Double Burden Of Disease Research Articles

Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt.

The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region. To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis. Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl. Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29). Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.

Food Perceptions and Dietary Changes for Chronic Condition Management in Rural Peru: Insights for Health Promotion.

Peru is undergoing a nutrition transition and, at the country level, it faces a double burden of disease where several different conditions require dietary changes to maintain a healthy life and prevent complications. Through semistructured interviews in rural Peru with people affected by three infectious and noninfectious chronic conditions (type 2 diabetes, hypertension, and neurocysticercosis), their relatives, and focus group discussions with community members, we analyzed their perspectives on the value of food and the challenges of dietary changes due to medical diagnosis. The findings show the various ways in which people from rural northern Peru conceptualize good (buena alimentación) and bad (mala alimentación) food, and that food choices are based on life-long learning, experience, exposure, and availability. In the context of poverty, required changes are not only related to what people recognize as healthy food, such as fruits and vegetables, but also of work, family, trust, taste, as well as affordability and accessibility of foods. In this paper we discuss the complexity of introducing dietary changes in poor rural communities whose perspectives on food are poorly understood and rarely taken into consideration by health professionals when promoting behavior change.

Parasites and allergy: Observations from Brazil.

Brazil is a middle-income country undergoing the epidemiological transition. Effects of changes in daily life habits and access to clean water, sanitation and urban services on a growing urban population have contributed to a double burden of both infectious and noncommunicable chronic diseases. Studies have indicated that parasite infections may modulate the human immune system and influence the development of allergic conditions such as asthma. However, there is no consensus in the published literature on the effects of parasitic infections on allergy, perhaps as a consequence of factors determining the epidemiology of these infections that vary between populations such as age of first infection, duration and chronicity of infections, parasite burden and species, and host genetic susceptibility. In this review, we discuss the observations from Brazil concerning the relationship between parasite infections and allergy.

Anthropometric Status among 6⁻9-Year-Old School Children in Rural Areas in Hai Phong City, Vietnam.

A double burden of malnutrition in Vietnamese children has emerged as a key challenge: childhood undernutrition remains a public health concern while childhood overweight/obesity has gradually increased. This study aimed to (1) estimate the prevalence of undernutrition and overnutrition among 6–9-year-old primary school children in rural areas of Vietnam, and (2) identify sociodemographic factors associated with undernutrition and overnutrition in this population. A cross-sectional survey was conducted in October 2016 in 2334 children from eight primary schools in rural areas in Hai Phong City, Vietnam. Anthropometric and demographic data were collected. The prevalence of underweight, stunting, wasting, and anthropometric failure was 8.0%, 5.1%, 5.3%, and 11.9%, respectively. Up to 22.1% of children were affected by overweight/obesity, and 31.0% by abdominal overweight/obesity. Low maternal education was associated with higher odds of underweight and anthropometric failure, whereas overweight/obesity or abdominal overweight/obesity were more likely in boys and children of mothers with a high education level. This study provides evidence for a double burden of diseases among primary school children in rural areas in Hai Phong City. Future interventions for the prevention and control of childhood undernutrition and overweight/obesity should take into account child sex and maternal education level.

Know Your Numbers: A Promising NCD-Prevention Strategy in LMICS

Background: Noncommunicable diseases (NCDs) are the leading cause of deaths globally, responsible for 70% of global deaths with two-thirds of these deaths occurring in low- and middle-income countries causing a double burden of disease. The Cameroon Baptist Convention Health Services (CBCHS) has established the first comprehensive NCD Prevention and Control program in Cameroon with a screening component called “Know Your Numbers (KYN)” in response to the growing prevalence of NCDs in the country as noticed in our annual patients’ statistics. KYN is built on the scientific basis that NCDs develop insidiously and progress slowly over time, usually undetected. Aim: To raise awareness on NCDs, screen for risk in 7 health districts and refer for care and treatment. Methods: In partnership with the local government through health districts, we systematically measured blood pressure, blood sugar, body mass index (BMI) and waist circumference measurement as well as assessed the lifestyle risk exposure of all participants, age 18 and above, using a prepared Risk Exposure Assessment Form (REAF) and collected data which were entered into an electronic database by a trained data clerk for analysis using Epi Info v 7.1. Results: Of 10,000 adults who were screened, 20% were hypertensive (BP > 140 systolic or > 90 diastolic), 2% were prediabetic, 31% were overweight (BMI 25-29), and 26% were obese (BMI 30+). Over 98% of all participants had at least one risk factor for NCDs. Conclusion: NCDs pose a major risk to the health of Cameroonians. Risk factors abound and expose the population to high risk of developing these diseases within the next 5-10 years. KYN is a promising strategy to create awareness and link people with obesity for treatment. It may help reduce the prevalence of NCDs and their complications if scaled up.

PHP332 - INTRODUCTION OF MOBILE HEALTH TECHNOLOGY AT THE PRIMARY HEALTHCARE LEVEL IN MONGOLIA

The main goal of the initiative is to improve the health of the population, especially by reaching out to disadvantaged population groups by introducing Mobile Health (mHealth) technology at the primary care level. Ultrasound apparatus, ECG, rapid diagnostic tests, other essential tools were distributed to support target family health centres in both urban and rural areas. A number of capacity building training were organised for the health workers of the target sites. Visiting Home Services (VHS), mobile application, and digitalising paper forms for the communicable and noncommunicable disease screening at the primary health care was applied in health information system. Mobile health service teams conducted health examination combined with screenings. Among the total adults examined, 14.1% new cases were detected as confirmed hyper tonic and 16.4% of confirmed diabetic. For 15.6% people were observed changes in ECG. For 20%, abnormal ultrasound imaged cases were confirmed. 105 new cases for Hepatitis B and 123 for Hepatitis C were confirmed. The mobile health based screening project implementation highlights the importance of investing comprehensively in strategies for implementation, without which any new initiative is less likely to be implemented successfully. Mongolia, a low to middle-income country with the double burden of disease, can serve as an example for other countries in the region and globally in the implementation of mobile health technologies to achieve better screening programs at the urban and rural setting.

Site-Specific Lung Cancer to Support National Cancer Control Programs in Indonesia

Background: Lung cancer surely increased particularly in developing country that has double burden of disease because of epidemiologic transition effected high incidence in productive age and premature death. Indonesia as a developing country has better life expectancy but there aren't national cancer control yet. National cancer registry as one of pivotal tools in priority setting of national cancer control. Aim: Epidemiology pattern of lung cancer based on National Cancer Registry to determine national cancer control programs. Methods: In 2016 Ministry of Health assigned 14 provinces (26 cities/districts) in Indonesia to enforce population-based cancer registry and Dharmais as a National Cancer Centre. All health facilities sent data to the National Referral Hospitals in each provinces which Canreg5 were used, year 2008-2012. Data from 14 National Referral Hospitals sent to Dharmais NCC for analysis. Results: Lung cancer posed in the first rank for male and the sixth rank for female by comparison 2:1. Peak incidence occurs in age group of 55 years for male meanwhile 50 years for female. However escalation of cases began in age group of 35 years for both sexes. Three provinces which have high incidence for lung cancer were Bali, South Sumatera and DKI Jakarta as capital city of Indonesia. Adenocarcinoma as the most common histology type. Despite most valid percentage and coverage from each province still quite low. Conclusion: Lung cancer become the first priority for cancer control program in male foremost three provinces. This issue highlighted and need further analysis to assess risk factor.

The Role of Multisectoral Collaboration in Indonesia for Successful Health Promotion

Background: Cancer had caused 14,067,900 people suffered in 2012. In Indonesia, with 357,000 cases, added by mortality and morbidity, cancer has added the country double burden of disease. Thus, preventive measure should be done to tackle the problem. One of the best ways is health promotion through the massive campaign and multisectoral collaboration using the momentum of annual World Cancer Day (WCD). Annual WCD has been held by National Cancer Control Committee (NCCC)-Ministry of Health (MoH), however, 2017 is the kick-off event which engages multisector to promote cancer awareness and knowledge. Aim: This campaign aims to increase awareness and knowledge about cancer (including the healthy lifestyle, detection program and treatment) among Indonesian. Strategy: The national action was planned based on the strategic objective of NCCC. The campaign was coordinated by NCCC-MoH of Indonesia and implemented throughout the country. The local situation, condition and creativity were encouraged to ensure the successful campaign. Program process: Initial coordination was made by NCCC. The proposal was disseminated to the centers across Indonesia. Then, centers would carry out the event and report to the NCCC. Meanwhile, a massive campaign in Jakarta was held by NCCC. Outcomes: There were 25 out of 34 provinces, consisted of 18 nongovernmental organizations (NGOs), 20 professional societies, 37 hospitals and 25 provincial public health service involved in the WCD campaign. This WCD was held under decree of Minister of Health. Several programs in the WCD were press briefing, seminars, talk show, fun campaign in public areas (i.e., celebrity performance, yoga), promotion via local television/newspaper and social media; early detection such as Papanicolaou test, mobile mammography, breast ultrasound, clinical breast examination and visual inspection of acetic acid. The impact of WCD 2017 was tremendous compared with previous year, with multisectoral involvement, overloaded participants and broke the World of Record Museum-Indonesia (MURI) with the most dancer involved dance for the cancer survivor. In addition, the impact can be seen in 2018, when no decree of the minister and national movement provided. In 2018, NCCC only organized a training of trainer with the hope of having an extension of the hand to deliver knowledge and awareness. Nevertheless, each part of Indonesia was commemorating their own WCD without any coordination. These evidence showed that NCCC had been successful to increase awareness and knowledge about cancer. What was learned: Many people were involved in the preparation, starting from doctors, local government, NGOs, hospitals, MoH, companies, survivors and celebrities. Moreover, social media campaign and celebrities played a great role in making this event succeed. Therefore, multisector collaboration is an essential part of raising awareness and knowledge about cancer.

Patient perspectives on medication self-management in rural Kenya: a cross-sectional survey.

The presence of HIV, tuberculosis and non-communicable diseases result in a double burden of disease in the East African community. Most studies have focused on urban Nairobi and western Kenya, leading to a lack of information on rural regions that make up 75% of the population. This study determined baseline rates and barriers to medication self-management in rural Meru County. A cross-sectional, descriptive community survey focused on Meru, Kenya. Participants were surveyed at a local Kithoka dispensary and the government operated Meru Level 5 Hospital. Seventy-five chronic illness patients between June 2016 and July 2016. Twelve-question Measures of Drug Self-Management Scale (MeDS). Baseline rates of medication self-management. A score of 10 or more defined 'adequate' medication drug self-management. The average MeDS score was 8.16 ± 2.4, indicating inadequate medication self-management. There was no significant difference across age (P = 0.75), and between the scores of males and females (8.1 ± 2.4 and 8.2 ± 2.5, respectively, P = 0.89). Minor side effects and the idea that taking medicines disrupt life were highly associated with inadequate drug self-management (r = 0.58). Forgetfulness and non-adherence had the highest correlation (r = 0.64). Cost is a large barrier, with 64% agreeing that they have a hard time paying for their medicines. All questions on the MeDS survey had statistically significant correlations with the overall score, while gender and age did not. The MeDS questionnaire showed to be an effective tool to evaluate risk of long-term non-adherence globally in rural populations.

Addressing the Double Burden of Malnutrition in Developing Countries: Need for Strategies to Improve the Lean Body Mass.

The double burden of childhood undernutrition and adult-onset adiposity-related chronic diseases is a key concern in many developing countries that are currently undergoing epidemiological and nutrition transition. Impaired linear growth with suboptimal lean body mass development seems to be the link between these 2 seemingly contrasting forms of malnutrition. Studies assessing the role of early nutrition in the later lean body mass development have shown consistent positive association. In addition, the nutrition during life course, especially the dietary intake of protein, zinc, calcium, and vitamin D status, impacts the lean body mass. Promoting increased intake of these important nutrients throughout life course would, therefore, be important for optimal development and maintenance of lean body mass. Diversified diets with increased consumption of nutrient-rich foods, especially milk and other animal source foods, are crucial for the development of optimal body composition and alleviation of the double burden of malnutrition.

Workforce issues of general practice in a developing country: Pakistan.

Pakistan is a developing country that has a double burden of communicable and non-communicable disease. Healthcare reform is required to combat these prevailing healthcare issues with the 'family medicine approach' to primary care. Developing a workforce of trained general practitioners (GPs) to implement this approach is essential but challenging, yet there are success stories not only from developed countries but also from a few developing countries. General practice is a specialty that has been recognised only recently in Pakistan. This article reviews the challenges of developing a workforce of trained GPs for primary care and proposes solutions to address the gap. Involving all stakeholders and organisations related to the specialty of general practice, integrating the subject of family medicine at an undergraduate level and encouraging postgraduate training and capacity-building through on-the-job training of GPs working in rural and urban primary care are all essential to develop a workforce of trained GPs in Pakistan. At the same time, standardisation and accreditation of primary care sites for training and research through public-private partnership are recommended.

Association between internal migration and epidemic dynamics: an analysis of cause-specific mortality in Kenya and South Africa using health and demographic surveillance data

BackgroundMany low- and middle-income countries are facing a double burden of disease with persisting high levels of infectious disease, and an increasing prevalence of non-communicable disease (NCD). Within these settings, complex processes and transitions concerning health and population are underway, altering population dynamics and patterns of disease. Understanding the mechanisms through which changing socioeconomic and environmental contexts may influence health is central to developing appropriate public health policy. Migration, which involves a change in environment and health exposure, is one such mechanism.MethodsThis study uses Competing Risk Models to examine the relationship between internal migration and premature mortality from AIDS/TB and NCDs. The analysis employs 9 to 14 years of longitudinal data from four Health and Demographic Surveillance Systems (HDSS) of the INDEPTH Network located in Kenya and South Africa (populations ranging from 71 to 223 thousand). The study tests whether the mortality of migrants converges to that of non-migrants over the period of observation, controlling for age, sex and education level.ResultsIn all four HDSS, AIDS/TB has a strong influence on overall deaths. However, in all sites the probability of premature death (45q15) due to AIDS/TB is declining in recent periods, having exceeded 0.39 in the South African sites and 0.18 in the Kenyan sites in earlier years. In general, the migration effect presents similar patterns in relation to both AIDS/TB and NCD mortality, and shows a migrant mortality disadvantage with no convergence between migrants and non-migrants over the period of observation. Return migrants to the Agincourt HDSS (South Africa) are on average four times more likely to die of AIDS/TB or NCDs than are non-migrants. In the Africa Health Research Institute (South Africa) female return migrants have approximately twice the risk of dying from AIDS/TB from the year 2004 onwards, while there is a divergence to higher AIDS/TB mortality risk amongst female migrants to the Nairobi HDSS from 2010.ConclusionResults suggest that structural socioeconomic issues, rather than epidemic dynamics are likely to be associated with differences in mortality risk by migrant status. Interventions aimed at improving recent migrant’s access to treatment may mitigate risk.

Weight status and food habits of preschool children in Abu Dhabi, United Arab Emirates: NOPLAS project.

Eating habits established during childhood affect health in later life. The United Arab Emirates (UAE) has a high prevalence of obesity in adolescents and adults; however, data on the health of preschool children are scarce. This study assessed the weight status and dietary habits of Emirati and non-Emirati children attending nurseries in Abu Dhabi, UAE. Weight and height were measured in children aged 18 months-4 years. Z scores for height-for-age (HAZ), weight-for-age (WAZ), and BMI-for-age (BAZ) were calculated based on WHO protocols. Parents completed a questionnaire regarding demographics and food frequency. A total of 203 children participated. Abnormal anthropometric status (z scores of <-2 or >2) for WAZ was indicated in 12.8% of Emirati children versus 1.4% of non-Emirati children (p=0.008) and for BAZ in 19.9% of Emirati children versus 8.4% of non-Emirati children (p<0.05). Emirati children exhibited higher prevalences of malnutrition (4.3% vs 1.4%), wasting (11.5% vs 2.8%), and overweight (8.5% vs 4.2%) than non-Emirati children and consumed discretionary calorie foods and typical components of Emirati cuisine (rice, fish, and pulses) significantly more often than non-Emirati children. Similar to findings in other countries undergoing economic transition, an indication of a double burden of disease was revealed in chil-dren attending nurseries in Abu Dhabi. Malnutrition and overnutrition were represented, especially among Emira-ti children, and were seemingly related to lifestyle rather than genetics. Therefore, policies focusing on child health interventions are required.

Causes of death at the University of Ghana Hospital in Accra-a 37-year review (1979-2015).

An analysis of the causes of death in developing countries is needed to improve healthcare delivery. The aim of this study was to conduct a descriptive analysis of the causes of death at the University of Ghana Hospital from 1979 to 2015. Data were extracted from the electronic database of the University of Ghana Hospital. Diseases were grouped into three broad groups of causes of death as per the Global Burden of Disease cause list, with some diseases of epidemiological importance outlined and analysed by age, gender and time in years. Of 3263 deaths, almost 60% were caused by non-communicable diseases (NCDs) that consisted of cancers, diabetes mellitus, cardiovascular diseases and other systemic conditions. Deaths by malaria, tuberculosis, diarrhoeal diseases and immunizable childhood diseases declined over the years while deaths from NCDs increased. The majority of cases of NCDs were due to cardiovascular disorders. The study suggests that Ghana has a double burden of disease with predominantly NCDs from cardiovascular diseases, metabolic disorders and cancers. Although malaria and other childhood-related illnesses have declined significantly, human immunodeficiency virus is fuelling the communicable disease mortalities. There is an urgent need to scale up NCD control interventions while strengthening communicable disease control.

The double burden of disease and the challenge of health access: Evidence from Access, Bottlenecks, Cost and Equity facility survey in Ghana.

Despite the double burden of infectious and chronic non-communicable diseases in Africa, health care expenditure disproportionately favours infectious diseases. In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. A total of 220 health facilities was surveyed across the country in 2011. Findings indicate that diagnoses and treatment of infectious diseases were more accessible than NCDs. In terms of treatment, 78% and 87% of health facilities had two of the recommended malaria drugs while less than 35% had essential diabetes and hypertension drugs. There is a significant unmet need for diagnoses and treatment of NCDs in Ghana. These inequities have implications for high morbidity and mortality from NCDs. We recommend the use of task shifting as a model to increase the delivery of NCD services.

The association of physical activity to blood cholesterol levels and blood pressure

Background & aims: Overweight, obesity, and related chronic diseases are becoming serious public health concerns in Cyprus and worldwide. Compounded with the existing issue of obesity and lack of exercise, such concerns expose the double burden of disease and may put stress on healthcare.

History and challenges of Brazilian social movements for the achievement of the right to adequate food

ABSTRACTThe historical struggles that Brazil faced to overcome malnutrition coincided with the empowerment of civil society and social movements which played a crucial role in the affirmation of health and food as social rights. After two decades under military dictatorship, Brazil went through a redemocratization process in the 1980s when activism emerged to demand spaces to participate in policy-making regarding the social agenda, including food and nutrition security (FNS). From 1988 onward institutional structures were established: the National Council of FNS (CONSEA) convenes government and civil society sectors to develop and monitor the implementation of policies, systems and actions. Social participation has been at the heart of structural changes achieved since then. Nevertheless, the country faces multiple challenges regarding FNS such as the double burden of disease, increasing use of pesticides and genetically modified seeds, weak regulation of ultra-processed products, and marketing practices that affect the environment, population health, and food sovereignty. This article aims at examining the development of the participatory political system and the role played by Brazilian social movements in the country’s policies on FNS, in addition to outlining challenges faced by those policies.

Morbidity profile of communicable diseases in a tertiary care hospital of Chandrapur, Maharashtra

Background: Worldwide, developed and developing countries are facing the double burden of communicable and non-communicable diseases. However, developing countries like India is more exposed and vulnerable due to multitude of factors. Objectives were to study the morbidity patterns of communicable diseases of indoor patients at tertiary care hospital and find out the seasonal distribution of the communicable diseases.Methods: A retrospective study was done over a period of 1 year from April 2016 to March 2017. 4766 admitted patients of communicable diseases were included using universal sampling method. Diagnosis was categorized as per International classification of Disease (ICD) 10 classification. Data was analyzed using spss 16.Results: Out of the total 4766 admitted patients, 62% were females and 38% were males. 56.40% patients admitted in the most productive age group (15-45 years) followed by 14.35% and 8.06% geriatric population and under 5 children respectively. Peak in admission was seen in monsoon season (July to Sept.). 34.54% patients were admitted for bacterial cause followed by 30.03% acute gastroenteritis (AGE). AGE, viral fever, malaria were more commonly seen in female while typhoid, measles, tuberculosis were more commonly seen in male.Conclusions: Many diseases have a seasonal variation and the burden of these diseases could be reduced if we take measures to detect the changes in their trend through the implementation of surveillance programs.

The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda

BackgroundThe double burden of infectious diseases coupled with noncommunicable diseases poses unique challenges for priority setting and for achieving equitable action to address the major causes of disease burden in health systems already impacted by limited resources. Noncommunicable disease control is an important global health and development priority. However, there are challenges for translating this global priority into local priorities and action. The aim of this study was to evaluate the influence of national, sub-national and global factors on priority setting for noncommunicable disease control in Uganda and examine the extent to which priority setting was successful.MethodsA mixed methods design that used the Kapiriri & Martin framework for evaluating priority setting in low income countries. The evaluation period was 2005–2015. Data collection included a document review (policy documents (n = 19); meeting minutes (n = 28)), media analysis (n = 114) and stakeholder interviews (n = 9). Data were analysed according to the Kapiriri & Martin (2010) framework.ResultsPriority setting for noncommunicable diseases was not entirely fair nor successful. While there were explicit processes that incorporated relevant criteria, evidence and wide stakeholder involvement, these criteria were not used systematically or consistently in the contemplation of noncommunicable diseases. There were insufficient resources for noncommunicable diseases, despite being a priority area. There were weaknesses in the priority setting institutions, and insufficient mechanisms to ensure accountability for decision-making. Priority setting was influenced by the priorities of major stakeholders (i.e. development assistance partners) which were not always aligned with national priorities. There were major delays in the implementation of noncommunicable disease-related priorities and in many cases, a failure to implement.ConclusionsThis evaluation revealed the challenges that low income countries are grappling with in prioritizing noncommunicable diseases in the context of a double disease burden with limited resources. Strengthening local capacity for priority setting would help to support the development of sustainable and implementable noncommunicable disease-related priorities. Global support (i.e. aid) to low income countries for noncommunicable diseases must also catch up to align with NCDs as a global health priority.

PROTOCOL: Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review.

PROTOCOL: Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review.