Prevalence and time trends in diabetes and physical inactivity among adult West African populations: the epidemic has arrived.

OBJECTIVE: To determine the prevalence and distribution of, and trends in, physical inactivity and diabetes in adult West African populations. DESIGN: Systematic review and meta-analysis. METHODS: Literature searches were conducted using four electronic databases. Journal hand searches and examination of citations of relevant articles were also undertaken. To be included, studies had to be population based, use clearly defined criteria for measuring diabetes and physical inactivity, present data that allowed calculation of the prevalence of diabetes or physical inactivity, and sample adult participants. Studies retrieved were appraised critically. Meta-analysis was performed using the DerSimonian-Laird random effect model. RESULTS: Twenty-one reports were retrieved for diabetes and 15 reports were retrieved for physical in/activity. Most studies (10 for diabetes and six for physical activity) were conducted solely among urban populations. The prevalence of diabetes in West Africa was approximately 4.0% [95% confidence interval (CI) 2.0-9.0] in urban adults and 2.6% (95%CI 1.5-4.4) in rural adults, and was similar in men and women [prevalence ratio (PR) 1.36, 95%CI 0.96-1.92]. Cumulative time trend analyses suggested an increase in the prevalence of diabetes among adults in urban West Africa, from approximately 3.0% (95%CI 1.0-7.0) to 4.0% (95%CI 2.0-9.0) in the past 10 years. The prevalence of inactivity in West Africa was 13% (95%CI 9.0-18.0). An association was found between physical inactivity and being older (> or = 50 years) (PR 1.82, 95%CI 1.36-2.44), female gender (PR 1.62, 95%CI 1.41-1.87) and urban residence (PR 2.04, 95%CI 1.58-2.63). CONCLUSIONS: Diabetes and physical inactivity are important public health issues in urban West Africa, with similar prevalences to wealthy industrialized countries. There is an urgent need for policy makers, politicians and health promotion experts to put measures in place to encourage active lifestyles and control diabetes in urban West Africa.

Prevalence and time trends in obesity among adult West African populations: a meta-analysis.

The objective of this study was to determine the distribution of and trends in obesity in adult West African populations. Between February and March 2007, a comprehensive literature search was conducted using four electronic databases. Journal hand searches, citations and bibliographic snowballing of relevant articles were also undertaken. To be included, studies had to be population-based, use well-defined criteria for measuring obesity, present data that allowed calculation of the prevalence of obesity and sample adult participants. Studies retrieved were critically appraised. Meta-analysis was performed using the DerSimonian-Laird random effect model. Twenty-eight studies were included. Thirteen studies were conducted in urban settings, 13 in mixed urban/rural and one in rural setting. Mean body mass index ranged from 20.1 to 27.0 kg(2). Prevalence of obesity in West Africa was estimated at 10.0% (95% CI, 6.0-15.0). Women were more likely to be obese than men, odds ratios 3.16 (95% CI, 2.51-3.98) and 4.79 (95% CI, 3.30-6.95) in urban and rural areas respectively. Urban residents were more likely to be obese than rural residents, odds ratio 2.70 (95% CI, 1.76-4.15). Time trend analyses indicated that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years, accounted for almost entirely in women. Urban residents and women have particularly high risk of overweight/obesity and obesity is rising fast in women. Policymakers, politicians and health promotion experts must urgently help communities control the spread of obesity in West Africa.

Systematic review on the prevalence of diabetes, overweight/obesity and physical inactivity in Ghanaians and Nigerians.

OBJECTIVE: To review the prevalence of diabetes, obesity and physical inactivity among Ghanaians and Nigerians in Africa, Europe and North America. METHODS: This systematic literature review used MEDLINE 1966--2005, EMBASE 1980--2005 and cited references to identify relevant studies on Ghanaians and Nigerians. RESULTS: No studies on Ghanaians or Nigerians in Europe or North America have been reported. Sixteen studies in Africa were included; 13 on Nigerians and three on Ghanaians. The data were limited, poorly reported and not easily comparable. Pooled analysis was not possible. Precise time trend analysis was not possible, but diabetes seemed rare at 0.2% in urban Ghana in 1963 and 1.65% in urban Nigeria in 1985. The prevalence of diabetes in Nigerian adults (age > or = 40 years) in 2000 was 6.8% [confidence intervals (CI) 4.6-9.0]. In Ghana, the prevalence of diabetes in adults (age > or = 25 years) was 6.3% (CI 5.6-7.0) in 1998. Obesity (body mass index > or = 30) among Nigerian adults was 8.8% (CI 7.0-10.6) in 2000, and obesity in Ghanaian adults (> or = 25 years) was 14.1% (CI 13.1-15.1%) in 1998. Various studies reported that 25-57% of Nigerians were physically inactive. CONCLUSION: Although weak, the evidence base points to a rise in diabetes prevalence in Ghana and Nigeria, with major urban-rural differences. There is an urgent need for accurate and comparable surveys on diabetes and its risk factors among Nigerians and Ghanaians. Effective public health policies are vital to control the diabetes epidemic.