We conducted a systematic review and meta-analysis of twenty-eight US-based studies applying the findings of the Diabetes Prevention Program, a clinical trial that tested the effects of a lifestyle intervention for people at high risk for diabetes, in real-world settings. The average weight change at twelve months after the intervention was a loss of about 4 percent from participants' baseline weight. Change in weight was similar regardless of whether the intervention was delivered by clinically trained professionals or lay educators. Additional analyses limited to seventeen studies with a nine-month or greater follow-up assessment showed similar weight change. With every additional lifestyle session attended, weight loss increased by 0.26 percentage point. We conclude that costs associated with diabetes prevention can be lowered without sacrificing effectiveness, using nonmedical personnel and motivating higher attendance at program sessions.

The burden of hypertension in Sub-Saharan Africa has been increasing over the past few decades. However, a large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular disease in the region. We conducted a systematic review and meta-analysis to assess the recent burden of hypertension in Sub-Saharan Africa, based on studies published between 2000 and 2013. We pooled data from 33 surveys involving over 110 414 participants of mean age 40 years. Hypertension prevalence varied widely across the studies (range 15%-70%), partly because of differences in participant mean ages (31-76 years). The predicted prevalence of hypertension at mean participant ages of 30, 40, 50, and 60 years were 16%, 26%, 35%, and 44%, respectively, with a pooled prevalence of 30% (95% confidence interval, 27%-34%). Of those with hypertension, only between 7% and 56% (pooled prevalence: 27%; 95% confidence interval, 23%-31%) were aware of their hypertensive status before the surveys. Overall, 18% (95% confidence interval, 14%-22%) of individuals with hypertension were receiving treatment across the studies, and only 7% (95% confidence interval, 5%-8%) had controlled blood pressure. This review found a high prevalence of hypertension, as well as low percentage of hypertension awareness, treatment, and control in Sub-Saharan Africa, highlighting the need for implementation of timely and appropriate strategies for diagnosis, control, and prevention.

BackgroundAccurate contemporary data on the burden of Chronic Kidney Disease (CKD) on the African continent are lacking. We determined the prevalence of CKD in adult populations living in Africa, and variations by stage, gender, estimated Glomerular Filtration Rate (eGFR) equation, and residence.MethodsFor this systematic review, we searched multiple electronic databases for original studies on CKD prevalence reported from January 1, 2000 to December 31, 2016. Two reviewers independently undertook quality assessment and data extraction. We stabilized the variance of study-specific estimates with the Freeman-Turkey single arcsine transformation and pooled the data using a random effects meta-analysis models.ResultsA total of 98 studies involving 98,432 individuals were included in the final meta-analysis. The overall prevalence was 15.8% (95% CI 12.1–19.9) for CKD stages 1–5 and 4.6% (3.3–6.1) for CKD stages 3–5 in the general population. Equivalent figures were greater at 32.3% (23.4–41.8) and 13.3% (10.7–16.0) in high-risk populations (people with hypertension, diabetes, HIV). CKD prevalence was higher in studies based on the Cockcroft-Gault formula than MDRD or CKD-EPI equations; and in studies from sub-Saharan Africa compared with those from North Africa (17.7, 95% CI 13.7–22.1 vs 6.1, 95% CI 3.6–9.3, p < 0.001). There was substantial heterogeneity across studies (all I2 > 90%) and no evidence of publication bias in main analyses.ConclusionCKD is highly prevalent across Africa, inviting efforts into prevention, early detection and control of CKD in adults living on the African continent which is particularly important in a resource limited environment.Trial RegistrationProspero Registration ID: CRD42017054445.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-0930-5) contains supplementary material, which is available to authorized users.

A systematic review of risk prediction models conducted by Justin Echouffo-Tcheugui and Andre Kengne examines the evidence base for prediction of chronic kidney disease risk and its progression, and suitability of such models for clinical use.