Rural and semi-urban residence were strongly associated with hypertension, contrary to what has been found in similar studies in sub-Saharan Africa. Intervention to reduce the burden of hypertension in The Gambia could be further targeted towards rural areas.

ObjectivesNon-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia.DesignNationwide cross-sectional health examination survey using the WHO STEPwise survey methods.SettingThe Gambia.ParticipantsThis study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25–64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533).Primary and secondary outcome measuresThe primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans).ResultsTwo-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women.ConclusionThere is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity.

ObjectiveMonitoring health outcomes disaggregated by socioeconomic position (SEP) is crucial to ensure no one is left behind in efforts to achieve universal health coverage. In eye health planning, rapid population surveys are most commonly implemented; these need an SEP measure that is feasible to collect within the constraints of a streamlined examination protocol. We aimed to assess whether each of four SEP measures identified inequality—an underserved group or socioeconomic gradient—in key eye health outcomes.DesignPopulation-based cross-sectional survey.ParticipantsA subset of 4020 adults 50 years and older from a nationally representative sample of 9188 adults aged 35 years and older in The Gambia.Outcome measuresBlindness (presenting visual acuity (PVA) <3/60), any vision impairment (VI) (PVA <6/12), cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) at two operable cataract thresholds (<6/12 and <6/60) analysed by one objective asset-based measure (EquityTool) and three subjective measures of relative SEP (a self-reported economic ladder question and self-reported household food adequacy and income sufficiency).ResultsSubjective household food adequacy and income sufficiency demonstrated a socioeconomic gradient (queuing pattern) in point estimates of any VI and CSC and eCSC at both operable cataract thresholds. Any VI, CSC <6/60 and eCSC <6/60 were worse among people who reported inadequate household food compared with those with just adequate food. Any VI and CSC <6/60 were worse among people who reported not enough household income compared with those with just enough income. Neither the subjective economic ladder question nor the objective asset-wealth measure demonstrated any socioeconomic gradient or pattern of inequality in any of the eye health outcomes.ConclusionWe recommend pilot-testing self-reported food adequacy and income sufficiency as SEP variables in vision and eye health surveys in other locations, including assessing the acceptability, reliability and repeatability of each question.

Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality globally. Co-occurrence of risk factors predisposes an individual to NCDs; the burden increases cumulatively with the number of risk factors. Our study aimed to examine the co-occurrence of NCD risk factors among adults in The Gambia. This study is based on a random nationally representative sample of 4111 adults aged 25-64 years (78% response rate) with data collected between January and March 2010 in The Gambia using the WHO STEPwise survey methods. We restricted our analysis to non-pregnant participants with valid information on five NCD risk factors: high blood pressure, smoking, obesity, low fruit and vegetable consumption, and physical inactivity (n=3000 adults with complete data on all risk factors). We conducted age-adjusted and fully-adjusted gender stratified multinomial logistic regression analysis to identify factors associated with the number of NCD risk factors. More than 90% of adults had at least one risk factor. Only 7% (95% CI: 5.2-9.8) had no risk factor; 22% (95% CI: 19.1-24.9) had at least three. Older age and ethnicity were significantly associated with having three or more risk factors (versus none) among men in the fully adjusted model. Lower education, older age, and urban residence were significantly associated with three or more risk factors (versus none) among women.The burden of NCDs is expected to increase in The Gambia if preventive and control measures are not taken. There should be an integrated approach targeting all risk factors, including wider treatment and control of hypertension.

BackgroundThe prevalence of obesity has more than doubled in West Africa over the past 15 years. Obesity is increasing at a faster rate in developing countries compared with developed countries. Possible explanations include epidemiological and nutritional transition, increased consumption of processed foods, and urbanisation. A 1996 study revealed a double burden of over- and under-weight in The Gambia. We examined overweight and obesity prevalence and the associated risk factors in Gambian adults.MethodsThis study uses a random nationally-representative sample of 4111 adults aged 25–64 years (78% response rate) collected in 2010 using the WHO STEPwise survey methods, restricted to non-pregnant participants with valid weight and height measurements (n=3533). We categorised body mass index from measured height and weight to determine underweight, overweight and obesity (WHO thresholds). Analyses were stratified by gender. All analyses were weighted for non-response and adjusted for complex survey design using STATA14. We conducted multivariate multinomial regression analysis to identify factors associated with underweight, overweight and obesity, using normal weight as reference. Fully adjusted relative risk ratios (ARRR) with their corresponding 95% confidence intervals (CI) are reported.ResultsTwo-fifths of adults in The Gambia were overweight or obese, with a higher prevalence of obesity in women (17.0%, [95% CI 14.7% to 19.7%] vs 8.1% in men, [6.0–11.0%]) and urban residents. Urban residence, abdominal obesity, higher education, and age were significantly associated with obesity among both men and women. Obesity was also significantly associated with low fruit and vegetable intake in men, and with hypertension and ethnicity in women. Most of these variables were also significantly associated with overweight. Compared with rural residents, the risk of overweight and obesity among urban residents were three- and six-fold higher respectively in men (overweight: ARRR 3.1, 95% CI 1.7 to 5.6; obesity: 6.6, 2.5–17.2) and in women (overweight: 3.2, 1.9–5.4; obesity: 5.9, 3.1–11.2). No significant associations were found for underweight, except for smoking and ethnicity in men and old age and ethnicity in women.ConclusionThis study reveals that the burden of obesity is increasing at an alarming rate in The Gambia. Preventive strategies should be directed at raising awareness of the risk factors, discouraging harmful beliefs on weight, and the promotion of healthy diet and physical activity particularly in urban areas and among women.