scholarly journals Prevalence and Risk Factors of Childhood Hypertension in Urban-Rural Areas of China: A Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-18
Author(s):  
Xiaohua Liang ◽  
Lun Xiao ◽  
Yetao Luo ◽  
Jiapei Xu
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Family Income ◽  
Gestational Hypertension ◽  
Primary School Children ◽  
Rural Children ◽  
Cell Counts ◽  
Increased Risk ◽  
Urban Rural ◽  
Childhood Hypertension

Objective. The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China. Methods. Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6∼12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model. Results. The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R2 values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively. Conclusions. The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension.

scholarly journals Subnational variation of stunting, wasting and malnutrition in Chinese primary-school children between 2010 and 2014: urban–rural disparity

2019 ◽  
Vol 22 (11) ◽  
pp. 2043-2054 ◽  
Author(s):  
Yanhui Dong ◽  
Kristina Bennett ◽  
Catherine Jan ◽  
Bin Dong ◽  
Zhiyong Zou ◽  
...  
Keyword(s):  
Primary School ◽  
School Children ◽  
Rural Areas ◽  
Mainland China ◽  
Urban Children ◽  
Primary School Children ◽  
Rural Children ◽  
Cross Sectional ◽  
Urban Rural ◽  
Childhood Stunting

AbstractObjectiveTo examine urban–rural disparity in childhood stunting, wasting and malnutrition at national and subnational levels in Chinese primary-school children in 2010 and 2014.DesignData were obtained from two nationwide cross-sectional surveys conducted in 2010 and 2014. Malnutrition was classified using the Chinese national ‘Screening Standard for Malnutrition of Children’.SettingAll twenty-seven mainland provinces and four municipalities of mainland China.ParticipantsChildren aged 7–12 years (n215 214; 107 741 in 2010 and 107 473 in 2014) from thirty-one provinces.ResultsStunting, wasting and malnutrition prevalence were 1·9, 12·3 and 13·7 % in 2010, but decreased to 1·0, 9·4 and 10·2 % in 2014, respectively. The prevalence of stunting, wasting and malnutrition in both urban and rural children was higher in western provinces, while lower in eastern provinces. Although the prevalence of wasting and malnutrition was higher in rural children than their urban counterparts, the urban–rural disparity in both wasting and malnutrition decreased from 2010 to 2014 (prevalence OR: wasting, 1·35 to 1·16; malnutrition, 1·50 to 1·27). A reversal occurred in 2014 in several eastern provinces where the prevalence of wasting and malnutrition in urban children surpassed their rural peers. The urban–rural disparity was larger in western provinces than eastern provinces.ConclusionsThe shrinking urban–rural disparity and the reversal in wasting and malnutrition suggest that the malnutrition situation has improved during the post-crisis period, especially in the western provinces. Region-specific policies and interventions can be useful to sustainably mitigate malnutrition in Chinese children, especially in rural areas and the western provinces.

scholarly journals Classification of stillbirth by relative condition at death (Re Co De) at various trimesters of pregnancy: a rural tertiary teaching hospital based study

2017 ◽  
Vol 6 (8) ◽  
pp. 3550 ◽  
Author(s):  
V. Meera Rajagopal ◽  
Kalpana Betha ◽  
Satya Priya G.
Keyword(s):  
Risk Factors ◽  
Teaching Hospital ◽  
Rural Areas ◽  
Gestational Hypertension ◽  
Economic Status ◽  
Mode Of Delivery ◽  
Middle Income ◽  
Low Middle Income Countries ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

Background: New global health figures show India to have the highest rates of stillbirth in the world. While maternal and under 5 child mortality rates have halved, stillbirth remains a neglected global endemic. To reduce stillbirths, the prevalence, risk factors and causes must be known. The aim of the present study is to know the prevalence and classify stillbirths by ReCoDe classification system at different trimesters of pregnancy.Methods: This was a retrospective study done between January 2013 to March 2017 at MediCiti Institute of Medical Sciences, a rural tertiary teaching hospital, Telangana, India. A total of 112 cases of stillbirths were included. Data was obtained on demographic variables, risk factors such as preeclampsia, etc. Data regarding mode of delivery, fetal asphyxia, were recorded.Results: Stillbirth rate was 12.1/1000 births. Fifty four percent of the women were unbooked. Preterm stillbirths were a majority (67%). The intra-partum still birth rate was low (15.1%) contrary to what is seen in low middle-income countries. Gestational hypertension/Pre-eclampsia, abruptio placenta, fetal growth restriction and oligohydramnios were the leading causes of stillbirths.Conclusions: Pregnant women from rural background with low socio-economic status are prone for stillbirths. As stillbirths were more among unbooked cases, the study highlights the importance of counselling, creating awareness in the rural areas regarding the importance of regular antenatal checkups. Identifying risk factors like pre-eclampsia, anemia etc., at early weeks will enable us to initiate appropriate strategies to improve pregnancy outcome.

scholarly journals Prevalence and risk factors of prolonged corrected QT interval in general Chinese population

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Qun Ma ◽  
Zhao Li ◽  
Xiaofan Guo ◽  
Liang Guo ◽  
Shasha Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Chinese Population ◽  
Liaoning Province ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Cvd Risk ◽  
Specific Risk ◽  
Increased Risk ◽  
General Chinese Population

Abstract Background Corrected QT (QTc) interval has been correlated with total and CVD mortality. Although much is known about the relation between prolonged QTc interval and clinical outcome, there is no information on the prevalence and specific risk factors of QTc prolongation in general Chinese population. We evaluated the prevalence of prolonged QTc interval and its risk factors in general Chinese population, aiming to fill in the gaps in the literature and provide evidence for potential CVD risk prediction and disease burden estimate in community. Methods A population-based survey was conducted on 11,209 participants over the age of 35 in rural areas of Liaoning Province from 2012 to 2013. Twelve-lead ECGs and automatic analysis were performed on all participants. Logistic regression adjustments were made by using the Bazett’s formula to correlate specific risk factors with prolonged QTc intervals (> 440 ms) for potential confounders. Results The overall prevalence of prolonged QTc interval was 31.6%. The prevalence increased significantly with age (24.1% among those aged 35–44 years; 28.3%, 45–54 years; 35.2%, 55–64 years; 43.4%, ≥65 years, P < 0.001). Participants with a history of CVD had a higher prevalence of QTc prolongation (40.7% vs. 30.0%). In the fully adjusted logistic regress model, older age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated independently with increased risk for prolonged QTc interval (All P < 0.05). We found no significant differences between general obesity, hypocalcemia and hypomagnesemia with prolongation of QTc interval. Female sex showed opposite results after applying clinical diagnostic criteria, and high physical activity could reduce the risk of prolonged QTc interval. Conclusions The prevalence of prolonged QTc interval was relatively high in general Chinese population and listed relevant factors, which would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies in community.

scholarly journals A spatial and temporal analysis of risk factors associated with sporadic Shiga toxin-producingEscherichia coliO157 infection in England between 2009 and 2015

2018 ◽  
Vol 146 (15) ◽  
pp. 1928-1939 ◽  
Author(s):  
Richard Elson ◽  
Katherine Grace ◽  
Roberto Vivancos ◽  
Claire Jenkins ◽  
Goutam K. Adak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Temporal Analysis ◽  
Water Supplies ◽  
Residential Proximity ◽  
Source Of Infection ◽  
Spatial And Temporal Analysis ◽  
Increased Risk ◽  
Animal Contact ◽  
Travel Abroad

AbstractInfection with STEC O157 is relatively rare but has potentially serious sequelae, particularly for children. Large outbreaks have prompted considerable efforts designed to reduce transmission primarily from food and direct animal contact. Despite these interventions, numbers of infections have remained constant for many years and the mechanisms leading to many sporadic infections remain unclear.Here, we show that two-thirds of all cases reported in England between 2009 and 2015 were sporadic. Crude rates of infection differed geographically and were highest in rural areas during the summer months. Living in rural areas with high densities of cattle, sheep or pigs and those served by private water supplies were associated with increased risk. Living in an area of lower deprivation contributed to increased risk but this appeared to be associated with reported travel abroad. Fresh water coverage and residential proximity to the coast were not risk factors.To reduce the overall burden of infection in England, interventions designed to reduce the number of sporadic infections with STEC should focus on the residents of rural areas with high densities of livestock and the effective management of non-municipal water supplies. The role of sheep as a reservoir and potential source of infection in humans should not be overlooked.

scholarly journals Socioeconomic gradients of adverse birth outcomes and related maternal factors in rural and urban Alberta, Canada: a concentration index approach

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033296 ◽  
Author(s):  
Maria Ospina ◽  
Álvaro Román Osornio-Vargas ◽  
Charlene C Nielsen ◽  
Susan Crawford ◽  
Manoj Kumar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Diabetes ◽  
Gestational Age ◽  
Rural Areas ◽  
Gestational Hypertension ◽  
Adverse Birth Outcomes ◽  
Maternal Risk Factors ◽  
Maternal Risk ◽  
Rural And Urban ◽  
Pregnancy Weight

ObjectiveUsing a summary measure of health inequalities, this study evaluated the distribution of adverse birth outcomes (ABO) and related maternal risk factors across area-level socioeconomic status (SES) gradients in urban and rural Alberta, Canada.DesignCross-sectional study using a validated perinatal clinical registry and an area-level SES.SettingThe study was conducted in Alberta, Canada. Data about ABO and related maternal risk factors were obtained from the Alberta Perinatal Health Program between 2006 and 2012. An area-level SES index derived from census data (2006) was linked to the postal code at delivery.ParticipantsWomen (n=3 30 957) having singleton live births with gestational age ≥22 weeks.Primary and secondary outcome measuresWe estimated concentration indexes to assess inequalities across SES gradients in both rural and urban areas (CIdxRand CIdxU, respectively) for spontaneous preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), gestational hypertension, gestational diabetes, smoking and substance use during pregnancy and pre-pregnancy weight >91 kg.ResultsThe highest health inequalities disfavouring low SES groups were identified for substance abuse and smoking in rural areas (CIdxR−0.38 and −0.23, respectively). Medium inequalities were identified for LGA (CIdxR−0.08), pre-pregnancy weight >91 kg (CIdxR−0.07), substance use (CIdxU−0.15), smoking (CIdxU−0.14), gestational diabetes (CIdxU−0.10) and SGA (CIdxU−0.07). Low inequalities were identified for PTB (CIdxR−0.05; CIdxU−0.05) and gestational diabetes (CIdxR−0.04). Inequalities disfavouring high SES groups were identified for gestational hypertension (CIdxR+0.04), SGA (CIdxR+0.03) and LGA (CIdxU+0.03).ConclusionsABO and related maternal risk factors were unequally distributed across the socioeconomic gradient in urban–rural settings, with the greatest concentrations in lower SES groups of rural areas. Future research is needed on underlying mechanisms driving SES gradients in perinatal health across the rural–urban spectrum.

scholarly journals Prioritizing Causal Risk Factors for Severe COVID-19: An Exhaustive Mendelian Randomization Study

2021 ◽  
Author(s):  
Yitang Sun ◽  
Jingqi Zhou ◽  
Kaixiong Ye
Keyword(s):  
Risk Factors ◽  
Fat Mass ◽  
Blood Cells ◽  
Drug Targets ◽  
Large Scale ◽  
Mendelian Randomization ◽  
White Blood Cells ◽  
Fat Free Mass ◽  
Cell Counts ◽  
Increased Risk

Abstract Identifying causal risk factors for severe coronavirus disease 2019 (COVID-19) is critical for its prevention and treatment. Many associated pre-existing conditions and biomarkers have been reported, but these observational associations suffer from confounding and reverse causation. Here, we perform a large-scale two-sample Mendelian randomization (MR) analysis to evaluate the causal roles of many traits in severe COVID-19. Our results highlight multiple body mass index (BMI)-related traits as risk-increasing: BMI (OR:1.89, 95% CI:1.51–2.37), hip circumference (OR:1.46, 1.15–1.85), and waist circumference (OR:1.82, 1.36–2.43). Our multivariable MR analysis further shows that the BMI-related effect is driven by fat mass (OR:1.63, 1.03–2.58), but not fat-free mass (OR:1.00, 0.61–1.66). Several white blood cell counts are negatively associated with severe COVID-19, including those of neutrophils (OR:0.76, 0.61–0.94), granulocytes (OR:0.75, 0.601–0.93), and myeloid white blood cells (OR:0.77, 0.62–0.96). Furthermore, some circulating proteins are associated with an increased risk of (e.g., zinc-alpha-2-glycoprotein) or protection from severe COVID-19 (e.g., interleukin-3/6 receptor subunit alpha). Our study shows that fat mass and white blood cells underlie the etiology of severe COVID-19. It also identifies risk and protective factors that could serve as drug targets and guide the effective protection of high-risk individuals.

scholarly journals The Urban-Rural Disparity in the Status and Risk Factors of Health Literacy: A Cross-Sectional Survey in Central China

2020 ◽  
Vol 17 (11) ◽  
pp. 3848 ◽  
Author(s):  
Wenna Wang ◽  
Yulin Zhang ◽  
Beilei Lin ◽  
Yongxia Mei ◽  
Zhiguang Ping ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Literacy ◽  
Rural Areas ◽  
Central China ◽  
Rural Populations ◽  
Cross Sectional ◽  
Basic Health ◽  
Significant Difference ◽  
The Status ◽  
Urban Rural

Health literacy is the ability of individuals to access, process, and understand health information to make decisions regarding treatment and their health on the whole; it is critical to maintain and improve public health. However, the health literacy of urban and rural populations in China has been little known. Thus, this study aims to assess the status of health literacy and explore the differences of its possible determinants (e.g., socio-economic factors) among urban and rural populations in Henan, China. A cross-sectional study, 78,646 participants were recruited from a populous province in central China with a multi-stage random sampling design. The Chinese Resident Health Literacy Scale was adopted to measure the health literacy of the respondents. In the participants, the level of health literacy (10.21%) in central China was significantly lower than the national average, and a big gap was identified between urban and rural populations (16.92% vs. 8.09%). A noticeable difference was reported in different aspects and health issues of health literacy between urban and rural populations. The health literacy level was lower in those with lower levels of education, and a significant difference was identified in the level of health literacy among people of different ages and occupations in both urban and rural areas. Note that in rural areas, as long as residents educated, they all had higher odds to exhibit basic health literacy than those uneducated; in rural areas, compared with those aged 15 to 24 years, residents aged 45 to 54 years (OR = 0.846,95% CI (0.730, 0.981)), 55 to 64 years (OR = 0.716,95% CI (0.614, 0.836)) and above 65 years (OR = 0.679, 95% CI (0.567, 0.812)) were 84.6%, 71.6%, and 67.9%, respectively, less likely to exhibit basic health literacy. Considering the lower health literacy among rural residents compared with their urban counterparts, a reorientation of the health policy-making for Chinese rural areas is recommended. This study suggests that urban–rural disparity about health literacy risk factors should be considered when implementing health literacy promotion intervention.

ASSOCIATION OF ANTHROPOGENIC AND BIOTIC FACTORS WITH THE RISK OF PEDIATRIC MULTIPLE SCLEROSIS

2020 ◽  
pp. 42-51
Author(s):  
Smagina I.V. ◽  
Elchaninova E.Y. ◽  
Raevskikh V.M.
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Rural Areas ◽  
Demyelinating Disease ◽  
Control Method ◽  
Medical Documentation ◽  
Biotic Factors ◽  
Oil Refineries ◽  
Altai Region ◽  
Increased Risk

Introduction. Multiple sclerosis – (MS) is a chronic autoimmune demyelinating disease of the central nervous system, the risk of which depends on a combination of genetic and environmental factors. The disease begins most often at the age of 30 to 50 years, but 3-10% of patients have MS debut in childhood. There are features of the clinical course, prognosis, and risk factors of pediatric MS (pediatric-onset MS). At the same time, environmental risk factors for MS are more significant in children than in adults. Objectives: to identify anthropogenic and biotic factors associated with an increased risk of pediatric MS in the Altai region of the Russian Federation. Patients and methods: 86 patients with pediatric MS and 86 volunteers without MS (aged 21.7±5.8 and 23.4±7.2 years, respectively; p=0.428), Caucasians, born and living in the Altai region took part in an observational epidemiological study using the case-control method. The questionnaire survey and analysis of personal medical documentation regarding potential risk factors for MS were completed. Results. Patients with pediatric MS make up 6.5% of all MS patients in the Altai region. The prevalence of pediatric MS is 2.1 times higher in cities than in rural areas. An increased risk of pediatric MS is associated with living within 5 km of chemical, oil refineries (OR 2.11; 95% CI 1.04-4.30; p=0.038), working on a computer for more than 5 hours a day (OR 11.91; 95% CI 2.65-53.55; p=0.001), having a history of herpes virus infection (OR 2.59; 95% CI 1.10-6.12; p=0.029), chicken pox (OR 2.14; 95% CI 1.15-3.96; p=0.015), chronic tonsillitis (OR 2.47; 95% CI 1.22-4.99; p=0.012), traumatic brain injury (OR 3.99; 95% CI 1.24-12.76; P=0.019). Conclusion. The identified risk factors can be the basis for recommendations for the prevention of MS in persons with high genetic risk of this disease, as well as planning prospective studies of risk factors of pediatric MS and mechanisms of their implementation.

Environmental factors explain socioeconomic prevalence differences in myopia in 6-year-old children

2017 ◽  
Vol 102 (2) ◽  
pp. 243-247 ◽  
Author(s):  
J Willem L Tideman ◽  
Jan Roelof Polling ◽  
Albert Hofman ◽  
Vincent WV Jaddoe ◽  
Johan P Mackenbach ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Environmental Factors ◽  
Maternal Education ◽  
Family Income ◽  
Risk Groups ◽  
Lifestyle Factors ◽  
Birth Cohort Study ◽  
Family Socioeconomic Status ◽  
Increased Risk

PurposeHigh myopia (≤−6 D) usually has its onset before 10 years of age and can lead to blinding complications later in life. We examined whether differences in myopia prevalences in socioeconomic risk groups could be explained by differences in lifestyle factors.MethodsA total of 5711 six-year-old children participating in the prospective population-based birth cohort study Generation R underwent a stepwise ophthalmic examination, which included visual acuity and objective cycloplegic refraction to identify children with myopia (≤−0.5D). Daily activities, ethnicity, factors representing family socioeconomic status and housing were ascertained by questionnaire. Risk assessments of myopia and mediation analyses were performed using logistic regression; attenuation of risks was calculated by bootstrapping.ResultsPrevalence of myopia was 2.4% (n=137). Myopic children spent more time indoors and less outdoors than non-myopic children (p<0.01), had lower vitamin D (p=0.01), had a higher body mass index and participated less in sports (p=0.03). Children of non-European descent (OR 2.60; 95% CI 1.84 to 3.68), low maternal education (OR 2.27; 95% CI 1.57 to 3.28) and low family income (OR 2.62; 95% CI 1.8 to 3.74) were more often myopic. Lifestyle factors explained the majority of the increased risk for ethnicity (82%; 95% CI 55 to 120), maternal education (69%; 95% CI 45 to 109) and family socioeconomic status (71%; 95% CI 46 to 104).ConclusionThis study found environmental factors to be strong risk factors for myopia already at the age of 6 years. The myopia prevalence differences in socioeconomic groups were greatly determined by differences in distribution of these environmental risk factors, highlighting the importance of lifestyle adjustments in young children developing myopia.

P6369Prevalence of severe hypertension in a sub-Saharan African community

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Gaye ◽  
A L Janeczek ◽  
X Jouven ◽  
D Luu ◽  
E Marijon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Rural Areas ◽  
Severe Hypertension ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Sub Saharan Africa ◽  
Global Health Initiative ◽  
Increased Risk ◽  
Sub Saharan

Abstract Background Individuals with SH have high 10-year risk of cardiovascular disease, especially when additional risk factors or target organ damage are present. Though some data from in-hospital or selected populations are available, there are no studies reporting community-level prevalence of Severe Hypertension (SH) in sub-Saharan Africa. Purpose Using a cross-sectional design in Abidjan (Ivory Coast), we assessed prevalence of Severe Hypertension among adults. Methods Study participants were recruited within the framework of The Heart Fund's global health initiative. Data were collected in August 2016 from 6 randomly selected sites, ensuring representativeness of both urban and rural areas. Blood pressure (BP) was measured twice, 10 minutes apart, after optimal resting time. Blood pressure measurement were standardized between sites and SH was defined as systolic blood pressure ≥180 and/or diastolic blood pressure ≥110 mmHg at both readings. Demographics and data on cardiovascular history/risk factors were collected in the field. Ethics approval for the study was obtained from the National Ethical Committee of Côte d'Ivoire and written informed consent was obtained from all adult patients. Results Among 1,785 subjects examined, 1,182 aged between 18 and 75 years were included in this analysis. The prevalence of SH was 14.1% (12.5% females vs 17.0% males; P=0.03) (Figure). Among participants with severe hypertension, 28.9% were either undiagnosed or untreated. Alarmingly, subjects at high cardiovascular risk (age ≥60 years and/or obese) had even higher prevalence of overall SH (29.6% and 24.9%, respectively) as well as undiagnosed/untreated SH (29.4% and 24.6%). SH prevalence was almost double in urban compared to rural areas (17.0% vs. 9.2%, P=0.02); however, conversely, undiagnosed/untreated SH was significantly higher in rural areas (50.4% vs 21.9%). Compared to normal bodyweight, those who were overweight and obese had a 1.95-fold (95% CI, 1.30–2.93; P<0.001)and 4.24-fold (95% CI, 2.68–6.74; P<0.001)increased odds of SH (adjusting for age and sex), respectively. Similarly, participants ≥60 years had a 6.04-fold (95% CI, 3.93–9.36; P<0.001)increased risk of undiagnosed SH compared to under 50 years. Finally, men had higher odds of SH compared to women (OR 1.71, 95% CI, 1.19–2.47; P=0.004). Figure 1 Conclusion(s) Our community-based study revealed very high prevalence of SH among adults in Abidjan area, with almost one out of every seven having SH. This underscores SH as a growing public health problemin sub-Saharan Africa.More concerning, a significant (almost one third) proportion of them were either undiagnosed or untreated.

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