80-7.08; p=<0.001), maternal education (RRR 2.84, CI 1.33-6.06; p=0.007), wealth index (RR 2.14, CI 1.19-3.84; p=0.011) and living in the different malaria epidemiological zones: lake endemic (RRR 10.57 CI 5.65-19.76; p=<0.001), coastal endemic area (RRR 4.86 CI 1.86-12.67; p=0.001), seasonal (RRR 0.21 CI 0.10-0.39; p=<0.001) and low risk (RRR 0.07, CI 0.03-0.17; p=<0.001). CONCLUSION The uptake of malaria preventive measures is still below 80% for both ITN and IPTpSP during pregnancy in Kenya. The significant results on determinants of the use of ITN and IPTpSP could be considered in implementing malaria prevention programmes during pregnancy. For example, sensitizing the community on the importance of antenatal care visits will provide a platform to teach the importance of malaria prevention in pregnancy. Moreover, the pregnant mothers receive an ITN and IPTpSP during the ANC visit.
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Affiliation(s)
- Beatrice Mkubwa
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Latifat Ibisomi
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa ,grid.416197.c0000 0001 0247 1197Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Samson Kinyanjui
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research (Coast), KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
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Ntamatungiro AJ, Kagura J, Weisser M, Francis JM. Pre-treatment HIV-1 drug resistance in antiretroviral therapy-naive adults in Eastern Africa: a systematic review and meta-analysis. J Antimicrob Chemother 2022; 77:3231-3241. [PMID: 36225089 DOI: 10.1093/jac/dkac338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pre-treatment HIV drug resistance (PDR) may result in increased risk of virological failure and acquisition of new resistance mutations. With recently increasing ART coverage and periodic modifications of the guidelines for HIV treatment, there is a need for an updated systematic review to assess the levels of the PDR among adults newly initiating ART in Eastern Africa. METHODS We conducted a systematic search for studies published between 1 January 2017 and 30 April 2022 in the MEDLINE Complete and CINAHL Complete, searched simultaneously using EBSCOhost, and Web of Science. To determine the overall PDR prevalence estimates, we extracted data from eligible articles and analysed prevalence estimates using Stata 14.2. RESULTS A total of 22 eligible observation studies were selected. The studies included a total of 5852 ART-naive people living with HIV. The overall pooled prevalence of PDR was 10.0% (95% CI: 7.9%-12.0%, I2 = 88.9%) and 9.4% (95% CI: 7.0%-11.9%, I2 = 90.4%) for NNRTIs, 2.6% (95% CI: 1.8%-3.4%, I2 = 69.2%) for NRTIs and 0.7% (95% CI: 0.3%-1.2%, I2 = 29.0%) for PIs. No major integrase strand transfer inhibitors (INSTI)-related mutations were identified. CONCLUSIONS We observed a moderate overall PDR prevalence among new ART initiators in this study. PDR to NNRTIs is more prevalent, underscoring the importance of the current WHO recommendation for replacement of NNRTIs by INSTIs. PDR to NRTIs was low but notable, which warrants continuous surveillance of pre-existing resistance to the dolutegravir co-administered NRTI in Eastern Africa.
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Affiliation(s)
- Alex J Ntamatungiro
- Ifakara Health Institute, Ifakara, Tanzania.,Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Maja Weisser
- Ifakara Health Institute, Ifakara, Tanzania.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Joel M Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Ware LJ, Maposa I, Kolkenbeck-Ruh A, Norris SA, Soepnel L, Crouch S, Kagura J, Naidoo S, Smith W, Davies J. Are cardiovascular health measures heritable across three generations of families in Soweto, South Africa? A cross-sectional analysis using the random family method. BMJ Open 2022; 12:e059910. [PMID: 36153021 PMCID: PMC9511591 DOI: 10.1136/bmjopen-2021-059910] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Cardiovascular disease is increasing in many low and middle-income countries, including those in Africa. To inform strategies for the prevention of cardiovascular disease in South Africa, we sought to determine the broad heritability of phenotypic markers of cardiovascular risk across three generations. DESIGN A cross-sectional study conducted in a longitudinal family cohort. SETTING Research unit within a tertiary hospital in a historically disadvantaged, large urban township of South Africa. PARTICIPANTS 195 individuals from 65 biological families with all three generations including third-generation children aged 4-10 years were recruited from the longest running intergenerational cohort study in Africa, the Birth to Twenty Plus cohort. All adults (grandparents and parents) were female while children were male or female. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was heritability of blood pressure (BP; brachial and central pressures). Secondary outcomes were heritability of arterial stiffness (pulse wave velocity), carotid intima media thickness (cIMT) and left ventricular mass indexed to body surface area (LVMI). RESULTS While no significant intergenerational relationships of BP or arterial stiffness were found, there were significant relationships in LVMI across all three generations (p<0.04), and in cIMT between grandparents and parents (p=0.0166). Heritability, the proportion of phenotypic trait variation attributable to genetics, was estimated from three common statistical methods and ranged from 23% to 44% for cIMT and from 21% to 39% for LVMI. CONCLUSIONS Structural indicators of vascular health, which are strong markers of future clinical cardiovascular outcomes, transmit between generations within African families. Identification of these markers in parents may be useful to trigger assessments of preventable risk factors for cardiovascular disease in offspring.
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Affiliation(s)
- Lisa J Ware
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Andrea Kolkenbeck-Ruh
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Larske Soepnel
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Simone Crouch
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Sanushka Naidoo
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Justine Davies
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
- Wallenberg Research Centre at Stellenbosch University, Stellenbosch Institute for Advanced Study, Stellenbosch, South Africa
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Kamwendo AJ, Hosseinipour MC, Kagura J. Improving viral load testing using a quality improvement approach in Blantyre, Malawi. PLoS One 2022; 17:e0269062. [PMID: 35675362 PMCID: PMC9176770 DOI: 10.1371/journal.pone.0269062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Viral load (VL) testing coverage remains low particularly in resource limited countries despite recommendation by World Health Organization, and Malawi is no exception. A quality improvement (QI) approach was used to improve VL testing coverage from 27% to a target of 80% at an urban health facility in Malawi. Methods A QI study employing a time-series quasi-experimental design with no comparison group was conducted at Chilomoni health centre in Blantyre from April 2020 to July 2020. A retrospective record review of all patient records (257) from 8 weeks before the study was conducted to determine baseline VL testing coverage. Root cause analysis of low VL testing coverage was done using fish-bone tool and factors prioritized using a Pareto-chart. Priority factors included inadequate capacity to update electronic medical records and competing tasks. Change ideas were identified and prioritized using an effort-impact matrix. Two change ideas; re-orienting ART providers on VL test order in EMR and dedicated ART provider to serve VL tested patients were implemented and tested in 5 Plan-Do-Study-Act (PDSA) cycles from the Model for Improvement (MFI), each lasting one week. The latter was tested, and adapted in 3 cycles, and eventually adopted for monitoring for another 5 weeks. VL testing coverage was tracked throughout the study using run charts and p-charts. Results VL testing coverage increased from 27% to 71% by the end of the study, with children aged 0 to 14 years having the lowest coverage throughout the study. Conclusion The MFI as a QI approach improved VL testing coverage through implementation of contextualized change ideas. A reliable data system, leadership buy-in and commitment are important for sustained improvement. Future research should focus on evaluating sustainability of improved VL testing coverage at the health facility and assessing barriers to VL testing among the paediatric population.
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Affiliation(s)
- Angella J. Kamwendo
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail: ,
| | - Mina C. Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Juliana Kagura
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Mukoma G, Wrottesley SV, Kagura J, Oni T, Micklesfield L, Norris SA. The relationships between socioeconomic status, dietary knowledge and patterns, and physical activity with adiposity in urban South African women. South African Journal of Clinical Nutrition 2022. [DOI: 10.1080/16070658.2022.2076374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Gudani Mukoma
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, South Africa
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Research Initiative for Cities Health and Equity, University of Cape Town, Cape Town, South Africa
| | - Lisa Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Developmental Science and Global Health Research Institute, University of Southampton, Southampton, UK
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11
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Meer R, Boateng D, Klipstein-Grobusch K, Norris SA, Kagura J. Incidence and correlates of high blood pressure from childhood to adulthood: the Birth to Twenty study. J Hypertens 2022; 40:274-282. [PMID: 34475345 PMCID: PMC8728753 DOI: 10.1097/hjh.0000000000003004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is growing evidence from high-income countries suggesting that hypertension developed in childhood and adolescence persists into adulthood. The objective of this study was to investigate the incidence and risk factors of high blood pressure (BP) in urban black children. METHODS We used data from the Birth to Twenty (BT20+) cohort in Johannesburg, South Africa constituting of children born in 1990 and who had their growth, development and blood pressure measured at six follow-up periods over the course of 13 years. High BP was classified as at least 95th percentile for age, sex and height. Incidence rate of high BP was calculated using survival analysis and risk factors were determined by use of Cox proportional hazard regression. RESULTS Over a follow-up period of 13 years, the overall incidence rate of high BP was 57 cases per 1000 person-years (95% CI 53.2-61.1). Risk for incident high BP increased with rapid relative weight gain in early childhood (hazard ratio =1.11, 95% CI 1.00-1.22), mid-childhood (hazard ratio = 1.13, 95% CI 1.03-1.24) and adolescence (hazard ratio = 1.21, 95% CI 0.99-1.47). Maternal parity significantly increased the risk for incident high BP (hazard ratio = 1.08, 95% CI 1.01-1.15). CONCLUSION Maternal parity and relative weight gain were determinants for incident high blood pressure in urban black South African children and adolescents. To reduce the high incidence and the disease burden of high BP, national programs should focus on promoting healthy lifestyle in early stages of life to prevent rapid weight gain and later cardiovascular disease risk. Further research is required to investigate whether incident high BP in childhood predict clinical outcomes in adulthood.
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Affiliation(s)
- Romain Meer
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences
| | - Shane A. Norris
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, UK
| | - Juliana Kagura
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences
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12
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Nonterah EA, Kanmiki EW, Agorinya IA, Sakeah E, Tamimu M, Kagura J, Kaburise MB, Ayamba EY, Nonterah EW, Awuni DA, Al-Hassan M, Ofosu W, Awoonor-Williams JK, Oduro AR. Prevalence and adverse obstetric outcomes of female genital mutilation among women in rural Northern Ghana. Eur J Public Health 2021; 30:561-567. [PMID: 31637426 DOI: 10.1093/eurpub/ckz195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. METHODS We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. RESULTS A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. CONCLUSIONS Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM.
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Affiliation(s)
- Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.,Navrongo War Memorial Hospital, Ghana Health Service, Navrongo, Ghana.,Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Edmund W Kanmiki
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Isaiah A Agorinya
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Evelyn Sakeah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Mariatu Tamimu
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Juliana Kagura
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael B Kaburise
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.,Navrongo War Memorial Hospital, Ghana Health Service, Navrongo, Ghana
| | - Emmanuel Y Ayamba
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Esmond W Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Denis A Awuni
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | | | - Winfred Ofosu
- Upper East Regional Health Directorate, Ghana Health Service, PMB, Bolgatanga, Ghana
| | | | - Abraham R Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
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13
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Kruger R, Gafane-Matemane LF, Kagura J. Racial differences of early vascular aging in children and adolescents. Pediatr Nephrol 2021; 36:1087-1108. [PMID: 32444927 DOI: 10.1007/s00467-020-04593-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 01/13/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
The prevalence of non-communicable disease (NCDs) is rising globally, with a large burden recorded in sub-Saharan countries and populations of black race/ethnicity. Accelerated vascular deterioration, otherwise known as early vascular aging (EVA), is the underlying factor for highly prevalent NCDs such as hypertension. The etiology of EVA is multifactorial with a central component being arterial stiffness with subsequent development of hypertension and cardiovascular complications. Although arterial stiffness develops with increasing age, many children and adolescents are subjected to the premature development of arterial stiffness, due to genetic or epigenetic predispositions, lifestyle and behavioral risk factors, and early life programming. Race/ethnic differences in pediatric populations have also been reported with higher aortic stiffness in black (African American) compared with age-matched white (European American) counterparts independent of blood pressure, body mass index, or socioeconomic status. With known evidence of race/ethnic differences in EVA, the pathophysiological mechanisms underlying graded differences in the programming of EVA are still sparse and rarely explored. This educational review aims to address the early life determinants of EVA in children and adolescents with a particular focus on racial or ethnic differences.
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Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa. .,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Lebo Francina Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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14
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Nonterah EA, Agorinya IA, Kanmiki EW, Kagura J, Tamimu M, Ayamba EY, Nonterah EW, Kaburise MB, Al-Hassan M, Ofosu W, Oduro AR, Awonoor-Williams JK. Trends and risk factors associated with stillbirths: A case study of the Navrongo War Memorial Hospital in Northern Ghana. PLoS One 2020; 15:e0229013. [PMID: 32084170 PMCID: PMC7034822 DOI: 10.1371/journal.pone.0229013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana. METHODS Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003-2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths. RESULTS A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates; neonates with low birth weight (4.02 [2.92, 5.53]) and extreme low birth weight (18.9 [10.9, 32.4]) were at a higher risk of still birth (p<0.001). Mothers who had undergone Female Genital Mutilation had 47% (1.47 [1.04, 2.09]) increase odds of having a stillbirth compared to non FGM mothers (p = 0.031). Mothers giving birth for the first time also had a 40% increase odds of having a stillbirth compared to those who had more than one previous births (p = 0.037). CONCLUSION Despite the modest reduction in stillbirth rates over the study period, it is evident from the results that stillbirth rate is still relatively high. Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths. Efforts aimed at impacting on stillbirths should include the elimination of outmoded cultural practices such as FGM.
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Affiliation(s)
- Engelbert A. Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Navrongo War Memorial Hospital, Ghana Health Service, Navrongo, Ghana
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Isaiah A. Agorinya
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Swiss Tropical and Public Health Institute, Socinstrasse, Basel, Switzerland, University of Basel, Peterplatz, Basel, Switzerland
| | - Edmund W. Kanmiki
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, Accra, Ghana
| | - Juliana Kagura
- Department of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Mariatu Tamimu
- Obstetrics and Gynaecology Department, University of Nairobi, Nairobi, Kenya
| | | | | | - Michael B. Kaburise
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Navrongo War Memorial Hospital, Ghana Health Service, Navrongo, Ghana
| | | | - Winfred Ofosu
- Upper East Regional Health Directorate, Ghana Health Service, PMB, Bolgatanga, Ghana
| | - Abraham R. Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
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15
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Naidoo S, Kagura J, Fabian J, Norris SA. Response by Naidoo et al to Letter Regarding Article "Early Life Factors and Longitudinal Blood Pressure Trajectories Are Associated With Elevated Blood Pressure in Early Adulthood: BT20 Cohort". Hypertension 2019; 73:e84. [PMID: 31067204 DOI: 10.1161/hypertensionaha.119.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanushka Naidoo
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Centre, Department of Medicine, Johannesburg, South Africa
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
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16
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Nonterah EA, Adomolga E, Yidana A, Kagura J, Agorinya I, Ayamba EY, Atindama S, Kaburise MB, Alhassan M. Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 31038334 PMCID: PMC6489153 DOI: 10.4102/phcfm.v11i1.1892] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 07/23/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022] Open
Abstract
Background Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana. Aim The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits. Setting The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana. Methods A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC. Results We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31–13.8). The median gestational age at booking was 14 weeks (5–36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4–47.1], and was high among teenage mothers (52% [34.9–67.8]), mothers who booked in the third trimester (55% [33.6–74.7]) and grand multiparous women (58% [30.7–81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58–2.46]), booking during the third trimester (OR = 2.06 [1.78–2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19–8.32]). Conclusion Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery. Keywords anaemia in pregnancy; booking visit; maternal and child health; Navrongo; rural; Ghana.
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Affiliation(s)
- Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana; and, Navrongo War Memorial Hospital, Navrongo.
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17
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Naidoo S, Kagura J, Fabian J, Norris SA. Early Life Factors and Longitudinal Blood Pressure Trajectories Are Associated With Elevated Blood Pressure in Early Adulthood. Hypertension 2019; 73:301-309. [DOI: 10.1161/hypertensionaha.118.11992] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sanushka Naidoo
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health (S.N., J.K., S.A.N.), University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health (S.N., J.K., S.A.N.), University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health (J.K.), University of the Witwatersrand, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Centre (J.F.), University of the Witwatersrand, Johannesburg, South Africa
- Division of Nephrology, Department of Internal Medicine, School of Clinical Medicine (J.F.), University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health (S.N., J.K., S.A.N.), University of the Witwatersrand, Johannesburg, South Africa
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18
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Munthali RJ, Manyema M, Said-Mohamed R, Kagura J, Tollman S, Kahn K, Gómez-Olivé FX, Micklesfield LK, Dunger D, Norris SA. Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis. BMJ Open 2018; 8:e023404. [PMID: 30573484 PMCID: PMC6303607 DOI: 10.1136/bmjopen-2018-023404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women. SETTING Rural and urban South Africa. DESIGN Cross-sectional. PARTICIPANTS Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study. RESULTS The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76). CONCLUSIONS Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.
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Affiliation(s)
- Richard J Munthali
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mercy Manyema
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Dunger
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, MRL Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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19
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Munthali RJ, Sahibdeen V, Kagura J, Hendry LM, Norris SA, Ong KK, Day FR, Lombard Z. Genetic risk score for adult body mass index associations with childhood and adolescent weight gain in an African population. Genes Nutr 2018; 13:24. [PMID: 30123368 PMCID: PMC6090951 DOI: 10.1186/s12263-018-0613-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/13/2018] [Indexed: 11/10/2022]
Abstract
Background Ninety-seven independent single nucleotide polymorphisms (SNPs) are robustly associated with adult body mass index (BMI kg/m2) in Caucasian populations. The relevance of such variants in African populations at different stages of the life course (such as childhood) is unclear. We tested whether a genetic risk score composed of the aforementioned SNPs was associated with BMI from infancy to early adulthood. We further tested whether this genetic effect was mediated by conditional weight gain at different growth periods. We used data from the Birth to Twenty Plus Cohort (Bt20+), for 971 urban South African black children from birth to 18 years. DNA was collected at 13 years old and was genotyped using the Metabochip (Illumina) array. The weighted genetic risk score (wGRS) for BMI was constructed based on 71 of the 97 previously reported SNPs. Results The cross-sectional association between the wGRS and BMI strengthened with age from 5 to 18 years. The significant associations were observed from 11 to 18 years, and peak effect sizes were observed at 13 and 14 years of age. Results from the linear mixed effects models showed significant interactions between the wGRS and age on longitudinal BMI but no such interactions were observed in sex and the wGRS. A higher wGRS was associated with an increased relative risk of belonging to the early onset obese longitudinal BMI trajectory (relative risk = 1.88; 95%CI 1.28 to 2.76) compared to belonging to a normal longitudinal BMI trajectory. Adolescent conditional relative weight gain had a suggestive mediation effect of 56% on the association between wGRS and obesity risk at 18 years. Conclusions The results suggest that genetic susceptibility to higher adult BMI can be tracked from childhood in this African population. This supports the notion that prevention of adult obesity should begin early in life. The genetic risk score combined with other non-genetic risk factors, such as BMI trajectory membership in our case, has the potential to be used to screen for early identification of individuals at increased risk of obesity and other related NCD risk factors in order to reduce the adverse health risk outcomes later. Electronic supplementary material The online version of this article (10.1186/s12263-018-0613-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard J Munthali
- 1Faculty of Science, School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa.,2Sydney Brenner Institute for Molecular Bioscience (SBIMB), University of the Witwatersrand, The Mount, 9 Jubilee Road, Parktown, Johannesburg, Gauteng 2193 South Africa.,3MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Venesa Sahibdeen
- 2Sydney Brenner Institute for Molecular Bioscience (SBIMB), University of the Witwatersrand, The Mount, 9 Jubilee Road, Parktown, Johannesburg, Gauteng 2193 South Africa.,4Faculty of Health Sciences, Division of Human Genetics, School of Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Juliana Kagura
- 3MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Liesl M Hendry
- 1Faculty of Science, School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa.,2Sydney Brenner Institute for Molecular Bioscience (SBIMB), University of the Witwatersrand, The Mount, 9 Jubilee Road, Parktown, Johannesburg, Gauteng 2193 South Africa
| | - Shane A Norris
- 3MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Ken K Ong
- 3MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa.,5MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Felix R Day
- 5MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Zané Lombard
- 1Faculty of Science, School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa.,2Sydney Brenner Institute for Molecular Bioscience (SBIMB), University of the Witwatersrand, The Mount, 9 Jubilee Road, Parktown, Johannesburg, Gauteng 2193 South Africa.,4Faculty of Health Sciences, Division of Human Genetics, School of Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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Nkomo P, Richter LM, Kagura J, Mathee A, Naicker N, Norris SA. Environmental lead exposure and pubertal trajectory classes in South African adolescent males and females. Sci Total Environ 2018; 628-629:1437-1445. [PMID: 30045563 DOI: 10.1016/j.scitotenv.2018.02.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
The effects of environmental lead exposure in the neuro-endocrine system have been shown to impact the maturation and tempo of puberty development in adolescents. In low and middle income countries very little is known regarding the detrimental health effects of childhood lead exposure with regard to the tempo of puberty development. To help address this gap in data, we examined the association between lead exposure and puberty progression in males and females. Study participants from the urban Birth to Twenty Plus (BT20+) birth cohort in Soweto-Johannesburg, South Africa with data for blood lead levels at age 13years, cord blood lead levels, pubic hair development and breast development in females, and pubic hair development and genital development in males, were included in this study. The sample comprised 1416 study participants (n=684 females). Pubertal development trajectory classes were defined using Latent Class Growth Analysis. Data were examined for (i) an association between cord blood lead levels and pubertal trajectory classes; and (ii) an association between blood lead levels at age 13years and pubertal trajectory classes. In females, there was an association between adolescent elevated blood lead levels (≥5μg/dL) and lower level of maturation at age 9years and slower progression of pubic hair and breast development (relative risk ratio (RRR)=0.45, p<0.0001; 95% CI (0.29-0.68)) and (RRR=0.46, p<0.01; 95% CI (0.27-0.77)), respectively. In males, elevated blood lead levels at birth were associated with slower tempo of pubic hair development (RRR=0.20, p<0.05). Findings from this study suggest a possible role for environmental lead in altering pubertal development in South African adolescents as shown by slower tempo of progression through the Tanner stages pubertal development in females and males. There were also gender-differences between the effects of prenatal and postnatal lead exposure during pubertal development.
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Affiliation(s)
- Palesa Nkomo
- Environment & Health Research Unit, Medical Research Council, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Linda M Richter
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Angela Mathee
- Environment & Health Research Unit, Medical Research Council, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, South Africa.
| | - Nisha Naicker
- Environment & Health Research Unit, Medical Research Council, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, South Africa.
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
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Pisa PT, Micklesfield LK, Kagura J, Ramsay M, Crowther NJ, Norris SA. Different adiposity indices and their association with blood pressure and hypertension in middle-aged urban black South African men and women: findings from the AWI-GEN South African Soweto Site. BMC Public Health 2018; 18:524. [PMID: 29673339 PMCID: PMC5907712 DOI: 10.1186/s12889-018-5443-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background To report associations between different adiposity indices [anthropometric and dual-energy X-ray absorptiometry (DXA) measures] and blood pressure (BP) and hypertension in urban black South African adults. Methods Anthropometric and DXA whole body measures were performed on 1026 men and 982 women. Participants were classified as being hypertensive if they had a systolic BP (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg. Within each gender the relationship of adiposity with BP and hypertension risk was assessed using linear and logistic regression models respectively. Bivariate models were computed for each body composition variable. Furthermore, we computed a multiple regression model to illustrates how body composition parameters are associated with the outcome variables independent of each other. Results The males were significantly taller and had a higher fat free soft tissue mass (FFSTM), DBP and socio-economic status, and were more likely to use tobacco and be hypertensive (48.0% vs. 38.8%). The females had higher body mass index (BMI), waist circumference (WC), fat mass (FM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), FM/FFSTM ratio and body fat % than males. All body composition parameters were positively associated with hypertension. In both males and females, the FM/FFSTM ratio associated the strongest with hypertension illustrating the following odds ratios [males: 70.37 (18.47, 268.16) p ≤ 0.001; females 2.48 (0.86,7.21) p = 0.09]. The multiple regression model, indicated that the VAT and WC significantly associated with both SBP and DBP in the men and women respectively, whilst WC was the only significant predictor for hypertension. Conclusions All body composition parameters were associated with hypertension and FM/FFSTM ratio showed the strongest relationship. It was reassuring that WC remains a useful measure of central adiposity that can be used as a risk indicator for hypertension if more sophisticated measures are not available. Furthermore, our data in part, implies that reducing abdominal adiposity in aging adults could contribute to reducing the risk of elevated blood pressure and hypertension. Electronic supplementary material The online version of this article (10.1186/s12889-018-5443-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pedro T Pisa
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Prioreschi A, Munthali RJ, Kagura J, Said-Mohamed R, De Lucia Rolfe E, Micklesfield LK, Norris SA. The associations between adult body composition and abdominal adiposity outcomes, and relative weight gain and linear growth from birth to age 22 in the Birth to Twenty Plus cohort, South Africa. PLoS One 2018; 13:e0190483. [PMID: 29338002 PMCID: PMC5770024 DOI: 10.1371/journal.pone.0190483] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/17/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The growing prevalence of overweight and obesity in low- or middle-income countries precipitates the need to examine early life predictors of adiposity. OBJECTIVES To examine growth trajectories from birth, and associations with adult body composition in the Birth to Twenty Plus Cohort, Soweto, South Africa. METHODS Complete data at year 22 was available for 1088 participants (536 males and 537 females). Conditional weight and height indices were generated indicative of relative rate of growth between years 0-2, 2-5, 5-8, 8-18, and 18-22. Whole body composition was measured at year 22 (range 21-25 years) using dual energy x-ray absorptiometry (DXA). Total fat free soft tissue mass (FFSTM), fat mass, and abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were recorded. RESULTS Birth weight was positively associated with FFSTM and fat mass at year 22 (β = 0.11, p<0.01 and β = 0.10, p<0.01 respectively). Relative weight gain from birth to year 22 was positively associated with FFSTM, fat mass, VAT, and SAT at year 22. Relative linear growth from birth to year 22 was positively associated with FFSTM at year 22. Relative linear growth from birth to year 2 was positively associated with VAT at year 22. Being born small for gestational age and being stunted at age 2 years were inversely associated with FFSTM at year 22. CONCLUSIONS The importance of optimal birth weight and growth tempos during early life for later life body composition, and the detrimental effects of pre- and postnatal growth restriction are clear; yet contemporary weight-gain most strongly predicted adult body composition. Thus interventions should target body composition trajectories during childhood and prevent excessive weight gain in early adulthood.
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Affiliation(s)
- Alessandra Prioreschi
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Richard J. Munthali
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Emanuella De Lucia Rolfe
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Lisa K. Micklesfield
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Micklesfield LK, Kagura J, Munthali R, Crowther NJ, Jaff N, Gradidge P, Ramsay M. Demographic, socio-economic and behavioural correlates of BMI in middle-aged black men and women from urban Johannesburg, South Africa. Glob Health Action 2018; 11:1448250. [PMID: 30079826 PMCID: PMC6084500 DOI: 10.1080/16549716.2018.1448250] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/02/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is a high and increasing prevalence of overweight and obesity in South Africans of all ages. Risk factors associated with overweight and obesity must be identified to provide targets for intervention. OBJECTIVE To identify the demographic, socio-economic and behavioural factors associated with body mass index (BMI) in middle-aged black South African men and women. METHODS Data on demographic and socio-economic factors were collected via questionnaire on 1027 men and 1008 women from Soweto Johannesburg, South Africa. Weight and height were measured and BMI was determined. Behavioural factors included tobacco use and consumption of alcohol, and physical activity data were collected using the Global Physical Activity Questionnaire. Menopausal status was determined for the women, and HIV status was available for 93.6% of the men and 39.9% of the women. RESULTS Significantly more women were overweight or obese than men (87.9 vs. 44.9%). Smoking prevalence (current or former) and minutes spent in moderate to vigorous intensity physical activity was significantly different between the sexes (both p < 0.0001). In the final hierarchical model, marital status (+ married/cohabiting), household asset score (+), current smoking (-), moderate to vigorous physical activity (-) and HIV status (- HIV infected) significantly contributed to 26% of the variance in BMI in the men. In the women, home language (Tswana-speaking compared to Zulu-speaking), marital status (+ unmarried/cohabiting), education (-), current smoking (-) and HIV status (- HIV infected) significantly contributed to 14% of the variance in BMI. CONCLUSIONS The sex difference in BMI and the prevalence of overweight and obesity between black South African men and women from Soweto, as well as the sex-specific associations with various demographic, socio-economic and behavioural factors, highlight the need for more tailored interventions to slow down the obesity epidemic.
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Affiliation(s)
- Lisa K. Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Munthali
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Jaff
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philippe Gradidge
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - http://orcid.org/0000-0001-7124-3788NorrisShane A.
a
as members of AWI-Gen the H3Africa Consortium
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Munthali RJ, Kagura J, Lombard Z, Norris SA. Early Life Growth Predictors of Childhood Adiposity Trajectories and Future Risk for Obesity: Birth to Twenty Cohort. Child Obes 2017; 13:384-391. [PMID: 28520476 DOI: 10.1089/chi.2016.0310] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 12/16/2022]
Abstract
BACKGROUND There is growing evidence of variations in adiposity trajectories among individuals, but the influence of early life growth patterns on these trajectories is underresearched in low- and middle-income countries. Therefore, our aim was to examine the association between early life conditional weight gain and childhood adiposity trajectories. METHODS We previously identified distinct adiposity trajectories (four for girls and three for boys) in black South African children (boys = 877; girls = 947). The association between the trajectories and early life growth patterns, and future obesity risk was assessed by multivariate linear and multinomial logistic and logistic regressions. Conditional weight gain independent of height was computed for infancy (0-2 years) and early childhood (2-4 years). RESULTS Conditional weight gain before 5 years of age was significantly associated with early onset of obesity or overweight (excess weight) BMI trajectories in both boys and girls. In girls, greater conditional weight gain in infancy was associated with increased relative risk of being in the early-onset obese to morbid obese trajectory, with relative risk ratios of 2.03 (95% confidence interval: 1.17-3.52) compared to belonging to a BMI trajectory in the normal range. Boys and girls in the early-onset obesity or overweight BMI trajectories were more likely to be overweight or obese in early adulthood. CONCLUSIONS Excessive weight gain in infancy and early childhood, independent of linear growth, predicts childhood and adolescent BMI trajectories toward obesity. These results underscore the importance of early life factors in the development of obesity and other NCDs in later life.
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Affiliation(s)
- Richard J Munthali
- 1 Faculty of Science, School of Molecular and Cell Biology, University of the Witwatersrand , Johannesburg, South Africa .,2 Sydney Brenner Institute for Molecular Bioscience (SBIMB), University of the Witwatersrand , Johannesburg, South Africa .,3 MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand , Johannesburg, South Africa
| | - Juliana Kagura
- 3 MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand , Johannesburg, South Africa
| | - Zané Lombard
- 1 Faculty of Science, School of Molecular and Cell Biology, University of the Witwatersrand , Johannesburg, South Africa .,4 Division of Human Genetics, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand and National Health Laboratory Service , Johannesburg, South Africa
| | - Shane A Norris
- 3 MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand , Johannesburg, South Africa
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Kagura J, Adair LS, Munthali RJ, Pettifor JM, Norris SA. Association Between Early Life Growth and Blood Pressure Trajectories in Black South African Children. Hypertension 2016; 68:1123-1131. [PMID: 27672027 DOI: 10.1161/hypertensionaha.116.08046] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 06/23/2016] [Accepted: 08/23/2016] [Indexed: 11/16/2022]
Abstract
Early growth is associated with blood pressure measured on one occasion, but whether early life growth patterns are associated with longitudinal blood pressure trajectories is under-researched. Therefore, we sought to examine the association between early growth and blood pressure trajectories from childhood to adulthood. Blood pressure was measured on 7 occasions between ages 5 and 18 years in the Birth to Twenty cohort study, and conditional variables for growth in infancy and mid-childhood were computed from anthropometric measures (n=1937, 52% girls). We used a group-based trajectory modeling approach to identify distinct height-adjusted blood pressure trajectories and then tested their association with growth between birth and mid-childhood adjusting for several covariates. Three trajectory groups were identified for systolic and diastolic blood pressure: lower, middle, and upper in boys and girls, separately. In boys, predictors of the middle or upper systolic blood pressure trajectories versus the lower trajectory were in birth weight (odds ratio 0.75 [95% confidence interval 0.58-0.96] per SD) and relative weight gain in infancy (4.11 [1.25-13.51] per SD). In girls, greater relative weight gain and linear growth in both infancy and mid-childhood were consistently associated with an almost 2-fold higher likelihood of being in the upper versus lower systolic blood pressure trajectory. The associations for the diastolic blood pressure trajectories were inconsistent. These findings emphasize the importance of identifying children at risk of progression to high blood pressure. Accelerated growth in infancy and mid-childhood may be a key target for early life intervention in prevention of elevated blood pressure progression.
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Affiliation(s)
- Juliana Kagura
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa (J.K., L.S.A., R.J.M., J.M.P., S.A.N.); and Department of Nutrition, University of North Carolina, Chapel Hill (L.S.A.).
| | - Linda S Adair
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa (J.K., L.S.A., R.J.M., J.M.P., S.A.N.); and Department of Nutrition, University of North Carolina, Chapel Hill (L.S.A.)
| | - Richard J Munthali
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa (J.K., L.S.A., R.J.M., J.M.P., S.A.N.); and Department of Nutrition, University of North Carolina, Chapel Hill (L.S.A.)
| | - John M Pettifor
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa (J.K., L.S.A., R.J.M., J.M.P., S.A.N.); and Department of Nutrition, University of North Carolina, Chapel Hill (L.S.A.)
| | - Shane A Norris
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa (J.K., L.S.A., R.J.M., J.M.P., S.A.N.); and Department of Nutrition, University of North Carolina, Chapel Hill (L.S.A.)
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Munthali RJ, Kagura J, Lombard Z, Norris SA. Childhood adiposity trajectories are associated with late adolescent blood pressure: birth to twenty cohort. BMC Public Health 2016; 16:665. [PMID: 27473865 PMCID: PMC4966706 DOI: 10.1186/s12889-016-3337-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/21/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Elevated blood pressure in childhood is a risk factor for adult hypertension which is a global health problem. Excess adiposity in childhood creates a predisposition to develop adult hypertension. Our aim was to explore distinct sex-specific adiposity trajectories from childhood to late adolescence and examined their association with blood pressure. METHODS Latent Class Growth Mixture Modeling (LCGMM) on longitudinal data was used to derive sex-specific and distinct body mass index (BMI: kg/m(2)) trajectories. We studied 1824 black children (boys = 877, girls = 947) from the Birth to Twenty (Bt20) cohort from Soweto, South Africa, and obtained BMI measures at ages 5 through 18 years. Participants with at least two age-point BMI measures, were included in the analysis. Analysis of variance (ANOVA), chi-square test, multivariate linear and standard logistic regressions were used to test study characteristics and different associations. RESULTS We identified three (3) and four (4) distinct BMI trajectories in boys and girls, respectively. The overall prevalence of elevated blood pressure (BP) was 34.9 % (39.4 % in boys and 30.38 % in girls). Boys and girls in the early onset obesity or overweight BMI trajectories were more likely to have higher BP values in late adolescence. Compared to those in the normal weight BMI trajectory, girls in early onset obesity trajectories had an increased risk of elevated BP with odds ratio (OR) of 2.18 (95 % confidence interval 1.31 to 4.20) and 1.95 (1.01 to 3.77). We also observed the weak association for boys in early onset overweight trajectory, (p-value = 0.18 and odds ratio of 2.39 (0.67 to 8.57)) CONCLUSIONS: Distinct weight trajectories are observed in black South African children from as early as 5 years. Early onset adiposity trajectories are associated with elevated BP in both boys and girls. It is important to consider individual patterns of early-life BMI development, so that intervention strategies can be targeted to at-risk individuals.
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Affiliation(s)
- Richard J. Munthali
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, The Mount, 9 Jubilee Road, Parktown, Johannesburg, 2193 South Africa
- Sydney Brenner Institute for Molecular Biosciences (SBIMB), University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Zané Lombard
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, The Mount, 9 Jubilee Road, Parktown, Johannesburg, 2193 South Africa
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Shane A. Norris
- MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
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Kagura J, Adair LS, Pisa PT, Griffiths PL, Pettifor JM, Norris SA. Association of socioeconomic status change between infancy and adolescence, and blood pressure, in South African young adults: Birth to Twenty Cohort. BMJ Open 2016; 6:e008805. [PMID: 27029771 PMCID: PMC4823398 DOI: 10.1136/bmjopen-2015-008805] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Social epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between infancy and adolescence, and blood pressure, in young adults, and the impact of early growth on this relationship. SETTING Data for this study were obtained from a 'Birth to Twenty' cohort in Soweto, Johannesburg, in South Africa. PARTICIPANTS The study included 838 Black participants aged 18 years who had household SES measures in infancy and at adolescence, anthropometry at 0, 2, 4 and 18 years of age and blood pressure at the age of 18 years. METHODS We computed SES change using asset-based household SES in infancy and during adolescence as an exposure variable, and blood pressure and hypertension status as outcomes. Multivariate linear and logistic regressions were used to investigate the associations between SES change from infancy to adolescence, and age, height and sex-specific blood pressure and hypertension prevalence after adjusting for confounders. RESULTS Compared to a persistent low SES, an upward SES change from low to high SES tertile between infancy and adolescence was significantly associated with lower systolic blood pressure (SBP) at the age of 18 years (β=-4.85; 95% CI -8.22 to -1.48; p<0.01; r(2)=0.1804) after adjusting for SES in infancy, small-for-gestational-age (SGA) and weight gain. Associations between SES change and SBP were partly explained by weight gain between birth and the age of 18 years. There was no association between SES mobility and diastolic blood pressure, mean arterial pressure or hypertension status. CONCLUSIONS Our study confirms that upward SES change has a protective effect on SBP by the time participants reach young adulthood. Socioeconomic policies and interventions that address inequality may have the potential to reduce cardiovascular disease burden related to BP in later life.
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Affiliation(s)
- Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Linda S Adair
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Pedro T Pisa
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Paula L Griffiths
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Centre for Global Health and Human Development, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - John M Pettifor
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Kagura J, Adair LS, Musa MG, Pettifor JM, Norris SA. Blood pressure tracking in urban black South African children: birth to twenty cohort. BMC Pediatr 2015; 15:78. [PMID: 26173634 PMCID: PMC4502542 DOI: 10.1186/s12887-015-0402-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 07/06/2015] [Indexed: 12/26/2022] Open
Abstract
Background Hypertension is an emerging public health problem in South Africa. Recent evidence from longitudinal studies has shown that hypertension in adulthood can be traced back to childhood. There is scarcity of longitudinal data on paediatric blood pressure (BP) particularly in African populations. The objective of this study is to assess the prevalence of hypertension and evaluate BP tracking between childhood and late adolescence among South African black Children. Methods This study utilized data from the Birth to Twenty cohort, which is comprised of children born in Soweto, Johannesburg in 1990 (N = 3273, 78.5 % black). Data on BP and anthropometry were collected at six follow-up periods between ages 5 and 18 years. Blood pressure status was classified using the Fourth report on National High Blood pressure program in children and adolescents. Pearson correlation coefficients and relative risk ratios (RR) were used to describe tracking of BP between childhood and late adolescence. Results The overall point prevalence ranged from 9.2 to 16.4 % for prehypertension and 8.4 to 24.4 % for hypertension. Tracking coefficients ranged from 0.20 to 0.57 for SBP and 0.17- 0.51 for DBP in both sexes over the 14 years of measurement. The proportion of children who maintained an elevated BP status between childhood, adolescence and age 18 years ranged from 36.1 % at age 5 years to 56.3 % at age 13 years. Risk of having elevated BP at 18 years ranged from; RR: 1.60 (95 % CI: 1.29–2.00) at 5 years to RR: 2.71 (95 % CI: 2.32–3.17) at 14 years of age. Conclusions This study reports high prevalence of elevated BP which tracks from early childhood into late adolescence. These findings emphasize the importance of early identification of children at risk of developing elevated BP and related risk factors plus timely intervention to prevent hypertension in adulthood.
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Affiliation(s)
- Juliana Kagura
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa.
| | - Linda S Adair
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa. .,Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
| | - Mogi G Musa
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa.
| | - John M Pettifor
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa.
| | - Shane A Norris
- Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa.
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