Epidemiological Transition Research Articles

Transition towards cancer mortality predominance over cardiovascular disease mortality in Brazil, 2000–2019: a population-based study

Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil. We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs=CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time. From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD. An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil. National Council for Scientific and Technological Development (CNPq).

Dementia in migrants living in Lazio region, Italy: prevalence and population characteristics

Abstract Background Given ongoing demographic and epidemiological transitions, dementia prevalence is expected to rise among both native populations and migrants. Understanding this phenomenon is crucial for healthcare planning. This study, part of the IMMIDEM project (GR-2021-12372081), aims to estimate dementia prevalence in Lazio by migrant status. Methods A cross-sectional study was conducted on individuals aged ≥50, living in Lazio and receiving assistance from the Regional Health Service as of December 31, 2022. A validated algorithm based on Health Information Systems identified patients with dementia. Migrant status was defined by Country of birth, categorized as native Italians, migrants from Highly Developed Countries (HDCs) and from High Migratory Pressure Countries (HMPCs). Age-standardized prevalence of dementia was estimated overall and by migrant status, and 95% confidence intervals (CI) were calculated. Dementia population characteristics were described and compared according to migrant status using χ2test. Results The study included 3,976,160 individuals: 88.9% Italians, 1.7% migrants from HDCs, and 9.4% from HMPCs. Among them, 38,708 had dementia, with a prevalence of 8.48‰ (CI: 8.39-8.57). Dementia prevalence by migrant status was 8.68‰ (CI: 8.58-8.77) in Italians, 6.90‰ (CI: 6.19-7.62) in HDCs migrants, and 5.73‰ (CI:5.37-6.10) in HMPCs migrants. Demographic traits across migrant categories reveal distinct age and gender patterns, with more elderly Italians and a higher male percentage among migrants. From a clinical perspective, Italians showed a higher percentage of circulatory system diseases than migrants (23.5% Italians, 19.2% HDCs, 18.7% HMPCs, p = 0.001), along with a greater percentage of anti-dementia drug prescriptions (54.4% Italians, 50.9% HDCs, 47.4% HMPCs, p < 0.001). Conclusions The study found lower dementia prevalence among migrants compared to native Italians, with reduced access to healthcare services, especially in individuals from HMPCs. Key messages • The dementia prevalence in migrants is lower than in native Italians. • These findings suggest potential underdiagnosis and undertreatment, urging policymakers and healthcare providers to address these healthcare disparities.

Life course prevention - challenges for public health lying ahead

Abstract Issue/problem Demographic and epidemiological transitions have now shifted the focus from vulnerable population groups onto the active population, in particular young adults. At the same time lessons from the covid-19 pandemic taught us about missing actions on the elderly. While the latter have shown compliance and have followed most preventative activities, we observe scepticism and reluctance in the young adults. Description of the problem The covid-19 pandemic showed that young to middle-aged adults were the most reluctant group to adhere to preventative measures but in complying to the recommendations concerning vaccination. Since European activities are now focusing on addressing determinants of NCDs and are hoping to mobilise all population strata, including young and middle-aged adults, it would be important to explore how this mindset might affect the overall attitude to prevention. Results Health policy should explore specifically the needs of young to middle-aged adults (e.g. ages 30 to 44) to list their specific needs, expectations from preventative activities. On the other hand, it would be necessary to find out about the concerns, reluctance, and objections. The interplay of these will play a significant role in acceptance of present and future preventative activities. Exploration on these topics presents the following challenges: 1. Multiple sources of information on given health problems; 2. Lack of structured accessible and well-understandable explanations of advantages and benefits; 3. Inappropriate communication by health professionals or agencies on their behalf; 4. Complexity of the problem, which is then translated into complex and not easily understood messages. Lessons Learning about the specific needs of young adults, their expectations from the health systems in terms of prevention and health care as these will shape their overall attitude to prevention and have an impact on their families, particularly children. Key messages • Knowledge about expectations, needs, concerns, and reserves with respect to prevention is essential for the future activities on prevention. • Involving young and middle-aged adults in the preparation of the future preventative activities for their population groups is essential.

CKD incidence, predictors & progression: African migrants vs. Non-Migrants (RODAM cohort study)

Abstract Background Limited longitudinal data exist on chronic kidney disease (CKD) in African populations undergoing epidemiological transitions. We investigated incidence, long-term predictors, and progression of CKD among Ghanaians residing in rural- and urban-Ghana, and Ghanaian migrants in the Netherlands (Amsterdam). Methods We analysed data from 2183 participants in the transcontinental population-based prospective RODAM-cohort, followed for approximately seven years. CKD incidence and its progression to end-stage renal disease (ESRD) were defined using KDIGO criteria. CKD incidence was calculated using age-and sex-standardization for those without CKD at baseline. Long-term predictors of CKD incidence were identified using one-step robust Poisson regression. CKD progression to ESRD from baseline was also assessed using robust Poisson regressions. Results Overall age-and-sex standardized CKD incidence was 11.0% (95%CI; 9.3%-12.3%). Rural and urban-Ghanaians had higher CKD incidence (12.5%;8.5%-15.5%; 12.3%;8.2%-15.8%; respectively) than Amsterdam-Ghanaians (7.6%; 5.4%-10.6%). Residence in Amsterdam was associated with lower CKD incidence compared to rural Ghana after adjustments (Incidence Rate Ratio=0.34; 0.13-0.89), but not with urban-Ghana (IRR=1.07; 0.69-1.67). CKD incidence predictors were advanced age, female sex, alcohol consumption, uric acid levels, and hypertension. CKD progression to ESRD was 2.5% (1.4%-3.6%) in rural- Ghana, 2.3% (1.3%-3.2%) in urban-Ghana and 0.0% in Amsterdam. Conclusions One-tenth of Ghanaians developed CKD over seven-years, with higher incidence in Ghana compared to Europe. Age, female sex, alcohol use, uric acid levels, and hypertension were predictive factors. CKD progression to ESRD was minimal. High CKD incidence among Ghanaians, especially among non-migrants, calls for in-depth assessment of contributing factors and targeted interventions. Key messages • We observed higher CKD Rates in Rural/Urban Ghana vs. Amsterdam:Indicating geographic Disparities. • CKD Predictors: Age, Sex, Alcohol, Uric Acid, Hypertension (Minimal ESRD Progression). Interventions target: Non-Migrant Ghanaians.

Predictive machine learning algorithms for metabolic syndrome among Tunisian adults

Abstract Background Metabolic syndrome (MS), a cluster of interconnected risk factors for cardiovascular disease and type 2 diabetes, poses a significant health burden globally. In Tunisia, amidst an ongoing epidemiological transition, the prevalence of MS presents a growing concern. Our study aimed to identify the potential risk factors of MS and propose better machine learning (ML) based models for predicting MS among Tunisian adults. Methods Data was sourced from the Tunisian Health Examination Survey THES-2016, encompassing individuals aged 20 years and older. MS was defined based on the criteria set by the International Diabetes Federation. Logistic regression (LR) was employed to determine risk factors for MS. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Five ML algorithms (Naïve Bayes, Support Vector Machine (SVM), Artificial Neural Network (ANN), AdaBoost, and Random Forest (RF)) were utilized to predict MS. Performance evaluation was conducted using accuracy, precision, recall, and area under the curve (AUC) metrics. Results Among the 8908 participants, the prevalence of MS was 32.8% (95% CI: 31.4% - 34.6%). LR identified age group 60-69 years (aOR: 18.5, 95% CI: 16.9-19.9, p < 0.001), female sex (aOR: 1.7, 95% CI: 1.2-1.9), sedentariness (aOR: 1.6, 95% CI: 1.5-1.8) and low education level (aOR: 1.2, 95% CI: 1.1-1.4) as significant factors associated with MS. Among ML models tested, AdaBoost had the highest accuracy (89.8%), followed by SVM (89.6%). Naïve Bayes had the highest Recall (98.1%) and the most performant AUC (91.4%), while RF had the highest Precision (70.8%). The ANN had an accuracy of 89%, a precision of 70.4%, a recall of 78.7% and an AUC of 85.1%. Conclusions Our study highlighted the effectiveness of ML algorithms like AdaBoost and SVM in predicting MS among Tunisian adults, offering potential as early detection tools. However, further validation with larger datasets is necessary to solidify their utility in healthcare settings. Key messages • Metabolic syndrome, a complex of cardiovascular risk factors, presents a substantial global public health challenge and is particularly pronounced in Tunisia. • Machine learning algorithms, notably AdaBoost and Support Vector Machine, demonstrate promise in forecasting and addressing metabolic syndrome.in Tunisian adults.

7.X.1. Providing BoD estimates on a regional level – necessity in assessing health inequalities

Abstract Burden of disease indicators, such as Disability-adjusted life years (DALY), Years lost due to disability (YLD) and Years lost due to death (YLL) have become standard indicators in public health reporting systems. Due to the combination of morbidity and mortality, the DALY provides valuable information on the burden due to specific diseases. These tools are employed by policymakers to devise intervention programs with the objective of enhancing the collective health of the population. Studies at the subnational level offer a greater added value to the public health information systems. Identifying variations in health outcomes and disease burden across different regions is a key factor when introducing targeted interventions and allocating resources. Health inequalities persist also in countries with good health systems and well-developed welfare state. There are notable contrasts in the political, economic and social environments across Europe. Moreover, the European countries are at different stages of the epidemiological transition, which encompasses a range of factors influencing health and modifiable risk behaviours. These differences are determined by socioeconomic inequalities at national and sub-national level, such as municipalities, counties and others. It is therefore imperative to provide BoD indicators at the most possible detailed regional-level and to link this information with further indicators such as deprivation indexes or Gini coefficients. Obtaining regional-level data for BoD analysis and health inequalities is not straightforward and can pose many challenges. Data availability is usually scarce and may involve significant resources in collecting it. Data quality and data completeness can also pose challenges in the reporting systems, which can result in under-reporting of certain diseases and overlooking health problems in the population. Also, countries with smaller populations are confronted with the challenge of a limited number of cases, which poses difficulties in obtaining regional estimates. The following workshop presents examples from European BoD studies, that have analysed health inequalities at regional level. The first presentation shows a country comparison study of the overall YLL and their association with socioeconomic and geographical inequalities. The second is from an Estonian study, representing a country with a small population that has developed its own methodology for assessing regional health issues. The third presentation from the German BoD study presents results on 96 spatial planning regions, which have been combined with the German index of socioeconomic deprivation. The final presentation brings example from Norway, where the association between YLL and education and income is examined at municipality level. Key messages • By comparing BoD estimates at the regional level, policymakers and public health officials can identify areas with higher disease burdens, indicating potential health inequalities. • Linking information on BoD indicators with data on regional and socioeconomic inequalities is essential when monitoring developments and tailoring strategies in public health outcomes.

Strengthening uptake of breast cancer screening services in Tanzania; re-visiting the breast cancer screening messages

BackgroundBreast Cancer remains among the top five cancers responsible for morbidity and mortality globally. For many years, infectious (communicable) diseases were a primary concern in low- and middle-income countries (LMICs) compared to higher-income countries, where non-communicable diseases (NCDs) were already a major concern. However, starting from the early 2000s, the LMICs including Tanzania has witnessed an epidemiological transition being equally affected by NCDs, and breast cancer, is among the prevalent NCDs. While the evidence is vast on the role of breast cancer screening messages in promoting screening, debunking myths, and addressing barriers to the uptake of breast cancer services, context-specific messages are limited. Amidst the changing technology, growth of social media and cultural dynamics, context-specific breast cancer screening messages are needed. We aimed to analyze the breast cancer screening messages from the experiences of women seeking care at Ocean Road Cancer Institute in Tanzania.MethodsAn exploratory qualitative case study adopting in-depth interviews (IDI) and focused group discussion (FGD) was carried out among purposefully selected women aged from 18 years to 65 years seeking care from Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Eighteen women participated in the IDIs, and 16 women participated in FGD. Data analysis followed inductive qualitative content analysis.FindingsThree main categories emerged: the existence of multiple sources of breast cancer screening messages, the strengths and weaknesses of breast cancer screening messages, and clients’ mixed perceptions of breast cancer screening messages.ConclusionThe findings of this study depict that although breast cancer screening promotion messages are regarded as a source of information about cancers, they fall short of completeness and relevance to the otherwise at-risk population and trigger negative perceptions toward screening. Therefore, this study advocates revisiting the breast cancer screening messages, employing participatory approaches to tailor the screening messages and communication media to fit specific audiences. This calls for re-designing both the content of the messages and means of delivery; thus, collaborative efforts are needed.

The Diverse Effects of Government Sponsored Health Insurance and the Role of Public Hospitals in Kerala

The Kerala model of development, founded on ‘good health at low cost’ in the 1970s, was seriously threatened by economic, social, demographic, and epidemiological transitions in Kerala, leading to ‘poor health at exorbitant cost’ by the early 2000s. To tackle these exorbitant healthcare costs, mainly precipitated by a reliance on private hospitals, the state government partnered with the central government to introduce various Government-Sponsored Health Insurance (GSHI) schemes. This study traces the diverse effects that the state policy might have created in Kerala by using GSHI as a mechanism to divert the GSHI-covered households towards public hospitals between 2008 and 2020.

Sensitization and allergy to pineapple and coconut juice in patients followed up for allergic diseases in Parakou, Benin

Objectives: Little is known about adverse food reactions. The aim of this study was to investigate the sensitization and allergy to two tropical fruits, pineapple (Ananas comosus) and coconut (Cocos nucifera), among patients followed up for allergic disease in Borgou Teaching Hospital in Parakou, Benin. Materials and Methods: A prospective cross-sectional study was conducted in 2021. Adult patients (≥18 years) who were followed up for allergic asthma, rhinitis, or conjunctivitis were included in the study. Information on clinical manifestations following pineapple juice or coconut water drinking was collected, and skin prick testing was carried out. Results: Overall, 101 patients were enrolled, male-female ratio of 0.4:1 and mean age of 33.4 (±14.4) years. Clinical manifestations were triggered by pineapple in 53.5%, mainly mouth and lip pruritus (38.6%). The prevalence of sensitization was 36.6%. Allergy was diagnosed in 24.8% (or 46.3% of those who complained) and was associated with mouth and lip pruritus (odds ratio [OR] = 4.1; 95% confidence interval [CI] = 1.6–10.6; P = 0.003), bronchospasm (OR = 3.7;95%CI = 1.1–12.7; P = 0.031), allergic rhinitis (OR = 3.5; 95%CI = 1.2–10.4; P = 0.020), and conjunctivitis (OR = 4.4; 95%CI = 1.6–12.5; P = 0.007). Clinical manifestations after ingestion of coconut water reportedly occurred in 18.8% and were mostly bronchospasm (8.9%). The prevalence of sensitization was 20.8%. Allergies were diagnosed in 6.9% (or 33.3% of those who complained), with no association found with demographic or clinical characteristics. Conclusion: Pineapple is a common cause of food allergy among patients who are followed up in Borgou Teaching Hospital, while coconut is less responsible for this disorder. More studies are required to improve knowledge of allergic diseases in Sub-Saharan Africa, which is facing an epidemiological transition.

Pattern of Mortality among Patients Admitted in Medical Wards in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study

Introduction: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. Morbidity and mortality pattern is a reflection of disease burden. Detailed assessment of these parameters tends to aid in formulating pivotal aspects of in-hospital policies, standards of care and so consequently promoting efficient work systems. The aim of this study is to identify the pattern of mortalities in medical wards in a tertiary care hospital.Methods: This retrospective descriptive cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital focusing on all patients admitted to the medical wards (General Medical, Hepatology, Nephrology, Neurology, Endocrinology, Pulmonology, Cardiology and Gastrology) between January 1 to December 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference Number: 390/2080/81). Total population sampling was done. Data were analyzed using Microsoft Excel and SPSS.Results: Among 10124 admitted patients in medical wards, mortality was reported in 732 (7.22%). The number of deaths seen in general medical ward was 389 (53.14%) and in liver ward was 85 (11.61%). Systemic cause of death due to respiratory diseases was 157 (21.5%) and liver disease was 143 (19.6%).Conclusions: The respiratory disease is responsible for a higher proportion of deaths among admitted patients. However, the deaths due to liver disease are increasing because of the rise in cirrhosis of the liver in the younger age group.

Trends and social determinants of the obesity epidemic among reproductive-age women in ten Asian countries

The rapid epidemiological transition in Asian countries, resulting from the rising trend of urbanisation and lifestyle changes, is associated with an increasing risk of obesity in women of reproductive age. This is the first study to investigate the trends and population-attributable fraction (PAF) of obesity, and the interaction effects of education and wealth on obesity among reproductive-age women aged 15–49 years in ten Asian countries. This cross-sectional study examined the most recent (2000 to 2022) Demographic and Health Surveys (DHS) data from ten Central and Southeast Asian countries. Multilevel multinomial logistic regression models were used to compute odds ratios (ORs). PAFs adjusted for communality were calculated using adjusted ORs and prevalence estimates for each risk factor. This study included a weighted sample of 743,494 reproductive-age women. All the countries showed an increasing trend for obesity and a decreasing trend for underweight, except for the Maldives. The highest PAFs of obesity were associated with women who were married (PAF = 22.2%; 95% CI 22.1, 22.4), aged 35–49 years (PAF = 16.4%; 95% CI 15.5, 17.1), resided in wealthy households (PAF = 14.5%; 95% CI 14.4, 14.5), watched television regularly (PAF = 12.5%; 95% CI 12.1, 12.8), and lived in urban areas (PAF = 7.8%; 95% CI 7.7, 8.0). The combined PAF showed that these five risk factors were associated with 73.3% (95% CI 71.8, 74.9) of obesity among reproductive-age women. Interaction analysis between women’s education and household wealth revealed that having a secondary or higher level of education and residing in a wealthier household was associated with a lower risk of obesity (OR = 0.71, 95% CI 0.66, 0.76). The findings of this study suggest that, in order to address the rising rate of obesity among women in Asian countries, education and lifestyle modifications in urban areas should be a priority. Pakistan and the Maldives need to be a priority given the rapidly increasing trends in obesity and underweight subpopulations in their respective countries.

Dietary Practices of Cancer Outpatients at Nyeri County Referral Hospital, Kenya; A Cross Sectional Survey

The global burden of non-communicable diseases remains unacceptably high and Kenya is among the countries experiencing an epidemiological transition from the communicable to non-communicable diseases. In Kenya, cancer is the second leading cause of non-communicable disease related mortalities after the cardiovascular diseases and Nyeri County is among the counties that are leading in this burden of non-communicable diseases. This study sought to assess the dietary practices of the cancer patients on chemotherapy at Nyeri County and Referral Hospital in comparison with the recommended dietary practices. Analytical cross-sectional study design was employed and the data on the dietary practices was collected using a 24-hour recall and a Food Frequency Questionnaire (FFQ). Sixty one percent of the respondents were female while 39% were male. Sixty one percent had acquired primary school education and half of the respondents survive on a monthly income of between 0-10,000. Breast cancer was the most common cancer type in the population (39%), followed by esophageal and throat cancer at 14.5% and gastric cancer at 14%. Prostate cancer was the most prevalent among the male respondents at 11%. The mean energy intake of the respondents was 1068+- 520 Kcals which was not meeting the requirements as per the ESPEN clinical guidelines on cancer. The dietary patterns identified from the research were, excessive consumption of foods from the starchy foods and the fats category (65.1%) and less than half (41.9%) were not attaining the minimum daily requirements of the fruit’s servings recommended by the World Health Organization (WHO). Nutrition education and counselling is key in improving the dietary practices among the cancer patients. However, 44.19% had not received nutrition education and counselling regarding the appropriate diet to consume in the course of their treatment. This study found out that the dietary practices of the cancer patients do not meet the recommended clinical guidelines on cancer nutrition and almost half of the population had not received nutrition education and counselling services. Social and behavior change is one of the possible strategies that could be adopted to deliver nutrition information to the population, to improve the knowledge, attitude and dietary practices of cancer patients in Kenya, which in turn will improve their nutrition outcomes.

Dynamic Progression of Hypertension and Diabetes in the Democratic Republic of Congo from 2019 to 2023.

Introduction: The Democratic Republic of Congo (DRC) does not have national prevalence data for arterial hypertension (HTN) or diabetes (type I and II combined) to aid evidence-based decision-making, despite the assumption of epidemiological transition in low- and middle-income countries. The aim of this study was to estimate a proxy of prevalence for HTN and diabetes. Methodology: This study used routine monthly reported data pertaining to HTN and diabetes from the District Health Information Software 2 (DHIS2), spanning 2019-2023. Data underwent quality assessment and adjustments using standardization before analysis. Equity analyses were carried out at the national and sub-national levels. Epidemiological curves and maps were produced to analyze trends in the prevalence of HTN and diabetes among adults aged 18 and over. Permission to use the data was obtained from the regulatory authority. Results: Over five years, incidence of HTN increased from 13.23% (CI 95%: 13.22-13.24) to 15.23% (CI 95%: 15.22-15.24) (+15.1% relative increase), and diabetes rose from 2.73% (CI 95%: 2.72-2.74) to 3.345% (CI 95%: 3.34-3.35) (+16.3% relative increase), with provincial variations observed. Conclusions: In the DRC, hypertension and diabetes are advancing rapidly. Primary and preventative healthcare services and public health interventions must prioritize these diseases.

Clinical features of gastroesophageal reflux disease and erosive esophagitis: Insights from patients undergoing esophagogastroduodenoscopy in resource-limited Ethiopia.

Gastroesophageal reflux disease (GERD) is a common disease worldwide with varying clinical presentations and risk factors. Prevalence data for Africa is lacking, but an increasing trend is expected due to demographic and epidemiological transitions. Although endoscopic studies for general gastrointestinal disorders have shown some patients with erosive esophagitis (EE), no studies in Ethiopia have investigated the clinical characteristics, risk factors, and severity of GERD using esophagogastroduodenoscopy (EGD). To assess the clinical features of GERD in Ethiopian patients who underwent EGD and determine the severity and risk factors of EE. We conducted a multicenter, retrospective cross-sectional study of 221 patients diagnosed with GERD and endoscopic findings of EE at Trauma Associated Severe Hemorrhage and Amniotic Membrane Stem Cell between January 2019 and August 2022. Data were collected from electronic medical records and phone call interviews. We used descriptive statistics and binary logistic regression analysis with SPSS version 26 to identify the association between variables with a statistical significance set at P value < 0.05. The mean ± SD age of the patients was 44.8 (± 15.9) years, with a male-to-female ratio of 1.6:1. The most commonly reported symptom was epigastric pain (80.5%), followed by heartburn (43%). Los Angeles (LA)-A EE was diagnosed in 71.1% of patients, followed by LA-B (14.9%), LA-C (7.7%), and LA-D (5.9%). Multivariate analysis showed that age 50 or above, presence of bleeding, and endoscopic findings of duodenitis/duodenopathy were significantly associated with severe EE (P < 0.05). Stricture and Barrett's esophagus were observed in 4.5% and 1.36% of patients with EE, respectively. Most of the patients had milder EE with fewer complications. However, severe EE was more prevalent in older patients and those with duodenitis/duodenopathy.

The state of primary healthcare centers in Saudi Arabia: A regional analysis for 2022.

This study examines the 2022 distribution of primary healthcare centers across Saudi Arabia's 20 regions, focusing on disparities and healthcare accessibility. A quantitative analysis of the Ministry of Health's data was conducted. Primary healthcare centers distribution was evaluated by calculating the number of primary healthcare centers per 100,000 population across different administrative regions. The study uncovered regional disparities, with the PHCs-per-100,000-people ratio showing significant variance. Regions like Riyadh had an above-average ratio with 7.5 PHCs-per-100,000-people, while Jeddah lagged behind with a concerning 3.2 PHCs-per-100,000-people despite being a populous city. The PHC-per-capita ratio declined to 6.6 in 2022 from 8.0 in 2017. The data also revealed that the Eastern Province showed an increase in the number of primary healthcare centers. Disparities in the distribution of primary healthcare centers in 2022 highlight a critical need for equitable healthcare access across Saudi Arabia. Many regions require increased primary healthcare center allocation to match population needs. The findings underscore the urgency of integrating these insights into policy frameworks to achieve the goals of Vision 2030, emphasizing the development of a sustainable and equitable healthcare system. Policymakers need to consider these disparities to guide the strategic placement of primary healthcare centers and ensure an equitable healthcare system. This study provides a basis for targeted policy interventions to improve healthcare equity and prepare the health system for future demographic and epidemiological transitions.

Evaluation of the Nutritional Knowledge in Relation to Secondary Prevention Among Doctors and Nurses in the Northern of Morocco: A Cross-Sectional Study.

Morocco is a country that has been experiencing an epidemiological and health transition characterized by a change in lifestyle and an increase in mortality for non-communicable diseases (NCDs). The objective of this study is to evaluate the nutritional knowledge in relation to secondary prevention of doctors and nurses working in the hospitaland primary healthcare centersin Morocco.Specific knowledge about nutrition for diabetes, for high blood pressure and high cholesterol, for functional colopathy, for iron deficiency anemia, for vitamin B12 deficiency, for overweight and for hyperuricemia or gout attack were evaluated. Cross-sectional exploratory study carried out between June and December 2022, using a self-administered questionnaire developed on the basis of similar studies and the several standardized nutrition guides. A random cluster survey included 238 nurses and 131 doctors working in health centers and 234 nurses and 54 doctors working in hospitals. Statistical analyses were carried out using SPSS version 21.0 software, the Kolmogorov-Smirnov test, the Mann Whitney test, and Spearmen's correlation. Multiple linear regression analysis was used to explore the most significant sociodemographic variables. Among the seven nutritional content areas assessed in this study, we found that among doctors, the nutrition axis for high blood pressure and high cholesterol had the median correct response score of (0.57 interquartile range (IQR) (0.28, 0.71)). The same for nurse, but with the lower scores ((0.28 IQR (0, 0.43)) , (0.28 IQR (0.07, 0.42)) respectively). Our results do not reveal any statistically significant association of the median of total score of answers of both health professionals (nurses or of doctors) with their gender (p=0.383). However, they were significantly associated with basic training (p<0.001), continuous training (p=0.002), receiving information on nutrition (p=0.018), and their age (p=0.016). In conclusion, this study highlighted the major gaps in the nutritional knowledge of doctors and nurses regarding secondary prevention of NCDs. However, they should undergo continuing nutrition education programs to ensure safe and sound nutritional advice not only to patients but also to the public.Furthermore, policymakers should devote systematic efforts to nutrition education during basic training in medical and nursing schools, which will provide doctors and nurses with adequate training.

P131 URBAN-RURAL PATTERNING OF BEHAVIORAL AND ANTHROPOMETRIC CORRELATES OF HYPERTENSION AMONG THE AO NAGAS OF NAGALAND, INDIA

Background and objectives: In the context of an epidemiological and nutrition transition among the ethnic groups in India, leading to an increase in prevalence of hypertension, this study aims to explore the urban-rural pattern of behavioral and anthropometric correlates of hypertension among the Ao Nagas of Nagaland, India. Materials and Methods: A total sample of 1250 Ao Nagas, aged 20-49 years, residing in city, town and village areas were examined for blood pressure, body weight, height and waist circumference. Interview was taken using the WHO stepwise tool for the surveillance of NCDs. The behavioral and anthropometric correlates of hypertension were determined using multinomial logistic regression in SPSS 17.0. The presence of hypertension was considered as the outcome variable. Results: In the city, the male residents in the older age group (35-49 yr) had 3.53 times higher risk of been hypertensive than those in the younger age group (20-35 yr). Overweight males had 3.23 times higher risk of been hypertensive than those who had normal weight. Females in the older age group had 5.48 times higher risk of been hypertensive than the females who were in the younger age group. In the town, males who were abdominally obese had 2.93 times higher risk of been hypertensive as compared to those who were not abdominally obese. In the village, males who were overweight had 5.66 times higher risk of been hypertensive as compared to those who had normal weight. Females in the older age group had 1.89 times higher risk of been hypertensive as compared to those in the younger age group. Abdominally obese females had 3.45 times and those who consume alcohol had 6.22 times risk of been hypertensive as compared to females who were not abdominally obese and who doesn’t drink alcohol. Conclusion: Age, abdominal obesity, overweight and alcohol consumption were significantly associated with hypertension.

P011 PREVALENCE OF HYPERTENSION AND ASSOCIATION WITH RED MEAT AND VEGETABLE CONSUMPTION IN A MEGACITY IN NIGERIA: A POPULATION-BASED SURVEY

Background and Objectives: Hypertension is a growing burden worldwide, but the impact is worse in developing countries especially in cities, due to epidemiologic transition, rapid urbanization and socioeconomic dynamics. We determine the current prevalence of hypertension, and association with red meat and vegetable consumption in Lagos, a megacity in Nigeria. Methods: This was a population-based opportunistic cross-sectional survey of 2244 voluntary adults ≥ 18years residents of Lagos megacity in Nigeria. Socio-demographic and clinical characteristics were obtained. We measured blood pressure by Omron M3 automatic upper arm monitor after ≥5 min of rest. We defined hypertension as systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg or use of antihypertensive drugs. Qualitative information on meat and vegetable consumption was documented. Chi squared and multiple logistic regression methods were used to determine association and predictor of hypertension respectively, and odds ratio with confidence interval as the measure of effect size. P value of &lt; 0.05 was taken as statistical significance. Results: 2244 participants were analyzed, with mean age of 46±14 years, and 75% were women. More than 26% were overweight or obese, 43.2% drinks alcoholic beverages, and 30.3% men and 3.5% women smoked cigarettes. The overall prevalence of hypertension was similar in males (38.1%) and females (37.4%), and it increases with age, reaching 46.7% in ≥ 60years. Daily consumption of meat (38.6% versus 28%(rarely), p =0.03), and infrequent consumption of vegetables (47.7%% versus 19.2%9 (daily intake), p = 0.006) were associated with higher prevalence of hypertension. Older age (OR, 2.133(CI, 1.61 – 2.83)), and family history of hypertension (OR, 1.51(CI, 1.20 – 1.92)) were the predictors of hypertension. Conclusions: The prevalence of hypertension is high among middle age urban dwellers in Lagos, Nigeria. Avoidance of red meat, and increased consumption of vegetables, may reduce the burden of hypertension in the population.

Study of lifestyle diseases (obesity and diabetes mellitus) among employees of an electronics manufacturing unit at Tumakuru.

Background: The world has experienced an epidemiological transition due to urbanisation, increased food and tobacco consumption, and reduced physical activity, leading to a shift from communicable to non-communicable diseases (NCDs). This transition has heightened the prevalence of lifestyle-related diseases, particularly in industrial workforces. Objectives: This study aims to assess the knowledge, attitude, and practice (KAP) on lifestyle diseases among employees of an electronics manufacturing company in Tumakuru district, Karnataka State. Materials &amp; Methods: A total of 502 employees aged 30-60 were selected using systematic random sampling from a pool of 1,448 employees. Data were collected using a structured questionnaire based on the NIOSH worker well-being questionnaire (WellBQ) and the WHO STEPS Surveillance Manual for NCDs. The questionnaire evaluated participants' knowledge of lifestyle diseases, attitudes towards prevention, and lifestyle practices. Results: Of the 502 respondents, 458 (91.2%) were male, with the majority (58%) in the 40-49 age group. Only 56% of participants were aware of the major causes of diabetes, while 68% were unaware of preventive measures. Additionally, 30% lacked knowledge about diabetes and its diagnosis, 43% were unaware that lifestyle diseases are chronic, and 38% did not recognise that these conditions could lead to premature death. Notably, 60% of respondents reported no regular physical activity. Conclusion: The findings indicate a significant risk of developing lifestyle diseases among employees, underscoring the need for targeted health policies and educational programs to promote healthy lifestyles and mitigate the rising trend of NCDs in this industrial workforce

Pertussis upsurge, age shift and vaccine escape post-COVID-19 caused by ptxP3 macrolide-resistant Bordetella pertussis MT28 clone in China

ObjectivesChina has experienced a notable upsurge in pertussis cases post-COVID-19, alongside an age shift to older children, increased vaccine escape, and a notable rise in the prevalence of macrolide-resistant Bordetella pertussis. Here, we present a genomic epidemiological investigation of these events. MethodsWe performed a retrospective observational study using culture-positive B pertussis isolated in Shanghai, China, from 2016 to 2024. We analysed strain and pertussis epidemiology dynamics by integrating whole-genome sequencing of 723 strains with antimicrobial susceptibility, transcriptomic profile, and clinical data. We compared the genome sequences of Shanghai strains with 6450 Chinese and global strains. ResultsFrom pre-COVID-19 (before December 2019) to post-COVID-19, patients shifted from predominantly infants (90%, 397/442) to a higher proportion of infections in older children (infant: 16%, 132/844), with the share of vaccinated individuals surging from 31% (107/340) to 88% (664/756). The macrolide-resistant Bordetella pertussis prevalence increased from 60% (267/447) to 98% (830/845). The emergence and expansion of a ptxP3-lineage macrolide-resistant clone, MR-MT28, which is uniquely capable of causing substantial infections among older children and vaccinated individuals, was temporally strongly associated with the pertussis upsurge and epidemiological transition. Although MR-MT28 showed increased expression of genes encoding pertussis toxin, it was associated with significantly milder clinical symptoms and a lower hospitalization rate. MR-MT28 likely originated in China around 2016, after acquiring several key mutations, including a novel prn150 allele, and has been detected across multiple regions in China. In addition, 26% (50/195) of MR-MT28 has evolved into predicted Pertactin (PRN)-deficient strains, with an IS481 insertion being the predominant mechanism. Discussion: We report that the post-COVID-19 upsurge of pertussis in China is associated with ptxP3-MR-MT28, and provide evidence that pathogen evolution is likely the primary factor driving + pertussis upsurge, age shift, and vaccine escape. MR-MT28 poses a high risk of global spread and warrants global surveillance.