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Background The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa. Methods We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I 2 statistic. Findings In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I 2 =98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I 2 =98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I 2 =99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines. Interpretation Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity. Funding This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
Background The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa. Methods We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I 2 statistic. Findings In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I 2 =98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I 2 =98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I 2 =99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines. Interpretation Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity. Funding This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
Purpose The prevalence of overweight and obesity in children and adolescents is on the increase in developing countries. Therefore, a cheap, accessible and simple screening tool such as the mid-upper arm circumference (MUAC) is required for the prompt assessment. The purpose of this paper is to determine the usefulness of MUAC in assessing overnutrition in comparison with bioelectrical impedance analysis (BIA). Design/methodology/approach Participants included 1,067 children aged 6–18 years recruited from private and public schools in Egor Local Government Area in Benin City, Nigeria. Body fat was estimated by BIA using a Tanita scale, whereas the MUAC was measured with a non-elastic tape. Receiver operating characteristic analysis was used to test the ability of MUAC to determine children and adolescents identified as overweight and obese by BIA. Findings The prevalence of overnutrition by MUAC (12.4 percent – overweight 6.0 percent and obesity 6.4 percent) was comparable to that by BIA (12.3 percent – overweight 5.4 percent, obesity 6.9 percent). There was a significant correlation between MUAC and body fat percentage, fat mass, fat mass index and fat-free mass index in both males and females (p=0.000). Research limitations/implications This study, in contrast to most other studies on the use of MUAC in the assessment of overnutrition, has the advantage of using BIA cut-offs values against body mass index which does not assess body fat composition. BIA is, however, not the gold standard in the measurement of body fat composition. The optimal MUAC cut-off values of this study may not be representative of the entire country because of its restriction to Benin. Similar studies from different parts of Nigeria will be required to validate this smoothed MUAC percentiles for use in the screening of children and adolescents for overnutrition. Originality/value MUAC compares well with BIA in this study and can be a useful, alternative and practical screening tool for assessing obesity in the resource-poor setting.
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