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Background/objectives To develop age- and sex-specific centile reference curves for fat-free mass (FFM) and fat mass (FM) adjusted for height in an adult Kenyan population and to investigate the association between FM, FFM and blood pressure (BP). Subjects/methods Measures of body composition from bioimpedance analyses and BP were collected in 1995 participants aged [greater than or equal to]50 years in Nakuru County, Kenya. Reference curves were produced using the LMS method. Multivariable linear regression models were used to test the cross-sectional association between body composition indexes and BP. Results The age- and sex-specific reference curves for body composition (FMI and FFMI) confirmed that FFMI is lower in both men and women with increasing age. FMI declines with age in women while among men the decline starts after 70 years. FFM was higher in men (47.4 [plus or minus] 7.2 kg) than in women (38.8 [plus or minus] 5.5 kg), while FM was lower in men (17.3 [plus or minus] 8.1 kg) than in women (24.4 [plus or minus] 10.2 kg). FMI, FFMI and BMI were all positively associated with systolic and diastolic BP, and after adjusting for body weight, FFMI remained positively associated with systolic BP and the FMI remained positively associated with diastolic BP. There was no evidence to suggest that FMI and FFMI were superior to measurement of BMI alone. Conclusions These body composition reference curves provide normative data on body composition for older adults in Kenya. Further research should consider the prospective associations with health, including frailty-related outcomes., Author(s): Madeleine C. Bastawrous [sup.1] , Carmen Piernas [sup.1] , Andrew Bastawrous [sup.2] , Jason Oke [sup.1] , Daniel Lasserson [sup.3] , Wanjiku Mathenge [sup.4] [sup.5] , Matthew J. Burton [...]

Problem Visual Impairment affects nearly 285 million people worldwide. Although there has been much progress in combating the burden of visual impairment through initiatives such as VISION 2020, barriers to progress, especially in African countries, remain high. Approach The Rwandan Ministry of Health has formed partnerships with several nongovernmental organizations and has worked to integrate their efforts to prevent and treat visual impairment, including presbyopia. Local setting Rwanda, an eastern African country of approximately 11 million people. Relevant changes The Rwandan Ministry of Health developed a single national plan that allows key partners In vision care to coordinate more effectively in measuring eye disease, developing eye care infrastructure, building capacity, controlling disease, and delivering and evaluating services. Lessons learnt Collaboration between stakeholders under a single national plan has ensured that resources and efforts are complementary, optimizing the ability to provide eye care. Improved access to primary eye care and insurance coverage has increased demand for services at secondary and tertiary levels. A comprehensive strategy that includes prevention as well as a supply chain for glasses and lenses is needed. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Probleme Pres de 285 millions de personnes dans le monde presentent des deficiences visuelles. Bien que les efforts pour reduire la charge qu'elles representent aient beaucoup progresse, grce a des initiatives telles que VISION 2020, les obstacles au progres, en particulier dans les pays d'Afrique, restent importants. Approche Le Ministere de la Sante rwandais a etabli des partenariats avec plusieurs organisations non gouvernementales en tchant d'integrer leurs efforts pour prevenir et traiter les deficiences visuelles, notamment la presbytie. Environnement local Le Rwanda, un pays d'Afrique de l'Est comptant environ 11 millions d'habitants. Changements significatifs Le Ministere de la Sante rwandais a mis en place un plan national qui permet une coordination plus efficace entre les partenaires cles de l'ophtalmologie, pour depister les maladies des yeux, developper des infrastructures de prise en charge des affections oculaires, renforcer les capacites, controler les maladies, fournir des services et evaluer ces derniers. Lecons tirees La collaboration entre les differents acteurs, dans le cadre d'un plan national unique,.a permis d'assurer la complementarite des ressources et des efforts et d'optimiser les capacites de prise en charge des affections oculaires. L'amelioration de l'acces aux soins oculaires de base ainsi qu'aux assurances a intensifie la demande de services aux niveaux secondaire et tertiaire. Une strategie globale de prevention et d'acquisition de lunettes ct de lentilles est maintenant necessaire. [TEXT NOT REPRODUCIBLE IN ASCII] Situacion La discapacidad visual afecta aproximadamente a 285 millones de personas en todo el mundo. Si bien se han hecho muchos avances en la lucha contra la carga de la discapacidad visual mediante iniciativas como el programa VISION 2020, las barreras hacia el progreso siguen siendo altas, especialmente en los paises de Africa. Enfoque El Ministerio de Salud de Rwanda ha establecido colaboraciones con varias organizaciones no gubernamentales y ha trabajado para integrar sus esfuerzos para prevenir y tratar la discapacidad visual, incluida la presbicia. Marco regional Rwanda, un pais del Africa oriental con aproximadamente 11 millones de habitantes. Cambios importantes El Ministerio de Salud de Rwanda desarrollo un unico plan nacional que permite a los colaboradores clave que trabajan en la atencion oftalmica coordinar de una manera mas efectiva la medicion de las enfermedades oculares, el desarrollo de una infraestructura para la atencion oftalmica, la generacion de capacidades, el control de las enfermedades y la prestacion y evaluacion de servicios. Lecciones aprendidas La colaboracion entre las partes interesadas bajo un unico plan nacional ha garantizado que los recursos y esfuerzos sean complementarios, optimizando la capacidad de proporcionar servicios de atencion oftalmica. La mejora del acceso a la atencion oftalmica primaria y la cobertura del seguro ha incrementado la demanda de servicios a nivel secundario y terciario. Se necesita una estrategia exhaustiva que incluya la prevencion y una cadena de suministro de gafas y lentes., Ameliorer les soins oculaires au Rwanda Mejorar la atencion oftalmica en Rwanda Introduction Visual impairment--both preventable and treatable--affects an estimated 285 million people globally. Most of the people affected (87%) [...]

Background The link between poverty and health is central to the Millennium Development Goals (MDGs). Poverty can be both a cause and consequence of poor health, but there are few epidemiological studies exploring this complex relationship. The aim of this study was to examine the association between visual impairment from cataract and poverty in adults in Kenya, Bangladesh, and the Philippines. Methods and Findings A population-based case-control study was conducted in three countries during 2005-2006. Cases were persons aged 50 y or older and visually impaired due to cataract (visual acuity < 6/ 24 in the better eye). Controls were persons age- and sex-matched to the case participants with normal vision selected from the same cluster. Household expenditure was assessed through the collection of detailed consumption data, and asset ownership and self-rated wealth were also measured. In total, 596 cases and 535 controls were included in these analyses (Kenya 142 cases, 75 controls; Bangladesh 216 cases, 279 controls; Philippines 238 cases, 180 controls). Case participants were more likely to be in the lowest quartile of per capita expenditure (PCE) compared to controls in Kenya (odds ratio = 2.3, 95% confidence interval 0.9-5.5), Bangladesh (1.9, 1.1-3.2), and the Philippines (3.1, 1.7-5.7), and there was significant dose-response relationship across quartiles of PCE. These associations persisted after adjustment for self-rated health and social support indicators. A similar pattern was observed for the relationship between cataract visual impairment with asset ownership and self-rated wealth. There was no consistent pattern of association between PCE and level of visual impairment due to cataract, sex, or age among the three countries. Conclusions Our data show that people with visual impairment due to cataract were poorer than those with normal sight in all three low-income countries studied. The MDGs are committed to the eradication of extreme poverty and provision of health care to poor people, and this study highlights the need for increased provision of cataract surgery to poor people, as they are particularly vulnerable to visual impairment from cataract., Introduction Improvements in health are at the heart of the Millennium Development Goals, with the recognition that better health is central to the primary aim of reducing poverty as well [...]

Background The World Health Organization estimates that there were 37 million blind people in 2002 and that the prevalence of blindness was 9% among adults in Africa aged 50 years [...]

Background: Diseases of the posterior segment of the eye, including age-related macular degeneration (AMD), have recently been recognised as the leading or second leading cause of blindness in several African countries. However, prevalence of AMD alone has not been assessed. We hypothesized that AMD is an important cause of visual impairment among elderly people in Nakuru, Kenya, and therefore sought to assess the prevalence and predictors of AMD in a diverse adult Kenyan population. Methods and Findings: In a population-based cross-sectional survey in the Nakuru District of Kenya, 100 clusters of 50 people 50 y of age or older were selected by probability-proportional-to-size sampling between 26 January 2007 and 11 November 2008. Households within clusters were selected through compact segment sampling. All participants underwent a standardised interview and comprehensive eye examination, including dilated slit lamp examination by an ophthalmologist and digital retinal photography. Images were graded for the presence and severity of AMD lesions following a modified version of the International Classification and Grading System for Age-Related Maculopathy. Comparison was made between slit lamp biomicroscopy (SLB) and photographic grading. Of 4,381 participants, fundus photographs were gradable for 3,304 persons (75.4%), and SLB was completed for 4,312 (98%). Early and late AMD prevalence were 11.2% and 1.2%, respectively, among participants graded on images. Prevalence of AMD by SLB was 6.7% and 0.7% for early and late AMD, respectively. SLB underdiagnosed AMD relative to photographic grading by a factor of 1.7. After controlling forage, women had a higher prevalence of early AMD than men (odds ratio 1.5;95% CI, 1.2-1.9). Overall prevalence rose significantly with each decade of age. We estimate that,inKenya,283,900 to 362,800 people 50 y and older have early AMD and 25,200 to 50,500 have late AMD, based on population estimates in 2007. Conclusions: AMD is an important cause of visual impairment and blindness in Kenya. Greater availability of low vision services and ophthalmologist training in diagnosis and treatment of AMD would be appropriate next steps., Introduction In the latest estimates of global blindness and visual impairment undertaken by the World Health Organization, in 2010, age-related macular degeneration (AMD) is the third most common cause of [...]