Non-communicable Diseases In sub-Saharan Africa Research Articles

Sugar-Sweetened Beverages and Diet Related Chronic Non-Communicable Diseases in Sub-Saharan Africa

abstract In Sub-Saharan Africa (SSA), diet-related chronic non-communicable diseases (DR-CNCDs) pose a growing public health threat, jeopardising progress towards achieving Sustainable Development Goal 3.4. One contributing factor to this rising threat is the recent surge in consumption of sugar-sweetened beverages (SSBs), across SSA in recent years. Using the socio-ecological model, this commentary explores the nexus between DR-NCDs and SSBs and offers interventions to address this public health challenge at the individual, interpersonal, community, organisational and policy levels. At the individual level, health education campaigns should target individuals and ensure an increase in awareness creation. The life-course approach underscores the importance of promoting healthier dietary choices from childhood to prevent diet-related non-communicable diseases in later life. Schools and workplaces enforcing local policies that discourage SSB consumption patterns will make a huge difference at the community and organisational levels. At the societal/policy level, comprehensive strategies such as sugar taxes, front-of-pack labelling, advertising restrictions and health education programmes are crucial.

Extruded wholegrain sorghum porridges fortified with baobab fruit and moringa leaves display bioactive phenolics-related health-promoting properties

Background and objectivesFood-to-food fortification (FtFF) is gaining traction as a strategy to enhance nutritional value of cereal-based foods. Sorghum, a major food crop for millions in the semi-arid tropics lends itself to such FtFF efforts. Such food-to-food fortified (FtF fortified) foods also contain bioactive phenolics with health-promoting properties in relation to potential protection against diet-related non-communicable diseases (NCDs) whose prevalence is increasing in sub-Saharan Africa. In this study, the effects of extrusion cooking of sorghum-based porridges FtF fortified with baobab fruit powder and moringa leaf powder on antioxidant, anti-inflammatory, antidiabetic and anti-lipogenic properties were determined. FindingsFtFF porridges showed higher phenolic content (phenolic acids and their esters, flavonoids and their glycosides) and greater radical scavenging properties and reduction in advanced glycation end products (AGEs) compared to unfortified porridges. Extruded instant porridges had lower phenolic content, radical scavenging properties and showed less reduction in AGEs compared to conventionally wet-cooked porridges. All porridges exerted antioxidant effects in Caco-2 cells and FtFF inhibited nitric oxide (NO) formation in RAW 264.7 cells. Extracts from all porridge samples exhibited prevention and reduction of adipocyte formation in 3 T3-L1 cells, indicating anti-lipogenic effects. ConclusionFtFF (with moringa and baobab) and extrusion cooking can be used to produce instant porridges from wholegrain sorghums with targeted health-promoting properties to address rising non-communicable diseases in sub-Saharan Africa. Significance and noveltyThis study highlights the potential of FtFF with tropical plant foodstuffs to improve health-promoting properties of cereal wholegrain-based starchy staple foods.

Evaluating a multifaceted implementation strategy and package of evidence-based interventions based on WHO PEN for people living with HIV and cardiometabolic conditions in Lusaka, Zambia: protocol for the TASKPEN hybrid effectiveness-implementation stepped wedge cluster randomized trial

BackgroundDespite increasing morbidity and mortality from non-communicable diseases (NCD) globally, health systems in low- and middle-income countries (LMICs) have limited capacity to address these chronic conditions, particularly in sub-Saharan Africa (SSA). There is an urgent need, therefore, to respond to NCDs in SSA, beginning by applying lessons learned from the first global response to any chronic disease—HIV—to tackle the leading cardiometabolic killers of people living with HIV (PLHIV). We have developed a feasible and acceptable package of evidence-based interventions and a multi-faceted implementation strategy, known as “TASKPEN,” that has been adapted to the Zambian setting to address hypertension, diabetes, and dyslipidemia. The TASKPEN multifaceted implementation strategy focuses on reorganizing service delivery for integrated HIV-NCD care and features task-shifting, practice facilitation, and leveraging HIV platforms for NCD care. We propose a hybrid type II effectiveness-implementation stepped-wedge cluster randomized trial to evaluate the effects of TASKPEN on clinical and implementation outcomes, including dual control of HIV and cardiometabolic NCDs, as well as quality of life, intervention reach, and cost-effectiveness.MethodsThe trial will be conducted in 12 urban health facilities in Lusaka, Zambia over a 30-month period. Clinical outcomes will be assessed via surveys with PLHIV accessing routine HIV services, and a prospective cohort of PLHIV with cardiometabolic comorbidities nested within the larger trial. We will also collect data using mixed methods, including in-depth interviews, questionnaires, focus group discussions, and structured observations, and estimate cost-effectiveness through time-and-motion studies and other costing methods, to understand implementation outcomes according to Proctor’s Outcomes for Implementation Research, the Consolidated Framework for Implementation Research, and selected dimensions of RE-AIM.DiscussionFindings from this study will be used to make discrete, actionable, and context-specific recommendations in Zambia and the region for integrating cardiometabolic NCD care into national HIV treatment programs. While the TASKPEN study focuses on cardiometabolic NCDs in PLHIV, the multifaceted implementation strategy studied will be relevant to other NCDs and to people without HIV. It is expected that the trial will generate new insights that enable delivery of high-quality integrated HIV-NCD care, which may improve cardiovascular morbidity and viral suppression for PLHIV in SSA. This study was registered at ClinicalTrials.gov (NCT05950919).

Climate change-induced shifts in the food systems and diet-related non-communicable diseases in sub-Saharan Africa: a scoping review and a conceptual framework

ObjectivesTo determine the relationship between climate change, food systems and diet-related non-communicable diseases (DR-NCDs) in sub-Saharan Africa (SSA) and propose a conceptual framework for food systems in SSA.DesignA scoping review.Eligibility...

The Africa non-communicable diseases (NCD) Open Lab: Impact of a portfolio of clinical studies to deepen the understanding of NCDs in sub-Saharan Africa.

Clinical research in sub-Saharan Africa (SSA) has often focussed on communicable diseases. However, with the increasing burden of non-communicable diseases (NCDs), there is a need for Africa-specific NCD research. GSK established the Africa NCD Open Lab in 2014. Three calls for proposals were advertised through various media channels. An external independent scientific advisory board, predominantly representing African scientists and NCD experts, reviewed and selected projects to receive funding. An additional programme in the Africa NCD Open Lab was designed to build statistical capability by supporting training initiatives. We assessed the impact of the Africa NCD Open Lab in three ways: scientific quality with impact; research training and professional development; and research environments. We captured metrics through regular reports/interactions with researchers; via a final report; and through exit interviews with principal investigators. Twenty projects in 11 African countries were funded; reports from 18 completed projects are available (data capture is ongoing). Overall, 139 articles have been published in peer-reviewed journals and other data have been presented at conferences and other forums. Most completed projects led to positive outcomes, such as further research, informing policy, or positively impacting clinical care, including three projects that saw changes to regional or national practice guidelines: the CREOLE study in Nigeria; the African Severe Asthma Program in Uganda; and the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension in South Africa. Participation in the Africa NCD Open Lab led to the award of 34 grants related to or influenced by increased research capacity or experience. Significant professional development related to the projects also occurred with higher-level degrees being awarded, including 30 MScs, 30 PhDs, and nine postdoctoral fellowships. Through these projects, research capacity was strengthened across the region by equipping core research facilities, training research staff, strengthening research support services, and supporting the expansion of investigator networks. The completed Africa NCD Open Lab projects demonstrate high-quality research outcomes addressing important health challenges with potential benefits to African populations. Based on the success of the Africa NCD Open Lab, additional funding has been secured to extend the Open Lab initiative.

Diet changes due to urbanization in South Africa are linked to microbiome and metabolome signatures of Westernization and colorectal cancer

Transition from traditional high-fiber to Western diets in urbanizing communities of Sub-Saharan Africa is associated with increased risk of non-communicable diseases (NCD), exemplified by colorectal cancer (CRC) risk. To investigate how urbanization gives rise to microbial patterns that may be amenable by dietary intervention, we analyzed diet intake, fecal 16 S bacteriome, virome, and metabolome in a cross-sectional study in healthy rural and urban Xhosa people (South Africa). Urban Xhosa individuals had higher intakes of energy (urban: 3,578 ± 455; rural: 2,185 ± 179 kcal/d), fat and animal protein. This was associated with lower fecal bacteriome diversity and a shift from genera favoring degradation of complex carbohydrates (e.g., Prevotella) to taxa previously shown to be associated with bile acid metabolism and CRC. Urban Xhosa individuals had higher fecal levels of deoxycholic acid, shown to be associated with higher CRC risk, but similar short-chain fatty acid concentrations compared with rural individuals. Fecal virome composition was associated with distinct gut bacterial communities across urbanization, characterized by different dominant host bacteria (urban: Bacteriodota; rural: unassigned taxa) and variable correlation with fecal metabolites and dietary nutrients. Food and skin microbiota samples showed compositional differences along the urbanization gradient. Rural-urban dietary transition in South Africa is linked to major changes in the gut microbiome and metabolome. Further studies are needed to prove cause and identify whether restoration of specific components of the traditional diet will arrest the accelerating rise in NCDs in Sub-Saharan Africa.

Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis

Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.

Addressing Mental Health Challenges and Non-communicable Diseases in Sub-Saharan Africa: An Analysis from Health Systems Approach

Abstract Non-communicable diseases (NCDs) including mental health issues are a substantial public health concern globally. This review article explores the mental health challenges of people living with other NCDs in Sub-Saharan Africa and proposes interventions to address them. The authors argue health systems challenges that perpetuate mental health challenges amongst patients with other NCDs that include inadequacy of health professionals, challenges in logistics and supplies, capacity building, poor service delivery and policies. To overcome these challenges, countries in Sub-Saharan Africa must prioritise investment in their health workforce including mental health officers, training, retention, good policy and governance, provision of medications, task shifting and resource allocation to deliver comprehensive and accessible mental health care for individuals living with NCDs. The adoption of health system approach will also help to accelerate progress towards the Sustainable Development Goal 3.4 by 2030.

Chronic non-communicable diseases in sub-Saharan Africa

Chronic non-communicable diseases in sub-Saharan Africa

Performance evaluation of national healthcare systems in the prevention and treatment of non-communicable diseases in sub-Saharan Africa.

Non-communicable diseases (NCDs) remain a major public health concern globally, threatening the achievement of sustainable development goal 3.4 (SDG 3.4), which seeks to reduce premature NCD-related deaths by one-third by 2030. According to the World Health Organization (WHO), improving the efficiency of NCD spending (i.e., maximizing the impact of every dollar spent on NCDs) is one of the strategic approaches for achieving SDG target 3.4. This study aims to assess the efficiency and productivity of NCDs spending in 34 sub-Saharan African (SSA) countries from 2015 to 2019. The study employed the data envelopment analysis (DEA) double-bootstrap truncated and Tobit regressions, one-stage stochastic frontier analysis (SFA) model, the Malmquist productivity index (MPI), and spatial autocorrelation analysis to estimate NCDs spending efficiency, identify the context-specific environmental factors that influence NCDs spending efficiency, evaluate total productivity change and identify its components, and assess the spatial interdependence of the efficiency scores. The estimated average DEA bias-corrected NCD spending efficiency score was 87.3% (95% CI: 86.2-88.5). Additionally, smoking per capita, solid fuel pollution, alcohol use, governance quality, urbanization, GDP per capita, external funding for NCDs, and private domestic funding for NCDs healthcare services were found to be significantly associated with NCDs spending efficiency. The study also revealed a decline of 3.2% in the MPI, driven by a 10.6% technical regress. Although all countries registered growth in efficiency, except for the Central Africa Republic and DR Congo, the growth in efficiency was overshadowed by the decline in technical change. Global Moran's I test indicated the existence of significant positive spatial autocorrelation in the efficiency of NCDs spending across SSA countries. The study underscores the importance of efficient use of resources in NCDs treatment and prevention and increased investment in NCDs research and development in achieving the SDG target 3.4.

Access to comprehensive services for HIV and non-communicable diseases in sub-Saharan Africa

Access to comprehensive services for HIV and non-communicable diseases in sub-Saharan Africa

Bioactive compounds and antioxidant activities in peeled and unpeeled sweetpotato roots of different varieties and clones in Uganda

Rising incidences of non-communicable diseases (NCDs) in Sub-Saharan Africa (SSA) necessitates research into local functional foods, crucial in managing these conditions. This study aimed to investigate compositional changes in the bioactive compounds and antioxidant activities of peeled and unpeeled roots of Ugandan sweetpotato varieties with different flesh colours using spectrophotometric methods. Bioactive compounds and antioxidant activities, on dry weight basis were significantly higher (P<0.05) in unpeeled than peeled roots. Phenolic compounds were significantly higher (P = 0.001) in white, cream, and purple-fleshed roots (59.67–121.04 mg GAE/g) than in yellow and orange-fleshed roots (0.89–10.89 mg GAE/g). The deep orange-fleshed had the highest total carotenoids (averagely 269.82 µg/g) and the white the lowest (averagely 8.36 µg/g). Total alkaloids in the sweetpotato roots ranged between 24.05 and 233.70 µg CE/g, below the potential toxicity range of 3–10 mg/g. The anthocyanin content of purple-fleshed roots was significantly higher (15.29 mg/g; P<0.001) than the other varieties, which ranged between 0.86 and 2.44 mg/g. Principal component analysis showed a stronger relationship between phenolics, anthocyanins, tannins, and ABTS radical scavenging antioxidant activity. Vitamin C and total carotenoids were more correlated with FRAP antioxidant activity. Consumption of different sweetpotato varieties with the peels could aid in managing NCDs in SSA.

Mapping research evidence on implementation of the WHO ‘best buys’ and other interventions for the prevention and control of non-communicable diseases in sub-Saharan Africa: a scoping review protocol

BackgroundThe rising burden of non-communicable diseases (NCDs) is a global health concern. To reduce the burden of morbidity, mortality and disability due to NCDs, the World Health Organization (WHO) developed ‘best buys’ and other interventions for the prevention and control of NCDs by member countries. However, their extent of implementation especially in sub-Saharan African countries (SSA) is not known. Therefore, this scoping review aims to map and describe research evidence on implementation of the WHO’s ‘best buys’ and other interventions for reducing unhealthy diets in SSA.MethodsThis review will be guided by the enhanced version of Arksey and O’Malley’s framework and the recent Joanna Briggs Institute guidelines for scoping reviews. To identify the relevant published literature for this review, a comprehensive keyword search will be conducted in PubMed, SCOPUS, EBSCOhost (CINAHL, Health Resource and PsycINFO) and Cochrane Library from 2017 to 2021. Boolean terms (‘AND’ and ‘OR’), as well as Medical Subject Heading terms, will be included where essential. Government websites of SSA countries, the WHO’s website and Google Scholar will be consulted for grey literature such as governmental policies/strategies focus on reducing unhealthy diets. Moreover, the reference list of included evidence sources will be searched for additional literature. Two reviewers will independently screen the articles at the abstract and full-text screening phases guided by the review eligibility criteria. Also, all relevant data will be extracted independently by two reviewers, analysed thematically and the findings reported qualitatively.DiscussionThe evidence produced by this review will help identify implementation and policy gaps to inform future implementation research/interventions studies using a variety of evidence-based strategies towards the prevention and control of NCDs due to unhealthy diets in the WHO Africa Region. Platforms such as peer review journals, policy briefs and conferences will be used to disseminate this review’s findings.

Ethnopharmacological Study of Medicinal Plants Used for the Treatment of Cardiovascular Diseases and Their Associated Risk Factors in sub-Saharan Africa.

Cardiovascular diseases (CVDs) are the leading cause of global mortality, including deaths arising from non-communicable diseases in sub-Saharan Africa (SSA). Consequently, this study aimed to provide details of medicinal plants (MPs) employed in SSA for the treatment of CVDs and their related risk factors to open new avenues for the discovery of novel drugs. The extensive ethnopharmacological literature survey of these MPs in 41 SSA countries was based on studies from 1982 to 2021. It revealed 1,085 MPs belonging to 218 botanical families, with Fabaceae (9.61%), Asteraceae (6.77%), Apocynaceae (3.93%), Lamiaceae (3.75%), and Rubiaceae (3.66%) being the most represented. Meanwhile, Allium sativum L., Persea americana Mill., Moringa oleifera Lam., Mangifera indica L., and Allium cepa L. are the five most utilised plant species. The preferred plant parts include the leaves (36%), roots (21%), barks (14%), fruits (7%), and seeds (5%), which are mostly prepared by decoction. Benin, Mauritius, Nigeria, South Africa, and Togo had the highest reported use while most of the investigations were on diabetes and hypertension. Despite the nutraceutical advantages of some of these MPs, their general toxicity potential calls for caution in their human long-term use. Overall, the study established the need for governments of SSA countries to validate the efficacy/safety of these MPs as well as provide affordable, accessible, and improved modern healthcare services.

Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities.

Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid but variable epidemiological transition fuelled by the pace of urbanization, with disease burden profiles shifting from communicable diseases to non-communicable diseases (NCDs). Information on the epidemiology of T2DM has increased, but wide variations in study methods, diagnostic biomarkers and criteria hamper analytical comparison, and data from high-quality studies are limited. The prevalence of T2DM is still low in some rural populations but moderate or high rates are reported in many countries/regions, with evidence for an increase in some. In addition, the proportion of undiagnosed T2DM is still high. The prevalence of T2DM is highest in African people living in urban areas, and the gradient between African people living in urban areas and people in the African diaspora is rapidly fading. However, data from longitudinal studies are lacking and there is limited information on chronic complications and the genetics of T2DM. The large unmet needs for T2DM care call for greater investment of resources into health systems to manage NCDs in SSA. Proposed health-system paradigms are being developed in some countries/regions. However, national NCD programmes need to be adequately funded and coordinated to stem the tide of T2DM and its complications.

Prevalence And Distribution Of Non-Communicable Diseases In Sub-Saharan Africa: The Case Of Hypertension, Diabetes, And Chronic Kidney Disease/Acute Kidney Injury

Non-communicable Diseases (NCDs) has been on the rise in Sub-Saharan Africa (SSA). Its burden is affecting health systems, quality of life, and economies. If not attended to, NCDs are projected to cause more deaths by 2030. This study aims to present the geographical distribution of three NCDs, namely Hypertension (HPT), Diabetes, and chronic kidney disease/Acute Kidney Injury (CKD/AKI) across SSA to help inform policy and future research. A systematic literature search was performed in several databases, to identify articles/surveys reporting epidemiology data on HPT, DM, CKD/AKI in the general population in each country in SSA. Articles were screened and those that meet the study criteria were included. Data were extracted and compiled in Excel for final presentation, with geographical heat maps. Majority (65%) of countries in SSA have an HPT prevalence between 20-40%. Diabetes has a prevalence of below 10% in the majority (80.5%) of the countries in SSA. High prevalence rates of over 20% were recorded in Mauritius (22.8%) and Somalia (36.5%). Burundi, Kenya, Cameroon, and Madagascar had the highest prevalence of CKD/AKI, with rates of 45.7%, 38.6%, 32.3%, and 31.6% respectively. The prevalence of HPT, Diabetes, and CKD/AKI in SSA are relatively on the rise. Action-oriented research and policies focused on helping to reduce the rising burden of NCDs in SSA are needed. Investing in the health workforce and increasing healthcare financing is also key in the response to the growing burden of NCDs.

Screening for Atrial Fibrillation in Sub-Saharan Africa: A Health Economic Evaluation to Assess the Feasibility in Nigeria.

Background:Cardiovascular disease reflects a major burden of non-communicable disease in Sub-Saharan Africa (SSA). Early detection and treatment of atrial fibrillation (AF), as a preventive measure against stroke, is currently not in the scope of the World Health Organization recommendation to reduce cardiovascular disease.Objective:We hypothesized that screening for AF would be an important approach to determine the true AF prevalence in the general population in African countries and to identify asymptomatic AF patients at risk for stroke to optimize prevention.Methods:A decision analytic model was developed to study the health-economic impact of AF screening in Nigeria over a life-time horizon. The patient population explored in the model was a population of newly detected AF cases that would be diagnosed with a one-time systematic screening for AF with a single lead ECG device in community health centres across Nigeria.Conclusions:The health gain per newly detected AF patient (N = 31,687) was 0.41 QALY at a cost of $5,205 per patient with 100% NOAC use, leading to an ICER of $12,587 per QALY gained. The intervention was cost-effective with a 99.9% warfarin use with an ICER of $1,363 per QALY gained. The total cost of a single screening session was $7.3 million for the total screened population in Nigeria or $1.60 per patient screened. Screening for AF to detect AF patients in need for stroke prevention can be a cost-effective intervention in the Sub-Saharan region, depending on type of anticoagulant used and drug costs.

Recognition and management of clinically significant drug-drug interactions between antiretrovirals and co-medications in a cohort of people living with HIV in rural Tanzania: a prospective questionnaire-based study.

The extent to which drug-drug interactions (DDIs) between antiretrovirals (ARVs) and co-medications are recognized and managed has not been thoroughly evaluated in limited-resource settings. This prospective questionnaire-based study aimed to determine the prevalence and risk factors for unrecognized/incorrectly managed DDIs in people living with HIV followed-up at the Chronic Diseases Clinic of Ifakara (CDCI) and enrolled in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). We prospectively included ARV-treated adults receiving ≥1 co-medication coming for a follow-up visit at the CDCI between March and July 2017. Using a structured questionnaire, physicians were requested to identify potentially clinically significant DDIs in the prescribed treatment, to provide recommendations for their management and to indicate any hurdles to implement the recommendations. Prescriptions were subsequently screened for DDIs using the Liverpool DDIs database. Identified clinically significant DDIs and their recommended management according to the DDIs database were compared with the information provided in the questionnaires. Among 334 participants, the median age was 47 years (IQR = 40-56 years), 69% were female and 82% had ≥1 non-communicable disease (NCD). Overall, 129 participants had ≥1 clinically relevant DDI, which was not recognized and/or incorrectly managed in 56 participants (43%). Of those, 6 (11%) were due to limited monitoring options or medication affordability issues. In the multivariable logistic regression, the presence of ≥1 NCD was associated with an increased risk for unrecognized/incorrect DDI management (OR = 15.8; 95% CI = 1.8-139.6). Recognition/appropriate management of DDIs is suboptimal, highlighting the need for educational programmes, pharmacovigilance activities and increased access to medications and monitoring options. This should become a focus of HIV programmes given the increasing burden of NCDs in sub-Saharan Africa.

Prevalence and patterns of chronic communicable and non-communicable diseases multimorbidity in sub-Saharan Africa: protocol for a systematic review

# Background The burden of multimorbidity is rising globally. In sub-Saharan Africa (SSA), the growing prevalence of non-communicable diseases alongside the already existing high burden of chronic communicable diseases such as human immunodeficiency virus (HIV) presents a complex form of multimorbidity relative to patterns observed in high income countries. There is a gap in understanding the true burden of multimorbidity in SSA, in particular at interface of chronic communicable and non-communicable diseases (NCDs). The primary objective of this systematic review is to identify, evaluate and summarise the evidence on the prevalence and patterns of chronic communicable and NCDs multimorbidity in SSA. # Methods and analysis This protocol was developed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. A comprehensive search will be conducted on selected electronic databases including Medline, Embase, African Journals Online, based on a predefined search strategy for observational studies reporting primary data on multimorbidity from any country in the SSA region. Additionally, we will explore grey literature databases and check reference lists of included studies. Study selection, assessment of quality of included studies and data extraction will be carried out independently by two reviewers. A narrative synthesis will be conducted and meta-analysis will be carried out where applicable. # Conclusion The proposed systematic review will provide insights into the interface of chronic communicable diseases and NCDs in SSA. We expect this will provide additional insights into the true picture of multimorbidity in the region and assist policy makers to design appropriate prevention and management strategies. This review does not require ethical approval. Upon completion, it will be submitted for publication in peer-reviewed journals, and disseminated through relevant academic conferences. **Prospero registration**: CRD42020183539

Association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases in sub-Saharan Africa: a systematic review and meta-analysis

In previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This systematic review and meta-analysis aimed to determine the associations between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs and estimate the prevalence of key metabolic risk factors among the food-insecure patients in sub-Saharan Africa. This study was guided by the Centre for Reviews and Dissemination (CRD) guidelines for undertaking systematic reviews in healthcare. The following databases were searched for relevant literature: PubMed, EBSCOhost (CINAHL with full text, Health Source - Nursing, MedLine). Epidemiological studies published between January 2015 and June 2019, assessing the associations between food insecurity and metabolic risk outcomes in sub-Saharan African populations, were selected for inclusion. Meta-analysis was performed with DerSimonian-Laird’s random-effect model at 95% confidence intervals (CIs). The I2 statistics reported the degree of heterogeneity between studies. Publication bias was assessed by visual inspection of the funnel plots for asymmetry, and sensitivity analyses were performed to assess the meta-analysis results’ stability. The Mixed Methods Appraisal Tool (MMAT) – Version 2018 was used to appraise included studies critically. The initial searches yielded 11,803 articles, 22 cross-sectional studies were eligible for inclusion, presenting data from 26,609 (46.8% males) food-insecure participants, with 11,545 (42.1% males) reported prevalence of metabolic risk factors. Of the 22 included studies, we identified strong evidence of an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs, based on 20 studies. The meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00) derived from 14 studies. The most prevalent type of metabolic risk factors was dyslipidaemia 27.6% (95% CI: 6.5% to 54.9%), hypertension 24.7% (95% CI: 15.6% to 35.1%), and overweight 15.8% (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males. In this systematic review and meta-analysis, exposure to food insecurity was adversely associated with a wide spectrum of key metabolic risk factors, such as obesity, dyslipidaemia, hypertension, underweight, and overweight. These findings highlight the need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes. Further, these findings should guide recommendations on the initiation of food insecurity status screening and treatment in clinical settings as a basic, cost-effective tool in the practice of preventive medicine in sub-Saharan Africa.PROSPERO registration number: PROSPERO 2019 CRD42019136638.