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.
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.
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DOI：
10.1016/s2213-8587(17)30432-1
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发表时间：
2018-03
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通讯作者：
Nyirenda M
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作者：
Price AJ;Crampin AC;Amberbir A;Kayuni-Chihana N;Musicha C;Tafatatha T;Branson K;Lawlor DA;Mwaiyeghele E;Nkhwazi L;Smeeth L;Pearce N;Munthali E;Mwagomba BM;Mwansambo C;Glynn JR;Jaffar S;Nyirenda M
撒哈拉以南非洲正处于快速的人口转型期，非传染性疾病日益成为发病率和死亡率的重要原因。我们调查了糖尿病，超重和肥胖，高血压和多发性硬化症的负担，他们的治疗，以及他们与生活方式和其他因素在马拉维，一个非常贫穷的国家，主要是农村，但迅速增长的城市人口，以确定高风险人群和适当的干预措施。在这项基于人群的横断面研究中，我们招募了居住在卡隆加区和利隆圭市两个定义的地理区域的所有成年人（≥18岁）。所有自我定义为通常居住在研究地区的成年人都有资格，并在家庭层面招募。参与者接受了采访，进行了人体测量和血压测量，并收集了空腹血液样本。研究结果是糖尿病的患病率估计和风险比（定义为空腹血糖至少7·0 mmol/L或自我报告既往糖尿病诊断）、高血压（收缩压至少140 mm Hg，舒张压至少90 mm Hg，或自我报告当前抗高血压药物），超重（BMI为25.0 - 29.9 kg/m2）和肥胖（BMI为30.0 kg/m2或以上），以及多项（上述两种或两种以上情况），按特定地点（城市与农村）、特定年龄和特定性别分组，使用负二项回归计算。我们使用χ2似然比检验来评估年龄、地点和性别的异质性。在2013年5月16日至2016年2月8日期间，我们在利隆圭的24367名合格城市成年人中招募了15013名（62%），在卡隆加区的15806名合格农村成年人中招募了13878名（88%）。 超重和肥胖、高血压和糖尿病非常普遍，在城市居民中更是如此，不那么贫穷，教育程度高于农村，最贫穷，教育程度最低的参与者。18%的城市男性（5211名参与者中的961名）和44%（9 282人中的4 115人），占9%（521/5834），农村男子和27% 7497名农村妇女中有2038人超重或肥胖，16%（5212人中的859人），14%（9793人中的1349人），13%（5847人中的787人）和14%（8025人中的1101人）患有高血压;分别有3%（3928人中的133人）、3%（7867人中的225人）、2%（5004人中的84人）和2%（7116人中的124人）患有糖尿病。在566名糖尿病患者中，233名（41%）未确诊，在4096名高血压患者中，2388名（58%）未确诊。接受糖尿病或高血压药物治疗的参与者中，只有不到一半的人糖尿病（207名参与者中的84名[41%]）或血压（1183名参与者中的440名[37%]）得到了良好的控制。城市妇女的多发病率最高（n=519，7%）。超重和肥胖、高血压和糖尿病在马拉维的城市和农村非常普遍，但许多患者未被诊断，管理有限。迫切需要当地循证的多部门、创新和有针对性的干预措施来管理已经很高的负担。Wellcome Trust.
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. 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/m2 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 χ2 likelihood ratio tests to assess heterogeneity by age, location, and sex. 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%). 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. Wellcome Trust.