Côte d’Ivoire Dual Burden of Disease (CoDuBu): Study Protocol to Investigate the Co-occurrence of Chronic Infections and Noncommunicable Diseases in Rural Settings of Epidemiological Transition

Abstract

BackgroundIndividual-level concomitance of infectious diseases and noncommunicable diseases (NCDs) is poorly studied, despite the reality of this dual disease burden for many low- and middle-income countries (LMICs).ObjectiveThis study protocol describes the implementation of a cohort and biobank aiming for a better understanding of interrelation of helminth and Plasmodium infections with NCD phenotypes like metabolic syndrome, hypertension, and diabetes.MethodsA baseline cross-sectional population-based survey was conducted over one year, in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d’Ivoire. We randomly identified 1020 consenting participants aged ≥18 years in three communities (Taabo-Cité, Amani-Ménou, and Tokohiri) reflecting varying stages of epidemiological transition. Participants underwent health examinations consisting of NCD phenotyping (anthropometry, blood pressure, renal function, glycemia, and lipids) and infectious disease testing (infections with soil-transmitted helminths, schistosomes, and Plasmodium). Individuals identified to have elevated blood pressure, glucose, lipids, or with infections were referred to the central/national health center for diagnostic confirmation and treatment. Aliquots of urine, stool, and venous blood were stored in a biobank for future exposome/phenome research. In-person interviews on sociodemographic attributes, risk factors for infectious diseases and NCDs, medication, vaccinations, and health care were also conducted. Appropriate statistical techniques will be applied in exploring the concomitance of infectious diseases and NCDs and their determinants. Participants’ consent for follow-up contact was obtained.ResultsKey results from this baseline study, which will be published in peer-reviewed literature, will provide information on the prevalence and co-occurrence of infectious diseases, NCDs, and their risk factors. The Taabo HDSS consists of rural and somewhat more urbanized areas, allowing for comparative studies at different levels of epidemiological transition. An HDSS setting is ideal as a basis for longitudinal studies since their sustainable field work teams hold close contact with the local population.ConclusionsThe collaboration between research institutions, public health organizations, health care providers, and staff from the Taabo HDSS in this study assures that the synthesized evidence will feed into health policy towards integrated infectious disease-NCD management. The preparation of health systems for the dual burden of disease is pressing in low- and middle-income countries. The established biobank will strengthen the local research capacity and offer opportunities for biomarker studies to deepen the understanding of the cross-talk between infectious diseases and NCDs.Trial RegistrationInternational Standard Randomized Controlled Trials Number (ISRCTN): 87099939; http://www.isrctn.com/ISRCTN87099939 (Archived by WebCite at http://www.webcitation.org/6uLEs1EsX)

Epidemiological links between malaria parasitaemia and hypertension

“…This study was done within the Côte d’Ivoire Dual Burden of Disease Study (CoDuBu), which aims to investigate the co-occurrence of infectious diseases and noncommunicable diseases (NCDs), in the Taabo health and demographic surveillance system (HDSS) [34]. Details of CoDuBu have been described elsewhere [35]. Briefly, 1019 adults (50% men) were randomly recruited in 2017 from three Taabo HDSS communities (Amani-Ménou, Taabo-Cité and Tokohiri).…”

Asymptomatic Plasmodium infection and glycemic control in adults: Results from a population-based survey in south-central Côte d’Ivoire

“…This study was carried out in 2017 in the frame of the Cô te d'Ivoire Dual Burden of Disease (CoDuBu) study, which recruited 1019 adults selected at random, to investigate the concomitance of common infections and NCDs, and their molecular determinants [1,4] The CoDuBu study was done within the Taabo health and demographic surveillance system (HDSS) [19], which is equivalent to a civil registration system that allows random sampling from the population. The detailed study protocol, including sampling procedure, is described elsewhere [1]. In brief, we estimated that we would need at least 976 participants given an expected malariadiabetes cooccurrence rate (assuming independence) of 2%, an error margin of 1%, and a non-response rate of 30%.…”

“…Based on the sampling frame, which included those meeting the inclusion criteria in each of three strata, we invited the participants in each stratum to the study in a random fashion until the desired sample size (reflecting the actual distribution in the three strata) was reached. At the end of the study, we recruited 252, 513, and 254 from Amani-Mé nou, Taabo-Cité , and Tokohiri, respectively [1]. Participants had several tests (including FG, HbA1c, malaria rapid diagnostic test (RDT), and microscopy using EDTA-buffered venous blood).…”

“…The rising rates of non-communicable diseases (NCDs) in a background of prevalent infectious diseases, and in the context of weak health systems in low-and middle-income countries (LMICs) have sparked interest on the potential role of common infections as risk factors for NCDs [1][2][3][4]. LMICs now have the greatest burden of mortality for diabetes worldwide, in part because of delayed diagnosis [5].…”

“…Population-based evidence on this link is therefore warranted for a deeper understanding of the diabetogenic effect of asymptomatic and potentially chronic carriage of PI. We investigated the association between PI and markers of glycemic control, including FG and glycated hemoglobin (HbA1c) in a population-based, malaria-endemic setting of south-central Cô te d'Ivoire [1,19,20]. We considered effect modification by hypothesized susceptibility factors to better differentiate the acute vs. longer-term associations of PI with glycemic control.…”