Summary Background Elevated blood pressure and glucose, serum cholesterol, and body mass index (BMI) are risk factors for cardiovascular diseases (CVDs); some of these factors also increase the risk of chronic kidney disease (CKD) and diabetes. We estimated CVD, CKD, and diabetes mortality attributable to these four cardio-metabolic risk factors for all countries and regions between 1980 and 2010. Methods We used data on risk factor exposure by country, age group, and sex from pooled analysis of population-based health surveys. Relative risks for cause-specific mortality were obtained from pooling of large prospective studies. We calculated the population attributable fractions (PAF) for each risk factor alone, and for the combination of all risk factors, accounting for multi-causality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific PAFs by the number of disease-specific deaths from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all inputs to the final estimates. Findings In 2010, high blood pressure was the leading risk factor for dying from CVDs, CKD, and diabetes in every region, causing over 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths; and cholesterol for 10%. After accounting for multi-causality, 63% (10.8 million deaths; 95% confidence interval 10.1–11.5) of deaths from these diseases were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7.1 million deaths; 6.6–7.6) in 1980. The mortality burden of high BMI and glucose nearly doubled between 1980 and 2010. At the country level, age-standardised death rates attributable to these four risk factors surpassed 925 deaths per 100,000 among men in Belarus, Mongolia, and Kazakhstan, but were below 130 deaths per 100,000 for women and below 200 for men in some high-income countries like Japan, Singapore, South Korea, France, Spain, The Netherlands, Australia, and Canada. Interpretations The salient features of the cardio-metabolic epidemic at the beginning of the twenty-first century are the large role of high blood pressure and an increasing impact of obesity and diabetes. There has been a shift in the mortality burden from high-income to low- and middle-income countries.
BackgroundAntenatal care (ANC) is a key strategy to decreasing maternal mortality in low-resource settings. ANC clinics provide resources to improve nutrition and health knowledge and promote preventive health practices. We sought to compare the knowledge, attitude and practices (KAP) among women seeking and not-seeking ANC in rural Kenya.MethodsData from a community-based cross-sectional survey conducted in Western Province, Kenya were used. Nutrition knowledge (NKS), health knowledge (HKS), attitude score (AS), and dietary diversity score (DDS) were constructed indices. χ2 test and Student’s t-test were used to compare proportions and means, respectively, to assess the difference in KAP among pregnant women attending and not-attending ANC clinics. Multiple regression analyses were used to assess the impact of the number of ANC visits (none, <4, ≥4) on knowledge and practice scores, adjusting for maternal socio-demographic confounders, such as age, gestational age, education level and household wealth index.ResultsAmong the 979 pregnant women in the survey, 59% had attended ANC clinics while 39% had not. The mean (±SD) NKS was 4.6 (1.9) out of 11, HKS was 6.2 (1.7) out of 12, DDS was 4.9 (1.4) out of 12, and AS was 7.4 (2.2) out of 10. Nutrition knowledge, attitudes, and DDS were not significantly different between ANC clinic attending and non-attending women. Among women who attended ANC clinics, 82.6% received malaria and/or antihelmintic treatment, compared to 29.6% of ANC clinic non-attendees. Higher number of ANC clinic visits and higher maternal education level were significantly positively associated with maternal health knowledge.ConclusionsSubstantial opportunities exist for antenatal KAP improvement among women in Western Kenya, some of which could occur with greater ANC attendance. Further research is needed to understand multi-level factors that may affect maternal knowledge and practices.
Objectives: To document the prevalence and the socio-spatial variations of obesity and to identify individual and household characteristics, lifestyles and dietary practices contributing to obesity and its socio-spatial distribution. Design: Population-based cross-sectional survey. We selected 1570 households from four strata characterised as unstructured and low building-density (ULBD), unstructured and high building-density (UHBD), structured and low buildingdensity (SLBD) and structured and high building-density (SHBD) areas. Structured areas are those that were allotted by the township authority (cadastral services), with public services; unstructured areas refer to those developed with no cadastral organisation. Setting: Ouagadougou, the capital city of Burkina Faso. Subjects: BMI was calculated in 2022 adults aged 35 years and above who were classified as obese when their BMI was $30 kg/m 2 . Obesity was investigated in relation to household and individual characteristics, lifestyles and dietary practices; adjusted odds ratios with 95 % confidence intervals were derived from a logistic regression model. Results: The overall prevalence of obesity was 14?7 % (males 5?5 % and females 21?9 %). Age, gender, household equipment index, usual transport with motor vehicles and micronutrient-rich food consumption were associated with obesity. After adjustment for these factors, obesity remained associated with the area of residence: residents from SHBD areas were more likely to be obese than those from ULBD areas (OR 5 1?41; 95 % CI 2?59,4?76). Conclusions: Obesity in Ouagadougou is a preoccupant problem that calls for more consideration. Thorough investigation is needed to assess the environmental factors that contribute to the socio-spatial disparity of obesity.
A population-based cross-sectional study was conducted to investigate the association of haemoglobin concentration and moderate-to-severe anaemia with afebrile Plasmodium falciparum (PF) infection in 456 rural children aged 6-23 months. Capillary blood was obtained for haemoglobin concentration measurement by HemoCue and malaria detection by blood smear microscopy. Anaemia was noted in 444 (97.4%) children with 194 (42.5%) being moderate-to-severe anaemia. PF infection was noted in 240 (52.6%) children with 117 (25.6%) being afebrile and 123 (27.0%) being febrile. Children with afebrile and those with febrile PF infection were more likely to have moderate-to-severe anaemia than children who were PF-free, with odds ratio (95% confidence interval) of 1.86 (1.07-3.23), p = 0.028 and 2.40 (1.29-4.48), p < 0.001, respectively. These results underline the high burden of both anaemia and PF infection in this population. Strategies aiming at controlling malarial anaemia and based on malaria case-treatment should consider both febrile and afebrile PF infection to allow for a better impact.
Summaryobjective To assess the effect of supplementation with iron or multiple micronutrients (MM) on the prevalence of anaemia in a malaria-endemic area.methods A community-based randomized double-blind trial was conducted in rural Burkina Faso, including children aged 6-23 months with haemoglobin (Hb) concentrations of 70-109 g ⁄ l who were randomized into an iron group (Fe, n = 96), an iron and zinc group (IZ, n = 100) or an MM group (MM, n = 100), 5 days ⁄ week for 6 months. All children were provided with insecticide-treated bednets; those who had a Plasmodium falciparum (PF) positive-smear at baseline and ⁄ or at each monthly checking received antimalarial therapy. None of the interactions on the effect of supplementation of baseline age (0.13), or baseline height-for-age z-score (P = 0.33), or incident PF parasitemia (P = 0.99), was significant.conclusion In this malaria-endemic area, in combination with malaria management, the MM supplement was more efficacious than the Fe supplement and the IZ supplement for reducing anaemia. Further investigation into limiting factors and amounts of micronutrients that would be more efficacious for reducing anaemia is recommended.
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