Introduction: To improve detection of undiagnosed diabetes in Africa, there is movement to replace the OGTT with A1C. The performance of A1C in the absence of hemoglobin-related micronutrient deficiencies, anemia and heterozygous hemoglobinopathies is unknown. Therefore, we determined in 441 African-born blacks living in America [male: 65% (281/441), age: 38 ± 10 y (mean ± SD), BMI: 27.5 ± 4.4 kg/m 2 ] (1) nutritional and hematologic profiles and (2) glucose tolerance categorization by OGTT and A1C. Methods: Hematologic and nutritional status were assessed. Hemoglobin <11 g/dL occurred in 3% (11/441) of patients and led to exclusion. A1C and OGTT were performed in the remaining 430 participants. ADA thresholds for A1C and OGTT were used. Diagnosis by A1C required meeting either A1C-alone or A1C&OGTT criteria. Diagnosis by OGTT-alone required detection by OGTT and not A1C. Results: Hemoglobin, mean corpuscular volume and red blood cell distribution width were 14.0 ± 1.3 g/dL, 85.5 ± 5.3 fL, and 13.2 ± 1.2% respectively. B12, folate, and iron deficiency occurred in 1% (5/430), 0% (0/430), and 4% (12/310), respectively. Heterozygous hemoglobinopathy prevalence was 18% (78/430). Overall, diabetes prevalence was 7% (32/430). A1C detected diabetes in 32% (10/32) but OGTT-alone detected 68% (22/32). Overall prediabetes prevalence was 41% (178/430). A1C detected 57% (102/178) but OGTT-alone identified 43% (76/178). After excluding individuals with heterozygous hemoglobinopathies, the rate of missed diagnosis by A1C of abnormal glucose tolerance did not change (OR: 0.99, 95% CI: 0.61, 1.62). Conclusions: In nutritionally replete Africans without anemia or heterozygous hemoglobinopathy, if only A1C is used, ~60% with diabetes and ~40% with prediabetes would be undiagnosed. Clinical Trial Registration: : www.ClinicalTrials.gov , Identifier: NCT00001853
Background and Purpose: Given that Ghana continues to record higher rates of adolescent pregnancy among rural dwellers, notably, those living in the Brong Ahafo, Central and Volta regions, it is surprising that scholarly information related to socio-cultural determinants of this sequel in these mentioned areas of the country is limited. This study sought to examine the socio-cultural factors associated with pregnancy among adolescent girls in Komenda-Edina-Eguafo-Abrem (KEEA) Municipality in the Central Region of Ghana. Methods and results: Using a matched case-control design with a 1:1 ratio, a facility-based sampling approach was used to select 400 adolescent females aged between 15 and 19 years. Chi-square analyses on the strictness level of rules and regulations in family [χ 2 (1) = 62.010, p < 0.05], freedom within the family to discuss issues related to sexuality [χ 2 (1) = 9.600, p < 0.05], religious support of sex before marriage [χ 2 (1) = 4.312, p < 0.05], peer influence to engage in sexual intercourse [χ 2 (1) = 7.793, p < 0.05], reaction of parents toward pregnancy [χ 2 (1) = 70.064, p < 0.05], and reaction of siblings toward pregnancy [χ 2 (1) = 66.702, p < 0.05] were significantly related to adolescents' pregnancy status. Additionally, binary logistic regression analysis also showed that non-pregnant adolescents were seven times more likely to belong to families with strict rules and regulations compared to pregnant adolescents [OR = 0.14, 95% CI = (0.07–0.25), p ≤ 0.01]. Non-pregnant adolescents were 3 times more likely to have freedom within the family to discuss issues related to sexuality compared to pregnant adolescents [OR = 0.33, 95% CI = (0.18–0.59), p ≤ 0.01]. However, pregnant adolescents were 3 times more likely to be influenced by their peers to engage in sexual intercourse [OR = 2.63, 95% CI = (1.46–4.74), p ≤ 0.001] and 3 times more likely to have parents with positive reaction toward adolescent pregnancy compared to non-pregnant adolescents [OR = 2.97, 95% CI = (1.15–7.70), p ≤ 0.05]. Additionally, these pregnant adolescents were eight times more likely to have siblings with positive reaction toward adolescent pregnancy [OR = 7.74, 95% CI = (2.59–21.4), p ≤ 0.001] compared to their non-pregnant counterparts. Conclusion: Adolescent pregnancy heightens the risk of negating birth outcomes that is independent of recognized confounding variables. Therefore, adolescent girls in the KEEA Municipality are likely to experience continuous exposure to the risk of pregna...
Background: Pregnancy among girls 10-19 years remains a challenge that requires critical resolution all over the world. Despite this worrying sexual phenomenon, research pertaining to prevention information and related services in Sub-Saharan nations like Ghana is sparse. This study sought to determine the influence of access to pregnancy prevention information and services on adolescent pregnancy in the Komenda-Edina-Eguafo-Abrem Municipality in the Central Region of Ghana. Methods and Results: Adopting a matched case-control research design with a 1:1 mapping, female adolescents aged between 15 and 19 years in the KEEA Municipality were selected using a facility based sampling technique. Results from both bivariate and multivariate analyses revealed that non-pregnant adolescents were about two times more likely to have access to pregnancy prevention information from health workers compared to pregnant adolescents [OR = 0.57, 95% CI = (0.33-0.96), p = 0.036]. Likewise, pregnant adolescents were five times more likely to have access to pregnancy prevention information from media compared to non-pregnant adolescents [OR = 5.44, 95% CI = (2.64-11.23), p = 0.000]. Additionally, non-pregnant adolescents were two times more likely to receive information on pregnancy prevention from school compared to pregnant adolescents [OR = 0.48, 95% CI = (0.28-0.81), p = 0.006]. Conclusion: Sexuality and reproductive health (SRH) programme organizers should target specific intervention programmes that focus on training health workers and/or other analogous staff to enhance their awareness, attitudes, and skills to more effectively meet with the specific needs of adolescents. Specific health workers training and redesign of health facilities to foster more adolescent user friendly working environment (e.g., extension in operational times, reduction in fees of SRH services, transforming physical design to promote privacy or confidentiality) ought to be encouraged. Different media outreach programmes should also combine other community level events [e.g., Ahinkorah et al. Adolescent Pregnancy Prevention Information and Services informative methods through schools (e.g., focus group discussions, participatory learning), assisting connections to health services, community information network (e.g., use of sirens)] to provide well-tailored advocacy that would help modify SRH and sociocultural norms that hinder positive sexual behaviors among young people.
Stress leads to physiologic dysfunction and cardiometabolic disease. Allostatic load score (ALS) measures stress-induced cardiovascular, metabolic, and inflammatory biomarkers. We estimated the odds of high ALS by reason for and age at immigration, duration of American residence, number of children, and socioeconomic status in 193 African immigrants (male: 65%, age 41 ± 10 y (mean ± Standard Deviation (SD)), range 22–65 y). ALS was calculated with High-ALS defined as ALS ≥ 3.0 and Low-ALS defined as ALS < 3.0. Oral glucose tolerance tests (OGTT) were performed, the cardiovascular disease (CVD) risk estimated, and TNF-α, an inflammatory cytokine, measured. Logistic regression was used to estimate odds of High-ALS. In the High- and Low-ALS groups, ALS were 4.0 ± 1.2 vs. 1.3 ± 0.7, diabetes prevalence: 14% vs. 4%, CVD risk: 23% vs. 8%, TNF-α levels: 15 ± 9 vs. 11 ± 6 pg/mL, respectively (all p ≤ 0.01). Immigrants were more likely to be in the High-ALS group if their reason for immigration was work or asylum/refugee (OR 2.18, p = 0.013), their age at immigration was ≥30 y (OR 3.28, p < 0.001), their duration of residence in United States was ≥10 y (OR 3.16, p = 0.001), or their number of children was ≥3 (OR 2.67, p = 0.019). Education, income, health insurance, marital status, and gender did not affect High-ALS odds. Factors adversely influencing allostatic load and cardiometabolic health in African immigrants were age at and reason for immigration, duration of residence in America, and number of children.
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