Cardiovascular risk factors in rural Kenyans are associated with differential age gradients,but not modified by sex or ethnicity

Abstract

Background: The relationship between metabolic disease and the non-modifiable risk factors sex, age and ethnicity in Africans is not well-established.

Aim: This study aimed to describe sex, age and ethnicity differences in blood pressure (BP) and lipid status in rural Kenyans.

Subjects and methods: A cross-sectional study was undertaken among rural Kenyans. BP and pulse rate (PR) were measured while sitting and fasting blood samples were taken for analysis of standard lipid profile. Standard anthropometric measurements were collected. Physical activity energy expenditure was obtained objectively and lifestyle data were obtained using questionnaires.

Results: In total, 1139 individuals (61.0% women) participated aged 17–68 years. Age was positively associated with BP and plasma cholesterol levels. Sitting PR was negatively associated with age in women only (sex-interaction p?<?0.001). Ethnicity did not modify any of the age-associations with haemodynamic or lipid outcomes. Differences in intercept between women and men were found in all parameters except for diastolic BP (p?=?0.154), with men having lower HDL-C but higher values in all other cardiovascular risk factors.

Conclusion: BP and plasma cholesterol levels increase with age at a similar gradient in men and women, but absolute levels of the majority of the risk factors were higher in men.     

SMOKELESS TOBACCO USE AMONG ADULTS IN THE NORTHERN PROVINCE OF SOUTH AFRICA: QUALITATIVE DATA FROM FOCUS GROUPS

The aim of this study was to investigate perceptions on the use of smokeless tobacco in the Northern Province, South Africa. Ten focus groups were conducted in 1999 with two heterogeneous groups (5 with middle-aged and 5 with the aged). They were mainly Northern Sotho speaking. From 72 participants 16 women and 8 men admitted to using snuff. The most popular types of smokeless tobacco used were homemade snuff and only a few used ‘commercial” snuff. The basic ingredients for homemade snuff were tobacco and other plant leaves. Snuff was found to have important functions and to be socially acceptable in the groups studied mainly for ceremonial and medicinal use and to a lesser degree for relaxation and pleasure. Generally, positive and medicinal effects were noted for snuff use. Most participants agreed that it is addictive, but only a few acknowledged the negative effects in terms of causing cancer.     

Williams–Beuren syndrome in diverse populations

Williams–Beuren syndrome (WBS) is a common microdeletion syndrome characterized by a 1.5Mb deletion in 7q11.23. The phenotype of WBS has been well described in populations of European descent with not as much attention given to other ethnicities. In this study, individuals with WBS from diverse populations were assessed clinically and by facial analysis technology. Clinical data and images from 137 individuals with WBS were found in 19 countries with an average age of 11 years and female gender of 45%. The most common clinical phenotype elements were periorbital fullness and intellectual disability which were present in greater than 90% of our cohort. Additionally, 75% or greater of all individuals with WBS had malar flattening, long philtrum, wide mouth, and small jaw. Using facial analysis technology, we compared 286 Asian, African, Caucasian, and Latin American individuals with WBS with 286 gender and age matched controls and found that the accuracy to discriminate between WBS and controls was 0.90 when the entire cohort was evaluated concurrently. The test accuracy of the facial recognition technology increased significantly when the cohort was analyzed by specific ethnic population (P‐value < 0.001 for all comparisons), with accuracies for Caucasian, African, Asian, and Latin American groups of 0.92, 0.96, 0.92, and 0.93, respectively. In summary, we present consistent clinical findings from global populations with WBS and demonstrate how facial analysis technology can support clinicians in making accurate WBS diagnoses.     

Family structure effects on early sexual debut among adolescent girls in Rakai,Uganda

This study assessed the association between household family structure and early sexual debut among adolescent girls, ages 15–19, in rural Rakai District, Uganda. Early sexual debut is associated with detrimental physical, emotional, and social outcomes, including increased risk of HIV. However, research on the family’s role on adolescents’ sexual risk behaviors in sub-Saharan Africa has been minimal and rarely takes into account the varying family structures within which African adolescents develop. Using six rounds of survey data (2001–2008) from the Rakai Community Cohort Study, unmarried adolescent girls (n = 1940) aged 15–17 at their baseline survey, were followed until age 19. Parametric survival models showed that compared to adolescent girls living with both biological parents, girls who headed their own household and girls living with stepfathers, grandparents, siblings, or other relatives had significantly higher hazards of early sexual debut before age 16. Adolescent girls were significantly more likely to debut sexually if neither parent resided in the household, either due to death or other reasons. In addition, the absence of the living biological father from the home was associated with a higher risk of sexual debut, regardless of the biological mother’s presence in the home. Our study’s findings suggest that family structure is important to adolescent girls’ sexual behavior. There is need for research to understand the underlying processes, interactions, and dynamics of both low and high-risk family structures in order to devise and strategically target interventions for specific types of family structures.     

The rebellious man: Next-of-kin accounts of the death of a male relative on antiretroviral therapy in sub-Saharan Africa

ABSTRACT

The HIV response is hampered by many obstacles to progression along the HIV care cascade, with men, in particular, experiencing different forms of disruption. One group of men, whose stories remain untold, are those who have succumbed to HIV-related illness. In this paper, we explore how next-of-kin account for the death of a male relative. We conducted 26 qualitative after-death interviews with family members of male PLHIV who had recently died from HIV in health and demographic surveillance sites in Malawi, Tanzania, Kenya, Uganda, Zimbabwe and South Africa. The next-of-kin expressed frustration about the defiance of their male relative to disclose his HIV status and ask for support, and attributed this to shame, fear and a lack of self-acceptance of HIV diagnosis. Next-of-kin painted a picture of their male relative as rebellious. Some claimed that their deceased relative deliberately ignored instructions received by the health worker. Others described their male relatives as unable to maintain caring relationships that would avail day-to-day treatment partners, and give purpose to their lives. Through these accounts, next-of-kin vocalised the perceived rebellious behaviour of these men, and in the process of doing so neutralised their responsibility for the premature death of their relative.     

A delicate web: Household changes in health behaviour enabled by microcredit in Burkina Faso

Abstract

Providing microcredit to women in developing countries has long been highlighted as a simple and effective strategy for poverty reduction and health improvement. However, little is known about how microcredit enables changes in health behaviour. This knowledge is critical to further strengthen microcredit initiatives. This qualitative study, conducted in Burkina Faso, shows how microcredit can not only facilitate savings and investment strategies, but also lead to changes in household decision-making, enabling women to initiate health prevention, seek health treatment and manage health emergencies. Some changes led to increased household burdens for women that impeded health gains, such as administrative loan delays by the microcredit institution and reduced household contributions by the husband. Furthermore, the study highlighted the fragile nature of health gains, which may be eroded due to economic shocks on a household, such as crop failure, drought or illness.     

Alcohol misuse,policy and treatment responses in Sub-Saharan Africa: The case of Uganda

Abstract

Alcohol has become an important feature in the lives of many inhabitants of Sub-Saharan Africa and is increasingly associated with excessive consumption and negative personal and social consequences. Uganda is one of the Sub-Saharan countries with the highest rate of alcohol-related burden in the world, but supply and demand reduction strategies such as regulatory measures, prevention and treatment programs are hardly available. Consequently, the aim of this article is to critically review the situation in Uganda as part of a regional trend. First, the origins of alcohol misuse and emerging policy initiatives in Sub-Saharan Africa are discussed. Then, the consequences of alcohol misuse in Uganda are highlighted, as well as policy and treatment responses. Recommendations are formulated for developing more effective and culturally adapted treatment programs and policies.     

Covariates of high-risk sexual behaviour of men aged 50 years and above in sub-Saharan Africa

Since the advent of HIV/AIDS, sexuality studies in sub-Saharan Africa (SSA) have focused mainly on the sexual behaviour of the younger generation (15–49 years) and little has been done to understand the sexual behaviour of those a 50 years and above. The objective of this study is therefore to examine the covariates of high-risk sexual behaviour among men aged 50 years plus within the SSA region. Data from Demographic and Health Surveys of 10 SSA countries were pooled together and a sample of 5394 men aged 50 years plus who have ever had sex was analysed. Findings show that in SSA, a large proportion of men aged 50 years plus (74%) were sexually active and a substantial proportion of these men engaged in unsafe sexual behaviours, such as having multiple sexual partners and unprotected sex. The multivariate logistic regression analysis showed that involvement with multiple sexual partners was significantly associated with older age, urban residence, religion, having primary or secondary education, and ever taken an HIV test. Condom use at last sex was significantly associated with age at first sex, multiple sexual partners, level of education and ever been tested for HIV. These results suggest that HIV prevention and intervention programmes should also target older men as they are also sexually active and at risk of being infected because of unsafe sexual practices.