Browsing by Author "Kagura, Juliana"

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Different adiposity indices and their association with blood pressure and hypertension in middle-aged urban black South African men and women: findings from the AWI-GEN South African Soweto Site
(BioMed Central, 2018-04) Pisa, Pedro T.; Micklesfield, Lisa K.; Kagura, Juliana; Ramsay, Michele; Crowther, Nigel J.
Background: To report associations between different adiposity indices [anthropometric and dual-energy X-ray absorptiometry (DXA) measures] and blood pressure (BP) and hypertension in urban black South African adults. Methods: Anthropometric and DXA whole body measures were performed on 1026 men and 982 women. Participants were classified as being hypertensive if they had a systolic BP (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg. Within each gender the relationship of adiposity with BP and hypertension risk was assessed using linear and logistic regression models respectively. Bivariate models were computed for each body composition variable. Furthermore, we computed a multiple regression model to illustrates how body composition parameters are associated with the outcome variables independent of each other. Results: The males were significantly taller and had a higher fat free soft tissue mass (FFSTM), DBP and socio-economic status, and were more likely to use tobacco and be hypertensive (48.0% vs. 38.8%). The females had higher body mass index (BMI), waist circumference (WC), fat mass (FM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), FM/ FFSTM ratio and body fat % than males. All body composition parameters were positively associated with hypertension. In both males and females, the FM/FFSTM ratio associated the strongest with hypertension illustrating the following odds ratios [males: 70.37 (18.47, 268.16) p ≤ 0.001; females 2.48 (0.86,7.21) p = 0.09]. The multiple regression model, indicated that the VAT and WC significantly associated with both SBP and DBP in the men and women respectively, whilst WC was the only significant predictor for hypertension. Conclusions: All body composition parameters were associated with hypertension and FM/FFSTM ratio showed the strongest relationship. It was reassuring that WC remains a useful measure of central adiposity that can be used as a risk indicator for hypertension if more sophisticated measures are not available. Furthermore, our data in part, implies that reducing abdominal adiposity in aging adults could contribute to reducing the risk of elevated blood pressure and hypertension.
Early life factors associated with childhood trajectories of violence among the birth to twenty- plus cohort in Soweto, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Muchai, Lilian Njeri; Kagura, Juliana; Naicker, Sara
Introduction Violence against children has devastating and long-term negative consequences on individuals' and society's health, social and economic well-being. There is limited research on the life course experience of violence especially in Africa. This study aimed to identify sub-groups of physical & sexual violence victimization patterns separately in childhood, and evaluate early life factors predicting these violence trajectories. Methods This study used data from age 5 to 18 years from the ongoing prospective Birth to Twenty Plus cohort (Bt20+). Children within the Bt20+ cohort with data on physical and sexual violence in at least 2-time points between 5 and 18 years were included in the analyses. Group-based trajectory modelling was employed to identify groups of children with similar patterns of violence over time. Descriptive statistics was used to summarize study variables by violence trajectory group membership, while multivariable logistic regression was used to identify early life factors measured between birth and 5 years, associated with violence trajectory group membership. Results Two trajectory groups were identified for both physical and sexual violence victimization. For physical violence victimization, the majority of participants fell into the adolescent limited group (65.1%) and just over a third (34.9%) of the children were in the chronic increasing group. For sexual violence victimization, most participants fell into the adolescent limited group (74.1%, with a quarter in the late increasing (25.9%) group. Early life factors associated with a higher risk of chronic increasing physical violence victimization trajectory group membership, after adjusting for covariates, were being male (aOR 1.67, 95% CI 1.31; 2.10) and having a mother with at least secondary education compared to higher education (aOR 1.73, 95% CI 1.08; 2.76). In addition, residing in middle, compared to low, socioeconomic households (aOR 0.68, 95% CI 0.50; 0.92) was protective against membership in this group. Residing in high compared to low socioeconomic households, was the only early life factor with marginally significant (aOR 0.63, 95% CI 0.42; 0.95) association with membership in the late-increasing sexual violence victimization trajectory group, with those in better-off households less likely to experience sexual violence victimization with this pattern. Conclusion Children within the same community can follow different patterns of both physical and sexual violence victimization across childhood. Identification of early factors that predict membership to sub-groups of violence trajectories provides key violence prevention intervention points that can preempt or mitigate children’s exposure or experience of violence. Future research should explore a larger variety of early life factors proximal to the child as well as those more distal at the community and school levels
Factors associated with extreme nonadherence to tb treatment among adult defaulters attending Gqeberha clinic between 2018 and 2019
(University of the Witwatersrand, Johannesburg, 2024) Chipise, Elisha; Kagura, Juliana; Tshuma, Ndumiso
Background Tuberculosis remains a significant public health problem in sub-Saharan Africa leading to high morbidity, mortality, social and economic implications. Tuberculosis is a curable condition that can be eliminated. However, global efforts towards ending TB are under threat from patients’ nonadherence to effective TB treatment. This study aimed to determine the prevalence and factors associated with extreme nonadherence to TB treatment among adult defaulters attending Gqeberha clinic in South Africa. Methods The study is a secondary data analysis of a cross sectional study on TB defaulters attending Gqeberha clinic. The analysis included 144 participants with minimum age of 18 years who had defaulted treatment between April 2018 and September 2019. TB nonadherence and study characteristics were described using frequencies and percentages. Extreme nonadherence was defined by an aggregate score of at least 4 based on the Morisky Medication Adherence 8-item scale (MMA8). The prevalence of extreme nonadherence was estimated using percentage frequencies while univariable and multivariable logistic regression modelling were performed to identify the factors associated with extreme nonadherence. Results There were 18(12.9%) TB defaulters who had extreme nonadherence. The majority of TB defaulters 65.2% (n=90) were men. All participants involved had a minimum age of 18 years. 73.4% (n =102) of the study participants stayed in formal dwellings, 79.1% (n =110) were unemployed, 68.8% (n =95) had not attained matric level qualification and 78.4% (n =109) were either single, divorced or separated. A larger proportion of participants, 79.9% (n =111) stayed within 5km radius of Gqeberha clinic, 65.5% (n =91) experienced shorter waiting times and 84.2% (n =117) acknowledged constant availability of medicines at the health facility. However, 69.1% (n =96) did not have a family member who encouraged them to attend clinic visits, 64% (n =89) lacked adequate food whilst taking medication, and 80.6% (n=112) had inadequate income to cover their basic needs whilst on treatment. After adjusting for covariates, those who took other medication besides TB treatment had 0.33 times odds (95% CI: 0.11-0.97) of extreme nonadherence compared to their contrasting peers. All the other factors were not significant in the adjusted model. Conclusion The prevalence of extreme nonadherence to TB treatment among adult defaulters was low. The participants involved in the study were from low-income families with the majority being unemployed, having low educational attainment and lacking adequate food during treatment course. The use of multiple drugs was significantly associated with lower odds of extreme nonadherence. There is need to intensify programs aimed at improving adherence to treatment if the end TB by 2035 goal is to be realized.
Factors associated with vector control for onchocerciasis control in sub-Saharan Africa (2000 – 2023) : a systematic review
(University of the Witwatersrand, Johannesburg, 2024) Ngbede, Daniel; Kagura, Juliana; Mall, Sumaya
Background: Onchocerciasis is a neglected tropical disease and the second most common infectious cause of blindness worldwide, after trachoma. The vector which carries this parasite is a blackfly from the simulium genus, the parasite is transmitted to humans through the bite of an infected black fly during a blood meal. Alternative control strategies such as local vector control have been employed to complement the mass administration of ivermectin. There remains no synthesis of studies that have examined the use of vector control for onchocerciasis in the Sub- Saharan African (SSA) region. Objective: To examine the factors associated with vector control in the fight against onchocerciasis in Sub-Saharan Africa as through synthesis of the literature. Methods: A systematic search was conducted of the Cochrane Library, PubMed, Web of Science, and Scopus databases to identify relevant studies. Studies had to be published in peer-reviewed journals between January 2000 and March 2023. Data were extracted from the studies. Two independent reviewers conducted quality assessments using the Joanna Briggs Institute (JBI) critical appraisal checklist. Results: Our search identified 343 studies of which 19 were included in this review. Several factors were found to influence blackfly vector control programs. Programmatic factors include intervention duration and effectiveness, implementation challenges, resource availability, and larvicide application practices. Vector-related factors include blackfly susceptibility to larvicides, species variation, and genetic mechanisms of resistance. Environmental factors such as rainfall patterns, river size, and the presence of dams affect blackfly breeding sites. Human-related factors encompassed community knowledge and engagement, commitment to sustainability, and human activities that impacted breeding habitats. Overall, the quality of the included studies was found to be high as per the quality appraisal tool. Conclusion: This systematic review emphasizes the importance of considering multiple factors in the design and implementation of effective blackfly vector control programs for onchocerciasis in sub-Saharan Africa. Programmatic challenges, vector biology, environmental factors, and human factors should be considered. Policymakers and public health practitioners should optimize interventions based on these findings
Genetic risk score for adult body mass index associations with childhood and adolescent weight gain in an African population
(BioMed Central, 2018-08) Munthali, Richard J.; Sahibdeen, Venesa; Kagura, Juliana; Hendry, Liesl M.; Norris, Shane A.; Ong, Ken K.; Lombard, Zané; Day, Felix R.
Background: Ninety-seven independent single nucleotide polymorphisms (SNPs) are robustly associated with adult body mass index (BMI kg/m2) in Caucasian populations. The relevance of such variants in African populations at different stages of the life course (such as childhood) is unclear. We tested whether a genetic risk score composed of the aforementioned SNPs was associated with BMI from infancy to early adulthood. We further tested whether this genetic effect was mediated by conditional weight gain at different growth periods. We used data from the Birth to Twenty Plus Cohort (Bt20+), for 971 urban South African black children from birth to 18 years. DNA was collected at 13 years old and was genotyped using the Metabochip (Illumina) array. The weighted genetic risk score (wGRS) for BMI was constructed based on 71 of the 97 previously reported SNPs. Results: The cross-sectional association between the wGRS and BMI strengthened with age from 5 to 18 years. The significant associations were observed from 11 to 18 years, and peak effect sizes were observed at 13 and 14 years of age. Results from the linear mixed effects models showed significant interactions between the wGRS and age on longitudinal BMI but no such interactions were observed in sex and the wGRS. A higher wGRS was associated with an increased relative risk of belonging to the early onset obese longitudinal BMI trajectory (relative risk = 1.88; 95%CI 1.28 to 2.76) compared to belonging to a normal longitudinal BMI trajectory. Adolescent conditional relative weight gain had a suggestive mediation effect of 56% on the association between wGRS and obesity risk at 18 years. Conclusions: The results suggest that genetic susceptibility to higher adult BMI can be tracked from childhood in this African population. This supports the notion that prevention of adult obesity should begin early in life. The genetic risk score combined with other non-genetic risk factors, such as BMI trajectory membership in our case, has the potential to be used to screen for early identification of individuals at increased risk of obesity and other related NCD risk factors in order to reduce the adverse health risk outcomes later.
Impact of early growth on blood pressure from childhood to adulthood: birth-twenty cohort
(2016) Kagura, Juliana
Background Childhood hypertension is of great concern parallel to the obesity epidemic and early manifestation of antecedents of primary hypertension like arteriosclerosis. Patterns of early growth are associated with spiraling rates of raised blood pressure (BP) in paediatric populations. However, not much is known about early growth and its effect on BP from childhood to early adulthood. This study hypothesizes early life growth is associated with BP from childhood to adulthood. Methods Data for this study came from a sample of black children from the Birth to Twenty cohort study of children born in Soweto, Johannesburg in 1990. Firstly, persistence of elevated BP between ages 5 and 18 was estimated from sex, anthropometry and BP measurements. Secondly, the association between socio-economic status (SES) change between infancy and adolescence computed from physical household assets and BP at 18 years of age was evaluated using multivariable analyses. Finally, longitudinal BP trajectories were identified using group-based trajectory modeling and multinomial models were used to assess the association of BW, RWG and RHG, and BP trajectories adjusted for several covariates. Results The prevalence of hypertension ranged between 8.4 to 24.4% and risk of maintaining the elevated BP status was almost 2-fold between ages 5 and 18 years: RRR: 1.60(95%CI: 1.29- 2.00). An upward social mobility was associated with a 5mmHg reduction in SBP (β: -4.85, 95%CI: - 8.22 - -1.48). Three distinct early patterns of BP development called trajectory groups were identified for SBP and diastolic BP (DBP) for each sex; namely: “lower”, “middle” and “upper.” A kilogram increase in birth weight (BW) reduced the odds of being in the middle compared to lower SBP trajectory (OR: 0.75, 95%CI: 0.58-0.96), while RWG in infancy was associated with a 4-fold increased odds of being in the upper vs lower SBP trajectory for boys (OR: 4.11, 95%CI: 1.25-13.51). In girls, relative weight gain (RWG) (OR: 1.63, 95%CI: 1.08-2.46; 1.77(1.22-2.56)) and relative height gain (RHG) (OR: 1.90, 95%CI: 1.27-2.86; 2.12(1.39-3.23)) in infancy and mid-childhood was associated with almost 2-fold increase in odds of being in the upper vs lower trajectory. The middle SBP trajectory in girls was predicted by RWG (OR: 1.33, 95%CI: 1.00-1.76) and RHG (OR: 1.58, 95%CI: 1.15-2.17) in infancy. DBP trajectories were significantly but inconsistently associated with RWG and RHG for boys and RWG in mid-childhood and infancy in girls for the middle and upper trajectories. Conclusions Distinct BP trajectories are established in childhood and persist into early adulthood. Improving SES throughout childhood may have a protective effect on BP. Policy recommendations around early identification of children with elevated BP accompanied by interventions targeted at optimal growth and interrupting the atypical BP trajectories may reduce the burden of disease attributed to hypertension, especially in girls.
Trend of Pre-antiretroviral Therapy HIV-1 Drug Resistance in Kilombero and Ulanga Antiretroviral Cohort, South-Western Tanzania, for over 15 years (2005-2020)
(University of the Witwatersrand, Johannesburg, 2024) Ntamatungiro, Alex; Kagura, Juliana
Introduction Pre-treatment HIV drug-resistance (PDR) may result in increased risk of virological failure and subsequently acquisition of new HIV drug resistant mutations. With recent increase in antiretroviral therapy (ART) coverage and periodic modifications of the guidelines for HIV treatment, monitoring changes in levels of PDR is critical, particularly in under-sampled areas, such as rural Tanzania. This PhD project aimed to determine the trend and patterns of PDR in the Kilombero and Ulanga antiretroviral cohort (KIULARCO), analyse the impact of recent HIV-1 infection, and dolutegravir rollout in rural Tanzania. Methods The study comprised a systematic review and meta-analysis of primary studies about prevalence of PDR among ART-naive people living with HIV (PLHIV) (³15 years old), published between 2017 and 2022. The data had to be in one or several of the countries of Eastern Africa, namely, Ethiopia, Kenya, Malawi, Rwanda, Mozambique, Tanzania, and Uganda. Thereafter, cross- sectional analyses of data on newly HIV-1-diagnosed ART-naïve adults (aged ≥ 15 years), enrolled in the on-going prospective clinic-based observational rural antiretroviral cohort- KIULARCO focusing on various aspects of PDR. Multivariate logistic regressions were used to determine the factors associated with recent HIV-1 infection, and viral suppression at 12-months in patients initiating dolutegravir-based ART in the KIULARCO. Results Overall, the pooled prevalence estimate of any PDR was 10.0% (95% CI: 7.9%–12.0%, I2 =88.9%) among 22 studies in the general adults’ population, which was higher than the previously reported prevalence of 8.7% using data available until 2016 in the Eastern Africa region. PDR was mainly driven by non-nucleoside reverse transcriptase inhibitors (NNRTI); whereas the pooled prevalence of PDR to nucleoside reverse transcriptase inhibitors (NRTI) was 2.6% (95% CI: 1.8%–3.4%, I2=69.2%). Remarkably, PDR to NRTIs in a sub-population of recently HIV-1 infected PLHIV in the KIULARCO was high at 12.5%. Also, there was a notable tendency to an increasing prevalence of PDR to NRTI, with the overall prevalence of 2.1% in the first five-year period (2005-2009) of the ART program in Tanzania, and 3.4 % in the most recent period (2019-2022). Moreover, there was no PDR to the dolutegravir co-administered NRTI in those with viremia ≥50 copies/mL, at one year, in patients initiating dolutegravir-based ART in the KIULARCO 2 years after dolutegravir roll. Notably, dolutegravir-based ART was associated with >2 times the odds of viral suppression compared to NNRTI-based ART with an adjusted odds ratio (aOR) of 2.10 (95% CI 1.12-3.94). Conclusions There is notable level of PDR to NRTI among general adults’ population in Eastern Africa region, that was high among recently HIV-1 infected PLHIV in a representative rural Sub-Saharan Africa setting. Hence, routine surveillance of pre-existing resistance to the DTG co-administered NRTI remains particularly important, in resource-limited settings, to prevent risk of failure of newer antiretroviral agents such as dolutegravir, which would be detrimental to Tanzania and other low- and middle-income countries for the aim to “end AIDS by 2030”. Our results underline the benefit of programmatic uptake of dolutegravir -based ART in low- and middle-income countries.