Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: analysis from the SPICES multi-country project.

Aims: Accurate prediction of a person's risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries. Methods and results: We used data from a multi-country study involving 9309 participants, i.e. 4941 in Europe, 3371 in South Africa, and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score were investigated. The variation in the adjusted total and component scores was compared across contexts using analysis of variance. The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2), and the difference was statistically significant (P < 0.001). The prevalence and per cent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score, respectively. Contribution of behavioural factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas, contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%). Conclusion: The total risk score, subcomponents, categories, and their contribution to total score greatly vary across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource-limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings are recommended.

Dietary outcomes of community-based CVD preventive interventions: a systematic review and meta-analysis.

OBJECTIVE: We aimed to synthesise available evidence on the effects of community-based interventions in improving various dietary outcome measures. DESIGN: Systematic review and meta-analysis. SETTING: We searched databases including Medline, EMBASE, PSYCINFO, CINAHL and the Cochrane registry for studies reported between January 2000 and June 2022. The methodological quality of the included studies was evaluated using the Cochrane risk of bias tools for each study type. For some of the outcomes, we pooled the effect size using a random-effects meta-analysis. PARTICIPANTS: A total of fifty-one studies, thirty-three randomised and eighteen non-randomised, involving 100 746 participants were included. RESULTS: Overall, thirty-seven studies found a statistically significant difference in at least one dietary outcome measure favouring the intervention group, whereas fourteen studies found no statistically significant difference. Our meta-analyses indicated that, compared with controls, interventions were effective in decreasing daily energy intake (MJ/d) (mean difference (MD): -0·25; 95 % CI: -0·37, -0·14), fat % of energy (MD: -1·01; 95 % CI: -1·76, -0·25) and saturated fat % of energy (MD: -1·54; 95 % CI: -2·01, -1·07). Furthermore, the interventions were effective in improving fibre intake (g/d) (MD: 1·08; 95 % CI: 0·39, 1·77). Effective interventions use various strategies including tailored individual lifestyle coaching, health education, health promotion activities, community engagement activities and/or structural changes. CONCLUSION: This review shows the potential of improving dietary patterns through community-based CVD preventive interventions. Thus, development and implementation of context-specific preventive interventions could help to minimise dietary risk factors, which in turn decrease morbidity and mortality due to CVD and other non-communicable diseases.

Survival pattern of colorectal cancer in Sub-Saharan Africa: A systematic review and meta-analysis.

Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region.

Dietary diversity and its determinants among children aged 6-23 months in Ethiopia: evidence from the 2016 Demographic and Health Survey.

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

Development and validation of food frequency questionnaire for food and nutrient intakes of adults in Butajira, Southern Ethiopia.

We developed a culturally-specific Food Frequency Questionnaire (FFQ) to the Ethiopian context and evaluate its validity in comparison to two 24-h dietary recalls (24-HRs) of food and nutrient intake. To evaluate the validity of a culturally-specific FFQ against two 24-HRs, we used a paired t-test, Wilcoxon-signed-rank test, Correlation coefficients, cross-classification, κ and Bland-Altman analysis. The FFQ was obtained 15 d after the second 24-HR was completed. A total of 105 adults, of which 43 (41 %) were men and 62 (59 %) women, aged 20-65 years participated in this present study. Mean energy and macronutrient intake obtained from the FFQ were significantly higher than those obtained from the mean of two 24-HRs. For energy and nutrient intakes, the crude correlation ranged from 0⋅05 (total fat) to 0⋅49 (vitamin B1). The de-attenuated correlation ranged from to 0⋅10 (total fat) to 0⋅80 (vitamin A). For the majority of food groups, no significant difference was observed in the median intake of food and nutrients. Crude correlation for food groups ranged from 0⋅12 (egg) to 0⋅78 (legumes). The de-attenuated correlation ranged from 0⋅24 (egg) to 1⋅00 (meat/poultry/fish and dairy). The FFQ is valid to assess and rank individuals in terms of intake of most food groups according to high and low intake categories.

Diagnostic performance of midupper arm circumference for detecting severe wasting among infants aged 1-6 months in Ethiopia.

BACKGROUND: Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6-59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1-6 mo. OBJECTIVE: The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1-6 mo. METHODS: We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1-6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of -3 SDs from the median as per the WHO 2006 child growth standards. Receiver operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs. RESULTS: The median age, MUAC, and WLZ were 100 d (IQR: 69-145 d), 119 mm (IQR: 103-130 mm), and -1.27 (IQR: -2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n = 101 (21.6%) and n = 61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI: 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI: 76.7%, 91.4%) and a specificity of 76.0% (95% CI: 71.2%, 80.2%). CONCLUSIONS: A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1-6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo.

Development and Validation of a Risk Score to Predict Low Birthweight Using Characteristics of the Mother: Analysis from BUNMAP Cohort in Ethiopia.

At least one ultrasound is recommended to predict fetal growth restriction and low birthweight earlier in pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. Hence, we developed and validated a model and risk score to predict low birthweight using maternal characteristics during pregnancy, for use in resource limited settings. We developed the model using a prospective cohort of 379 pregnant women in South Ethiopia. A stepwise multivariable analysis was done to develop the prediction model. To improve the clinical utility, we developed a simplified risk score to classify pregnant women at high- or low-risk of low birthweight. The accuracy of the model was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plot. All accuracy measures were internally validated using the bootstrapping technique. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. Age at pregnancy, underweight, anemia, height, gravidity, and presence of comorbidity remained in the final multivariable prediction model. The AUC of the model was 0.83 (95% confidence interval: 0.78 to 0.88). The decision curve analysis indicated the model provides a higher net benefit across ranges of threshold probabilities. In general, this study showed the possibility of predicting low birthweight using maternal characteristics during pregnancy. The model could help to identify pregnant women at higher risk of having a low birthweight baby. This feasible prediction model would offer an opportunity to reduce obstetric-related complications, thus improving the overall maternal and child healthcare in low- and middle-income countries.