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This essay explores the amazing phenomenon that in Europe since ca. 1700 most diseases have shown a pattern of 'rise-and-fall'. It argues that the rise of so many diseases indicates that their ultimate cause is not to be sought within the body, but in the interaction between humans and their environment. In their tireless pursuit of a better life, Europeans have constantly engaged in new activities which exposed them to new health risks, at a pace that evolution could not keep up with. Fortunately, most diseases have also declined again, mainly as a result of human interventions, in the form of public health interventions or improvements in medical care. The virtually continuous succession of diseases starting to fall in the 18th, 19th and 20th centuries suggests that the concept of an “epidemiological transition” has limited usefulness.

Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

The outbreak of Covid-19 pandemic highlighted the existence of a hospital bed shortage in Italy, as a result of a longstanding trend. The article analyses this process by an international comparison with other Western European countries, highlighting the intensity of hospital bed reduction in Italy, as a fundamental component of NHS rationalisation. Although it was based on solid grounds, international data suggest that hospital bed reduction was probably excessive, depriving the NHS of organisational slack. Moreover, de-hospitalisation would have been matched with a stronger development of primary and community care. The relative shortage of these services, along with the lack of integrated networks between hospital and non-hospital care, explains many difficulties experienced by hospitals in tackling Covid patients. Beyond investments in health care, these elements call to re-think the organisation of health care provision at local level, questioning the purchaser-provider split.

Demographic changes with an increasingly higher proportion of older adults worldwide and an epidemiologic transition resulting in more teeth retained and higher demand and expectations set up new scenarios for the oral health of the older population. Thus, geriatric dentistry must be reconfigured, transitioning from the traditional focus on prosthesis to a more holistic discipline, actively incorporating geriatric and gerontologic aspects. We describe some situations that provide the rationale for a new conceptual framework for the advancement of geriatric dentistry as a clinical specialty. On the basis of scientific evidence and our academic experience, we propose 4 concepts that should steer the discipline during the following years and become its structural pillars: minimal intervention dentistry, oral functionality, patient-centered care, and interdisciplinary teamwork. Since data and evidence are limited, a special focus on poor and developing countries is incorporated. Adjusting clinical guidelines and public health policies around these concepts will increase access to oral care for older people, including those with physical or social barriers, and will ensure better oral health–related quality of life and well-being. These concepts have deep consequences in the education and training of new dentists and specialists, at the public and private levels.

Background: Increase in Non-communicable diseases in spite of many steps taken for prevention and control is challenge for all over world, these epidemiological transition leas to need of health care services at community level with quality health care services. Under Ayushman Bharat Programme transformation of existing health facilities in Health and Wellness center to deliver universal and free comprehensive primary health care. Delivering Non communicable disease health services is one of major component of HWCs. Objectives:.Study was conducted to conduct analysis of Publication on Non communicable disease and Ayushman Bharat Health and Wellness Center. Methodology: Retrospective observational study was conducted On 30.01.2021, the Pubmed was accessed to collect publication on Non communicable disease and Ayushman Bharat, Health and Wellness Centre. Bibliometric analysis was conducted with quantity indicators for measuring productivity and quality indicators for measurement of output. Structural indicator for measured inter linkage between authors, publication Information on PubMed was used for analysis with the help of R Studio. Results: The PubMed search filtered for annual scientific production including journal ,book , document etc from 1978 to 2021 are found total publication are 2377.Out of Total publication after analysing most relevant sources include PLOS One was found most relevant source around 91.In Correspondence Authors from various countries India is on 3rd number which is around 114 authors. Conclusion: There are many publications on this key words and most publication are published in recent 10 years. Indian contribution in this area in on 3rd no in all over world.

Cardiovascular disease (CVD) is the leading cause of death worldwide; approximately 80% of CVD deaths occur in low-income and middle-income countries (LMICs). The epidemiologic transition to a high burden of ischemic heart disease (IHD) has happened with greater rapidity in LMICs than in high-income countries. The absolute number of individuals with premature IHD has increased substantially. Higher event rates are observed compared with high-income countries. The technological capability to do extraordinary things for patients has increased, as has patient demand, in a setting of constrained resources and expensive health care of variable quality.

Currently, the health challenge in Indonesia is the epidemiological transition, which is known as three disease burdens, namely the high prevalence of infectious diseases, the increase in non-communicable diseases and diseases that should have been resolved before but have re-emerged. Non-communicable diseases require more attention, as the productive age increases in Indonesia, several factors such as lifestyle, diet, and others make non-communicable diseases increase, so health needs to receive attention in increasing the degree of public health, one of which is health services. This study aims to determine the relationship between knowledge, attitudes, and perceptions of pain with the utilization of health services for patients with non-communicable diseases at Regional General Hospital (RSUD) Haji Makassar. This research is a quantitative study with an observational approach using a cross sectional design. The population in this study were 1037 patients with non-communicable diseases at Haji Makassar Hospital. The sample selection used accidental sampling technique, in order to obtain a sample of 87 people. Data analysis used univariate and bivariate analysis. The results of this study indicate that knowledge of non-communicable diseases (ρ = 0.000), attitude of officers (ρ = 0.100), and perception of pain (ρ = 0.016). Suggestions to the hospital to make improvements regarding the condition of the hospital, the availability of facilities, types, or variations of health services that are more complete. Doctors, nurses or officers give more special attention to the patient's condition when providing services and further explain the patient's health condition.

Background Taiwan has implemented a national health insurance system since 1995 with high coverage and utilization rate. However, the health care system in Taiwan is facing immense challenges due to rapid population ageing. We have evaluated the landscape of population health by revisiting the results of GBD 2017 study. Methods Taiwan vital registration data (1980–2016) and Taiwan national health insurance database (2016) were used. We also conducted benchmarking comparisons with selected countries in East Asia from 1990 to 2017. Results The age-standardized disability-adjusted life-year (DALY) rates decreased by one-quarter from 1990 to 2017; however, progress was relatively slow compared to the comparator countries and has been stagnant recently. The Social-demographic Index (SDI) level in Taiwan in 2017 was 0.86, which is similar to Japan, Singapore, and South Korea in 2017, while the SDI level of China in 2017 was similar to that of Taiwan (0.69) in 1990. Although Taiwan's SDI reached the same level as those in Japan, Singapore, and South Korea in 2017, modifiable risk factors still contributed to nearly half of Taiwan's total disease burden. Five leading risk factors (high fasting plasma glucose, high body-mass index, alcohol use, illicit drug use, and impaired kidney function) accounted for a higher DALY rate in Taiwan than comparator countries in 2017. Conclusion Taiwan made marked progress in health from 1990 to 2017. However, interventions targeted on major modifiable disease risk factors should be prioritized to realize the full potential of heath improvement in the process of rapid socioeconomic development.

Purpose Recent public health policy emphasizes the achievement of healthy aging as average life expectancy increases worldwide. Evidence for healthy aging from low- and middle-income countries (LMIC) is limited. The purpose of this paper is to assess the prospects of healthy aging and its associated factors in the Indian context. Design/methodology/approach The study was based on a national-level panel survey, the Indian Human Development Survey (IHDS) conducted in 2004-05 and 2011-12. The analytical sample consists of 10,218 elderly individuals who were 60 years old and above at the baseline. Change in health status was assessed based on disability and disease incidence at the follow-up. A generalized estimating equation (GEE) model was performed to assess health status change. Findings Increasing age was a risk factor for all dimensions of health outcomes. Elderly from the lowest wealth quintiles were more likely to lose health due to short-term morbidity, whereas the highest wealth quintiles were more likely to lose health due to long-term and multi-morbidity, indicating evidence for the presence of the “disease of affluence”. Social capital, such as living in a joint family acted as a protective factor against health risks. Originality/value With the results showing the evidence of the “disease of affluence” and “disease of poverty” in different health outcomes, there should be a health policy focus that copes with undergoing epidemiological transition. It is also important to pay attention to health-protecting factors such as social and familial support to achieve healthy aging.

Background Sub-Saharan Africa is going through an epidemiological transition, including an impressive increase in non-communicable diseases. The introduction of medicines has not kept pace with the needs in developing countries. The objectives of this study were to (i) examine the correlation between the number of medicine approvals and disease burden and (ii) compare approval timelines of medicines with disease burden in South Africa in the period 2012–2017. Methods The dataset was compiled from publicly available data on medicines registered in South Africa between 2012 and 2017. A correlation analysis was conducted to determine the level of alignment between the number and nature of medicines registered, as determined by the WHO ATC Classification and the Lancet Global Burden of Disease data. Median registration timelines were determined to assess whether medicines for diseases of higher burden were registered faster. Results A total of 3059 registered medicines were included in the study, including 2779 generic medicines, 267 new chemical entities and 13 vaccines. There was a high level of alignment between the number of medicines registered to treat diseases with higher disease burden levels more effectively, except for lower respiratory tract infections and HIV/AIDS which showed less medicines registered as compared to expectations based on disease burden, respectively. HIV/AIDS showed a lower level of correlation with a much higher disease burden compared to number of medicines registered, but simultaneously also a much shorter median registration timeline (32 months) compared to the other disease areas. Conclusions There was generally a high level of alignment between disease burden and number of medicines authorised, except for HIV/AIDS and lower respiratory tract infections. Regulatory authorities should continue to consider burden of disease data to ensure that public health needs are met.

Background Contemporary registries on atrial fibrillation (AF) are scare in North African countries. Hypothesis In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. Methods NATURE‐AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one‐year follow‐up period. All the patients with an Electrocardiogram‐documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. Results A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2DS2VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12‐month follow‐up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. Conclusions NATURE‐AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

Objectives: The objective is to determine the frequency and the semiological and evolutionary profiles of infectious spondylodiscitis in hospital practice in Kara. Patients and methods: This was a cross-sectional study of a case series of patients with infectious spondylodiscitis, who were admitted to the rheumatology department of Kara University Hospital in North Togo. Results: Among the 3972 examined patients, 86 (33 males and 53 females) patients (2.16%) had infectious spondylodiscitis. The average age of these patients at the onset of the disease was 47.20 years. The average duration of the disease was 11.41 months. Tuberculosis was suspected in 77 of 86 patients (89.53%). The infectious spondylodiscitis most often affected the lumbar (51.04%) and dorsal (21.87%) segments and was associated with a pulmonary location in 31 patients (36.04%). In addition to underdevelopment and poor hygiene (72 cases), alcoholism (15 cases) and human immunodeficiency virus infection (10 cases) were the main risk factors identified. The progress with the medical treatment was favorable in 65 patients (75.58%) and 16 patients were lost to follow-up. Conclusion: The frequency of infectious spondylodiscitis reflects the underdevelopment and poor hygiene levels in Black Africa. Its etiology is most commonly associated with tuberculosis and remains a concern despite the epidemiological transition of the different diseases.

Colombia is experiencing an epidemiologic transition, with an increasing incidence of cancerous neoplasms prevalent in high-income countries, while infection-associated tumors remain highly prevalent. According to international standards, Colombia has a deficit of radiotherapy machines (a shortage of about 47 machines) and radiation oncology specialists (a shortage of about 19 to 149 specialists based on number of centers and incident cases, respectively) to meet the national demand, which may induce an inappropriate dynamic in radiation oncology services. Estimates based on cancer incidence trends and the rate of new specialists in radiation oncology expected to graduate per year suggest that the current deficit will remain unchanged or may even increase during the next decades. The situation is critical because of the existence of a single training program in the country for a population of 45 million inhabitants and the low availability of educational programs offered in the Latin American region to cover the national demand. A comprehensive analysis of radiotherapy services should include data on medical physicists, radiotherapists, and the oncology nursing workforce; however, we found no reliable information available. A better balance between the educational programs offered and the demand for radiotherapy is highly valuable.

Background : An epidemiological transition occurs during the turn of the 21 st century. Non- communicable diseasespredominate over the communicable diseases along with the global economic development. Among the non-communicable diseases, injuries and accidents become a major concern. Objectives: To identify the pattern of injuries prevailing in a rural community in Sirajganj district during 1st November 2015 to 31st January 2016, Materials and Methods: This cross sectional study was conducted among the people living in the rural area near to Shahjadpur Upazila Health Complex of Sirajganj. A total of 442 respondents were interviewed face-toface using a semi-structured questionnaire. Convenience sampling technique was adopted. Collected data were cleaned and analyzed with SPSS software (version 20.0). Results: There were 204 cases of injuries. Fall, cut injury, road traffic accident (RTA) and burn constituted 30.4%,30.4%,15.2% and 12.3% of the injuries respectively. Among the injured cases, 73 went to any health facility to seek treatment. Majority (53.4%) of the injured cases faced loss of activity with hand, 13.2% developed loss of mobility. Among the 73 injured persons who went to any healthcare facility for obtaining treatment, 2.7% expired, 4.1% lives with disability, 15.1% had temporary disability and 78.1% recovered. Nearly half (43%) of the respondents mentioned that they did not have idea about injury prevention. Conclusion: This study reiterates the need to spread the knowledge of pattern of injuries and its prevention through available evidence based strategies and multiple dissemination channels in rural areas. KYAMC Journal Vol. 11, No.-3, October 2020, Page 118-123

Iran is a developing country facing demographic transition. Cancers are among the major non-communicable disorders with remarkable budern on the health-care governing systems. Extended life expectancy of Iranian population, change in living style, as well as promoted diagnostic and treatment methods have resulted into significant malignancies emergence and detection. Understanding the trend of this epidemiologic transition is required for proper allotment of resources. In this manuscript, overall epidemiologic pattern of cancers and their burden transition is reviewed. In addition, more concerning neoplasia (gastrointestinal, breast, thyroid, urologic, and respiratory system cancers) are reviewed in more details.

India is undergoing an epidemiological transition to non-communicable diseases (NCDs), with NCDs contributing to nearly 60 percent of all deaths in India. NCDs are challenging to manage given their silent onset, low health awareness, significant informational asymmetry, and low health-seeking behavior among the rural population and the poor in India. The Ministry of Health and Family Welfare (MoHFW), Government of India, launched Ayushman Bharat to move from a sectoral and segmented approach of health service delivery to a more comprehensive one. As part of this effort, a program was launched for population-based screening (PBS) and management of five common NCDs—hypertension, diabetes, oral, breast, and cervical cancers. The success of the program, among other things, will be determined largely by the early detection, timely treatment, and diligent follow-ups to manage the five NCDs. In line with WHO’s Global action plan for the prevention and control of NCDs 2013–2020, India is the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025. However, challenges like human resource shortfall, limited capacities of the health workers, heavy burden of managing multiple health priorities, and poor utilization of public health facilities may affect the outcomes of this ambitious initiative Technology can serve as an enabler in solving some of these problems. Dell Technologies and Tata Trusts have partnered with the Ministry of Health and Family Welfare, Government of India, to develop a technology solution for the PBS NCD initiative. It consists of a suite of mobile and web apps on a cloud platform for health workers, doctors, and health administrators to enable care delivery for people across the country. The solution has been deployed in states across the country with adoption gaining momentum amongst health care providers. While early process indicators are encouraging, it is important to examine individual clinical outcomes, population outcomes and cost effectiveness which are the primary objectives of such a program. The learnings from this digital health program can then be transposed to similar healthcare settings. The paper covers four challenges commonly encountered in the context of running large-scale digital health programs in a multi-state, multi-facility, and multi-stakeholder system. These are adoption of technology by health workers with low digital literacy, feasibility of running tech solutions in remote areas, value proposition of the solution for users and finally the know-how on building and rolling-out technology at scale to reach millions of people.

The increasing flow of globalization in all fields, technological and industrial developments have been many bring changes to people's behavior and lifestyle. Changes in food consumption patterns as well as reduced physical activity and environmental pollution also contribute to lifestyle changes. These changes have unconsciously influenced the epidemiological transition with the increasing cases of degenerative diseases. Along with these changes in human lifestyle, one of the problems that arise in the health sector is an increase in the incidence of metabolic syndrome. This study aims to determine the relationship of socioeconomic status with metabolic syndrome in outpatients at the Labuang Baji Makassar Hospital. This type of research is an analytic survey with a cross sectional approach. Sampling was done using accidental sampling technique with a sample size of 70 people. Data collection was carried out by collecting secondary data and primary data. Data analysis was performed using the chi-square test. The results showed that there was no significant relationship between socioeconomic status and metabolic syndrome. Metabolic syndrome patients were found to be highest at the age of 60-69 years. Most of the people with metabolic syndrome are women with retired jobs. The metabolic syndrome incidence increases with the high level of education.

In the wake of demographic and epidemiological transition, rising life expectancy and disability has become a global, national and regional phenomenon. Though estimates of life expectancy at birth are available at regular time intervals, there are limited studies on estimates of disability-free life expectancy by gender and regions in India. Study design Compares life expectancy of disabled and overall population by seven type of disability. Objective This study examines the gender differential and regional disparity of disability-free life expectancy (DFLE) and Life lived with disability (LWD) among disabled in India. Methods Data from Census of India, 2011 and abridged life table from Sample Registration System 2011 has been used. Disability-free life expectancy (DFLE) was estimated using Sullivan method. Life lived with disability was calculated for all major states included in the study by the types of disabilities. Results In 2011, the DFLE in India was 58.1 years for males and 60.78 years for females compared to life expectancy of 66.87 years for males and 70 years for females. On average, females in India had lived more years with disability than males. Similarly, the DFLE of rural areas was 58.6 compared to 62.3 in urban areas. The DFLE was 59.26 years movement, 58.88 for mental retardation and 58.81 for mental illness. The age pattern of DFLE decreases with increasing age for both males and females. The regional variation in DFLE is large. The DFLE of males in the state of Jammu and Kashmir was 62.4 compared to 56.4 in Assam. Similarly, for females, the DFLE was 61.8 years in Gujarat and 63.1 years in Tamil Nadu. Conclusion Though the overall life expectancy and DFLE were higher for females than for males, females lived with disability for more years than males. The DFLE was lowest for mental retardation followed by mental illness. The poorer states of India has lower DFLE compared to richer states.

Background The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study. Methods We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period. Results The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality. Conclusions Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.

OBJECTIVES: To investigate associations between self-reported sleep duration and cardiometabolic (CM) risk factors in African-origin adults residing in five countries spanning the epidemiologic transition. DESIGN: Cross-sectional SETTING AND PARTICIPANTS: Ghanaian (n=491), South African (n=503), Jamaican (n=508), Seychellois (n=501) and American (n=480) men and women. MEASUREMENTS: Self-reported sleep duration was obtained using questionnaires. Sex and sitestratified logistic regression analyses investigated relationships between sleep duration, individual CM risk factors and a binary CM risk variable (presence of ≥3 CM risk factors), adjusting for age, physical activity and education. RESULTS: Sleep duration distributions varied by cohort: 44.5%, 41.4%, 35.9%, 16.8% and 2.5% of American, Jamaican, Seychellois, Ghanaian and South African men reported

Background: India is undergoing a rapid epidemiological transition, from underweight to overweight/obese population. Obesity is a major risk factor in type 2 diabetes and cardiovascular diseases, and is also implicated as a factor in neurological diseases such as Alzheimer’s disease. A robust, pan-Indian estimate of obesity is not yet available. Purpose: This study estimates the pan-Indian prevalence of obesity, stratified across nonmodifiable (age and gender) and modifiable (education and physical activity levels) factors, and across zones and urban/rural. Methodology: Data for 1,00,531 adults from a nationwide randomized cluster sample survey ( Niyantrita Madhumeha Bharata 2017, phase 1) were analyzed. Obesity was determined using body mass index, and cross-tabulations were calculated across zones, age, gender, education, physical activity, and area. To determine statistical significance, t-tests were used. The odds of obesity within each category of the various factors were calculated using binary logistic regression. Results: Prevalence of obesity in India is 40.3%. Zonal variations were seen as follows: south highest at 46.51% and east lowest at 32.96%. Obesity was higher among women than men (41.88% vs. 38.67%), urban than rural (44.17% vs. 36.08%), and over 40 than under 40 (45.81% vs. 34.58%). More education implied a higher obesity (44.6% college vs. 38% uneducated), as did lowered physical activity (43.71% inactive vs. 32.56% vigorously active). The odds ratio for physical activity was 3.83, stronger than age (1.58), education (1.4), urban (1.3), and gender (1.2). Conclusion: Obesity levels in India are very high, across all zones. The odds of being obese increases with age, and is higher among women and among urban dwellers. Obesity is the highest among aging urban men and women who are college educated and are sedentary. Physical activity and aging are the strongest determinants of obesity. Given the high cost of obesity in terms of type 2 diabetes, cardiovascular diseases, and Alzheimer’s disease, urgent public health measures are necessary to reduce its impact.

Purpose: There is increasing interest in the understanding of key influences over successful implementation of health policies within ever-changing contexts of national health systems. The epidemiological transition in Vietnam, combined with an urgent need for improving efficiency of the national health system under the government’s administrative reforms, form important facilitators of restructuring the public health system. This paper explored the implementation processes of policy on establishment of the Centers for Diseases Control (CDC) in Vietnam during 2016– 2019. Methods: The study employed a cross-sectional and mixed methods design. Staff surveys were collected at 55 out of 63 provinces and in-depth interviews, focus groups were conducted in three purposefully selected provinces. Quantitative data were analysed using descriptive statistics and qualitative data were analyzed thematically. The innovation implementation framework guided the study. Results: After 3 years of introduction, 82.5% of provinces had established the CDCs. Implementation of CDC establishment policy was influenced by 1) management support; 2) alignment between policy and practice; 3) values towards CDC,; and 4) implementation climate. Other external key influencers included political, social, and cultural factors. Conclusion: Our study provides a framework and evidence to guide future inquiry into the factors that affect the relationship between policy implementation and other contextual factors in healthcare organizations.

Background Minimal data are available on the clinical activity of general practitioners (GPs) in Africa. Objective To describe the health problems managed by GPs in Mali as compared with France where epidemiological transition is already advanced. Methods A retrospective, multicenter study, conducted in five Malian Community Health Centers. We compared their consultation data to those of the ECOGEN (Eléments de la COnsultation en médecine GENérale) study conducted in 128 French general practices, after data standardization for age and sex. Results Malian and French databases included 19 068 and 19 341 consultations, respectively. Patients had an average of 1.2 health problems managed per consultation in Mali, versus 2.2 in France. They were dominated by infections (51.3%) in Mali, including malaria (24.9%), pneumonia (9.0%) and gastrointestinal infections (5.0%). In comparison with French GPs, Malian GPs more frequently managed cardiovascular (20.2% versus 13.5%), respiratory (15.0% versus 12.4%) and digestive (13.3% versus 7.8%) problems, and less frequently musculoskeletal (3.1% versus 12.6%), endocrine/metabolic (1.5% versus 10.7%) and psychological (0.2% versus 8.2%) problems. The main activity performed by French GPs was prevention (11.0%), which was nominal in Mali. Apart from hypertension, which accounted for 18.9% of the health problems managed in Mali, chronic conditions were less often managed by Malian GPs than by French GPs (12.3% versus 39.6%). Conclusions Africa is currently at the crossroads where chronic conditions carried with the epidemiological transition are progressing, while the burden of communicable diseases is still overwhelming. Along with the enhancing medicalization of primary care in Mali, the transition of practices is just emerging.

Background Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and three-quarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I2 = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.

Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of Canada has brought together its partners from the Americas annually, to reflect on the evolution of Family Medicine on the continent since Alma-Ata, and to look forward to future challenges. Family doctors are but one element of a strong health system. Family Medicine provides key ingredients to respond to population health needs especially as countries move through the epidemiological transition to face larger burdens of chronic disease and multimorbidity. In this paper, we provide a high-level overview of the state of Family Medicine on the continent. We then analyze trends in the education of family physicians to face this changing landscape, including the emphasis on the leader role of future family physicians. Postgraduate programs in Family Medicine in the Americas are placing increasing emphasis on teaching collaborative care in view of creating truly interdisciplinary health teams for the benefit of patients. Resumo Desde 2012, o Centro Besrour de Medicina Global de Família, na Faculdade de Medicina de Família do Canadá, reúne seus parceiros das Américas anualmente para refletir sobre a evolução da Medicina de Família no continente desde Alma-Ata e para os desafios futuros. Os médicos de família são apenas um elemento de um forte sistema de saúde. A Medicina de Família fornece ingredientes-chave para responder às necessidades de saúde da população, especialmente à medida em que os países passam pela transição epidemiológica para enfrentar um fardo maior de doenças crônicas e de multimorbidade. Neste artigo, fornecemos uma visão geral de alto nível do estado da Medicina de Família no continente. Em seguida, analisamos as tendências na educação dos médicos de família para enfrentar esse cenário em mudança, incluindo a ênfase no papel de líder dos futuros médicos de família. Os programas de pós-graduação em Medicina de Família nas Américas estão enfatizando cada vez mais o ensino do cuidado colaborativo, a fim de criar equipes de saúde verdadeiramente interdisciplinares para o benefício dos pacientes.

Many low- and middle-income countries (LMICs) are undergoing an epidemiological transition. With an improvement in socioeconomic conditions and an aging population, cardiovascular diseases (CVDs), like cardiac arrhythmias, are expected to increase in these countries. However, there are limited studies on the epidemiology and management of cardiac arrhythmias in LMICs. This review will highlight the unique challenges and opportunities that these countries face when managing cardiac arrhythmias.

Background: Epidemiological transition is causing a shift from Communicable to Non­Communicable Diseases (NCD). NCD is a serious threat because it impacts decreasing productivity and increasing economic and social burdens for the community. The control of NCD risk factors in Indonesia is carried out by empowering the community through the Inte­grated Non­­-­­Com­municable Diseases Health Post (Posbindu NCD). One of the important factors determining the success of imple­menting Posbindu is the role of cadres. This study aims to analyze the factors that affect the performance of Posbindu cadres. Subjects and Method: This was an analytic obser­vational study with a cross-sectional design. The study was conducted in 25 posbindus in Karanganyar, Central Java, from February to April 2020. A sample of 200 cadres from 25 cadres was selected by stratified random sam­pling. The dependent variable was the perform­ance of the Pos­­bindu cadres. The independent variables were training, ability, length of em­ployment, motivation, the leader­­ship of the Posbindu chair­man, social network support and appreciation. Data were analyzed using multilevel logistic regression with Stata 13. Results: Job performance increa­sed with trai­ning (b= 1.75; 95% CI= 0.28 to 3.22; p= 0.019), good ability (b= 2.50; 95% CI= 0.95 to 4.04; p= 0.002)­, tenure ≥1 year (b= 1.99; 95% CI= 0.05 to 3.92; p= 0.044), strong moti­vation (b= 2.57; 95% CI= 1.25 to 3.89; p

Aims: To determine the prevalence and 10 years risk of type-2 diabetes mellitus in rural English speaking South West Cameroon. Methods: Between April and June 2018, we conducted community screening campaigns in 6 English speaking rural communities of Cameroon. We adapted the Finish Diabetes Association Type 2 diabetes risk assessment tool to enable us classify participants as low or high risk cases. Results: In a sample of 983 participants aged ≥30 years, we found 37 (3.8%) persons with type 2 diabetes (12 existing and 25 newly diagnosed) and 149 (15.1%) persons at high risk of developing diabetes within 10 years. We estimated that within 10 years 65 (6.9%) new cases of diabetes will emerge from the study population. Older participants (54 - 87 years) were 2.5 times (AOR 2.5, CI: 1.0, 6.2) more likely to have diabetes compared to younger (30 - 44 years) participants. The risk of developing diabetes within 10 years was statistically significantly increased among participants who were semi-active, older, had a high BMI, had a family history of diabetes or had high systolic blood pressure. Conclusions: Our study identified a brewing diabetes crisis in rural Cameroon, confirming the recent International Diabetes Federation warnings of an impending rural diabetes crisis in Sub-Saharan Africa. There is therefore an urgent need for measures to avert the situation such as expanding the urban-focused diabetes service to rural areas.

Background: The so-called protected tribal population are also facing burden of noncommunicable diseases. The high altitude tribes are thought to be genetically and environmentally protected from hypertension (HTN) like diseases. Objective: The objective is to estimate the prevalence of HTN among tribes residing at high altitudes (>6000 feet above sea level) of India. Methods: The meta-analysis was undertaken during March to August 2018. National Library of Medicine's PubMed database, and Google scholar were comprehensively searched including search terms such as “blood pressure, hypertension and prevalence” combined with “tribal, tribes, high altitude, India.” Articles on the prevalence of HTN were searched first and then were segregated on the basis of high altitude (>6000 ft). Results: Initially, 69 references and a total of 16 abstracts were screened. After applying the inclusion and exclusion criteria on 16, eight studies were included. Meta-analysis of the prevalence of selected studies resulted in a pooled estimate mean prevalence of HTN among tribal population to be 11.43% (95% confidence interval: 6.72%–17.21%). Conclusion: The role of epidemiological transition needs to be read in the context of social anthropology to identify factors preventing HTN among high altitude tribes.

Background: Cardiovascular disease (CVD) is the major cause of premature morbidity and mortality in India and is undergoing an epidemiological transition, now affecting the urban poor. It is important to assess patients for CVD risk and mitigate risk factors as a primary mode of prevention of CVD accordingly. Objective: The objective of the study was to assess the 5-year risk of cardiovascular events and the prevalence of CVD risk factors in an underprivileged area of Bangalore City. Methods: Community-based house-to-house survey of all adults aged 30 years and above, using an interview schedule on Epicollect mobile application, capturing sociodemographic details and CVD risk factors based on the INTERHEART risk assessment which included dietary risk factors, smoking and alcohol, physical activity, and central obesity. Blood pressure, random blood sugar, height, weight, and waist circumference measurement were done. The National Health and Nutrition Examination Survey CVD risk assessment charts were used to calculate the 5-year risk of a cardiovascular event. Results: Of 1184 study participants, 23% had moderate risk (10%–20%) and 30% had high risk (>20%) of a cardiovascular event in the next 5 years. Factors such as being not currently married, belonging to a religious minority, lower education, not being gainfully employed, belonging to a joint family, and salty food consumption were significantly associated with higher CVD risk. Conclusion: Urban underprivileged areas with undermined social determinants of health have significantly high burden of CVD risk and hence require a holistic approach to CVD risk assessment and noncommunicable diseases care starting with easy to use CVD risk assessment charts by community level health workers. Cardiovascular diseases risk assessment, diabetes, hypertension, noncommunicable diseases, urban health

Objective: To determine associations between standardized prevalence ratios of Metabolic Syndrome (MS), High Blood Pressure (HBP), and Obesity (O) with structural factors in ecuadorian population aged 20 to 59. Methods: An ecological study was conducted through data from the Ecuador’s National Health and Nutrition Survey 2013-2014, and National Census. Standardized prevalence ratio (SPR) variability was analyzed with Poisson multiple regression models (adjusted Relative Risk). Results: The SPR variability for the three diseases was associated with non-affiliation to social security, and inversely related to lower urbanization. HBP and O were associated with functional illiteracy and higher rates of primary care physicians/1000 inhabitants. HBP and MS were related to poor housing. Conclusions: Policies of non-communicable chronic diseases control in ecological transition countries need to take structural variations into account.

Summary Background Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. Methods This study included adult deaths from natural causes in Sao Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. Findings The study included 2,060 deaths in Sao Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for “Other NCDs” (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. Interpretation The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.

Background Reliable cause of death (COD) data are not available for the majority of deaths in Papua New Guinea (PNG), despite their critical policy value. Automated verbal autopsy (VA) methods, involving an interview and automated analysis to diagnose causes of community deaths, have recently been trialled in PNG. Here, we report VA results from three sites and highlight the utility of these methods to generate information about the leading CODs in the country. Methods VA methods were introduced in one district in each of three provinces: Alotau in Milne Bay; Tambul-Nebilyer in Western Highlands; and Talasea in West New Britain. VA interviews were conducted using the Population Health Metrics Research Consortium (PHMRC) shortened questionnaire and analysed using the SmartVA automated diagnostic algorithm. Results A total of 1655 VAs were collected between June 2018 and November 2019, 87.0% of which related to deaths at age 12 years and over. Our findings suggest a continuing high proportion of deaths due to infectious diseases (27.0%) and a lower proportion of deaths due to non-communicable diseases (NCDs) (50.8%) than estimated by the Global Burden of Disease Study (GBD) 2017: 16.5% infectious diseases and 70.5% NCDs. The proportion of injury deaths was also high compared with GBD: 22.5% versus 13.0%. Conclusions Health policy in PNG needs to address a ‘triple burden’ of high infectious mortality, rising NCDs and a high fraction of deaths due to injuries. This study demonstrates the potential of automated VA methods to generate timely, reliable and policy-relevant data on COD patterns in hard-to-reach populations in PNG.

Background: Diabetes is a major public health challenge in the present phase of socio-demographic and epidemiological transition leading to various complications causing high mortality and morbidity. Diabetes is often not diagnosed in early phase especially in rural areas. This study was carried out to observe changing trends, prevalence of diabetes and its association with major risk factors in rural community.Methods: A community based cross sectional study was carried out among 700 individuals (306 men and 394 women) aged 18-65 years living in villages under rural field practice area of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutpally, Krishna district, Andhra Pradesh. Information on socio-demographic data, dietary habits and life style was obtained. Height, weight,blood pressure and capillary blood glucose were measured.Conclusion: The prevalence of diabetes is about 22.6% of the study subjects of whom 11.9% are known and 10.7% are newly diagnosed. The prevalence of Diabetes is increasing at an alarming rate even in rural population and nearly half of them aren’t aware of their diabetes status. Diabetes when detected early can prevent lot of complications and improve the quality of life of the individual.

Background: Bacterial meningitis occurs worldwide but Africa remains the most affected continent, especially in the "Meningitis belt" that extends from Senegal to Ethiopia. Three main bacteria are responsible for causing bacterial meningitis, i.e., N. meningitidis (Nm), S. pneumoniae and H. influenzae type b. Among Nm, serogroup A used to be responsible for up to 80 to 85% of meningococcal meningitis cases in Africa. Since 2000, other Nm serogroups including W, X and C have also been responsible for causing epidemics. This overview aims to describe the main patterns of meningitis disease cases and pathogens from 1928 to 2018 in Africa with a special focus on disease conditions “out-of-the-belt” area that is still usually unexplored. Methods: Based on basic spatio-temporal methods, and a 90-years database of reported suspected meningitis cases and death from the World Health Organization, we used both geographic information system and spatio-temporal statistics to identify the major localizations of meningitis epidemics over this period in Africa. Findings: Bacterial meningitis extends today outside its historical limits of the meningitis belt. Since the introduction of MenAfrivac vaccine in 2010, there has been a dramatic decrease in NmA cases while other pathogen species and Nm variants including NmW, NmC and Streptococcus pneumoniae have become more prevalent reflecting a greater diversity of bacterial strains causing meningitis epidemics in Africa today. Interpretation: Bacterial meningitis remains a major public health problem in Africa today. Formerly concentrated in the region of the meningitis belt with Sub-Saharan and Sudanian environmental conditions, the disease extends now outside these historical limits to reach more forested regions in the central parts of the continent. With global environmental changes and massive vaccination targeting a unique serogroup, an epidemiological transition of bacterial meningitis is ongoing, requiring both a better consideration of the etiological nature of the responsible agents and of their proximal and distal determinants. Funding Statement: The study was funding by the NGO « Organisation pour le Developpement Durable de Mai51 ndombe » (NGO ODDM), the URF-ECMI (Training and Research Unit in Ecology of infectious diseases, Medicine Faculty, University of Kinshasa, DRC) and UMR MIVEGEC, UMR CNRS IRD UM, Montpellier, France. JFG is supported by an “Investissement d’Avenir” managed by Agence Nationale de la Recherche (LabEx CEBA: ANR-10-LABX55 25-01), and is also supported by Institut de recherche pour le developpement (IRD), Institut national de la recherche pour l’agriculture, l’alimentation et l’environnement (INRAE), Universite de Montpellier and Ecole des Hautes Etudes en Sante Publique (EHESP). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This research was not considered human subjects research. Therefore, consultation of an ethics committee and consent to participate is not required.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, responsible for 18 million deaths and 366 million disability-adjusted life years lost each year. Over 80% of these take place in low- and middle-income countries, where access to cardiology and cardiac surgery services is limited. Congenital heart defects, rheumatic heart disease, ischemic heart disease, and endemic pathologies such as endomyocardial fibrosis and Chagas disease are highly prevalent in low- and middle-income countries. In particular, the burden of ischemic heart disease is rapidly increasing along with the epidemiological transition from communicable to non-communicable diseases as globalization and economic growth takes place. The growing global burden of cardiovascular disease places even more priority on addressing gaps in access to diagnostic, preventive, and curative services to better understand the burden of, more timely detect, and adequately treat cardiovascular pathology.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, and rapidly growing with the epidemiological transition of low- and middle-income countries (LMICs) from communicable to non-communicable diseases. Timely detection is paramount to avoid progressive disease with a poorer prognosis, yet screening mechanisms for cardiovascular diseases are limited beyond dedicated clinics and centers in LMICs. Moreover, diagnostic modalities are sparse, limiting conclusive diagnosis for many living with cardiovascular diseases in LMICs. However, opportunities arise to train community health workers and non-clinicians to screen people in their communities, whilst generating knowledge on the true burden in countries and regions to hold policy-makers and decision-makers accountable for the gaps in cardiac care.

Background: Sub-Saharan Africa is undergoing an epidemiological transition fueled by the interaction between infectious and cardiovascular diseases. Our cross-sectional study aimed to characterize the spectrum of abnormalities suggesting end-organ damage on ECG and transthoracic echocardiograms (TTE) among older adults with cardiovascular diseases in rural South Africa. Methods: The prevalence of ECG and TTE abnormalities was estimated; χ 2 analyses and multivariable logistic regressions were performed to test their association with sex, hypertension, and other selected comorbidities. Results: Overall, 729 ECGs and 155 TTEs were completed, with 74 participants completing both. ECG evaluation showed high rates of left ventricular hypertrophy (LVH, 36.5%) and T wave abnormalities (13.6%). TTE evaluation showed high rates of concentric LVH (31.6%), with moderate-severe (56.8%) diastolic dysfunction. Participants with hypertension showed more cardiac remodeling on ECG by LVH (45.4% versus 22.1%, P P P P P =0.001). Male participants (n=326, 40.2%) were more likely than females (n=484, 59.8%) to show ECG abnormalities like LVH (45% versus 30.8%, P P P Conclusions: Our findings suggest that cardiovascular diseases are widespread in rural South Africa, with a larger burden of hypertensive heart disease than previously appreciated, and define the severity of end-organ damage that is already underway. Local health systems must adapt to face the growing burden of hypertension, as suboptimal rates of hypertension diagnosis and treatment may dramatically increase the heart failure burden.

On March 2–3, 2011—ahead of the first UN High-Level Meeting on NCDs—a conference hosted in Boston (MA, USA) focused on the NCDs of the world's poorest billion, whose poverty was embodied in young average age, low energy intake, and subsistence through physical labour.30 Participants at the Boston event argued that global thinking about NCDs had been too focused on a theory of epidemiological transition, which projected epidemics of chronic disease associated with development.31 This theory created a blind spot regarding the existence and pattern of non-infectious conditions before declines in infectious mortality (pre-transitional NCDIs). The poorest populations were still experiencing NCDIs as part of a nexus of hunger, toxic environments, infectious diseases, and lack of health care. The NCDIs that emerged under these circumstances were both more severe and more varied than could be captured by frameworks developed for other populations. In April, 2011, the WHO African Regional Office held a consultation of health ministers in Congo (Brazzaville).32 The Brazzaville Declaration on NCDs called for an expanded NCDI agenda addressing haemoglobinopathies (sickle cell disease), mental disorders, and violence and injury.32 Other prominent African health experts called for a 5 × 5 strategy inclusive of neuropsychiatric disorders and infectious risks.33, 34 In July, 2013, at a meeting in Rwanda, a group of NCD unit leaders from ten African ministries of health called for a complementary strategy for NCDIs.35 This NCDI equity agenda focused on policies and integrated health-sector interventions to eliminate deaths among the poorest children and young adults (aged

Cardiovascular diseases (CVDs) have become the leading cause of mortality in India. This epidemiological transition is largely because of the increase in the prevalence of CVDs and CVD risk factors in India. In 2016, the estimated prevalence of CVDs in India was estimated to be 54.5 million. Heart failure (HF) is a major health problem in India with a postadmission mortality of 20%–30%. Heart transplant is the final treatment for HF if intractable to medical management. Number of heart transplantations done in India is still very less compared to the disease burden and may be attributed to less awareness for organ donation in India. As the number of heart transplantation is increased drastically in the past decade, we need to have proper information about heart transplantation program in India. This is our attempt to simplify information regarding heart transplantation for cardiothoracic units planning to start such a program.

Introduction Epidemiological transition remains a key contributor to the rising prevalence of non-communicable diseases (NCDs) across developing nations. Population-specific NCD risk factors estimates derived using World Health Organization (WHO) 'STEP-wise approach' are crucial for devising evidence-based public health interventions to combat NCDs. Objective To estimate the prevalence of behavioral and biological risk factors for NCDs among the rural adult population of Puducherry district in India. Methodology STEPS survey was conducted by following all three steps (behavioral, physical measurements and biochemical risk factors) of NCD risk factor assessment. A total of 790 participants were selected from 50 villages through multistage cluster sampling method. STEPS instrument was used to assess behavioral risk factors, physical measurements and biochemical (fasting blood glucose and total cholesterol) risk factors. Results Tobacco use and alcohol consumption were present among 11.3% (95% Confidence Interval (CI): 9-13.6%) and 19.2% (95% CI: 16.5-22.4%) of the population, respectively. Low physical activity, inadequate intake of fruits and vegetables, overweight and obesity were observed among 29.3% (95% CI: 26.2-32.7%), 89.8% (95% CI: 87.6-92%), 15.6% (95% CI: 13.1-18.3%) and 38.9% (95% CI: 35.4-42.2%), respectively. About 28.2% (95% CI: 25.2-31.6%) had hypertension and 24.4% (95% CI: 20-29%) had diabetes mellitus. Abdominal obesity was twice highly prevalent among women. Tobacco and alcohol use were more common among men, whereas low physical activity, obesity and hypercholesterolemia were higher among women. Conclusion Public health interventions to promote healthy lifestyle need to be initiated especially to increase physical activity, intake for fruits and vegetables, and quitting of tobacco and alcohol consumption in the rural population of Puducherry.

Africa is a complex and diverse continent that faces numerous challenges. It is a region in epidemiological transition which is currently experiencing a dual burden of communicable and non-communicable diseases. The high prevalence of cardiometabolic disease (CMD) on the continent is driven largely by the increasing prevalence of obesity in the more affluent African nations. Although epidemiological studies demonstrate that a greater level of total body fat is associated with a higher risk for CMD, there is a complex association between body fat distribution and CMD risk. Thus, visceral adipose tissue (VAT) is considered a prime etiological agent for CMD, while subcutaneous adipose tissue (SAT) may act as a protective factor. The literature demonstrates positive correlations of VAT with type 2 diabetes, hypertension, and atherogenic dyslipidemia. However, the mechanisms via which VAT and SAT modulate CMD risk in African patients require further investigation. In addition, studies from high-income countries have shown that HIV and antiretroviral therapy (ART) are associated with changes in body fat distribution and higher risk for CMDs. The prevalence of HIV infection is at its highest in sub-Saharan Africa. However, cross-sectional studies from this region have produced contradictory results on the association of HIV and ART with CVD risk factors, and data is required from large prospective studies to clarify these relationships.

Background: Many African countries including Nigeria are said to be at various stages of an epidemiological transition from communicable to non-communicable diseases (NCD). Objective: This study determined the current pattern and correlates of hypertension among adults in some rural commu- nities in South West Nigeria. Methods: It was a descriptive cross-sectional study of 1012 individuals across 16 rural communities. The respondents’ blood pressure, weight, height and waist circumference were measured. Bivariate and multivariate analyses were done. Results: Among the participants, 461 (45.6%) had hypertension out of whom 217 (47.1%) and 244 (52.9%) had stage 1 and stage 2 hypertension respectively. The systolic, diastolic and mean arterial blood pressures increased with age. The significant predictors of hypertension were; increasing age (p

Nutrition and the incidence of diseases during early life are considered environmental factors that determine people’s height when they become adults. While there is extensive literature focusing on the relationship between physical growth, general mortality and infant mortality rates, few studies analyse the impact of certain disease groups on the final height of historical populations. Using regional mortality rates by causes of death, the main objective of this study is to determine the onset of the disease environment during early life for populations born in Spain between 1916 and 1930, and its relationship with the stature reached at 21 years of age. A population-averaged model is performed on epidemic-infectious, gastrointestinal, and congenital diseases during the gestation period and first year of life. The disease burden in early life had a statistically significant negative effect on adult stature. These results support the premise that an improvement in the disease environment could lead to a greater number of short children surviving and therefore a decrease in the average height.