A community-based cluster randomized survey of noncommunicable disease and risk factors in a peri-urban shantytown in Lima, Peru

BMC International Health and Human Rights

Joseph R Zunt¹  Jorge O Alarcón⁴  Stephen E Hawes³  Silvia M Montano²  Kristen Heitzinger³ 

[1] Departments of Neurology, Global Health, and Medicine, University of Washington, Seattle, WA, USA;U.S. Naval Medical Research Unit No. 6, Callao, Peru;Department of Epidemiology, University of Washington, Seattle, WA, USA;Instituto de Medicina Tropical “Daniel A. Carrión”, Universidad Nacional Mayor de San Marcos, Lima, Peru

关键词: Noncommunicable disease;    Shantytown;    Slum;    Peru;   

Others  :  854498
DOI  :  10.1186/1472-698X-14-19

 received in 2013-09-22, accepted in 2014-05-09,  发布年份 2014

【 摘 要 】

Background

An estimated 863 million people–a third of the world’s urban population–live in slums, yet there is little information on the disease burden in these settings, particularly regarding chronic preventable diseases.

Methods

From March to May 2012, we conducted a cluster randomized survey to estimate the prevalence of noncommunicable diseases (NCDs) and associated risk factors in a peri-urban shantytown north of Lima, Peru. Field workers administered a questionnaire that included items from the WHO World Health Survey and the WHO STEPS survey of chronic disease risk factors. We used logistic regression to assess the associations of NCDs and related risk factors with age and gender. We accounted for sampling weights and the clustered sampling design using statistical survey methods.

Results

A total of 142 adults were surveyed and had a weighted mean age of 36 years (range 18–81). The most prevalent diseases were depression (12%) and chronic respiratory disease (8%), while lifetime prevalence of cancer, arthritis, myocardial infarction, and diabetes were all less than 5%. Fifteen percent of respondents were hypertensive and the majority (67%) was unaware of their condition. Being overweight or obese was common for both genders (53%), but abdominal obesity was more prevalent in women (54% vs. 10% in men, p < 0.001). Thirty-five percent of men binge drank and 34% reported current smoking; these behaviors were less common among women (4% binge drank, p < 0.001; 8% smoked, p = 0.002). Increasing age was associated with an increased risk of abdominal obesity (Odds Ratio (OR) = 1.04, 95% CI = 1.01, 1.07, p = 0.02), hypertension (OR = 1.06, 95% CI = 1.02, 1.10, p = 0.006), arthritis (OR = 1.07, 95% CI = 1.03, 1.11, p < 0.001) and cancer (OR = 1.13, 95% CI = 1.07, 1.20, p < 0.001) in adjusted models. The prevalences of other NCDs and related risk factors were similar when stratified by age or gender.

Conclusions

This study underlines the important burden of noncommunicable disease in informal settlements in Peru and suggests that prevention and treatment interventions could be optimized according to age and gender.

【 授权许可】

   
2014 Heitzinger et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]UN-Habitat: State of the world’s cities 2012/2013: prosperity of cities. Book State of the World's Cities 2012/2013: Prosperity of Cities 2013.
• [2]WHO and UN-HABITAT: Hidden cities: unmasking and overcoming health inequities in urban settings. In Book Hidden cities: Unmasking and Overcoming Health Inequities In Urban Settings. Geneva: The WHO Centre for Health Development, Kobe, and the United Nationas Human Settlements Programme (UN-HABITAT); 2010.
• [3]Sclar ED, Garau P, Carolini G: The 21st century health challenge of slums and cities. Lancet 2005, 365:901-903.
• [4]Riley LW, Ko AI, Unger A, Reis MG: Slum health: diseases of neglected populations. BMC 2007, 7:2. BioMed Central Full Text
• [5]Unger A, Riley LW: Slum health: from understanding to action. PLoS Med 2007, 4:1561-1566.
• [6]Smit W, Hancock T, Kumaresen J, Santos-Burgoa C, Sanchez-Kobashi Meneses R, Friel S: Toward a research and action agenda on urban planning/design and health equity in cities in low and middle-income countries. J Urban Health 2011, 88:875-885.
• [7]Solar OIA: A conceptual framework for action on the social determinants of health. In Book A Conceptual Framework For Action On The Social Determinants Of Health. Geneva: WHO; 2010.
• [8]WHO: Global status report on noncommunicable diseases 2010. In Book Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011.
• [9]Huynen MM, Vollebregt L, Martens P, Benavides BM: The epidemiologic transition in Peru. Rev Panam Salud Publica 2005, 17:51-59.
• [10]Huicho L, Trelles M, Gonzales F, Mendoza W, Miranda J: Mortality profiles in a country facing epidemiological transition: an analysis of registered data. BMC Public Health 2009, 9:47. BioMed Central Full Text
• [11]Miranda JJ, Gilman RH, Garcia HH, Smeeth L: The effect on cardiovascular risk factors of migration from rural to urban areas in Peru: PERU MIGRANT study. BMC Cardiovasc Disord 2009, 9:23. BioMed Central Full Text
• [12]Miranda JJ, Gilman RH, Smeeth L: Differences in cardiovascular risk factors in rural, urban and rural-to-urban migrants in Peru. Heart 2011, 97:787-796.
• [13]Davies AR, Miranda JJ, Gilman RH, Smeeth L: Hypertension among adults in a deprived urban area of Peru - undiagnosed and uncontrolled? BMC research notes 2008, 1:2. BioMed Central Full Text
• [14]Jacoby E, Goldstein J, Lopez A, Nunez E, Lopez T: Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities. Prev Med 2003, 37:396-405.
• [15]LoretdeMola C, Stanojevic S, Ruiz P, Gilman RH, Smeeth L, Miranda JJ: The effect of rural-to-urban migration on social capital and common mental disorders: PERU MIGRANT study. Soc Psychiatry Psychiatr Epidemiol 2012, 47:967-973.
• [16]Robinson CL, Baumann LM, Gilman RH, Romero K, Combe JM, Cabrera L, Hansel NN, Barnes K, Gonzalvez G, Wise RA, Breysse PN, Checkley W: The Peru Urban versus Rural Asthma (PURA) Study: methods and baseline quality control data from a cross-sectional investigation into the prevalence, severity, genetics, immunology and environmental factors affecting asthma in adolescence in Peru. BMJ open 2012, 2:e000421.
• [17]Weygandt PL, Vidal-Cardenas E, Gilman RH, Avila-Tang E, Cabrera L, Checkley W: Epidemiology of tobacco use and dependence in adults in a poor peri-urban community in Lima. Peru BMC Pulm Med 2012, 12:9. BioMed Central Full Text
• [18]Galvez-Buccollini JA, Paz-Soldan VA, Herrera PM, DeLea S, Gilman RH: Gender differences in sex-related alcohol expectancies in young adults from a peri-urban area in Lima, Peru. Rev Panam Salud Publica 2009, 25:499-505.
• [19]Bernabe-Ortiz A, Benziger CP, Gilman RH, Smeeth L, Miranda JJ: Sex differences in risk factors for cardiovascular disease: the PERU MIGRANT study. PLoS One 2012, 7:e35127.
• [20]Bernabe-Ortiz A, Gilman RH, Smeeth L, Miranda JJ: Migration surrogates and their association with obesity among within-country migrants. Obesity 2010, 18:2199-2203.
• [21]Czechowicz JA, Messner AH, Alarcon-Matutti E, Alarcon J, Quinones-Calderon G, Montano S, Zunt JR: Hearing impairment and poverty: the epidemiology of ear disease in Peruvian schoolchildren. Otolaryngol Head Neck Surg 2010, 142:272-277.
• [22]Escuela Saludable y Ecologica, Lomas de Zapallal [http://awb-seattle.org/projects/featured-project/ webcite]
• [23]Henderson RH, Sundaresan T: Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method. Bull World Health Organ 1982, 60:253-260.
• [24]Bennett S, Woods T, Liyanage WM, Smith DL: A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat Q 1991, 44:98-106.
• [25]WHO: WHO STEPS Instrument for noncommunicable disease risk factor surveillance (STEPS). In Book WHO STEPS Instrument for Noncommunicable Disease Risk Factor Surveillance (STEPS). Geneva: World Health Organization; 2011.
• [26]WHO: Physical status: the use and interpretation of anthropometry. In Book Physical Status: The Use and Interpretation of Anthropometry. Geneva: World Health Organization; 1995.
• [27]WHO: Waist circumference and waist-hip ratio: report of a WHO expert consultation, 8–11 December 2008. In Book Waist circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, 8–11 December 2008. Geneva: World Health Organization; 2011.
• [28]Medina-Lezama J, Pastorius CA, Zea-Diaz H, Bernabe-Ortiz A, Corrales-Medina F, Morey-Vargas OL, Chirinos DA, Munoz-Atahualpa E, Chirinos-Pacheco J, Chirinos JA, Investigators P: Optimal definitions for abdominal obesity and the metabolic syndrome in Andean Hispanics: the PREVENCION study. Diabetes Care 2010, 33:1385-1388.
• [29]Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG: Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009, 42:377-381.
• [30]Instituto Especializado de Salud Mental "Honorio Delgado - Hideyo Noguchi: Estudio epidemiológico metropolitano en salud mental 2002. In Book Estudio Epidemiológico Metropolitano en Salud Mental 2002. Volume 18. Lima: Instituto Especializado de Salud Mental “Honorio Delgado - Hideyo Noguchi”; 2002.
• [31]Jain RK, Aras RY: Depression in geriatric population in urban slums of Mumbai. Indian J Public Health 2007, 51:112-113.
• [32]Dasgupta A, Battala M, Saggurti N, Nair S, Naik DD, Silverman JG, Balaiah D, Raj A: Local social support mitigates depression among women contending with spousal violence and husband's risky drinking in Mumbai slum communities. J Affect Disord 2013, 145:126-129.
• [33]Gruebner O, Khan MM, Lautenbach S, Muller D, Kramer A, Lakes T, Hostert P: Mental health in the slums of Dhaka - a geoepidemiological study. BMC Public Health 2012, 12:177. BioMed Central Full Text
• [34]Gruebner O, Khan MM, Lautenbach S, Muller D, Kraemer A, Lakes T, Hostert P: A spatial epidemiological analysis of self-rated mental health in the slums of Dhaka. Int J Health Geogr 2011, 10:36. BioMed Central Full Text
• [35]Brashier B, Londhe J, Madas S, Vincent V, Salvi S: Prevalence of selfreported respiratory symptoms, asthma and chronic bronchitis in slum area of a rapidly developing Indian city. Open J Respir Dis 2012, 2:73-81.
• [36]Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, Chowdhury MA, Alam MN, Mahmud TA, Chowdhury MR, Tahir M: Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study. J Rheumatol 2005, 32:348-353.
• [37]Ayah R, Joshi MD, Wanjiru R, Njau EK, Otieno CF, Njeru EK, Mutai KK: A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi. Kenya BMC Public Health 2013, 13:371. BioMed Central Full Text
• [38]Oti SO, van de Vijver SJ, Agyemang C, Kyobutungi C: The magnitude of diabetes and its association with obesity in the slums of Nairobi, Kenya: results from a cross-sectional survey. Trop Med Int Health 2013, 18:1520-1530.
• [39]Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E, Kapoor SK: Are the urban poor vulnerable to non-communicable diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad. Natl Med J India 2007, 20:115-120.
• [40]Hussain A, Rahim MA, Azad Khan AK, Ali SM, Vaaler S: Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh. Diabet Med 2005, 22:931-936.
• [41]Singh AK, Mani K, Krishnan A, Aggarwal P, Gupta SK: Prevalence, awareness, treatment and control of diabetes among elderly persons in an urban slum of delhi. Indian Journal Com Med 2012, 37:236-239.
• [42]Galvez-Buccollini JA, Paz-Soldan V, Herrera P, DeLea S, Gilman RH, Anthony JC: Links between sex-related expectations about alcohol, heavy episodic drinking and sexual risk among young men in a shantytown in Lima, Peru. Int Fam Plan Perspect 2008, 34:15-20.
• [43]Daniel OJ, Adejumo OA, Adejumo EN, Owolabi RS, Braimoh RW: Prevalence of hypertension among urban slum dwellers in Lagos, Nigeria. J Urban Health 2013, 90:1016-1025.
• [44]Ettarh R, Van de Vijver S, Oti S, Kyobutungi C: Overweight, obesity, and perception of body image among slum residents in Nairobi, Kenya, 2008–2009. Prev Chronic Dis 2013, 10:E212.
• [45]van de Vijver SJ, Oti SO, Agyemang C, Gomez GB, Kyobutungi C: Prevalence, awareness, treatment and control of hypertension among slum dwellers in Nairobi, Kenya. J Hypertens 2013, 31:1018-1024.
• [46]Sverdlik A: Ill-health and poverty: a literature on health in informal settlements. Environ Urbanization 2011, 23:123-155.
• [47]Oti SO, van de Vijver SJ, Kyobutungi C, Gomez GB, Agyemang C, Van Charante EP M, Brewster LM, Hendriks ME, Schultsz C, Ettarh R: A community-based intervention for primary prevention of cardiovascular diseases in the slums of Nairobi: the SCALE UP study protocol for a prospective quasi-experimental community-based trial. Trials 2013, 14:409. BioMed Central Full Text