Urbanicity and lifestyle risk factors for cardiometabolic diseases in rural Uganda: a cross-sectional study.

BACKGROUND: Urban living is associated with unhealthy lifestyles that can increase the risk of cardiometabolic diseases. In sub-Saharan Africa (SSA), where the majority of people live in rural areas, it is still unclear if there is a corresponding increase in unhealthy lifestyles as rural areas adopt urban characteristics. This study examines the distribution of urban characteristics across rural communities in Uganda and their associations with lifestyle risk factors for chronic diseases. METHODS AND FINDINGS: Using data collected in 2011, we examined cross-sectional associations between urbanicity and lifestyle risk factors in rural communities in Uganda, with 7,340 participants aged 13 y and above across 25 villages. Urbanicity was defined according to a multi-component scale, and Poisson regression models were used to examine associations between urbanicity and lifestyle risk factors by quartile of urbanicity. Despite all of the villages not having paved roads and running water, there was marked variation in levels of urbanicity across the villages, largely attributable to differences in economic activity, civil infrastructure, and availability of educational and healthcare services. In regression models, after adjustment for clustering and potential confounders including socioeconomic status, increasing urbanicity was associated with an increase in lifestyle risk factors such as physical inactivity (risk ratio [RR]: 1.19; 95% CI: 1.14, 1.24), low fruit and vegetable consumption (RR: 1.17; 95% CI: 1.10, 1.23), and high body mass index (RR: 1.48; 95% CI: 1.24, 1.77). CONCLUSIONS: This study indicates that even across rural communities in SSA, increasing urbanicity is associated with a higher prevalence of lifestyle risk factors for cardiometabolic diseases. This finding highlights the need to consider the health impact of urbanization in rural areas across SSA. Please see later in the article for the Editors' Summary.

Should young people be paid for getting tested? A national comparative study to evaluate patient financial incentives for chlamydia screening.

BACKGROUND: Patient financial incentives ("incentives") have been widely used to promote chlamydia screening uptake amongst 15-24 year olds in England, but there is scarce evidence of their effectiveness. The objectives of the study were to describe incentives used to promote chlamydia screening in Primary Care Trusts (PCTs) in England and to evaluate their impact on coverage and positivity rate. METHODS: PCTs that had used incentives between 1/1/2007 and 30/6/2009 (exposed) were matched by socio-demographic profile and initial screening coverage with PCTs that had not (unexposed). For each PCT, percentage point change in chlamydia screening coverage and positivity for the period before and during the incentive was calculated. Differences in average change of coverage and positivity rate between exposed and unexposed PCTs were compared using linear regression to adjust for matching and potential confounders. RESULTS: Incentives had a significant effect in increasing average coverage in exposed PCTs (0.43%, CI 0.04%-0.82%). The effect for voucher schemes (2.35%) was larger than for prize draws (0.16%). The difference was greater in females (0.73%) than males (0.14%). The effect on positivity rates was not significant (0.07%, CI -1.53% to 1.67%). CONCLUSIONS: Vouchers, but not prize draws, led to a small absolute but large relative increase in chlamydia screening coverage. Incentives increased coverage more in females than males but had no impact on reported positivity rates. These findings support recommendations not to use prize draws to promote chlamydia screening and contribute to the evidence base of the operational effectiveness of using patient incentives in encouraging public health action.

Who is being tested by the English National Chlamydia Screening Programme? A comparison with national probability survey data.

OBJECTIVES: We compare data collected by England's National Chlamydia Screening Programme (NCSP) with national probability survey data to examine demographic and behavioural differences that may be important in understanding who the NCSP is reaching and interpreting chlamydia positivity. METHODS: Data for 538,119 men and women aged 16-24 years who were screened in 2008 and data collected from 2180 interviewees in Britain's second National Survey of Sexual Attitudes and Lifestyles 1999-2001 (Natsal-2), of whom 644 were tested for chlamydia, were compared using the χ2 statistic and logistic regression. RESULTS: Compared with Natsal-2, the NCSP tested more women (67% vs. 49%). NCSP participants were more likely to be younger: 29% were 16-17 years versus 16% of men and 15% of women in Natsal-2; from ethnic minority groups: 17% of men and 14% of women versus 8% and 6%, respectively, in Natsal-2; not to have used condoms at last sex: 66% of men and 68% of women versus 48% and 63%, respectively, in Natsal-2: and more likely to report two or more partners in the last year: 62% of men and 47% of women versus 47% and 30%, respectively, in Natsal-2. In multivariate analyses, higher AOR of chlamydia positivity were found for those reporting non-use of condoms and for those reporting multiple partners in both the NCSP and Natsal-2. CONCLUSIONS: The NCSP is testing young people at increased risk of chlamydia. The impact of this testing bias on the effectiveness of the programme should be evaluated.

Will chlamydia screening reach young people in deprived areas in England? Baseline analysis of the English National Chlamydia Screening Programme delivery in 2008.

BACKGROUND: The National Chlamydia Screening Programme (NCSP) was established in England to control chlamydia in people <25 years. This study examined variations in NCSP delivery in 2008, its first full year of national coverage, by comparing the distribution of screening venues and coverage with the risk of testing positive in men and women by socioeconomic circumstances (SEC) and age. METHODS: A total of 550,000 NCSP screening records from 2008 were linked to the Index of Multiple Deprivation 2007. NCSP provision (venues/1000 population aged 13-24 years) was examined by SEC. NCSP coverage (tests/target population) and chlamydial positivity (positive results/[positive + negative results]) were examined separately in men and women by SEC and age. Odds ratios for positivity were calculated, adjusted for socioeconomic quintile, age, ethnicity, behavior, and screening provider. RESULTS: NCSP coverage was just 4.1% (95% confidence interval [CI]: 4.0-4.1) in men and 9.6% (95% CI: 9.5-9.6) in women. Screening provision and coverage were highest in more socioeconomically deprived areas where chlamydia positivity was also highest. The adjusted odds for testing positive in the most deprived areas was 1.4 (95% CI: 1.3-1.5) times higher in men and 1.4 (95% CI: 1.4-1.5) times higher in women than the least deprived areas. CONCLUSIONS: In the first year in which all areas delivered screening, the NCSP's total coverage was low, particularly in men. However, coverage was higher in deprived populations, who were also at increased risk of testing positive for infection. This analysis provides a baseline by which to monitor social variations in NCSP delivery as coverage expands.

Media and Digital Technologies for Mixed Methods Research in Public Health Emergencies Such as COVID-19: Lessons Learned From Using Interactive Radio-SMS for Social Research in Somalia.

Radio shows which invite audience participation via short message service (SMS)-interactive radio-SMS-can be designed as a mixed methods approach for applied social research during COVID-19 and other crises in low and middle income countries. In the aftermath of a cholera outbreak in Somalia, we illustrate how this method provides social insights that would have been missed if a purely qualitative or quantitative approach were used. We then examine the strengths and limitations associated with interactive radio-SMS through an evaluation using a multimethod comparison. Our research contributes an application of a mixed methods approach which addresses a specific challenge raised by COVID-19, namely utilizing media and digital technologies for social research in low and middle income countries.

Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. METHODS: We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. RESULTS: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, -0.59; 95% CI, -0.86 to -0.31), BMI (SMD, -0.32; 95% CI, -0.45 to -0.18), SBP (SMD, -0.40; 95% CI, -0.55 to -0.25) and DBP (SMD, -0.34; 95% CI, -0.51 to -0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, -0.34; 95% CI, -0.62 to -0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. CONCLUSIONS: Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.