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Background HIV and antiretroviral drugs, particularly protease inhibitors and nucleoside reverse transcriptase inhibitors, may increase the risk of Metabolic Syndrome (MetS) among people living with HIV (PLHIV). However, following the introduction of better drugs like dolutegravir, data on the burden of MetS are limited. This study aimed to assess the prevalence of MetS and associated factors among PLHIV on antiretroviral therapy (ART) in Tanzania. Methods This was a cross-sectional study among PLHIV aged ≥ 18 years on antiretroviral therapy for ≥ 1 year at Bugando Medical Centre in Mwanza conducted in 2020. Demographic and healthy-lifestyle-related non-communicable disease risk factors data were collected. Additionally, data on lipid profile, blood glucose, blood pressure, and waist circumference were collected for analysis of MetS according to the International Diabetes Federation criteria. Factors associated with MetS were assessed using logistic regression. A P ≤ 0.05 was considered statistically significant. Results Data for 223 participants were analyzed. The mean (SD) age was 44 (± 12) years and 79.8% (178) were females. A majority 78% (174) were on a tenofovir, lamivudine,and dolutegravir regimen. About 12.1% (27) were either current or past smokers, 45.3% (101) were past alcohol drinkers, 22.9% (51) were current drinkers, 12.1% (27) reported taking ≥ 5 servings of vegetables and fruits per day and 5.8% (13) were physically inactive. The prevalence of MetS was 22.9%. The only factors that were associated with Mets were fat mass index and adequate intake of vegetables and fruits, (adjusted odds ratio (aOR) 2.9, 95% CI 1.0, 7.9, P = 0.04) and (aOR1.2, 95% CI 1.0, 1.3, P = 0.02), respectively). Conclusion The prevalence of MetS remains high among PLHIV. Adiposity and adequate fruit and vegetable intake increased the risk. The introduction of new ART regimens shows no effect on MetS prevalence. Research is needed to understand how lifestyle changes could reduce MetS in PLHIV.

Background Rheumatic Heart Disease (RHD) continues to cause suffering and premature deaths in many sub-Saharan Africa (SSA) countries, where the disease is still endemic. RHD is largely preventable and determining its community burden is an important critical step in any RHD prevention program. Methods We conducted a cross-sectional study of 5–16 years old pupils from 11 primary schools participating in an RHD prevention program in 4 districts in Tanzania, between 2018 and 2019. At the school, all children were invited to participate after receiving consent from their parents/guardians. Participating children filled a questionnaire and were auscultated for cardiac murmurs. Echocardiographic screening was done by two experienced cardiologists, using a hand-held machine (V-Scan, GE®). All positive screening tests were stored for further examination by the same two cardiologists to reach to a consensus of definite, borderline or no RHD, using a modified World Heart Federation (WHF) criterion. Results Of the 6895 children invited, 4738 (68.7%) were screened and 4436 (64.3%) had complete data. The mean (SD) age was 10.04 (2.43) years, and 2422 (54.6%) were girls. Fifty three (1.2%) children were found to have a murmur. The proportion of children with trace or mild valvular regurgitation, sub-valvular/chordal thickening and valvular thickening/deformity were 8.3%, 1.3%, and 1.0%, respectively. Sub-clinical RHD was found in 95 children (59 definite and 36 borderline), giving a prevalence of 2.1%, [95% CI 1.7% – 2.6%]. Sub-clinical RHD was independently associated with female sex (aOR 1.83, 95% CI 1.18–2.85, p = 0.007), older age groups (aOR 1.73, 95% CI 1.10–2.72, p = 0.018 for age group 11–14 years; and aOR 3.02 95% CI 1.01–9.05, p = 0.048 for age group 15–16 years), as well as presence of a cardiac murmur, aOR 5.63 95% CI 2.31–13.69, p Conclusion The prevalence of sub-clinical RHD among primary school children in Tanzania is 2.1%, similar to previous reports in SSA. Efforts to prevent and control RHD in our communities are highly warranted.

Background: Simple and less costly screening tools are needed to combat the rising non-communicable diseases epidemic. This study aimed to evaluate the utility of The Finnish Diabetes Risk Score (FINDRISC) as a screening tool for prediabetes, T2D, and metabolic syndrome (MetS) in a population of young adults in urban Mwanza, Tanzania. Methods: A cross-sectional community-based study was conducted among participants aged 18–35 years. The FINDRISC questionnaire was used to collect data and compute the FINDRISC scores for each participant. Socio-demographic, anthropometric, blood glucose, and lipid profiles data were collected accordingly. Results: A total of 259 participants were recruited into the study. The median age was 21 years (IQR 19–27), and more than half 60.2% (156) were females. In total, 32.8% (85) of the participants had at least a slightly elevated risk of developing T2D in 10 years’ time. Compared to the Oral Glucose Tolerance Test (OGTT), FINDRISC had a sensitivity and specificity of 39.1% and 69.2%, respectively (aROC = 0.5). The FINDRISC score significantly correlated with MetS (p = 0.001). Conclusion: In this study, FINDRISC has shown low sensitivity and specificity in the screening of pre-diabetes/T2D. However, it has potential utility in the screening of MetS in a young-adult population.

Background Improving cardiovascular health requires public knowledge and reduction of modifiable cardiovascular disease (CVD) risk factors. This study assessed knowledge of risk factors and warning signs for CVDs among young and middle-aged adults in Morogoro, Tanzania. Methods We conducted a community-based survey as part of cluster randomized controlled study of community health workers (CHWs) intervention for reduction of blood pressure among young and middle-aged adults in rural Morogoro. Information on socio-demographic characteristics, knowledge of risk factors and warning signs for CVDs was collected using an interviewer administered questionaire. Knowledge was assessed using open-ended questions followed by closed-ended questions. Descriptive statistics were used to describe knowledge of risk factors and warning signs. Logistic regression analysis was used to investigate factors associated with adequate knowledge of risk factors and warning signs for CVDs. Results Two-thirds (65.7%) of the participants had heard about CVDs. The main sources of information were mainly relatives/ neighbors (64.8%) and radio (53.0%). Only 28.3% of the participants reported health care providers as source of information about CVDs. More than half of the participants (52.4%) did not mention even one risk factor spontaneously while 55.2% were unable to mention any warning sign. When asked to select from a list, 6.9% were unable to correctly identify any risk factor whereas 11.8% could not correctly identify even a single warning sign. Quarter of participants (25.4%) had good knowledge score of risk factors, 17.5% had good knowledge score of warning signs and 16.3% had overall good knowledge of both risk factors and warning signs. Residing in Ulanga, having higher education level, having ever checked blood pressure and being overweight/obese predicted adequacy of knowledge score for both risk factors and warning signs. Conclusion Knowledge of risk factors and warning signs in this rural population of young and middle-aged adults was generally low. Health care providers were less likely to provide health education regarding risk factors and warning signs for CVDs. Health promotion interventions to increase population knowledge of risk factors and warning signs should be implemented for successful reduction of CVDs in Tanzania.

traditionally, non-communicable diseases were diseases of public health concern in developed countries. Due to economic transition, they are becoming more prevalent in low and middle-income countries. Despite the trend, little has been done in the population of young adults of developing countries. This research aimed to explore the magnitude of type 2 diabetes mellitus, hypertension, dyslipidemia, and abdominal obesity among the young adult population in an urban setting of Tanzania.the current research used a cross-sectional community-based design, involving apparently healthy young adults aged 18 to 34 years, not known to have diabetes, hypertension, or dyslipidemia. Data on socio-demographic characteristics, medical history, anthropometry, blood pressure, and lipids were obtained per standard operating procedures and analyzed using STATA 13. Association between outcome variables (type 2 diabetes mellitus, hypertension, dyslipidemia, and abdominal obesity) and predictor variables (age, sex, education level, occupation, and economic status) were assessed by logistic regression.245 young adults with a median age of 21 (interquartile range [IQR]: 18-25) were recruited. Prevalence of diabetes mellitus and of impaired glucose tolerance (IGT) were 7.8% and 15.5% respectively. Abdominal obesity and dyslipidemia were present in 11.8% and 45.1% respectively. 34.3% had hypertension and the risk was significantly higher in males compared to females (OR 1.8, 95%CI 1.1, 3.1). The atherogenic coefficient was significantly associated with abdominal obesity; other atherogenic indices did not show significant associations with current disease conditions.alarmingly high prevalence of diabetes mellitus, impaired glucose tolerance, hypertension, abdominal obesity, and dyslipidemia were observed among young adults in Mwanza. This study highlights the need for concerted efforts for interventions targeting young adults in combating diabetes and cardiovascular disease (CVD) risk factors in Tanzania.

ObjectiveFFQ are often used to estimate food and nutrient intakes to rank individuals by their level of intake. We evaluated the relative validity of a semi-quantitative FFQ created for use in Tanzania by comparing it with two 24 h diet recalls.DesignWe measured relative validity of the FFQ with deattenuated energy-adjusted rank correlations for nutrients, deattenuated rank correlations for food groups, and performed a cross-classification analysis of energy-adjusted nutrient quartiles using percentage of agreement and Bland–Altman analysis.SettingInterviews were conducted in 2014 in participants’ homes in Ukonga, Dar es Salaam, Tanzania.SubjectsWe surveyed 317 adults aged 40 years or older from the general public.ResultsDeattenuated energy-adjusted rank correlation coefficients of nutrients ranged from −0·03 for riboflavin to 0·41 for percentage of energy from carbohydrates, with a median correlation of 0·21. Coefficients for food groups ranged from 0·00 for root vegetables to 0·51 for alcohol, with a median of 0·35. Relative to the average of the two 24 h diet recalls, the FFQ overestimated energy intake and intakes of all nutrients and food groups, other than tea, with ratios among nutrients ranging from 1·34 for SFA to 7·08 for vitamin A; and among food groups from 0·92 for tea to 9·00 for fruit. The percentage of participants classified into the same nutrient intake quartile ranged from 23 % for SFA to 32 % for both niacin and pantothenic acid, with a median of 28 %.ConclusionsThe FFQ performed moderately well in urban Tanzanian adults.

IntroductionInjury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across multiple countries. Using data from a novel cohort, we examined the prevalence and incidence of serious injuries and associated risk factors across five sites in sub-Saharan Africa (SSA).MethodsA common baseline and follow-up survey was administered to participants. The study population included 1316 persons at baseline and 904 persons at follow-up. Frequencies were calculated, and logistic regression models were used to assess risk factors for injury.ResultsA total of 233 (17.7%) persons reported a serious injury at baseline and 60 (6.6%) reported a serious injury 6 months later at follow-up. Sixty-nine per cent of participants responded to the follow-up questionnaire. At baseline and follow-up, the most common cause of serious injury at urban sites was transport related, followed by poison/overdose. In rural Uganda, sharp instruments injuries were most common, followed by transport-related injuries. Living at an urban site was associated with an increased odds for serious injury compared with those at the rural site (OR: 1.83, 95% CI 1.15 to 2.90). Participants who consumed above a moderate amount of alcohol were at a higher risk of serious injury compared with those who did not consume alcohol (OR: 1.86, 95% CI 1.02 to 3.41). High level of education was an important risk factor for injury.ConclusionAt baseline and follow-up, common causes of serious injury were transport related, sharp instrument and poison/overdose. Alcohol consumption, urban location and education are important risk factors for injury. It is feasible to collect longitudinal injury data using a standardised questionnaire across multiples sites in SSA. Longitudinal data collection should be leveraged to obtain robust data on risk factors for injury in SSA.

Background. Hypertension, which is the single most important risk factor for CVDs, is increasing at an alarming rate in most developing countries. This study estimated the prevalence, awareness, treatment, and control of hypertension among young and middle-aged adults in rural Morogoro, Tanzania. Furthermore, it explored factors associated with both prevalence and awareness of hypertension. Methods. A cross-sectional survey was conducted as part of the cluster randomized controlled study of community health workers (CHWs) interventions for reduction of blood pressure in a randomly selected sample of young and middle-aged population in rural Morogoro. Sociodemographics, lifestyle-related factors, history of diagnosis, and treatment for hypertension were collected using a questionnaire adopted from the STEPS survey tool. Blood pressure, height, and weight were measured at home following standard procedures. Descriptive statistics were used to estimate prevalence, awareness, treatment, and control of hypertension. Multiple logistic regression models were used to assess determinants of hypertension and awareness. Result. The prevalence of hypertension was 29.3% (95% CI: 27.7–31.0). Among individuals with hypertension, only 34.3% were aware of their hypertension status. Only around one-third (35.4%) of those who were aware of their hypertension status were currently on antihypertensive medication. Hypertension control was attained in only 29.9% among those on medications. Older age (p<0.001), use of raw table salt (p<0.001), and being overweight/obese (p<0.001) were associated with hypertension. Predictors of awareness of hypertension status were older age, being a female, higher socioeconomic status, use of raw table salt, a history of diabetes, and overweight/obesity (all p<0.001). Alcohol drinking was associated with low awareness for hypertension status (p<0.001). Conclusion. There is high prevalence of hypertension with low rates of awareness, treatment, and control among young and middle-aged adults in rural Tanzania. Community-level health promotion and screening campaigns for hypertension and other CVD risk factors should be intensified.

Background The prevalence of type 2 diabetes mellitus (T2D) and other NCDs is on the rise globally, low-income countries like Tanzania are not spared. Affordable and effective screening tools are needed to combat these epidemics. This study aimed to evaluate the utility and applicability of the Finnish Diabetes Risk Score (FINDRISC) as one of the screening tools for T2D and its potential risk factors in population of young adults from an urban setting in Tanzania. Methods A community based cross-sectional study was conducted in urban setting Mwanza-Tanzania. Data was collected using FINDRISC questionnaire (assessing Age, BMI, waist circumference, physical activity participation, vegetable consumption, and history of high blood pressure, history of high blood sugar and family history of diabetes) and physical assessment of, blood pressure, waist circumference and hip circumference. Laboratory measurements for fasting blood glucose, oral glucose tolerance and lipid profile. Data was analyzed using STATA 13. Pearson’s correlation was used to assess the associations between FINDRISC with clinical and biochemical parameters. Linear regression was used to assess the extent at which FINDRISC predicted various clinical and biochemical parameters. P-value was considered significant at p≤0.05. Results Of the 259 participants enrolled, 32.8% were in the FINDRISC categories of “at least slightly elevated risk” to “high risk” of developing T2D in 10 years’ time. FINDRISC correlated with FBG (r=0.12, p=0.05), diastolic blood pressure (r=0.19, p=0.02), mean arterial blood pressure (r=0.13, p=0.036), low density lipoprotein cholesterol (r=0.19, p =0.005), and waist to hip ratio - WHR (r=0.34, p = 0.001). Furthermore, FINDRISC explained 11% of the variation in WHR (Adjusted r2 = 0.11, p=0.001), 3% of diastolic blood pressure (adjusted r2= 0.03, p = 0.02), 3% of low density lipoprotein cholesterol (adjusted r2=0.03, p=0.005), 1% of mean arterial pressure (adjusted r2=0.01, p=0.036) and 1% of FBG (r2=0.01, p=0.05). Conclusion This study provides novel insights on the potential utility of FINDRISC as a simple and non-invasive screening tool for metabolic syndrome-related ailments among young adults in Africa. Longitudinal studies, with context-specific modifications of FINDRISC, are suggested to ascertain its predictive value for future T2D in this population.

To determine the glycemic index (GI) of selected cereals and association with their microstructure. The GI of whole grain pilaf (WGP), instant brown rice (IBR), whole maize ugali (MWU), and refined maize ugali (RMU) was assessed in a randomized trial. Fourteen healthy participants with mean age of 25 years were administered 50 g portions of available carbohydrates from glucose and various test foods after an overnight fast on separate occasions. Capillary blood samples of participants were used to measure blood glucose over 2 hr. The GI was calculated as per standard protocol. The microstructure of test foods, determined by scanning electron microscopy was evaluated to understand the measured GI values. The GI (mean ± standard error) of IBR was the highest (87.8 ± 6.8) followed by RMU (74.7 ± 6.5) and WMU (71.4 ± 5.1). WGP had medium GI (58.9 ± 5.1; P < 0.01 vs. IBR). Microstructure examination of IBR revealed disruption of bran layer and presence of fissures indicating loss of intactness of bran. Stereozoom images for WGP revealed intact bran and germ. For RMU and WMU, the grain was milled leading to loss of integrity. IBR, RMU, and WMU have high GI values, which is likely due to disruption of bran layer, endosperm modification (IBR), and loss of grain matrix (WMU, RMU). WGP has medium GI probably due to fairly intact bran and germ. PRACTICAL APPLICATION: Wholegrain or whole meal flour may not necessarily be low in glycemic index (GI; low GI < 55; medium 55 to 69 and high GI ≥70). "Ugali" a commonly consumed cereal staple food in Tanzania made from either refined or whole meal maize flour was found to be a high GI food. Intact whole grain foods, such as whole grain pilaf (mixed intact whole grains) is a healthier alternative to milled whole grains such as whole meal maize flour. Instant quick cooking brown rice exhibited a high GI, due to the processing method, suggesting that regular brown rice may be a healthier option.

Background Overweight and obesity are on the rise in developing countries including sub-Saharan Africa. We undertook a four-country survey to show the collective burden of these health conditions as they occur currently in sub-Saharan Africa and to determine the differences between urban and rural populations and other socio-economic factors. Methods Participants were nurses in two hospitals in Nigeria (200), school teachers in South Africa (489) and Tanzania (229), and village residents in one peri-urban (297) and one rural location in Uganda (200) who completed a standardised questionnaire. Their height and weight were measured and body mass index calculated. Factor analysis procedure (Principal component) was used to generate a wealth index. Univariate and multivariate analyses with binary logistic regression models were conducted to examine the associations between potential correlates and the prevalence of overweight and obesity with 95 % confidence intervals. Results The prevalence of overweight and obese (combined) was 46 %, 48 %, 68 %, 75 % and 85 % in rural Uganda, peri-urban Uganda, Nigeria, Tanzania and South Africa (SA), respectively. Rural Uganda, Peri- urban Uganda, Nigeria, Tanzania and SA had obesity prevalence of 10 %, 14 %, 31 %, 40 % and 54 %, respectively (p =25 kg/m2 in Nigeria [Age > =45 - AOR = 9.11; 95 % CI: 1.72, 48.16] and SA [AOR = 6.22; 95 % CI: 2.75, 14.07], while marital status was predictor of BMI > =25 kg/m2 only in peri-urban Uganda. [Married - AOR = 4.49; 95 % CI: 1.74, 11.57]. Those in Nigeria [AOR = 2.56; 95 % CI: 1.45, 4.53], SA [AOR = 4.97; 95 % CI: 3.18, 7.78], and Tanzania [AOR = 2.68; 95 % CI: 1.60, 4.49] were more likely to have BMI > =25 kg/m2 compared with the rural and peri-urban sites. Conclusion The high prevalence of overweight and obesity in these sub-Saharan African countries and the differentials in prevalence and risk factors further highlights the need for urgent focused intervention to stem this trend, especially among women, professionals and urban dwellers.

Background Cardiovascular diseases (CVDs) increasingly contribute to morbidity and mortality in Tanzania. Public knowledge about CVD risk factors is important for the primary prevention of CVDs and can be improved through community-based interventions delivered by community health workers (CHWs). However, evidence of the utility of CHWs in improving knowledge and CVD risk factors profile is lacking in Tanzania. This study aims at assessing the effect of training CHWs and their CVD-specific interventions for reduction of hypertension and other CVD risk factors among adults in Morogoro, Tanzania. Methods This study will use a mixed-methods design with both quantitative and qualitative approaches. A baseline quantitative survey will be conducted to assess knowledge, prevalence, and determinants of CVD risk factors in a random sample of 2950 adults aged 25–64 years. A cluster randomized controlled design with pre-test will be used to assess the effects of CVD-specific interventions delivered by CHWs on reduction of blood pressure and proportion of other CVD risk factors among 516 adults with raised blood pressure from 12 randomly selected villages in Morogoro, Tanzania. Focus group discussion (FGDs) will be conducted at the end of the intervention to assess perceived quality and acceptability of CVD-specific interventions delivered by CHWs. The intervention will consist of a five-day CVD-specific training to CHWs from villages randomized to the intervention. Trained CHWs will then provide home health education and healthy lifestyle promotion for prevention of CVD risk factors, counseling about hypertension screening for early identification, and referral and linkage of individuals with elevated blood pressure to health facilities. Since intensity of the intervention is key to reinforce behavior change, CHWs will visit the participants every month for the first six months, then bi-monthly thereafter up to 12 months. Except for referral of participants with raised blood pressure identified during the baseline survey, control villages will not receive any interventions delivered by CHWs. At the end of the intervention period, an end-line survey will be conducted in both intervention and control villages to evaluate changes in knowledge, blood pressure, and proportion of other CVD risk factors. Discussion The results of this study are likely to have positive policy implications for the prevention of CVD risk factors through the use of CHWs in the provision of CVD-specific interventions, especially now that the Tanzanian government is considering implementing and scaling up a nation-wide multitask CHW cadre. Trial registration PACTR Registry, PACTR201801002959401. Registered on 10 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-2924-9) contains supplementary material, which is available to authorized users.

Background. Fibroblast growth factor-21 is an endocrine regulator with therapeutic and diagnostic potential. The levels and pattern of circulating FGF-21 have been described mainly in European and Asian populations. Given its strong association with adiposity, and the reported ethnic variabilities in body composition, examining FGF-21 in an African population is crucial. Methods. We measured levels of circulating FGF-21 in 207 overweight and obese Tanzanian males with or without type 2 diabetes mellitus (T2DM), and using statistical approaches, we explored their relationship with anthropometric and biochemical parameters. Results. Consistent with previous reports from European and Asian populations, we found higher levels of FGF-21 in people with T2DM compared to those without the disease. Based on statistical models, measures of adiposity explained up to 59% of the variability in FGF-21 levels in the circulation. Conclusion. Levels of circulating FGF-21 in overweight and obese African males are higher in T2DM and strongly correlate with measures of adiposity.

Background. Elevated blood pressure has been reported among treatment naïve HIV-infected patients. We investigated prevalence of hypertension and its associated risk factors in a HAART naïve HIV-infected population in Dar es Salaam, Tanzania.Methods. A cross-sectional analysis was conducted among HAART naïve HIV-infected patients. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. Overweight and obesity were defined as body mass index (BMI) between 25.0–29.9 kg/m2and ≥30 kg/m2, respectively. We used relative risks to examine factors associated with hypertension.Results. Prevalence of hypertension was found to be 12.5%. After adjusting for possible confounders, risk of hypertension was 10% more in male than female patients. Patients aged ≥50 years had more than 2-fold increased risk for hypertension compared to 30–39-years-old patients. Overweight and obesity were associated with 51% and 94% increased risk for hypertension compared to normal weight patients. Low CD4+ T-cell count, advanced WHO clinical disease stage, and history of TB were associated with 10%, 42%, and 14% decreased risk for hypertension.Conclusions. Older age, male gender, and overweight/obesity were associated with hypertension. Immune suppression and history of TB were associated with lower risk for hypertension. HIV treatment programs should screen and manage hypertension even in HAART naïve individuals.

Background Whilst the burden of non-communicable diseases is increasing in developing countries, little data is available on blood pressure among Tanzanian children. This study aimed at determining the blood pressure profiles and risk factors associated with elevated blood pressure among primary school children in Dar es Salaam, Tanzania. Methods We conducted a cross sectional survey among 446 children aged 6–17 years from 9 randomly selected primary schools in Dar es Salaam. We measured blood pressure using a standardized digital blood pressure measuring machine (Omron Digital HEM-907, Tokyo, Japan). We used an average of the three blood pressure readings for analysis. Elevated blood pressure was defined as average systolic or diastolic blood pressure ≥ 90th percentile for age, gender and height. Results The proportion of children with elevated blood pressure was 15.2% (pre-hypertension 4.4% and hypertension 10.8%). No significant gender differences were observed in the prevalence of elevated BP. Increasing age and overweight/obese children were significantly associated with elevated BP (p = 0.0029 and p

ObjectiveTo identify predominant dietary patterns in four African populations and examine their association with obesity.DesignCross-sectional study.Setting/SubjectsWe used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men.ResultsWe identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern’s lowest tertile (both PConclusionsWe identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.

Author(s): Ekoru, Kenneth; Young, Elizabeth H; Dillon, David G; Gurdasani, Deepti; Stehouwer, Nathan; Faurholt-Jepsen, Daniel; Levitt, Naomi S; Crowther, Nigel J; Nyirenda, Moffat; Njelekela, Marina A; Ramaiya, Kaushik; Nyan, Ousman; Adewole, Olanisun O; Anastos, Kathryn; Compostella, Caterina; Dave, Joel A; Fourie, Carla M; Friis, Henrik; Kruger, Iolanthe M; Longenecker, Chris T; Maher, Dermot P; Mutimura, Eugene; Ndhlovu, Chiratidzo E; Praygod, George; Pefura Yone, Eric W; Pujades-Rodriguez, Mar; Range, Nyagosya; Sani, Mahmoud U; Sanusi, Muhammad; Schutte, Aletta E; Sliwa, Karen; Tien, Phyllis C; Vorster, Este H; Walsh, Corinna; Gareta, Dickman; Mashili, Fredirick; Sobngwi, Eugene; Adebamowo, Clement; Kamali, Anatoli; Seeley, Janet; Smeeth, Liam; Pillay, Deenan; Motala, Ayesha A; Kaleebu, Pontiano; Sandhu, Manjinder S | Abstract: BackgroundAnti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.MethodsPooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (g2.3 mmol/L) was analysed using regression models.FindingsAmong 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.InterpretationEvidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR = 1.49, p = 0.008), NAS abuse (PR = 2.06, p = 0.02) and IPV (PR = 2.93, p p p = 0.036) were protective of NAS but current smokers (OR = 2.98, p p = 0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Background. HIV infection and long-term HAART use are associated with metabolic and morphological changes. We assessed prevalence, types, and risk factors associated with lipodystrophy among HIV-infected adults attending CTC in Dar es Salaam, Tanzania. Methods. Analysis included 466 HIV-infected patients. Study protocol involved administration of structured questionnaire to collect sociodemographic and clinical information. Diagnosis of lipodystrophy was based on physician clinical assessment. Results. Lipodystrophy was present in 95 (20.4%) of the study participants, with lipoatrophy being the most common (49.5%) followed by mixed lipodystrophy (37.9%), and lipohypertrophy was the least prevalent (12.6%). Male gender, older age, long duration on HAART, and use of Stavudine containing regimen were associated with lipodystrophy (all p<0.05). The risk for lipodystrophy was 1.6 times (AOR = 1.66, 95% CI = 1.01–2.72) for male participants and 13.3 times (AOR = 13.3, 95% CI = 6.4–27.7) for those on HAART. Long duration on HAART and use of Stavudine containing regimen were also associated with increased risk for lipodystrophy. Lipodystrophy was associated with poor perception about own body image and decreased social interactions. Conclusions. Lipodystrophy is common among HIV-infected patients in Tanzania, especially among male patients and those on HAART. Regular screening, monitoring, and patient awareness are needed for early identification and appropriate management.

Background: Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. Methods: We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individuallevel data on one or more of the following traits in HIVþ and HIV-, or ARTþ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. Results: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, 0.59; 95% CI, 0.86 to 0.31), BMI (SMD, 0.32; 95% CI, 0.45 to 0.18), SBP (SMD, 0.40; 95% CI, 0.55 to 0.25) and DBP (SMD, 0.34; 95% CI, 0.51 to 0.17). Among HIVþ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, 0.34; 95% CI, 0.62 to 0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. Conclusions: Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA. http://ije.oxfordjournals.org/ http://dx.doi.org/10.1093/ije/dyt198

We assessed the prevalence and determinants of high blood pressure (BP), and barriers to diagnosis and treatment, in Dar es Salaam, Tanzania.We surveyed and screened 2174 community-dwelling adults aged at least 40 years in 2014 and conducted a follow-up after 1 year.Median BP was 131/81 mmHg, and hypertension prevalence was 37%. Mean adjusted difference in SBP was 4.0 mmHg for overweight, 6.3 mmHg for obese class I, and 10.5 mmHg for obese class II/III compared with normal weight participants. Those who were physically inactive had 4.8 mmHg higher SBP compared with those with more than 24 h of moderate or vigorous activity per week. Drinkers of at least 10 g of alcohol per day had 4.5 mmHg higher SBP than did nondrinkers. Among hypertensive participants, 48% were previously diagnosed, 22% were treated, and 10% were controlled. Hypertensive participants without health insurance were 12% less likely to have been previously diagnosed than insured hypertensive participants. Of referred participants, 68% sought care, but only 27% were on treatment and 8% had controlled BP at follow-up. Reasons for not seeking care included lack of symptoms, cost of visit, and lack of time. Reasons for not being on treatment included lack of symptoms, not being prescribed treatment, and having finished one course of treatment.Major risk factors for hypertension in Dar es Salaam are overweight, obesity, inadequate physical activity, and limited access to quality medical care. Increased insurance coverage and community-based screening, along with quality medical care and patient education, may help control this burgeoning epidemic.

Background. Stiff porridge (ugali) made from unrefined maize flour has been a staple food in Tanzania. Recently, high intakes of refined carbohydrates and energy-dense foods have been documented in urban areas in Tanzania. We assessed cultural acceptability, perceptions and barriers to consumption of unrefined carbohydrates in Tanzania. Methods. Twelve focus group discussions (FGDs) were conducted among 44 overweight and obese adults aged 40–65 years. All FGDs were audio-recorded, and QSR N6 software was used for data analysis. Results. Most participants (77%) had tried and liked unrefined maize ugali prior to our study. For unrefined sorghum ugali, 12 participants had tried it before, and 9 of them liked it. Brown rice was found to be unpopular and was considered a diet for diabetic patients; four participants had tried it before and all reported to like it. Sensory appeal, availability, and affordability were key facilitators whereas high cost, scarcity, and negative perceptions toward whole grains were mentioned as barriers to consumption of unrefined carbohydrates. Conclusion. Our study has identified facilitators and barriers to consumption of unrefined carbohydrates in Tanzania. Educational strategies are recommended in order to increase consumption of unrefined carbohydrates and consequently reduce diet-related chronic diseases in Tanzania.

BACKGROUND Sub-Saharan Africa (SSA) has a disproportionate burden of both infectious and chronic diseases compared with other world regions. Current disease estimates for SSA are based on sparse data, but projections indicate increases in non-communicable diseases (NCDs) caused by demographic and epidemiologic transitions. We review the literature on NCDs in SSA and summarize data from the World Health Organization and International Agency for Research on Cancer on the prevalence and incidence of cardiovascular diseases, diabetes mellitus Type 2, cancer and their risk factors. METHODS We searched the PubMed database for studies on each condition, and included those that were community based, conducted in any SSA country and reported on disease or risk factor prevalence, incidence or mortality. RESULTS We found few community-based studies and some countries (such as South Africa) were over-represented. The prevalence of NCDs and risk factors varied considerably between countries, urban/rural location and other sub-populations. The prevalence of stroke ranged from 0.07 to 0.3%, diabetes mellitus from 0 to 16%, hypertension from 6 to 48%, obesity from 0.4 to 43% and current smoking from 0.4 to 71%. Hypertension prevalence was consistently similar among men and women, whereas women were more frequently obese and men were more frequently current smokers. CONCLUSIONS The prevalence of NCDs and their risk factors is high in some SSA settings. With the lack of vital statistics systems, epidemiologic studies with a variety of designs (cross-sectional, longitudinal and interventional) capable of in-depth analyses of risk factors could provide a better understanding of NCDs in SSA, and inform health-care policy to mitigate the oncoming NCD epidemic.

Aim We conducted a health survey to assess the prevalence of cardiovascular disease (CVD) risk factors and explore their socioeconomic correlates in a population of young and middle-aged men in the fast-growing city of Mwanza, Tanzania.

Background : The increase in prevalence of diabetes and pre-diabetes in sub-Saharan Africa underlines the importance of understanding its magnitude and causes in different population groups. We analyzed data from the Africa/Harvard Partnership for Cohort Research and Training (PaCT) studies to determine the prevalence of diabetes and pre-diabetes and risk factors associated with diabetes. Methodology : Participants were randomly selected from peri-urban ( n =297) and rural ( n =200) communities in Uganda, and teachers were recruited from schools ( n =229) in urban Tanzania. We used a standardized questionnaire to collect socio-demographic and self-reported disease status including diabetes status. Blood glucose was also measured after participants fasted for 8 h. We used standard protocols for anthropometric and blood pressure measurement. Results : The overall prevalence of diabetes was 10.1% and was highest in rural Ugandan residents (16.1%) compared to teachers in Tanzania (8.3%) and peri-urban Ugandan residents (7.6%). The prevalence of pre-diabetes was 13.8%. The prevalence of self-reported diabetes was low across all sites, where 68% of participants with diabetes were not captured by self-report. In multivariable logistic regression analysis, family history (OR 2.5, 95% CI: 1.1, 5.6) and hypertension (OR 2.3, 95% CI: 1.1, 5.2) were significantly associated with diabetes. Conclusions : The prevalence of diabetes and pre-diabetes in Uganda and Tanzania is high, differs markedly between population groups, and remains undiagnosed in an alarmingly high proportion of individuals. These findings highlight the need for large-scale, prospective studies to accurately quantify the burden and identify effective intervention and treatment strategies across diverse African populations. Keywords: non-communicable; risk factors; underdiagnoses; sub-Saharan Africa; Tanzania; Uganda (Published: 23 May 2016) Citation: Glob Health Action 2016, 9: 31440 - http://dx.doi.org/10.3402/gha.v9.31440

Objective : To investigate the prevalence of obesity and central adiposity and to assess if any significant relationship exists between obesity and other risk factors for cardiovascular diseases (CVD) in an African population. Methods : A cross-sectional, epidemiological study was conducted in three distinct areas: urban, rural and a pastoralist population in Tanzania. Results : The overall prevalence of obesity (body mass index (BMI)≥30 kg/m 2 ) was 14.2% and that of adiposity was 16.9%. Of the obese participants, 40.5% had reached higher education levels and 59.1% lived in the urban area. Significant hypertension (48.1%), hypercholesterolemia (32.4%), hypertriglyceridemia (20.3%), elevated LDL-C (33.8%), and hyperglycemia (4.6%) were seen among obese participants. Elevated plasma leptin concentration and low REE were observed among obese participants. Conclusion : Obesity, associated with significant biochemical derangement, is now a health problem in Tanzania. Effective strategies for primary prevention of obesity need to be introduced, especially in urban areas in Tanzania.

1. In the present study we investigated the difference in the distribution of selected cardiovascular disease risk factors among three middle-aged Tanzanian populations with different lifestyles. 2. The prevalence of hypertension and overweight was higher in urban areas than in rural areas. Plasma leptin concentration was also highest in urban areas. Based on these results, we speculated that overweight in the urban population may be partly due to adiposity. 3. Resting energy expenditure was lower in urban areas than in other areas for both genders. These findings suggest that the high prevalence of overweight in the urban population may be partly due to low physical activity levels.

The prevalence of obesity and dyslipidemia and the mean frequency of intake of selected dietary factors were studied in 545 participants aged 46-58 y and living in three areas in Tanzania. The prevalence of obesity (body mass index ofor = 30 kg/m2) was 22.5% among women and 5.4% among men, p0.001. Higher rates of obesity were observed in both men and women in an urban (U) area of Dar. The prevalence of dyslipidemia [(TC-HDL-C)/HDL-C5] among men was higher in a pastoralists (P) population of the Maasai in Monduli (22.6%) than in Dar (9.6%) and rural (R) Handeni (7.3%, p0.05). The mean resting energy expenditure (REE) was higher in subjects from the rural and pastoralists populations than in urban dwellers (0.024 kcal/min/kg, p0.001). The three areas showed different dietary patterns with subjects from the urban area consuming coconut milk (4 d/wk, p0.001) and meat (2.5 d/wk, p0.05), more often than the rural population of Handeni which had the highest consumption of green vegetables (4.2 d/wk, p0.001). Participants from Monduli had the highest consumption of milk per day (1,219 mL/d, p0.001). A simple correlation analysis showed that body mass index (BMI) correlated positively with the frequency of intake of coconut milk, fish and meat, and negatively with REE and milk consumption. Total cholesterol (TC) was negatively correlated with the frequency of intake of green vegetables, fish and the REE, and correlated positively with meat consumption and BMI in both genders. Independent of other factors, important contributors to obesity and dyslipidemia in this population were dietary factors such as meat (p0.001) and fish (p0.05), and a lower REE (p0.05). These findings suggest that unhealthy diet and lower energy expenditure are important contributors to obesity and dyslipidemia in Tanzania.

The increasing prevalence of overweight and obesity among children has become a public health concern both in developing and developed countries. Previous research studies have shown that favourable perception of one's body weight is an important factor in weight control. This study determined prevalence of overweight and obesity and assessed perception about body weight among primary schoolchildren in Dar es Salaam, Tanzania. In this cross sectional study, nine schools were selected randomly from a list of all primary schools in Dar es Salaam. A structured questionnaire was used to collect data on socio-demographic characteristics and lifestyle information including perception about body weight. Height and weight were measured following standard procedures. Chi- square tests and multiple logistic regressions were used to determine factors which influence perceptions about body weight. A total of 446 children were included into the study. The mean body mass index (BMI) was 16.6 ± 4.0 kg/m2 (16.1 ± 4.0 for males and 17.0 ± 4.0 for females). Prevalence of overweight and obesity was 9.8% and 5.2%, respectively. The prevalence of overweight and obesity was significantly higher among girls, 13.1% and 6.3% compared to boys with 6.3% and 3.8% overweight and obese respectively (P=0.0314). Overall, the prevalence of overweight and obesity was 15.0% (10.1% among boys and 19.4% among girls). One-third (33.3%) of the children perceived their body weight as overweight or obese. Among overweight and obese children, 35.4% had unfavourable perception of their body weights. There was a statistically significant difference between perceived body weight and actual body weight as indicated by BMI for both boys and girls (P < 0.05). Age of the child (AOR = 0.55 95% CI 0.36-0.85) and area of residence (COR = 0.64 95% CI 0.44-0.95) were found to be significant predictors of favourable perception of one's body weight. In conclusion, the prevalence of overweight and obesity is not very high in this population. However over a third of overweight and obese children, had unfavourable perception of their body weights. We recommend targeted educational programmes about overweight and obesity and the associated health effects in order to instil a behaviour of self consciousness on overweight and obesity among children in Tanzania.

Background. With the rapid rollout of antiretroviral therapy (ART) in sub-Saharan Africa (SSA), there has been an increasing concern about cardiovascular risks related to ART. However, data from human immunodeficiency virus (HIV)–infected populations from this region are very limited. Methods. Among 6385 HIV-infected adults in Dar es Salaam, Tanzania, we investigated the nonfasting lipid changes over 3 years following ART initiation and their associations with different first-line ART agents that are commonly used in SSA. Results. In the first 6 months of ART, the prevalence of dyslipidemia decreased from 69% to 54%, with triglyceride (TG) decreasing from 127 mg/dL to 113 mg/dL and high-density lipoprotein (HDL) cholesterol increasing from 39 mg/dL to 52 mg/dL. After 6 months, TG returned to its baseline level and increased to 139 mg/dL at 3 years; total cholesterol and low-density lipoprotein cholesterol continued to increase whereas HDL cholesterol leveled off. The prevalence of dyslipidemia increased to 73% after a 3-year follow-up. In multivariate analyses, patients on zidovudine-containing regimens had a greater reduction in TG levels at 6 months (−16.0 vs −6.3 mg/dL), and a lower increase at 3 years compared to patients on stavudine-containing regimens (2.1 vs 11.7 mg/dL, P< .001); patients on nevirapine-based regimens had a higher increase in HDL cholesterol levels at 3 years compared to those on efavirenz-based regimens (13.6 vs 9.5 mg/dL, P= .01). Conclusions. Our findings support the latest World Health Organization guidelines on the substitution of stavudine in first-line ART in resource-limited settings, and provide further evidence for selection of lipid-friendly ART for patients in SSA.

Background. Prevalence of obesity is increasing throughout the world at an alarming rate. Appropriate perception of one’s own body weight is important for improved weight control behavior. This study was conducted to determine the prevalence of overweight and obesity and assess perception of body weight among middle aged adults in Dar es Salaam, Tanzania. Methods. Structured questionnaire was used to collect sociodemographic and lifestyle information including perception about body weight. Anthropometric measurements were taken by a trained person following standard procedures. Results. Prevalence of obesity was 13% and 36% among men and women, respectively. There was significant gender difference in perception of body weight (12% and 25% of men and women perceived their body weight as overweight). Only 2% of women perceived themselves as obese whereas none of the men did so. Among overweight men, only 22% perceived themselves as overweight/obese compared to 38% of overweight women who perceived themselves as overweight/obese. Overall, majority of the participants (87%) were willing to lose weight. Conclusions. There is a great difference between perceived and actual body weight with men underestimating their body weight more than women. Educational programs regarding overweight and obesity and the associated health consequences are highly recommended in Tanzania.

Limited data are available on dyslipidemia in HIV-infected patients in resource-limited settings. We performed a cross-sectional analysis in antiretroviral therapy (ART)-naive, non-fasting HIV-infected patients in Tanzania between November 2004 to June 2008. Robust linear regression modeling was performed. Lipid parameters were assessed in 12,513 patients [65% women; median (interquartile range) age, 36 (30-42) years; CD4 count, 143 (51-290) cells/mm]. Low high-density lipoprotein was prevalent in 67% and increased triglyceride in 28%. High triglyceride and low high-density lipoprotein levels were associated with low CD4 counts (P < 0.001). In this ART-naive Tanzanian population, dyslipidemia was highly prevalent and associated with advanced disease. The impact of ART on these changes requires further exploration.

A new chromone derivative named terminalianone (1) was isolated from the African plant, Terminalia brownii Fresen (Combretaceae) in Tanzania. Its structure was determined to be 7-hydroxy-3-[6′-hydroxyphenyl-2′-oxo-ethyl]chromone by FAB-MS and NMR spectral data.

To investigate the effects of daily supplementation with docosahexaenoic acid (DHA) on coronary heart disease risks in 38 middle-aged men with hypertension and/or hypercholesterolemia in Scotland, a five-week double-blind placebo-controlled dietary supplementation with either 2 g of DHA or active placebo (1 g of olive oil) was conducted. Percent composition of DHA in plasma phospholipids increased significantly in DHA group. Systolic and diastolic blood pressure and heart rate decreased significantly in DHA group, but not in placebo group. High-density lipoprotein cholesterol (HDL-C) increased significantly, and total cholesterol (TC)/HDL-C and non-HDL-C/HDL-C ratios decreased significantly in both groups. There was no change in TC and non-HDL-C. We conclude that 2 g/day of DHA supplementation reduced coronary heart disease risk factor level improving blood pressure, heart rate, and lipid profiles in hypertensive, hypercholesterolemic Scottish men who do not eat fish on a regular basis.

The purpose of this cross-sectional study was to investigate the association of periodontitis and/or tooth loss with hypertension by excluding the common confounders. Eighty-one Tanzanian women who were aged 46–58 years, nonsmokers, nonalcoholic drinkers, and on no medication underwent clinical examination. Multiple-regression analysis showed that the severity of periodontitis was significantly correlated with increased systolic blood pressure and diastolic blood pressure. Simple-regression analysis indicated that the severity of periodontitis was inversely correlated with 24-hour urinary excretion of potassium (r=-0.579,P=0.0004) and also inversely with the frequency of intakes of green vegetables (r=-0.232,P=0.031) and fruits (r=-0.217,P=0.0043). Low-potassium intake in the diet mostly accompanied by low dietary fiber intake increases BP as well as periodontal inflammation. Potassium intake may be an important factor linking periodontitis and hypertension in middle-aged nonsmoking and nonalcoholic women on no medication, although chronic inflammation such as periodontitis may cause hypertension through a more direct mechanism.

Michelle Holmes and colleagues argue that there is an urgent need for longitudinal cohorts based in sub-Saharan Africa to address the growing burden of noncommunicable diseases in the region.

Background Prevalence of metabolic syndrome (MS) is rapidly increasing worldwide. To investigate the spread of MS risks and its relationship with eating habits including fish intake, we carried out a health examination for young and middle-aged men. Methods The subjects were 97 healthy men (20 to 50 years) living in Mwanza, located on the shore of Lake Victoria in Tanzania. The health examination was conducted according to the basic protocol of WHO-CARDIAC (Car diovascular Di seases and A limentary C omparison) Study. This survey included anthropometric measurements, a dietary questionnaire, blood pressure measurement, and blood and 24-hour urine (24U) collection. Excretions of sodium, potassium and taurine (Tau) in 24U were estimated as the biomarkers of salt, vegetable and fish product intakes respectively. Results In this survey, 62.5 % of the young and 63.3% of the middle-aged adults had MS risks. The most prevalent MS risk factor was increased blood pressure (50.0% of young adults and 53.1% of the middle-aged). Tau excretions in 24U and n-3 fatty acid levels in plasma were significantly lower in young adults than those in the middle-aged (both P < 0.05). The eating frequencies of non-traditional foods such as donuts and ice cream showed negative correlations with age (r = -0.282, P < 0.01 and r = -0.246, P < 0.05), while salt intake positively correlated with age (r = 0.236, P < 0.05). Tau excretion in 24U was inversely correlated with atherosclerosis index (r = -0.306, P < 0.01) and fasting blood glucose (r = -0.284, P < 0.05). Conclusions Young adults in Mwanza had a decreased frequency of eating habit of fish products compared with the middle-aged as indicated by Tau excretion in 24U and n-3 fatty acid level in the plasma, and over half of young adults had one or more MS risks just as the middle-aged. The change in food habit of lowered fish intake and raised exotic food intake might be concluded to increase MS risks in young men.

Background Urban areas in Africa suffer a serious problem with dual burden of infectious diseases and emerging chronic diseases such as cardiovascular diseases (CVD) and diabetes which pose a serious threat to population health and health care resources. However in East Africa, there is limited literature in this research area. The objective of this study was to examine the prevalence of cardiovascular disease risk factors and their correlates among adults in Temeke, Dar es Salaam, Tanzania. Results of this study will help inform future research and potential preventive and therapeutic interventions against such chronic diseases. Methods The study design was a cross sectional epidemiological study. A total of 209 participants aged between 44 and 66 years were included in the study. A structured questionnaire was used to evaluate socioeconomic and lifestyle characteristics. Blood samples were collected and analyzed to measure lipid profile and fasting glucose levels. Cardiovascular risk factors were defined using World Health Organization criteria. Results The age-adjusted prevalence of obesity (BMI ≥ 30) was 13% and 35%, among men and women (p = 0.0003), respectively. The prevalence of abdominal obesity was 11% and 58% (p < 0.0001), and high WHR (men: >0.9, women: >0.85) was 51% and 73% (p = 0.002) for men and women respectively. Women had 4.3 times greater odds of obesity (95% CI: 1.9–10.1), 14.2–fold increased odds for abdominal adiposity (95% CI: 5.8–34.6), and 2.8 times greater odds of high waist-hip-ratio (95% CI: 1.4–5.7), compared to men. Women had more than three-fold greater odds of having metabolic syndrome (p = 0.001) compared to male counterparts, including abdominal obesity, low HDL-cholesterol, and high fasting blood glucose components. In contrast, female participants had 50% lower odds of having hypertension, compared to men (95%CI: 0.3–1.0). Among men, BMI and waist circumference were significantly correlated with blood pressure, triglycerides, total, LDL-, and HDL-cholesterol (BMI only), and fasting glucose; in contrast, only blood pressure was positively associated with BMI and waist circumference in women. Conclusion The prevalence of CVD risk factors was high in this population, particularly among women. Health promotion, primary prevention, and health screening strategies are needed to reduce the burden of cardiovascular disease in Tanzania.

Background : Large prospective epidemiologic studies are vital in determining disease etiology and forming national health policy. Yet, such studies do not exist in sub-Saharan Africa (SSA) notwithstanding the growing burden of chronic diseases. Objective : We explored the feasibility of establishing a large-scale multicountry prospective study at five sites in four sub-Saharan countries. Design : Based on country-specific considerations of feasibility, Nigeria enrolled health care professionals, South Africa and Tanzania enrolled teachers, and Uganda enrolled village residents at one rural and one periurban site each. All sites used a 6-month follow-up period but different approaches for data collection, namely standardized questionnaires filled out by participants or face-to-face interviews. Results : We enrolled 1415 participants from five sites (range 200–489) with a median age of 41 years. Approximately half had access to clean-burning cooking fuel and 70% to piped drinking water, yet 92% had access to a mobile phone. The prevalence of chronic diseases was 49% among 45- to 54-year-olds and was dominated by hypertension (21.7% overall) – ranging from 4.5 to 31.2% across sites – and a serious injury in the past 12 months (12.4% overall). About 80% of participants indicated willingness to provide blood samples. At 6-month follow-up, 68% completed a questionnaire (45 to 96% across sites) with evidence that mobile phones were particularly useful. Conclusions : Our pilot study indicates that a large-scale prospective study in SSA is feasible, and the burden of chronic disease in SSA may already be substantial necessitating urgent etiologic research and primary prevention. Keywords: non-communicable; chronic disease; injury; South Africa; Nigeria; Tanzania; Uganda (Published: 25 May 2015) Citation: Glob Health Action 2015, 8 : 27422 -http://dx.doi.org/10.3402/gha.v8.27422

To compare dietary habits and percent compositions of omega (omega)-3 fatty acid (FA) in plasma phospholipids and to examine if there is any association between fish intake and selected coronary disease risk (CHD) factors in this population.Cross sectional population study.Three areas in Tanzania: urban Dar es Salaam (D), rural Handeni (H) and pastoralist population of Maasai in Moduli (Mo).One hundred and five participants (Dar 36, Handeni 37 and Monduli 32) aged 47-57 years.Fatty acids composition in plasma phospholipids.The frequency of intake of fish, meat, coconut milk and fruits was higher in Dar than in Handeni or Monduli (all p0.0001). The Maasai from Monduli had the highest percentage consumption of milk in a week (p0.0001) and lowest intake of fish (p0.0001). Participants from Handeni had the highest prevalence of consumption of green vegetables (p0.0001). Percent compositions of arachidonic acid (AA; C20: 4omega-6) and docosahexaenoic acid (DHA; C22: 6omega-3) in plasma phospholipids were the lowest in Monduli (p0.0001). Selected coronary disease risk factors were higher in the urban area Dar. The frequency of intake of fish per week correlated negatively with total cholesterol (TC) and LDL-C and HBA1c percent but not with blood pressure. The percent composition of omega-3 FA in plasma phospholipids was positively correlated with the frequency of intake of fish a week.Our results indicate that, there are significant differences in dietary patterns among the three study areas, and that the intake of fish is inversely associated with selected risk factors for coronary heart disease.

It has recently been reported that the major green tea polyphenolic constituent, epigallocatechin 3-gallate (EGCG), mimics the cellular effects of insulin including the reductive effect on the gene expression of rate-limiting gluconeogenic enzymes in a cell culture system. We show that administration of green tea that contains EGCG caused a reduction in the level of mRNAs for gluconeogenic enzymes, phosphoenolpyruvate carboxykinase and glucose-6-phosphatase in the mouse liver. EGCG alone was also found to down-regulate the gene expression of these enzymes but not so curcumin or quercetin. The results of this study support the idea that green tea intake may be beneficial in the prevention of diabetes mellitus.

Oxidative stress was reported to be involved not only in cardiovascular diseases, but also in hypertension. Epidemiologic studies indicated that tea consumption slightly reduces blood pressure. We conducted two studies to determine whether black and green tea can lower blood pressure (BP) in stroke-prone spontaneously hypertensive rats (SHRSP). Male SHRSP (n=15) were allowed to recover for 2 wk after a transmitter for measuring BP was implanted in the peritoneal cavity. The rats were divided into three groups: the control group consumed tap water (30 mL/d); the black tea polyphenol group (BTP) consumed water containing 3.5 g/L thearubigins, 0.6 g/L theaflavins, 0.5 g/L flavonols and 0.4 g/L catechins; and the green tea polyphenol group (GTP) consumed water containing 3.5 g/L catechins, 0.5 g/L flavonols and 1 g/L polymetric flavonoids. The telemetry system was used to measure BP, which were recorded continuously every 5 min for 24 h. During the daytime, systolic and diastolic BP were significantly lower in the BTP and GTP groups than in the controls. Protein expressions of catalase and phosphorylated myosin light chain (MLC-p) were measured in the aorta by Western blotting. GTP significantly increased catalase expression, and BTP and GTP significantly decreased MLC-p expression in the aorta. These data demonstrate that both black and green tea polyphenols attenuate blood pressure increases through their antioxidant properties in SHRSP. Furthermore, because the amounts of polyphenols used in this experiment correspond to those in approximately 1 L of tea, the regular consumption of black and green tea may also provide some protection against hypertension in humans.

To examine the determinants for elevated plasma leptin concentration in normal weight (NW), obese (OB), and morbidly obese (MO) individuals in Tanzania.Cross-sectional epidemiological study, the CARDIAC study.Three areas in Tanzania; Dar es Salaam, urban (U), Handeni, rural (R) and Monduli, pastoralists (P), in August 1998.Five hundred and forty five participants from a random sample of 600 people aged 46-58 years.Plasma leptin concentrations, height, weight, body mass index (BMI), lipid profiles, haemoglobin A1c (HBA1c), and blood pressure (BP).Plasma leptin concentrations were higher in women than in men (women; 16.0 ng/mL, men; 3.1 ng/mL; p0.0001). Women showed a higher mean body mass index (BMI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) than men. In both genders, plasma leptin concentration, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), systolic BP (SBP) and diastolic BP (DBP) were significantly higher in OB than in NW participants. MO women had significantly higher leptin concentration, SBP and DBP compared with the other two groups. In NW men, log leptin concentrations showed a direct correlation with weight, BMI, HBA1c, TC, LDL-C, TG, SBP and DBP (all p0.0001 except TG; p0.001), while among NW women and OB men, weight and BMI correlated positively with log leptin (all p0.05). OB women observed a positive correlation between log leptin and weight, BMI and LDL-C. Regression analysis indicated that among NW subjects, gender, BMI and TC explained 53.9% of the variation in log leptin. In OB subjects, gender, BMI and LDL-C explained 51.7% of the variability in leptin levels. No relationship was found between log leptin and CVD risk factors among MO subjects.The most important determinants for hyperleptinaemia in NW participants were gender, BMI, TC, while in addition to these LDL-C, was an important determinant of leptin concentration in OB individuals. In MO women, the high leptin concentrations did not reflect the amount of adipose stores.

To assess the relationship between dietary factors and cardiovascular (CVD) risk factors in middle-aged men and women, in urban, rural and pastoral settings in Tanzania.Cross-sectional epidemiological study designed according to the protocol of the World Health Organisation (WHO) Cardiovascular Diseases and Alimentary Comparison (CARDIAC) study.Three centres in Tanzania, namely Dar es Salaam (urban), Handeni (rural) and Monduli (pastoral population).The subjects, aged 47-57 years, were recruited randomly from administrative lists available from each centre.Blood pressure (BP) was measured using a centrally calibrated automatic BP machine (Khi machine). Dietary history of the participants was obtained using a standard questionnaire designed on the basis of a seven-day recall system. Height, weight, serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDLC), haemoglobin A1c, sodium, potassium and magnesium were measured.The prevalence of hypertension (BPor = 140/90 mmHg or antihypertensive drug use), obesity (body mass index (BMI)or = 30 kg/m2) and hypercholesterolaemia (TC5.2 mmol/l) were lowest in the rural area. Consumption of green vegetables, milk, coconut milk, meat, and fish varied significantly between the three areas. Important determinants for BP among men were BMI (p0.001), and salt intake (p0.05). Among women, TC (p0.05), age (p0.05), BMI (p0.001) and coconut milk consumption (p0.001) were important BP determinants. Salt intake was positively associated with systolic BP (SBP) and diastolic BP (DBP) in men but not among women (both SBP and DBP p0.05 respectively). Dietary determinants of serum TC were meat, fish and green vegetable consumption.Differences in dietary habits contributed significantly to the urban-rural-pastoral variations in CVD risk pattern in Tanzania.

Background: Childhood obesity has increased over the past two decades. Child obesity is likely to persist through adulthood and increases the risk of non-communicable diseases (NCDs) later in life. This study assessed knowledge and attitudes towards obesity among primary school children in Dar es Salaam, Tanzania. Materials and Methods: A cross-sectional study was conducted in randomly selected primary schools in Dar es Salaam. A structured questionnaire was used to assess the knowledge and attitudes. Anthropometric and blood pressure measurements were taken using standard procedures. Results: A total of 446 children were included in the analysis. The mean age of the participants was 11.1 ± 2.0 years. The mean body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 16.6 ± 4.0 kg/m 2 , 103.9 ± 10.3 mmHg and 65.6 ± 8.2 mmHg, respectively. Prevalence of obesity (defined as BMI >95 th percentile for age and sex) was 5.2%. Half of the children (51.1%) had heard about obesity from teachers at school (20%), radio (19.4%) and books/newspaper (17.3%). Less than half (45.4%) had knowledge about the risk factors for childhood obesity and correctly defined obesity (44.6%). However, a good number of the children (72.1%) were aware that they can be affected by obesity. Majority of them had negative attitude towards obesity and various factors leading to or resulting from childhood obesity. Conclusions: Knowledge about childhood obesity among primary school children is moderate and have negative attitude towards obesity. Integrating educational programs early in primary schools may be an effective strategy to impact knowledge about obesity and other non-communicable diseases early in childhood.

To examine the relationship between obesity and lipid profiles and to compare the effects of total obesity and central adiposity on lipids in three locations in Tanzania.Cross-sectional epidemiological study.Three areas in Tanzania: Dar es Salaam (urban), Handeni (rural) and Monduli (pastoralists), in August 1998.Five hundred and forty five men and women from a random sample of 600 people aged 46-58 years.Mean BMI, waist circumference, WHR, TC, HDL-C, LDL-C, TG and LDL/HDL ratio. Prevalence rates of overweight,obesity, central obesity and dyslipidaemia.As compared to men, women had higher BMI (24.7 versus 22.5 kg/m2, p0.0001), waist circumference (92.4 versus 89.1 cm, p0.05), TC (4.9 versus 4.2 mmol/L, p0.0001) and LDL-C (3.3 versus 2.6 mmol/L, p0.0001). The urban population demonstrated higher levels of lipid factors than the rural population (TC, men 4.8 mmol/L; women 5.3 mmol/L, p0.0001; TG, men 3.6 mmol/L; women 3.7 mmol/L, p0.0001, LDL-C, men 2.8 mmol/L, p0.0001). BMI and waist circumference correlated positively with serum TC, TG, and LDL-C in both genders. Stepwise regression analysis showed that BMI predicted triglyceride concentration in men (p0.05) and women (p0.0001). Waist circumference predicted levels of TC in women only (p0.0001) and of LDL-C in both genders (men p0.05, women p0.0001). The prevalence of overweight, obesity and central obesity were significantly higher in urban than in rural areas in both men and women. Compared to lean subjects, obese men and women had significantly higher mean serum TC, TG, LDL-C and a higher prevalence of dyslipidaemia. The mean levels of TC, TG and LDL cholesterol increased across successive increases in BMI and waist circumference quintiles in both genders.Subjects from the urban area had greater lipid abnormalities related to obesity than those from the rural area and that, central adiposity had a greater effect on total cholesterol and LDL cholesterol among women than was BMI.

In this assessment of cardiovascular risk factors, we examined the prevalence of selected risk factors according to the World Health Organisation (WHO) CARDIAC Study protocol and compared them with a similar study conducted more than a decade ago. The survey was carried out in Dar es Salaam (D, urban), Handeni (H, rural) and Monduli (Mo, semi-nomadic area). Subjects aged 47-57 were recruited randomly for blood pressure and anthropometrical measurements, 24 h urine collection and blood sampling. A structured questionnaire was used to obtain dietary information. The 1998 survey studied 446 subjects, while the 1987 survey included 496 men and women. The measured weight, body mass index (BMI) and prevalence of obesity (BMIor = 30 kg/m(2)) increased significantly among women in the 1998 survey in rural Handeni and urban Dar. The overall prevalence of obesity was higher for women in the most recent survey (22.8%, P0.0001). Diastolic blood pressure (DBP) was higher in the most recent survey for women in Handeni. The overall prevalence of hypertension (blood pressure160/95 mmHg, or antihypertensive drug use), rose to 41.1% in 1998, (P0.001) for men and to 38.7% (P0.05) for women. The mean total serum cholesterol and prevalence of hypercholesterolaemia increased significantly in the most recent survey in the three studied areas. The overall prevalence of hypercholestrolaemia (serum cholesterol5.2 mmol/l) was higher in the 1998 survey for both men (21.8%, P0.0001) and women (54.0%, P0.0001). The mean HDL cholesterol increased significantly in the most recent survey, with a significant reduction in the mean atherogenic index, though these were still at higher levels (men 5.8, P0.0001; women 5.1, P0.0001 vs. 1987). A strong positive correlation was observed between blood pressure (SBP and DBP) and body mass index, total serum cholesterol and sodium to potassium ratio. These data suggest that for the past decade there has been an increase in the mean levels and prevalence of selected cardiovascular risk factors in Tanzania.