Non-communicable diseases among children in Ghana: health and social concerns of parent/caregivers.

Background: Globally, there is a progressive rise in the burden of non-communicable diseases (NCDs). This paper examined the health and social concerns of parents/caregivers on in-patient care for children with NCDs in Ghana. Methods: This was a cross-sectional study in three large health facilities in Ghana (the largest in the South, the largest in the North and the largest in the Eastern part of Ghana. Data was collected with a structured questionnaire among 225 caregivers (≥18 years) of 149 children with NCDs in health facilities in the three regions. Data was analyzed with simple descriptive statistics. Results: Most caregivers 169(75.0%) were women, relatively young (median age 35years), mostly married and resided in urban areas. Sickle cell disease was the commonest NCD among the children. All 169(75.0%) caregivers believed children suffer NCDs because of sins of parents/ancestors, 29(12.9%) believed herbalists/spiritualists have insights into treating NCDs and 73(32.6%) have previously used herbs/traditional medicine for child's illness. NCD in children was a burden and caused financial difficulties for families. Most caregivers (>96.0%) indicated NCDs in children should be included in national health insurance benefits package and a comprehensive national NCD policy is needed. Conclusion: Absence of national NCD policy for children is a major challenge. The burden of care rests mainly on the parents/ caregivers. A national strategic intervention on the importance of awareness generation on the causes, risk factors, prevention and treatment of NCDs for families and communities is essential. Government support through national health and social policy initiatives are essential.

Updates on communicable and non-communicable diseases in LMICs.

In this issue of African Health Sciences, we bring you diverse topics ranging from determinants of infant survival, to hernias and genes.

A Systematic Review of Studies on Blood Pressure in Iranian Pediatric Population: First Report From the Middle East and North Africa

Context:Blood pressure (BP) tracks from childhood to adulthood, and has ethnic variations. Therefore, it is important to assess the situation of pediatric BP in different populations. This study aims to systematically review the studies conducted on BP in Iranian children and adolescents. Evidence Acquisition: We conducted a systematic review on published and national data about pediatric BP in Iran, our search was conducted in Pub Med, Medline, ISI, and Scopus, as well as in national databases including Scientific Information database (SID), IranMedex and Irandoc from 1990 to 2014. Results: We found 1373 records in the primary search including 840 from international and 533 from national databases. After selection and quality assessment phases, data were extracted from 36 papers and four national data sources. Mean systolic BP (SBP) varied from 90.1 ± 14 mmHg (95% CI 89.25, 90.94) to 120.2 ± 12.3 (118.98, 121.41) mmHg, and for diastolic BP (DBP) from 50.7 ± 11.4 (50.01, 51.38) to 79.2 ± 12.3 (77.95, 80.44) mmHg. The frequency of elevated BP had large variation in sub-national studies with rates as low as 0.4% (0.009, 1.98) for high SBP and as high as 24.1% (20.8, 27.67) for high DBP. At national level, three surveys reported slightly raised rates of elevated BP from 2009 to 2012. Conclusions: The findings provide practical information on BP levels in Iranian pediatric population. Although differences exist on the findings of various studies, this review underscores the necessity of tracking BP from childhood, and implementing interventions for primordial prevention of hypertension.

Le double fardeau épidémiologique chez les personnes âgées en milieu rural africain : tendances de mortalité et causes de décès à Nouna (Burkina Faso)

This study aims to quantify the phenomenon of the double epidemiological burden in Burkin-Faso. Data from Nouna Health and Demographic Surveillance System (HDSS) were used with a total of 4427 deaths among those aged 50 and over, between 1993 and 2012 (including 2323 for which a cause is clearly diagnosed). The share of deaths due to communicable diseases did not significantly decline over time (-13%; p-value=0.158) while the proportion of deaths from non-communicable causes increased significantly (+178%; p-value<0.001). This resulted primarily from a rise in mortality rates from cardiovascular disease, especially among men. The rise of cardiovascular diseases led to a reduction in the life expectancy at age 50 (-2.65 years) between 1997-2004 and 2005-2012. Mortality from cardiovascular diseases contributes to the double epidemiological burden among the elderly in Burkina Faso.

Evaluation of Calretinin as a New Marker in the Diagnosis of Hirschsprung Disease

Background: Hirschsprung’s disease (HD) is a congenital intestinal motility disorder with absence of ganglion cells in the colonic wall. Diagnosis of the disease is mainly based on the identification of the lack of ganglion cells in the pathology sections of the colon which is very difficult and time consuming and also needs several serial cut sections. There are many proposed markers in this field in the literature but none of them has been satisfactory. Calretinin immunohistochemistry (IHC) has been introduced as a new diagnostic marker to overcome the problems in diagnosis of this disease about 5 years ago. However there are few studies regarding the benefits and pitfalls of this marker. Objectives: The aim of this study is to determine the diagnostic value of calretinin IHC in detecting aganglionosis (HD). Patients and Methods: 27 HD patients and 28 non-Hirschsprung’s disease (NHD) patients were collected in a prospective study and calretinin IHC was performed on 31 aganglionic and 51 normoganglionic full wall thickness sections of colectomies (some of the cases had more than 1 section). The IHC slides were evaluated by two pathologists and the diagnostic value was calculated in comparison with gold standard which is the presence or absence of ganglion cells in serial Hematoxylin and Eosin (HE) stained sections of the colectomies. Results: There was great concordance between the final diagnosis of both pathologists and gold standard (k > 0.9). Calretinin immunostaining showed 100% specificity and positive predictive value and more than 90% sensitivity and negative predictive value. High agreement was present between the two pathologists (k > 0.9). Conclusions: Calretinin IHC is a very convenient, useful and valuable method to demonstrate aganglionosis in HD patients. Loss of calretinin immunostaining in lamina propria and submucosa is characteristic of HD.

FATORES DE RISCO PARA DOENÇAS CRÔNICAS NÃO TRANSMISSÍVEIS E VARIÁVEIS SOCIODEMOGRÁFICAS DE SERVIDORES PÚBLICOS

Objetivo: Associar fatores de risco para doenças crônicas não transmissíveis (DCNT) com variáveis sociodemográficas de servidores de uma instituição pública de ensino superior. Métodos: Estudo transversal, realizado no período de 2012 a 2013. Utilizou-se um questionário com variáveis sociodemográficas, fatores de risco para DCNT e aferição de peso e estatura. Classificou-se o estado nutricional de acordo com o índice de massa corporal. Analisaram-se os dados pelos programas Epi-Info 3.2.1 e Bioestat 5.0. As associações foram verificadas pelos testes qui-quadrado de Yates, de tendência e exato de Fisher (p≤0,05). Resultados: Participaram 225 servidores, maioria de mulheres (64,4%), na faixa etária entre 45-54 anos (37,3%) e escolaridade superior a 12 anos de estudo (85,8%). O sexo associou-se ao excesso de peso (p=0,034), consumo diário de leite integral (p=0,023), consumo insuficiente de frutas, legumes e verduras - FLV (p=0,020) e consumo insuficiente de feijão (p=0,000), sendo mais frequentes entre mulheres. Entre os homens, foi mais frequente o consumo excessivo de bebida alcoólica (p=0,000). O excesso de peso associou-se à faixa etária (p=0,008). O hábito de fumar (p=0,004) e o consumo diário de leite integral (p=0,016) apresentaram associação com a escolaridade. Conclusão: Encontrou-se elevada prevalência de fatores de risco para doenças crônicas não transmissíveis na amostra estudada, com associação para sexo, faixa etária e escolaridade. O excesso de peso apresentou maior ocorrência nas mulheres e nas idades acima de 45 anos, hábitos alimentares inadequados no sexo feminino, maior ingestão de bebida alcoólica no masculino e hábito de fumar nos indivíduos com maior escolaridade.

Mobilizing for the Lilongwe Diabetes Peer Support Programme in Malawi

Diabetes has become a significant cause of morbidity and mortality in Malawi but there are shortages of drug supply and healthcare providers to support quality care and treatment. Diabetes self-management support is necessary to improve patient outcomes, and peer support has gained acceptance as a solution for improving diabetes self-management. In this programme summary, we describe the components and facilitators essential to implementing a diabetes peer support programme in Lilongwe, Central Malawi. Peer support has the potential to play a key role for the Ministry of Health in the development of the 2011-2026 health sector strategic plan, which addresses diabetes and non-communicable diseases.

Consumption of sweetened beverages among schoolgoing children in a densely populated township in Lilongwe, Malawi

Background The growing global childhood obesity pandemic has not spared lowincome countries like Malawi, where 8% of children below the age of five years are overweight. Globally, regular consumption of sweetened beverages is implicated among the factors that fuel childhood obesity. Despite the growing problem, there are no local studies on any aspect of sweetened beverage consumption among children in Malawi that could help in guiding interventions and public health nutrition policies. Aim We aimed to assess sweetened beverage consumption among school-going children in Chilinde, a densely populated township in Lilongwe, the capital city of Malawi. Methods A total of 60 school-going children whose caregivers gave verbal consent were included, and a structured questionnaire was administered to the caregiver (or other knowledgeable and responsible member of the household) of each eligible child. Results Our results showed that 50 of the 60 children sampled were consuming a wide-range of sweetened beverages on a regular basis on any day of the week, mostly during meal times (n = 23), before going to school (n = 22), and after school (n = 19). One-third of the children were reportedly consuming up to 300 mL of several sweetened beverages per day. Conclusion Like in many countries around the world, consumption of sweetened beverages appears to be common among young school-going children in this urban setting in Malawi. As the country builds public health responses to the growing problem of non-communicable diseases, early preventive interventions among children should be given priority.

THE ASSOCIATION OF DEMOGRAPHIC VARIABLES AND DIETARY HABITS ON BODY MASS INDEX OF FOREIGN-BORN POPULATION IN SOUTH KOREA

The Republic of Korea (Korea) has been composed of a single ethnic group and, until very recently, has had little or no experience with large-volume of immigrants. The country, once known for its large-scale emigration, has emerged as a popular destination. As the foreign-born populations continue to grow, they experience dietary pattern changes. Dietary changes of immigrants are often associated with weight increase and consequently the risk of non-communicable diseases such as diabetes. This study examined the association of demographic variables and dietary habits on Body Mass Index (BMI) of foreign nationals living in Korea, based on a cross-sectional sample of 193 foreign-born men (120) and women (73). A web-based survey program, Zoho survey, was used to capture self-reported region of origin, socio-demographic variables, weight, height, frequency of physical activity, and food frequencies. For the entire sample (n=193), the World Health Organization (WHO) classification and the Korean Society for the Study of Obesity cut-off points of BMI were used. The average BMI was 24.6 (SD=3.6) kg/m2. Significant associations were observed between BMI and age (χ² (8, N=193) =26.22, p<.01), gender (χ² (2, N=193) =11.45, p<.01), and religious affiliation (χ² (4, N=191) =9.53, p<.05). On average, participants had meat and carbonated drinks 2.2 times a week; high calorie foods 1.5 times a week; and, dairy products 2.4 times a week. A significant correlation (r=.14, p<.05) between BMI and eating meat was also observed. This study showed that the BMI varied with age, gender and religion. Frequent consumption of meat was associated with a significant increase in BMI. This increase in BMI could be associated with the dietary changes experienced by the newcomers or absence of more familiar products. Consequently, as the volume of immigrants continues to increase in Korea, it is imperative to consider designing and implementing public health policies specifically in relation to a healthy diet that can impact the prevalence of preventable chronic diseases. Thus, health education among foreign-born population in Korea should focus on reducing the intake of meat and high energy foods.

Prevalence of General and Abdominal Obesity in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study

Background: Pediatric obesity is one of the predisposing risk factors for many non-communicable diseases. Objectives: The purpose of this study was to estimate the national prevalence of general and abdominal obesity among Iranian children and adolescents. Patients and Methods: This cross-sectional nation-wide study was performed in 30 provinces in Iran among 14880 school students aged 6 – 18 years, selected by multistage random cluster sampling. The World Health Organization growth curve was used to categorize Body Mass Index (BMI). Obesity was defined as BMI equal to or higher than the age- and gender-specific 95th percentile; abdominal obesity was considered as waist-to-height ratio of more than 0.5. Results: Data of 13486 out of 14880 invited students were complete (response rate of 90.6%). They consisted of 6543 girls and 75.6% urban residents, and had a mean age of 12.45 (95% CI: 12.40 - 12.51) years. The prevalence rate of general and abdominal obesity was 11.89% (13.58% of boys vs. 10.15% of girls) and 19.12% (20.41% of boys vs. 17.79% of girls), respectively. The highest frequency of obesity was found in the middle school students (13.87% general and 20.84% abdominal obesity). The highest prevalence of general obesity was found in Boushehr (19%) followed by Guilan and Mazandaran (18.3%, 18.3%), while the lowest prevalence was observed in Hormozgan (2.6%). The highest frequency of abdominal obesity was found in Mazandaran (30.2%), Ardabil (29.2%) and Tehran (27.9%). Provinces such as Sistan-Baloochestan (8.4%), Hormozagan (7.4%), and Kerman (11.4%) had the lowest prevalence of abdominal obesity. The Southern and South Eastern provinces had the lowest prevalence of general obesity (2.6% and 5.6%) and abdominal obesity (7.4% and 8.8%). Moreover, the highest prevalence of obesity was found in North and North West Iran by maximum frequency of 18.3% general obesity and 30.2% of abdominal obesity. Conclusions: The results showed a high prevalence of general and abdominal obesity among boys living in the Northern provinces of Iran. The present study provides insights that policy makers should consider action-oriented interventions for prevention and control of childhood obesity at national and sub-national level.

Use of BARD scoring system in non-alcoholic fatty liver disease patients and its correlation with ultrasonographic grading in Gizan, Saudi Arabia

Purpose: To assess the efficacy of the BARD scoring system in Saudi non‐alcoholic fatty liver disease (NAFLD) patients attending Gizan General Hospital and to identify the clinical variables associated with advanced fibrosis. . Methods: The cross-sectional study involved 120 patients aged ≥ 18 years who attended the Ultrasound Department of Gizan General Hospital, Gizan, Saudi Arabia, during January – June 2013. BARD scoring system comprised the following variables: body mass index (BMI) ≥ 28 = 1 point, aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio ≥ 0.8 = 2 points, and type 2 diabetes mellitus = 1 point. Results: Patients with advanced fibrosis were older (55.0 years) than patients with no/mild fibrosis (48.6 years), albeit not significantly so. A higher BMI was associated with advanced fibrosis in males, females and all study participants (p = 0.013, 0.016 and 0.001, respectively). Advanced fibrosis was more common in older patients with a higher weight to height ratio. Logistic regression suggested that age ≥ 50 years was associated with a 2.52-fold increase in the risk of advanced fibrosis, but this did not have a significant clinical impact (p = 0.087). BMI > 28 was associated with a 26.73-fold increased risk of advanced fibrosis, while AST/ALT ≥ 0.8 was associated with an 18.46-fold increased risk of advanced liver fibrosis (p = 0.002 and 0.006, respectively). Conclusion: The major risk factors for advanced fibrosis using BARD scoring system in patients with NAFLD were old age, BMI > 28, and AST/ALT ≥ 0.8. In addition, grade 3 ultrasonographic fatty liver significantly correlated with advanced fibrosis.