Triggers YaredDraft PPT template 2b yred.pptx

Triggers YaredDraft PPT template 2b yred.pptx

1.  Summary of the community-based physical and blood sugar level measurements among household heads in Addis Ababa, 2023. Dr. Yared Mamushet Yifru (MD, MSC, Associate professor of Neurology) Department of Neurology, Addis Ababa University. ComBAT study first round dissemination workshop May 31, 2023, Capital Hotel, Addis Ababa

2. Presentation outlines Background Methods Results Discussions Conclusions References 12/11/2024 ComBAT study 2

3. Background NCDs are becoming the leading cause of death in low- and middle-income countries. (WHO, 2023). Globally, NCDs kill 41 million people per year ≈ 71% of all deaths globally (WHO, 2023). Globally, NCDs were the leading cause of premature mortality, 18% (males= 21%, females= 14%) (WHO/NCD portal, 2023). Cancer , cardiovascular diseases, diabetes , and COPD, are increasingly becoming the main cause of mortality in sub-Saharan Africa (WHO/AFRO, 2023). 12/11/2024 ComBAT study 3

4. Con’td NCDs account for 40% of total deaths in Ethiopia, with only 1.6% of the population free of NCD risk factors (WHO/AFRO, 2020). NCDs have a significant economic and financial burden in Ethiopia, costing at least 31.3 billion birrs per year and 1.8% of GDP (WHO/AFRO, 2020). A large proportion of the population with raised blood pressure and elevated blood glucose remain undiagnosed contributing to the increasing burden of the problem (Bekele et al, 2017). 12/11/2024 ComBAT study 4

5. Con’td There is a need to assess the burden of these NCDs in a community for knowing the exact burden and for the timely prevention and control of the consequences. Hence, we tried ; To assess the proportion of the study population with raised blood pressure, overweight, and obesity, To assess the proportion of the study population with diabetes based on their blood sugar level . Trained general practitioners (GPs) measured the ff measurements after careful calibration of the measurement scales; 12/11/2024 ComBAT study 5

6. Specific measurements Blood pressure (in mmHg) Weight ( in Kg) Height (in centimeters) Body mass index (in Kg/m 2 ) Waist circumference (in centimeters) Hip circumference (in centimeters) Waist-to-hip ratio Blood sugar level ( RBS/FBS in mg/dL) Tuesday, 12 November 2024 ComBAT study 6

7. Hypertension

8. 1. Blood pressure (BP) BP was measured 3 times and we took an average of the 3 measured values of SBP/DBP, Based on the average SBP/DBP we classified the readings into the following categories , Tuesday, 12 November 2024 ComBAT study 8

9. Currently, more than 1.4 billion of the world’s population have hypertension and this figure is expected to rise to 1.6 billion by the year 2025 (8). The prevalence of hypertension is highest in the African region , with about 46% of adults aged 25 years and older being hypertensive compared to 35% in the Americas and other HIC, and 40% elsewhere in the world (9)

10. It is estimated that around 62% of cardiovascular diseases (CVDs) and 49% of ischemic heart diseases are attributable to high BP in the world. And 45% of deaths due to heart disease and 51% of deaths due to stroke are due to hypertension(7)

11. There is no national prevalence study on hypertension in Ethiopia. And prevalence figures of hypertension also vary across different studies (3 ) Meta-analysis of observational studies estimates the prevalence of hypertension to be between 20 - 30% in Ethiopia (1, 5).

12. According to one recent systematic review and meta-analysis the highest prevalence of hypertension was observed in Addis Ababa (25.35%) and the lowest was in Tigray region (15.36%) (6). According to Kibret et al .the prevalence of hypertension in urban population Ethiopia ranged from 16.9 % - 30.27 % in between 2009 and 2014(1)

13. The prevalence of hypertension in our cohort (this study )was 19.83 % .

14. And those having isolated systolic and diastolic hypertension were 6.86% and 7.63% respectively. When “ elevated blood pressure” (120-129/<80) according to the new American Heart Association (AHA),is considered abnormal , the prevalence of abnormal blood pressure rises to 30.6%.

15. While this result is comparable to the prevalence of HPN in Ethiopia (19.6%) (1), it was lower than studies done in other urban settings of the country (2, 3), and also is lower than the global hypertension prevalence of (24.1%) (4 ).

16. The prevalence of hypertension in this study is reduced in comparisons to previous years, which might be due to better awareness about the illness and the new practice of using extension health workers in Ethiopia.

17. References 1. Kibret KT, Mesfin YM. Prevalence of hypertension in Ethiopia: a systematic meta‐analysis. Public Health Rev. 2015; 36(14):1‐12. 2. Awoke A, Awoke T, Alemu S, Megabiaw B. Prevalence and associated factors of hypertension among adults in Gondar, North west Ethiopia:a community based cross-sectional study. BMC Cardiovasc Disord . 2012;12:113 3. Tesfaye F, Byass P, Wall S. Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovasc Disord . 2009;9 (39doi: 10.1186/1471-2261-9-39 ). Available at: http://www.biomedcentral.com/1471-2261/9/39 . 4. Zhou B, Bentham J, Di Cesare M, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population‐based measurement studies with 19.1 million participants. Lancet. 2017;389(10064):37‐55. 5. Molla M. Systematic reviews of prevalence and associated factors of hypertension in Ethiopia: finding the evidence. SJPH. 2015;3(4):514–519. doi : 10.11648/j.sjph.20150304.19. 6. Tiruneh SA, Bukayaw YA, Yigizaw ST, Angaw DA. Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS One. 2020 Dec 31;15(12):e0244642. doi : 10.1371/journal.pone.0244642. 7. World Health Organization. Causes of Death. Geneva; 2008. Available from https://www.who.int/gho/mortality_burden_disease/ causes_death_2008/en/. 8. Kearney PM, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension : analysis of worldwide data. Lancet. 2005;365:217–23. 9. Ferdinand KC. Uncontrolled hypertension in sub-Saharan Africa: Now is the time to address a looming crisis. J Clin Hypertens (Greenwich). 2020 Nov;22(11):2111-2113. doi : 10.1111/jch.14046.

18. 4. Blood sugar level A calibrated glucometer was used to measure the blood sugar level of the household heads. Household heads were asked for the eligibility criteria for either RBS or FBS measurement along with the time of blood sugar sample was taken; Tuesday, 12 November 2024 ComBAT study 18

19. Diabetes Mellitus Diabetes prevalence has been rising more rapidly in middle- and low-income countries. Around 80% of people with diabetes and about five million diabetes-related deaths were reported in low income and middle-income countries. (10)

20. The pooled prevalence of DM in Ethiopia is 6.5%, and prevalence studies in Africa in general show a range from 4.4% to 7% and , in sub-Saharan Africa of 3% , while it is 8.5 % for global prevalence (3)(4). In our study 66( 11.4 %) of household heads were diabetic based on fasting Blood Sugar determination (  126),

21. Diabetes and pre-diabetes In our study 66( 11.4 %) of household heads were diabetic based on fasting Blood Sugar determination (  126 ) According to World Health Organization(WHO) and American Diabetes Association(ADA) definitions of pre-diabetes 54( 9.33 %) and 149( 25.73 %.) were pre-diabetic respectively

22. The 11. 4% prevalence of diabetes in this study is also higher than the prevalence seen in studies done in other parts of the country, Southern Ethiopia ( 1.9% )(7) Dessie town, Northeast Ethiopia ( 6.8% )(8) and Mizan Aman Town, Southwest Ethiopia, ( 6.5 %)(9)

23. In our cohort of patients the prevalence of pre-diabetes ( 25.7% ) was also higher than one prevalence study done on prevalence of pre-diabetes in Desse Town north Ethiopia( 15.7 % )(8)

24. In a country with an estimated population of 115 million people and low national per capita income, any surge in the prevalence of diabetes will incur a significant burden to the already strained healthcare delivery and could incurs a significant cost.

25. So besides public education about healthy lifestyles to reduce the risk of diabetes like exercise , reducing overweight and obesity and dietary choice , routine screening to be done by people to detect pre-diabetes and diabetes is important.  

26. 2. Weight and height ➡︎ BMI The body mass index was calculated and categorized as follows; Underweight : <18.5 Kg/m 2 Normal: 18.5-24.9 Kg/m 2 Overweight: 25-29.9 Kg/m 2 Class I obesity: 30-34.9 Kg/m 2 Class II obesity: 35-39.9 Kg/m 2 Class III (extreme obesity): ≥ 40 Kg/m 2 Tuesday, 12 November 2024 ComBAT study 26 Figure 1: Blood pressure measurement categories among household heads in Addis Ababa, Ethiopia, 2023 (n=5,533). https :// doi.org/10.1136/jnnp.2007.117150 https :// doi.org/10.1136/jnnp.2007.117150 https :// doi.org/10.1136/jnnp.2007.117150 https :// doi.org/10.1136/jnnp.2007.117150 https://doi.org/10.1136/jnnp.2007.117150

27. 3. Waist and hip circumference (Waist to hip ratio) The World Health Organization (WHO) recommends a waist-to-hip ratio below 1 to reduce the health risk. Tuesday, 12 November 2024 ComBAT study 27 Figure 2: WHR measurement categories stratified by gender among household heads in Addis Ababa, Ethiopia, 2023 (n=5,485).

28. Conclusions Around 20% (one-fifth) of the HH heads were found to be hypertensive based on their BP readings. Almost 30% and a little more than 10% of the HH heads were found to be overweight and obese respectively. Nearly 10% of male HHs were in a high health risk category based on the WHR as compared to 73% of female HHs b ased on their waist-to-hip ratio. A little more than one-tenth of the HHs were diabetic based on the FBS level measurement. 12/11/2024 ComBAT study 28

29. Recommendations Initiatives aimed at expanding access to centers for NCD screening should be considered. Public health education about healthy lifestyles to lower the risk of diabetes, such as exercise, reducing overweight and obesity, and dietary choices. Tuesday, 12 November 2024 ComBAT study 29