ABSTRACT
Aim: To estimate the prevalence and risk factors for metabolic syndrome (MetS) among HIV positive patients on antiretroviral therapy (ART) in Tanzania. Study Design: A cross sectional study was conducted among adults aged ≥18years living with HIV-infection and receiving ART. Place and Duration of Study: The study participants were recruited from 12 care and treatment clinics in Dar es Salaam (urban) and Mbeya (rural) regions between October 2011 and February 2012. Methodology: The prevalence of MetS was assessed using International Diabetes Federation’s criteria. Biochemical assays, anthropometric measurements, demographic characteristics and lifestyle behavioural data were collected. Results: Study response rate was 351/377(93.1%) and 177 (50.4%) recruited participants were from urban settings and 238 (67.8%) were females. The prevalence of MetS was 25.6% and was higher among participants from urban than those from rural areas (35.6% vs 15.5%, p<.001). The components of MetS including raised triglyceride (43.5% vs 21.3%, p<.001), low high density lipoprotein (85.9% vs 28.2%, p<.001) and raised blood fasting glucose (10.2% vs 5.2%, p=.04) were more common among participants from urban than those from rural settings. MetS Risk factors including; consumption of fruits/vegetables <5 days/week (77.0% vs 59.3%, p<.001), not participating on vigorous intensity activities (65.5% vs 29.4% p<.001) and consuming mixed cooking oil (animal/vegetable) (15.5% vs 8.5%, p=.03) were higher among participants from rural than those from urban areas. In rural, only consumption of vegetables/fruits <5 days/week (AOR=5.50, 95%CI 1.21-24.95, p=.005) predicted the prevalence of MetS. In urban; sex (female) (AOR=3.01, 95%C 1.31-6.85, p=.002), having primary/no formal education (AOR=0.32, 95%CI 0.12-0.89, p=.04) and ex- or current alcohol drinker (AOR=2.43, 95%CI 1.17-5.06, p=.02) were significant predictors of MetS. Conclusion: Prevalence, components and predictors of MetS prevailed more in urban than in rural settings. Interventions targeting prevention of MetS to reduce diabetes and cardiovascular diseases should consider settings diversification.
ABSTRACT
Information on the different spoligotype families of Mycobacterium tuberculosis in Tanzania is limited; and where available; restricted to small geographical areas. This article describes the genetic profile of M. tuberculosis across Tanzania and suggests how spoligotype families might affect drug resistance and treatment outcomes for smear positive pulmonary tuberculosis patients in Tanzania. We conducted the study from 2006 to 2008; and the isolates were obtained from samples collected under the routine drug resistance surveillance system. The isolates were from specimens collected from 2001 to 2007; and stored at the Central and Reference Tuberculosis Laboratory. A total of 487 isolates from 23 regions in the country were spoligotyped. We were able to retrieve clinical information for 446 isolates only. Out of the 487 isolates spoligotyped; 195(40.0) belonged to the Central Asian (CAS) family; 84 (17.5) to the Latin American Mediterranean (LAM) family; 49 (10.1) to the Latin American Mediterranean (LAM) family; 49 (10.1) to the East-African Indian (EAI) family; and 33 (6.8) to the Beijing family. Other isolates included 1 (0.2) for H37Rv; 10 (2.1) for Haarlem; 4 (0.8) for S family; 58 (11.9) for T family and 52 (10.7) for unclassified. No spoligotype patterns were consistent with M. bovis. Regarding treatment outcomes; the cure rate was 80 with no significant variation among the spoligotype families. The overall level of MDR TB was 2.5 (3/121); with no significant difference among the spoligotype families. All Beijing strains (11.8; 30/254) originated from the Eastern and Southern zones of the country; of which 80 were from Dar es Salaam. Isolates from the CAS and T families were reported disproportionately from the Eastern-Southern zone; and EAI and LAM families from the Northern-Lake zones but the difference was not statistically significant. Five isolates were identified as non-tuberculous Mycobacteria. In conclusion; M. tuberculosis isolates from pulmonary tuberculosis cases in Tanzania were classified mostly within the CAS; LAM; and EAI and T families; while the Beijing family comprised about 7 isolates only. Consistently good treatment outcomes were recorded across these spoligotype families. The proportion of drug resistance strains was low. The findings also suggest variation of spoligotype families with varying geographical localities within the country; and identify this area for further research to confirm this finding