학술논문
Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi.
Document Type
Academic Journal
Author
Price AJ; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi. Electronic address: alison.price@lshtm.ac.uk.; Crampin AC; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.; Amberbir A; Medical and Research Department, Dignitas International, Zomba, Malawi.; Kayuni-Chihana N; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.; Musicha C; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.; Tafatatha T; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.; Branson K; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.; Lawlor DA; MRC Integrated Epidemiology Unit and School of Social and Community Epidemiology Medicine, University of Bristol, Bristol, UK.; Mwaiyeghele E; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.; Nkhwazi L; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.; Smeeth L; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.; Pearce N; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.; Munthali E; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.; Mwagomba BM; Global Health Implementation Program, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi; Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.; Mwansambo C; Ministry of Health, Lilongwe, Malawi.; Glynn JR; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.; Jaffar S; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.; Nyirenda M; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi.
Source
Publisher: The Lancet, Diabetes & Endocrinology Country of Publication: England NLM ID: 101618821 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2213-8595 (Electronic) Linking ISSN: 22138587 NLM ISO Abbreviation: Lancet Diabetes Endocrinol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Sub-Saharan Africa is in rapid demographic transition, and non-communicable diseases are increasingly important causes of morbidity and mortality. We investigated the burden of diabetes, overweight and obesity, hypertension, and multimorbidity, their treatment, and their associations with lifestyle and other factors in Malawi, a very poor country with a predominantly rural-but rapidly growing urban-population, to identify high-risk populations and inform appropriate interventions.
Methods: In this cross-sectional, population-based study, we enrolled all adults (≥18 years) residing in two defined geographical areas within Karonga District and Lilongwe city. All adults self-defining as usually resident in the study areas were eligible, and recruited at household level. Participants were interviewed, had anthropometry and blood pressure measured, and had fasting blood samples collected. The study outcomes were prevalence estimates and risk ratios for diabetes (defined as fasting blood glucose of at least 7·0 mmol/L or self-report of a previous diagnosis of diabetes), hypertension (systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or self-report of current antihypertensive medication), overweight (BMI of 25·0-29·9 kg/m2 ) and obesity (BMI of 30·0 kg/m 2 or more), and multimorbidity (two or more of the above conditions) by location-specific (urban vs rural), age-specific, and sex-specific groups, calculated using negative binomial regression. We used χ 2 likelihood ratio tests to assess heterogeneity by age, location, and sex.
Findings: Between May 16, 2013, and Feb 8, 2016, we enrolled 15 013 (62%) of 24 367 eligible urban adults in Lilongwe and 13 878 (88%) of 15 806 eligible rural adults in Karonga District. Overweight and obesity, hypertension, and diabetes were highly prevalent, more so in urban residents, the less poor, and better educated than in rural, the poorest, and least educated participants. 18% of urban men (961 of 5211 participants) and 44% (4115 of 9282) of urban women, and 9% (521 of 5834) of rural men and 27% (2038 of 7497) of rural women were overweight or obese; 16% (859 of 5212), 14% (1349 of 9793), 13% (787 of 5847), and 14% (1101 of 8025) had hypertension; and 3% (133 of 3928), 3% (225 of 7867), 2% (84 of 5004), and 2% (124 of 7116) had diabetes, respectively. Of 566 participants with diabetes, 233 (41%) were undiagnosed, and of 4096 participants with hypertension, 2388 (58%) were undiagnosed. Fewer than half the participants on medication for diabetes or hypertension had well controlled diabetes (84 [41%] of 207 participants) or blood pressure (440 [37%] of 1183 participants). Multimorbidity was highest in urban women (n=519, 7%).
Interpretation: Overweight and obesity, hypertension, and diabetes are highly prevalent in urban and rural Malawi, yet many patients are undiagnosed and management is limited. Local-evidence-informed multisectoral, innovative, and targeted interventions are needed urgently to manage the already high burden.
Funding: Wellcome Trust.
(Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Methods: In this cross-sectional, population-based study, we enrolled all adults (≥18 years) residing in two defined geographical areas within Karonga District and Lilongwe city. All adults self-defining as usually resident in the study areas were eligible, and recruited at household level. Participants were interviewed, had anthropometry and blood pressure measured, and had fasting blood samples collected. The study outcomes were prevalence estimates and risk ratios for diabetes (defined as fasting blood glucose of at least 7·0 mmol/L or self-report of a previous diagnosis of diabetes), hypertension (systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or self-report of current antihypertensive medication), overweight (BMI of 25·0-29·9 kg/m
Findings: Between May 16, 2013, and Feb 8, 2016, we enrolled 15 013 (62%) of 24 367 eligible urban adults in Lilongwe and 13 878 (88%) of 15 806 eligible rural adults in Karonga District. Overweight and obesity, hypertension, and diabetes were highly prevalent, more so in urban residents, the less poor, and better educated than in rural, the poorest, and least educated participants. 18% of urban men (961 of 5211 participants) and 44% (4115 of 9282) of urban women, and 9% (521 of 5834) of rural men and 27% (2038 of 7497) of rural women were overweight or obese; 16% (859 of 5212), 14% (1349 of 9793), 13% (787 of 5847), and 14% (1101 of 8025) had hypertension; and 3% (133 of 3928), 3% (225 of 7867), 2% (84 of 5004), and 2% (124 of 7116) had diabetes, respectively. Of 566 participants with diabetes, 233 (41%) were undiagnosed, and of 4096 participants with hypertension, 2388 (58%) were undiagnosed. Fewer than half the participants on medication for diabetes or hypertension had well controlled diabetes (84 [41%] of 207 participants) or blood pressure (440 [37%] of 1183 participants). Multimorbidity was highest in urban women (n=519, 7%).
Interpretation: Overweight and obesity, hypertension, and diabetes are highly prevalent in urban and rural Malawi, yet many patients are undiagnosed and management is limited. Local-evidence-informed multisectoral, innovative, and targeted interventions are needed urgently to manage the already high burden.
Funding: Wellcome Trust.
(Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)