Community In Southwest Nigeria Research Articles

P17.12 Providing evidence to support community based hct screening programs – the voice of vulnerable rural youths in south-west nigeria

Background Low uptake of HIV testing services (HCT) in healthcare settings was reported by a study carried out in the South-south region of Nigeria. High acceptability of home based HCT has been reported in a previous study in South Africa. Home based testing also increased uptake of screening for HIV and syphilis among previously untested individuals in Brazil. Methods A cross sectional descriptive study was carried out among out-of-school youths in two rural communities in southwest Nigeria. The aim of the study was to determine the prevalence of HIV testing and the preferred venue for the tests. Multistage sampling method was used to select 360 respondents in each of the communities. Information was collected by trained interviewer’s using a pretested questionnaire. Data was analysed using Epi info statistical software version 3.6.3 and IBM SPSS version 20. Bivariate and multivariate analysis was carried out at p Results Mean age of respondents was 19.85 ± 2.71, majority were males (55.0%) and had at least secondary school education (66.7%). Most (86.5%) had heard of HCT, the commonest source of information being TV/Radio (49.0%), Health worker (14.2%), friends/family members (12.3%). Only 14.6% had been tested for HIV. Among this group, 8.3% were tested for medical reasons and 6.3% tested voluntarily. Testing was conducted at the health facility and laboratories in 11.3% out of the 14.6% of respondents that had been tested. Youths who had at least a secondary school education and use condoms were more likely to have been tested. Majority (78.0%) were willing to be tested among this group, more than a third (36.8%) will prefer to be tested within the community (workplace, school, home or mobile outreach). Conclusion Rural youths in this study are willing to be tested for HIV. Provision of this service within the community will improve access and uptake.

Social support and management of hypertension in South-west Nigeria.

SummaryIntroductionSocial support can facilitate compliance or adherence to recommended treatment regimens, especially for chronic disease management. There is little data from Africa on the role of social support in the management of chronic disease.ObjectiveThe current study investigated the relationship between social support for treatment compliance among hypertensive subjects in a poor urban community in southwest Nigeria. A second objective was identifying the correlates of social support in the study sample.MethodsThe study was a community-based, cross-sectional and descriptive study of 440 community residents (mean age 60 years, 65.2% women) from Idikan community, Ibadan, Nigeria who had hypertension.ResultsMost subjects (~ 93%) reported receiving some social support from family members and approximately 55% reported receiving social support from friends. Social support from friends (p < 0.0001) but not from family (p = 0.162) was significantly associated with good compliance with treatment for hypertension. Factors associated with receiving significant support from both family and friends included marital status and religion, while age and educational level were associated with receiving significant support from family members only. Gender was not significantly associated with receiving social support.ConclusionWe concluded that social support is strongly associated with hypertension treatment compliance in this community in south-west Nigeria. These findings suggest a need for exploring the promotion of social support as a useful tool in chronic disease treatment programmes.

Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria.

Introduction. The morbidity and mortality from malaria are still unacceptably high in the developing countries, especially among the vulnerable groups like pregnant women and under-five children, despite all control efforts. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of malaria preventive measures like Insecticide Treated Nets (ITN) by community members. Therefore, this study assessed the knowledge of malaria prevention among caregivers of under-five children and pregnant women in a rural community in Southwest Nigeria.Methodology. This is part of a larger malaria prevention study in rural Southwest Nigeria. A descriptive cross-sectional survey was conducted among pregnant women and caregivers of under-five children in Igbo-Ora, a rural town in Southwest Nigeria using a semi-structured, interviewer-administered questionnaire. Information was obtained on knowledge of malaria prevention, and overall composite scores were computed for knowledge of malaria prevention and ITN use. Data were analyzed using SPSS version 16. Associations between variables were tested using a Chi-square with the level of statistical significance set at 5%.Results. Of the 631 respondents, 84.9% were caregivers of under-five children and 67.7% were married. Mean age was 27.7 ± 6.3 years with 53.4% aged between 20 and 29 years. Majority (91.1%) had at least primary school education and 60.2% were traders. Overall, 57.7% had poor knowledge of malaria prevention. A good proportion (83.5%) were aware of the use of ITN for malaria prevention while 30.6% had poor knowledge of its use. Respondents who were younger (<30 years), had at least primary education and earn <10,000/per month had significantly poor knowledge of ITN use in malaria prevention. Majority (60.0%) respondents had poor attitude regarding use of ITNs.Conclusion. This study showed that the knowledge of malaria prevention is still low among under-five caregivers and pregnant women in rural Southwest Nigeria despite current control measures. There is a need for concerted health education intervention to improve the knowledge of rural dwellers regarding malaria prevention, including the use of ITN. This will go a long way to improving the reported low level of ownership and utilization of ITN in the rural areas.

Fasting Blood Glucose Profile among Secondary School Adolescents in Ado-Ekiti, Nigeria.

Background. Over the past two decades there has been an increase in type 2 diabetes mellitus (T2DM) in children. Baseline data is needed to assess the impact of changing lifestyles on Ado-Ekiti, a previously semiurban community in Southwest Nigeria. This study was therefore conducted to assess the fasting blood glucose (FBG) of adolescents in Ado-Ekiti, Nigeria. Methodology. This was a cross-sectional study involving 628 adolescents from three different secondary schools in Ado-Ekiti, Nigeria. With parental consent, volunteers completed a structured questionnaire, and an overnight FBG was measured. Results. There were 346 males and 282 females (male : female ratio = 1.2 : 1). Their ages ranged from 10 to 19 years (mean age: 14.2 ± 1.7 years). Four hundred and forty-four (70.7%) had normal FBG, while 180 (28.7%) and 4 (0.6%) had FBG in the prediabetic and diabetic range, respectively. Female gender, age group 10–14 years, and family history of obesity were significantly associated with impaired FBG (P value <0.001, <0.001, and 0.045, resp.). Conclusion. Impaired FBG is common among secondary school adolescents and it is more prevalent among younger female adolescents (10–14 years) with positive family history of obesity.

Willingness to accept preventive bilateral mastectomy among women in rural and urban communities in South-Western Nigeria

Background: Breast cancer is the commonest cancer in women with highest mortality in developing countries due to late presentation. The decision to remove both breasts through preventive bilateral mastectomy among high risk individuals in developing countries would transcend social, cultural and even spiritual boundaries. Preventive mastectomy if considered among women at high risk, can significantly reduces the life time risk of developing breast cancer. The study compared willingness to accept preventive bilateral mastectomy among women who reside in urban and rural communities in South-West Nigeria. Methods: Both quantitative and qualitative methods were employed. The quantitative study was a cross-sectional comparative survey among 680 women aged 20 years and above selected using a multi-stage sampling technique from two predominantly rural and urban Local Government Areas. Participants were interviewed using semi-structured, interviewer-administered questionnaires. In the qualitative study, focus group discussion sessions were held with the women in both rural and urban areas and analysed using detailed content analysis and results presented with Z-Y tables. Quantitative data were analysed using SPSS software version 16.0. Results: Results showed that One hundred and sixty seven (49.1%) and 132 (38.8%) of women in urban and rural areas respectively were willing to accept preventive bilateral mastectomy as a primary prevention strategy if they are identified to be at high risk. (χ 2 =7.3, P = 0.007). For those who were unwilling to accept preventive bilateral mastectomy as an option for breast cancer prevention, the commonest reasons were cosmetic-related (disfigurement and scars). The determinants of willingness to accept preventive bilateral mastectomy among women in rural areas were: self-perceived risk in urban areas and level of education (P = 0.035). Respondents at high self-perceived risk of breast cancer in rural areas were 1.94 times more likely to accept preventive bilateral mastectomy compared with those at average self-perceived risk (OR 1.94, CI 1.22-3.08). Conclusions: The study concluded that respondents with increased knowledge of breast cancer, high level of educational attainment and high self-perceived risk of breast cancer were more likely to accept preventive bilateral mastectomy as a primary prevention strategy if found to be at high risk for developing breast cancer.

Trained Community Volunteers Improve Tuberculosis Knowledge and Attitudes Among Adults in a Periurban Community in Southwest Nigeria

Nigeria has the world's 10th largest tuberculosis (TB) burden. Targeted community-based interventions can potentially help reduce TB incidence. We designed an intervention in a periurban community where 10 community volunteers were trained to provide community TB education and also detect and refer TB suspects to a nearby clinic. To determine the effect of the intervention on knowledge, attitude, and preventive practices of TB, we compared results from a pre-intervention survey with those of a post-intervention survey. Pre-intervention, respondents had a mean knowledge score of 10.6 ± 7.0 of a possible 34, a mean attitude score of 5.8 ± 3.3 of a possible 10, and a mean practice score of 5.3 ± 1.4 of a possible 7. The intervention significantly increased the mean knowledge score to 16 ± 5.4 (P < 0.001) and mean attitude score to 7.0 ± 1.8 (P < 0.001); however, there was no statistically significant difference in the mean practice score. Eight TB suspects were referred to the clinic, and one suspect was subsequently diagnosed with TB. The use of trained community volunteers to share information on TB improved the overall knowledge and attitudes of respondents. Continued empowerment of the community should be encouraged to promote TB prevention and care.

Health Risks and Healthcare Delivery in Flood Disaster Affected Communities in Southwest Nigeria

The incidence of flooding is becoming highly prevalent in Nigeria. The causes range from the depletion of atmospheric elements through carbon emission, illicit dumping of refuse in waterways, unfriendly physical planning and erection of structures along flood plains. Persons in flood affected communities are highly susceptible to stressrelated health challenges, including cholera and pyretic illnesses, which mostly affect women and children. This study interrogates the structural readiness of the Nigerian health system and the capacity to address disasters and the illness/disease conditions that are aftermath of flood disasters. In-depth interviews were conducted among 30 respondents who were affected by Ibadan flood disasters. This study found that the community lived on deplorable environmental structures with unapproved building plans that obstruct waterways. The victims confirmed government efforts in provision of relief services but expressed dissatisfaction in the mode of its implementation. Despite unpleasant experiences of the flood, victims still had to travel long distance to relief distribution points; be on a long queue for long hours; and struggle to establish status as victims in order to qualify for support from the government. There was inadequate provision of functional health facilities by the government to accommodate comprehensive, quality and long-term infrastructures for flood victims. Improvement in health security and infrastructure for vulnerable groups, and accessibility to emergency and post-emergency care and support is suggested.

Cardiovascular risk factors in semi-urban communities in southwest Nigeria: Patterns and prevalence

IntroductionOver 80% of cardiovascular deaths take place in low- and middle-income countries; most of these deaths are due to modifiable risk factors. The study aimed at estimating the prevalence and pattern of major cardiovascular risk factors in both men and women older than 18years. MethodsThis is a cross-sectional study of cardiovascular risk factors among semi-urban dwellers in Ekiti State, south-western, Nigeria. 750 participants were drawn from 10 communities. The instrument used was the standard WHO STEPS (II) questionnaire, while blood samples were obtained for analysis. ResultsThere were 750 participants with 529 (70.53%) females. The mean age of participants was 61.7±18.50years and participants’ ⩾65years comprised 38.3%. There were 0.8%, 24.9% and 12.4%, who at the time of this study smoked cigarettes, consumed alcohol, and ate a high salt diet, respectively. The prevalence of hypertension, diabetes, generalized and abdominal obesity was 47.2%, 6.8%, 8.5% and 32.0%, respectively, with only 48.9% receiving hypertension treatment. Elevated total cholesterol, LDL-cholesterol, and low HDL was seen in 4.4%, 16.7% and 56.3% respectively. ConclusionHigh prevalence of cardiovascular risk factors call for an urgent need for more public health attention and reinforcement of primary preventive strategies to curb its menace.

Reliability of Rapid Diagnostic Tests in the diagnosis of malaria amongst children in two communities in South West Nigeria

Background Prompt treatment of malaria following adequate diagnosis helps to reduce morbidity and mortality in children. Lack of resources and adequate manpower in developing countries make malaria microscopy difficult. The Rapid Diagnostic Test kit (RDT) remains unpopular despite its availability and ease of use because of lack of local research on its effectiveness leading to over-prescription of Artemisinin Combination Therapy (ACT).

Association between Snoring and Indices of Oropharyngeal Space among Adult in a Community in South West Nigeria

Association between Snoring and Indices of Oropharyngeal Space among Adult in a Community in South West Nigeria

Challenges of hemodialysis in a new renal care center: call for sustainability and improved outcome.

BackgroundNephrologists are faced with enormous challenges in the management of patients with end-stage renal disease, especially in sub-Saharan Africa, where hemodialysis is the most common modality of renal replacement therapy in the region. Therefore, we reviewed our 3 years of experience with hemodialysis services in a tertiary hospital located in a rural community of South West Nigeria. This was with a view to presenting the profile of hemodialysis patients and the challenges they face in sustaining hemodialysis.MethodsWe reviewed the case records and hemodialysis registers for 176 patients over the 3 years from November 2010 to December 2013. The data were analyzed using Statistical Package for the Social Sciences version 20 software.ResultsOf the 176 patients, 119 (66.9%) were males. The mean age of the patients was 44.87±17.21 years. Most were semiskilled or unskilled (111; 63.5%) and 29 (16.5%) were students. Twenty-six (14.8%) had acute kidney injury in the failure stage. Chronic glomerulonephritis, hypertensive nephropathy, and diabetic nephropathy accounted for 45.3%, 23.3%, and 12.1%, respectively, of patients with end-stage renal disease. Only 6.8% of patients could afford hemodialysis beyond 3 months.ConclusionSustainability of maintenance hemodialysis is poor in our environment. Efforts should be intensified to improve other modalities of renal replacement therapy, in particular kidney transplantation, which is cost-effective in the long-term. Also, preventive measures such as education for affected patients and the general population would assist in reducing the prevalence and progression to end-stage renal disease.

The prevalence and subjective handicap of epilepsy in Ilie — A rural riverine community in South West Nigeria: A door-to-door survey

BackgroundThe prevalence of epilepsy is high in tropical countries, particularly in Africa with an estimated mean prevalence of 15 per 1000. There is lack of recent data on epilepsy prevalence in Nigeria. The main objective of this study was to determine the prevalence of epilepsy in Ilie in South West (SW) Nigeria, and the secondary objectives were to determine the clinical characteristics, the seizure types with electroencephalography (EEG) recording, the pattern of treatment, and to evaluate the subjective handicap of people with epilepsy (PWE). Materials and methodsThe study, which was descriptive cross-sectional, was carried out in Ilie, a rural community in South West Nigeria, using a simple random sampling technique. The survey was done in 2 phases from January 2013 to April 2013.Phase 1: Door-to-door screening using the WHO Neuroscience Research Protocol to detect neurological disorders by health workers.Phase 2: Individuals with positive screening had complete neurologic examination by neurologists as well as an EEG recording. The questionnaires for survey of epilepsy in tropical countries and subjective handicap of epilepsy were administered to all PWE. ResultsTwo thousand two hundred twelve individuals from 231 households were screened during the first phase, and 33 cases of neurologic diseases were detected. During the second phase, 10 cases were confirmed to be epilepsy by neurologists, thus giving a crude lifetime prevalence of 10/2212=4.5/1000 population (95% CI=2.30–8.04). ConclusionsThe prevalence of epilepsy in Ilie in South West Nigeria is rather low compared with previous figures from studies in rural Africa.

Ownership and utilisation of insecticide-treated mosquito nets among caregivers of under-five children and pregnant women in a rural community in southwest Nigeria.

Malaria still constitutes a serious public health problem in Nigeria despite control efforts. The use of Insecticide Treated Net (ITN) has been proven to be an effective preventive modality in the control of malaria but its utilisation has been shown to be low. This study assessed the ownership and utilisation of ITN in Igbo-Ora, a rural community in Ibarapa Central Local Government Area (LGA) of Oyo State, Southwest Nigeria. A descriptive cross-sectional survey among female caregivers of under-five children and pregnant women was conducted using semi-structured interviewer-administered questionnaire. Data were analyzed using SPSS version 16. Among 631 respondents that participated, 84.9% were caregivers of under-five children. Mean age was 27.7 ± 6.3 years with 53.4% between 20-29 age group. Majority, 91.1% had at least primary education, 60.2% were traders and 69.7% were married. Most respondents, 71.8% had at least one type of mosquito nets. Among those that had, 85.4% had window/door net, 25.2% untreated mosquito net while only 15.5% had ITN. Overall, 11.1% of the respondents had ITN among which 78.6% had ever slept under an ITN. Among those that had ever slept under an ITN, slightly less than half 49.1% slept under an ITN the previous night. Less educated respondents were five times more likely to use ITN (95% CI = 1.24-21.28). This study revealed very low ownership and utilisation of lTNs. There is need to improve on the knowledge of community members of the relevance of ownership and utilisation of ITN in malaria prevention.

Intergenerational Life Courses of Teenage Pregnancy in Ogbomosho South‐Western Nigeria

Concern that the teenage pregnancy rate in an urban community in Southwest Nigeria has doubled within the last decade prompted an intergenerational survey of a sample of 277 respondents (163 pregnant teenagers, 91 teen parents and 23 adult parents who were once teen parents) selected through snowballing and then interviewed in four group discussions in Ogbomosho, Nigeria. Findings revealed that 43.5 per cent of the female and 48.5 per cent of the male teenagers informed their parents first when they became pregnant or made someone pregnant respectively. They also showed that lack of knowledge about puberty (21.3%) was a major factor that influenced teenage pregnancy. The majority (53.4%) of the respondents believed that their parents perceived teenage pregnancy as God's blessing, while it was perceived as sign of poverty by their school teachers (36.5%). Blame for unwanted pregnancy was put on the girls by 49.5 per cent of the respondents. Focused educational enlightenment for teenagers on sexual reproductive health is needed for reshaping teenagers' risky behaviours. This is in line with 25.6 per cent of the respondents who felt that community youth forum on sex education could reduce teenage pregnancy.

Prevalence and pattern of overweight and obesity in three rural communities in southwest Nigeria.

BackgroundLimited data exist on the prevalence of overweight and obesity in the Nigerian adult rural population. This study therefore assessed the prevalence and pattern of overweight and obesity in adults in three rural communities of the Ife North Local Government Area, Nigeria.Materials and methodsA total of 777 adults between 20 and 90 years of age were recruited into this cross-sectional study, which was performed over a 6-month period using a multistage proportional stratified random sampling technique. Sociodemographic data and anthropometric variables were obtained.ResultsA total of 385 (49.5%) men and 395 (50.5%) women participated in the study. The mean age and body mass index of the participants were 36.3±14.3 years and 23.53±4.6 kg/m2, respectively. The overall crude prevalence of overweight and obesity in the total population were 20.8% and 8.4%, respectively. Obesity increased across the age gradient, peaking in the 51- to 60-year age-group in men and women. Among the overweight and obese subjects (n=227), 70.9% of them were overweight and the remaining 29.1% were obese, with class I obesity accounting for 20.7% of these overweight and obese subjects.ConclusionThe prevalence of overweight and obesity in these communities was 20.8% and 8.4% respectively, indicating a trend towards increased prevalence. Class I obesity is the most common obesity pattern, and obesity increased across the age gradient, peaking in the 51- to 60-year age-group. There is a need for regular community education on healthy lifestyles, and regular health screening to control the rising prevalence of overweight and obesity, as well as to prevent or reduce the risk of obesity comorbidities in these communities.

Emergence of Extended Spectrum Beta-Lactamase-Producing Gram Negative Bacilli among patients with community acquiredUrinary Tract Infection (CA-UTI) in a Community in South West Nigeria

This study investigated the antimicrobial susceptibility pattern of Gram negative bacilli causing UTI in two Hospitals in a cosmopolitan community in South West, Nigeria. BU is a Tertiary-Care Hospital, and SH is a Private General Practitioner Hospital. One hundred (100) urine samples were collected at each station during the six-month study period and analyzed using standard bacteriology procedures. Bacteria were isolated from the urine samples on MacConkey agar, Blood agar and chocolate agar and isolates tested for susceptibility to 28 different antibiotics using the disc diffusion method. Further, isolates showing resistance to ceftazidime were screened for ESBL production by double disc synergy test (DDST). 20 urine samples (16 from SH and 4 from BU) yielded growth of bacteria which all showed resistance to more than one of the tested antibiotics. The urine samples from a patient yielded growth of two different bacteria species. All isolates showing resistance to ceflazidime (n=15) tested positive for ESBL. Blochemical characterization tests confirmed the ESBL producers as Klebsiella. pneumonia (n=14) and Enterobacter cloacae (n=1). There was an incidence of multiple drug-resistant ESBL producing Gram negative bacilli in this community.

High acceptance of artemisinin-based combination therapy for the home management of malaria in rural communities in southwest Nigeria.

Artemisinin based combination therapy (ACT) is the global gold standard for treatment of malaria. In sub-Saharan Africa the majority of malaria cases is treated at home. In rural southwest Nigeria we set out to evaluate the feasibility and acceptability of using artemether-lumefantrine (AL) at the community level to treat acute uncomplicated malaria. Following advocacy and community mobilisation in a rural area in south-west Nigeria, 60 community medicine distributors (CMDs: patent medicine sellers, selected mothers from the community and health-care workers) were trained to recognise the signs and symptoms of childhood malaria and to treat febrile children aged 6-59 months with AL, after ruling out certain danger signs. At the end of one year, the programme was evaluated by conducting a 2-week fever recall survey among caregivers, inspection of CMD records to evaluate caregivers' adherence to the treatment schedule, CMDs' performance and the coverage of febrile children with AL. Data was analysed using descriptive statistics. Based on CMDs' records, 97.6% (1019/1044) of the children treated with AL received the correct dose. Over half (52.3%) of the children (288/551) whose caregivers participated in the 2-week fever recall survey reportedly received AL from a CMD. Reasons for not receiving AL included non-availability of a CMD [35.7%; 94/263] or drug stock out [28.1%; 74/263]. Of the children treated with AL, 80.2% (231/288) received prompt treatment at the correct dose and for the correct length of time. Ninety-eight percent of the caregivers perceived AL to be effective and none reported severe adverse events. The use of AL at the community level is feasible and acceptable in the home management of malaria in rural southwest Nigeria. Challenges that must be addressed include avoiding stock outs, ensuring adequate number of CMDs and providing incentives to ensure their availability.

Herpes Simplex (Hsv–1, 2) Seropositivity: A Study Carried Out Among Diabetic and Non-Diabetic Patients in A Community In Southwest Nigeria

Herpes Simplex (Hsv–1, 2) Seropositivity: A Study Carried Out Among Diabetic and Non-Diabetic Patients in A Community In Southwest Nigeria

English

This study explored the antecedent factors influencing the practice of exclusive breast feeding (EBF) among lactating mothers in Ayete, a rural community in Southwest Nigeria. A three-stage random sampling technique was used to select 410 mothers of newborns and infants less than six months from households. A pretested semi-structured questionnaire which included a 14-point knowledge scale was used for data collection. Data were analyzed using descriptive statistics, Chi-square test and analysis of variance (ANOVA). Mean age was 27.4&plusmn;5.9 years and 67.1% respondents were aware that EBF should be initiated immediately after birth. Mean knowledge score on EBF was 8.2&plusmn;2.9. Age, educational level and occupation were significantly associated with knowledge of EBF (p&lt;0.05). Main perceived challenges associated with EBF were loss of essential nutrients by mothers (87.6%) and inducement of hunger (26.2%). Only 10.2% of respondents were practicing EBF as at the time of the study. Reasons for not practicing EBF included baby needs herbs for strength and vitality (31.3%), baby needed water to quench thirst (23.9%) and non-satisfaction with breast milk alone (20.8%). Practice of EBF was significantly more among respondents earning less than N5000.00 monthly (p&lt;0.05). Continuous sensitization activities are needed to promote breast feeding among lactating mothers. Key words: Exclusive breastfeeding, lactating mothers, antecedent factors.&nbsp;

Propensity for Diabetes and Correlation of its Predisposing Factors in Ota, Nigeria

Body Mass Index (BME) and Random Blood Glucose (RBG) are considered important predisposing factors for type 2 diabetes mellitus in adults. This study assessed the propensity to become diabetic based on the relationship between Body Mass Index (BME), Random Blood Glucose (RBG), gender and age in a community in South west Nigeria. The study included a convenient sample size of 140 healthy adult individuals who met the inclusion criteria. Anthropometric indices including height and weight were measured and Blood samples analyzed for random blood glucose. A significant positive correlation was observed (r = +0.32) between BME and RBG in females while there was no correlation in the males (r = -0.05). The males were found to be less likely to be diabetic than the females. The relationship between age and RBG was significantly positive in both males and females. The study confirms the hypothesis that a positive correlation exist between BME and RBG but only in women. This suggests that other causes including sex could predispose to diabetes and reiterates the diabetogenic effect of adiposity.