13 / 48
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 14 NUMBER 2 • DECEMBER 2017
51
enrollment. The study complied with the Declaration of Helsinki.
Data were collected simultaneously in all study centres of the
participating countries, using a standardised case report form
(CRF). The following variables were collected: socio-demographic
characteristics (age, gender, educational level, alcohol consumption,
tobacco use and employment type), history of hypertension,
diabetes status and systolic and diastolic blood pressure (BP, in
mmHg).
BP was measured using an automated BP machine (Omron 750
IT) in the seated position after the participant had been at rest for
five to 10 minutes. Three measurements were taken on the right
arm and the average of the last two was retained.
12
Weight, height,
and waist and hip circumference were measured using standard
procedures and equipment following WHO guidelines.
13
Weight
was measured to the nearest 0.5 kg and height to the nearest 0.5
cm. Body mass index (BMI, kg/m
2
) was calculated as body weight
in kg divided by the square of the height in metres. The waist
circumference (WC) was measured with a tape midway between the
lower rib margin and iliac crest. Waist-to-hip ratio was calculated as
waist circumference (cm) divided by hip circumference (cm).
Fasting capillary glucose concentration was obtained using a
standardised glucometer (Accu-chek Aviva; Hoffmann-LA Roche,
Ltd, Germany) in all the settings. Fasting total cholesterol, high-
density lipoprotein (HDL-C) and low-density lipoprotein cholesterol
(LDL-C), triglycerides, uric acid and serum creatinine concentrations
were acquired using locally available routine standard techniques
and procedures.
Hypertension was diagnosed in the presence of systolic or
diastolic blood pressure ≥ 140 or 90 mmHg or ongoing blood
pressure-lowering medications over the past 15 consecutive
days. Uncontrolled hypertension was defined as blood pressure ≥
140/90 mmHg in participants on BP control agents for the last 30
consecutive days. Duration of hypertension was defined as date of
survey minus date of diagnosis of hypertension.
Hyperglycaemia was defined as fasting capillary glucose level ≥
6.1 mmol/l (110 mg/l) and diabetes was defined as fasting capillary
glucose level ≥ 7.1 mmol/l (126 mg/dl) or physician-documented
history of diabetes, or patient on glucose-controlling agents (oral or
insulin) for the last 15 consecutive days. Impaired fasting glycaemia
was defined as fasting capillary glucose levels between 6.1 and 7.1
mmol/l (110–126 mg/dl).
Overweight and obesity were defined using BMI and WHO
criteria,
14
i.e. normal: 18.5 kg/m
2
≤ BMI ≤ 24.99 kg/m
2
; overweight:
25 kg/m
2
≤ BMI ≤ 29.99 kg/m
2
; obesity: 30 kg/m
2
≤ BMI ≤ 39.99
kg/m
2
, morbid obesity: BMI ≥ 40 kg/m
2
. Hypercholesterolaemia was
defined as a total cholesterol level > 5.18 mmol/l.
The metabolic syndrome (MS) was defined according to
the International Diabetes Federation (IDF) consensus criteria:
15
central obesity plus any two of the following: raised triglyceride
levels ≥ 150 mg/dl (1.7 mmol/l) or specific treatment for this lipid
abnormality, reduced HDL-C < 40 mg/dl (1.03 mmol/l) in men and <
50 mg/dl (1.29 mmol/l) in women or specific treatment for this lipid
abnormality, raised blood pressure (≥ 130/85 mmHg) or treatment
of previously diagnosed hypertension, raised fasting plasma
glucose level ≥ 100 mg/dl (5.6 mmol/l) or previously diagnosed type
2 diabetes.
15
Increased waist circumference was defined as > 102 cm for men
and > 88 cm for women. With a BMI > 30 kg/m
2
, central obesity
was assumed without measurement of waist circumference.
15
Alcohol consumption was categorised as low-to-moderate
consumption (less than or equal to one local beer daily for women
and two local beers for men) and excessive consumption (more than
two local beers daily).
16
Smoking status was determined as current
smokers, former smokers (having smoked in the past but having
stopped for two or more weeks prior to the survey, however, those
who had stopped within two weeks of the survey were considered
current smokers), and never smoked.
Statistical analysis
DataanalysiswasdoneusingtheStatisticalPackageforSocialSciences
(SSPS Inc, Chicago, IL) software version 20.0. Categorical variables
were summarised as counts and percentages while continuous
variables were summarised as means, median, standard deviation
(SD) and percentiles where appropriate. Group comparisons used
the chi-squared or Fisher’s exact tests for categorical variables, and
the Student
t
-test for continuous variables. A
p
-value < 0.05 was
considered statistically significant.
Results
Table 1 shows the general characteristics of the study population. A
total of 844 adults (57.4% were women and overall mean age was
52.6 ± 11.6 years) were included in the study, among whom 154
and 216, respectively, were from Cameroon and Nigeria, 240 from
the DRC and 240 from Madagascar. The majority (76.6%) of the
study participants were urban dwellers. The men were more likely to
be employed and to be educated than the women (both
p
< 0.001).
The women were more likely to be overweight, obese or morbidly
obese than the men (
p
< 0.001). The men had a significantly higher
mean triglyceride levels than the women (2.9 vs 2.2 mmol/l;
p
=
0.019) and lower mean HDL-C levels (1.6 vs 1.8 mmol/l;
p
= 0.004).
Men also had higher mean normal values of serum creatinine (90.8
vs 75.7 µmol/l,
p
< 0.001) and uric acid (295.0 vs 233.2 µmol/l,
p
< 0.001) than the women. Men and women had similar mean
systolic (149.5 vs 149.5 mmHg) and diastolic (91.9 vs 90.6 mmHg)
blood pressures, respectively.
The overall prevalence of hypertension [previously aware/
diagnosed (48.1%) and newly diagnosed (26%)] was 74.1%
[Cameroon (91.5%), Nigeria (66.8%), DRC (99.1%) and
Madagascar (45.0%)]. The overall prevalence of diabetes in the
study was 15.7% and ranged from 24.8% in Nigeria, 15.6% in
Cameroon and 15.0% in DRC, to 8.7% in Madagascar (
p
= 0.003).
Excessive alcohol consumption was reported in 25.6% of study
participants, with the highest prevalence in Cameroon (36.6%),
and the lowest in Nigeria, where all participants reported low-to-
moderate consumption (
p
= 0.007).
Of the study participants, 17.3% were either current or former
smokers. A significant difference (
p
< 0.001) in prevalence of
smoking across the countries was noted, with the highest prevalence
in Madagascar (32.9%), followed by Cameroon (13%), then DRC
(10.9%), and Nigeria (10.0%) being the lowest.
Of the study participants, 32.3 and 36.3% were overweight
and obese (obesity 31.8%), or morbidly obese (4.5%), respectively.
Overweight was highest in Madagascar (39.2%) and lowest in
Nigeria (28.4%), while overall obesity was highest in Cameroon
(53.6%) and lowest in Madagascar (10.0%) (
p
< 0.001). Details
of the cardiometabolic risk factors across the countries are shown
in Table 2.
When participants were assessed according to their hyperten-
sion status (Table 3), diabetes mellitus and hypercholesterolaemia