WHO STEPS Research Articles

Prevalence and factors associated with stroke risk factors in an urban community of Parakou, Northern Benin, 2016.

Sub-Saharan Africa faces a heavy burden of stroke due to the growth of its risk factors. We aimed to estimate the prevalence of stroke risk factors and identify the factors associated with metabolic risk factors in the district of Titirou, in Parakou (northern Benin) in 2016. A cross-sectional study was conducted. It included people aged at least 15 years, living in Titirou for at least 6 months, and who had given their written consent to participate in the study. A door-to-door survey was performed from 15 march to 15 July 2016 in each neighborhood until the pre-determined number was reached. Sociodemographic data, medical histories, anthropometric and blood pressure measures were recorded using the WHO STEPS approach. The prevalence of stroke risk factors was calculated, and a multivariable logistic regression was done to identify the factors associated with metabolic risk factors for stroke. A total of 4671 participants were included with a mean age of 27.7±12.9 years and a sex ratio of 0.98. Concerning the behavioral risk factors for stroke, 17.2% were alcohol consumers, 3.5% were smokers, 21.5% had low fruit and vegetable intake, and 51.1% had low physical activity practice. The prevalence of metabolic risk factors for stroke was respectively of 8.7% for obesity, 7.1% for high blood pressure, 1.7% for self-reported diabetes, and 2.2% for dyslipidemia. Age (p<0.001), sex (p<0.001), marital status (p<0.001) and professional occupation (p = 0.010) were associated with obesity. Age was also associated with high blood pressure (p<0.001) and diabetes (p<0.001). Dyslipidemia varied according to smoking (p = 0.033) and low physical activity practice (p = 0.003). The study revealed a significant prevalence of some stroke risk factors. Targeted local interventions for primary prevention of stroke should be promoted in this community.

Risk Factors Distribution for Cardiovascular Diseases among High School Students

Background and Aim: Cardiovascular diseases (CVDs) are the chronic non-communicable diseases and leading cause of mortality due to various risk factors such as diabetes, tobacco usage, hypertension, obesity, dyslipidemia, and physical inactivity. The incidence of CVDS is rising rapidly due to these risk factors. These risk factors track at different ages starting from childhood to adulthood and their distribution varies with gender. Therefore, the prevalence of these risk factors among high school students need to be determined. The present study aimed to assess the different risk factor’s distribution for cardiovascular diseases. Methodology: This cross-sectional study was carried out among 940 high school students (aged 12-18 years) of Nowshera Pakistan from September, 2020 to December, 2021. Random sampling technique and WHO steps methodology was used for the assessment of various risk factors. All the randomly selected participants were recruited conventionally. Descriptive statistics was used to measure the risk factors distribution among high school students. SPSS version 24 was used for data analysis. Results: The overall mean age of the students was 15.8±1.4 years whereas age varied from 12 years to 18 years. Of the total 940 students, about 59% (n=555) were boys and 41% (n=385) were girls. The prevalence of tobacco, overweight, and hypertension among boys were 33.2%, 12.1%, 7.2%, and 17.6% (P&lt; 0.001) respectively. However, their prevalence among girls were 7.1%, 1.4%, 12.2%, and 23.8% (P&lt;0.001) respectively. The hypercholesterolemia was found higher among boys whereas girls had more prevalent high triglycerides levels compared to boys. Conclusion: The present study found a higher incidence of risk factors for cardiovascular diseases among high school students. These risk factors need to be reduced to control cardiovascular diseases among the young population. Also, this study found a poor profile of various risk factors for cardiovascular disease that require future nation-wide investigation to clarify the precise findings. Keywords: Cardiovascular disease, Risk factors, Hypertension

Effect of age and sex on the associations between potential modifiable risk factors and both type 2 diabetes and impaired fasting glycaemia among West African adults

BackgroundType 2 diabetes mellitus (T2DM) is becoming one of the leading causes of morbidity and mortality worldwide, including among Africans. Knowledge of the association between traditional risk factors and both diabetes and pre-diabetes, and whether these differ by age and sex, is important for designing targeted interventions. However, little is known about these associations for African populations.MethodsThe study used data from WHO STEPS surveys, comprising 15,520 participants (6,774 men and 8,746 women) aged 25–64 years, from 5 different West African countries, namely Burkina Faso (4,711), Benin (3,816), Mali (1,772), Liberia (2,594), and Ghana (2,662). T-test and chi-square tests were used to compare differences in the prevalence of traditional risk factors for both sexes. Multinomial logistic regression was conducted to ascertain the relative risks (RR) and 95% confidence intervals (CI) for both T2DM and impaired fasting glucose (IFG) relating to each risk factor, including obesity [defined by BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)], high blood pressure (HBP), fruit and vegetable consumption, physical inactivity, alcohol consumption, and smoking. Models for each of these traditional risk factors and interactions with age and sex were fitted.ResultsFactors associated with T2DM and IFG were age, obesity [defined by BMI, WC, WHtR, and WHR], HBP, smoking, physical inactivity, and fruit and vegetable consumption (p < 0.05). Analysis of interaction effects showed few significant differences in associations between risk factors and T2DM according to age or sex. Significant interaction with age was observed for HBP*age and T2DM [RR; 1.20, 95% CI: (1.01, 1.42)) (p = 0.04)], WHtR*age and T2DM [RR; 1.23, 95% CI: (1.06, 1.44) (p = 0.007)] and WHR*age and IFG [RR: 0.79, 95% CI: (0.67, 0.94) (p = 0.006)]. Some interactions with age and sex were observed for the association of alcohol consumption and both IFG and T2DM, but no clear patterns were observed.ConclusionThe study found that with very few exceptions, associations between traditional risk factors examined and both IFG and T2DM did not vary by age or sex among the West African population. Policies and public health intervention strategies for the prevention of T2DM and IFG should target adults of any age or sex in West Africa.

How alcohol and/or tobacco use and raised glycemia are associated with oral hygiene practices among Burkinabè adults: Evidence from the first national non-communicable disease risk factors survey

Socio-demographic correlates with oral hygiene practices are commonly investigated. The present study aimed to determine whether alcohol and/or tobacco use and hyperglycemia were associated with oral hygiene practices among Burkinabè adults. This descriptive, cross-sectional study included 4550 adults selected through multistage cluster sampling performed during the first WHO STEPS survey conducted in 2013 in Burkina Faso. The practices we considered were the frequencies of tooth cleaning, the fluoridated toothpaste use and the dentist visit within the past-six months. We collected data on self-reported alcohol and tobacco use and measured fasting blood glucose (FBG). About 82.8% of respondent reported they cleaned their teeth at least once a day, 31.5% cleaned them at least twice a day, 25.4% used fluoridated toothpaste, 2.2% had visited a dentist in the past six months, 38.8% used either alcohol or tobacco and 8.4% had raised FBG. After adjusting for socio-demographic factors, alcohol and/or tobacco use was an unfavorable factor for tooth cleaning at least once a day [aOR = 0.7 (0.6–0.8) p < 0.001], or at least twice a day [aOR = 0.6 (0.5–0.7) p < 0.001]. Moreover, raised FBG was negatively associated with cleaning tooth at least twice a day [aOR = 0.7 (0.5–0.9) p < 0.01] or the use of fluoridated toothpaste [aOR = 0.7 (0.6–0.9) p < 0.05]. Oral health education in addition to cardiovascular risk factor reduction should be efficiently integrated in the behavioral lifestyle interventions’ strategies for the non-communicable diseases’ prevention.

Noncommunicable diseases risk factors and the risk of COVID-19 among university employees in Indonesia.

IntroductionNoncommunicable diseases (NCDs) are still a major public health problem in Indonesia. Studies have shown that risk factors of NCDs are associated with coronavirus disease 2019 (COVID-19) severity and mortality. However, it is unclear whether NCD risk factors are also risks for new COVID-19 cases. This study aimed to obtain an NCD risk profile among university employees and its associations with contracting COVID-19.MethodsA cross-sectional study was conducted in October 2021. Participants were administrative employees of Universitas Indonesia (UI), Depok City, West Java. Assessment of NCD risk factors was based on the World Health Organization STEPwise approach to NCD risk factor surveillance (WHO STEPS). Demographic, working, and medical-history data were obtained electronically by using a Google Form. Physical and laboratory examinations were done in the Integrated Post for NCDs. Risks were expressed as adjusted odds ratio (ORadj) and 95% confidence interval (CI) in multivariate analyses.ResultsA total of 613 employees were enrolled. Men were predominant (54.8%), and about 36% of them work in shift as security personnel. About 66.7% were overweight or obese and 77.8% had hypertension. There were 138 (22.8%) employees who had COVID-19. Nearly all (95.6%) had been fully vaccinated against COVID-19. At-risk waist circumference (ORadj 1.72, 95% CI 1.15–2.56, p = 0.008) and total cholesterol level of 200–239 mg/dL (ORadj 2.30, 95% CI 1.19–4.44, p = 0.013) were independent risk factors, but shift work (ORadj 0.52, 95% CI 0.34–0.80, p = 0.003) was protective against COVID-19.ConclusionThe prevalence of NCD risk factors among university administrative employees was high, increasing the risk of contracting COVID-19. A behavioral intervention program to manage NCD risk factors at the university level is urgently needed according to the Health Promoting University framework.

A Cross Sectional Assessment of the Profile of Risk Factors of Non-Communicable Diseases Among Health Care Staff of a Tertiary Cancer Hospital.

BackgroundNon-communicable disease (NCD) is the leading cause of death, accounting for 70% of total death globally, and posing a major public health challenge. In India, nearly 5.8 million people (WHO report, 2015) die from NCDs every year. The basic element of NCD prevention is the identification of the associated risk factors and risk modification. The objective of the current study was conducted to assess the prevalence of risk factors for NCDs among healthcare staff of the two units of a Tertiary Cancer Hospital in Varanasi, India, using WHO STEPS approach.MethodsThis cross sectional study was conducted among 528 participants who were willing to participate in the study, from among 967 healthcare staffs of the two units of the Tertiary Cancer Hospital. The participants were interviewed and the anthropometric and biochemical parameters were measured.ResultsThe prevalence of risk factors, associated with NCD, tobacco use, alcohol use, extra salt in diet, less than 5 servings of fruits/vegetables, physical inactivity and self-perceived high stress score was found in 34 (6.43%), 90 (17.04%), 461 (87.3%), 412 (78.03%), 409 (77.4%) and 159 (30.11%) respondents, respectively. Multiple logistic regression revealed that Diabetes was significantly associated with male sex, high BMI and physical inactivity. Hypertension was found significantly associated with male sex, increasing age, tobacco and or alcohol consumption, high BMI and high stress. Dyslipidemia was also found significantly associated with high BMI, male sex, physical inactivity and high stress levels.ConclusionA high prevalence of risk factors for NCDs was found among the healthcare staff and it is the need of the hour to take preventive measures to reduce the prevailing burden of NCD.

Prevalence of Usage Nicotine and its Dependence among Patients with Depression

Background: Smoking is common and people with mental disorders are no exception. Few studies have looked at the pervasiveness of usage of tobacco and dependence of nicotine in depressed patients in undeveloped states such as Pakistan. Therefore, in this study, the aim was to determine the prevalence of tobacco use, addiction of nicotine and the inspiration to quit smoking in major depressive disorder affected patients. Study Design: A cross-sectional descriptive study. Place and Duration: In the Department of Psychiatry and Behavioral Sciences, LGH Lahore, Pakistan and Psychiatry Alfalah diagnostic centre, Azhar Medical Plaza Timergara for the duration of six months from August 2021 to January 2022. Methods: The study was held amongst patients with diagnosis of depression form the Department of Psychiatry (outpatient and inpatient). A semi-structured form was used to collect data using and for nicotine use; WHO STEPS tool was used. The Nicotine Dependence was assessed by Fagerstrom Test, Smokeless Tobacco by Modified Fagerstrom and Motivation Assessment were used: Willingness to Quit Ladder was pragmatic for users of nicotine. The data was analyzed and compiled using the SPSS version 20.0. Results: The study comprised 110 subjects (mean age: 36.2 ±9.80 years, 50 men and 60 women) diagnosed with Major Depressive Disorder (mean disease duration: 1.56 ± 2.21 years) were included. 60 of 110 patients (54.5%) used one type or numerous types of tobacco. The patients smoked only tobacco were (n = 38, 63.4%), smokeless tobacco was used by 14 subjects (23.3%) and 13.3% (n = 8) used smokeless and smoked tobacco both. The percentage of smokers of any type of tobacco is greater in men as compared to women (p = 0.029). Among who smokes (n = 38), about fifty percent were heavily addicted 24(63.2%), and 14 (36.8%) were moderately addicted. Almost all (92.8%) of the smoke-less category (n = 14) were highly addicted. Among the combined users, almost all (6/8 = 75%) were heavily addicted to nicotine. A comparatively insignificant proportion (23.3%) of users of nicotine were strongly agreed to stop using any tobacco type. Conclusions: The usage of nicotine prevalence and dependence was supposed to be greater in individuals with depression. In low-resource environments such as Pakistan, the practice of translated and standardized tools of screening can be effectively cast-off to assess the nicotine usage burden in standard practice clinically. Keywords: Nicotine, Depression, Tobacco and Nicotine dependence.

Prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019.

Hyperglycemia leads to serious damage to the body, especially the blood vessels and nerves. This study aimed to determine the prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019. This was a cross-sectional, descriptive and analytical study, nested in the Tanvè Health Study (TAHES) cohort. It covered all residents of the villages of Tanvè and Dékanmey, aged 25 years and above, and having given their written consent. Data were collected in the households during the fourth annual monitoring visit in 2019 using the WHO STEPS Wise approach. Hyperglycemia was defined as a fasting capillary blood glucose value ≥ 110 mg/dL. Data were analyzed with R Studio software version 3.5.1. A total of 1331 subjects were included in the study with a 60% female predominance and a sex ratio (male/female) of 0.7. The median age was 40 years (Q1 = 32 years; Q3 = 53 years) with a range of 25 and 98 years. The prevalence of hyperglycemia was 4.6%. In multivariate analysis, advanced age (AOR = 1.03; 95%CI = 1.02-1.73; p = 0.004), male sex (AOR = 2.93; 95%CI = 1.49-5.84; p = 0.023), monthly income> 105,000 FCFA (AOR = 2.63; 95%CI = 1.24-5.63; p = 0.030), abdominal obesity (AOR = 2.80; 95%CI = 1.29-6.16; p = 0.007, and obesity (AOR = 1.68; 95%CI = 0.75-3.59; p = 0.004) were statistically associated with hyperglycemia. The prevalence of hyperglycemia is not negligible in rural areas in Benin. Our study found that older age, male gender, high income, abdominal obesity, and obesity are determining factors in its occurrence.

Simplified hypertension screening methods across 60 countries: An observational study.

Simplified blood pressure (BP) screening approaches have been proposed. However, evidence is limited to a few countries and has not documented the cardiovascular risk amongst missed hypertension cases, limiting the uptake of these simplified approaches. We quantified the proportion of missed, over-diagnosed, and consistently identified hypertension cases and the 10-year cardiovascular risk in these groups. We used 60 WHO STEPS surveys (cross-sectional and nationally representative; n = 145,174) conducted in 60 countries in 6 world regions between 2004 and 2019. Nine simplified approaches were compared against the standard (average of the last 2 of 3 BP measurements). The 10-year cardiovascular risk was computed with the 2019 World Health Organization Cardiovascular Risk Charts. We used t tests to compare the cardiovascular risk between the missed and over-diagnosed cases and the consistent hypertension cases. We used Poisson multilevel regressions to identify risk factors for missed cases (adjusted for age, sex, body mass index, and 10-year cardiovascular risk). Across all countries, compared to the standard approach, the simplified approach that missed the fewest cases was using the second BP reading if the first BP reading was 130-145/80-95 mm Hg (5.62%); using only the second BP reading missed 5.82%. The simplified approach with the smallest over-diagnosis proportion was using the second BP reading if the first BP measurement was ≥140/90 mm Hg (3.03%). In many countries, cardiovascular risk was not significantly different between the missed and consistent hypertension groups, yet the mean was slightly lower amongst missed cases. Cardiovascular risk was positively associated with missed hypertension depending on the simplified approach. The main limitation of the work is the cross-sectional design. Simplified BP screening approaches seem to have low misdiagnosis rates, and cardiovascular risk could be lower amongst missed cases than amongst consistent hypertension cases. Simplified BP screening approaches could be included in large screening programmes and busy clinics.

Study of Risk Factors for Noncommunicable Diseases Among Urban Slum Population of Western Maharashtra Using WHO STEPS Approach

Background: Noncommunicable diseases NCDs are considered to be the leading cause of death worldwide. These are the cause for almost 85% of premature deaths occurring in low- and middle-income countries. Materials and Methods: Community-based cross-sectional study was conducted among 125 randomly selected people ≥18 years in the urban slum area which is the field practice area of the Department of Community Medicine, KIMS, Karad, Maharashtra, India. The World Health Organization developed STEPwise approach for the surveillance of NCDs and its risk factors were used. STEP 1 (behavioral risk factors), STEP 2 (physical measurements), and STEP 3 (biochemical measurements) were included in our study. Data were analyzed using SPSS software. P &lt; 0.05 was considered to be statistically significant. Results: The prevalence of behavioral risk factors such as smoking was 11.2% among males, smokeless tobacco use was 29.6% among females, alcohol use was 16.8% among males, sedentary lifestyle was 16.8% among the age of 26–45 years, ≥5 fruit and vegetable servings/day was consumed by only 4%. Prevalence of hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia was 36%, 11.2%, 37.6%, and 31.2%, respectively. Conclusion: Various NCD risk factors assessed from our study showed high prevalence among urban slum population. Surveillance of risk factors and adequate awareness among urban slum population is essential to prevent spread of NCDs.

IDF21-0661 Addressing diabetes and hypertension through an innovative, community-based, and people centered model

Background: In Vietnam, noncommunicable diseases (NCDs) account for 77% of all deaths. Diabetes and hypertension (HTN) are leading contributors to the country’s NCD burden and many people remain undiagnosed. The 2015 WHO STEPS survey indicated that 18.9% of those surveyed had hypertension, but only 43.1% detected at screening were aware of their status. Of these, just 13.6% reported that their blood pressure (BP) was being managed at a health facility. The significant gaps in the treatment cascade are attributed to limited awareness, limited health care worker capacity at the primary health care (PHC) level, and lack of convenient access to screening, prevention, and adherence counselling. In 2016, PATH and the Novartis Foundation, collaborated with the Ho Chi Minh City Municipal Health Department and the General Department of Preventive Medicine (GDPM) to launch the Communities for Healthy Hearts program in Ho Chi Minh City. In 2019, with funding from Access Accelerated, the program expanded to three provinces and included diabetes screening and linkage to care. Aim: The project’s overarching goal is to improve diabetes and hypertension awareness, screening, diagnosis, treatment, and case management amongst adults over 40. Method: The project’s methodology is centered around increasing (1) diabetes and hypertension awareness and health seeking demand, (2) access to quality patient–centered services for diabetes and hypertension at the PHC level, and (3) retention in care. The model was designed in partnership with the Ministry of Health and local partners based on findings from a targeted audience assessment and informed by the global HEARTS technical package, the Expanded Chronic Care Model, and the Framework on Integrated People-Centered Health Services. Results: From 2016-2019 the program screened 121,273 people over 40. Of those screened, 24.7% were at risk for hypertension, 55% were diagnosed, 57% were treated, and 57% of those treated reached the target blood pressure. The number of people with hypertension listed at Commune Health Stations increased 20 times, from 800 people to 16,455 people. From October 2019 to March 2021, 93,425 adults over 40 were screened for diabetes and HTN. Of those screened, 32.7% had elevated blood pressure and/or were considered at risk for diabetes and were referred to health facilities. Of those referred, 51.3% were diagnosed with hypertension, and 0.6% with diabetes. Of those confirmed, 93.8% were treated. Of those treated, 80.5% achieved blood pressure control and 77.1% achieved blood glucose control, an improvement from past programs. Discussion: The program’s unique multi-pronged model that included public-sector health services as well as private partnerships, extension of services to convenient community locations, capacity building for health workers and community volunteers, and the use of digital technologies to raise awareness and ensure linkage to care, resulted in increased screening and retention rates as compared to national averages. The project found that early diagnosis, greater proportion of patients initiating treatment, and improved control were supported by system-level interventions. The combined interventions that made up the model were a first step in Vietnam towards a differentiated care approach for NCDs that is sustainable and scalable.

Relationship Between Physical Inactivity and Obesity in the Urban Slums of Lahore

IntroductionThere are several factors such as physical inactivity, sedentary lifestyle, and diet that can be responsible for weight gain or obesity. Regular physical activity is important for better physical and emotional well-being. The objective of the study is to observe the prevalence of obesity or over-weight and how lack of physical activity contributes to weight gain and other health issues.MethodsThis cross-sectional study was conducted in Shalamar Town, Lahore on 646 participants. Data was collected using the WHO STEPS instrument. The inclusion criteria were a minimum age of 30 years and residents of Shalimar Town, Lahore for more than five years. The exclusion criteria were participants with comorbid conditions like HIV, TB, and terminal stage of cancer. Test of association and binary logistic regression analysis was performed to observe a significant association between demographic variables and non-communicable diseases among the participants involved in performing physical exercise.ResultsAbout 22.1% of the participants had normal BMI, 5.3% were underweight whereas 34.2% of the participants were overweight and 32.4% obese. Male participants were found to be more physically active compared to females. Hypertension and diabetes were statistically significantly associated with physical activity. BMI and waist-hip ratio were found to be associated with moderate physical exercise.ConclusionMost of the participants were not involved in moderate physical activity. Overall, an alarming 66.6% of the participants were either overweight or obese. In general, males were found to participate more in intense physical activity.

Prevalence of and factors associated with hypertension, diabetes, stroke and heart attack multimorbidity in Botswana: Evidence from STEPS 2014 survey.

BackgroundBotswana, like other Sub-Saharan Africa (SSA) countries is currently undergoing demographic and epidemiological transitions which are shown by an increase in chronic non-communicable diseases (NCDs) and their associated risk factors. The aim of this study was to examine the prevalence of and factors associated with hypertension, diabetes and stroke/heart attack multimorbidity in Botswana. The definition of multimorbidity used in this study is the presence of two or more NCDs in an individual.MethodsThis study used secondary data derived from the Botswana WHO STEPS 2014 survey. The survey employed a nationally representative multi-stage sampling design. The study sample consisted of 3527 respondents aged 20–69 years of age who had successfully completed the questionnaire and met the inclusion criteria. Multivariable logistic regression analyses were used to assess factors associated with multimorbidity. All comparisons were considered to be statistically significant at 5% level. Statistical tests were performed using Statistical Package for Social Sciences (SPSS) version 25.ResultsPrevalence of hypertension, diabetes and stroke/heart attack multimorbidity was estimated to be at 3.5% in the sampled population. The odds of reporting multimorbidity were highest among females (AOR = 9.73, 95% CI = 8.30–11.42) than males and among respondents aged 35–49 (AOR = 1.20, 95% C.I. = 1.10–1.31) and 50–69 years (AOR = 1.52, 95% C.I. = 1.23–1.67) than individuals aged 20–24 years. Moreover, the odds of multimorbidity were significantly higher among married (AOR = 15.92, 95% C.I. = 13.40–18.92) and living together (AOR = 6.68, 95% C.I. = 5.72–7.81) couples; and individuals who reported that they earn an average annual household income of BWP ≥20 000 (AOR = 2.25, 95% CI = 1.84–2.75) compared to their counterparts. Behavioural risk factors significantly associated with higher odds of multimorbidity were obesity (AOR = 6.79, 95% C.I. = 6.20–7.90), physical inactivity (AOR = 4.41, 95% C.I. = 3.65–5.31) and hazardous alcohol consumption (AOR = 1.49, 95% CI = 1.23–1.81). On the other hand the odds of reporting multimorbidity were significantly low among individuals with sufficient consumption of fruits and vegetables (AOR = 0.47, 95% C.I. = 0.39–0.56) and non-tobacco users (AOR = 0.58, 95% CI = 0.49–0.68).ConclusionMultimorbidity was more common among females, the elderly people and was associated with obesity, poor fruit and vegetable intake, and tobacco use. Strategies to combat NCDs and multimorbidity should be aimed to target early stages of life since behavioural factors and lifestyles that increase the likelihood of disease are entrenched in earlier stages of life.

Socio-demographic and lifestyle factors associated with hypertension in Nigeria: results from a country-wide survey.

With the rising prevalence of hypertension, especially in Africa, understanding the dynamics of socio-demographic and lifestyle factors is key in managing hypertension. To address existing gaps in evidence of these factors, this study was carried out. A cross-sectional survey using a modified WHO STEPS questionnaire was conducted among 3782 adult Nigerians selected from an urban and a rural community in one state in each of the six Nigerian regions. Among participants, 56.3% were women, 65.8% were married, 52.5% resided in rural areas, and 33.9% had tertiary education. Mean ages (SD) were 53.1 ± 13.6 years and 39.2 ± 15.0 years among hypertensive persons and their normotensive counterparts respectively. On lifestyle, 30.7% had low physical activity, 4.1% consumed tobacco currently, and 35.4% consumed alcohol currently. In comparison to unmarried status, being married (OR = 1.88, 95% CI: 1.41-2.50) or widowed (OR = 1.57, 95% CI: 1.05-2.36) was significantly associated with hypertension, compared with never married. Compared with no formal education, primary (OR = 1.44, 95% CI: 1.12-1.85), secondary (OR = 1.37, 95% CI: 1.04-1.81), and tertiary education (OR = 2.02, 95% CI: 1.57-2.60) were associated with hypertension. Low physical activity (OR = 1.23, 95% CI: 1.05-1.42), alcohol consumption, (OR = 1.18, 95% CI: 1.02-1.37), and unemployment status (OR = 1.42; 95% CI: 1.07-1.88) were also associated with hypertension. Our study indicates an association of socio-demographic and lifestyle factors with hypertension, hence, there is a need for counselling, health education and policy formulation and implementation targeting these factors to prevent and control hypertension.

Oral hygiene practices and their sociodemographic correlates among adults in Burkina Faso: results from the First National Survey

BackgroundSociodemographic parameters are the driving determinants of oral hygiene practices. This study aims to describe oral hygiene practices and associated sociodemographic factors in the Burkinabè population using the first nationally representative data.MethodsThis descriptive, cross-sectional study included 4677 adults through multistage cluster sampling performed during the first WHO STEPS survey conducted in 2013 in Burkina Faso. The practices we considered were the frequencies of tooth cleaning, fluoridated toothpaste use and dentist visits within the last six months. Sociodemographic variables and oral hygiene practices were described, and the first variables were used as the explanatory variables for the seconds in the multivariable analyses.ResultsIndividuals who cleaned teeth at least once a day represented 82.8% and at least twice a day represented 31.4%; 25.6% used fluoridated toothpaste and 2.1% visited a dentist. With the highest odds ratio, only being educated was a favourable factor for each oral hygiene practice. Living in an urban area or being a younger adult were favourable factors for cleaning teeth at least twice a day or the use of a fluoridated paste. Female gender applied more to regular tooth cleaning, as well as to dentist visits.ConclusionCleaning teeth at least once a day was common among Burkinabè, while cleaning at least twice a day, the use of fluoridated paste or dentist visits were infrequent. Education was the key favourable determinant for healthy oral hygiene practices, and improving oral health literacy interventions through basic health education should be promoted.

Prevalence, Awareness, Treatment, and Control of Hypertension and Diabetes: Results From Two State-Wide STEPS Survey in Punjab and Haryana, India.

BackgroundIndia which is home to more than one sixth of the world's population, accounts for more than two thirds of total deaths due to non-communicable diseases (NCD). Out of this, hypertension and diabetes are the most common NCDs. Awareness, treatment, and control of hypertension and diabetes remains a major challenge despite various national programs being run to curb the rising burden NCDs. In order to fill the knowledge gap, awareness, treatment, and control of diabetes and hypertension were studied by using data from the STEPS survey among the adult population in two major northern Indian states of Punjab and Haryana.MethodsTwo state-wide NCD risk factors surveys were conducted using WHO STEPS methodology among 5,127 individuals in Punjab and 5,078 individuals in Haryana aged 18–69 years in the year 2014–15 and 2016–18. Standardized questionnaire was used to determine the behavioral risk factors in step one followed by anthropometric measurements for physical risk factors in step two and in the third step serum and urine samples were collected for biochemical risk factors.ResultsThe prevalence of hypertension in Punjab was 40.1% while that in Haryana was 26.2%. In Punjab, only 48.3% of the hypertensive were aware of their condition, 30.9% were on treatment while only 18.3% of the cases were controlled. While in Haryana 33.4% of the respondents were aware of their condition, 26.3% are on treatment while only 12% of the cases were controlled. Similarly, the prevalence of diabetes was 14.3 and 15.1% in Punjab and Haryana, respectively. In Punjab 34.2% of diabetics were aware of their condition, 28.2% were on treatment while only 14.2% of the cases were controlled. The awareness and control rates in Haryana were similar to that in Punjab. 29.5% of the respondents were aware of their condition, 22.4% were on treatment while only 13.8% of the cases of diabetes were controlled. Family history of diabetes and hypertension was found to be associated with higher odds of being aware, on treatment and controlled blood glucose and blood pressure levels in both Punjab and Haryana.DiscussionHypertension and diabetes are a major public health problem in Punjab and Haryana and awareness, treatment and control rates are low which require specific interventions with a focus on access to treatment, regular follow up for better control. There is an urgent need to effectively implement the existing national NCD programmes in these states in India.

Cardiovascular health through a sex and gender lens in six South Asian countries: Findings from the WHO STEPS surveillance.

BackgroundSex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low- and middle-income countries. The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries.MethodsWe conducted a retrospective analysis of the World Health Organization’s “STEPwise approach to surveillance of risk factors for non-communicable disease” or “STEPS” from six South Asian countries, surveys conducted between 2014-2019. The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke). Multivariate linear and logistic regression models were performed. Multiple imputation with chained equations was performed.ResultsThe final analytic sample consisted of 33 106 participants (57.5% females). The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92]. Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08, P < 0.05) was significantly associated with better CVH compared to males. Being married (βmale = -0.30, 95% CI = -0.37, -0.23 vs βfemale = -0.23, 95% CI = -0.29, -0.17; P < 0.001) and having a household size ≥5 (βmale = -0.15, 95% CI = -0.24, -0.06 vs βfemale = -0.11, 95% CI = -0.16, -0.04; P < 0.01) were associated with poorer CVH, more so in males. Being married was also associated with high risk of CVD (ORmale = 2.54, 95% CI = 1.68-3.86, P < 0.001 vs ORfemale = 1.19, 95% CI = 0.84-1.68, P = 0.31), significant in males.ConclusionsAmong the South Asian population, being female may be advantageous in having an ideal CVH. However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.

Demographic characteristics associated with awareness of cigarette health warnings and thinking about quitting among current adult cigarette smokers in Zambia, 2017.

INTRODUCTIONNoticing health warnings on cigarette packages has been associated with thinking about quitting. This study examined sociodemographic characteristics associated with awareness of health warnings on cigarette packages and thinking about quitting because of health warning labels among adults who currently smoked tobacco.METHODSWe analyzed data from the 2017 Zambia WHO STEPS survey (STEPwise approach to surveillance) for noncommunicable disease risk factors. Descriptive analyses and logistic regression were performed to assess the association of select sociodemographic characteristics with awareness of health warnings and thinking about quitting because of health warnings.RESULTSAdults who currently smoked tobacco who were aged 30–44 years, of Chewa ethnicity, or with a formal education, were more likely to be aware of health warnings than those aged 18–29 years (adjusted prevalence ratio, APR=1.26; 95% CI: 1.02–1.54), of Bemba ethnicity (APR=1.43; 95% CI: 1.17–1.74), or with no formal education (APR: 2.61–5.95). Among all adults who currently smoked, those of Chewa ethnicity (APR=1.55; 95% CI: 1.03–2.35), or with a formal education (APR:1.80–4.38), were more likely to report thinking about quitting because of health warnings than those who were of Bemba ethnicity or with less than primary school education level. Women who currently smoked were 49% less likely (APR=0.51; 95% CI: 0.23–0.84) to report thinking about quitting than men. Among a subset of adults who currently smoked who were aware of health warning labels, no sociodemographic characteristics were significantly associated with thinking about quitting in unadjusted or adjusted models.CONCLUSIONSSociodemographic characteristics such as sex, ethnicity, and education level were significantly associated with awareness of cigarette health warnings. Among cigarette smokers aware of health warnings, no sociodemographic differences in thinking about quitting were found. Tobacco control campaigns may need to target people of ethnicities with the highest smoking prevalence in the country.

Investigating the Association between Unhealthy Dietary Habits and Obesity among Libyan Adults.

Background: Although an increasing number of studies have reported on nutrition transition and unhealthy eating habits (UEHs) worldwide, there is a paucity of studies on UEHs in the Arab region, particularly in Libya. Aim: This study investigated the associations between obesity among Libyan adults and UEHs. Methods: A cross-sectional survey was conducted at the five major districts in Benghazi, Libya. A multistage cluster sampling strategy was implemented to choose and recruit Libyan adults. Anthropometric measurements were gathered by highly qualified nurses, using the Segmental Body Composition Monitor and a portable Stadiometer. The study used and adapted the two Self-administered questionnaires: the WHO STEPS Instrument and eating behaviors linked with obesity questionnaire. Results: Among a total of 401 participants who were successfully recruited in this study, 253 (63%) were female (aged 20–65 years), the response rate achieved was 78%. The prevalence of obesity amongst Libyan adults was estimated to be 42.4%. The results revealed the presence of a significant association between obesity (BMI ≥ 30 kg/m2) and five UEHs for Libyan men and six UEHs for Libyan women. For Libyan men, an association was found between obesity and the following five explanatory factors: fast food intake in a day and a week, which were (OR: 2.52, 95% CI: 4.04–12.32) and (OR: 4.65, 95% CI: 1.04–9.46), respectively; large food portion sizes consumed at one sitting (OR: 19.54, 95% CI: 1.41–27.74); a high frequency of skipping breakfast either in a typical day or a week, which were (OR: 0.02, 95% CI: 0.01–0.77) and (OR: 0.03, 95% CI: 0.01–0.24), respectively. For Libyan women, a significant association was found between obesity and the following six explanatory factors: fast food intake in a day and a week, which were (OR: 2.14, 95% CI: 3.32–11.12) and (OR: 5.5, 95% CI: 1.88–16.11), respectively; intake of sugar-sweetened beverages in a typical week (OR: 4.02, 95% CI: 1.35–11.99); and large food portion sizes consumed at one sitting at one sitting (OR: 3.40, 95% CI: 1.18–9.84); and a high frequency of skipping breakfast either in a typical day or a week, which were (OR: 0.11, 95% CI: 0.03–0.43) and (OR: 0.12, 95% CI: 0.08–0.63), respectively. Conclusions: The findings of the study reveal areas of action for Libyan researchers, clinicians, policymakers, and government officials about UEHs in the Libyan context. This could inform establishing and developing new interventions for preventing and controlling the obesity epidemic through food system improvements.

Single-center, retrospective study on changes in pain-relieving therapy after bone metastasis detection by bone scintigraphy in prostate cancer patients

Whole-body bone scintigraphy (WB-BS) is used for detecting and monitoring metastatic spread of prostate cancer (PCa) and to investigate bone pain episodes. To investigate the impact of a positive WB-BS on pain-relieving medicine prescription in PCa patients, a single-center, retrospective cohort study with PCa patients classified as positive for bone metastases (BM) by WB-BS was conducted. Demographic, clinical, and ambulatory pain-relieving medicine prescription data were evaluated. Pain-relieving medicines were categorized according to the WHO ‘Analgesic Ladder’. Regimens adopted before and after WB-BS were compared. Differences were considered significant at p<0.05. A total of 180 PCa patients were diagnosed with BM, 64.4% of whom were ≥65 years of age. Thirty-three patients were prescribed analgesics only after WB-BS, mostly including NSAIDs and weak opioids. Pain-relieving prescription changed after WB-BS in patients with prescriptions before and after WB-BS, with a reduction in NSAIDs and adjuvants and an increase in weak and strong opioids. In addition, 40% of patients with WHO analgesic step 1 drugs and 21.7% of patients with WHO step 2 drugs before WB-BS changed to other WHO steps after WB-BS. Pain-relieving prescriptions changed after a positive WB-BS, providing evidence that it could contribute to clinical management of painful metastatic PCa patients.