Coprevalence and associations of diabetes mellitus and hypertension among people living with HIV/AIDS in Cameroon.

BACKGROUND: The association between HIV infection and increased cardiometabolic risk, attributed to chronic inflammation in people living with HIV (PLWH) and/or antiretroviral therapy (ART) effects, has been inconsistent. In this study, we aimed to assess the associations of HIV-related factors with hypertension (HTN) and type-2 diabetes mellitus (T2DM), and the potential mediation effects of body mass index (BMI) in the associations between ART use and HTN or T2DM in PLWH in Cameroon. METHODS: A cross-sectional study was conducted with 14,119 adult PLWH from Cameroon enrolled in the International epidemiology Databases to Evaluate AIDS (IeDEA) between 2016 and 2021. HTN was defined as systolic/diastolic blood pressure ≥ 140/90 mmHg and/or current use of antihypertensive medication, while T2DM was defined as fasting blood sugar ≥ 126 mg/dL and/or use of antidiabetic medications. Univariable and multivariable multinomial logistic regression analyses examined the associations of factors with HTN alone, T2DM alone, and both (HTN + T2DM). Mediation analyses were conducted to assess the potential mediation roles of BMI, while controlling for age, sex, and smoking. RESULTS: Of the 14,119 participants, 9177 (65%) were women, with a median age of 42 (25th-75th percentiles: 35-51) years. Age > 50 years was associated with HTN alone, T2DM alone, and HTN + T2DM compared to the age group 19-29 years. Men had higher odds of having HTN + T2DM. Overweight and obesity were predictors of HTN alone compared to being underweight. WHO stages II and III HIV disease were inversely associated with HTN alone compared to stage I. The odds of diabetes alone were lower with ART use. BMI partially mediated the association between ART use and hypertension, with a proportion of mediation effect of 49.6% (all p < 0.02). However, BMI did not mediate the relationship between ART use and diabetes. CONCLUSIONS: Traditional cardiovascular risk factors were strongly associated with hypertension among PLWH, while HIV-related exposures had smaller associations. BMI partially mediated the association between ART use and hypertension. This study emphasizes the importance of screening, monitoring, and managing HTN and T2DM in older, male, and overweight/obese PLWH. Further research on the associations of HIV disease stage and ART use with HTN and T2DM is warranted.

Prevalence and associations of chronic kidney disease among antiretroviral therapy-naïve persons living with HIV in Lagos, Nigeria.

BACKGROUND: Chronic kidney disease (CKD) affects almost 10% of the global populace including people living with HIV (PLWH). PLWH acquire CKD from both traditional and HIV-specific CKD risk factors. This study aimed to determine the prevalence of CKD and associated factors among antiretroviral therapy (ART) naïve PLWH in Lagos, Nigeria.  METHODS: This is a secondary data analysis among adult (≥ 18 years) ART-naïve PLWH enrolled at a large ART clinic in Lagos over 6 years. CKD was defined as estimated glomerular filtration rates (eGFR) below 60ml/min/1.73m2 over 3 months. Three estimators [Body surface area corrected Cockcroft Gault (BSA-CG), Modification of Diet in Renal Disease (MDRD), Chronic kidney disease Epidemiology Collaboration (CKD-EPI)] were used to determine the burden of CKD with no race correction factor. Age- and sex-standardised prevalence rates were determined. Cohen Kappa and Spearman correlations were used to compare the estimators. Logistic regressions were applied to identify variables associated with prevalent CKD. RESULTS: Among 2 772 PLWH, the mean age was 38 years with males older than females (p < 0.001). The majority of participants were females (62.1%), married (54.8%), employed (85.7%), had underweight or normal body mass index (BMI) (62.2%), and were diagnosed with World Health Organization (WHO) clinical stages 1 and 2 (55.5%). The age- and sex-standardised prevalence of CKD ranged from 10.0 - 17.6% with the highest Spearman's correlation (0.928) observed with MDRD and CKD-EPI equations. Increasing age [AOR (95% CI), equation] was significantly associated with CKD across all equations [1.09 (1.06 - 1.13), BSA-CG; 1.07 (1.05 - 1.10), MDRD; 1.09 (1.06 -1.12), CKD-EPI]. Other variables associated with CKD [AOR (95% CI), equation] were anaemia [2.50 (1.34 - 4.68), BSA-CG; 1.73 (1.04 - 2.86), MDRD], BMI <25 kg/m2 [3.35 (1.55 - 7.26), BSA-CG; 2.02 (1.18 - 3.46), CKD-EPI], and CD4 counts ≤ 200 cells/µL [2.02 (1.06 - 3.87), BSA-CG]. CONCLUSION: There was a high prevalence of CKD among ART-naïve PLWH at enrollment, which highlights the need to evaluate this population for CKD. Aside increasing age and low CD4 counts, none of the traditional or HIV-specific risk factors were related to CKD diagnosis.

Social determinants of health and diabetes self-care management in South Africa.

OBJECTIVE: Diabetes is an incapacitating condition affecting millions of people in South Africa. Maintaining optimal glycaemic control is crucial in preventing diabetes complications, highlighting the importance of diabetes self-care. This study examined how Social Determinants of Health (SDoH) are associated with self-care management practices in individuals with diabetes in South Africa using the framework developed by the Healthy People 2020 initiative. METHODS: This study utilised cross-sectional Project Mind baseline data collected in 2017. Self-care management was coded on a scale from '0' (never) to '7' (daily adherence). For analysis, this scale was dichotomised into two categories: low self-care (scores 0-5) and high self-care (scores 6-7). Furthermore, adherence with these daily self-care activities was categorised into three levels: no adherence, partial adherence (inconsistent or partial adherence to activities), and full adherence (consistent adherence to all self-care activities). RESULTS: The analytical sample (n = 539) was predominantly female (76%), with a mean age of 54 years, urban residents (60%), unemployed (70%), and attained secondary education (11.3%). In determining the attainment of a higher scale of self-care, age (AOR = 1.02, CI=[0.99,1.05]) and secondary education (AOR = 1.13, CI=[1.02, 2.03]) were associated with an increase in the scale of self-care. Conversely, urban residency (AOR = 0.50, CI=[0.29,0.88]) and being obese (AOR = 0.43, CI=[0.19,1.00]) were associated with a lower scale of self-care. Although not statistically robust, food insecurity decreased while being a woman and having a stable house showed an increased association. Travelling longer distances to access healthcare was positively associated with no adherence, and urban residency has a negative association with full adherence relative to partial adherence. CONCLUSIONS: The associations between SDoH and diabetes self-care management within a South African context highlight the need for a more holistic understanding and approach to interventions. Future endeavours should examine these determinants more broadly and formulate integrative strategies to ameliorate diabetes self-care.

Targeted proteomics identifies potential biomarkers of dysglycaemia, beta cell function and insulin sensitivity in Black African men and women.

AIMS/HYPOTHESIS: Using a targeted proteomics approach, we aimed to identify and validate circulating proteins associated with impaired glucose metabolism (IGM) and type 2 diabetes in a Black South African cohort. In addition, we assessed sex-specific associations between the validated proteins and pathophysiological pathways of type 2 diabetes. METHODS: This cross-sectional study included Black South African men (n=380) and women (n=375) who were part of the Middle-Aged Soweto Cohort (MASC). Dual-energy x-ray absorptiometry was used to determine fat mass and visceral adipose tissue, and fasting venous blood samples were collected for analysis of glucose, insulin and C-peptide and for targeted proteomics, measuring a total of 184 pre-selected protein biomarkers. An OGTT was performed on participants without diabetes, and peripheral insulin sensitivity (Matsuda index), HOMA-IR, basal insulin clearance, insulin secretion (C-peptide index) and beta cell function (disposition index) were estimated. Participants were classified as having normal glucose tolerance (NGT; n=546), IGM (n=116) or type 2 diabetes (n=93). Proteins associated with dysglycaemia (IGM or type 2 diabetes) in the MASC were validated in the Swedish EpiHealth cohort (NGT, n=1706; impaired fasting glucose, n=550; type 2 diabetes, n=210). RESULTS: We identified 73 proteins associated with dysglycaemia in the MASC, of which 34 were validated in the EpiHealth cohort. Among these validated proteins, 11 were associated with various measures of insulin dynamics, with the largest number of proteins being associated with HOMA-IR. In sex-specific analyses, IGF-binding protein 2 (IGFBP2) was associated with lower HOMA-IR in women (coefficient -0.35; 95% CI -0.44, -0.25) and men (coefficient -0.09; 95% CI -0.15, -0.03). Metalloproteinase inhibitor 4 (TIMP4) was associated with higher insulin secretion (coefficient 0.05; 95% CI 0.001, 0.11; p for interaction=0.025) and beta cell function (coefficient 0.06; 95% CI 0.02, 0.09; p for interaction=0.013) in women only. In contrast, a stronger positive association between IGFBP2 and insulin sensitivity determined using an OGTT (coefficient 0.38; 95% CI 0.27, 0.49) was observed in men (p for interaction=0.004). A posteriori analysis showed that the associations between TIMP4 and insulin dynamics were not mediated by adiposity. In contrast, most of the associations between IGFBP2 and insulin dynamics, except for insulin secretion, were mediated by either fat mass index or visceral adipose tissue in men and women. Fat mass index was the strongest mediator between IGFBP2 and insulin sensitivity (total effect mediated 40.7%; 95% CI 37.0, 43.6) and IGFBP2 and HOMA-IR (total effect mediated 39.1%; 95% CI 31.1, 43.5) in men. CONCLUSIONS/INTERPRETATION: We validated 34 proteins that were associated with type 2 diabetes, of which 11 were associated with measures of type 2 diabetes pathophysiology such as peripheral insulin sensitivity and beta cell function. This study highlights biomarkers that are similar between cohorts of different ancestry, with different lifestyles and sociodemographic profiles. The African-specific biomarkers identified require validation in African cohorts to identify risk markers and increase our understanding of the pathophysiology of type 2 diabetes in African populations.

Waist circumference thresholds predicting incident dysglycaemia and type 2 diabetes in Black African men and women.

AIMS: To determine the waist circumference (WC) thresholds for the prediction of incident dysglycaemia and type 2 diabetes (T2D) in Black South African (SA) men and women and to compare these to the advocated International Diabetes Federation (IDF) Europid thresholds. MATERIALS AND METHODS: In this prospective study, Black SA men (n = 502) and women (n = 527) from the Middle-aged Sowetan Cohort study who had normal or impaired fasting glucose at baseline (2011-2015) were followed up until 2017 to 2018. Baseline measurements included anthropometry, blood pressure and fasting glucose, HDL cholesterol and triglyceride concentrations. At follow-up, glucose tolerance was assessed using an oral glucose tolerance test. The Youden index was used to determine the optimal threshold of WC to predict incident dysglycaemia and T2D. RESULTS: In men, the optimal WC threshold was 96.8 cm for both dysglycaemia and T2D (sensitivity: 56% and 70%; specificity: 74% and 70%, respectively), and had higher specificity (P < 0.001) than the IDF threshold of 94 cm. In women, the optimal WC threshold for incident dysglycaemia was 91.8 cm (sensitivity 86%, specificity 37%) and for T2D it was 95.8 cm (sensitivity 85%, specificity 45%), which had lower sensitivity, but higher specificity to predict incident dysglycaemia and T2D than the IDF threshold of 80 cm (sensitivity: 97% and 100%; specificity: 12% and 11%, respectively)). CONCLUSIONS: We show for the first time using prospective cohort data from Africa that the IDF Europid WC thresholds are not appropriate for an African population, and show that African-specific WC thresholds perform better than the IDF Europid thresholds to predict incident dysglycaemia and T2D.

Iodine deficiency in pregnancy along a concentration gradient is associated with increased severity of preeclampsia in rural Eastern Cape, South Africa.

BACKGROUND: Preeclampsia is a leading cause of maternal mortality and morbidity in South Africa. Iodine deficiency in pregnancy, which is amenable to correction through iodine supplementation, has been reported to increase the risk of preeclampsia. However, the association of iodine nutrition status with preeclampsia in South Africa has not been studied. METHODS: We enrolled 51 randomly selected normotensive pregnant controls at term together with 51 consecutively selected cases of preeclampsia and 51 cases of severe preeclampsia/eclampsia, all in the third trimester, from Mthatha Regional and Nelson Mandela Academic Hospital in the Eastern Cape Province. Urinary iodine concentration (UIC), serum thyroid-stimulating hormone (TSH), triiodothyronine (FT3), thyroxine (FT4) and thyroglobulin (Tg) levels were compared between cases and controls. RESULTS: The respective chronological and gestational ages at enrolment for normotensive, preeclampsia and severe preeclampsia/eclampsia participants were: age 23, 24 and 19 years (p = 0.001), and gestational age 38, 34, and 35 weeks (p < 0.001). The median gravidity was 1 for all three groups. The median UIC, FT4, FT3 revealed a decreasing and Tg a rising trend with the severity of preeclampsia (p < 0.05). TSH had a non-significant rising trend (p > 0.05). The respective median values for normotensive, preeclampsia and severe preeclampsia/eclampsia participants were UIC 217.1, 127.7, and 98.8 µg/L; FT4 14.2, 13.7, and 12. pmol/L; FT3 4.8, 4.4, and 4.0 pmol//L; Tg 19.4, 21.4, and 32. Nine microgram per liter; TSH 2.3, 2.3, and 2.5 mIU/L. UIC < 100 µg/L, Tg > 16 µg/L and FT4 < 11.3 pmol/L were independent predictors of preeclampsia/eclampsia syndrome. CONCLUSION: Women with severe preeclampsia/eclampsia had significantly low UIC and high Tg, suggesting protracted inadequate iodine intake. Inadequate iodine intake during pregnancy severe enough to cause elevated Tg and FT4 deficiency was associated with an increased risk of severe preeclampsia/eclampsia.

Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017.

BACKGROUND: Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017. METHODS: Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimate disease for all countries, because data on nonrheumatic valvular diseases are extremely limited for some regions of the world, such as Sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for both sexes and each 5-year age group, location, and year from 1990 to 2017. RESULTS: Globally, CAVD and degenerative mitral valve disease caused 102 700 (95% uncertainty interval [UI], 82 700-107 900) and 35 700 (95% UI, 30 500-42 500) deaths, and 12.6 million (95% UI, 11.4 million-13.8 million) and 18.1 million (95% UI, 17.6 million-18.6 million) prevalent cases existed in 2017, respectively. A total of 2.5 million (95% UI, 2.3 million-2.8 million) DALYs were estimated as caused by nonrheumatic valvular diseases globally, representing 0.10% (95% UI, 0.09%-0.11%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and degenerative mitral valve disease between 1990 and 2017 by 101% (95% UI, 79%-117%) and 35% (95% UI, 23%-47%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries. CONCLUSIONS: These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults. Efforts to clarify modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.

The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Chronic kidney disease (CKD) causes substantial global morbidity and increases cardiovascular and all-cause mortality. Unlike other chronic diseases with established strategies for screening, there has been no consensus on whether health systems and governments should prioritize early identification and intervention for CKD. Guidelines on evaluating and managing early CKD are available but have not been universally adopted in the absence of incentives or quality measures for prioritizing CKD care. The burden of CKD falls disproportionately upon persons with lower socioeconomic status, who have a higher prevalence of CKD, limited access to treatment, and poorer outcomes. Therefore, identifying and treating CKD at the earliest stages is an equity imperative. In 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a controversies conference entitled "Early Identification and Intervention in CKD." Participants identified strategies for screening, risk stratification, and treatment for early CKD and the key health system and economic factors for implementing these processes. A consensus emerged that CKD screening coupled with risk stratification and treatment should be implemented immediately for high-risk persons and that this should ideally occur in primary or community care settings with tailoring to the local context.

Atrial thrombus detection on transoesophageal echocardiography in patients with atrial fibrillation undergoing cardioversion or catheter ablation: A pooled analysis of rates and predictors.

OBJECTIVE: To summarize data on the rates and predictors of left atrial thrombus/left atrial appendage thrombus (LAT/LAAT) detection by transoesophageal echocardiography (TEE) before electrical cardioversion (ECV) or catheter ablation (CA) for atrial fibrillation (AF). METHODS: EMBASE, MEDLINE, and Web of Science Core Collection were searched to identify all studies providing relevant data and published by October 7, 2020. A random-effects meta-analysis method was used to pool effect size estimates. RESULTS: A total of 85 studies were included, reporting data from 56 660 patients with AF. In patients undergoing CA and ECV, the pooled prevalence of LAT/LAAT was 1.8% and 7.5% in those not on oral anticoagulation (OAC), 1.8% and 5.5% in those taking OAC, and 1.3% and 4.9% in case of adequate OAC, respectively. According to the type of OAC, the prevalence was 2.0% and 7.6% for vitamin K antagonist, 1.3% and 3.5% for direct oral anticoagulant. Predictors of LAT/LAAT detection were nonparoxysmal AF (odds ratio [OR]: 3.6, 95% confidence interval: 2.4-5.2), hypertension (OR: 2.9, 1.2-7.0), previous stroke (OR: 3.0, 1.6-5.63), heart failure (OR: 4.3, 2.7-6.8), and CHADS2 score ≥2 (OR: 3.3, 1.9-5.8) for patients undergoing CA; and heart failure (OR: 2.8, 1.3-6.2) and the CHA2 DS2 -VASc score (OR: 2.55, 1.5-4.5) for those undergoing ECV. CONCLUSION: The prevalence of LAT/LAAT in AF patients undergoing ECV or CA varies widely, mainly due to differences in patient risk profiles and OAC types. Further research should determine whether the predictors of LAT/LAAT detection identified by this study could be used to select patients who require preprocedural TEE.

The association of red meat intake with inflammation and circulating intermediate biomarkers of type 2 diabetes is mediated by central adiposity.

We explored the role of lipid accumulation products and visceral adiposity on the association between red meat consumption (RMC) and markers of insulin resistance (IR) and inflammation in USA adults. Data on RMC and health outcome measurements were extracted from the 2005-2010 US National Health and Nutrition Examination Surveys. Overall 16 621 participants were included in the analysis (mean age = 47·1 years, 48·3 % men). ANCOVA and 'conceptus causal mediation' models were applied while accounting for survey design. In adjusted models, a lower RMC was significantly associated with a cardio-protective profile of IR and inflammation. BMI had significant mediation effects on the association between RMC and C-reactive protein (CRP), apo B, fasting blood glucose (FBG), insulin, homoeostatic model assessment of IR and ß-cell function, glycated Hb (HbA1c), TAG:HDL ratio and TAG glucose (TyG) index (all Ps < 0·05). Both waist circumference and anthropometrically predicted visceral adipose tissue mediated the association between RMC and CRP, FBG, HbA1c, TAG:HDL ratio and TyG index (all Ps < 0·05). Our findings suggest that adiposity, particularly the accumulation of abdominal fat, accounts for a significant proportion of the associations between red meat consumption, IR and inflammation.

Risk models to predict late-onset seizures after stroke: A systematic review.

BACKGROUND AND PURPOSE: We performed a systematic review to evaluate available risk models to predict late seizure onset among stroke survivors. METHODS: We searched major databases (PubMed, SCOPUS, and Cochrane Library) from inception to October 2020 for articles on the development and/or validation of risk models to predict late seizures after a stroke. The impact of models to predict late-onset seizures was also assessed. We included seven articles in the final analysis. For each of these studies, we evaluated the study design and scope of predictors analyzed to derive each model. We assessed the performance of the models during internal and external validation in terms of discrimination and calibration. RESULTS: Three studies focused on ischemic stroke alone, with c-statistic values ranging from 0.73 to 0.77. The SeLECT model from Switzerland was externally validated in Italian, German, and Austrian cohorts where c-statistics ranged from 0.69 to 0.81. This model along with the PSEiCARe model, were internally validated and calibration performance was provided for both models. The CAVS and CAVE models reported on the risk of late-onset seizures in patients with hemorrhagic stroke. The CAVS model derivation cohort was racially diverse. The CAVS model's c-statistic was 0.76, while the CAVE model had a c-statistic of 0.81. Calibration and internal validation were not performed for either study. The CAVS model, created from a Finnish population, was externally validated in American and French cohorts, with c-statistics of 0.73 and 0.69, respectively. Finally, the two studies focusing on both types of stroke came from the PoSERS and INPOSE models. Neither model provided c-statistics, calibration metrics, internal or external validation information. We found no evidence of the presence of impact studies to assess the effect of adopting late-onset seizure risk models after stroke on clinical outcomes. CONCLUSION: The SeLECT model was the only model developed in line with proposed guidelines for appropriate model development. The model, which was externally validated in a very similar and homogeneous population, may need to be tested in a more racially/ethnic diverse and younger population; testing the SeLECT model, accounting for overall brain health is likely to improve the identification of high-risk patients for late post stroke seizures.

Prevalence and determinants of chronic kidney disease in urban adults' populations of northern Cameroon.

BACKGROUND: Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa. AIM: Assess the prevalence and determinants of CKD in Garoua and Figuil cities of the North region of Cameroon. METHODS: A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m2) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30 mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes. RESULTS: A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4-46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5%, respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD. CONCLUSION: The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy.

Iodine nutrition status in Africa: potentially high prevalence of iodine deficiency in pregnancy even in countries classified as iodine sufficient.

OBJECTIVE: To assess the burden of iodine deficiency in pregnancy in Africa using estimated pregnancy median urinary iodine concentration (pMUIC). DESIGN: pMUIC for each African country was estimated using a regression equation derived by correlating the school-age children (SAC) median UIC (mUIC) and pMUIC from countries around the globe, and the SAC mUIC data for African countries obtained from the Iodine Global Network (IGN) 2017 and 2019 Score cards. SETTING: Iodine deficiency was endemic in many African countries before the introduction of iodine fortification, mainly through universal salt iodisation programmes about 25 years ago. There is a scarcity of data on the level of iodine nutrition in pregnancy in Africa. Women living in settings with pMUIC below 150 µg/l are at risk of iodine deficiency-related pregnancy complications. PARTICIPANTS: Fifty of the fifty-five African countries that had data on iodine nutrition status. RESULTS: A cut-off school age mUIC ≤ 175 µg/l is correlated with insufficient iodine intake in pregnancy (pregnancy mUIC ≤ 150 µg/l). Twenty-two African countries had SAC mUIC < 175 µg/l, which correlated with insufficient iodine intake during pregnancy (pMUIC < 150 µg/l). However, nine of these twenty-two countries had adequate iodine intake based on SAC mUIC. CONCLUSIONS: There is likely a high prevalence of insufficient iodine intake in pregnancy, including in some African countries classified as having adequate iodine intake in the general population. A SAC mUIC ≤ 175 µg/l predicts insufficient iodine intake among pregnant women in these settings.

May Measurement Month 2019: an analysis of blood pressure screening results from Cameroon.

The multi-country May Measurement Month (MMM) screening campaign aims to raise awareness on blood pressure (BP) and hypertension in individuals and communities, and measure BP, ideally, of those who had no BP measurement in the preceding year. We here report key findings from the Cameroon arm of MMM 2019. An opportunistic sample of adults (≥18 years) was included from 5 May to 5 June 2019 across 15 sites (markets, churches, homes, motor parks, workplaces, and hospitals/clinics). Data collection, cleaning, the definition of hypertension, and statistical analysis followed the standard protocol. The mean age of the 30 187 participants screened was 36.9 (SD: 14.9) years, 50.4% were female (5% of whom were pregnant), and 94.4% were screened out of the hospital/clinic settings. After multiple imputation of missing data, 6286 (20.8%) had hypertension, 24.0% were taking antihypertensive medication, and 705 (11.2%) of all participants with hypertension had controlled BP. In linear regression models adjusted for age, sex, and antihypertensive medicines use, a previous diagnosis of hypertension, a history of stroke, and use of antihypertensive medicines were significant predictors of systolic and diastolic BP levels. BPs were also significantly higher when measured in public outdoors, public indoors (diastolic BP only), workplaces, and other unspecified areas compared to hospitals/clinic settings. MMM19 is the largest ever BP screening campaign in a single month, in Cameroon and despite the limitations resulting from non-random sample selection, the opportunistic screening allows access to awareness and screening for hypertension out of the hospital/clinic settings.

HIV-MSS: A user-friendly management support system for better planning of HIV care services.

The advent of antiretroviral therapy (ART) has transformed HIV infection from a deadly disease to a manageable chronic condition. The life expectancy of people living with HIV has been prolonged dramatically. Therefore, health systems are now confronted with new challenges, with ever-increasing number of newly diagnosed cases, fuelling the pool of existing patients, with many comorbidities and requiring hospital admissions. Are health systems prepared to handle large and increasing numbers of people with HIV? We developed a HIV-Management Support System (MSS) to support service evaluation and management using simulation by capturing individual patient's pathways within HIV services in the United Kingdom. Two scenarios were tested: (1) the impact of increasing the number of diagnosed cases in steps of 5% on human resources and (2) the impact of treating all patients with ART on hospital admissions. A 5% increase in newly diagnosed HIV cases increases human resource requirements between 4% and 8%, whereas the impact of treating all HIV patients with ART on hospital admissions is far greater. HIV services are under intense pressure and managing patient and service needs are far more important than ever, hence the development of our HIV MSS is timely, to support better planning of services. Note that the HIV simulation model presented in this study is the first of its kind.

Dietary patterns are associated with likelihood of hepatic steatosis among US adults.

BACKGROUND AND AIM: Non-alcoholic fatty liver disease is a rapidly growing public health problem. In this study, we explored the association between dietary patterns (DPs) and fatty liver and liver function tests. METHODS: This was a cross-sectional study using data from the US community-based National Health and Nutrition Examination Survey. Participants with data on dietary intake, blood pressure, and status for diabetes mellitus were analyzed. DPs were determined by principal components analysis. Analysis of covariance and logistic regression models accounted for the survey design and sample weights. RESULTS: Of the 20 643 eligible participants, 45.7% had prevalent fatty liver. Three DPs collectively explained 50.8% of variance in dietary nutrients consumption. The first DP was representative of a diet containing high levels of saturated and mono-unsaturated fatty acids, total fat and carbohydrate; the second DP comprised vitamins, minerals and dietary fibre; and the third DP was mainly representative of polyunsaturated fatty acids. In adjusted multivariable regression models, participants in the top quarter of the second DP had 34% lower odds of prevalent fatty liver (odds ratio 0.66 [95% confidence interval [CI]: 0.43-0.71]), while those in the top quarter of the first DP had 86% higher odds (1.86 [95% CI: 1.42-2.95]) of prevalent fatty liver, relative to participants in the bottom quarter of each of the DPs. CONCLUSION: Our findings suggest that a diet with high load of vitamins, minerals, and fiber content is associated with a lower prevalence of non-alcoholic fatty liver disease.

Evaluation of the accuracy of two point-of-care haemoglobin meters used in sub-Saharan African population: a cross-sectional study.

BACKGROUND: Point-of-care haemoglobin meters are attractive solutions to improve timely diagnosis of anaemia in resource-limited settings. However, concerns regarding the accuracy of these meters may affect their adoption. The accuracy of two hand-held point-of-care haemoglobin meters was evaluated against reference full blood count analyser. METHODS: This was a hospital-based cross-sectional study conducted at the Douala General hospital, Cameroon. Two handheld haemoglobin meters were assessed: Urit12® (URIT Medical Electronics Co.,Ltd. Guangxi, China) and MissionHb®(ACON Laboratories, Inc., San Diego, USA); against a reference standard CELL-DYN RUBY® (ABBOTT DIAGNOSTICS, Illinois, USA). The Pearson's correlation and Bland-Altman agreement were used to assess the technical accuracy of the meters. Clinical accuracy was evaluated using total error allowable and area under the Receiver Operating Curve. Finally, their agreement with the reference in diagnosing anaemia was assessed using the kappa statistic. RESULTS: A total of 228 participants were included in the study. The mean haemoglobin values of both haemoglobin meters (MissionHb®: 11.6 ± 2.5 g/dl; Urit12®: 10.9 ± 2.7 g/dl) were significantly higher than the reference value (10.5 ± 2.5 g/dl), p < 0.001 for both meters. Both haemoglobin meters had good correlation with the reference analyser (r = 0.89 and r = 0.90 for Urit12® and MissionHb® respectively) and good agreement on the Bland-Altman plots. However, the MissionHb® meter did not meet the clinical accuracy requirements (p < 0.001). Even though both meters were excellent at identifying the presence of anemia (MissionHb® - AUC = 0.9161, Urit 12® - AUC = 0.9009), they, however, both had weak agreement with the reference analyser in diagnosing the severity of anaemia (K = 0.39 for MissionHb®, p < 0.001 and K = 0.54 for Urit12®, p < 0.001). CONCLUSION: Although both devices showed technical accuracy with a positive correlation with the reference analyser and were able to accurately diagnose the presence of anemia, both meters however, had sub-optimal agreement with the reference analyser in diagnosing the degree of severity of anaemia among our participants.

Prevalence of metabolic syndrome in sub-Saharan Africa: A systematic review and meta-analysis.

BACKGROUND AND AIMS: There are rising levels of cardiovascular diseases (CVDs) and diabetes in Sub-Saharan Africa (SSA). Metabolic syndrome (MS) is a precursor of these conditions, but the data on the prevalence of MS in SSA are fragmented. We conducted a systematic review and meta-analysis to estimate the prevalence of MS in SSA and determine the population groups that are most at risk. METHODS AND RESULTS: We systematically searched PubMed, Embase and African Journals Online for all published articles reporting MS prevalence in SSA populations. Random effects models were used to calculate the pooled prevalence overall and by major study-level characteristics. A total of 65 studies across fourteen different countries comprising 34,324 healthy participants aged ≥16 years were included in the meta-analysis. The overall prevalence of MS according to the different diagnostic criteria was: IDF: 18.0% (95%CI:13.3-23.3), IDF-ethnic: 16.0% (95%CI:11.3-21.4), JIS: 23.9% (95%CI: 16.5-32.3), NCEP-ATP III: 17.1% (95%CI:12.8-22.0) and WHO: 11.1% (95%CI:5.3-18.9). The prevalence of MS was higher in women than in men, and higher in (semi-)urban than in rural participants. The MS prevalence was highest in Southern Africa, followed by Eastern, Western and Central Africa. Substantial heterogeneity in the prevalence estimates across studies were not explained by major study-level characteristics, while apparent publication biases were likely artefactual. CONCLUSIONS: MS is not rare in SSA. The prevalence of MS was highest for women, populations in urban areas, and populations in Southern Africa. Public health intervention efforts are needed to prevent further increases in the burden of MS in the region.

Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa.

BACKGROUND: To determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) determined by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town. METHODS: Data collection in this cross-sectional study included interviews, clinical measurements and biochemical analyses, including serum creatinine and cystatin C levels. GFR was based on the CKD Epidemiology Collaboration (CKD-EPI) equations (CKD-EPI creatinine (CKD-EPIcr), CKD-EPI cystatin C (CKD-EPIcys), CKD-EPI creatinine-cystatins (CKD-EPIcr-cys)), Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formula (CGF). GFR < 60 mL/min/1.73 m2 defined CKD. RESULTS: Among 392 men and 700 women, mean GFR, was between 114.0 (CKD-EPIcr) and 135.4 mL/min/1.73 m2 (CGF) in men, and between 107.5 (CKD-EPIcr-cys) and 173.4 mL/min/1.73 m2 (CGF) in women. CKD prevalence ranged from 2.3% (CKD-EPIcr and MDRD) to 5.1% (CKD-EPIcys) in men and 1.6% (CGF) to 6.7% (CKD-EPIcr-cys) in women. The kappa statistic was high between CKD-EPIcr and MDRD (0.934), and CKD-EPIcys and CKD-EPIcr-cys (0.815), but fair-to-moderate between the other eqs. (0.353-0.565). In the basic regressions, older age and body mass index ≥30 kg/m2, but not gender, were significantly associated with CKD-EPIcr-defined CKD. In the presence of these three variables, hypertension, heart rate ≥ 90 beats/minute, diabetes and low-density lipoprotein cholesterol were significant predictors of prevalent CKD. CONCLUSIONS: Varying CKD prevalence estimates, because of different GFR equations used, underscores the need to improve accuracy of CKD diagnoses. Furthermore, screening for CKD should be incorporated into the routine assessment of high-risk patients such as those with hypertension or diabetes.

The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action.

BACKGROUND: In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025. MAIN BODY: Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children's Fund (UNICEF), WHO and the World Bank. The Institute for Health Metrics and Evaluation (IHME) has published country-level estimates of obesity in children aged 2-4 years. For children aged 5-19 years, obesity estimates are available from the NCD Risk Factor Collaboration. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2-4 years has increased moderately. In 1975, obesity in children aged 5-19 years was relatively rare, but was much more common in 2016. CONCLUSIONS: It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity. Although cost-effective interventions such as WHO 'best buys' have been identified, political will and implementation have so far been limited. There is therefore a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity. To be successful, the obesity epidemic must be a political priority, with these issues addressed both locally and globally. Work by governments, civil society, private corporations and other key stakeholders must be coordinated.