Background 
Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa.


Methods 
We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies.


Findings 
We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results.


Conclusion 
The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities.

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Hypertension in older adults in Africa: A systematic review and meta-analysis.

Behavioral factors influencing childhood obesity: a systematic review and meta-analysis.

Studies have shown that products resulting from oils heated for long periods under high temperatures contain polar compounds such as polymers, dimers, free fatty acids, and acrylamide, which lead to metabolic changes, malabsorption of essential fat, and development of cancer. The air frying process is capable of reaching the characteristic color and similar flavor obtained by deep fat frying, and reduces the amount of oil content and polar compounds. However, it has not been extensively studied and should receive a greater focus on the detailed evaluation of components and properties of foods and the effects on the human health.

Frying Process: From Conventional to Air Frying Technology

Background Hypertension is a major health problem in Ghana, being a leading cause of admissions and deaths in the country. In the context of a changing food and health policy environment, we undertook a systematic review (PROSPERO registration number: CRD42020177174) and a meta-analysis of the prevalence of adult hypertension, and its awareness and control in Ghana. Methods We searched major databases including PubMed, Embase as well as Google Scholar and online digital collections of public universities of Ghana to locate relevant published and unpublished community-based articles up till April 2020. Findings Eighty-five articles involving 82,045 apparently-healthy subjects aged 15–100 years were analyzed. In individual studies, the prevalence of hypertension, defined in most cases as blood pressure ≥ 140/90 mmHg, ranged from 2.8% to 67.5%. The pooled prevalence from the meta-analysis was 27.0% (95% CI 24.0%-30.0%), being twice as high in the coastal (28%, 95% CI: 24.0%-31.0%) and middle geo-ecological belts (29%, 95% CI: 25.0%-33.0%) as in the northern belt (13%, 95% CI: 7.0%-21.0%). The prevalence was similar by sex, urban-rural residence or peer-review status of the included studies. It did not appear to vary over the study year period 1976–2019. Of the subjects with hypertension, only 35% (95% CI: 29.0%-41.0%) were aware of it, 22% (95% CI: 16.0%-29.0%) were on treatment and 6.0% (95% CI: 3.0%-10.0%) had their blood pressure controlled. Sensitivity analyses corroborated the robust estimates. There was, however, high heterogeneity (I2 = 98.7%) across the studies which was partly explained by prevalent obesity in the subjects. Conclusion More than one in four adults in Ghana have hypertension. This high prevalence has persisted for decades and is similar in rural and urban populations. With the low awareness and poor control of hypertension, greater investments in cardiovascular health are required if Ghana is to meet the global target for hypertension.

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Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis.

Objectives 
As an emerging middle-income country, Indonesia is grappling with the double burden of malnutrition across all age groups, including adolescents. Slow gains in reducing undernutrition are compounded by rapidly increasing overnutrition. This study aims to determine the patterns and determinants of this double burden, particularly stunting, thinness and overweight, among adolescent girls and boys aged 12–18 years in Indonesia.


Methods 
A cross-sectional survey was conducted among 2,160 girls and boys in the districts of Klaten and Lombok Barat in 2017. Data were collected on adolescents’ nutritional status, sociodemographic characteristics, morbidity, dietary intake and physical activity and other relevant factors. Multivariable logistic regression models using generalized estimation equation were employed to determine risk factors for stunting, thinness and overweight.


Results 
About a quarter of adolescent girls (25%) and boys (21%) were stunted. Approximately 5% of girls and 11% of boys were thin, whereas 11% girls and boys each were overweight. Living in a higher wealth household (OR = 0.67; 95% CI: 0.49–0.91), compared to a lower wealth household, and living in a district with higher socioeconomic status (OR = 0.63; 95% CI: 0.51–0.79) were associated with lower odds of being stunted. Adolescent education was also protective against stunting (OR = 0.52; 95% CI: 0.33–0.88). Older adolescents aged 15–18 years were more likely to be stunted (OR = 1.88; 95% CI: 1.42–2.46). Being a girl was associated with reduced odds of being thin (OR = 0.42; 95% CI: 0.30–0.58). Higher household wealth (OR = 1.93; 95% CI: 1.27–2.97) predicted being overweight, while maternal primary or some secondary education, compared to no or incomplete primary education, was protective against adolescent overweight (OR = 0.60; 95% CI: 0.40–0.90).


Conclusion 
Indonesian adolescent girls and boys face both extreme spectrums of malnutrition. Addressing the dual burden of malnutrition requires a multi-pronged approach, and urgent shift is warranted in nutrition policy and programmes targeting adolescents to effectively address the associated underlying determinants.

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Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia

Childhood overnutrition is a serious public health problem, with consequences that extend into adulthood. The aim of this study was to determine the prevalence and determinants of overweight and obesity among school-age children in two urban settings in Ghana. This cross-sectional study involved 3089 children (9–15 years) recruited between December 2009 and February 2012 in Accra and Kumasi, Ghana. Socio-demographic, dietary, and physical activity data were collected using pretested questionnaires. BMI-for-age z-scores were used to categorize anthropometric data of the children as thin, normal, or overweight/obese. Determinants of overweight were examined using multiple logistic regressions. Seventeen percent of children were overweight or obese. Children who reported lower participation (< 3 times/week) in sports activity were 44% more likely to be overweight or obese (AOR = 1.44; 95% CI: 1.07, 1.94). Maternal tertiary education (AOR = 1.91, 95% CI: 1.07, 3.42), higher household socioeconomic status (AOR = 1.56, 95% CI: 1.18, 2.06), and attending private school (AOR = 1.74, 95% CI: 1.31, 2.32) were also associated with elevated risk of overweight and obesity. Physical inactivity is a modifiable independent determinant of overweight or obesity among Ghanaian school-aged children. Promoting and supporting a physically active lifestyle in this population is likely to reduce risk of childhood overnutrition.

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Prevalence and predictors of overweight and obesity among school-aged children in urban Ghana.

Dyslipidemia during childhood has been associated with higher risk of atherosclerosis later in life. Information on the lipid profile of Ghanaian children is scarce. The aim of this study was to assess the lipid profiles of school children between the ages of 9–15 years, living in urban Ghana. A total of 802 randomly selected school-age children participated in the Ghana School Survey implemented in Kumasi and Accra, Ghana. A structured questionnaire was used to collect information on child and maternal socio-demographic characteristics (including age, education, and occupation), 7-day food frequency, home and school activity, as well as measurement of weight and standing height. Weight, height, and age data were converted into BMI-for-age indices to determine weight status. Finger-prick fasting blood samples were taken from the school-age children. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol levels were determined using the CardioChek® PA Test System. Reference lipid levels based on the US National Cholesterol Education Program 2001 guidelines were used to determine the proportion of children with dyslipidemia. The mean TC, LDL-C, HDL-C, and TG levels were 149.0 ± 57.0 mg/dl, 80.1 ± 38.6 mg/dl, 53.5 ± 19.4 mg/dl, and 71.4 ± 54.7 mg/dl, respectively. Mean TC/HDL-C ratio was 3.0 ± 1.0. The proportion of children with abnormal values were 12.1% for TC, 4.5% for TG, 28.4% for HDL-C, 9.2% for LDL-C, and 6.6% for TC/HDL-C ratio. The levels of dyslipidemia (HDL, LDL, and TC/HDL-C ratio) were higher among overweight/obese compared to normal-weight children. More frequent fruit consumption was also linked with lower LDL-C (p = 0.020) while watching television (TV) in the mornings was linked with both higher TC (p = 0.011) and TG (p = 0.006). Majority of urban-dwelling Ghanaian school children had normal lipid profiles. However, the higher levels of dyslipidemia observed among overweight and obese children suggest the need for population level physical activity and dietary interventions among children to reduce risk of cardiovascular diseases in adult life.

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Lipid profile and dyslipidemia among school-age children in urban Ghana.

Anemia remains a serious public health concern, globally, affecting learning ability and physical development of children. Anemic children are at a higher risk of diminished economic productivity and low earning capacity in adulthood due to impaired school performance and reduced work capacity. Anemia contributes to about a quarter of Africa’s nutrition-related Disability Adjusted Life Years. The objective of this study was to determine the prevalence of anemia and its associated risk factors among school-aged children (SAC) between ages 9 and 15 years in urban Ghana. The analysis included a randomly selected subsample of 1,634 children from a larger study on nutrition of SAC enrolled between 2009 and 2012 in private and public basic schools in the Accra and Kumasi Metropolis in Ghana. Socio-demographic and household characteristics were collected with questionnaires. Weight and height were taken to the nearest 0.1kg and 0.1cm, respectively. Dietary information was collected using a food frequency questionnaire. Data were analyzed using IBM SPSS Statistic version 23. The relationship between hemoglobin levels and socio-demographic variables, and predictors of hemoglobin levels were determined using Chi-square and binary logistic regression. The mean hemoglobin concentration of the study participants was 12.9±1.3 g/dL. In Kumasi, SAC had higher mean hemoglobin concentration (13.1±1.2 g/dL) compared to those from Accra (12.6±1.3 g/dL; p=0.001). Mean hemoglobin concentration was significantly higher among males than females (13.0±1.4 g/dL vs 12.8±1.2 g/dL; p=0.002). Prevalence of anemia was 20.4%; mild anemia was most common (13.6% of total sample). Anemia cases were higher in public schools (24.6%) compared to private (18.2%). Two-thirds of anemia cases (64.0%) were from schools in Accra. Males had significantly higher prevalence of anemia (26.5%) than females (15.9%; p <0.05). In the adjusted logistic regression model, only city of residence (OR+1.65, 95% CI: 1.44–1.83), thinness (OR=2.60, 95% CI: 1.11-5.75), stunting (OR=1.85, 95% CI: 1.99-3.10) and overweight (OR=0.60, 95% CI: 0.36-0.94) were significantly associated with anemia. In this study, anemia was significantly associated with location and nutritional status. Key words: anemia, Ghana, hemoglobin, schoolchildren, urban settings, metropolis, Accra, Kumasi

/pdf/anemia-prevalence-and-associated-factors-among-school-age-2ccntxq5.pdf

Helena Nti

Papers

Prevalence and predictors of overweight and obesity among school-aged children in urban Ghana.

Lipid profile and dyslipidemia among school-age children in urban Ghana.

Anemia prevalence and associated factors among school-age children in Accra and Kumasi metropolis in Ghana