Prevalence and Determinants of Undernutrition among 6- to 59-Months-Old Children in Lowland and Highland Areas in Kilosa District, Tanzania: A Cross-Sectional Study.

BACKGROUND: Undernutrition is the most dominant form of malnutrition among children in developing countries. Studies conducted in Tanzania have reported high levels of undernutrition among children below five years of age. However, there is limited information on differences in stunting prevalence across agroecological zones. This study aimed to determine the prevalence of undernutrition and its determinants in the lowland and highland areas in Kilosa District, Tanzania. METHODS: A cross-sectional study was conducted in a sample of 200 randomly selected households from the lowland and 141 from the highland areas of Kilosa District in Morogoro Region, Tanzania. Sociodemographic, feeding practices, hygiene, and sanitation data were collected using a structured questionnaire. Weight and height of children were measured using a standard procedure, and age was calculated from the birth date obtained from the child growth card. Anthropometric data were analyzed by using Emergency Nutrition Assessment (ENA) software. The logistic regression model was used to explore the determinants of undernutrition. RESULTS: Prevalence of stunting, underweight, and wasting was 41.0%, 11.5%, and 2.5% in lowland and 64.5%, 22.0%, and 1.4% in highland areas, respectively. The prevalence of stunting and underweight was higher in the highland compared to the lowland areas (p < 0.001). Significant determinants of underweight were areas of residence (AOR 4.21, 95% CI: 1.62-10.9), age of the children (AOR 5.85, 95% CI: 1.81-18.97), and child birth weight (AOR, 4.98 95% CI: 1.65-15.05), while determinants of stunting were the area of residence (AOR, 2.77 95% CI: 1.43-5.36), maternal age (AOR, 0.33 95% CI: 0.14-0.79), sex of a child (AOR, 1.89 95% CI: 1.03-3.50), and child birth weight (AOR, 3.29 95% CI: 1.21-8.97). CONCLUSION: The prevalence of undernutrition, especially stunting and underweight, was high in the study areas. Determinants of stunting differed between highlands and lowland areas, highlighting the needs of having properly integrated interventions based on the geographical location.

Gestational diabetes mellitus in sub-Saharan Africa: systematic review and metaregression on prevalence and risk factors.

OBJECTIVE: We systematically reviewed publications on prevalence and risk factors for gestational diabetes mellitus (GDM) in the 47 countries of sub-Saharan Africa. METHODS: We conducted a systematic search in PUBMED and reviewed articles published until June 2014 and searched the references of retrieved articles. We explored sources of heterogeneity among prevalence proportions with metaregression analysis. RESULTS: Of 1069 articles retrieved 22 studies were included. Half were from West Africa, specifically Nigeria, five from South Africa and six from East and Central Africa. There were differences in screening methods and diagnosis criteria used, even between studies carried out in the same country and same time period. Metaregression analysis indicated high heterogeneity among the studies (I(2) = 100, P < 0.001), which could not be sufficiently explained by study setting, population, diagnostic criteria or time trend, although we observed a relatively higher prevalence in studies carried out after 2000 (5.1% vs. 3.2%), when women at risk were selected (6.5% vs. 3.8%) and when more current diagnostic criteria were used (5.1% vs. 4.2%). Associations with risk factors were reported in six studies. Significant risk factors reported in more than one study were overweight and/or obesity, family history for type 2 diabetes, previous stillbirth, previous macrosomic child and age >30 years. CONCLUSIONS: There are few studies on prevalence and risk factors for GDM in Sub-Saharan Africa and heterogeneity is high. Prevalence was up to about 14% when high-risk women were studied. Preventive actions should be taken to reduce the short- and long-term complications related to GDM in Sub-Saharan Africa.

High blood pressure and associated risk factors among women attending antenatal clinics in Tanzania.

AIM: Hypertension during pregnancy (HDP) is one of the leading causes of maternal and perinatal mortality worldwide. This study examined prevalence and potential risk factors for HDP among pregnant women in Tanzania. METHODS: We examined 910 pregnant women, aged at least 20 years, mean gestational age 27 weeks, from rural (n = 301) and urban (n = 609) areas, during their usual antenatal clinic visits. Hypertension was defined as clinic SBP at least 140 mmHg or DBP at least 90 mmHg. Dietary assessment included dietary diversity score using 16 food groups. Multiple logistic regression analysis was used to assess the independent association of risk factors associated with prevalence of hypertension. RESULTS: A total of 62 women (6.9%) had HDP, prevalence being higher in urban (8.1%) compared to rural area (4.4%). For the urban area, mother's age [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.03-1.20], gestational age (OR 1.10, 95% CI 1.02-1.20), mid-upper arm circumference (OR 1.13, 95% CI 1.01-1.23), dietary diversity score (OR 1.31, 95% CI 1.20-1.60) and being HIV-positive (OR 2.40, 95% CI 1.10-5.18) were independently associated with HDP. When adjusted for proteinuria, associations with HIV status and mid-upper arm circumference weakened. In the rural area, HDP risk increased with age and gestational age. CONCLUSION: Prevalence of HDP was higher in urban compared to rural area, which points at high risk for preterm delivery, low birth weight and future cardiovascular diseases. The observed risk factors identify risk groups to be screened and targeted for prevention. The role of HIV status needs to be further explored.

Prevalence of gestational diabetes mellitus in urban and rural Tanzania.

AIM: To estimate prevalence of gestational diabetes mellitus (GDM) and associated determinants in urban and rural Tanzania. METHODS: A cross-sectional study was conducted from 2011 through 2012 in selected urban and rural communities. Pregnant women (609 urban, 301 rural), who were not previously known to have diabetes, participated during usual ante-natal clinic visits. Capillary blood samples were collected at fasting and 2h after 75 g glucose load and were measured using HemoCue. Diagnosis of GDM was made using 1999 World Health Organization (WHO) criteria. RESULTS: Women in rural areas were younger (26.6 years) than in urban areas (27.5 years). Mean gestational age, height, and mid-upper arm circumference (MUAC) were similar for the two areas. Overall prevalence of GDM averaged 5.9%, with 8.4% in urban area and 1.0% in rural area. Prevalence of GDM was higher for women who had a previous stillbirth (OR 2.8, 95% CI 1.5-5.4), family history of type 2 diabetes (OR 2.1, 95% CI 1.1-4.2), and MUAC above 28 cm (OR 1.9, 95% CI 1.1-3.3), and lower for women with normal hemoglobin compared with anemia (OR 0.45, 95% CI 0.22-0.93). CONCLUSIONS: Prevalence of GDM is higher than expected in urban areas in Tanzania, indicating an increasing population who are at risk for delivery complications and type 2 diabetes in Sub-Saharan Africa.