Non-communicable Diseases and Associated Risk Factors among People Living with Human Immunodeficiency Virus in a Rural Hospital in Kenya

Yıl 2025, Cilt: 19 Sayı: 1, 72 - 82

Susan Onyango , Laurent De Kiev Cleenewerck , Moyosola Bamidele , Denis Bwesigye Akankunda

https://doi.org/10.21763/tjfmpc.1506285

Öz

Introduction: Non-communicable diseases are a growing burden in people living with human immunodeficiency virus (HIV). Kenya has good documentation of the prevalence of non- communicable diseases in the general population, but not in people living with human immunodeficiency virus.
Objective: The study assessed the prevalence of hypertension and diabetes mellitus and associated risk factors for non-communicable disease in this population.
Methods: We conducted a cross-sectional study with 1,595 people aged 18 to 69 in a rural HIV clinic using the World Health Organization's stepwise approach. We used descriptive statistics to examine the baseline characteristics. We reported prevalence, calculated the mean of knowledge for risk factors, and identified the factors associated with the diagnoses for non-communicable diseases by using multiple regression. We defined diabetes mellitus as fasting blood sugar ≥ 7 mmol/l (126mg/dl), hypertension as blood pressure≥140/90 mmHg, and obesity for men and women with waist circumference >102 cm and >88 cm, respectively.
Results: The proportion of women participants was 65.9%. Diabetes accounted for 10.3%, hypertension 9.8%, and obesity 32.7%. The ratio of those who had ever been screened for diabetes before were 9.2%, while those who had ever been screened for hypertension were 21.8%. Alcohol use was 12.5%, while physical inactivity was 15%. The mean score for knowledge of risk factors for hypertension was 0.9 and for diabetes mellitus, it was 0.3, both out of 8. Hypertension and diabetes mellitus were associated with obesity, increased number of years on antiretroviral therapy, advanced age, and physical inactivity.
Conclusion and Contribution: The study reported a high prevalence of non-communicable diseases, low knowledge of risk factors, and limited screening for non-communicable diseases highlighting missed opportunities for prevention. Implementing early screening and health education in the standard care package for HIV/AIDS (Acquired immunodeficiency syndrome) is crucial as a strategy for the prevention of non-communicable diseases.

Anahtar Kelimeler

Diabetes Mellitus, Hypertension, Obesity, HIV, Non-Communicable Diseases, Risk factors, Prevalence

Etik Beyan

The study obtained approval from Euclid University Research and Ethics Committee, Maseno University Ethical Review Committee Proposal No. MUERC/968/21, The National Commission for Science, Technology, and Innovation (NACOSTI) License No: NACOSTI/P/21/10507, and authorization from Homa Bay County Health Department REF: MOH/RA/VOL.VII (29). All respondents were of age to give consent, that is, above 18 years old. The principal investigator read the consent form to the participants and consent was obtained in the presence of the data collector before data collection. We ensured that each respondent understood that “participation in the study was completely voluntary and refusing to participate would not affect their treatment, and that they could also withdraw at any point.” Participants were also informed that their confidentiality would be protected.

Destekleyen Kurum

The authors received no financial support nor any sponsorship for research, authoeship or publication.

Teşekkür

We thank all research participants, Homa Bay County Health Department, and Marindi Sub County Hospital staff. The authors are grateful to the dedicated study field and laboratory staff members. The authors also thank John Oloo Oketch and Dr. Francis Aila Oketch, from the Department of Health, Homa Bay County for their substantial contributions in training the study field team and reviewing of the manuscript respectively.

Kenya'da Kırsal Bir Hastanede İnsan İmmün Yetmezlik Virüsü ile Yaşayan Kişiler Arasında Bulaşıcı Olmayan Hastalıklar ve İlişkili Risk Faktörleri

Öz

Giriş: Bulaşıcı olmayan hastalıklar, insan immün yetmezlik virüsü (Human immunodeficiency virus-HIV) ile yaşayan kişilerde giderek artan bir yük oluşturmaktadır. Kenya, genel nüfusta bulaşıcı olmayan hastalıkların yaygınlığına ilişkin iyi belgelere sahiptir, ancak insan immün yetmezlik virüsü ile yaşayan kişilerde bu durum söz konusu değildir.
Amaç: Bu çalışmada hipertansiyon ve diabetes mellitus prevalansı ve bu popülasyonda bulaşıcı olmayan hastalıklar için ilişkili risk faktörleri değerlendirilmiştir.
Yöntemler: Dünya Sağlık Örgütünün aşamalı yaklaşımını kullanarak kırsal bir HIV kliniğinde 18-69 yaş arası 1.595 kişiyle kesitsel bir çalışma yürüttük. Temel özellikleri incelemek için tanımlayıcı istatistikler kullandık. Prevalansı bildirdik, risk faktörleri için bilgi ortalamasını hesapladık ve çoklu regresyon kullanarak bulaşıcı olmayan hastalıklar için tanılarla ilişkili faktörleri belirledik. Diyabetes mellitusu açlık kan şekeri ≥ 7 mmol/l (>126mg/dl) hipertansiyonu ≥140/90 mmHg ve obeziteyi erkekler ve kadınlar için sırasıyla bel çevresi >102 cm ve >88 cm olarak tanımladık.
Sonuçlar: Kadın katılımcıların oranı %65,9 idi. Diyabet oranı %10,3, hipertansiyon %9,8 ve obezite %32,7'dir. Daha önce diyabet taraması yapılanların oranı %9,2, hipertansiyon taraması yapılanların oranı ise %21,8'dir. Alkol kullanım sıklığı %12,5 iken fiziksel hareketsizlik sıklığı %15'tir. Hipertansiyon için risk faktörleri bilgi puanı ortalaması 0,9 ve diabetes mellitus için 0,3 olup her ikisi de 8 üzerinden değerlendirilmiştir. Hipertansiyon ve diabetes mellitus obezite, antiretroviral tedavide geçirilen yıl sayısının artması, ileri yaş ve fiziksel hareketsizlik ile ilişkilendirilmiştir.
Sonuç ve Öneri: Çalışma, bulaşıcı olmayan hastalıkların yüksek prevalansını, risk faktörleri hakkında düşük bilgi düzeyini ve bulaşıcı olmayan hastalıklar için sınırlı taramayı rapor ederek önleme için kaçırılan fırsatları vurgulamıştır. HIV/AIDS (Acquired immunodeficiency syndrome-kazanılmış immün yetmezlik sendromu) için standart bakım paketinde erken tarama ve sağlık eğitiminin uygulanması, bulaşıcı olmayan hastalıkların önlenmesi için bir strateji olarak çok önemlidir.

Anahtar Kelimeler

Diabetes Mellitus, Hipertansiyon, Obezite, HIV, Bulaşıcı olmayan hastalıklar, Risk faktörleri, Prevalans

Etik Beyan

The study obtained approval from Euclid University Research and Ethics Committee, Maseno University Ethical Review Committee Proposal No. MUERC/968/21, The National Commission for Science, Technology, and Innovation (NACOSTI) License No: NACOSTI/P/21/10507, and authorization from Homa Bay County Health Department REF: MOH/RA/VOL.VII (29). All respondents were of age to give consent, that is, above 18 years old. The principal investigator read the consent form to the participants and consent was obtained in the presence of the data collector before data collection. We ensured that each respondent understood that “participation in the study was completely voluntary and refusing to participate would not affect their treatment, and that they could also withdraw at any point.” Participants were also informed that their confidentiality would be protected.

Destekleyen Kurum

The authors received no financial support nor any sponsorship for research, authoeship or publication.

Teşekkür

We thank all research participants, Homa Bay County Health Department, and Marindi Sub County Hospital staff. The authors are grateful to the dedicated study field and laboratory staff members. The authors also thank John Oloo Oketch and Dr. Francis Aila Oketch, from the Department of Health, Homa Bay County for their substantial contributions in training the study field team and reviewing of the manuscript respectively.

Kaynakça

• 1. Duffy M, Ojikutu B, Andrian S, Sohng E, Minior T, Hirschhorn LR. Non-communicable diseases and HIV care and treatment: models of integrated service delivery. Tropical Medicine & International Health. 2017;22(8):926-937. doi:10.1111/tmi.12901
• 2. Gouda HN, Charlson F, Sorsdahl K, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017. The Lancet Global Health. 2019;7(10):e1375-e1387. doi:10.1016/S2214-109X(19)30374-2
• 3. Zungu N, Mabaso M, Kumalo F, et al. Prevalence of non-communicable diseases (NCDs) and associated factors among HIV positive educators: Findings from the 2015/6 survey of Health of Educators in Public Schools in South Africa. PLoS ONE. 2019;14.
• 4. Ekrikpo U, Akpan E, Ekott J, Bello A, Okpechi I, Kengne A. Prevalence and correlates of traditional risk factors for cardiovascular disease in a Nigerian ART-naive HIV population: a cross-sectional study. BMJ Open. 2018;8.
• 5. Biraguma J, Mutimura E, Frantz J. Knowledge about modifiable risk factors for non-communicable diseases adults living with HIV in Rwanda. African Health Sciences. 2019;19:3181-3189.
• 6. Ciccacci F, Tolno VT, Doro Altan AM, et al. Noncommunicable Diseases Burden and Risk Factors in a Cohort of HIV+ Elderly Patients in Malawi. AIDS Res Hum Retroviruses. 2019;35(11-12):1106-1111. doi:10.1089/AID.2019.0125
• 7. Daniels ME, Donilon TE, Bollyky TJ. The Rising Epidemic of NCDs in Low- and Middle-Income Countries. Council on Foreign Relations; 2014:9-18. doi:10.2307/resrep24187.8
• 8. Ataklte Feven, Erqou Sebhat, Kaptoge Stephen, Taye Betiglu, Echouffo-Tcheugui Justin B., Kengne Andre P. Burden of Undiagnosed Hypertension in Sub-Saharan Africa. Hypertension. 2015;65(2):291-298. doi:10.1161/HYPERTENSIONAHA.114.04394
• 9. NASCOP. Kenya HIV Progress Report 2020: World AIDS Day. National AIDS and STI Control Programme; 2020. Accessed November 28, 2023. https://www.nascop.or.ke/
• 10. World Health Organization. The WHO STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance.; 2017. Accessed July 28, 2024. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps
• 11. World Health Organization. WHO Technical Specifications for Automated Non-Invasive Blood Pressure Measuring Devices with Cuff.; 2020:72. Accessed July 28, 2024. https://cdn.who.int/media/docs/default-source/searo/indonesia/who-tech-spec-for-automated-non-invasive-blood-pressure-measuring-devices-with-cuff.pdf?sfvrsn=b112be47_2
• 12. Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nature Reviews Endocrinology. 2020;16(3):177-189. doi:10.1038/s41574-019-0310-7
• 13. World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008. World Health Organization; 2011. https://www.who.int/publications/i/item/9789241501491
• 14. World Health Organization, International Diabetes Federation. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO/IDF Consultation.; 2006. Accessed January 5, 2021. http://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/
• 15. International Diabetes Federation. IDF Diabetes Atlas 10th Edition 2021. IDF Africa Region; 2021. Accessed July 8, 2024. https://diabetesatlas.org/data/en/country/104/ke.html
• 16. Njuguna B, Kiplagat J, Bloomfield GS, Pastakia SD, Vedanthan R, Koethe JR. Prevalence, Risk Factors, and Pathophysiology of Dysglycemia among People Living with HIV in Sub-Saharan Africa. Saely CH, ed. Journal of Diabetes Research. 2018;2018:6916497. doi:10.1155/2018/6916497
• 17. Todowede OO, Sartorius B. Todowede, Olamide O; Sartorius, Benn; (2017) Prevalence of metabolic syndrome, discrete or comorbid diabetes and hypertension in sub-Saharan Africa among people living with HIV versus HIV-negative populations: a systematic review and meta-analysis protocol. BMJ. In: BMJ Open; 2017. doi:10.1136/bmjopen-2017-016602
• 18. Duncan AD, Goff LM, Peters BS. Type 2 diabetes prevalence and its risk factors in HIV: A cross-sectional study. PLOS ONE. 2018;13(3):e0194199. doi:10.1371/journal.pone.0194199
• 19. Samad F, Harris M, Puskas CM, et al. Incidence of diabetes mellitus and factors associated with its development in HIV-positive patients over the age of 50. BMJ Open Diab Res Care. 2017;5(1):e000457. doi:10.1136/bmjdrc-2017-000457
• 20. Bratt G, Brännström J, Missalidis C, Nyström T. Development of type 2 diabetes and insulin resistance in people with HIV infection: Prevalence, incidence and associated factors. Andrei G, ed. PLOS ONE. 2021;16(6):e0254079. doi:10.1371/journal.pone.0254079
• 21. Gomes A, Reyes EV, Garduno LS, et al. Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy. PLoS ONE. 2016;11.
• 22. Oktay AA, Akturk HK, Jahangir E. Diabetes mellitus and hypertension: a dual threat. Current Opinion in Cardiology. 2016;31(4). https://journals.lww.com/co-cardiology/Fulltext/2016/07000/Diabetes_mellitus_and_hypertension__a_dual_threat.11.aspx
• 23. Mitambo C, Khan S, Matanje-Mwagomba BL, et al. Improving the screening and treatment of hypertension in people living with HIV: An evidence-based policy brief by Malawi’s Knowledge Translation Platform. Malawi Medical Journal. 2017;29:224-228.
• 24. Bigna JJ, Ndoadoumgue AL, Nansseu JR, et al. Global burden of hypertension among people living with HIV in the era of increased life expectancy: a systematic review and meta-analysis. Journal of Hypertension. 2020;38(9). Accessed July 8, 2024. https://journals.lww.com/jhypertension/Fulltext/2020/09000/Global_burden_of_hypertension_among_people_living.5.aspx
• 25. Xu Y, Chen XJ, Wang K. Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis. Journal of the American Society of Hypertension : JASH. 2017;11 8:530-540.
• 26. Achwoka D, Oyugi J, Mutave R, et al. High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya. PLoS ONE. 2020;15.
• 27. Alanazi FK, Alotaibi JS, Paliadelis P, Alqarawi N, Alsharari A, Albagawi B. Knowledge and awareness of diabetes mellitus and its risk factors in Saudi Arabia. Saudi Medical Journal. 2018;39(10):981-989. doi:10.15537/smj.2018.10.22938
• 28. Tekle T, Wolka E, Nega B, Kumma WP, Koyira MM. Knowledge, Attitude and Practice Towards Cervical Cancer Screening Among Women and Associated Factors in Hospitals of Wolaita Zone, Southern Ethiopia. Cancer Management and Research. 2020;Volume 12:993-1005. doi:10.2147/CMAR.S240364
• 29. Krishnamoorthy Y, Ganesh K, Sakthivel M. Prevalence and determinants of breast and cervical cancer screening among women aged between 30 and 49 years in India: Secondary data analysis of National Family Health Survey - 4. Indian J Cancer. Published online January 27, 2021. doi:10.4103/ijc.IJC_576_19
• 30. Ministry of Health, Kenya National Bureau of Statistics. Kenya STEPwise Survey for Non-Communicable Diseases Risk Factors 2015 Report. Division of Non Communicable diseases Afya house, Cathedral Road; 2015. Accessed July 8, 2024. https://www.knbs.or.ke/kenya-stepwise-survey-for-non-communicable-diseases-risk-factors-2015-report/