There is a high prevalence of hypertension in rural and urban areas of Tanzania, with low levels of detection, treatment and control. This demonstrates the need for cost-effective strategies for primary prevention, detection and treatment of hypertension and the growing public health challenge of non-communicable diseases in Sub-Saharan Africa.

A population-based survey in 1996 and 1997 of 770 adults (aged > or = 15 years) from an urban district of Dares Salaam and 928 from a village in rural Kilimanjaro district (Tanzania) revealed that the prevalence of diabetes, impaired fasting glucose (IFG), overweight, obesity, and physical inactivity was higher in the urban area for men and women. The difference between urban and rural prevalence of diabetes was 3.8 [1x1-6.5]% for men and 2x9 [0x8-4.9]% for women. For IFG, the difference was 2x8 [0x3-5x3]% for men and 3x9 [1x4-6x4]% for women; for overweight and obesity, the difference was 21.5 [15.8-27.1]% and 6.2 [3x5-8.9]% for men and 17x4 [11.5-23.3]% and 12.7 [8x5-16x8]% for women, respectively. The difference in prevalence of physical inactivity was 12x5 [7.0-18.3]% for men and 37.6 [31x9-43.3]% for women. For men with diabetes, the odds for being overweight, obese and having a large waist:hip ratio were 14.1, 5.3 and 12.5, respectively; for women the corresponding values were 9x0, 10x5 and 2x4 (the last not significant) with an attributable fraction for overweight between 64% and 69%. We conclude that diabetes prevalence is higher in the urban Tanzanian community and that this can be explained by differences in the prevalence of overweight. The avoidance of obesity in the adult population is likely to prevent increases in diabetes incidence in this population.

Osteoporosis is reported to be rare in Black Africa. The low fracture incidence among North American black women is explained by a high peak bone mass and preservation of bone mineral into old age. To assess whether this is the case among Black African women, we measured bone mineral content (BMC) and bone mineral density (BMD), using single- and dual-photon absorptiometry, in 195 rural Gambian women aged over 44 years and 391 white women of comparable age from three centers in the U.K. Measurements were made at the midshaft of the radius, distal radius, lumbar spine, and femoral neck. The influence of height, weight, and nationality on BMC and BMD was analyzed. BMC and BMD decreased with age at all sites. Age, decreasing weight, but not height were independently associated with lower BMC at all sites. BMC in Gambian women was lower than in British women by 31% at the lumbar spine and 16% at the midshaft of the radius. After adjustment for age, height, and weight, BMC among Gambian women remained 24% lower at the lumbar spine and 10% lower at the radius. In women aged over 64 years, BMC at the lumbar spine was 42% lower and BMD was 31% lower in The Gambia (for all comparisons, p < 0.005). We conclude that bone mineral mass is not preserved in elderly Gambian women. However, minimal trauma fractures are rare in this population. These results challenge the concept of BMC as a primary determinant of fracture risk.

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