Browsing by Author "Beune, E."

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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
Chronic kidney disease burden among African migrants in three European countries and in urban and rural Ghana: The RODAM cross-sectional study
(Nephrology Dialysis Transplantation, 2018-01) Adjei, D.N.; Stronks, K.; Adu, D.; Beune, E.; Meeks, K.; Smeeth, L.; Addo, J.; Owuso-Dabo, E.; Klipstein-Grobusch, K.; Spranger, J.et.al.
Background: Chronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions. Methods: For this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70 years. CKD status was defined according to severity of kidney disease using the combination of glomerular filtration rate (G1-G5) and albuminuria (A1-A3) levels as defined by the 2012 Kidney Disease: Improving Global Outcomes severity classification. Comparisons among sites were made using logistic regression analysis. Results: CKD prevalence was lower in Ghanaians living in Europe (10.1%) compared with their compatriots living in Ghana (13.3%) even after adjustment for age, sex and conventional risk factors of CKD [adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.56-0.88, P = 0.002]. CKD prevalence was markedly lower among Ghanaian migrants with hypertension (adjusted OR = 0.54, 0.44-0.76, P = 0.001) and diabetes (adjusted OR = 0.37, 0.22-0.62, P = 0.001) compared with non-migrant Ghanaians with hypertension and diabetes. No significant differences in CKD prevalence was observed among non-migrant Ghanaians and migrant Ghanaians with no hypertension and diabetes. Among Ghanaian residents in Europe, the odds of CKD were lower in Amsterdam than in Berlin, while among Ghanaian residents in Ghana, the odds of CKD were lower in rural Ghana (adjusted OR = 0.68, 95% CI 0.53-0.88, P = 0.004) than in urban Ghana, but these difference were explained by conventional risk factors. Conclusion: Our study shows important differences in CKD prevalence among Ghanaians living in Europe compared with those living in Ghana, independent of conventional risk factors, with marked differences among those with hypertension and diabetes. Further research is needed to identify factors that might explain the observed difference across sites to implement interventions to reduce the high burden of CKD, especially in rural and urban Ghana.
Cross-sectional study of association between psychosocial stressors with chronic kidney disease among migrant and non-migrant Ghanaians living in Europe and Ghana: the RODAM study
(BMJ Open, 2019-06-17) Adjei, D.N.; Stronks, K.; Adu, D.; Beune, E.; Meeks, K.; Smeeth, L.; Addo, J.; Owusu-Dabo, E.; Klipstein-Grobusch, K.; Mockenhaupt, F.; Schulze, M.; Danquah, I.; Spranger, J.; Bahendeka, S.K.; Agyemang, C.
Objectives The association between psychosocial stressors (PS) and chronic kidney disease (CKD) among sub-Saharan African (SSA) populations is unknown. We examined the association between PS and CKD prevalence among rural and urban Ghanaians and Ghanaian migrants living in three European cities. We also assessed if the influence of PS on CKD is partially mediated by primary risk factors (hypertension and diabetes) of CKD. Design A multi-centred cross sectional data from the Research on Obesity and Diabetes among African Migrants study. Setting Rural and urban Ghana and three European cities (Amsterdam, Berlin and London). Participants A random sample of 5659 adults (Europe 3167, rural Ghana 1043 and urban Ghana 1449) aged 25–70 years. Explanatory measures PS defined by negative life events, perceived discrimination, perceived stress at work/ home and depressive symptoms. Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification. Comparisons between PS and CKD outcomes were made using logistic regression analyses across all sites. Results We observed higher proportion of negative life events (68.7%) and perceived permanent stress (15.9%) among Ghanaians living in Ghana than Ghanaians living in Europe. Depressive symptoms (7.5%) and perceived discrimination (29.7%) were more common among Ghanaians living in Europe than Ghanaians living in Ghana. No significant association was observed between any of the PS constructs and CKD outcomes across sites except for positive association between stress at work/home and albuminuria (2.81, 95% CI 1.46 to 5.40) and CKD risk (2.78, 95% CI 1.43 to 5.43) among Ghanaians living in Berlin. Conclusion Our study found a positive association between stress at work/home and albuminuria and CKD risk. There was no convincing evidence of associations between the other PS constructs and the prevalence of CKD risk. Further studies are needed to identify potential factors driving the high prevalence of CKD among these populations.
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.
Dietary patterns and type 2 diabetes among Ghanaian migrants in Europe and their compatriots in Ghana: The RODAM study
(Nature Publishing Group, 2018) Galbete, C.; Nicolaou, M.; Meeks, K.; Klipstein-Grobusch, K.; De-Graft Aikins, A.; Addo, J.; Amoah, S.K.; Smeeth, L.; Owusu-Dabo, E.; Spranger, J.; Agyemang, C.; Mockenhaupt, F.P.; Beune, E.; Stronks, K.; Schulze, M.B.; Danquah, I.
Background/objectives: We aimed to study the associations of dietary patterns (DPs) with type 2 diabetes (T2D) among Ghanaian adults. Subjects/methods: In the multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study (n = 4543), three overall DPs ("mixed", "rice, pasta, meat and fish," and "roots, tubers and plantain") and two site-specific DPs per study site (rural Ghana, urban Ghana and Europe) were identified by principal component analysis. The DPs-T2D associations were calculated by logistic regression models. Results: Higher adherence to the "rice, pasta, meat and fish" DP (characterized by legumes, rice/pasta, meat, fish, cakes/sweets, condiments) was associated with decreased odds of T2D, adjusted for socio-demographic factors, total energy intake and adiposity measures (odds ratio (OR)per 1 SD = 0.80; 95% confidence interval (CI) = 0.70-0.92). Similar DPs and T2D associations were discernible in urban Ghana and Europe. In the total study population, neither the "mixed" DP (whole grain cereals, sweet spreads, dairy products, potatoes, vegetables, poultry, coffee/tea, sodas/juices, olive oil) nor the "roots, tubers and plantain" DP (refined cereals, fruits, nuts/seeds, roots/tubers/plantain, fermented maize products, legumes, palm oil, condiments) was associated with T2D. Yet, after the exclusion of individuals with self-reported T2D, the "roots, tubers and plantain" DP was inversely associated with T2D (ORper 1 SD = 0.88; 95% CI = 0.69-1.12). Conclusion: In this Ghanaian population, DPs characterized by the intake of legumes, fish, meat and confectionery were inversely associated with T2D. The effect of a traditional-oriented diet (typical staples, vegetables and legumes) remains unclear. © 2018 The Author(s).
Differences in Alcohol Consumption and Drinking Patterns in Ghanaians in Europe and Africa: The RODAM Study
(PloS one, 2018-11) Addo, J.; Cook, S.; Galbete, C.; Agyemang, C.; Klipstein-Grobusch, K.; Nicolaou, M.; Danquah, I.; Schulze, M.B.; Brathwaite, R.; Mockenhaupt, F.P.; Beune, E.; Meeks, K.; de-Graft Aikins, A.; Bahendaka, S.; Owusu-Dabo, E.; Smeeth, L.
BACKGROUND: Little is known about alcohol consumption among Africans living in rural and urban Africa compared to African migrants in Europe. We compared the patterns of alcohol consumption in a group of Ghanaians living in different locations in Ghana and in Europe and examined the factors associated with drinking alcohol. METHODS: Data were from a cross-sectional study (RODAM) of Ghanaians aged 25-70 years living in rural and urban Ghana and in Amsterdam, Berlin and London. Information on how often participants consumed at least one standard alcoholic drink in the preceding 12 months, the type of alcoholic beverage and the average serving size was obtained using a food propensity questionnaire. The associations between drinking alcohol and socio-demographic variables, and frequency of attending religious services were investigated using logistic regression models stratified by site and sex. For Ghanaians living in Europe, the number of years since migration and acculturation were also included in the model as covariates. RESULTS: 4280 participants (62.2% women) were included in the analyses. In both men and women, the prevalence of drinking and amount of alcohol consumed per day was highest in Berlin (prevalence of drinking 71.0% and 61.7%) and lowest in urban Ghana (41.4% and 26.8%). After adjustment for age and education in both men and women in Europe, those attending religious services less frequently reported higher levels of drinking alcohol than non-attendants (never attend/no religion compared to attending service at least once a week men OR 4.60 95% CI 2.85, 7.44; women OR 1.80 95% CI 1.12, 2.90) p-trend with frequency <0.001 in men; 0.002 in women); this association was seen also in men in rural Ghana (p-trend = 0.001) and women in urban Ghana (p-trend = 0.02). The prevalence of drinking was positively associated with years since migration in both men and women in Europe ((OR per years increase in time lived in Europe 1.25 (95% CI 1.02,1.53) test for trend p = 0.03 in women; OR 1.29 (95% CI 1.03, 1.62 p = 0.03 in men) but no association was found with self-reported measures of acculturation (ethnic identity, cultural orientation or social networks). CONCLUSION: There are marked differences in alcohol consumption between Ghanaians living in Europe and in Ghana suggesting migration has an important influence of drinking patterns and also suggesting the possibility of requiring different strategies in alcohol reduction campaigns among Ghanaians in different locations.
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.
Dyslipidaemia among Ghanaian migrants in three European countries and their compatriots in rural and urban Ghana: The RODAM study
(Atherosclerosis, 2019-05) van der Linden, E.; Meeks, K.; Beune, E.; de-Graft Aikins, A.; Addo, J.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Bahendeka, S.et.al.
Background and aims African populations have a favourable lipid profile compared to European populations. However, the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the lipid profiles of Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in three European countries. Methods We used data from a multi-centre, cross-sectional study among Ghanaian adults residing in rural- and urban-Ghana and London, Amsterdam and Berlin (n = 5482). Dyslipidaemias were defined using the 2012 European Guidelines on Cardiovascular Prevention. Comparisons between groups were made using age-standardised prevalence and prevalence ratios (PRs) with adjustments for important covariates. Results In both sexes, the age-standardised prevalence of high total cholesterol (TC) and LDL-cholesterol (LDL-C) was lower in rural- than in urban-Ghana and Ghanaian migrants in Europe. Adjusted PRs of high TC and LDL-C were higher in urban-Ghana (TC PR = 2.15, 95%confidence interval 1.69–2.73) and Ghanaian migrant men (TC PR = 2.03 (1.56–2.63)) compared to rural-Ghana, but there was no difference between rural- and Ghanaian migrant women (TC PR = 1.01 (0.84–1.22)). High triglycerides levels were as prevalent in rural-Ghana (11.6%) as in urban-Ghana (12.8%), but were less prevalent in Ghanaian migrant women (2.0%). In both sexes, low HDL-cholesterol was most prevalent in rural-Ghana (50.1%) and least prevalent in Europe (12.9%). Conclusion The lipid profile varied among ethnically homogeneous African populations living in different geographical locations in Africa and Europe. Additional research is needed to identify factors driving these differential risks to assist prevention efforts.
Factors hindering hypertension control: perspectives of front-line health professionals in rural Ghana
(Public Health, 2020-01-07) Aikins, A.D.; Nyaaba, G.N.; Masana, L.; Beune, E.; Agyemang, C.
Objective: Hypertension (HTN) control remains a major public health challenge in sub-Saharan Africa (SSA). Health professionals influence patient adherence and self-management practices for HTN particularly in rural and lower socio-economic communities in SSA. Contextual evidence on the reasons for the suboptimal control of HTN in clinical settings is crucial to improving health delivery practices for HTN and preventing HTN related-complications. Study design: A cross-sectional qualitative study. Methods: Semistructured interviews were conducted among 40 purposively sampled front-line health professionals in seven health facilities in northern Ghana. Data were analysed using a thematic approach through pre-identified and evolving themes. Results: We identified three key themes underlying the poor HTN control. First, health professionals’ barriers included communication difficulties, poor collaboration and referrals among health professionals and limited training on HTN and other non-communicable diseases (NCDs). Secondly, health systemerelated barriers included limited health personnel, drug shortages, inadequate facilities and equipment and challenges with National Health Insurance (NHIS). The third theme was patient-related barriers including non-adherence, use of traditional treatments, sociocultural factors and lack of appreciation. Conclusion: A holistic public health approach, which builds upon health professionals’ capacities, harnesses and integrates into existing health policy and systems structures and empowers and collaborates with communities could contribute to improving HTN control in rural settings. Health policymakers need to consider the sociocultural, economic and geographical characteristics in such settings, which influence health service delivery practices in designing and implementing HTN interventions. There is also a need for health policy to integrate NCD training and management of multiple and comorbid conditions into the training curriculum of health training institutions to build health professionals capacity to facilitate the uptake of evidence-based NCD interventions and manage the double burden of diseases.
Food variety, dietary diversity, and type 2 diabetes in a multi-center cross-sectional study among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study
(European Journal of Nutrition, 2017-09) Danquah, I.; Galbete, C.; Meeks, K.; Nicolaou, M.; Klipstein-Grobusch, K.; Addo, J.; Aikins, A.D.-G.; Amoah, S.K.; Agyei-Baffour, P.; Boateng, D.; Bedu-Addo, G.; Spranger, J.; Smeeth, L.; Owusu-Dabo, E.; Agyemang, C.; Mockenhaupt, F.P.; Beune, E.; Schulze, M.B.
Purpose: The importance of dietary diversification for type 2 diabetes (T2D) risk remains controversial. We investigated associations of between- and within-food group variety with T2D, and the role of dietary diversification for the relationships between previously identified dietary patterns (DPs) and T2D among Ghanaian adults. Methods: In the multi-center cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study (n = 3810; Ghanaian residence, 56%; mean age, 46.2 years; women, 63%), we constructed the Food Variety Score (FVS; 0–20 points), the Dietary Diversity Score (DDS; 0–7 points), and the Diet Quality Index-International (DQI-I) variety component (0–20 points). The associations of these scores, of a “rice, pasta, meat and fish” DP, of a “mixed” DP, and of a “roots, tubers and plantain” DP with T2D were calculated by logistic regression. Results: The FVS was inversely associated with T2D, adjusted for socio-demographic, lifestyle, and anthropometric factors [odds ratio (OR) for T2D per 1 standard deviation (SD) increase: 0.81; 95% confidence interval (CI) 0.71–0.93]. The DDS and the DQI-I variety component were not associated with T2D. There was no association of the “mixed” DP and the “roots, tubers and plantain” DP with T2D. Yet, the “rice, pasta, meat and fish” DP is inversely associated with T2D (OR for T2D per 1 SD increase: 0.82; 95% CI 0.71–0.95); this effect was slightly attenuated by the FVS. Conclusions: In this Ghanaian population, between-food group variety may exert beneficial effects on glucose metabolism and partially explains the inverse association of the “rice, pasta, meat and fish” DP with T2D. © 2017 The Author(s)
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.
Illness representations and coping practices for self-managing hypertension among sub-Saharan Africans: A comparative study among Ghanaian migrants and non-migrant Ghanaians
(Patient Education and Counseling, 2019-04) Nyaaba, G.N.; Agyemang, C.; Masana, L.; de-Graft Aikins, A.; Beune, E.; Larrea-Killinger, C.; Stronks, K.
Objective Hypertension (HTN) control is a major obstacle among sub-Saharan African populations partly due to poor self-management. We explored and compared how persons’ social and physical context shapes their illness representations regarding HTN and the coping strategies they develop and adapt to mitigate challenges in self-managing HTN. Methods A cross sectional multisite qualitative study using semi-structured interviews among 55 Ghanaians with HTN living in The Netherlands and urban and rural Ghana. A thematic approach was used in data analysis. Results Family HTN history, personal experiences with HTN and outcomes of using biomedical and traditional treatments shaped participants’ illness representations and coping strategies. Migrants and urban non-migrants modified medication schedules and integrated taking medication into daily routine activities to cope with experienced side effects of taking antihypertensive medication while rural non-migrants used traditional remedies and medicines to mitigate experienced medication side effects and/or in search for a cure for HTN. Conclusion Contextual factors within participants’ social and physical environments shape their illness representations and coping strategies for HTN though interactive phrases. Practice implications Health professionals should harness the relationships within peoples’ social and physical environments, encourage implementation of family-wide behavioural changes and involve family and communities in HTN treatment to enhance patients’ self-management of HTN.
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) Nyaaba, G.N.; Stronks, K.; Meeks, K.; Beune, E.; Owusu-Dabo, E.; Addo, J.; de-Graft Aikins, A.; Mockenhaupt, F.; Bahendeka, S.et.al
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 self-management. 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.
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.
Knowledge and perceptions of type 2 diabetes among Ghanaian migrants in three European countries and Ghanaians in rural and urban Ghana: The RODAM qualitative study
(PLoS ONE, 2019-04) de-Graft Aikins, A.; Dodoo, F.; Awuah, R.B.; Owusu-Dabo, E.; Addo, J.; Nicolaou, M.; Beune, E.; Mockenhaupt, F.P.; Danquah, I.; Bahendeka, S.et.al
African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants’ knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities.
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.