The last frontier for global Non-Communicable Disease action: the Emergency Department - a cross-sectional study from East Africa

Abstract Background Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients, to inform interventions targeting patients with NCDs in emergency care settings. Methods Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a survey of 923 adults aged 18 and over at Kenyatta National Hospital Emergency Department (KNH ED), the largest hospital in East Africa between May-October 2018. We used descriptive statistics and covariate-adjusted logistic analysis to analyze results. We included the following socio-demographic variables in our models: age, income, household size (t-test), sex, education, marital status, work status, and poverty status (chi-squared test or fisher's exact test). Findings More than a third of respondents had hypertension (35.8%, n=225/628), one in five had raised blood sugar or diabetes (18.3%, n=61/333), and more than one in ten reported having cardiovascular disease (11.7%, n=90/769). Having lower levels of education was associated with tobacco use (OR 6.0, 95% CI 2.808-12.618, p < 0.0001), while those with higher levels of education reported increased alcohol use (OR 0.620 (95% CI 0.386-0.994, p = 0.0472). While a predominant proportion of respondents had had some form of screening for either hypertension (80.3%, n=630/772), blood sugar (42.6%, n=334/767) or cholesterol (13.9%, n=109/766), the proportion of those on treatment was low, with the highest proportion being half of those diagnosed with hypertension reporting taking medication(51.6%, n=116/225). Determinants of disease burden were age, sex, and income. Interpretation Comprehension of the unique epidemiology and characteristics of patients presenting to the ED is key to guide care in African populations. Patient-driven interventions, and collaboration with community-based stakeholders such as patient navigators, are ideal considerations to sustainably address NCDs leveraging the ED in the resource-limited setting. Funding Hecht-Albert Global Health Pilot Innovation Award for Junior Faculty, Global Health Leadership Institute, Yale University.

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The last frontier for global non-communicable disease action: The emergency department—A cross-sectional study from East Africa

PLoS ONE ◽

10.1371/journal.pone.0248709 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0248709

Author(s):

Christine Ngaruiya ◽

Mbatha Wambua ◽

Thomas Kedera Mutua ◽

Daniel Owambo ◽

Morgan Muchemi ◽

...

Keyword(s):

Emergency Department ◽

East Africa ◽

Blood Sugar ◽

Sex Education ◽

Communicable Disease ◽

Primary Source ◽

Communicable Diseases ◽

High Risk Population ◽

Cross Sectional ◽

Targeted Interventions

Introduction Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients to inform interventions targeting patients with NCDs in emergency care settings. Materials and methods Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a survey of 923 adults aged 18 and over at Kenyatta National Hospital Emergency Department (KNH ED) between May-October 2018. Age, income, household size(t-test), sex, education, marital status, work status, and poverty status (chi-squared test or fisher’s exact test) were assessed using descriptive statistics and analyzed using covariate-adjusted logistic analysis. Results Over a third of respondents had hypertension (35.8%, n = 225/628), 18.3% had raised blood sugar or diabetes (18.3%, n = 61/333), and 11.7% reported having cardiovascular disease (11.7%, n = 90/769). Having lower levels of education was associated with tobacco use (OR 6.0, 95% CI 2.808–12.618, p < 0.0001), while those with higher levels of education reported increased alcohol use (OR 0.620 (95% CI 0.386–0.994, p = 0. 0472). While a predominant proportion of respondents had had some form of screening for either hypertension (80.3%, n = 630/772), blood sugar (42.6%, n = 334/767) or cholesterol (13.9%, n = 109/766), the proportion of those on treatment was low, with the highest proportion being half of those diagnosed with hypertension reporting taking medication (51.6%, n = 116/225). Conclusions This study establishes the ED as a high-risk population with potential for high impact in East Africa, should targeted interventions be implemented. Comprehension of the unique epidemiology and characteristics of patients presenting to the ED is key to guide care in African populations.

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Incidental Hyperglycemia and Detection of Diabetes in Patients Presenting to the Emergency Department of a Tertiary Care Hospital

Nepal Medical Journal ◽

10.37080/nmj.81 ◽

2020 ◽

Vol 3 (1) ◽

pp. 26-31

Author(s):

Ashish Thapa ◽

Anugya Amatya ◽

Roshan Parajuli

Keyword(s):

Emergency Department ◽

Diagnostic Criteria ◽

Blood Sugar ◽

Tertiary Care ◽

Data Entry ◽

Adverse Outcomes ◽

Final Outcome ◽

Undiagnosed Diabetes ◽

Care Hospital ◽

Cross Sectional

Introduction: Nearly half of people with diabetes don’t know they have it. It is often not diagnosed until complications appear. The aim of the study was to determine the prevalence of diabetes mellitus and prediabetes in patients presenting to the Emergency Department with incidental hyperglycemia, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications. Methods: It was an observational cross-sectional study, 720 patients from Emergency Department of Kathmandu Medical College, Sinamangal were screened from December 2018 to March 2019 and a total of 128 patients with incidental hyperglycemia (>140mg/dl) were included. Patients with a previous diagnosis of diabetes, unstable patients and pregnant patients were excluded. Incidental hyperglycemia, fasting blood sugar, 2 hours postprandial blood sugar and HbA1c were noted, data entry was done in Microsoft Excel and analysis was done using the SPSS 24. Results: Total of 128 patients were enrolled for the study.10% of the patients had hyperglycemia and 34% among the hyperglycemic had the finding in the absence of history of diabetes. Incidental hyperglycemia ranged from 150-500 mg/dl. Among the incidental hyperglycemic, 29% and 36% had prediabetes and diabetes respectively. Incidental hyperglycemia was divided into four groups; <159, 160-179, 180-199 and >200 mg/dl, and each group was analyzed with the diagnostic criteria and the final outcome. It was found that each group correlated well with the diagnostic criteria and final outcome and was found to be statistically significant with p<0.0001 based on the Chi square test. Conclusions: Following the patients with incidental hyperglycemia in the Emergency Department, a significant number of undiagnosed diabetes or prediabetes can be diagnosed, early intervention can be started that can prevent progression from prediabetes to diabetes and risk of complications can be reduced.

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PENTINGNYA POSBINDU KELILING DALAM MENDETEKSI PENYAKIT TIDAK MENULAR DI RW. 05, KELURAHAN KEDAUNG KALIANGKE

Jurnal Muara Sains, Teknologi, Kedokteran dan Ilmu Kesehatan ◽

10.24912/jmstkik.v5i1.6344 ◽

2021 ◽

Vol 5 (1) ◽

pp. 9

Author(s):

Yohanes Firmansyah ◽

Desi Natalia Ginting ◽

Ernawati Su ◽

Yana Sylvana ◽

Welhan Chau ◽

...

Keyword(s):

Community Participation ◽

Communicable Disease ◽

Population Group ◽

Communicable Diseases ◽

T Test ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Non Communicable Diseases ◽

Chi Square Test

Non-communicable diseases (NCD) especially hypertension and cardiovascular diseases have become the highest cause of death in the world with a mortality rate of nine million deaths (44% of all non-communicable disease deaths and 31% of all global causes of death). The purpose of this study was to determine the effectiveness of the Mobilization in Utilization Of Community Participation (Mobilization POSBINDU) activities to detect risk factor and early diagnosis of non-communicable diseases (NCD) especially hypertension. Methods: Cross-sectional method was applied to the society in Sector 5th Kedaung Kaliangke District, the variables in this research were tested using the chi-square test, Independent T-test, and Mann Whitney test. Results: 40 respondents who met the study criteria. There were no differences in the incidence of hypertension (55% vs 60%; p-value: 1,000), average of SBP (138.25 (24.36) vs 144.45 (20.24); p-value: 0.394) and average of DBP (85 (68 -132) vs 83 (58 - 105) mmHg; p-value: 0.369) between 2 groups of people who have never been to Posbindu with those who are routinely to Posbindu. There are still many people who have not been screened from Posbindu activities and still urgently need to Mobilization in Utilization Of Community Participation Program (Posbindu Linpung) to get more people for early detection of NCD. Conclusion: Posbindu Linpung has proven effective in finding new cases of hypertension in the community. This is proven by the fact that there is no difference in the mean blood pressure of a population group that has never been screened with a group that routinely does a screening. Keywords: mobilization posbindu ; routinely ; hypertension AbstrakPenyakit tidak menular (PTM) khususnya hipertensi dan penyakit kardiovaskuler telah menjadi penyebab kematian tertinggi di dunia dengan angka mortalitas sembilan juta kematian (44% dari semua kematian penyakit tidak menular dan 31% dari semua penyebab kematian global). Tujuan penelitian untuk mengetahui efektivitas dari kegiatan Posbindu PTM Keliling Kampung dalam surveilans faktor risiko dan deteksi dini PTM. Metode: Potong lintang pada masyarakat RW 05 Kelurahan Kedaung Kaliangke, serta data penelitian di uji dengan uji Chi-square , Independent T-Test, dan Mann Whitney. Hasil Penelitian: 40 responden yang memenuhi kriteria penelitian. Tidak didapatkan perbedaan kejadian hipertensi (55% vs 60% ; p-value : 1,000), rata-rata TDS (138,25 (24,36) mmHg vs 144,45 (20,24) mmHg ; p-value : 0,394) dan rata-rata TDD (85 (68 - 132) mmHg vs 83 (58 - 105) mmHg ; p-value : 0,369) yang tidak bermakna antar 2 kelompok masyarakat yang tidak pernah ke posbindu dengan yang rutin ke posbindu. Hal ini membuktikan bahwa masih banyak masyarakat yang belum terskrining dari kegiatan Posbindu dan masih sangat memerlukan Posbindu Linpung untuk menjaring lebih banyak masyarakat untuk deteksi dini PTM. Kesimpulan: Posbindu Linpung terbukti efektif dalam menjaring kasus baru penyakit tidak menular (hipertensi dan obesitas) yang berada dalam masyarakat. Hal ini terbukti dari tidak terdapat perbedaan rerata tekanan darah dari kelompok populasi yang tidak pernah melakukan skrining dengan kelompok yang rutin melakukan skrining.

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EFFECT OF EMPLOYEE LABOR EXPENSES ON THE RESPONSE TIME IN EMERGENCY DEPARTMENT OF SAMPANG HOSPITAL, INDONESIA

Majalah Biomorfologi ◽

10.20473/mbiom.v31i2.2021.57-65 ◽

2021 ◽

Vol 31 (2) ◽

pp. 57

Author(s):

Miftahul Khoirul Insan ◽

Prananda Surya Airlangga ◽

Lilik Djuari

Keyword(s):

Emergency Department ◽

Response Time ◽

Sex Education ◽

Daily Routine ◽

Observation Data ◽

Chi Square ◽

Cross Sectional ◽

Exact Test ◽

Emergency Patients ◽

Cross Sectional Design

Background: The Emergency Department (ED) has the main purpose of receiving, triageing, stabilizing, and providing acute health services to patients, including those who require resuscitation and emergency patients to some degree. An indicator of the success of medical treatment of emergency patients is the speed of providing adequate assistance both in daily routine situations or during disasters. Factors that influence nurses’ motivation to work, especially implementing triage at the Emergency Department include the characteristics of nurses such as age, sex, education, length of work and training. Objective: To analyze the effect of workload of the medical staff of the Emergency Department on the response time in the Emergency Department of Sampang Hospital, Indonesia. Materials and Methods: Observational analytic research with cross-sectional design. Sampling was performed with total sampling method to 24 people who met the criteria. Data collection was done by questionnaire and observation. Data were analyzed using the Chi-square correlation test and Fisher’s exact test. Results: There was a significant influence between workload and response time of triage P1 of Emergency Department staff at Sampang Hospital, Indonesia (p=0.015), whereas in triage P2 and P3 there was no effect of workload of staff on response time (p>0.05). Conclusion: In Emergency Department of Sampang Hospital, Indonesia, the response time in all categories of emergency (P1/red, P2/yellow, and P3/green) is fast. Workload correlates significantly with response time in P1/red category, while in P2/yellow and P3/green categories the workload has no effect on the response time.

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Syndromic Surveillance of Communicable Diseases in Mobile Clinics During the Arbaeenia Mass Gathering in Wassit Governorate, Iraq, in 2014: Cross-Sectional Study (Preprint)

10.2196/preprints.10920 ◽

2018 ◽

Author(s):

Faris Lami ◽

Wejdan Asi ◽

Adnan Khistawi ◽

Iman Jawad

Keyword(s):

Acute Diarrhea ◽

Syndromic Surveillance ◽

Communicable Disease ◽

Disease Outbreaks ◽

Cross Sectional Study ◽

Communicable Diseases ◽

Mass Gathering ◽

Sectional Study ◽

Cross Sectional ◽

Mobile Clinics

BACKGROUND Arbaeenia is the largest religious mass gathering organized annually in Karbala city, Iraq, and is attended by 8-14 million people. Outbreaks of communicable diseases are a significant risk due to overcrowding and potential food and water contamination. Syndromic surveillance is often used for rapid detection and response to disease outbreaks. OBJECTIVE This study was conducted to identify the main communicable diseases syndromes among pilgrims during the Arbaeenia mass gathering in Wassit governorate, Iraq, in 2014. METHODS This cross-sectional study was conducted in the 40 mobile clinics established within Wassit governorates along the road to Karbala during the Arbaeenia mass gathering. Six communicable disease syndromes were selected: acute watery diarrhea, bloody diarrhea, fever and cough, vomiting with or without diarrhea, fever and bleeding tendency, and fever and rash. A simple questionnaire was used to directly gather basic demographics and the syndromic diagnosis from the attendees. RESULTS A total of 87,865 patients attended the clinics during the 10-day period, with an average of 219 patients/clinic/day. Approximately 5% (3999) of the attendees had communicable diseases syndromes: of these, 1693 (42%) had fever and cough, 1144 (29%) had acute diarrhea, 1062 (27%) presented with vomiting with/without diarrhea, and 100 (2%) had bloody diarrhea. The distribution of the syndromes did not vary by age or gender. Stool specimen cultures for <italic>Vibrio cholerae</italic> performed for 120 patients with acute diarrhea were all negative. CONCLUSIONS Syndromic surveillance was useful in determining the main communicable diseases encountered during the mass gathering. Expansion of this surveillance to other governorates and the use of mobile technology can help in timely detection and response to communicable disease outbreaks.

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Carbohydrate knowledge in diabetic emergency department patients at an academic institution

Journal of Hospital Administration ◽

10.5430/jha.v6n2p15 ◽

2017 ◽

Vol 6 (2) ◽

pp. 15

Author(s):

Preeti Dalawari ◽

David Sprowls ◽

Vicki Moran ◽

Eric Armbrecht

Keyword(s):

Emergency Department ◽

Blood Sugar ◽

Cross Sectional ◽

Tertiary Center ◽

Patients With Diabetes ◽

History Of ◽

Interview Survey ◽

Level Of Knowledge ◽

Emergency Department Patients ◽

Research Assistants

Background: Diabetes Mellitus (DM) affects 12.3% of the U.S. population and is responsible for $245 billion in annual costs. Knowledge about their disease is an important part of patients’ self-management.Objective: The objective of this study was to describe the baseline level of knowledge of patients with diabetes in this emergency department (ED), including behaviors related to healthy eating such as carbohydrate counting (CC).Methods: This was a cross sectional interview survey conducted at an academic tertiary center. An 8-item survey was developed to assess areas of diabetes self-care and carbohydrate knowledge. Trained research assistants approached all medically stable, non-pregnant ED patients with a past medical history of diabetes for participation. Descriptive statistics and ANOVA analysis were used.Results: Of the 115 patients approached, 98 were willing to participate; 54% were using insulin and 68% were female. The average age was 55 (SD +/- 14) years and diagnosed for an average of 12 (SD +/- 10) years. Fifty three percent did not check their morning blood sugar. Only 20% could accurately state the target hemoglobin A1c. While 48% of participants could relate the importance of carbohydrates to blood sugar, only 5% could state the number of grams of carbohydrates in a slice of bread. Only 1 participant correctly answered all 4 of the carbohydrate questions. Higher education and more visits with a nutritionist were associated with carbohydrate knowledge.Conclusions: Carbohydrate knowledge among this ED population was poor. Opportunities exist for patient education.

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Syndromic Surveillance of Communicable Diseases in Mobile Clinics During the Arbaeenia Mass Gathering in Wassit Governorate, Iraq, in 2014: Cross-Sectional Study

JMIR Public Health and Surveillance ◽

10.2196/10920 ◽

2019 ◽

Vol 5 (4) ◽

pp. e10920 ◽

Cited By ~ 3

Author(s):

Faris Lami ◽

Wejdan Asi ◽

Adnan Khistawi ◽

Iman Jawad

Keyword(s):

Acute Diarrhea ◽

Syndromic Surveillance ◽

Communicable Disease ◽

Disease Outbreaks ◽

Cross Sectional Study ◽

Communicable Diseases ◽

Mass Gathering ◽

Sectional Study ◽

Cross Sectional ◽

Mobile Clinics

Background Arbaeenia is the largest religious mass gathering organized annually in Karbala city, Iraq, and is attended by 8-14 million people. Outbreaks of communicable diseases are a significant risk due to overcrowding and potential food and water contamination. Syndromic surveillance is often used for rapid detection and response to disease outbreaks. Objective This study was conducted to identify the main communicable diseases syndromes among pilgrims during the Arbaeenia mass gathering in Wassit governorate, Iraq, in 2014. Methods This cross-sectional study was conducted in the 40 mobile clinics established within Wassit governorates along the road to Karbala during the Arbaeenia mass gathering. Six communicable disease syndromes were selected: acute watery diarrhea, bloody diarrhea, fever and cough, vomiting with or without diarrhea, fever and bleeding tendency, and fever and rash. A simple questionnaire was used to directly gather basic demographics and the syndromic diagnosis from the attendees. Results A total of 87,865 patients attended the clinics during the 10-day period, with an average of 219 patients/clinic/day. Approximately 5% (3999) of the attendees had communicable diseases syndromes: of these, 1693 (42%) had fever and cough, 1144 (29%) had acute diarrhea, 1062 (27%) presented with vomiting with/without diarrhea, and 100 (2%) had bloody diarrhea. The distribution of the syndromes did not vary by age or gender. Stool specimen cultures for Vibrio cholerae performed for 120 patients with acute diarrhea were all negative. Conclusions Syndromic surveillance was useful in determining the main communicable diseases encountered during the mass gathering. Expansion of this surveillance to other governorates and the use of mobile technology can help in timely detection and response to communicable disease outbreaks.

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Deteksi Dini Faktor Risiko Penyakit Tidak Menular Pada Masyarakat Desa Andepali Kecamatan Sampara Kabupaten Konawe

AKSIOLOGIYA Jurnal Pengabdian Kepada Masyarakat ◽

10.30651/aks.v4i2.3491 ◽

2020 ◽

Vol 4 (2) ◽

pp. 16

Author(s):

I Putu Sudayasa ◽

Muhammad Fathur Rahman ◽

Amiruddin Eso ◽

Jamaluddin Jamaluddin ◽

Parawansah Parawansah ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Early Detection ◽

Blood Sugar ◽

Disease Risk ◽

Communicable Disease ◽

Communicable Diseases ◽

Normal Range ◽

Non Communicable Diseases ◽

Chronic Respiratory Diseases

ABSTRAKPenyakit tidak menular (PTM) merupakan penyakit yang tidak ditularkan dan tidak ditransmisikan kepada orang lain dengan bentuk kontak apapun, menyebabkan kematian dan membunuh sekitar 35 juta manusia setiap tahunnya, atau 60% dari seluruh kematian secara global, dengan 80% pervalensi pada negara berkembang. Penyakit tidak menular, khususnya penyakit kardiovaskuler, kanker, penyakit pernapasan kronis, dan diabetes merupakan ancaman utama bagi kesehatan dan perkembangan manusia saat ini. Tujuan pengabdian masyarakat yang terintegrasi kuliah kerja nyata (KKN) Tematik, untuk mendeteksi faktor risiko penyakit tidak menular, pada masyarakat Kecamatan Sampara, Kabupaten Konawe. Metode kegiatan berupa penyuluhan kesehatan, pemeriksaan tekanan darah, kadar kolesterol, gula darah sewaktu dan asam urat. Telah dilakukan skrining dan deteksi dini fator risiko penyakit tidak menular terhadap 67 orang responden, meliputi 14 laki–laki dan 53 perempuan. Pada hasil pemeriksaan tekanan darah, didapatkan jumlah yang mengalami hipertensi 28,35 %, normotensi 67,16, dan hipotensi 4,47 %. Pada pemeriksaan Kolesterol Total, didapatkan kolesterol dalam batas normal 2,38 % dan tinggi 37,31 %. Hasil pemeriksaan gula darah sewaktu (GDS), didapatkan kadar GDS dalam batas normal 85,07 % dan kadar GDS tinggi 14,92 %. Pada pemeriksaan Asam Urat didapatkan dalam batas normal adalah 91,04 % dan tinggi 8,95 %.Kata kunci: Faktor Risiko; Penyakit Tidak Menular Early Detection of Non-communicable Disease Risk Factors in Andepali Village Community, Sampara District, Konawe RegencyABSTRACTNon-communicable disease (PTM) is a disease that is not transmitted and is not transmitted to others by any form of contact, causing death and killing around 35 million people each year, or 60% of all deaths globally, with 80% prevalence in developing countries. PTM, especially cardiovascular disease, cancer, chronic respiratory diseases, and diabetes are the main threats to human health and development today. The purpose of integrated community service is the Thematic Real Work Study (KKN), to detect risk factors for non-communicable diseases, in the community of Sampara District, Konawe Regency. The method of activity in the form of health education, blood pressure, cholesterol levels, blood sugar and uric acid. Screening and early detection of risk factors for non-communicable diseases have been carried out on 67 respondents, including 14 men and 53 women. On the results of blood pressure examination, it was found that the amount of hypertension was 28.35%, normotension 67.16% and hypotension 4.47%. In the examination of Total Cholesterol, cholesterol was found to be within the normal limit of 2.38% and 37.31% high. Examination results of Blood Sugar (GDS), obtained levels of GDS in the normal range of 85.07% and high GDS levels of 14.92%. In the examination of Gout found in the normal range is 91.04% and high 8.95%.Keywords: gout; blood sugar; cholesterol; non-communicable diseases; blood pressure

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Validation analysis of Global Health Security Index (GHSI) scores 2019

BMJ Global Health ◽

10.1136/bmjgh-2020-003276 ◽

2020 ◽

Vol 5 (10) ◽

pp. e003276

Author(s):

Matthew J Boyd ◽

Nick Wilson ◽

Cassidy Nelson

Keyword(s):

Global Health ◽

External Validity ◽

Communicable Disease ◽

Communicable Diseases ◽

Linear Regression Models ◽

Global Health Security ◽

Health Security ◽

Future Events ◽

Security Index ◽

The Impact

IntroductionThe COVID-19 pandemic powerfully demonstrates the consequences of biothreats. Countries will want to know how to better prepare for future events. The Global Health Security Index (GHSI) is a broad, independent assessment of 195 countries’ preparedness for biothreats that may aid this endeavour. However, to be useful, the GHSI’s external validity must be demonstrated. We aimed to validate the GHSI against a range of external metrics to assess how it could be utilised by countries.MethodsGlobal aggregate communicable disease outcomes were correlated with GHSI scores and linear regression models were examined to determine associations while controlling for a number of global macroindices. GHSI scores for countries previously exposed to severe acute respiratory syndrome (SARS), Middle East respiratory syndrome and Ebola and recipients of US Global Health Security Agenda (GHSA) investment were compared with matched control countries. Possible content omissions in light of the progressing COVID-19 pandemic were assessed.ResultsGHSI scores for countries had strong criterion validity against the Joint External Evaluation ReadyScore (rho=0.82, p<0.0001), and moderate external validity against deaths from communicable diseases (−0.56, p<0.0001). GHSI scores were associated with reduced deaths from communicable diseases (F(3, 172)=22.75, p<0.0001). The proportion of deaths from communicable diseases decreased 4.8% per 10-point rise in GHSI. Recipient countries of the GHSA (n=31) and SARS-affected countries (n=26), had GHSI scores 6.0 (p=0.0011) and 8.2 (p=0.0010) points higher than matched controls, respectively. Biosecurity and biosafety appear weak globally including in high-income countries, and health systems, particularly in Africa, are not prepared. Notably, the GHSI does not account for all factors important for health security.ConclusionThe GHSI shows promise as a valid tool to guide action on biosafety, biosecurity and systems preparedness. However, countries need to look beyond existing metrics to other factors moderating the impact of future pandemics and other biothreats. Consideration of anthropogenic and large catastrophic scenarios is also needed.

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Ultra-Processed Food Consumption Among Chilean Preschoolers Is Associated With Diets Promoting Non-communicable Diseases

Frontiers in Nutrition ◽

10.3389/fnut.2021.601526 ◽

2021 ◽

Vol 8 ◽

Author(s):

C. Araya ◽

C. Corvalán ◽

G. Cediel ◽

L. S. Taillie ◽

M. Reyes

Keyword(s):

Total Energy ◽

Energy Intake ◽

Food Consumption ◽

Communicable Disease ◽

Primary Source ◽

Nutrient Composition ◽

Cross Sectional ◽

Total Sugars ◽

Adverse Health Outcomes ◽

Polyunsaturated Fats

Introduction: In adults, intake of ultra-processed foods (UPF) has been linked with poor diets and adverse health outcomes. In young children, evidence is scarcer but suggests a higher dietary share of UPF.Objective: To quantify the intake of UPF and its association with the nutrient composition of the diet in a sample of preschoolers in Santiago, Chile.Methods: Cross-sectional analysis of dietary data (24-h recall survey) from 960 preschoolers. Foods were categorized according to the extent and purpose of processing (NOVA classification) and participants were classified in quintiles of UPF intake. We explored the associations between UPF intake (% of the total energy) and intake of nutrients of concern for non-communicable disease development (carbohydrates, total sugars, fats, and sodium), and nutrients for promotion (proteins, polyunsaturated fats, iron, calcium, zinc, vitamins A, D, C, and B12, folate, and fiber) using multivariate regression after controlling for covariates.Results: UPF constituted 49% of the total energy intake. Preschoolers with higher intake consumed more energy, saturated and monounsaturated fats, carbohydrates, total sugars, and vitamin D, compared to preschoolers in the lowest quintile of UPF intake. In contrast, UPF intake was negatively associated with the consumption of proteins, polyunsaturated fats, fiber, zinc, vitamin A, and sodium (p < 0.05).Conclusion: In Chilean preschoolers, UPF was the primary source of energy intake. The dietary share of UPF was associated with the nutrient composition of the diet. Improving children's diet should consider not only promoting healthy food consumption but also limiting UPF consumption.

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