Browsing by Author "Bahendeka, S."

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African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus
(Adis, 2021) Mbanya, J.C.; Lamptey, R.; Uloko, A.E.; Ankotche, A.; Moleele, G.; Mohamed, G.A.; Ramracheya, I.; Ramaiya, K.; Ndiweni, M.; Mbaye, M.N.; Bahendeka, S.; Kalra, S.
The prevalence of diabetes in sub-Saharan Africa (SSA) is growing rapidly, and a steadily increas ing number of adults are estimated to be living with type 2 diabetes mellitus (T2DM). Insulin therapy is the treatment of choice in patients who present with severe hyperglycaemia and in most of those who do not achieve target goals on oral hypoglycaemic agents. Initiating treat ment with the appropriate type of insulin based on the meal patterns and lifestyle of the indi vidual patient is a strategy that is more likely than others to improve glycaemic control and adherence. African cuisine typically has a high carbohydrate load. Given these predominantly carbohydrate-rich food habits, it is essential to modify this dietary pattern whilst at the same time ensuring that insulin therapy is initiated, titrated and maintained in a timely manner, as needed to suit the patient’s habits. To date, there are no published clinical guidelines to guide practitioners and patients on tailoring insulin to match the high carbohydrate content in African cuisine. To address this gap, we have reviewed current insulin therapy practices and propose a patient-centric guide to insulin therapy based on African cuisine. A literature search was conducted for studies published in English up to November 2019 that focused on the choice of insulin and its dosing in relation to African foods. All articles extracted were reviewed by an expert group. The recommendation of the expert group was that basal-bolus and premix insulin regimens are best suited to manage post-meal glycaemia in African cuisine. The timing and constituents of the meal, portion sizes, glycaemic load and glycaemic index of meals should be considered when choosing the type of insulin and insulin regimen. Assessment of individual preferences and comorbidities should be prioritised and form an integral part of diabetes management.
Association between socioeconomic position and the prevalence of type 2 diabetes in Ghanaians in different geographic locations: the RODAM study.
(2017) Addo, J.; Agyemang, C.; de-Graft Aikins, A.; Beune, E.; Schulze, M.B.; Danquah, I.; Galbete, C.; Nicolaou, M.; Meeks, K.; Klipstein-Grobusch, K.; Bahendeka, S.; Mockenhaupt, F.P.; Owusu-Dabo, E.; Kunst, A.; Stronks, K.; Smeeth, L.
ACKGROUND: The prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the literature. This study examined the association between socioeconomic position (SEP) and diabetes in Ghanaians in Europe and in Ghana. METHODS: Data were derived from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study of Ghanaian adults aged 25-70 years residing in Europe (Amsterdam, Berlin and London) and in urban and rural Ghana. Educational attainment (elementary, secondary or higher) and occupational class (low or high) were used as indicators of SEP. Age-standardised prevalence of diabetes and prevalence ratios were evaluated separately for men and women of different SEP in Ghana and Europe. RESULTS: A total of 5290 participants were included in the analyses. The prevalence of diabetes decreased with increasing level of education in Ghanaian men and women in Europe and in men in urban Ghana, whereas diabetes prevalence increased with increasing level of education in men and women in rural Ghana. The association between occupational class and the prevalence of diabetes followed a less consistent pattern in men and women in the different locations. CONCLUSIONS: The association of diabetes and SEP differed in rural Ghana compared with urban settings in Ghana and Europe and comparing men and women, highlighting the complex interaction of SEP and the development of diabetes. These findings have important implications for diabetes prevention strategies in Ghanaians in different locations.
Cardiovascular disease risk prediction in sub-Saharan African populations — Comparative analysis of risk algorithms in the RODAM study
(International Journal of Cardiology, 2018-03) Boateng, D.; Agyemang, C.; Beune, E.; Meeks, K.; Smeeth, L.; Schulze, M.B.; Addo, J.; de-Graft Aikins, A.; Galbete, C.; Bahendeka, S.; Danquah, I.; Agyei-Baffour, P.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Spranger, J.; Kengne, A.P.; Grobbee, D.E.; Klipstein-Grobusch, K.
Background: Validated absolute risk equations are currently recommended as the basis of cardiovascular disease (CVD) risk stratification in prevention and control strategies. However, there is no consensus on appropriate equations for sub-Saharan African populations. We assessed agreement between different cardiovascular risk equations among Ghanaian migrant and home populations with no overt CVD. Methods: The 10-year CVD risks were calculated for 3586 participants aged 40–70 years in the multi-centre RODAM study among Ghanaians residing in Ghana and Europe using the Framingham laboratory and non-laboratory and Pooled Cohort Equations (PCE) algorithms. Participants were classified as low, moderate or high risk, corresponding to < 10%, 10–20% and > 20% respectively. Agreement between the risk algorithms was assessed using kappa and correlation coefficients. Results: 19.4%, 12.3% and 5.8% were ranked as high 10-year CVD risk by Framingham non-laboratory, Framingham laboratory and PCE, respectively. The median (25th–75th percentiles) estimated 10-year CVD risk was 9.5% (5.4–15.7), 7.3% (3.9–13.2) and 5.0% (2.3–9.7) for Framingham non-laboratory, Framingham laboratory and PCE, respectively. The concordance between PCE and Framingham non-laboratory was better in the home Ghanaian population (kappa = 0.42, r = 0.738) than the migrant population (kappa = 0.24, r = 0.732) whereas concordance between PCE and Framingham laboratory was better in migrant Ghanaians (kappa = 0.54, r = 0.769) than the home population (kappa = 0.51, r = 0.758). Conclusion: CVD prediction with the same algorithm differs for the migrant and home populations and the interchangeability of Framingham laboratory and non-laboratory algorithms is limited. Validation against CVD outcomes is needed to inform appropriate selection of risk algorithms for use in African ancestry populations. © 2017 The Authors
Cross-sectional study of association between socioeconomic indicators and chronic kidney disease in rural-urban Ghana: The RODAM study
(BMJ Open, 2019-04-04) Adjei, D.N.; Stronks, K.; Adu, D.; Beune, E.; Meeks, K.; Smeeth, L.; Addo, J.; Owusu-Dabo, E.; Klipstein-Grobusch, K.; Mockenhaupt, F.P.; Danquah, I.; Spranger, J.; Bahendeka, S.; Aikins, A.D.; Agyemang, C.
Objectives Studies from high-income countries suggest higher prevalence of chronic kidney disease (CKD) among individuals in low socioeconomic groups. However, some studies from low/middle-income countries show the reverse pattern among those in high socioeconomic groups. It is unknown which pattern applies to individuals living in rural and urban Ghana. We assessed the association between socioeconomic status (SES) indicators and CKD in rural and urban Ghana and to what extent the higher SES of people in urban areas of Ghana could account for differences in CKD between rural and urban populations. Setting The study was conducted in Ghana (Ashanti region). We used baseline data from a multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study. Participants The sample consisted of 2492 adults (Rural Ghana, 1043, Urban Ghana, 1449) aged 25–70 years living in Ghana. Exposure Educational level, occupational level and wealth index. Outcome Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification: albuminuria, reduced glomerular filtration rate and high to very high CKD risk based on the combination of these two. Results All three SES indicators were not associated with CKD in both rural and urban Ghana after age and sex adjustment except for rural Ghana where high wealth index was significantly associated with higher odds of reduced estimated glomerular filtration rate (eGFR) (adjusted OR, 2.38; 95% CI 1.03 to 5.47). The higher rate of CKD observed in urban Ghana was not explained by the higher SES of that population. Conclusion SES indicators were not associated with prevalence of CKD except for wealth index and reduced eGFR in rural Ghana. Consequently, the higher SES of urban Ghana did not account for the increased rate of CKD among urban dwellers suggesting the need to identify other factors that may be driving this.
Differential associations between psychosocial stress and obesity among Ghanaians in Europe and in Ghana: findings from the RODAM study
(Social Psychiatry and Psychiatric Epidemiology, 2019-03-11) de‑Graft Aikins, A.; Baratin, C.; Beune, E.; van Schalkwijk, D.; Meeks, K.; Smeeth, L.; Addo, J.; Owusu‑Dabo, E.; Bahendeka, S.; Mockenhaupt, F.P.; Danquah, I.; Schulze, M.B.; Spranger, J.; Boateng, D.; Klipstein‑Grobusch, K.; Stronks, K.; Agyemang, C.
Purpose Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration. This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana. Methods Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex. Results Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (β = 0.78, 95% CI 0.34–1.22) and WC (β = 1.96, 95% CI 0.79–3.12) among male Ghanaian migrants. Similarly, stress at work or at home was positively associated with BMI (β = 0.28, 95% CI 0.00–0.56) and WC (β = 0.84, 95% CI 0.05–1.63) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (β = − 0.66, 95% CI − 1.03 to − 0.28; β = − 1.71 95% CI − 2.69 to − 0.73, respectively) and females (β = − 0.81, 95% CI − 1.20 to − 0.42; β = − 1.46, 95% CI − 2.30 to − 0.61, respectively). Conclusions Negative life events and stress at work or at home are associated with increased body weight among male Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations to assist prevention efforts.
Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care
(Diabetes Therapy, 2019-12) Kalra, S.; Czupryniak, L.; Kilov, G.; Lamptey, R.; Kumar, A.; Unnikrishnan, A.G.; Boudiba, A.; Abid, M.; Akanov, Z.A.; Latheef, A.; Araz, M.; Audehm, R.; Bahendeka, S.
Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.
Higher prevalence of peripheral arterial disease in Ghana compared to Ghanaian migrants in Europe: The RODAM study
(International Journal of Cardiology, 2019-12-14) Amoah, A.G.B.; Hayfron-Benjamin, C.F.; Van den Born, B.J.; Maitland-van der Zee, A.H.; Van der Linden, E.L.; Stronks, K.; Klipstein-Grobusch, K.; Bahendeka, S.; Danquah, I.; Beune, E.; Smeeth, L.; Agyemang, C.
Background: Evidence suggests that the burden of peripheral artery disease (PAD) is rising more rapidly than other forms of cardiovascular diseases in sub-Saharan Africa, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of PAD among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in three European countries. Methods: Cross-sectional analyses of baseline data fromthemulticenter Research on Obesity and Diabetesamong African Migrants (RODAM) study were done. Data from 5516 participants living in Europe (1487 Amsterdam, 546 Berlin, 1047 London) and Ghana [1419 urban and 1017 rural] aged 25–70years were included. PAD was defined as ankle brachial index≤0.90. Comparisons among sites were made using logistic regression analysis. Results: The age-standardized prevalence of PAD was higher in Ghanaians living in rural [7.52%, 95% CI = 5.87–9.51] and urban [8.93%, 7.44–10.64] Ghana than for their compatriots living in Europe [5.70%, 4.35–7.35 for London; 3.94%, 2.96–5.14 for Amsterdam; and 0.44%, 0.05–1.58 for Berlin]. The differences persisted even after adjustment for age, sex, education and the conventional cardiovascular risk factors [adjusted odds ratio= 3.16, 95% CI=2.16–4.61, p b .001 for rural-Ghana; and 2.93, 1.87–4.58, p b .00 for urban-Ghana, compared with Ghanaian migrants in Europe]. Conclusions: Our study shows that Ghanaians living in Ghana have higher prevalence of PAD than their migrant compatriots. Further work is needed to identify potential factors driving the high prevalence of PAD among nonmigrant Ghanaians to assist interventions aimed at reducing PAD burden.
Ideal cardiovascular health among Ghanaian populations in three European countries and rural and urban Ghana: the RODAM study
(Internal and Emergency Medicine, 2018-04) van Nieuwenhuizen, B.; Zafarmand, M.H.; Beune, E.; Meeks, K.; De-Graft Aikins, A.; Addo, J.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Bahendeka, S.; Schulze, M.B.; Danquah, I.et.al.
Cardiovascular health (CVH) is a construct defined by the American Heart Association (AHA) as part of its 2020 Impact Goal definition. CVH has, until now, not been evaluated in Sub-Saharan African populations. The aim of this study was to investigate differences in the prevalence of ideal CVH and its constituent metrics among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in three European countries. The AHA definition of CVH is based on 7 metrics: smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting plasma glucose. These were evaluated among 3510 Ghanaian adults (aged 25-70 years) residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin) in the multi-centre RODAM study. Differences between groups were assessed using logistic regression with adjustments for gender, age, and education. Only 0.3% of all participants met all 7 metrics of the AHA's definition of ideal CVH. Compared to rural Ghana (25.7%), the proportions and adjusted odds ratio (OR) of individuals who had 6-7 CVH metrics in the ideal category were substantially lower in urban Ghana, (7.5%; OR 0.204, 95% CI 0.15-0.29), Amsterdam (4.4%; 0.13, 0.08-0.19), Berlin (2.7%; 0.06, 0.03-0.11), and London (1.7%; 0.04, 0.02-0.09), respectively. The proportion of ideal CVH for the various metrics ranged from 96% for all sites in the smoking metric to below 6% in the diet metric. The proportion of ideal CVH is extremely low in Ghanaians, especially among those living in urban Ghana and Ghanaian migrants in Europe.
Innovative ways of studying the effect of migration on obesity and diabetes beyond the common designs: lessons from the RODAM study.
(2016) Agyemang, C.; Beune, E.; Meeks, K.; Addo, J.; de-Graft Aikins, A.; Bahendeka, S.; Danquah, I.; Mockenhaupt, F.P.; Schulze, M.B.; Klipstein-Grobusch, K.; Smeeth, L.; Stronks, K.
ype 2 diabetes and obesity are major global public health problems, with migrant populations in high-income countries being particularly affected. Type 2 diabetes and obesity are also major threats in low- and middle-income countries, from which most migrant populations originate. Transitioning of societies and the resulting changes in lifestyles are thought to be major driving forces, but the key specific factors within this broad category still need to be determined. Migrant studies provide a unique opportunity to understand the potential underlying causes of these conditions, but current research is mainly geared toward analyzing the differences between migrants and the host populations in the countries of settlement. For better understanding, there is a need to extend migrant health research across national boundaries. This review discusses innovative ways of studying the effect of migration on type 2 diabetes and obesity beyond the common designs and the relevance of extending migrant health studies across national boundaries in the current era of increasing global migration. Specifically, we describe the burden and different methods for conducting migrant studies. We use the Research on Obesity and Diabetes among African Migrants (RODAM) study as a case study, discussing the methods, some results, and lessons learned, including challenges and an essential recipe for success that may guide future migrant health research.
Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study
(Internal and Emergency Medicine, 2019-03-14) De‑Graft Aikins, A.; Nyaaba, G.N.; Stronks, K.; Meeks, K.; Beune, E.; Owusu‑Dabo, E.; Addo, J.; Mockenhaupt, F.; Bahendeka, S.; Klipstein‑Grobusch, K.; Smeeth, L.; Agyemang, C.
Hypertension (HTN) control is crucial in preventing HTN-related complications such as stroke and coronary heart disease. Yet, HTN control remains suboptimal particularly among sub-Saharan African (SSA) populations partly due to poor selfmanagement. Self-management of HTN is influenced by social support, but the evidence on the role of social support on HTN control particularly among SSA populations is limited. This study assessed the association between multiple proxies for social support and HTN control among Ghanaians resident in Ghana and Europe. The Research on Obesity and Diabetes among African Migrants (RODAM) study participants with HTN and who self-reported HTN (n = 1327) were included in this analysis. Logistic regression was used to assess the association between proxies of social support and HTN control (SBP < 140 mmHg and DBP < 90 mmHg) with adjustments for age and socioeconomic status (SES). Among Ghanaian males in both Europe and Ghana, cohabiting with more than two persons was associated with increased odds of having HTN controlled. Male hypertensive patients cohabiting with ≥ 5 persons had the highest odds of having HTN controlled after adjustment for age and SES (OR 0.30; 95% CI 0.16–0.57; 0.60; 0.34–1.04, respectively). This association was not observed among females. Relationship status, frequency of religious activity attendance and satisfaction with social support did not show any significant association with HTN control. Our study shows that cohabitation is significantly associated with HTN control but in males only. The other proxies for social support appeared not to be associated with HTN control. Involving persons living with Ghanaian men with HTN in the treatment process may help to improve adherence to HTN treatment. Further research is needed to explore in-depth, how these social support proxies could contribute to improved HTN control among SSA populations.
Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe: The RODAM study
(Journal of Diabetes and Its Complications, 2019-04-30) Amoah, A.G.B.; Hayfron-Benjamin, C.; Hayfron-Benjamin, B.V.D.; Maitland - van der Zee, A.H.; Meeks, K.A.C.; Klipstein-Grobusch, K.; Bahendeka, S.; Spranger, J.; Danquah, I.; Mockenhaupt, F.; Beune, E.; Smeeth, L.; Agyemang, C.
Aims: To compare microvascular and macrovascular complication rates among Ghanaians with type 2 diabetes (T2D) living in Ghana and in three European cities (Amsterdam, London and Berlin). Methods: Data from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were analyzed. 650 Ghanaian participants with T2D (206 non-migrant and 444 migrants) were included. Logistic regression analyses were used to determine the association between migrant status and microvascular (nephropathy and retinopathy) and macrovascular (coronary artery disease (CAD), peripheral artery disease (PAD) and stroke) complications with adjustment for age, gender, socioeconomic status, alcohol, smoking, physical activity, hypertension, BMI, total-cholesterol, and HbA1c. Results: Microvascular and macrovascular complications rates were higher in non-migrant Ghanaians than in migrant Ghanaians (nephropathy 32.0% vs. 19.8%; PAD 11.2% vs. 3.4%; CAD 18.4% vs. 8.3%; and stroke 14.5% vs. 5.6%), except for self-reported retinopathy (11.0% vs. 21.6%). Except nephropathy and stroke, the differences persisted after adjustment for the above-mentioned covariates: PAD (OR 7.48; 95% CI, 2.16–25.90); CAD (2.32; 1.09–4.93); and retinopathy (0.23; 0.07–0.75). Conclusions: Except retinopathy, the rates of microvascular and macrovascular complications were higher in nonmigrant than in migrant Ghanaians with T2D. Conventional cardiovascular risk factors did not explain the differences except for nephropathy and stroke.
Obesity and type 2 diabetes in sub-Saharan Africans - Is the burden in today's Africa similar to African migrants in Europe? The RODAM study.
(2016) Agyemang, C.; Meeks, K.; Beune, E.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Addo, J.; de-Graft Aikins, A.; Bahendeka, S.; Danquah, I.; Schulze, M.B.; Spranger, J.; Burr, T.; Agyei-Baafour, P.; Amoah, S.K.; Galbete, C.; Henneman, P.; Klipstein-Grobusch, K.; Nicolaou, M.; Adeyemo, A.; van Straalen, J.; Smeeth, L.; Stronks, K.
BACKGROUND: Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. METHODS: A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25-70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. RESULTS: In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04-13.57; women, 33.9 %; PR: 4.11, 3.13-5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98-37.84; women, 54.2 %; PR: 6.63, 5.04-8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73-5.40; women, 9.2 %; PR: 1.81, 1.25-2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50-7.98; women, 10.2 %; PR: 2.21, 1.30-3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. CONCLUSION: Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.
The prevalence of metabolic syndrome among Ghanaian migrants and their homeland counterparts: the Research on Obesity and type 2 Diabetes among African Migrants (RODAM) study
(European Journal of Public Health, 2019-04-09) Aikins, A.D.; van der Linden, E.L.; Meeks, K.; Beune, E.; Addo, J.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Bahendeka, S.; Danquah, I.; Schulze, M.B.; Spranger, J.; Klipstein-Grobusch, K.; Appiah, L.T.; Smeeth, L.; Stronks, K.; Agyemang, C.
Background Metabolic syndrome (MetSyn) is an important risk factor for cardiovascular diseases and type 2 diabetes. It is unknown whether the MetSyn prevalence differs within a homogenous population residing in different settings in Africa and Europe. We therefore assessed the prevalence of MetSyn among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in Europe. Methods We used data from the cross-sectional multi-centre RODAM study that was conducted among Ghanaian adults aged 25–70 years residing in rural- and urban-Ghana and in London, Amsterdam and Berlin (n = 5659). MetSyn was defined according to the 2009 harmonized definition. Geographical locations were compared using age-standardized prevalence rates, and prevalence ratios (PRs), adjusted for age, education, physical activity, and smoking and stratified for sex. Results In men, the age-standardized prevalence of MetSyn was 8.3% in rural Ghana and showed a positive gradient through urban Ghana (23.6%, adjusted PR = 1.85, 95% confidence interval 1.17–2.92) to Europe, with the highest prevalence in Amsterdam (31.4%; PR = 4.45, 2.94–6.75). In women, there was a rural-to-urban gradient in age-standardized MetSyn prevalence (rural Ghana 25%, urban Ghana 34.4%, PR = 1.38, 1.13–1.68), but small differences in MetSyn prevalence between urban-Ghanaian and European-Ghanaian women (Amsterdam 38.4%; London 38.2%). Conclusion MetSyn is highly prevalent in Ghana as well as in Ghanaian migrants in Europe. To assist prevention efforts, further research is needed to understand the mechanisms driving the geographical differences in MetSyn prevalence between migrant and non-migrant Ghanaians.
Rationale and cross-sectional study design of the research on obesity and type 2 diabetes among African migrants: The RODAM study
(BMJ Open, 2014-03) Agyemang, C.; Beune, E.; Meeks, K.; Owusu-Dabo, E.; Agyei-Baffour, P.; De-Graft Aikins, A.; Dodoo, F.; Smeeth, L.; Addo, J.; Mockenhaupt, F.P.; Amoah, S.K.; Schulze, M.B.; Danquah, I.; Spranger, J.; Nicolaou, M.; Klipstein-Grobusch, K.; Burr, T.; Henneman, P.; Mannens, M.M.; Van Straalen, J.P.; Bahendeka, S.; Zwinderman, A.H.; Kunst, A.E.; Stronks, K.
Introduction: Obesity and type 2 diabetes (T2D) are highly prevalent among African migrants compared with European descent populations. The underlying reasons still remain a puzzle. Gene-environmental interaction is now seen as a potential plausible factor contributing to the high prevalence of obesity and T2D, but has not yet been investigated. The overall aim of the Research on Obesity and Diabetes among African Migrants (RODAM) project is to understand the reasons for the high prevalence of obesity and T2D among sub-Saharan Africans in diaspora by (1) studying the complex interplay between environment (eg, lifestyle), healthcare, biochemical and (epi)genetic factors, and their relative contributions to the high prevalence of obesity and T2D; (2) to identify specific risk factors within these broad categories to guide intervention programmes and (3) to provide a basic knowledge for improving diagnosis and treatment. Methods and analysis: RODAM is a multicentre cross-sectional study among homogenous sub-Saharan African participants (ie, Ghanaians) aged >25 years living in rural and urban Ghana, the Netherlands, Germany and the UK (http://rod-am.eu/). Standardised data on the main outcomes, genetic and non-genetic factors are collected in all locations. The aim is to recruit 6250 individuals comprising five subgroups of 1250 individuals from each site. In Ghana, Kumasi and Obuasi (urban stratum) and villages in the Ashanti region (rural stratum) are served as recruitment sites. In Europe, Ghanaian migrants are selected through the municipality or Ghanaian organisations registers. Ethics and dissemination: Ethical approval has been obtained in all sites. This paper gives an overview of the rationale, conceptual framework and methods of the study. The differences across locations will allow us to gain insight into genetic and non-genetic factors contributing to the occurrence of obesity and T2D and will inform targeted intervention and prevention programmes, and provide the basis for improving diagnosis and treatment in these populations and beyond.
Smoking prevalence differs by location of residence among Ghanaians in Africa and Europe: The RODAM study
(Public Library of Science, 2017) Brathwaite, R.; Addo, J.; Kunst, A.E.; Agyemang, C.; Owusu-Dabo, E.; De-Graft Aikins, A.; Beune, E.; Meeks, K.; Bahendeka, S.; Mockenhaupt, F.P.; Amoah, S.; Galbete, C.; Schulze, M.B.; Danquah, I.; Smeeth, L.
Background Although the prevalence of smoking is low in Ghana, little is known about the effect of migration on smoking. Comparing Ghanaians living in their country of origin to those living in Europe offers an opportunity to investigate smoking by location of residence and the associations between smoking behaviours and migration-related factors. Methods Data on a relatively homogenous group of Ghanaians living in London (n = 949), Amsterdam (n = 1400), Berlin (n = 543), rural Ghana (n = 973) and urban Ghana (n = 1400) from the cross-sectional RODAM (Research on Obesity & Diabetes in African Migrants) study were used. Age-standardized prevalence rates of smoking by location of residence and factors associated with smoking among Ghanaian men were estimated using prevalence ratios (PR: 95% CIs). Results Current smoking was non-existent among women in rural and urban Ghana and London but was 3.2% and 3.3% in women in Amsterdam and Berlin, respectively. Smoking prevalence was higher in men in Europe (7.8%) than in both rural and urban Ghana (4.8%): PR 1.91: 95% CI 1.27, 2.88, adjusted for age, marital status, education and employment. Factors associated with a higher prevalence of smoking among Ghanaian men included European residence, being divorced or widowed, living alone, Islam religion, infrequent attendance at religious services, assimilation (cultural orientation), and low education. Conclusion Ghanaians living in Europe are more likely to smoke than their counterparts in Ghana, suggesting convergence to European populations, although prevalence rates are still far below those in the host populations. © 2017 Brathwaite et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Variations in hypertension awareness, treatment, and control among Ghanaian migrants living in Amsterdam, Berlin, London, and nonmigrant Ghanaians living in rural and urban Ghana-the RODAM study
(Journal of Hypertension, 2018-01) Agyemang, C.; Nyaaba, G.; Beune, E.; Meeks, K.; Owusu-Dabo, E.; Addo, J.; Aikins, A.D.-G.; Mockenhaupt, F.P.; Bahendeka, S.; Danquah, I.; Schulze, M.B.; Galbete, C.; Spranger, J.; Agyei-Baffour, P.; Henneman, P.; Klipstein-Grobusch, K.; Adeyemo, A. .; Van Straalen, J.; Commodore-Mensah, Y.; Appiah, L.T.; Smeeth, L.; Stronks, K.
Objectives: Hypertension is a major burden among African migrants, but the extent of the differences in prevalence, treatment, and control among similar African migrants and nonmigrants living in different contexts in high-income countries and rural and urban Africa has not yet been assessed. We assessed differences in hypertension prevalence and its management among relatively homogenous African migrants (Ghanaians) living in three European cities (Amsterdam, London, and Berlin) and nonmigrants living in rural and urban Ghana. Methods: A multicenter cross-sectional study was conducted among Ghanaian adults (n=5659) aged 25-70 years. Comparisons between sites were made using prevalence ratios with adjustment for age, education, and BMI. Results: The age-standardised prevalence of hypertension was 22 and 28% in rural Ghanaian men and women. The prevalence was higher in urban Ghana [men, 34%; adjusted prevalence ratio=1.37, 95% confidence interval (CI), 1.10-1.70]; and much higher in migrants in Europe, especially in Berlin (men, 57%; prevalence ratio=2.21, 1.78-2.73; women, 51%; prevalence ratio=1.74, 1.45-2.09) than in rural Ghana. Hypertension awareness and treatment levels were higher in Ghanaian migrants than in nonmigrant Ghanaians. However, adequate hypertension control was lower in Ghanaian migrant men in Berlin (20%; prevalence ratio=0.43 95%, 0.23-0.82), Amsterdam (29%; prevalence ratio=0.59, 0.35-0.99), and London (36%; prevalence ratio=0.86, 0.49-1.51) than rural Ghanaians (59%). Among women, no differences in hypertension control were observed. About 50% of migrants to 85% of rural Ghanaians with severe hypertension (Blood pressure>180/110) were untreated. Antihypertensive medication prescription patterns varied considerably by site. Conclusion: Hypertension prevalence, awareness, and treatment levels were generally higher in African migrants, but blood pressure control level was lower in Ghanaian migrant men compared with their nonmigrant peers. Further work is needed to identify key underlying factors to support prevention and management efforts.