BackgroundContext-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa.MethodsThis was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence.ResultsA high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART.ConclusionsNon-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.

The authors acknowledge the support of the Nigeria Federal Ministry of Health and the WHO Nigeria Country Office in the conduct of this study. Special thanks to Victoria Nyawira Nyaga for checking through our statistical analyses. Authorship declaration: DA conceived and designed the study. DA, DQA and AA conducted the literature searches and data extraction. DA, DQA and EOO wrote the first draft. DA and MBA conducted the analysis. DA, AA, RGM, MTD, CO, NE, MOH, WA and IFA contributed to the final draft and checked for important intellectual content. All authors approved the manuscript as submitted.

BackgroundCentral obesity (CO) confers a significant threat on the cardio-metabolic health of individuals, independently of overall obesity. Disparities in the measures of fat distribution lead to misclassification of individuals who are at risk of cardio-metabolic diseases. This study sought to determine the prevalence and correlates of central obesity and normal-weight central obesity among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality (BCMM), South Africa, assess their health risk and examine the association between central obesity and cardio-metabolic diseases among adults with normal weight, measured by body mass index (BMI).MethodsA cross-sectional survey of 998 adults was carried out at the three largest outpatient clinics in BCMM. Overall and central obesity were assessed using BMI, waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHTR). The WHO STEPwise questionnaire was used for data collection. Blood pressure and blood glucose were measured. Normal-weight central obesity was defined as CO among individuals with normal weight, as assessed by BMI. Health risk levels were assessed using the National Institute for Health and Clinical Excellence (NICE) BMI-WC composite index. Bivariate and multivariate analyses were used to determine the prevalence of CO, normal-weight central obesity and the predictors of CO.ResultsThe mean age of participants was 42.6 (± 16.5) years. The prevalence of CO was 67.0, 58.0 and 71.0% by WC, WHR and WHTR, respectively. The prevalence of normal-weight central obesity was 26.9, 36.9 and 29.5% by WC, WHR and WHTR, respectively. About 41% of the participants had a very high health risk, 13% had increased risk or high risk and 33% had no health risk. Central obesity was significantly associated with hypertension but not associated with diabetes among those with normal weight (by BMI). Female sex, age over 30 years, marriage, secondary or tertiary level of education, non-smoking status, diabetes and hypertension significantly predicted central obesity among the study participants.ConclusionThe prevalence of central obesity among the study participants is high, irrespective of the defining criteria. One in three adults of normal weight had central obesity. Body mass index should therefore not be used alone for clinical assessment by healthcare workers in the study setting.

Background: Globally, alcohol use is responsible for 320 deaths every hour, and the impact is more among those in the younger age group. Despite the adverse health and social challenges associated with alcohol use, alcohol remains the most used and abused psychoactive substance among young adults. Our study aimed at determining the prevalence, correlates and frequency of alcohol use among young adults in two Nigerian universities. We further explored the role of family structure, family support and religion/religiosity on alcohol use in this study setting. Such findings could help to inform public health policy formulation in the country. Methods: This was a cross-sectional study conducted in two selected universities in the North Central region of Nigeria. The study was conducted among a final sample of 784 students selected using stratified random sampling. An interviewer-administered questionnaire was used to collect data on ever and current alcohol use and frequency of alcohol use between February and April 2018. The data were analysed using descriptive and inferential statistics. Results: The level of ever and current use of alcohol was 43.5 and 31.1%, respectively. The mean frequency of alcohol use among the study participants was three days, but ten days among current alcohol users. In the adjusted model, male sex, age above 19 years, infrequent attendance of religious rituals, and belonging to rich/middle-class family were significantly associated with a higher likelihood of ever use and current use of alcohol, while living in the same household as one's father was associated with lower odds of current and ever use of alcohol. Conclusion: There is a high rate of lifetime and current use of alcohol among university students in the study setting. Alcohol use was significantly associated with living with parents, religion and religiosity. Both high and low socioeconomic status were associated with alcohol use. There is a need to implement measures in controlling alcohol manufacturing and marketing as well as policies regulating alcohol outlets establishment around educational institutions as well as the working hours in such outlets. Finally, there is a need to organise interventions aimed at reducing this unhealthy social norm among students in this setting.

ObjectivesThis study examined hypertension prevalence, awareness, treatment and control and their determinants among adults attending health facilities in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape.DesignA cross-sectional analytical study.SettingsThe three largest outpatient clinics in BCMM.ParticipantsAmbulatory adults (aged 18 years and over) attending the study settings during the study period (n=998).Primary outcome measureThe prevalence of hypertension (systolic blood pressure (BP) of ≥140 mm Hg and/or a diastolic BP of ≥90 mm Hg or current medication for hypertension), the awareness of it (prior diagnosis of it) and its treatment and control (Eighth Joint National Committee Criteria of BP <140/90/90 mm Hg).Secondary outcome measureAssociated factors of hypertension, hypertension unawareness and uncontrolled hypertension.ResultsOf the 998 participants included, the prevalence of hypertension was 49.2%. Hypertension unawareness was reported by 152 participants (23.1%) with significant gender difference (p=0.005). Male sex, age <45 years, higher level of education, single status, current employment, higher monthly income, current smoking, alcohol usage, absence of diabetes and non-obese were significantly associated (p<0.05) with hypertension unawareness.Of the participants who were aware of having hypertension (n=339), nearly all (91.7%, n=311) were on antihypertensive medication and only 121 participants (38.9%) achieved the BP treatment target. In the multivariate logistic regression model analysis, ageing (95% CI 1.9 to 4.4), being married (95% CI 1.0 to 2.0), male sex (95% CI 1.2 to 2.3), concomitant diabetes (95% CI 1.9 to 3.9), lower monthly income (95% CI 1.2 to 2.2), being unemployed (95% CI 1.0 to 1.9) and central obesity (95% CI 1.5 to 2.8) were the significant and independent determinants of prevalent hypertension.ConclusionThe prevalence and awareness of hypertension was high in the study population. In addition, the suboptimal control of BP among treated individuals, as well as the significant cardiovascular risk factors, warrant the attention of health authorities of BCMM and the country.

Background Targeted public health response to obesity in Nigeria is relatively low due to limited epidemiologic understanding. We aimed to estimate nationwide and sub-national prevalence of overweight and obesity in the adult Nigerian population. Methods MEDLINE, EMBASE, Global Health, and Africa Journals Online were systematically searched for relevant epidemiologic studies in Nigeria published on or after 01 January 1990. We assessed quality of studies and conducted a random-effects meta-analysis on extracted crude prevalence rates. Using a meta-regression model, we estimated the number of overweight and obese persons in Nigeria in the year 2020. Results From 35 studies ( n = 52,816), the pooled crude prevalence rates of overweight and obesity in Nigeria were 25.0% (95% confidence interval, CI: 20.4–29.6) and 14.3% (95% CI: 12.0–15.5), respectively. The prevalence in women was higher compared to men at 25.5% (95% CI: 17.1–34.0) versus 25.2% (95% CI: 18.0–32.4) for overweight, and 19.8% (95% CI: 3.9–25.6) versus 12.9% (95% CI: 9.1–16.7) for obesity, respectively. The pooled mean body mass index (BMI) and waist circumference were 25.6 kg/m 2 and 86.5 cm, respectively. We estimated that there were 21 million and 12 million overweight and obese persons in the Nigerian population aged 15 years or more in 2020, accounting for an age-adjusted prevalence of 20.3% and 11.6%, respectively. The prevalence rates of overweight and obesity were consistently higher among urban dwellers (27.2% and 14.4%) compared to rural dwellers (16.4% and 12.1%). Conclusions Our findings suggest a high prevalence of overweight and obesity in Nigeria. This is marked in urban Nigeria and among women, which may in part be due to widespread sedentary lifestyles and a surge in processed food outlets, largely reflective of a trend across many African settings. KEY MESSAGES About 12 million persons in Nigeria were estimated to be obese in 2020, with prevalence considerably higher among women. Nutritional and epidemiological transitions driven by demographic changes, rising income, urbanization, unhealthy lifestyles, and consumption of highly processed diets appear to be driving an obesity epidemic in the country.

Aim: Tobacco use increases the risk of cardiovascular disease, premature death and certain cancers. This study investigated the prevalence and determinants of tobacco use among adults in Buffalo City Metropolitan Municipality (BCMM), South Africa. Methods: This study forms part of the cardio-metabolic risk survey carried out at the three largest outpatient clinics in BCMM. This multi-centre cross-sectional survey utilised the relevant items of the WHO STEPwise questionnaire to obtain information on demographic and behavioural characteristics of 1 107 participants. A total of 109 participants were excluded as a result of incomplete data. Thus, 998 participants (male = 327; female = 671) were included in the analysis. Self-reported, current use of any tobacco product was defined as tobacco use while secondary smoking was defined as exposure of non-smokers to environmental tobacco smoke, either at home or in the workplace. Results: Of all the study participants, 150 (15%) were current tobacco users and 335 (39.5%) of the non-smoking participants were exposed to secondary smoking. The majority of the tobacco users were males (70.7%) compared with females (29.3%). The commonest form of tobacco use was the manufactured cigarette. The mean age at initiation of smoking was 18.3 ± 5.1 and 22.6 ± 8.0 years for men and women, respectively. Only male sex (p = 0.000), single status (p = 0.003), no formal education (p = 0.007) and self-employment (p = 0.043) were significantly associated with tobacco use. Conclusion: High prevalence of tobacco use, especially cigarette smoking, in BCMM is worrisome given its strong association with cardiovascular events and cancers. The district health authorities should prioritise smoking cessation measures at the primary health care level.

Improved understanding of the current burden of hypertension, including awareness, treatment, and control, is needed to guide relevant preventative measures in Nigeria.A systematic search of studies on the epidemiology of hypertension in Nigeria, published on or after January 1990, was conducted. The authors employed randomeffects meta-analysis on extracted crude hypertension prevalence, and awareness, treatment, and control rates. Using a meta-regression model, overall hypertension cases in Nigeria in 1995 and 2020 were estimated. Fifty-three studies (n = 78 949) met our selection criteria. Estimated crude prevalence of pre-hypertension (120-139/80-89 mmHg) in Nigeria was 30.9% (95% confidence interval [CI]: 22.0%-39.7%), and the crude prevalence of hypertension (≥140/90 mmHg) was 30.6% (95% CI: 27.3%-34.0%). When adjusted for age, study period, and sample, absolute cases of hypertension increased by 540% among individuals aged ≥20 years from approximately 4.3 million individuals in 1995 (age-adjusted prevalence 8.6%, 95% CI: 6.5-10.7) to 27.5 million individuals with hypertension in 2020 (age-adjusted prevalence 32.5%, 95% CI: 29.8-35.3). The age-adjusted prevalence was only significantly higher among men in 1995, with the gap between both sexes considerably narrowed in 2020.Only 29.0% of cases (95% CI: 19.7-38.3) were aware of their hypertension, 12.0% (95% CI: 2.7-21.2) were on treatment, and 2.8% (95% CI: 0.1-5.7) had at-goal blood pressure in 2020. Our study suggests that hypertension prevalence has substantially increased in Nigeria over the last two decades. Although more persons are aware of their hypertension status, clinical treatment and control rates, however, remain low. These estimates are relevant for clinical care, population, and policy response in Nigeria and across Africa.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.