Non-communicable Disease Surveillance Research Articles

Global health efforts and opportunities related to the Belt and Road Initiative

Global health efforts and opportunities related to the Belt and Road Initiative

Prevalence of behavioural risk factors for road-traffic injuries among the Iranian population: findings from STEPs 2016.

To achieve Sustainable Development Goal 3.6 in Iran, we need to have a comprehensive understanding of the distribution of risky behaviours regarding road-traffic injuries at national and sub-national levels. Little is known about the road-use vulnerability patterns of road-traffic injuries in Iran. The aim of this study is to describe the prevalence of self-reported human risk factors in road-traffic injuries using the findings from a large-scale cross-sectional study based on the World Health Organization's stepwise approach to surveillance of non-communicable diseases (STEPs). A cross-sectional survey study in 2016 assessed the road-use pattern and prevalence of risky behaviours of people more than 18 years old. In this study, we planned to recruit 31 050 individuals as a representative sample at national and provincial levels. In practice, 30 541 individuals (3105 clusters) from urban and rural areas of Iran were selected. Basic socio-demographic data, major behavioural risk factors such as seatbelt and helmet non-compliance, drunk driving and occupant in a car with a drunk driver were assessed through baseline interviews gathered through an Android tablet-based questionnaire. The overall prevalence of seatbelt and helmet compliance was 75.2% (95% confidence interval: 74.7-75.7) and 13.9% (13.4-14.5), respectively, at the national level. The prevalence of risk-taking behaviours such as drink driving was 0.5% (0.4-0.6) and for being an occupant in a car with a drunk driver was 3.5% (3.2-3.8). At the provincial level, the highest age-standardized prevalence of seatbelt compliance (89.6%) was almost 1.5 times higher than the lowest provincial prevalence (58.5%). In 63% of provinces, the lowest prevalence of seatbelt compliance was observed among people aged 18-24 years old. In Iran, existing disease-prevention and health-promotion programmes should be expanded to target vulnerable subgroups that have more prevalent human risk factors for road-traffic injuries. Further research is required to investigate the context-specific proximal human risk factors and vulnerability patterns in Iran.

A community-based cross-sectional study of magnitude of dysglycemia and associated factors in Southwest Ethiopia

BackgroundDiabetes, one of the non-communicable diseases becoming major public health problems in the country, is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. This study aimed at assessing the prevalence of dysglycemia (type 2 diabetes and impaired fasting glucose) and associated factors for adults older than 40 years living in Southwest Ethiopia.MethodsA community-based cross-sectional study was conducted using the WHO STEPwise tool for surveillance of non-communicable diseases. Data was collected by face-to-face interview and measurement of anthropometry, blood pressure, and fasting blood sugar using pretested questionnaire, and it was analyzed using SPSS version 20. Logistic regression was used to identify associated factors with the outcome variable.ResultsThe overall prevalence of dysglycemia was 18.6% among adults older than 40 years. Type 2 diabetes accounts for 5.7%, and impaired fasting glucose accounts for 12.9%. Presence of family history of diabetes [AOR = 2.45, 95% CI (1.08, 5.52)], being overweight [AOR = 3.8, 95% CI (1.84, 7.95)], and being obese [AOR = 7.78, 95% CI (2.90, 20.91)] were significantly and independently associated with dysglycemia.ConclusionIn this study, the prevalence of dysglycemia was high. Having a family history of diabetes mellitus and higher body mass index (overweight or obese) were risk factors for dysglycemia.

Incorporating selected non-communicable diseases into facility-based surveillance systems from a resource-limited setting in Africa

BackgroundAs Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. The objectives of our study were to i) upgrade of the current surveillance system by adapting the data collection tools to NCD; ii) describe the occurrence and profile of selected NCD using these data collection tools.MethodsWorkshops were implemented in a first referral urban hospital of Mozambique to train clinical staff, administrative workers and nurses on NCD surveillance, as well as select conditions to be prioritized. Based on the WHO Global Action Plan and Brazaville Declaration for NCD prevention and control, we selected arterial hypertension, diabetes, stroke, chronic respiratory diseases, mental illness and cancers. Data collection tools used for CD were changed to include age, gender, outcome and visit type. Between February/2014 and January/2015 we collected data at an urban hospital in Mozambique’s capital.ResultsOver 12 months 92,018 new patients were assisted in this hospital. Data was missing or diagnosis was unreadable in 2637 (2.9%) thus only 89,381 were used for analysis; of these 6423 (median age 27 years; 58.4% female) had at least one selected NCD as their primary diagnosis: arterial hypertension (2397;37.31%), mental illness (1497;23.30%), asthma (1495;23.28%), diabetes (628;9.78%), stroke (299;4.66%), chronic obstructive pulmonary disease 61 (0.95%) and cancers 46 (0.72%). Emergency transfers were needed for 76 patients (1.2%), mainly due to hypertensive emergencies (31; 40.8%) and stroke (18;23.7%). Twenty-four patients died at entry points (0.3%); 10 of them had hypertensive emergencies.ConclusionChanges in existing surveillance tools for communicable diseases provided important data on the burden and outcomes of the selected NCD helping to identify priority areas for training and health care improvement. This information can be used to design the local NCD clinics and to strengthen the health information system in resource-limited settings in a progressive and sustainable way.

Association of screen time with subjective health complaints in Iranian school-aged children and adolescents: the CASPIAN-V study

Sedentary leisure time might be affecting children’s and adolescents’ general health. We investigated the association between watching television and computer use in this age group and psychosomatic health complaints. This study of 14,274 students aged 7–18 years was conducted in Iran between 2014 and 2015, as part of the fifth school-based nationwide health survey named the childhood and adolescence surveillance and prevention of adult non-communicable disease (CASPIAN-V) study. In addition to gathering data on time spent watching television or using a computer per day, we categorized the health complaints into somatic (headache, backache, stomach ache, and feeling dizzy) and psychological (feeling low, feeling nervous, irritability, and difficulty falling asleep) symptoms. Regression models were used to determine the relationships between variables. All psychological health complaints, as well as headaches, were significantly more prevalent in the over-14 age group, both in girls and boys. Lower socioeconomic status, living in families where one or two parents were absent, and living in urban areas were all associated with higher psychosomatic health problems. Also, more time spent watching television was associated with more stomach aches and irritability (OR = 1.12 and 1.14 respectively). More time spent using a computer correlated with a higher prevalence of stomach aches, irritability, feeling nervous, and difficulty falling asleep (OR = 1.15, 1.12, 1.29, and 1.07 respectively). Prolonged time spent on television watching or computer use might be associated with adverse effects on children’s and adolescents’ psychosomatic health status.

World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings: A key milestone achieved

World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings: A key milestone achieved

Prevalence and Correlates of Current Alcohol Use among Bhutanese Adults: A Nationally Representative Survey Data Analysis.

Background:Alcohol-related ailments are among the 10 leading causes of morbidity and mortality in Bhutan. The objectives of this article were to determine the prevalence and explore the correlates of current alcohol use among Bhutanese adults.Materials and Methods:This is a retrospective study of secondary data from the National Health Survey 2012 of Bhutan. The outcome variable of interest was current alcohol use. The questionnaire was developed following the World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) of noncommunicable diseases. Univariate and multivariate logistic regression was performed to identify the correlates of current alcohol use. The prevalence of current alcohol use was 30.9%. The correlates of current alcohol use were male sex [adjusted odds ratio (AOR) = 1.85; 95% confidence interval (CI) 1.47–2.36], widowhood (AOR = 2.92, 95% CI, 1.22–6.99), and chewing betel quid >20 times per week (AOR = 2.07, 95% CI, 1.08–4.03). Primary (AOR = 0.67, 95% CI, 0.50–0.91), high (AOR = 0.52, 95% CI, 0.38–0.71), and university (AOR = 0.46, 95% CI, 0.29–0.73) educated participants were less likely to be current alcohol users when compared with those who had no education. Compared with unskilled workers, services and sales workers were less likely to use alcohol regularly (AOR = 0.64, 95% CI, 0.49–0.82). Homemade alcohol Ara was the most common drink.Conclusion:The national prevalence of current alcohol use in Bhutan is higher than the national average in the WHO South-East Asia Region. Prevention should target the correlates and limit the availability of locally home-brewed Ara.

Factors Associated with Overweight and Obesity in an Urban Area of South East Nigeria

Background: Overweight and obesity present a growing health problem among Africans from all socioeconomic status. In Sub Saharan African, obesity is not only a consequence of overnutrition but possibly from excessive consumption of unbalanced diet dominated by carbohydrates and saturated fats. Characteristics of the distribution of obesity/overweight in Nigeria include its high prevalence along with socioeconomic class and in mid-life. Methods: Using the WHO STEP-wise approach to surveillance of noncommunicable diseases, we conducted a cross-sectional descriptive study of the adult population living in two urban slums in Enugu. The study was carried out in 2013. Statistical analysis was done using SPSS version. Results: A total of 605 (414 women (68.4%) and 191 (31.6%) men were recruited and analysed. The mean body mass index was 25.8 kg/m2 higher in females (26.7 kg/m2) than males (24 kg/m2) p < 0.01. The prevalence of overweight and obesity is 29.4% (178/605) and 19.5% (118/605) respectively. There also a modest prevalence of underweight 4% (24/605) among the population. All classes of obesity were significantly more prevalent in females. Significant positive correlates of BMI were: female sex (r = 0.21, p < 0.001), systolic blood pressure (0.25, p < 0.001), DBP (0.27, p < 0.001), fasting blood glucose (0.19, p < 0,001) and positive history of hypertension (0.23, P < 0.001). Negative correlates were physical activity and use of tobacco (0.2 (<0.001) and -0.16 (<0.001) respectively). Conclusion: The prevalence of obesity is relatively high in two urban slums in Enugu and co-exists with a modest rate of underweight. Public health and community-based approaches should be used to tackle these two-opposing social/health problems.

Childhood Overweight and Obesity and Associated Factors in Iranian Children and Adolescents: A Multilevel Analysis; the CASPIAN-IV Study.

Objective: The purpose of this paper is to explore multidimensional factors related to childhood obesity and overweight based on the data gathered on different aspects of the general health status were assessed among a large number of Iranian children and adolescents in the fourth phase of the “Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease” survey. It also aims to determine the degree to which each ecological context contributes to childhood overweight/obesity.Method: A total of 14,880 students and their parents were recruited. They filled out a questionnaire on their relationship with peers, body image, and psychosocial environment of school, dietary habits, life-style habits, physical activity pattern and socioeconomic status (SES). Their height, weight, was measured and body mass index (BMI) was calculated. Obesity and overweight was defined based on the WHO growth chart. Multilevel modeling using three-level random intercept logistic regression models were used to assess predictors of overweight and obesity. In our hierarchical models, children (first level) were conceptualized as being nested within provinces (second level) and provinces within quad regions (third level).Result: From among the 13,486 recruited students, 9.7% were overweight and 11.9% were obese. In multivariate model (adjusted model), being boy (OR:1.58), living in urban area (OR:1.58), having positive family history of obesity (OR = 2.04), breakfast skipping (OR: 1.46), socioeconomic status (OR moderateSES/lowSES = 1.44 and OR highSES/lowSES = 1.89), and birth weight (BW) (OR normalBW/lowBW = 1.33 and OR highBW/lowBW = 1.8) were associated with childhood obesity. Increasing age was the only factor in the obesity model that had a significant preventive effect on the odds of becoming obese (OR = 0.96, P < 0.001). In multivariate model, living in urban area, increasing age, high and moderate SES, high BW and family history of obesity were the significant predictors of overweight.Conclusion: Our findings show that high BW, sociodemographic characteristics, breakfast skipping, and family history of obesity are associated with childhood obesity and overweight. Therefore, developing strategies that consider the effects of diverse sociodemographic and environmental factors on childhood overweight and obesity would be the most effective way to prevent and manage this multifactorial health concern.

Approaches to Improve the Surveillance, Monitoring, and Management of Noncommunicable Diseases in HIV-Infected Persons: Viewpoint.

Low-income and middle-income countries (LMICs) are undergoing an epidemiological transition, in which the burden of noncommunicable diseases (NCDs) is rising and mortality will shift from infectious diseases to NCDs. Specifically, cardiovascular disease, diabetes, renal diseases, chronic respiratory diseases, and cancer are becoming more prevalent. In some regions, particularly sub-Saharan Africa, the dual HIV and NCD epidemics will pose challenges because their joint burden will have adverse effects on the quality of life and will likely increase global inequities. Given the austere clinical infrastructure in many LMICs, innovative models of care delivery are needed to provide comprehensive care in resource-limited settings. Improved data collection and surveillance of NCDs among HIV-infected persons in LMICs are necessary to inform integrated NCD-HIV prevention, care, and treatment models that are effective across a range of geographic settings. These efforts will preserve the considerable investments that have been made to prevent the number of lives lost to HIV, promote healthy aging of persons living with HIV, and contribute to meeting United Nations Sustainable Development Goals.

Prevalence and correlates of abdominal obesity among adults in Uganda: findings from a national cross-sectional, population based survey 2014

BackgroundOverweight and obesity are associated with health complications the gravity of which, vary with the regional deposition of the excess fat. The Body Mass Index (BMI) is often used to measure obesity although is an inferior predictor of cardiovascular disease risk mortality and morbidity compared with measures of abdominal obesity. We analyzed data from Uganda’s 2014 World Health Organization (WHO) STEPwise approach to surveillance of Non-communicable diseases (NCDs) survey to estimate the prevalence of abdominal obesity and associated factors to provide information on the prevention and control of overweight and obesity.MethodsData were collected using the WHO STEPS protocol. Waist measurement was taken using a non-stretchable standard tape measure mid-way between the lowest rib and iliac crest with the subject standing at the end of gentle expiration. Participants with waist circumference > 102 cm for men and 88 cm for women were classified as abdominally obese. We used weighted modified Poisson regression with robust error variance to estimate the prevalence of abdominal obesity and associated factors.ResultsOf the 3676 participants, 432 (11.8%) were abdominally obese; with the prevalence higher among females 412 (19.5%) compared with males 20 (1.3%). Compared with males, female participants were more likely to be abdominally obese Adjusted Prevalence Rate Ratio (APRR) 7.59 [5.58–10.33]. Participants who were married or cohabiting APRR 1.82 [1.29–2.57] and participants who were separated or divorced APRR 1.69 [1.17–2.46] were more likely to be abdominally obese compared with those who had never married before. Compared with rural dwellers, participants from urban areas were more likely to be abdominally obese APRR 1.29 [1.09–1.53]. Compared with participants with normal blood pressure, those with elevated blood pressure were more likely to be abdominally obese APRR 1.83 [1.57–2.14].Compared with participants without any education, those with secondary education were more likely to be abdominally obese APRR 1.42 [1.12–1.78].ConclusionsThere is a high prevalence of abdominal obesity among adults in Uganda which puts many at risk of developing associated metabolic complications. These data provide useful information for developing interventions and formulation of policies for the control and prevention of abdominal obesity in Uganda.

Weight underestimation for adults in Beijing and its association with chronic disease awareness and weight management

BackgroundObesity is known to be a risk factor to a variety of chronic diseases. Weight misperception has an impact on weight-loss attitude and behavior. We aimed to investigate factors associated with weight underestimation, and to assess the effect of hypertension, diabetes and dyslipidemia awareness on weight underestimation and weight management for overweight and obese adults.MethodsData was obtained from the 2011 Beijing Non-communicable disease and risk factors Surveillance (BJNCDRS). A total of 19,932 participants with measures of weight and height were included in the analysis. Self-perception of weight was obtained by asking, “How do you describe your weight?”, and the question for weight management was “Are you taking any actions to control your body weight?”. Multiple logistic regression was used to investigate factors related to weight underestimation.ResultsFor the underweight, normal weight, and overweight/obese categories, more than half of the participants perceived their weight accurately (63.6, 53.8, 66.2%, respectively). For overweight and obese adults, older age, male, rural residence, lower level of education, lower level of income, absence of hypertension, presence of diabetes and absence of dyslipidemia positively associated with weight underestimation, and awareness of having hypertension and dyslipidemia were negatively associated with weight underestimation (Adjusted OR(95%CI) were 0.70(0.61~ 0.79) and 0.71(0.62~ 0.80), respectively). Awareness of having hypertension and dyslipidemia were significantly associated with weight management (Adjusted OR (95%CI) were 1.42(1.25~ 1.62) and 1.53(1.36~ 1.72), respectively). There was no significant association between awareness of diabetes and weight underestimation(P > 0.05) or weight management(P > 0.05).ConclusionsMore than half of the participants perceived their weight accurately. For overweight/obese population, awareness of having hypertension and dyslipidemia could improve weight perception and weight management, whereas awareness of having diabetes might not.

Informing NCD control efforts in India on the eve of Ayushman Bharat

Informing NCD control efforts in India on the eve of Ayushman Bharat

National public health system responses to diabetes and other important noncommunicable diseases : Background, goals, and results of an international workshop at the Robert Koch Institute.

Diabetes mellitus and other noncommunicable diseases (NCDs) represent an emerging global public health challenge. In Germany, about 6.7 million adults are affected by diabetes according to national health surveys, including 1.3 million with undiagnosed diabetes. Complications of diabetes result in an increasing burden for individuals and society as well as enormous costs for the health care system. In response, the Federal Ministry of Health commissioned the Robert Koch Institute (RKI) to implement adiabetes surveillance system and the Federal Center for Health Education (BZgA) to develop adiabetes prevention strategy. In atwo-day workshop jointly organized by the RKI and the BZgA, representatives from public health institutes in seven countries shared their expertise and knowledge on diabetes prevention and surveillance. Day one focused on NCD surveillance systems and emphasized both the strengthening of sustainable data sources and the timely and targeted dissemination of results using innovative formats. The second day focused on diabetes prevention strategies and highlighted the importance of involving all relevant stakeholders in the development process to facilitate its acceptance and implementation. Furthermore, the effective translation of prevention measures into real-world settings requires data from surveillance systems to identify high-risk groups and evaluate the effect of measures at the population level based on analyses of time trends in risk factors and disease outcomes. Overall, the workshop highlighted the close link between diabetes prevention strategies and surveillance systems. It was generally stated that only robust data enables effective prevention measures to encounter the increasing burden from diabetes and other NCDs.

Modelling the prevalence of diabetes mellitus risk factors based on artificial neural network and multiple regression

Type 2 diabetes mellitus (T2DM) is a metabolic disease with complex causes, manifestations, complications and management. Understanding the wide range of risk factors for T2DM can facilitate diagnosis, proper classification and cost-effective management of the disease. To compare the power of an artificial neural network (ANN) and logistic regression in identifying T2DM risk factors. This descriptive and analytical study was conducted in 2013. The study samples were all residents aged 15-64 years of rural and urban areas in East Azerbaijan, Islamic Republic of Iran, who consented to participate (n = 990). The latest data available were collected from the Noncommunicable Disease Surveillance System of East Azerbaijan Province (2007). Data were analysed using SPSS version 19. Based on multiple logistic regression, age, family history of T2DM and residence were the most important risk factors for T2DM. Based on ANN, age, body mass index and current smoking were most important. To test for generalization, ANN and logistic regression were evaluated using the area under the receiver operating characteristic curve (AUC). The AUC was 0.726 (SE = 0.025) and 0.717 (SE = 0.026) for logistic regression and ANN, respectively (P < 0.001). The logistic regression model is better than ANN and it is clinically more comprehensible.

Acceptability and adoption of health-facility based NCD surveillance in Kulon Progo district, Yogyakarta

Background: Non-communicable diseases (NCD) have been recognized as the new disease pandemic to the developing world in recent years. In 2020, it is estimated that 70% of NCD-related deaths will occur in developing countries. The most prevalent NCD such as coronary heart diseases, cancer, respiratory diseases and diabetes mellitus. Since 2012 Indonesia MOH was established two main surveillance system i.e. health facility- and community-based surveillance systems. MOH report on 2015 showed those reporting from PHC less than 25%. The front-line of health facility-based surveillance is the primary health centers (PHC). Data should undergo validity and quality check by the District and Provincial Health Office before being sent to the central reporting system.This study aim to evaluate the implementation of health-facility based NCD surveillance and develops recommendations for increasing coverage NCD surveillance in Kulon Progo District. Method: We used RE-AIM (only Reach and Adoption) framework for evaluating the surveillance system. The Reach variables are coverage, knowledge, acceptance, constraint, infrastructure and feasibility. 76 NCD team at PHC and District Health office included doctor, nurse, program manager and laboratory staffs were interviewed and observed using a standardize questionnaire and checked list. Secondary data on NCD surveillance reports were collected and reviewed. Qualitative study were conducted through semi structured interviews and FGDs to evaluate acceptance, constraints and barriers of implementation. Descriptive analysis was used to analyze quantitative data and content analysis was performed on the qualitative data. Result: This study found that most of the health officer involving in the non-communicable program was having fair knowledge on web based NCD surveillance, and only 5% of the respondent has a good understanding on it. There are 19 Puskesmas was assessed on the completeness of the data entry on web based NCD surveillance.

Surveillance system evaluation of non-communicable diseases through integrated community-based intervention called ‘Posbindu PTM’ in Wonosobo district, Central Java province, Indonesia

Purpose: Non-communicable diseases are leading cause of the global death, especially from cardiovascular disease, cancers, chronic obstructive pulmonary disease, and diabetes. Prevention and primary detection of non-communicable disease in Indonesia were done through integrated community-based intervention called ‘Posbindu PTM’. Implementation of ‘Posbindu PTM’ needed to be evaluated to determine each component in the non-communicable disease surveillance systems. Methods: This study was descriptive. Respondent were programmer in district health office and programmer in 24 primary health care in Wonosobo. Surveillance system evaluation that used was programs evaluation based on WHO (structure, main function, support function and quality of surveillance system). Results: The weakness of ‘Posbindu PTM’ in Wonosobo were lack of knowledge in the regulation, networking, collaborating, risk factor detecting and reporting; not availability of technical guidebook; low training participant; low monitoring and evaluation activity; also complex reporting system. There was 84% ‘Posbindu PTM’ that had not reported on time and 87,50 % programmer had not done the analysis, interpretation, and dissemination. This was related to the completeness of the report caused too many data that needed to be collected and affect the timeliness of the report. Conclusion: Strengthening ‘Posbindu PTM’ should be done in the reporting system aspect, especially in the timeliness and analysis of the report. Monthly reminder and refreshing in reporting system were done to improve the reporting system aspect.

Prevalence of prehypertension and its associated factors among adults visiting outpatient clinic in Northeast Malaysia.

ObjectivesPrehypertension refers to a systolic blood pressure of 120–139 mmHg systolic or a diastolic blood pressure of 80–89 mmHg. Estimation of the prevalence of prehypertension in the population and identification of cardiovascular associated factors are important to reduce progression to hypertension. This study aimed to determine the prevalence of prehypertension and its associated factors among Malaysian adults.MethodsIn 2015, a cross-sectional study was conducted among adults visiting an outpatient clinic in Northeast Malaysia. Face-to-face interviews were conducted using Malay and English versions of the Malaysia Non-Communicable Disease surveillance questionnaire. This instrument captured information about sociodemographic, lifestyle status, and anthropometric data. Blood pressure was measured three times with a sphygmomanometer, the first measurement value was discarded, and an average of blood pressure from the second two readings was recorded for further data analysis. Logistic regression was performed to analyse factors associated with prehypertension.ResultA total 151 adults participated in the study, and the prevalence of prehypertension was 37.1% (95% confidence interval [CI]: 29.29, 44.69). Factors associated with prehypertension in this study were age (adjusted odds ratio [aOR] = 1.06 95% CI: 1.02, 1.11; p = 0.007), male sex (aOR = 4.44 95% CI: 1.58, 12.44; p = 0.005), and abnormal waist circumference (aOR = 31.65 95% CI: 11.25, 89.02; p < 0.001) as determined by multiple logistic regression analysis.ConclusionIn this study, the prevalence rate of prehypertension of 37.1% is higher than that of hypertension reported in the literature. Age, male sex, and abnormal waist circumference are significant associated factors that lead to prehypertension.

Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis.

To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. Systematic review and meta-analysis. We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hypertension 21.2% (95% CI 16.3-27.1), hypercholesterolemia 22.2% (95% CI 14.7-32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2-33.6), hypertriglyceridemia 27.2% (95% CI 20.7-34.8), low high-density lipoprotein 52.3% (95% CI 35.6-62.8), obesity 7.8% (95% CI 4.3-13.9), and depression 24.4% (95% CI 12.5-42.1). Invasive cervical cancer and diabetes prevalence were 1.3-1.7 and 1.3-18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.

Prevalence and influencing factors of respiratory symptoms among people aged 40 years and above in China

Objective: To investigate the prevalence and influencing factors on respiratory disease related symptoms (coughing, expectoration, persistent coughing and persistent expectoration) in Chinese people ≥40 years old. Methods: Data was collected from 162 surveillance points in the China Non-communicable and Chronic Disease Surveillance Project in 2010. A total number of 56 066 people, aged ≥40 years, were selected by multi-stage cluster random sampling method in this study. The prevalence rates of coughing, expectoration, persistent coughing and persistent expectoration were calculated according to gender by χ(2) test. Multivariate logistic regression model was used to analyze the related influencing factors. Results: The prevalence rates of coughing, persistent coughing, expectoration and persistent expectoration in men were significantly higher than that in women (P<0.01). The prevalence rate of respiratory symptoms was positively correlated with age and duration and amount of cigarette smoking (P<0.01), while negatively correlated with participants'education level (P<0.01). Results from multivariate logistic regression analysis showed that gender, age, education level, smoking-related parameters, areas of residency (in urban or rural areas), etc. were appeared as influencing factors on the prevalence of respiratory symptoms. Conclusion: The symptoms of chronic respiratory diseases appeared prevalent in Chinese population aged ≥40 years. Factors as older age, living in the central/western regions and smoking-related parameters were identified as of higher risks.