Urban African Setting Research Articles

Investigating the association between household exposure to Anopheles stephensi and malaria in Sudan and Ethiopia: A case-control study protocol.

Endemic African malaria vectors are poorly adapted to typical urban ecologies. However, Anopheles stephensi, an urban malaria vector formerly confined to South Asia and the Persian Gulf, was recently detected in Africa and may change the epidemiology of malaria across the continent. Little is known about the public health implications of An. stephensi in Africa. This study is designed to assess the relative importance of household exposure to An. stephensi and endemic malaria vectors for malaria risk in urban Sudan and Ethiopia. Case-control studies will be conducted in 3 urban settings (2 in Sudan, 1 in Ethiopia) to assess the association between presence of An. stephensi in and around households and malaria. Cases, defined as individuals positive for Plasmodium falciparum and/or P. vivax by microscopy/rapid diagnostic test (RDT), and controls, defined as age-matched individuals negative for P. falciparum and/or P. vivax by microscopy/RDT, will be recruited from public health facilities. Both household surveys and entomological surveillance for adult and immature mosquitoes will be conducted at participant homes within 48 hours of enrolment. Adult and immature mosquitoes will be identified by polymerase chain reaction (PCR). Conditional logistic regression will be used to estimate the association between presence of An. stephensi and malaria status, adjusted for co-occurrence of other malaria vectors and participant gender. Findings from this study will provide evidence of the relative importance of An. stephensi for malaria burden in urban African settings, shedding light on the need for future intervention planning and policy development.

Culture, community, and cancer: Understandings of breast cancer from a non-lived experience among women living in Soweto.

Individual perceptions compounded with socio-cultural beliefs and health system factors are key determinants of people's health seeking behavior and are widely cited as the causes of delayed breast cancer diagnosis among women from structurally vulnerable settings. Asking: "how do women with a non-lived experience of cancer understand the disease and, what informs their health seeking behaviors?", we explored individual, sociocultural and health system elements from a conceptual model derived from the Socioecological, Health Belief and Cancer Stigma Frameworks, to understand perspectives of breast cancer in a South African urban community setting. Using a deductive approach, we conducted a qualitative study consisting of 6 focus group discussions among 34 women from Soweto, Johannesburg (aged 35-74 years) and followed-up with 20 semi-structured in-depth interviews. Findings revealed some awareness of breast and other cancers, but confusion and gaps in understanding of the disease, resulting in socio-culturally influenced misperceptions of risks, causes, and outcomes following treatment of breast cancer. This fueled perceptions of profound fear and stigma against people with breast and other cancers. These findings together with participant perceptions of primary healthcare providers being unwelcoming, under-resourced, and insufficiently trained to deal with breast cancer, resulted in women reporting being reluctant to participating in screening/early detection care seeking behavior. They only accessed primary care when experiencing extreme pain or ill-health. Participants suggested as solutions for future interventions, the need for sustained community engagement, harnessing existing clinic and community stakeholders and resources to provide clear and understandable breast cancer information and encouragement for screening uptake. Health literacy gaps surrounding breast cancer fuels socio-culturally influenced misperceptions, fear, stigma, and fatalism among community women from Soweto, South Africa. Women perceive primary care providers of having insufficient knowledge, skills, and resources to provide effective breast cancer screening services. Participants suggested the need for greater community engagement involving primary clinics and existing community stakeholders working hand in hand. Clear, understandable, and consistent information about breast cancer must be regularly disseminated and communities must be regularly encouraged to utilise breast cancer screening services.

Household antibiotic use in Malawi: A cross-sectional survey from urban and peri-urban Blantyre.

Antimicrobial resistance (AMR) is a significant threat to public health. Use of antibiotics, particularly in contexts where weaker regulatory frameworks make informal access easier, has been identified as an important driver of AMR. However, knowledge is limited about the ways antibiotics are used in communities in Malawi and sub-Saharan Africa. Between April and July 2021, we undertook a cross-sectional survey of community antibiotic use practices in Blantyre, Malawi. We selected two densely-populated neighbourhoods (Chilomoni and Ndirande) and one peri-urban neighbourhood (Chileka) and undertook detailed interviews to assess current and recent antibiotic use, supported by the innovative "drug bag" methodology. Regression modelling investigated associations with patterns of antibiotic recognition. We interviewed 217 households with a total of 1051 household members. The number of antibiotics recognised was significantly lower among people with poorer formal health care access (people with unknown HIV status vs. HIV-negative, adjusted odds ratio [aOR]: 0.76, 95% CI: 0.77-.099) and amongst men (aOR: 0.83, 95% CI: 0.69-0.99), who are less likely to support healthcare-seeking for family members. Reported antibiotic use was mostly limited to a small number of antibiotics (amoxicillin, erythromycin and cotrimoxazole), with current antibiotic use reported by 67/1051 (6.4%) and recent use (last 6 months) by 440/1051 (41.9%). Our findings support the need for improved access to quality healthcare in urban and peri-urban African settings to promote appropriate antibiotic use and limit the development and spread of AMR.

Out-of-home life spaces valued by urban older adults with limited income.

Access to, and occupational performance in, out-of-home-life-spaces is linked to health, wellbeing and quality of life for older adults. There is little evidence of how this relates to older adults with limited resources in an African urban context. To describe the out-of-home-life-spaces accessed and valued by older adults with limited resources, living in an urban South African setting. An exploratory concurrent mixed methods study saw 84 rehabilitation clinicians conduct 393 face-to-face interviews with older adults. Clinicians produced reflective field notes and participated in focus groups. Quantitative data were analysed using descriptive statistics with SPSS Version X. Qualitative data were analysed through inductive content analysis. Older adults walked, used mini-bus taxis or private vehicles to get to places of worship, medical facilities, shops, family and friends and special interest gatherings on a weekly or monthly frequency. Lack of funds was the main barrier. Older adults aspired to travel, go on holiday and to visit out-of-town family homes. Exploring the daily lived experience of older, urban South Africans with limited resources brought to light the value they attribute to participation in activities that contribute to the wellbeing of their families and communities. Such activities are found in a variety of life spaces. Results could inform policy makers and service providers in their planning of community mobility, transportation services and health care, for older adults with limited resources.

Caregiver perspectives of risk and protective factors influencing early childhood development in low‐income, urban settings: A social ecological perspective

AbstractThis qualitative study explored caregivers' perceptions of factors influencing early childhood development in low‐income, urban South African settings, from a social ecological perspective. Individual interviews were conducted with 15 caregivers of 3–5‐year‐old children; a reflexive thematic analysis approach was adopted. In the family and home context, caregivers spoke about their role in developing, nurturing, providing, protecting and disciplining their children. Risks included low socioeconomic status, dysfunctional relationships and caregiver mental health; resources related to early learning and social support. In the preschool/school context, caregivers discussed the value of early learning, and priorities for selecting early childhood care and education settings. Community risks included violence and crime; resources mentioned were social support, community programmes and infrastructure. The social ecological model provides a holistic and contextually relevant perspective for understanding multiple factors (risks and protective factors) influencing early childhood development in low‐income South African settings.

Allergen sensitization and polysensitization pattern of adults and children in an urban Sub-Saharan African setting (Libreville, Gabon).

It is believed that allergic diseases are increasing in Africa. However, the health sector in Africa has yet to catch up with this paradigm shift. We looked at the number of patients referred to us for allergy testing and investigated allergen sensitization. A retrospective analysis was done on 97 serum allergen-specific IgE results collected from patients suspected of having allergies in Libreville from 2018 to 2021. Specific IgE responses to 180 allergens were investigated. The general sensitization patterns were analyzed. Also analyzed were sensitization patterns for adults and children. The difference in the IgE-binding allergen positivity rate between groups was calculated by using the chi-square (χ2) test. The allergens most commonly causing sensitization were from mites (65%), barley (48%), peach (48%), dog and/or cat dander (44%), house dust (44%), peanut (39%), tomato (39%), cockroach (37%), crab (36%), garlic and/or onion (34%), rye (34%), egg white (32%), shrimp (32%), kiwi (32%), soya bean (32%), citrus mix (29%), cheese (27%), milk (27%), walnut (27%), ox-eye daisy (24%) and orchard grass (24%). Moreover, 60% of patients (36 of 60) were polysensitized to inhalant allergens, 53% (31 of 58) were polysensitized to food allergens, and 29% (14 of 48) were polysensitized to inhalant and food allergens; 65% of patients (53 of 81) were sensitized to allergens originating from mites, fungi (including Candida albicans, Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum, and Pennicillium notatum), or bacteria (staphylococcal enterotoxin B). The sensitization pattern of allergens in our setting is rich and varied, with a high prevalence of polysensitization.

Sensory modulation dysfunction in child victims of trauma from four residential care sites in southern Gauteng, South Africa

INTRODUCTION: The ability to modulate sensory input or the way an individual responds to sensory information, to create an appropriate adaptive response may be influenced by exposure to trauma. The study aimed to describe sensory modulation dysfunction in child victims of trauma in clinical settings in a residential urban South African setting. METHOD: A descriptive quantitative research design was implemented. Using purposive sampling, child victims of trauma from four residential care sites were selected. The Child Sensory Profile"™ 2 was completed on 128 children by childcare workers. RESULTS: Of the participants 91.4 % (117) were identified with sensory modulation dysfunction with only 8.6% (11) participants displaying no symptoms and scoring 'just like the majority of others' in all categories of the summary scores. More than 50% of the participants presented with sensory thresholds and self-regulation according to Sensory Avoidance, Sensory Sensitivity and Low Registration Quadrants that were 'more than others and much more than others'. Over 50% of participants also displayed difficulty in Touch Sensory Processing and Social-Emotional and Attentional Behaviours, in the 'more than others and much more than others' range. The sensory profile for this sample of Child Victims of Trauma, differed significantly from typical children 'just like the majority of others', indicating a vigilant sensory subtype with increased sensory sensitivity and sensory avoiding. CONCLUSION: A high percentage of child victims of trauma presented with sensory modulation dysfunction, mostly with low thresholds for sensory input. Sensory Modulation dysfunction leads to a disruption in self-regulation and adaptive behaviour affecting participation in occupations

Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia

IntroductionThe growing importance of non-communicable diseases (NCDs) and high HIV prevalence in urban African settings may increase the burden of metabolic dysfunction-associated fatty liver disease (MAFLD). We assessed liver steatosis...

Skin and nasal colonization of coagulase-negative staphylococci are associated with atopic dermatitis among South African toddlers.

BackgroundSkin colonization with coagulase-negative staphylococci (CoNS) is generally beneficial, but recent investigations suggest its association with flares and atopic dermatitis (AD) severity. However, this relationship remains unclear.ObjectiveTo assess patterns of staphylococcal colonization and biofilm formation in toddlers with and without AD from rural and urban South African settings.MethodsWe conducted a cross-sectional study of AD-affected and non-atopic AmaXhosa toddlers from rural Umtata and urban Cape Town, South Africa. CoNS isolates were recovered from lesional, nonlesional skin samples and the anterior nares of participants. Identification of the staphylococci was achieved by MALDI-TOF mass spectrometry. The microtiter plate assay assessed in-vitro biofilm formation.ResultsCoNS and S. aureus commonly co-colonized nonlesional skin among cases (urban: 24% vs. 3%, p = 0.037 and rural 21% vs. 6%, p<0.001), and anterior nares in urban cases (24% vs. 0%, p = 0.002) than the control group. S. capitis colonization on nonlesional skin and anterior nares was positively associated with more severe disease in rural (48.3±10.8 vs. 39.7±11.5, P = 0.045) and urban cases (74.9±10.3 vs. 38.4±13, P = 0.004), respectively. Biofilm formation was similar between cases and controls, independent of rural-urban living.ConclusionCoNS colonization is associated with AD and disease severity and may be implicated in AD exacerbations. Studies are needed to understand their underlying pathological contribution in AD pathogenesis.

Cardiometabolic outcomes of women exposed to hyperglycaemia first detected in pregnancy at 3-6 years post-partum in an urban South African setting.

BackgroundHyperglycaemia first detected during pregnancy(HFDP) has far-reaching maternal consequences beyond the pregnancy. Our study evaluated the cardiometabolic outcomes in women with prior HFDP versus women without HFDP 3–6 years post-partum in urban South Africa.Design and methodsA prospective cohort study was performed of 103 black African women with prior HFDP and 101 without HFDP, 3–6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data was obtained from medical records. Post-partum, participants were re-evaluated for anthropometric measurements, body composition utilizing dual energy X-ray absorptiometry(DXA) and biochemical analysis (two-hour 75gm OGTT fasting insulin, lipids, creatinine levels and glucose levels). Cardiovascular risk was assessed by Framingham risk score(FRS). Carotid intima media thickness(cIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to cardiometabolic outcomes were assessed using multivariable logistic and linear regression models.ResultsForty-six(45.1%) HFDP women progressed to diabetes compared to 5(4.9%) in non HFDP group(p<0.001); only 20(43.4%) were aware of their diabetic status in the whole group. The odds(OR, 95% confidence interval(CI)) of progressing to type 2 diabetes(T2DM) and metabolic syndrome(MetS) after correcting for confounders in the HFDP group was 10.5(95% CI 3.7–29.5) and 6.3(95%CI 2.2–18.1), respectively. All visceral fat indices were found to be significantly higher in the HFDP group after adjusting for baseline body mass index. Ten-year estimated cardiovascular risk(FRS) and mean cIMT was statistically higher in the HFDP group(8.46 IQR 4.9–14.4; 0.48 mm IQR 0.44–0.53 respectively) compared to the non-HFDP group(3.48 IQR 2.1–5.7; 0.46mm IQR 0.42–0.50) respectively and this remained significant for FRS but was attenuated for cIMT after correcting for confounders. HIV did not play a role in progression to any of these outcomes.ConclusionWomen with a history of HFDP have a higher risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.

Addressing Environmental- and Public Health Through Urban Water Profiling of Emerging Contaminants in a South African Urban Setting

Addressing Environmental- and Public Health Through Urban Water Profiling of Emerging Contaminants in a South African Urban Setting

Developmental Outcomes of Children From an Urban Middle-Income South African Setting

ABSTRACT Early childhood development research typically focusses on populations that are either of upper or lower socioeconomic status. A population especially overlooked is the ‘missing-middle’, represented by middle-income, urban populations. Knowledge of children’s development from middle-income populations to guide the implementation and customisation of early intervention policies, is needed. The Vineland-3 was used to describe the developmental outcomes of 55 young children, six to 24 months old, from an urban, middle-income setting in South Africa. The mHealth PEDS was used to identify caregivers’ developmental concerns. Caregivers’ concerns were positively associated with their children’s developmental outcomes (φ = 0.355; p = .024), emphasising their valuable contribution in early identification of developmental delays. Fifteen percent (n = 8) of participants’ children presented with developmental delays, with low birth weight identified as a significant risk (φ = 0.415; p = .011) and higher maternal education as a significant protective factor (φ = 0.365; p = .016). High gross motor proficiency appears to be a strength within this population, while receptive language and play skills require attention. Early childhood development should be prioritised across all socioeconomic classes to help ensure that children from the ‘missing-middle’ do not miss out on the opportunity to thrive.

Health beliefs around stroke in an urban South African setting: a qualitative study

Health beliefs around stroke in an urban South African setting: a qualitative study

Putting cultural difference in its place: Barriers to access to health services for parents of children with intellectual disability in an urban African setting.

Access to appropriate specialist level services for children with intellectual disability is challenging in Africa, with very few services available. Much literature on the utilisation of services by carers of children with intellectual disability in Africa emphasises the supposed incompatibility between indigenous and western beliefs, failing to identify more obvious, embodied barriers to access to care. As part of a study on children with intellectual disability in Cape Town, South Africa, we interviewed caregivers regarding the difficulties in accessing care, specifically the complex, expensive and time-consuming travelling routes from home to care. Caregivers discussed the embodied difficulties accessing care. Everyday struggles with transport, and crowded, dangerous and hostile environments were identified as barriers to care. These challenges are often overlooked in the literature, in favour of an emphasis on cultural difference. This dualistic view of the world may obscure more obvious reasons why people find it difficult to use services, even when they are available.

Predictors of impaired pulmonary function in people living with HIV in an urban African setting.

BackgroundStudies have associated HIV with an increased risk of obstructive lung disease (OLD).ObjectivesWe aimed to identify the predictive factors for impaired lung function in an urban, African, HIV-positive population.MethodA cross-sectional study was performed in Johannesburg, South Africa, from July 2016 to November 2017. A questionnaire was administered and pre- and post-bronchodilator spirometry conducted. The predictors investigated included age, sex, antiretroviral treatment (ART) duration, body mass index, history of tuberculosis (TB) or pneumonia, occupational exposure, environmental exposure, smoking and symptoms of OLD (cough, wheeze, mucus and dyspnoea). Impaired lung function was defined as a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of < 0.70, or below the 20th percentile of normal.ResultsThe 98 ART-naïve participants (mean age = 34.0, standard deviation [s.d.] = 8.2), 85 participants on first-line ART (mean age = 36.9, s.d. = 6.6) and 189 participants on second-line ART (mean age = 43.5, s.d. = 7.9) were predominantly female (65.6%). Of the participants, 64 (17.2%) had impaired lung function and 308 had normal lung function. Linear regression identified age (β = –0.003, P < 0.01), male sex (β = –0.016, P = 0.03) and history of TB or pneumonia (β = –0.024, P < 0.01) as independent predictors of a lower FEV1/FVC ratio. Following logistic regression, only a history of TB or pneumonia (odds ratio = 2.58, 95% confidence interval = 1.47–4.52) was significantly related to impaired lung function (area under the receiver operating characteristic curve = 0.64).ConclusionOur data show that a history of TB or pneumonia predicts impaired lung function. In order to improve timely access to spirometry, clinicians should be alert to the possibility of impaired lung function in people with a history of TB or pneumonia.

Cardiometabolic Outcomes of Women Exposed to Hyperglycaemia First Detected in Pregnancy at 3–6 Years Post-Partum in an Urban South African Setting

Objective: Comparison of cardiometabolic outcomes in women exposed to hyperglycaemia first detected in pregnancy (HFDP) and a control group 3–6 years post-partum in urban South Africa. Design and Methods: A comparative study was performed of 103 women exposed to HFDP and 101 not exposed to HFDP 3–6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data were obtained from medical records. Post-partum, participants were re-evaluated for biochemical analysis (two-hour 75gm OGTT, fasting insulin, lipids creatinine and glucose levels). Cardiovascular risk was assessed by estimation of the Framingham risk score (FRS). Carotid intima media thickness (CIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to these cardiometabolic outcomes were assessed using multivariable logistic and linear regression models. Results: 46 (45.1%) HFDP-exposed women progressed to diabetes compared to 5 (5.0%) women in the control group (p<0.001); only 20 (43.4%) of the HFDP group were aware of their diabetic status. Adjusted odds ratio (aOR, 95% confidence interval (CI)) of progressing to type 2 diabetes was 11.0 (3.3–36.2). Both 10-year estimated cardiovascular risk (FRS) and mean CIMT were statistically higher in the HFDP-exposed group (8.46 IQR 4.9–14.4; 0.48 mm IQR 0.44-0,53, respectively) compared to the control group (3.48 IQR 2.1–5.7; 0.46mm IQR 0.42–0.50 respectively) though mostly driven by age, systolic blood pressure and diabetes. Conclusion: African women with a history of HFDP have an increased risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.

Metabolic syndrome at 6 weeks after delivery in a cohort of pre-eclamptic and normotensive women.

The association between pre-eclampsia and the subsequent development of metabolic syndrome has not been well documented in low- and middle-income countries. To compare the prevalence of metabolic syndrome at 6 weeks after delivery among women with pregnancies complicated by pre-eclampsia with that in a normotensive, low-risk control group in an urban South African (SA) setting. This was a prospective cohort study at two tertiary-level hospitals and one district-level hospital in Pretoria, SA. Women were recruited after delivery and were followed up 6 weeks later to confirm or exclude the diagnosis of metabolic syndrome. Metabolic syndrome was diagnosed in 48/150 women with pregnancies complicated by pre-eclampsia (32.0%), compared with 33/150 (22.0%) of the control group (p=0.05). Women who developed pre-eclampsia during pregnancy had an increased chance of metabolic syndrome being diagnosed 6 weeks after delivery. Guidelines should be developed to identify women with cardiometabolic risk, so that interventions may be implemented to modify this risk before and after pregnancy.

Monitoring Groundwater Use as a Domestic Water Source by Urban Households: Analysis of Data from Lagos State, Nigeria and Sub-Saharan Africa with Implications for Policy and Practice

The fundamental importance of groundwater for urban drinking water supplies in sub-Saharan Africa is increasingly recognised. However, little is known about the trends in urban groundwater development by individual households and its role in securing safely-managed drinking water supplies. Anecdotal evidence indicates a thriving self-supply movement to exploit groundwater in some urban sub-Saharan African settings, but empirical evidence, or analysis of the benefits and drawbacks, remains sparse. Through a detailed analysis of official datasets for Lagos State, Nigeria we examine the crucial role played by groundwater and, specifically, by household self-supply for domestic water provision. We then set this in the context of Nigeria and of sub-Saharan Africa. One of the novelties of this multi-scalar approach is that it provides a granular understanding from large-scale datasets. Our analysis confirms the importance of non-piped water supplies in meeting current and future drinking water demand by households in parts of sub-Saharan Africa and the role played, through self-supply, by groundwater. Our results demonstrate inconsistencies between datasets, and we make recommendations for the future. We argue that a key actor in the provision of drinking water supplies, the individual household, is largely overlooked by officially reported data, with implications for both policy and practice.

Obesity and adiposity of 3- to 6-year-old children born to mothers with hyperglycaemia first detected in pregnancy in an urban South African setting

Background Understanding the association between maternal metabolic conditions in pregnancy and the risk of childhood overweight, a growing concern in sub-Saharan Africa (SSA), helps to identify opportunities for childhood obesity prevention. Aim To assess the association between hyperglycaemia first detected in pregnancy (HFDP) (gestational diabetes mellitus [GDM] and diabetes in pregnancy [DIP]) and child obesity and adiposity in pre-school-aged children in South Africa, independently of maternal BMI. Subjects and methods Measurement of anthropometry and fat mass index (FMI) by the deuterium dilution method was done for 102 3–6-year-old children born to mothers with HFDP and 102 HFDP-unexposed children. Hierarchical regression analysis and generalised structural equation modelling (GSEM) were performed. Results The prevalence of overweight/obesity was 10.5% and 11.1% in children exposed to GDM and DIP, respectively, and 3.9% in the HFDP-unexposed group. Log-transformed FMI was significantly higher in the DIP-exposed group (β = 0.166, 95% CI = 0.014–0.217 p= .026), but not when adjusting for maternal pregnancy BMI (β = 0.226, 95% CI = 0.003–0.015, p = .004). GSEM showed significant total effects of maternal BMI and birth weight on FMI/BMI. Conclusions Maternal pregnancy BMI seems to play a greater role in the development of childhood adiposity than maternal hyperglycaemia, requiring further research and identifying maternal BMI as a relevant prevention target in our setting.

The Effect of Physical Activity Level and Body Adiposity on Fatty Infiltration of the Lumbar Multifidus in Apparently Healthy Individuals From an Urban African Setting

Background: Spine stability or core stability exercises are among the most recommended interventions in low back pain management. It is important to clarify whether physical activity and body adiposity affect lumbar muscle multifidus (LMM) among apparently healthy adults. Objectives: The current study aimed at investigating the effect of physical activity level (PAL) and body adiposity on fatty infiltration of LMM in apparently healthy individuals from an urban African setting. Methods: Fatty infiltration of LMM was visually graded as normal, slight, and severe using diagnostic ultrasound. Validated Hausa and English versions of IPAQ were employed to analyze PAL, and the bioelectrical impedance analysis machine was used to measure some of the body adiposity parameters and weight. Results: A slight fatty infiltration of LMM was observed in 40.3% of 196 participants. Slight fatty infiltration of LMM had a higher prevalence in female subjects (39.2%) than males (34.2%). Only two variables of age (P = 0.032; r = 0.153) and visceral fat (P = 0.0001; r = 0.308) had a relationship with fatty infiltration of LMM. Conclusions: Fatty infiltration of LMM was positively associated with visceral fat and weakly with age among the participants. However, fatty infiltration of LMM had no relationship with the PAL.