Prevalence, knowledge and practices on prevention and management of overweight and obesity among adults in Dodoma City, Tanzania.

BACKGROUND: Overweight/obesity is increasing leading to high rates of non-communicable diseases. The study aimed to assess the prevalence, knowledge and practices on prevention and management of overweight/obesity among adults in Dodoma region. METHODOLOGY: A cross- sectional research was conducted among 313 randomly selected adults aged 25-65 years. Face to face interviews were conducted to obtain demographic information, knowledge on preventing and managing overweight/obesity using a pre-tested questionnaire. Weight and height were measured following standard procedures and nutrition status was categorized using WHO criteria. Dietary intake was assessed using qualitative 24 hours recall to obtain dietary diversity score. Data was analyzed using the SPSS™ Version 20 to obtain descriptive and inferential statistics. RESULTS: About 62.6% (n = 196) of the participants were females. The overall prevalence of overweight/obesity was 59.7% (n = 186) of which 28% (n = 88) were overweight and 31.3% (n = 98) obese. Obesity was three times higher among females (41.8% vs 13.7%) than males. Overweight/obesity was positively associated with female sex (Adjusted OR 2.34; 95%CI: 1.235-4.68; p = 0.001), low knowledge (Adjusted OR 2.15; 95%CI: 1.22-3.81; p = 0.008) and negatively associated with dietary diversity score (Adjusted OR 0. 452; 95%CI: 0.199-1.87; p = 0.03). About 76% of respondents reported that overweight/obesity is a result of consuming high energy (38.8%; n = 92) and high fat foods (27%; n = 63). More than half of the respondents reported to be insensitive with kind of foods they consume and for those who were sensitive, 64% do so to avoid diseases. Furthermore, 60% control their weight by doing physical exercises while 18% by both physical exercises and diet management. However, about 43% did not know foods exposing individuals to health problems. CONCLUSION AND RECOMMENDATIONS: High prevalence of overweight/obesity was observed and significantly associated with female sex, low dietary diversity and knowledge on overweight/obesity prevention. This creates a need to improve knowledge on prevention of overweight/obesity.

Simple method for identification of women at risk of gestational diabetes mellitus in Arusha urban, Tanzania.

BACKGROUND: Screening for gestational diabetes mellitus in Tanzania is challenged by limited resources. Therefore, this study aimed to develop a simple method for identification of women at risk of gestational diabetes mellitus in Arusha urban, Tanzania. METHODS: This study used data from a cross sectional study, that was conducted between March and December 2018 in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Urine glucose was tested using urine multistics and blood glucose levels by Gluco-Plus™ and diagnosed in accordance with the World Health Organization's criteria. Anthropometrics were measured using standard procedures and maternal characteristics were collected through face-to-face interviews using a questionnaire with structured questions. Univariate analysis assessed individual variables association with gestational diabetes mellitus where variables with p-value of < 0.05 were included in multivariable analysis and predictors with p-value < 0.1 remained in the final model. Each variable was scored based on its estimated coefficients and risk scores were calculated by multiplying the corresponding coefficients by ten to get integers. The model's performance was assessed using c-statistic. Data were analyzed using Statistical Package for Social Science™. RESULTS: The risk score included body fat ≥ 38%, delivery to macrosomic babies, mid-upper arm circumference ≥ 28 cm, and family history of type 2 diabetes mellitus. The score correctly identified 98% of women with gestational diabetes with an area under the receiver operating characteristic curve of 0.97 (95% CI 0.96-0.99, p < 0.001), sensitivity of 0.98, and specificity of 0.46. CONCLUSION: The developed screening tool is highly sensitive and correctly differentiates women with and without gestational diabetes mellitus in a Tanzanian sub-population.

Design and validation of a food frequency questionnaire to assess the dietary intake for adults in pastoral settings in Northern Tanzania.

OBJECTIVE: Food frequency questionnaires are widely used as a dietary assessment tool in nutritional epidemiology to determine the relationship between diet and diseases. In Tanzania, there are several cultural variations in food intake which makes it necessary to design and validate a culture-specific food frequency questionnaire (CFFQ). Therefore, we designed a 27-items CFFQ and examine its validity in pastoral communities. Validity of CFFQ was assessed by comparing nutrient intake estimated from the CFFQ against the average from two 24-h diet recall (2R24). Spearman's correlation coefficients, cross classification and Bland-Altman's methods were used to assess the validity of CFFQ. RESULTS: A total of 130 adults aged 18 years and above completed both CFFQ and 2R24. Correlation coefficients between CFFQ and 2R24 ranged from low (r = - 0.07) to moderate (r = 0.37). The correlation coefficients were moderately significant for kilocalories (r = 0.31, p < 0.001), carbohydrate (r = 0.33, p < 0.001), magnesium (r = 0.37, p < 0.001), and iron (r = 0.34, p < 0.001). On average, about 69% of participants were correctly classified into the same or adjacent quartile of energy and nutrient intake, while 9% were misclassified by the CFFQ. Bland-Altman's plot demonstrated that the CFFQ had acceptable agreement with the 2R24.

Association between dietary diversity with overweight and obesity: A cross-sectional study conducted among pastoralists in Monduli District in Tanzania.

BACKGROUND: The prevalence of overweight and obesity is rising at a rapid pace and is associated with negative health consequences like cardiovascular diseases, type 2 diabetes and cancer. Obesity is a multifactorial problem that develops mainly from lifestyle factors including physical inactivity and poor dietary intake. Dietary diversity is a simplified method for assessing the adequacy and quality of diet and is associated with nutritional need and overall health status. Therefore, we conducted this study to synthesize the associations between consumption of a diversified diet and overweight/ obesity among adults living in pastoral communities in Monduli district in Tanzania. METHODS: This was a cross-sectional study conducted among 510 adults aged ≥ 18 years old in the Monduli district, Arusha region in Tanzania. We conducted face-to-face interviews to collect information about socio-demographic characteristics, 24-hours dietary recall, and anthropometric measurements. The dietary diversity score (DDS) was constructed and used to determine the diversity of the diet consumed. We performed the multivariate Poisson regressions to determine the prevalence ratio (PR) with 95% confidence intervals (CI). The dependent variables were overweight and general obesity as measured by body mass index (BMI), abdominal obesity measured by waist-hip ratio (WHR) and waist circumference (WC). RESULTS: The prevalence of general obesity based on BMI was 20.2% (95%CI; 16.9-23.9), abdominal obesity based on WHR was 37.8% (95%CI; 33.7-42.1), and WC was 29.1% (95%CI; 25.2-33.1). More than half (54.3%) of the participants consumed an adequate dietary diversity (DDS ≥4). After adjustment for potential confounders, the prevalence of abdominal obesity by WHR decreased with higher DDS among male (APR = 0.42; 95% CI, 0.22-0.77) and female participants (APR = 0.63; 95% CI, 0.41-0.94). There were inconsistent positive associations between DDS and prevalence of overweight and general obesity among male and female. There was no association between DDS and abdominal obesity by WC. CONCLUSION: More than half of the pastoralists have consumed an adequate diversified diet. Given the inconsistent findings on associations between dietary diversity and obesity measures, this study suggests that targeting dietary diversity as an overweight/obesity prevention strategy requires careful consideration.

Prevalence and determinants of hypertension among pastoralists in Monduli District, Arusha region in Tanzania: a cross-sectional study.

BACKGROUND: Hypertension is among the growing non-communicable diseases (NCDs) in developing countries and the leading cause of death worldwide. Pastoral areas have been identified to be at a higher risk of diseases due to challenges in their daily food production, livelihoods or mobility. Unfortunately, the prevalence of hypertension and the risk factors particularly affecting rural and pastoral populations are not fully understood, making intervention efforts challenging. The aim of this study was to determine the prevalence of hypertension and identify the risk factors among adults living in Monduli district in Tanzania. The findings will be useful for the provision of tailored interventions focused on community-specific nutritional and behavioral practices. METHODS: We conducted a community based cross-sectional study involving a sample of 510 adults aged above 18 years selected using a multistage cluster sampling in the Monduli district of Arusha region, Tanzania. Data were collected by using interviewer-administered questionnaires containing socio-demographic, physical activity, smoking and alcohol consumption. Anthropometry, systolic (SBP) and diastolic blood pressure (DBP) levels were measured. A one-day 24 h diet recall was conducted to evaluate the dietary habits of all participants. Both linear and logistic regression analysis were used to identify the independent predictors for hypertension and blood pressure levels. RESULTS: The prevalence of hypertension in this study was 25.7% (n = 131, 95% CI; 22.1-29.7). The odds of hypertension increased with being male (AOR = 1.75, 95%CI, 1.06-2.88), belonging to the older age group of 30-39 year olds (AOR = 3.3, 95%CI, 1.76-6.38), 40-59 year olds (AOR = 3.34, 95%CI, 1.75-6.37) and ≥ 60 year olds (AOR = 4.2, 95%CI, 2.02-8.87), being overweight or obese (AOR = 3.37, 95%CI, 1.18-9.62), have more hours spent sedentary (AOR = 3.19, 95%CI, 1.61-6.32), and consumption of fatty foods (AOR = 2.23, 95%CI, 1.27-3.93). The odds for hypertension was significantly reduced among participants who reported higher income (AOR = 0.47, 95% CI, 0.25-0.91), high level of physical activity (AOR = 0.55, 95%CI, 0.31-0.96) and those reported to consume fruit (AOR = 0.37, 95% CI, 0.18-0.77). Consumption of cereals was negatively associated with levels of SBP (ß = - 17.4, 95% CI, - 23.8; - 11.0) and DBP (ß = - 6.6, 95% CI, - 11.5,-1.79). CONCLUSION: About one in every four adults living in pastoral communities have been found to have hypertension in this study. Our findings suggest that older age, obesity or overweight, low physical activity, low income, and consumption of fatty foods increase the risk of hypertension among study population. Their diet was dominated by cereals with moderate intake of meat and milk and low fruits. There is a need to promote physical activities and consumption of fruits in the study population in order to fight against hypertension. Further research should be done to confirm the associations.

The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania.

BACKGROUND: Undernutrition poses a serious health challenge in developing countries and Tanzania has the highest undernutrition burden of Eastern and Southern Africa. Poor infant and young child feeding practices have been identified as the main causes for undernutrition. As dietary diversity is a major requirement if children are to get all essential nutrients, it can thus be used as one of the core indicators when assessing feeding practices and nutrition of children. Therefore, adequate information on the association between dietary diversity and undernutrition to identify potential strategies for the prevention of undernutrition is critical. Here we examined to what extent dietary diversity is associated with undernutrition among children of 6 to 23 months in Tanzania. METHODS: Using existing data from the Tanzania Demographic and Health Survey of 2015-2016, we carried out secondary data analysis. Stunting, Wasting and Underweight of the surveyed children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. A composite dietary diversity score was created by summing the number of food groups eaten the previous day as reported for each child by the mother ranging from 0 to 7. Then, minimum dietary diversity (MDD) of 4 food groups out of seven was used to assess the diversity of the diet given to children. Bivariate and multivariate logistic regression techniques were used to assess the crude and adjusted odds ratios of stunting, wasting and being underweight. RESULTS: A total of 2960 children were enrolled in this study. The prevalence of stunting was 31%, wasting 6% and underweight 14%. Among all children, 51% were female and 49% male. The majority (74%) of children did not reach the MDD. The most commonly consumed types of foods were grains, roots and tubers (91%), and Vitamin A containing fruits and vegetables (65%). The remaining food groups were reported to be consumed by a much lower proportion of children, including eggs (7%), meat and fish (36%), milk and dairy products (22%), as well as legumes and nuts (35%), and other vegetables (21%). Consumption of a diverse diet was significantly associated with a reduction of stunting, wasting and being underweight in children. The likelihood of being stunted, wasted and underweight was found to decrease as the number of food groups consumed increased. Children who did not receive the MDD had a significantly higher likelihood of being stunted (AOR = 1.37, 95% CI; 1.13-1.65) and underweight (AOR = 1.49, 95% CI; 1.15-1.92), but this was not the case for wasting. Consumption of animal-source foods has been found to be associated with reduced stunting among children. CONCLUSION: Consumption of a diverse diet is associated with a reduction in undernutrition among children of 6 to 23 months in Tanzania. Measures to improve the type of complementary foods in order to meet the energy and nutritional demands of children should be considered in Tanzania.

Insulin Resistance Among Pregnant Women in Urban Areas of Arusha Region, Tanzania.

Aim: To establish the prevalence of insulin resistance (IR) and its determinants among selected pregnant women in urban Arusha for taking preventive measures. Methods: A cross-sectional study was conducted between March and December 2018 at Ngarenaro and Kaloleni health facilities in Arusha District involving 230 randomly selected pregnant women who were not known to have diabetes before pregnancy. Blood glucose at fasting and 2 hr after consuming 75 grams of glucose dissolved in 300 mL of water was measured using Gluco-Plus™, serum insulin concentrations using ELISA machine (Synergy/HTX™; BioTek), and IR was calculated using the Homeostasis Model of Assessment formula. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regular tape, weight using SECA™, blood pressure using GT-868UF Geratherm™ machine, and height by stadiometer. Maternal characteristics were collected through face to face interviews using a structured questionnaire. Data were analyzed using the Statistical Package for Social Science™ Version 20. Results: The prevalence of IR was 21% (n = 49) and significantly associated with increased body fat percentage (adjusted odds ratio [AOR]: 1.68, 95% confidence interval [CI]: 1.01-2.5), family history of Type 2 diabetes mellitus (T2DM; AOR: 2.77, 95% CI: 1.21-6.33), hypertension (AOR: 2.5, 95% CI: 1.12-5.6), edema (AOR: 3.01, 95% CI: 1.31-6.96), and proteinuria (AOR: 3.44, 95% CI: 1.11-10.69). Conclusions: IR was higher among pregnant women with increased body fat percentage, family history of T2DM, hypertension, edema, and proteinuria. These findings call for large-scale screening to further explore risk factors to prevent gestational diabetes mellitus.

Prevalence of hyperglycemia in pregnancy and influence of body fat on development of hyperglycemia in pregnancy among pregnant women in urban areas of Arusha region, Tanzania.

BACKGROUND: Hyperglycemia in pregnancy is a medical condition resulting from either pre-existing diabetes or insulin resistance developed during pregnancy. This study aimed to determine the prevalence of hyperglycemia in pregnancy and influence of body fat percentage and other determinants on developing hyperglycemia in pregnancy among women in Arusha District, Tanzania. METHODS: A cross-sectional study was conducted between March and December 2018 at selected health facilities in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Blood glucose was tested by Gluco-Plus™ using the World Health Organization criteria at fasting and 2 h after consuming 75 g of glucose dissolved in 300 ml of water. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regulated tape, weight using SECA™, blood pressure using a GT-868UF Geratherm™ machine, and height using a stadiometer. Demographic and maternal characteristics were collected through face to face interviews using a structured questionnaire. RESULTS: The participants' mean age was 28 years (SD ± 6), mid-upper arm circumference 27 cm (SD ± 3.7), body fat 33.72% (SD ± 7.2) and pre-pregnancy body mass index 25.6 kg/m2 (SD ± 5.5). One-third of participants had mid-upper arm circumferences ≥28 cm with 25% being overweight and 22.7% obese before pregnancy. Prevalence of hyperglycemia in pregnancy was 16.2% (n = 76) of which 13% had gestational diabetes and 3.2% diabetes in pregnancy. Hyperglycemia in pregnancy was significantly associated with body fat percentage (AOR 1.33; 95% CI: 1.22-1.44), family history of Type 2 diabetes mellitus (AOR 6.95, 95% CI: 3.11-15.55), previous delivery of babies ≥4 kg (AOR 2.3, 95% CI: 1.00-5.28), mid-upper arm circumference ≥ 28 cm (AOR 1.2, 95% CI: 1.09-1.32), and Type 2 diabetes mellitus symptoms (AOR 2.83, 95% CI: 1.53-6.92). CONCLUSION: The prevalence of hyperglycemia in pregnancy was high, particularly among women with history of delivering ≥4-kg babies, increased body fat, mid-upper arm circumference, symptoms and/or family history of Type 2 diabetes mellitus. These findings identify opportunities to further explore the utility of body fat percentage and other determinants for rapid screening and management of hyperglycemia in pregnancy.

Capacity and capability of Tanzania health facilities to diagnose and manage diabetes mellitus in pregnancy.

AIMS: Gestational Diabetes Mellitus (GDM) remains a neglected cause of maternal and foetal morbidity and mortality in developing countries exacerbated by limited screening and management strategies. This study aimed to understanding how the RCH health system works in Tanzania, so as to provide opportunity for improving GDM screening and management. METHODS: A questionnaire was administered to facility staff and physical performance observed in 30 randomly selected public RCH facilities. RESULTS: Deficiencies identified included limited understaffing, late booking at ANC, and limited screening for GDM due to lack of equipment and supplies. Most women (96%) attending ANCs and postnatal care (87%) were managed at respective facilities with only 12% and 22% respectively being referred to higher levels of care. Facility staff were less trained or received fewer refresher courses in diabetes (0-5%), hypertension (4-6%), and other NCDs (0-16%) compared to training in PMCTC (39%), management of postpartum bleeding (31%) and HIV/AIDs (31%). CONCLUSION: Diabetes during pregnancy is rarely sought in public health facilities and its management is suboptimal. Training and refresher courses of staff in diabetes and hypertension should be uplifted and health systems should be strengthened to improve capacity and capability of facilities for better quality of care.

Gestational diabetes mellitus risk score: A practical tool to predict gestational diabetes mellitus risk in Tanzania.

BACKGROUND: Universal screening for hyperglycemia during pregnancy may be in-practical in resource constrained countries. Therefore, the aim of this study was to develop a simple, non-invasive practical tool to predict undiagnosed Gestational diabetes mellitus (GDM) in Tanzania. METHODS: We used cross-sectional data of 609 pregnant women, without known diabetes, collected in six health facilities from Dar es Salaam city (urban). Women underwent screening for GDM during ante-natal clinics visit. Smoking habit, alcohol consumption, pre-existing hypertension, birth weight of the previous child, high parity, gravida, previous caesarean section, age, MUAC ≥ 28 cm, previous stillbirth, haemoglobin level, gestational age (weeks), family history of type 2 diabetes, intake of sweetened drinks (soda), physical activity, vegetables and fruits consumption were considered as important predictors for GDM. Multivariate logistic regression modelling was used to create the prediction model, using a cut-off value of 2.5 to minimise the number of undiagnosed GDM (false negatives). RESULTS: Mid-upper arm circumference (MUAC) ≥ 28 cm, previous stillbirth, and family history of type 2 diabetes were identified as significant risk factors of GDM with a sensitivity, specificity, positive predictive value, and negative predictive value of 69%, 53%, 12% and 95%, respectively. Moreover, the inclusion of these three predictors resulted in an area under the curve (AUC) of 0.64 (0.56-0.72), indicating that the current tool correctly classifies 64% of high risk individuals. CONCLUSION: The findings of this study indicate that MUAC, previous stillbirth, and family history of type 2 diabetes significantly predict GDM development in this Tanzanian population. However, the developed non-invasive practical tool to predict undiagnosed GDM only identified 6 out of 10 individuals at risk of developing GDM. Thus, further development of the tool is warranted, for instance by testing the impact of other known risk factors such as maternal age, pre-pregnancy BMI, hypertension during or before pregnancy and pregnancy weight gain.