Dataset Information

Prevalence and associated factors of self-reported ischaemic heart disease and/or stroke: a cross-sectional nationally representative community-based study of adults in Malawi in 2017.

ABSTRACT:

Objective

This study aimed to assess the prevalence and associated factors of self-reported ischaemic heart disease (IHD) and/or stroke among adults in Malawi.

Design

Population-based cross-sectional study.

Setting

Nationally representative sample of general adult population in Malawi.

Participants

The sample included 4187 persons aged 18-69 years (32 years of median age) that participated in the '2017 Malawi STEPwise Approach to Non-Communicable Disease Risk-Factor Surveillance survey.'

Primary and secondary outcome measures

Self-reported history of IHD and/or stroke, along with biological, behavioural, psychosocial stress and sociodemographic covariates. Multivariable logistic regression calculated OR with 95% CI for IHD and/or stroke.

Results

The prevalence of IHD and/or stroke was 6.5%, 4.4% among men and 8.4% among women. In adjusted logistic regression analysis, older age (50-69 years) (adjusted OR (AOR) 3.49, 95% CI 1.75 to 6.94), female sex (AOR 2.09, 95% CI 1.45 to 3.01), Chewa speaking (AOR 4.62, 95% CI 1.32 to 16.22), English speaking (AOR 5.63, 95% CI 1.43 to 22.19), suicidal ideation, plan and/or attempt (AOR 1.87, 95% CI 1.11 to 3.13) and sedentary behaviour (AOR 2.00, 95% CI 1.12 to 3.59) were associated with IHD and/or stroke. In addition, in unadjusted analysis, non-paid or unemployed, urban residence, overweight, obesity and having hypertension were associated with IHD and/or stroke.

Conclusions

Almost 1 in 10 women and 1 in 20 men aged 18-69 years had IHD and/or stroke in Malawi. Several risk and protective factors were found that can be targeted in population health interventions.

SUBMITTER: Pengpid S

PROVIDER: S-EPMC8461691 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prevalence and associated factors of self-reported ischaemic heart disease and/or stroke: a cross-sectional nationally representative community-based study of adults in Malawi in 2017.

Pengpid Supa S Peltzer Karl K

BMJ open 20210923 9

<h4>Objective</h4>This study aimed to assess the prevalence and associated factors of self-reported ischaemic heart disease (IHD) and/or stroke among adults in Malawi.<h4>Design</h4>Population-based cross-sectional study.<h4>Setting</h4>Nationally representative sample of general adult population in Malawi.<h4>Participants</h4>The sample included 4187 persons aged 18-69 years (32 years of median age) that participated in the '2017 Malawi STEPwise Approach to Non-Communicable Disease Risk-Factor ...[more]

PMID: 34556509

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Project description:IntroductionThe global target for 2020 is that ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months.MethodsWe analysed data from the population-based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross-sectional household surveys. Data collection included structured interviews, home-based HIV testing and laboratory testing. Blood samples from PLHIV were analysed for HIV RNA, CD4 counts and recent exposure to antiretroviral drugs (ARVs). We calculated representative estimates for the prevalence of VLS (viral load <1000 copies/mL), nonsuppressed viral load (NVL; viral load ≥1000 copies/mL), virologic failure (VF; ARVs present and viral load ≥1000 copies/mL), interrupted ART (ARVs absent and viral load ≥1000 copies/mL) and rates of switching to second-line ART (protease inhibitors present) among PLHIV aged 15 to 59 years who participated in the PHIA surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe, initiated ART at least four months before the survey and were receiving ART at the time of the survey (according to self-report or ARV testing). We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second-line ART.ResultsWe included 9200 adults receiving ART of whom 88.8% had VLS and 11.2% had NVL including 8.2% who experienced VF and 3.0% who interrupted ART. Younger age, male sex, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married and residing in Zimbabwe, Lesotho or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female sex, shorter ART duration, higher CD4 count and alcohol use were associated with lower odds for VF and higher odds for interrupted ART. Many people with VF (44.8%) had CD4 counts <200 cells/µL, but few (0.31% per year) switched to second-line ART.ConclusionsCountries are approaching global VLS targets for adults. Treatment support, in particular for younger adults, and people with higher CD4 counts, and switching of people to protease inhibitor- or integrase inhibitor-based regimens may further reduce NVL prevalence.

Project description:IntroductionLate diagnosis of HIV (LD) increases the risk of morbidity, mortality, and HIV transmission. We used nationally representative data from population-based HIV impact assessment (PHIA) surveys in Malawi, Zambia, and Zimbabwe (2015-2016) to characterize adults at risk of LD and to examine associations between LD and presumed HIV transmission to cohabiting sexual partners.MethodsWe estimated the prevalence of LD, defined as CD4 count <350 cells/μL, among adults newly diagnosed with HIV during the surveys and odds ratios for associated factors. We linked newly diagnosed adults (index cases) to their household sexual partners and calculated adjusted odds ratios for associations between LD of the index case, viral load of the index case, and duration of HIV exposure in the relationship, and the HIV status of the household sexual partner.ResultsOf 1,804 adults who were newly diagnosed with HIV in the surveys, 49% (882) were diagnosed late. LD was associated with male sex, older age, and almost five times the odds of having an HIV-positive household sexual partner (adjusted odds ratio [aOR], 4.65 [95% confidence interval: 2.56-8.45]). Longer duration of HIV exposure in a relationship and higher viral load of the index case were both independently associated with higher odds of having HIV-positive household sexual partners. Individuals with HIV exposure of more than 5 years had more than three times (aOR 3.42 [95% CI: 1.63-7.18]) higher odds of being HIV positive than those with less than 2 years HIV exposure. The odds of being HIV positive were increased in individuals who were in a relationship with an index case with a viral load of 400-3499 copies/mL (aOR 4.06 [95% CI 0.45-36.46]), 3,500-9,999 copies/mL (aOR 11.32 [95% CI: 4.08-31.39]), 10,000-49,999 copies/mL (aOR 17.07 [95% CI: 9.18-31.72]), and ≥50,000 copies/mL (aOR 28.41 [95% CI: 12.18-66.28]) compared to individuals who were in a relationship with an index case with a viral load of <400 copies/mL.ConclusionsLD remains a challenge in Southern Africa and is strongly associated with presumed HIV transmission to household sexual partners. Our study underscores the need for earlier HIV diagnosis, particularly among men and older adults, and the importance of index testing.

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Project description:Objective This study aims to determine the prevalence and factors associated with injuries in the adult population of Nepal. Design and participants Secondary analysis of the data from the cross-sectional WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) Survey Nepal, 2019. A multistage cluster sample of 5593 adults aged 15–69 years who have been the usual residents of the household for at least 6 months. A binary logistic regression model was employed to identify the determinants of injuries. Setting Data were derived from the STEPS Survey Nepal, 2019. Primary and secondary outcome measures The primary outcome was injured person defined as one who had road traffic injuries (RTIs), had other serious unintentional/accidental injury, or had been seriously injured in a violent incident within the past 12 months. The secondary outcome measure was factors associated with injuries. Results Over 11% of the 4996 study participants reported any injuries during the past 12 months. About 3.75% of the participants experienced a RTI, 4.71% had experienced unintentional injuries other than RTI, while 5.33% had been injured in violent incidents. Individuals belonging to the middle wealth quintile (crude OR (COR)=2.95, 95% CI 1.27 to 6.84) were associated with increased odds of RTIs. By occupation, homemaker (COR=0.45, 95% CI 0.24 to 0.84) was protective against these injuries. Likewise, currently married individuals (COR=3.74, 95% CI 1.37 to 10.17), ever married individuals (COR=3.49, 95% CI 1.08 to 11.25) and individuals not in employment (COR=2.13, 95% CI 1.16 to 3.91) were associated with an increased likelihood of sustaining an intentional injury. Injuries were higher among rural participants. Conclusions This study provides the baseline population-based estimates of the prevalence of injuries in Nepal. It describes the mechanisms and risk factors of these injuries. It is hoped that this evidence will serve as a stimulus for future studies to elucidate comprehensive national information about injuries.

Project description:CONTEXT:The Public Health Workforce Interests and Needs Survey (PH WINS) was first fielded in 2014 and is the largest public health workforce survey in the nation. This article elucidates the methods used for the 2017 PH WINS fielding. PROGRAM OR POLICY:PH WINS was fielded to a nationally representative sample of State Health Agency Central Office (SHA-CO) staff, as well as local health department (LHD) staff. The instrument largely mirrored 2014, though the training needs section was revised, and a validated item measuring burnout in staff was added. IMPLEMENTATION:Staff lists were collected directly from all participating state and local agencies. Forty-seven state health agencies (SHAs), 26 large LHDs, and 71 midsize LHDs participated. All SHAs were surveyed using a census approach. The nationally representative SHA-CO frame is representative of all central office staff members. The nationally representative local frame was a complex survey design, wherein staff from LHDs were randomly sampled across 20 strata, based on agency size and geographic region. Staff were also contributed with certainty from large LHDs in nondecentralized states. The frame is representative of staff at LHDs serving more than 25 000 people and with 25 or more staff members. Other LHDs are excluded, and so PH WINS is not representative of smaller LHDs. Balanced repeated replication weights were used to adjust variance estimates for the complex design. EVALUATION:Overall, 47 604 people responded to PH WINS in 2017 across all frames. PH WINS 2017 achieved a response rate of 48%. The design effect for the SHA-CO frame was 1.46 and was 16.42 for the local frame. DISCUSSION:PH WINS now offers a nationally representative sample of both SHA-CO and LHD staff across 4 major domains: workplace environment, training needs, emerging concepts in public health, and demographics. Both practice and academia can use PH WINS to better understand the perceptions and needs of staff, address training gaps, and work to recruit and retain quality staff.

Project description:BackgroundLinking facility and household surveys through geographic methods is a popular technique to draw conclusions about the relationship between health services and population health outcomes at local levels. These methods are useful tools for measuring effective coverage and tracking progress towards Universal Health Coverage, but are understudied. This paper compares the appropriateness of several geospatial methods used for linking individuals (within displaced survey cluster locations) to their source of family planning (at undisplaced health facilities) at a national level.MethodsIn Malawi, geographic methods linked a population health survey, rural clusters from the Woman's Questionnaire of the 2015 Malawi Demographic and Health Survey (MDHS 2015), to Malawi's national health facility census to understand the service environment where women receive family planning services. Individuals from MDHS 2015 clusters were linked to health facilities through four geographic methods: (i) closest facility, (ii) buffer (5 km), (iii) administrative boundary, and (iv) a newly described theoretical catchment area method. Results were compared across metrics to assess the number of unlinked clusters (data lost), the number of linkages per cluster (precision of linkage), and the number of women linked to their last source of modern contraceptive (appropriateness of linkage).ResultsThe closest facility and administrative boundary methods linked every cluster to at least one facility, while the 5-km buffer method left 288 clusters (35.3%) unlinked. The theoretical catchment area method linked all but one cluster to at least one facility (99.9% linked). Closest facility, 5-km buffer, administrative boundary, and catchment methods linked clusters to 1.0, 1.4, 21.1, and 3.3 facilities on average, respectively. Overall, the closest facility, 5-km buffer, administrative boundary, and catchment methods appropriately linked 64.8%, 51.9%, 97.5%, and 88.9% of women to their last source of modern contraceptive, respectively.ConclusionsOf the methods studied, the theoretical catchment area linking method loses a marginal amount of population data, links clusters to a relatively low number of facilities, and maintains a high level of appropriate linkages. This linking method is demonstrated at scale and can be used to link individuals to qualities of their service environments and better understand the pathways through which interventions impact health.

Dataset Information

Prevalence and associated factors of self-reported ischaemic heart disease and/or stroke: a cross-sectional nationally representative community-based study of adults in Malawi in 2017.

Objective

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Prevalence and associated factors of self-reported ischaemic heart disease and/or stroke: a cross-sectional nationally representative community-based study of adults in Malawi in 2017.

Similar Datasets

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