David Mulenga

Prevalence and correlates of obesity among Lusaka residents, Zambia: a population-based survey

Background Non-communicable lifestyle diseases are a growing public health concern globally. Obesity is a risk factor for premature mortality from cardiovascular diseases and diabetes as well as all-cause mortality. The objective of the study was to estimate the prevalence and associated factors for obesity among Zambian adults in Lusaka district. Methods A community-based study was done among adults in Zambia. Descriptive and co-relational analyses were conducted to estimate the prevalence of being obese as well as identify associated factors. Results A total of 1,928 individuals participated in the survey, of which 33.0% were males. About half of the participants were aged 25–34 years (53.2%), and about two-thirds had attended at least secondary level of education (63.9%). Overall, 14.2% of the participants (5.1% of males, and 18.6% of females) were obese. Significant factors associated with obesity were sex, age, education, cigarette smoking and blood pressure. Male participants were 55% (AOR = 0.45; 95% CI [0.29, 0.69]) less likely to be obese compared to female participants. Compared to participants who were of age 45 years or older, participants of age 25–34 years were 61% (AOR = 0.39 (95% CI [0.23, 0.67]) less likely to be obese. Compared to participants who attained college or university level of education, participants who had no formal education were 63% (AOR = 0.37; 95% CI [0.15, 0.91]) less likely to be obese; and participants who had attained secondary level of education were 2.22 (95% CI [1.21, 4.07]) times more likely to be obese. Participants who smoked cigarettes were 67% (AOR = 0.33; 95% CI [0.12, 0.95]) less likely to be obese compared to participants who did not smoke cigarettes. Compared to participants who had severe hypertension, participants who had moderate hypertension were 3.46 (95% CI [1.34, 8.95]) times more likely to be obese. Conclusions The findings from this study indicate that Zambian women are more at risk of being obese. Prevention and control measures are needed to address high prevalence and gender inequalities in risks for non-communicable diseases in Zambia. Such measures should include policies that support gender specific approaches for the promotion of health behavior changes.

Risk assessment for yellow Fever in Western and north-Western provinces of zambia.

Background: North-Western and Western provinces of Zambia were reclassified as low-risk areas for yellow fever (YF). However, the current potential for YF transmission in these areas is unclear. Aims: To determine the current potential risk of YF infection. Setting and Design: A cross sectional study was conducted in North-Western and Western provinces of Zambia. Materials and Methods: Samples were tested for both YF virus-specific IgG and IgM antibodies by the ELISA and YF virus confirmation was done using Plaque Reduction Neutralization Test. The samples were also tested for IgG and IgM antibodies against other flaviviruses. Results: Out of the 3625 respondents who participated in the survey, 46.7% were males and 9.4% were aged less than 5 years. Overall, 58.1% of the participants slept under an impregnated insecticide-treated net and 20.6% reported indoor residual spraying of insecticides. A total of 616 (17.0%) samples were presumptive YF positive. The prevalence for YF was 0.3% for long-term infection and 0.2% for recent YF infection. None of the YF confirmed cases had received YF vaccine. Prevalence rates for other flaviviruses were 149 (4.1%) for Dengue, 370 (10.2%) for West Nile and 217 (6.0%) for Zika. Conclusion: There is evidence of past and recent infection of YF in both provinces. Hence, they are at a low risk for YF infection. Yellow fever vaccination should be included in the EPI program in the two provinces and strengthen surveillance with laboratory confirmation.

Prevalence and Correlates of Hypertension among Adults Aged 25 Yearsor Older in a Mining Town of Kitwe, Zambia

Background: Hypertension is a major risk factor for cardiovascular disease. The trend towards a higher burden of non-communicable chronic diseases in developing countries is of great concern as it adds to the burden of communicable diseases. The aim of this study was to estimate the prevalence and correlates of hypertension among adults in the City of Kitwe, Zambia. Methods: A modified WHO STEPs (STEPwise Approach to Surveillance) method was used to collect data through a community-based survey among persons aged 25 years or older living in urban Kitwe, Zambia. Prevalence of hypertension was estimated and compared between males and females. Odds ratio (OR) and adjusted odds ratio (AOR) and their 95% confidence intervals were used to establish associations between exposure factors and hypertension. Results: Altogether, 1627 persons participated in the survey of which 57.7% were females. Overall, 32.3% (33.5% of males and 31.1% of females, p=0.350) were hypertensive. Age and body mass index were significantly associated with hypertension. Compared to participants who were of age 45 years or older, participants who were below the age of 45 years were less likely to have hypertension (AOR=0.53, 95% CI [0.45, 0.62]) for 25-34 years age group, and AOR=0.61, 95% CI [0.50, 0.74]) for 35-44 years age group). Participants who had BMI of less than 18.5 kg/m2 were 50% (AOR=0.50, 95% CI [0.32, 0.77]) less likely to have hypertension compared to participants who had BMI of 30 kg/m2 or more. Meanwhile, participants who had BMI of 25.0-29.9 kg/m2 were 33% (AOR=1.33, 95% CI [1.05, 1.69] more likely to have hypertension compared to participants who had BMI of 30 kg/m2 or more. Conclusions: Our findings indicate that hypertension is prevalent among urban residents in Kitwe, Zambia. Effective prevention strategies including interventions to ensure lower BMIs, should be implemented, taking into considerations the risk factors identified in this study.

Changes in tuberculosis notifications and treatment delay in Zambia when introducing a digital X-ray service.

SETTING In August 2009, a digital chest X-ray (CXR) machine was installed at a busy urban health centre in Lusaka, Zambia. OBJECTIVE To describe the changes in tuberculosis (TB) notifications and treatment delay ≥7 days in Zambia after introducing a digital X-ray service. DESIGN Operational retrospective research of TB notification, laboratory and CXR data for Q4 2008 (prior to digital CXR) compared to Q4 2009. RESULTS Notifications for sputum smear-negative TB increased by 8.1%, from 370/527 (70.2%) in Q4 2008 to 425/544 (78.1%) in Q4 2009, despite a 6.7% decrease in sputum smear positivity in Q4 2009. TB treatment delay decreased from 75/412 (18.2%) in Q4 2008 to 52/394 (13.2%) in Q4 2009 (P = 0.05). CONCLUSION In Q4 2009, sputum smear-negative TB notifications increased and treatment delay decreased. However, accurate diagnosis of TB is challenging in this setting, and misdiagnosis and overtreatment may occur. Moreover, other factors in addition to the introduction of the digital X-ray service could have contributed to these findings. Nonetheless, we found that the digital X-ray service had many advantages and that it may aid in more efficient TB diagnosis.

Correlates of bullying victimization among school-going adolescents in Algeria: results from the 2011 global school-based health survey.

Introduction: Literature establishes negative public health impact of bullying. Bullies and bully-victims are more likely to engage in a cluster of other delinquent behaviors. Objectives: The objective of this study was to determine correlates of bullying victimization among school-going adolescents in Algeria. Materials and Methods: The study analyzed data from the 2011 Global School-Based Health Survey conducted among in-school adolescents in Algeria. Logistic regression analyzes were used to estimate associations between bullying victimization and selected variables. Results: A total of 4532 students participated in the survey of which 48.1% were males. Bullying victimization was estimated at 51.1% (47.2% among males and 54.9% among females). Males were 28% less likely to be bullied compared to females. Overall, adolescents aged Conclusion: Bullying victimization is frequent among Algerian in-school adolescents. This calls for a concerted effort to prevent and control bullying behavior using interventions that are gender sensitive.

Overweight and Obesity in Kaoma and Kasama Rural Districts of Zambia:Prevalence and Correlates in 2008-2009 Population Based Surveys

Background: Overweight and obesity (overweight/obesity) is associated with hypertension. Low- and middleincome countries are experiencing an obesity epidemic. There is growing evidence that the epidemic is on the increase in urban settings of developing countries. However, there is scanty information on the magnitude of this epidemic and its correlates in rural settings. The objective of the current study was to establish levels of overweight/obesity and its correlates in rural areas of Zambia. Designing interventions based on the correlates for overweight/obesity to reduce its prevalence may in turn lead to a reduction in the prevalence of hypertension. Methods: Cross sectional studies using a modified WHO Stepwise questionnaire were conducted. Logistic regression analyses were used to determine factors that were associated with overweight/obesity. Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) and their 95% confidence intervals are reported. Results: Totals of 895 participants from Kaoma and 1198 from Kasama took part in the study. Altogether, 7.6% of the participants were overweight and 2.5% were obese, with a combined prevalence of overweight/obesity of 10.1%. Factors that were independently associated with overweight/obesity were sex, education, vegetable consumption, smoking and hypertension. Female participants were 78% (AOR=1.78, 95% CI [1.46, 2.17]) more like to be overweight/ obese compared to males. Participants with secondary or higher education level were 2.04 (95% CI [1.56, 2.67]) times more likely to be overweight/obese compared to participants with lower levels of education. Participants who consumed vegetables 5 to 7 days in a week were 35% (AOR=1.35, 95% CI [1.06, 1.72]) more likely to be overweight/ obese compared to participants who ate vegetables less than 5 days in a week. Non smokers were 2.06 (95% CI [1.42, 2.98]) times more likely to be overweight/obese than smokers. Participants who were non hypertensive were 30% (AOR=0.70, 95% CI [0.59, 0.82]) less likely to be overweight/obese compared to participants who were hypertensive. Conclusions: Prevalence of overweight/obesity was low and this is the time to start instituting interventions to control the obesity epidemic in rural districts of Zambia.

Study of Indoor PM2.5 and Volatile Organic Compounds Concentration in Selected Rural and Urban Areas of Zambia

Background: High levels of household air pollution (HAP) occur in houses of many developing countries due to combustion of biomass fuels (wood, charcoal, cow dung, crop residues) in the households in open fires or inefficient stoves. Particulate Matter (PM2.5) and Volatile Organic Compounds (VOCs) are among the significant pollutants that are generated and can adversely affect the health of the exposed. Therefore, we monitored PM2.5 and VOC in selected rural and urban areas of the Copperbelt province of Zambia in order to measure the magnitude and correlates of HAP concentration levels. Methods: Indoor PM2.5 particles <2.5 µg in diameter (PM2.5) and VOCs were measured in 1,170 dwelling houses using Foobot (Model: FBT0002100 FCC ID: 2ADTK-FBT0002100, China). A standard questionnaire to capture the background and cooking characteristics such as kitchen type, fuel type and location of house in relation to ambient air pollution source was used. Data analysis using SPSS version 16 and EPIINFO were used at statistical significance level of 95% confidence interval. Results: Biomass fuel use in our study area was the dominant source of household energy for cooking. Mean indoor PM 2.5 varied greatly between households depending on fuel and kitchen type while the variations in VOC were not that much. Concentration levels for PM2.5 varied between 79 µg/m3 and 921 µg/m3, with an overall mean (SD) for daily average of 444.5 µg/m3 (170.2) while for VOC concentration levels ranged from 245 ppb to 393 ppb with an overall mean (SD) for daily average of 342 ppb (25.3). The median (Q1, Q2) indoor PM2.5 during cooking time was 501(411,686) µg/m3 and daily average 393(303,578) µg/m3 while VOC daily average was 343(320, 363) ppb concentrations in the entire study population. Conclusion: Household air pollution mean concentrations in rural and urban settings of Ndola and Masaiti excessively exceed the WHO guidelines; hence continued efforts through research and advocacy are needed to mitigate the health damaging levels of household air pollution.