Lipid and Diabetic Profiles of School Teachers in Afghanistan Facing Food Insecurity and Their Association with Knowledge Relating to Healthy Lifestyle

Objectives: To investigate lipid and diabetic profiles of school teachers in Kabul, Afghanistan, who face food insecurity, and examine the association of those with the teachers’ knowledge of non-communicable diseases (NCDs). Methods: A survey to examine biochemical indicators of NCDs (triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), hemoglobin A1c (HbA1c), blood pressure, height, weight, waist circumference), food insecurity, lifestyle and knowledge of NCDs was conducted among 600 school teachers. Analyses were made of biochemical indicators of NCDs, blood pressure, metabolic syndrome, obesity, and subject’s lifestyle in relation to food security and the subject’s knowledge of NCDs. Results: Thirty-nine percent of school teachers experienced food insecurity. The percentage of TC ≥ 200 mg/dL;HbA1c ≥ 5.5%;hypertension and metabolic syndrome were 20.2%, 29.7%, 32.2% and 33.7%, respectively. Food insecurity was associated with lower fruit and vegetable consumption and higher potato consumption. Food insecurity was associated with increased TC (AOR 2.03;95%CI: 1.23 - 3.34), decreased HDL (AOR 1.70;95%CI: 1.12 - 2.58), increased HbA1c (AOR 1.73;95%CI: 1.14 - 2.64), hypertension (AOR 1.68;95%CI: 1.01 - 2.80) and diagnosis of metabolic syndrome (AOR 1.78;95%CI: 1.18 - 2.68), after adjustment by demographic, socioeconomic and lifestyle variables. Among people living under condition of food insecurity, greater NCD knowledge was associated with smaller prevalence of TG ≥ 150 mg/dL, HDL Conclusions: Under conditions of food insecurity, diets have less variety and individuals are more likely to exhibit biomedical risk factors of NCDs. Even under conditions of food insecurity, people with knowledge of NCDs may have better coping strategies for their choice of lifestyles and exhibited a lower percentage of risk factors of NCDs.

Health Status and Health Facility Utilization of Community-Dwelling Elderly Living Alone in the Philippines: A Nationwide Cross-Sectional Study

Background: Increase of elderly people living alone has been a concern even in the Philippines where filial piety is widely practiced with the support of large number of young people. Objectives of this study were to examine the relationships between living alone with self-reported illness among community elderly and living alone with health facility utilization among sick community elderly in the Philippines. Methods: Data of 5577 elderly (aged ≥ 60 years) from the 2013 Philippines National Demographic and Health Survey were retrieved. Variables on living arrangements, self-reported illness, frequency of health facility visits, and admission to a health facility were used for analysis. Results: Among the elderly included in the analysis, 5.0% of them were living alone. Percentage of living alone was larger among rural elderly (6.0%) compared with urban elderly (3.6%);and among poor elderly (9.0%) compared with rich elderly (2.8%). Results of adjusted multivariate logistic regression analysis showed that the elderly living alone were more likely to report suffering from common colds (AOR 2.12;95% CI 1.57 - 2.86) or non-communicable diseases (AOR 2.18;95% CI 1.55 - 3.06), regardless of their socioeconomic status or insurance coverage. Among those who reported illness, the elderly living alone were more likely to visit a health facility with non-communicable disease (AOR 1.95;95% CI 1.22 - 3.14), after adjustment of other variables. Although elderly living alone who reported illness were likely to be admitted in a health facility, statistically significant association was not observed. Conclusion: Elderly living alone are more likely to report self-reported illness and use health facilities when they recognize their illness.

Geographical Patterns of Tuberculosis Notification Rates and Their Associations with Sociodemographic Characteristics in Communes in Phnom Penh, Cambodia

Objective: To identify the patterns of tuberculosis (TB) notification rates in Phnom Penh and examine their relationships with the population density, socioeconomic, residential and occupational characteristics. Methods: The numbers of total TB and smear-positive pulmonary TB cases reported between January 1, 2010 and December 31, 2012 in Phnom Penh were counted for 76 communes in Cambodia according to TB registration records filed under the national TB programme. Population, socioeconomic, residential and occupational characteristics for the communes were obtained from the 2008 General Population Census of Cambodia. The following indicators were developed for individual communes: smear-positive pulmonary TB notification rate (SPTB-NR) (per 100,000 population, in 36 months), population density (per km2), socioeconomic indicators, residential characteristics and occupational characteristics. Geographic patterns of these indicators and characteristics were analysed using ArcGIS. Associations between SPTB-NR and characteristics were analysed. Results: A total of 4102 TB cases were reported in 36 months, including 2046 SPTB cases. SPTB-NR for Phnom Penh was 135 cases per 100,000;median SPTB-NR by commune was 100. SPTB-NR was higher in outlying areas than in city centre communes;population density was high in the centre and low in the outlying areas. SPTB-NR was associated with larger percentage of household members per room (PR: 2.81, 95%CI: 2.68 - 2.93), percentage of population resident in the same commune Conclusions: The SPTB-NR in Phnom Penh did not follow the pattern of population density. Socioeconomic, residential and occupational characteristics by commune were associated with SPTB-NR. Development of prevention and control programmes by considering commune level characteristics is encouraged.

Social Activity Patterns Drive High Rates of Latent Tuberculosis Infection among Adolescents in Urban Tanzania<br/>—Latent TB Infection in Adolescents, Tanzania

SETTING: Dar es Salaam, Tanzania. OBJECTIVE: To determine the prevalence of latent tuberculosis (TB) infection (LTBI) among adolescents in a country with a high TB burden, and examine risks of LTBI according to their social activity patterns. METHODS: A cross-sectional study nested within a phase 2b randomised, placebo controlled, double blind study and consisted of 824 adolescents, 13 - 15 years old who had received Bacillus Calmette-Guérin (BCG) vaccine, were attending public secondary schools and had no evidence of active tuberculosis (TB). Anthropometric measurements were obtained, a questionnaire administered, and phlebotomy performed for a T spot interferon-γ?release assay (IGRA) to detect LTBI. RESULTS: Among 824 subjects, 149 (18%) had a positive IGRA. After adjusting for the influence of household socioeconomic status, history of TB contact, living environment and nutritional status, LTBI risk was higher in subjects with than without regular informal encounters with traditional alcoholic beverage drinkers (AOR, 6.37 [1.84 - 22.00]). Other significant factors for LTBI risk included contact with TB patient at school (AOR, 3.34 [1.14 - 9.80]), and living close to a health facility, as was observed among those from houses within a 10 - 30-minute walking distance to the nearest health facility, who were less likely to be IGRA-positive than those who were living within a 10-minute walking distance (AOR, 0.30 [95%CI, 0.13 - 0.69]). CONCLUSION: This IGRA study revealed a high prevalence of LTBI among adolescents in Dar es Salaam, Tanzania with prior BCG immunization. Informal social encounters were identified as independent risk factors for LTBI, along with a history of contact with TB patients, living environment characteristics and household socioeconomic status. Efforts focusing on risk of MTB transmission in adolescents at informal social gatherings will improve interventions to reduce LTBI in this population and consequently the subsequent risk of developing active TB disease.