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Objective: To identify predominant dietary patterns in four African populations and examine their association with obesity.Design: Cross-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.Results: We 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 P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity.Conclusions: We 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. [ABSTRACT FROM AUTHOR]

Objective: Home management of malaria (HMM) strategy was based on presumptive diagnosis of malaria and use of correct dose of chloroquine. However, the development of chloroquine resistant parasites in most endemic areas necessitated the recommendation of artemisinin combination therapy (ACT); and this has been demonstrated to be effective in HMM. However, the recommendation that ACT should be dispensed only to laboratory confirmed cases underscores the need to review the accuracy of mothers' presumptive diagnosis and provide evidence for a switch to parasite based diagnostic test. Methods: This was a follow-up study nested to a larger controlled intervention study carried out to assess the effect a malaria treatment guideline on mothers' adherence to correct treatment of malaria in children. In a subset, thick blood smears were prepared from finger prick blood samples of febrile children who have been presumptively diagnosed to have malaria by mothers on Days 0, 1, 2, 3, 7 and 14 to detect parasitaemia. The presumed diagnosis was compared with the presence of parasitaemia. Results: A total of 162 children with febrile illness (88 and 74 in intervention and control groups respectively) were studied. Sixty-four (72.7%) and 62 (83.8%) of the febrile cases presumed to have malaria in the intervention and control groups respectively had parasitaemia on Day 0. The sensitivity and specificity of mothers' diagnoses was 78.1% and 29.2%; 82.3% and 8.3%; in the intervention and control groups respectively. Conclusion: The low specificity of presumptive diagnosis has implication for the deployment of ACT at the community level in Nigeria. This supports current views on the need for a more sensitive and specific parasite-based diagnosis of malaria before ACT treatment. Further study to compare presumptive diagnosis of malaria with malaria diagnostic test carried out at the community level is needed to inform policy on the adoption of parasite based malaria diagnosis at community level. [ABSTRACT FROM AUTHOR]

Background: The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated. Methods: A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6-59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs. Results: Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86-97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74-97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 77%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported. Conclusion: ACTs can be successfully integrated into the HMM strategy. [ABSTRACT FROM AUTHOR]