World Health Organization STEPwise Approach Research Articles

Association of risk factors for high blood pressure across 46 low- and middle-income countries: A multi-country cross-sectional analysis.

Despite acknowledging the influence of various lifestyle and metabolic risk factors on hypertension, it remains uncertain to identify the primary contributors and differentiate which modifiable risk factors mediate the causal effects of hypertension. We aimed to examine the hierarchical association of eight prominent lifestyle and metabolic risk factors, along with demographic variables, with hypertension in adults and to explore the mediating effects of modifiable metabolic risk factors on hypertension. A cross-sectional study was conducted in 46 low- and middle-income countries using the World Health Organization (WHO) STEPwise approach to noncommunicable disease risk factor surveillance from 2002 to 2020. In a sample of 179 535 non-pregnant adults, we assessed the weighted population-attributable risk percentages (PAR%) for hypertension associated with eight risk factors. Additionally, we investigated the mediating role of metabolic risk factors on the effects of lifestyle risk factors on hypertension. After adjusting for the sample weight in each country, 26.7% of participants had hypertension. The prevalence of hypertension was highest in those aged ≥65 years, with obesity-associated hypertension (45.7%) exceeding the rates for overweight (32.2%) and non-overweight individuals (18.2%). These eight risk factors collectively explain 83.7% of the PAR% associated with hypertension adjusted for the communal variance. Among the modifiable factors, obesity contributed to a weighted PAR% of 38.2%, while sedentary behaviour and low physical activity combined accounted for a weighted PAR% of 3.1%. Overweight/obesity played a predominant mediating role in the correlation between lifestyle risk factors and systolic and diastolic blood pressure, with the indirect effect accounting for approximately 25-64% and 13-80% of the total effect, respectively. These findings offer new insights into the modified risk factors associated with hypertension in adults in low- and middle-income countries, highlighting the crucial role of maintaining a normal body weight for the effective prevention and management of hypertension.

Selected Non-communicable Disease Risk Factors and Mental Health of South African Durban-based Refugees: A Cross-sectional Study

Background Non-communicable diseases (NCDs) are the leading contributor to mortality and morbidity worldwide, with refugees considered more susceptible to NCDs. Refugees often encounter difficulties in accessing healthcare, resulting in delayed diagnostic assessment and treatment of mental disorders and NCDs, leading to the deterioration of the condition. The study aimed to ascertain the prevalence of risk factors for NCDs and mental health among South African Durban-based refugees. Methods This cross-sectional study was conducted among 121 randomly selected South African Durban-based refugees. Data on the metabolic risk factors for NCDs were collected using a modified version of the World Health Organisation (WHO) STEPwise approach to (NCDs) surveillance (STEPS) instrument. Participants' mental health disorders were determined with a Global Mental Health Assessment Tool-Primary Care Version questionnaire. Results A significant 38.80% of participants had normal BMI [x2 (5, n=47) = 82.55, p<.001], 24.0% were overweight [x2 (5, n=29) = 82.55, p<.001], 25.6% were obese class l [x2 (5, n=31) = 82.55, p<.001]. A significant 77.1% [x2 (2, n=64) = 76.79, p<.001] of the participants had desirable cholesterol levels, and 62.3% [x2 (2, n=71) = 44.57, p<.001] had normal fasting glucose levels. A significant 26.1% [x2 (4, n=31) = 64.82, p<.001] and 46.2% [x2 (4, n=55) = 64.82, p<.001] were classified as having hypertension stage I and II, respectively. A non-significant 32.2% and 25.0% experienced depression and anxiety. Conclusions The prevalence of hypertension and high BMI levels combined with mental disorders underscores the importance of healthcare service delivery to this vulnerable population in SA.

Behavioural risk factors for non-communicable diseases among South African Durban-based refugees: a cross-sectional study.

Behavioural risk factors for non-communicable diseases (NCDs) are rising among refugees, increasing chronic disease prevalence that causes morbidity and mortality. This study aimed to ascertain the prevalence, awareness and management of behavioural risk factors for NCDs among South African Durban-based refugees. A once-off quantitative, cross-sectional design was conducted on the behavioural risk factors for NCDs among 122 randomly selected Durban-based refugees using a modified version of the World Health Organisation (WHO) STEPwise approach to NCDs surveillance (STEPS) instrument. Participants' awareness and management of risk factors for NCDs were determined with a behavioural NCD awareness and management of behavioural NCD risk factor questionnaire. Smoking and alcohol prevalence were 4.1% and 20.7%, respectively, with 40.8% consuming fewer than five servings of fruit and/or vegetables daily. Participants performed more than 150 min of moderate physical activity per week. A significant 30.8% (p < 0.001) was aware that consuming alcohol poses an extremely large risk, similarly for smoking (38.7%; p < 0.001]. A significant 56.2% (p < 0.001) believe that regularly eating raw vegetables presents no risk, likewise for being physically active (51.7%; p < 0.001). A significant 40.6% (p < 0.001) of the participants always drink water or non-alcoholic drinks to manage their alcohol consumption, 54.2% (p < 0.001) manage their unhealthy diet by sometimes filling half their plates with fruits and vegetables, and 49.2% manage their physical activity levels by sometimes choosing a range of physical activities (p < 0.001). Refugees' lack of awareness of behavioural risk factors for NCDs highlights the importance for health service providers to present health promotion programs to make refugees aware of their behavioural NCD's risk factors and how it impacts their health.

Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda.

Hypertension is a major contributor to morbidity and mortality worldwide. Many people however are not aware of their possession of risk factors for hypertension. There is a paucity of literature in Uganda describing the risk profile of faculty at public universities. The purpose of this study was to determine the prevalence of hypertension risk factors among university teaching staff. This study was conducted among faculty at Makerere University in Uganda. The modified World Health Organization STEP-wise approach for non-communicable disease surveillance was used in data collection. Hypertension was defined as having a systolic blood pressure of ≥140mmHg and/or a diastolic blood pressure of ≥90mmHg, or being on antihypertensive medications. Participants were enrolled from the faculty lists by proportionate to size systematic sampling until the sample size for each college was obtained. Data was collected from January to March 2018. Multivariate logistic regression was used to determine factors associated with hypertension. A total of 141 participants were recruited into the study. The prevalent risk factors for hypertension include physical inactivity (78.7%), overweight (46.8%), obesity (20.6%), addition of extra salt to food (46.8%), current alcohol consumption (33.3%), history of smoking (10.6%), inadequate fruit and vegetable servings per day (100%), family history of hypertension (40.4%) and a family history of diabetes (22.7%). Hypertension was prevalent at 26.2% (95% CI 18.94-33.46%). The risk factors significantly associated with hypertension included a family history of hypertension (p=0.009), obesity (p=0.008) and male gender (p = 0.029). The prevalence of known hypertension risk factors among university teaching staff in urban Uganda is high. Majority of these risk factors are modifiable highlighting the need for continuous screening as well as introduction of prevention and health promotion strategies to reduce the risk burden.

Tobacco consumption in Mozambique in 2005 and 2015.

The burden related to smoking exposure is growing in many low-income settings. We aimed to quantify the use of smoked and smokeless tobacco in Mozambique in 2014/2015, and to compare the estimates with those obtained in 2005. A cross sectional study was conducted in 2014/2015 on a representative sample of the Mozambican population aged 15 to 64 years, following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95% confidence intervals were computed for different categories of tobacco consumption. The age-standardised prevalence in the age-group 25-64 years was compared with results from a STEPS survey conducted in 2005. Between 2005 and 2014/2015, the prevalence of daily smoking decreased from 9.1% to 3.4% (p < 0.05) in women and from 33.6% to 27.3% (p < 0.05) in men. There was a significant decrease in the daily consumption of hand-rolled cigarettes among women (from 3.1% to 1.4%, p < 0.05). Among men, there was a decrease in the prevalence of daily consumption of smokeless tobacco (from 3.5% to 1.0%, p < 0.05). In 2014/2015, both manufactured and hand-rolled cigarette consumption were more prevalent among men, while the use of smokeless tobacco was more common among women; the consumption of both hand-rolled cigarettes and smokeless tobacco were more prevalent in rural settings. In Mozambique, there was a decrease in the prevalence of daily smokers in both genders and of daily consumption of smokeless tobacco among men between 2005 and 2014/2015. Efforts are needed to maintain the positive trends.

Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study.

Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults. We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults. The final sample included data on 5691 participants (male: n=2521. 44.3% and female: n=3170, 55.7%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life's Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable. Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95% CI 0.98-4.18; P=.06). Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance.

Geographical and sociodemographic disparities in fruit and vegetables consumption among adults in Burkina Faso: baseline results from the 2013 WHO STEPS survey

BackgroundEvidence on sociodemographic determinants and spatial variations in the fruit and/or vegetable (FV) consumption was reported. This study aimed to explore geographical and sociodemographic disparities in the level of FV consumption among adults in Burkina Faso, using the national baseline data.MethodsThis was a cross-sectional secondary study of primary data obtained by the 2013 (September to October) World Health Organization Stepwise Approach to Surveillance survey conducted in Burkina Faso. The participants were 4402 women and men aged 25–64 years and living in all 13 Burkinabè Regions. Descriptive and analytical analyses were performed using Student’s t test, ANOVA, the chi-square test, Fisher’s exact test and logistic regressions.ResultsThe prevalence of a typical daily consumption of at least three servings was 4.1% (95% CI: 3.6–4.8) for fruits and 6.6% (95% CI: 5.9–7.3) for vegetables. The national prevalence of adequate FV intake was 5.1% (95% CI: 4.4–5.8), and for two Regions (“Centre-Ouest” and “Nord”) the pooled prevalence was 22.4%, while in the other eleven Regions its was significantly lower, 2.4% (p = 0.0001). Using quartiles derived from the national level of consumption, each of these two Regions had a higher proportion (about 50%) of their participants in the fourth quartile (the higher level). The associated sociodemographic factors with the adequate intake were being rural residents (aOR = 1.7, p = 0.011) and women (aOR = 1.3; p = 0.03).ConclusionExcept for the Regions of “Centre-Ouest” and “Nord” of Burkina Faso, the prevalence of adequate consumption of FV was very low in its other eleven Regions. Measures to increase consumption in urban people are urgent while women should be the key actor in the family-based approaches implementation and the nutrition education promoting FV consumption.

Two-decade trends and factors associated with overweight and obesity among young adults in Nepal.

Overweight and obesity are global epidemics in the adult population, and also affect young people. This study estimated the long-term trend (1996-2019) of overweight and obesity among young adults aged 18 to 29 years in Nepal by sex based on the World Health Organization (WHO) and Asian cut-offs for body mass index (BMI). We also investigated the demographic factors associated with overweight and obesity in the latest survey. This study utilized data from nationwide studies, Demographic and Health Surveys (DHSs) and WHO STEPwise approach to surveillance (STEPS) surveys. The trends in overweight and obesity were studied using trend analysis and joinpoint regression. Average annual percent changes (AAPCs) and their 95% confidence intervals (CIs) were calculated for the trends. Multivariable logistic regression was used to study the factors associated with overweight and obesity. The study findings showed significant upward trends in both overweight and obesity for women with AAPCs of 10.5 (95% CI 6.4-14.7) and 15.8 (95% CI 10.9-20.8) respectively. In the 25-29 age-group, the prevalence of overweight/obesity increased among women from 2.2% to 24.7% between 1996 and 2019, and among men from 8.8% to 25.4% between 2007 and 2019. Increased odds of overweight (AOR 9.15, 95% CI 6.64-12.60), and obesity (AOR 42.09, 95% CI 10.12-175.04) were found in 2019 compared to 1996. Older age and female sex, being married and urban residence were significantly associated with overweight and obesity. In conclusion, this study showed rapid upward trends in overweight and obesity among young adults in Nepal with an accelerated trend among women; the predictors for overweight were older age, female sex and married status, and those for obesity were older age, female sex, and urban residence.

Operationalization, characterization and validation of a healthy lifestyle index in 35 LMICs

Abstract Background For low- and middle-income countries (LMICs), there is no comprehensive and valid index reflecting overall lifestyle. This study aimed to operationalize, characterize, and validate a healthy lifestyle index (HLI), based on the World Health Organization (WHO) recommendations. Methods We used cross-sectional, complete-case data from individual-level, nationally representative surveys among non-pregnant adults in 35 LMICs, applying the WHO STEPwise approach to NCD risk factor surveillance (2009-2019; N = 125,607). The HLI was constructed based on WHO recommendations for fruit and vegetable intake, physical activity, smoking, and alcohol intake (unhealthiest = 0 points; healthiest = 16 points). We calculated the distributions of the HLI and its subcomponents across socio-demographic and geographic strata, accounting for the survey design and each country's World Bank population estimate. Partial Spearman correlations were calculated for the HLI with its subcomponents and cardio-metabolic risk markers. Results In this study (females: 51%, median age: 35.4 years), median HLI-score was 10.3 (interquartile range: 8.2-12.3), being highest in females (versus males) and low-income countries (versus middle-income countries). Twenty-two percent had at least five servings of fruits and vegetables per day (males: 20%, females: 24%); 82% exercised at least 600 MET-min/week (males: 87%, females: 78%); 69% never smoked (males: 40%, females: 97%); 64% were alcohol abstainers (males: 50%, females: 78%). Correlations of the HLI with its subcomponents were moderate and positive, ranging between r = 0.35 and r = 0.64; correlations with cardio-metabolic risk markers were weak, ranging between r = |0.02| and r =|0.12|. Conclusions The majority of adults in LMICs appear to live a healthy lifestyle, particularly women and individuals in low-income countries. Low fruit and vegetable intakes are a major concern. The HLI shows good content but poor construct validity. Key messages • There is an urgent need for interventions to promote fruit and vegetable consumption in LMICs. • The HLI is suitable to monitor lifestyles in LMICs on individual-, country- and WHO region-level.

Prevalence and knowledge of modifiable cardiovascular diseases risk factors among vulnerable population in Central Tanzania

BackgroundCardiovascular diseases (CVDs) are the global public health problem which has been associated with increasing prevalence of modifiable CVDs risk factors. This study aimed to describe the prevalence and knowledge of modifiable CVDs risk factors among vulnerable population of Central Tanzania.MethodsA community-based cross-sectional study design was employed. A total of 749 participants were interviewed. The socio-demographic information and modifiable CVDs risk factors (behavioral and biological) were measured using a modified World Health Organization (WHO) STEPwise approach for chronic disease risk factor surveillance. Knowledge of modifiable CVDs risk factors was measured by comprehensive heart disease knowledge questionnaire. Descriptive statistics were used to describe the knowledge and prevalence of modifiable CVDs risk factors. Logistic regression analysis was used to determine the factors associated with adequate knowledge of CVDs risk factors.ResultsThe prevalence of béhavioral risk factors were; current smokers and alcohol consumers were 4.4% and 18.0% respectively, use of raw salt was 43.7%, consumption of fruit/vegetables < 5 days per week was 56.9%. The prevalence of Biological CVDs risk factors was as follows: Overall, 63.5% (33.3% overweight and 29.9% obese) were overweight or obese, 4.5% were diabetic and 43.4% were hypertensive. Only 35.4% of participants had adequate knowledge of CVDs risk factors. Being a male (AOR = 1.44, 95%CI = 1.01–2.06, p < .05), having primary education (AOR = 6.43, 95%CI = 2.39–17.36, p < .0001), being employed (AOR = 1.59, 95%CI = 1.00-2.52, p < .05), ever checked blood pressure (AOR = 0.59, 95%CI = 0.42–0.84, p < .001), family history of hypertension (AOR = 0.38, 95%CI = 0.25–0.57, p < .0001) determined adequate knowledge of CVDs risk factors.ConclusionsThis study has revealed a high prevalence of modifiable CVDs risk factors and low knowledge of CVDs risk factors. Community health promotion interventions to increase population knowledge of CVDs risk factors are recommended for the efficacious reduction of CVDs in the country.

Age and Gender-Specific Pattern of Cardiovascular Disease Risk Factors in Saudi Arabia: A Subgroup Analysis from the Heart Health Promotion Study.

To investigate gender and age-specific distribution patterns of cardiovascular disease risk factors in the Saudi population for tailored health policies. From the heart health promotion study, 3063 adult Saudis were included in this study. The study cohort was divided into five age groups (less than 40 years, 40-45 years, 46-50 years, 51-55 years and ≥56 years). The prevalence of metabolic, socioeconomic, and cardiac risk was compared between the groups. Anthropometric and biochemical data were gathered using the World Health Organization stepwise approach to chronic disease risk factors. The cardiovascular risk (CVR) was determined using the Framingham Coronary Heart Risk Score. The prevalence of CVR risk increased with age in both genders. Both Saudi men and women exhibit similar propensities for sedentary lifestyles and unhealthy food habits. The prevalence of tobacco smoking was significantly higher and from an early age in males compared to females (28% and 2.7%, respectively, at age 18-29 years). There is no significant difference in either the prevalence of diabetes, hypertension, or metabolic syndrome between men and women before the age of 60 years. Old Saudi females (≥60 years) have a higher prevalence of diabetes (50% vs. 38.7%) and metabolic syndrome (55.9% versus 43.5%). Obesity was more prevalent in females aged 40-49 years onwards (56.2% vs. 34.9% males), with 62.9% of females aged ≥60 years being obese compared to 37.9% of males. Dyslipidaemia prevalence increased with the progression of age, significantly more in males than females. Framingham high-risk scores showed that 30% of males were at high risk of cardiovascular diseases at the age group of 50-59 years, while only 3.7% of the females were considered as such. Both Saudi men and women exhibit similar propensities for sedentary lifestyles and unhealthy food habits, with a marked increase in cardiovascular and metabolic risk factors with age. Gender differences exist in risk factor prevalence, with obesity as the main risk factor in women, while smoking and dyslipidaemia were the main risk factors in men.

Low attendance in cervical cancer screening, geographical disparities and sociodemographic determinants of screening uptake among adult women in Burkina Faso : results from the first nationwide population-based survey

ObjectiveTo explore the level, geographical disparities and sociodemographic determinants of cervical cancer screening uptake among adult women in Burkina Faso by using data from the first national population-based survey. MethodsThis was a cross-sectional secondary analysis of primary data obtained by the 2013 World Health Organization (WHO) Stepwise Approach to Surveillance survey conducted in Burkina Faso. All 13 Burkinabè regions, with their different rates of urbanization, were surveyed. Lifetime cervical cancer screening uptake was explored. We included 2293 adult women for analyses and performed Student's t, chi-square and Fisher's exact tests, and logistic regression. ResultsOnly 6.2% (95% CI: 5.3–7.3) of women had ever been screened for cervical cancer. For two regions (“Centre” and “Hauts-Bassins”), the pooled frequency was 16.6% (95% CI: 13.5–20.1) while in the other eleven regions it was significantly lower, 3.3% (95% CI: 2.5–4.2). In urban and rural areas, the respective frequencies for the screening uptake were 18.5% and 2.8% (p < 0.001), and in educated and un-educated women, frequencies were 27.7% and 3.3% (p < 0.001) respectively. The sociodemographic factors associated with screening uptake were being educated (adjusted odd-ratio [aOR] = 4.3; 95% CI: 2.8–6.7), urban residence (aOR = 3.8, 95% CI: 2.5–5.8) and having an occupation providing income (aOR = 3.1, 95% CI: 1.8–5.4). ConclusionThere was a significantly wide range in screening uptake between Burkina Faso regions, and the overall national as well as the region-specific levels were far below the WHO's target for cervical cancer elimination. Cervical cancer interventions should be tailored specifically for Burkinabè women with different educational levels, and prevention strategies based on community engagement integrating psychosocial considerations could be helpful.

Prevalence and Risk Factors of Hypertension in Hargeisa, Somaliland: A Hospital-Based Cross-Sectional Study

Hypertension is the leading risk factor for cardiovascular diseases and represents a major public health challenge worldwide. There is a paucity of information regarding the hypertension status of adults in Somaliland. We aimed to assess the magnitude of, and factors associated with, hypertension among adult patients seeking care at Hargeisa group hospital in Hargeisa city, Somaliland. We conducted a health facility-based cross-sectional study enrolling adult outpatients. We used the World Health Organization (WHO) STEPwise surveillance approach to obtain patient information. A total of 319 participants (54.2% males; mean age 40.4 ± 14.0 years) had complete data records. The prevalence of hypertension was 22.6% (95% confidence interval; 18.2-27.6%). The prevalence of hypertension increased with age and was higher in males (24.9%) than in females (19.9%). Age, cholesterolaemia and obesity were significantly associated with hypertension. Separate analyses for females and males revealed that obesity was significantly associated with hypertension in females but not in males. On the contrary, cholesterolaemia was significantly associated with hypertension in males but not in females. We found a high prevalence of hypertension and multiple risk factors for non-communicable diseases (NCDs) in outpatients seeking care in Hargeisa. Our findings emphasise the need for enhanced focus on the prevention and management of NCDs in Somaliland.

Effects of Age, Metabolic and Socioeconomic Factors on Cardiovascular Risk among Saudi Women: A Subgroup Analysis from the Heart Health Promotion Study.

Background: Cardiovascular disease (CVD) remains the leading cause of death in women. Along with the effect of age on the risk of CVD, the reproductive profile of women can influence cardiac health among women. Objectives: The objective of this study is to investigate the influence of age and reproductive stages on the development and progression of cardiovascular disease risks in Saudi women. Methods: For this study, we included 1907 Saudi women from the Heart Health Promotion Study. The study cohort was divided into five age groups (less than 40 years, 40-45 years, 46-50 years, 51-55 years, and ≥56 years). The cohort stratification was meant to correspond to the social and hormonal changes in women's life, including reproductive, perimenopausal, menopausal, and postmenopausal age groups. The groups were compared with respect to the prevalence of metabolic, socioeconomic, and cardiac risks, and the age group of less than 40 years was considered as the reference group. The World Health Organization stepwise approach to chronic disease risk factor Surveillance-Instrument v2.1 was used in this study to collect the anthropometric and biochemical measurements and the Framingham Coronary Heart Risk Score was used to calculate the cardiovascular risk (CVR). Logistic regression analysis was conducted to assess the independent effect of age on CVD risks after adjustment of sociodemographic factors. Results: Metabolic and CVR increased progressively with the increase in age. There was a sharp increase in obesity, hypertension, diabetes, and metabolic syndrome, from the age group <40 years to 41-45 years and then again between the age groups of 46-50 and ≥56 years. A similar noticeable increase in metabolic risk factors (high cholesterol, high triglyceride, high Low-Density Lipoprotein) was observed between the age group <40 years and 41-45 years, but with a steady increase with the increase in age between the other age groups. The high and intermediate Framingham Coronary Heart Risk Scores showed a progressive increase in prevalence with the increase in age, where the proportion doubled from 9.4% at the age group 46-50 years, to 22% at the age group 51-55 years. It doubled again at the age group ≥56 years to 53%-these sharp inflections in the risk of CVD correspond to the women's reproductive lives. Conclusions: In Saudi women, CVR increases with the increase of age. The influence of pregnancy and menopause is apparent in the prevalence of increased risks for cardiovascular and metabolic diseases.

The Trend of Risk for Cardiovascular Diseases During the Past Decade in Iran, Applying No-Lab and Lab-Based Prediction Models.

As a surrogate for all relevant risk factors, it is preferable to show trends in the mean cardiovascular disease(CVD) risk rather than to examine each risk factor trend separately. Using national representative data, this study aimed to determine the changes in the World Health Organization (WHO) CVD risk during the last decade considering both laboratory and non-laboratory risk scoring. We used data from five rounds of the WHO STEPwise approach to surveillance surveys (2007-2016). In all, 62,076 (31,660 women) participants aged 40-65 years were included and their absolute CVD risk were calculated. The generalized linear model was performed to assess the trend of CVD risk in men and women, and also in diabetic and non-diabetic individuals. We showed significant declining trends in the mean CVD risk in the laboratory (from 10.5% to 8.8%) and non-laboratory (10.1% to 9.4%) models in men. In women, a significant reduction was observed in the laboratory-based model (from 8.4% to 7.8%). The laboratory model showed a greater decrease in men than women (P-for interaction < 0.001) and in diabetic patients (from 16.1% to 13.6%) than non-diabetic individuals (from 8.2% to 7%) (p-for interaction = 0.002). The proportion of high-risk individuals (risk ≥ 10%) decreased from 40% in 2007 to 31.5% in 2016 in men and from 29.8% to 26.1% in women based on the laboratory-model. During the last decade, CVD risk had a significant decrease in men and women. The reduction was more evident in men and diabetic population. However, still, one-third of our population is considered high-risk.

Electrocardiogram abnormalities and renal impairment in patients with type 2 diabetes mellitus: A healthcare facilities-based cross-sectional study in Dang district of Nepal.

The global burden of diabetes mellitus is rising substantially, with a further increase in cardiovascular and kidney disease burden. These public health problems are highly prevalent in low- and middle-income countries, including Nepal. However, there is limited evidence on cardiac and renal conditions among patients with type 2 diabetes mellitus. We determined the status of electrocardiogram (ECG) abnormalities and renal impairment among patients with type 2 diabetes mellitus in Nepal. We carried out a cross-sectional study in Tulsipur Sub-Metropolitan City of Nepal using a multistage stratified sampling technique to recruit patients with type 2 diabetes mellitus. We used World Health Organization stepwise approach to surveillance (WHO STEPS) questionnaires and carried out resting ECG to collect data of 345 patients with type 2 diabetes mellitus. Logistic regression analysis assessed the factors associated with ECG abnormalities and renal impairment. The study showed that 6.1% of participants had major ECG abnormalities (95% confidence interval [CI] 3.8-8.6%), which were associated with hypertension (P=0.01%) and low socioeconomic status (P=0.01). The proportion of major and/or minor ECG abnormalities was 47.8% (95% CI 40.5-51%), and were significantly associated with age (odds ratio [OR] 1.04, 95% CI 1.01-1.07), higher education (OR 3.50, 95% CI 1.31-9.33), unemployment (OR 3.02, 95% CI 1.08-8.48), body mass index (OR 1.09, 95% CI 1.02-1.17) and duration of type 2 diabetes mellitus >5 years (OR 2.42, 95% CI 1.19-4.93). The proportion of renal impairment was 3.5% (95% CI 1.5-4.5%) which was associated with older age (OR 1.08, 95% CI 1.00-1.17) and hypertension (OR 12.12, 95% CI 1.07-138.22). A significant proportion of patients with type 2 diabetes mellitus had ECG abnormalities and renal impairment, which were significantly associated with hypertension. Therefore, hypertension management and early screening are essential to prevent future cardiorenal complications among patients with type 2 diabetes mellitus.

Determinants of Hypertension in Outpatients in East Java, Indonesia

Objective: To assess the prevalence of hypertension and to identify the causative factors. Method: The cross- cross-sectional study was conducted at Dr Soegiri Hospital, Lamongan, Indonesia, from March to July 2019, and comprised outpatients of either gender. Data was collected using a modified World Health Organisation STEPwise approach to surveillance questionnaire to identify the risk factors for hypertension. Data were analysed using the SPSS 16.0 statistical tool and logistic regression test. Results: Of the 184 subjects, 118(64.1%) were females and 66(35.9%) were males, and 96(52%) were aged &lt;60 years. Overall, 120(65.2%) subjects were hypertensive; 80(66.7%) females and 40(33.3%) males. The two main factors that significantly influenced the incidence of hypertension were body mass index (p=0.001) and consumption of vegetables (p=0.013). After adjusting for confounding factors, only body mass index was found to affect the incidence of hypertension (odds ratio: 5.61; 95% confidence interval: 1.686-18.659). Conclusion: Body mass index and and dietary patterns affected the incidence of hypertension. After adjusting for confounding factors, only the former was found to have significant association with hypertension. Keywords: Blood pressure, Body mass, Hypertension, Feeding, Dietary.

Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates.

The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking. To determine the incidence and 1-month case-fatality rates from high-quality studies of stroke epidemiology among Africans. We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (MEDLINE, ScienceDirect, Google Scholar, and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle-Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, 14 studies were eligible for inclusion. The total number of stroke cases was 2568, with a population denominator (total sample size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,384,102. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% confidence interval (CI) = 58.59-193.55), I2 = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI = 56.31-220.12), I2 = 99.2%, than females, 91.14 (95% CI = 47.09-176.37), I2 = 98.9%. One-month case-fatality rate was 24.45 (95% CI = 16.84-35.50), I2 = 96.8%, with lower estimates among males, 22.68 (95% CI = 18.62-27.63), I2 = 12.9%, than females, 27.57 (95% CI = 21.47-35.40), I2 = 51.6%. The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.

Relationship between serum lipids and depression: A cross sectional survey among adults in Haryana, India.

Dyslipidemia and mental illnesses are significant contributors to the global noncommunicable disease burden and studies suggest an association between them. Using data from a noncommunicable disease risk factor survey conducted in Haryana, India, we undertook a secondary data analysis to examine the association between lipids and depressive symptoms. The survey involved 5,078 participants and followed the World Health Organisation STEPwise approach to NCD risk factor surveillance approach. Biochemical assessments were undertaken in a subset of participants. Lipid markers were measured using wet chemistry methods. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Descriptive statistics were presented for all variables; logistic regression was used for association analyses. The mean age of the study population was 38 years and 55% of them were females. A majority of the participants belonged to a rural background. The mean total cholesterol was 176 mg/dL and approximately 5% of the participants were found to have moderate to severe depression. The association of total cholesterol (odds ratio [OR] 0.99, P = 0.84), LDL-cholesterol (OR = 1.00, P = 0.19), HDL-cholesterol (OR = 0.99, P = .76), and triglycerides (OR 1.00, P = .12) with depressive symptoms was not significant. This study did not find any association between lipids and depressive symptoms. However, further investigations using prospective designs are warranted to understand this relationship and complex interactions with other mediating factors better.

Exposing the Iceberg: A Study on Risk Assessment and Chronic Morbidity due to Non Communicable Diseases among Rural Population of Kerala Using STEPS Survey

Introduction: Non Communicable Diseases (NCDs) (heart diseases, chronic respiratory disease, stroke, diabetes, cancer) pose a significant public health burden especially in low and middle income countries. The increasing prevalence of NCDs will have significant implications in socio-economic and health sector and hence, needs immediate attention. Aim: To see the prevalence of NCDs and its risk factors among residents in a rural population of Pathanamthitta district. Materials and Methods: This cross-sectional survey was conducted among 2236 adults of both gender residing in Konni Block, Pathanamthitta over a period of six months using the World Health Organisation STEPwise approach to surveillance (WHO STEPS) survey, the Achutha Menon Centre Diabetes Risk Score (AMCDRS) and risk score to predict hypertension in primary care settings. Variables were expressed using proportions with 95% Confidence Intervals (CI). Chi-square test was used for comparison of proportions across groups. Logistic regression analysis were used to determine the predictors of morbid conditions. Results: Total of 2236 study participants consisted of 53.8% females and 46.2% males with the mean age 47±17.5 years was included. Among them, 683 (30.7%) suffered from one or more morbidity. Around 18.1% and 19.9% of study participants suffered from diabetes and hypertension, respectively. More than 25% of the study population was at risk of developing hypertension and diabetes. Substance abuse, obesity and family history of diabetes were found to be risk factors for the development of morbidity. Conclusion: The present study provides evidence of the growing burden of morbidity from NCDs. Increasing prevalence of multimorbidity and clustering of risk factors demand urgent and co-ordinated attention.