Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data.

BACKGROUND: Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. METHODS AND FINDINGS: We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. CONCLUSIONS: We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra.

Guidelines for surgeons on establishing projects in low-income countries.

BACKGROUND: There is increasing interest by surgeons in high-income countries to support colleagues in low-income countries to improve the provision of surgical care, particularly in rural areas. Such interest may be demonstrated by single individuals, short-term surgical missions, or establishment of partnerships. Such altruistic efforts may cause problems unless properly planned and carried out. METHODS: We reviewed the available literature and consulted widely to establish consensus guidelines for any surgeon considering participating in an initiative to improve surgical care in low-income countries. RESULTS: A series of recommendations is presented. These include ensuring that projects are appropriate, that there is an emphasis on training local healthcare providers in all aspects of perioperative care, that outcomes are monitored, and that initiatives work with local and regional training programs. CONCLUSIONS: With adherence to these recommendations, we hope that future partnerships and missions can maximize their effectiveness and minimize the risks of potential harm done.

The health of the "older women" in Accra, Ghana: results of the Women's Health Study of Accra.

The health of women residing in the developing countries is not limited to reproductive health conditions or infectious diseases. While these illnesses remain serious threats to a healthy life, as the population ages, the prevalence of illnesses considered to be of significance only in industrialized nations also increasingly afflicts the residents of the developing worlds. The health and well-being of the older women was evaluated in the 2003 Women's Health Study of Accra. This community based survey and clinical and laboratory examination of 1,328 women identified a significantly high prevalence of malaria and chronic, non-communicable diseases in all age groups without regard to education level or income. Hypertension, diabetes and obesity are significantly prevalent in women age 50 years and older. The prevalence of conditions which adversely affect health and quality of life, including impaired visual acuity, poor dentition, pain and limitations with mobility is significant in the women age 50 years and older. While these data are specific to Ghana, they have the potential to be generalizable to women in other urban areas in transition. As the life expectancy is increasing in developing countries, an increased awareness and treatment of chronic health conditions in the older women is critical to ensure a healthy life as they enter their golden years.

Results of the Women's Health Study of Accra: assessment of blood pressure in urban women.

BACKGROUND: The Women's Health Study of Accra was conducted to determine the burden of illness in a representative sampling of adult urban women. METHODS: This community-based survey selected study participants by a 2-stage cluster probability sample stratified by socioeconomic status based on the 2000 Ghanaian census data. It included a comprehensive household survey and medical and laboratory examination for 1328 women. Hypertension was defined as systolic blood pressure measurement > or = 140 mmHg or a diastolic of > or = 90 mmHg. RESULTS: A positive review of systems for hypertension was reported in 309 (23.7%) with only 52.5% using anti-hypertensive medication and only 4.4% had a normal blood pressure. The blood pressure measurement was elevated in 712/1303 (54.6%). Significant risk factors for an elevated blood pressure included age > or = 50 years (OR=14.24 [10.74,18.8], p<0.001); BMI > or = 30.00 (OR=2.89 [2.26,3.70], p<0.001); parity of three or more children (OR=5.16 [2.90,9.19], p<0.001); menopause before age 50 years (OR=5.88 [1.11,31.17], p=0.037); elevated fasting blood glucose (OR=3.98 [2.38,6.64], p<0.001); elevated fasting cholesterol (OR=1.69 [1.24, 2.30], p=0.001); no formal education (OR=2.75 [1.70,4.43], p<0.001) and first degree family history of hypertension (p<0.001). There was no association with income level, diet or activity. Significant protective factors include young age, nulliparity, normal BMI, and a lower than normal fasting LDL-cholesterol. CONCLUSION: The prevalence of presumptive hypertension is greater than anticipated. Public health initiatives to increase awareness of hypertension and to initiate and maintain treatment regimens will serve to improve the health of the women and the urban community.