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      Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis

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          Abstract

          The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6–15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6–16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.

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          Prevalence, Awareness and Control of Hypertension in Uganda

          Background Prevention and control of hypertension are critical in reducing morbidity and mortality attributable to cardiovascular diseases. Awareness of hypertension is a pre-condition for control and prevention. This study estimated the proportion of adults who were hypertensive, were aware of their hypertension and those that achieved adequate control. Methods We conducted a community based cross sectional survey among people≥15 years in Buikwe and Mukono districts of Uganda. People had their blood pressure measured and were interviewed about their social-demographic characteristics. Hypertension was defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or previous diagnosis of hypertension. Participants were classified as hypertensive aware if they reported that they had previously been informed by a health professional that they had hypertension. Control of hypertension among those aware was if systolic blood pressure was <140 mmHg and diastolic blood pressure was <90 mmHg. Results The age standardized prevalence of hypertension was 27.2% (95% CI 25.9–28.5) similar among females (27.7%) and males (26.4%). Prevalence increased linearly with age, and age effect was more marked among females. Among the hypertensive participants, awareness was 28.2% (95% CI 25.4–31.0) higher among females (37.0%) compared to males (12.4%). Only 9.4% (95% CI 7.5–11.1) of all hypertensive participants were controlled. Control was higher among females (13.2%) compared to males (2.5%). Conclusion More than a quarter of the adult population had hypertension but awareness and control was very low. Measures are needed to enhance control, awareness and prevention of hypertension.
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            Prevalence of dyslipidaemia among adults in Africa: a systematic review and meta-analysis

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              A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya

              Background Urban slum populations in Africa continue to grow faster than national populations. Health strategies that focus on non-communicable diseases (NCD) in this segment of the population are generally lacking. We determined the prevalence of diabetes and associated cardiovascular disease (CVD) risk factors correlates in Kibera, Nairobi’s largest slum. Methods We conducted a population-based household survey utilising cluster sampling with probability proportional to size. Households were selected using a random walk method and consenting residents aged 18 years and above were recruited. The WHO STEPS instrument was administered. A random capillary blood sugar (RCBS) was obtained; known persons with diabetes and subjects with a RCBS >11.1 had an 8 hours fasting blood sugar (FBS) drawn. Diabetes was defined as a RCBS of ≥ 11.1 mmol/l and a FBS of ≥ 7.0 mmol/l, or a prior diagnosis or receiving diabetes drug treatment. Results Out of 2061 enrolled; 50.9% were males, mean age was 33.4 years and 87% had a minimum of primary education. Only 10.6% had ever had a blood sugar measurement. Age adjusted prevalence of diabetes was 5.3% (95% CI 4.2-6.4) and prevalence increased with age peaking at 10.5% (95% CI 6.8-14.3%) in the 45–54 year age category. Diabetes mellitus (DM) correlates were: 13.1% smoking, 74.9% alcohol consumption, 75.7% high level of physical activity; 16.3% obese and 29% overweight with higher rates in women. Among persons with diabetes the odds of obesity, elevated waist circumference and hypertension were three, two and three fold respectively compared to those without diabetes. Cardiovascular risk factors among subjects with diabetes were high and mirrored that of the entire sample; however they had a significantly higher use of tobacco. Conclusions This previously unstudied urban slum has a high prevalence of DM yet low screening rates. Key correlates include cigarette smoking and high alcohol consumption. However high levels of physical activity were also reported. Findings have important implications for NCD prevention and care. For this rapidly growing youthful urban slum population policy makers need to focus their attention on strategies that address not just communicable diseases but non communicable diseases as well.
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                Author and article information

                Contributors
                bignarimjj@yahoo.fr
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                24 January 2019
                24 January 2019
                2019
                : 9
                : 588
                Affiliations
                [1 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, Department of Medicine, , Groote Schuur Hospital and University of Cape Town, ; Cape Town, South Africa
                [2 ]ISNI 0000 0001 2173 8504, GRID grid.412661.6, Department of Public Health, Faculty of Medicine and Biomedical Sciences, , University of Yaoundé 1, ; Yaoundé, Cameroon
                [3 ]ISNI 0000 0001 0668 6654, GRID grid.415857.a, Department for the Control of Disease, Epidemics and Pandemics, , Ministry of Public Health, ; Yaoundé, Cameroon
                [4 ]ISNI 0000 0001 2173 8504, GRID grid.412661.6, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, , University of Yaoundé 1, ; Yaoundé, Cameroon
                [5 ]ISNI 000000041936754X, GRID grid.38142.3c, Brigham and Women’s Hospital, , Harvard Medical School, ; Boston, MA USA
                [6 ]Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
                [7 ]ISNI 0000 0001 2171 2558, GRID grid.5842.b, Faculty of Medicine, , University of Paris Sud XI, ; Le Kremlin-Bicêtre, France
                Author information
                http://orcid.org/0000-0001-6155-235X
                http://orcid.org/0000-0002-4353-2352
                http://orcid.org/0000-0001-8018-6279
                Article
                37858
                10.1038/s41598-018-37858-z
                6345945
                30679752
                7e34fad4-7a26-4f7c-99db-b10e8244fa13
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 July 2018
                : 15 December 2018
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