title: High prevalence of hypertension and of risk factors for non-communicable diseases (NCDs): a population based cross-sectional survey of NCDS and HIV infection in Northwestern Tanzania and Southern Uganda.
abstract: BACKGROUND
  The burden of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa, but data available for intervention planning are inadequate. We determined the prevalence of selected NCDs and HIV infection, and NCD risk factors in northwestern Tanzania and southern Uganda.
  
  
  METHODS
  A population-based cross-sectional survey was conducted, enrolling households using multistage sampling with five strata per country (one municipality, two towns, two rural areas). Consenting adults (≥18 years) were interviewed using the WHO STEPS survey instrument, examined, and tested for HIV and diabetes mellitus (DM). Adjusting for survey design, we estimated population prevalences of hypertension, DM, obstructive pulmonary disease, cardiac failure, epilepsy and HIV, and investigated factors associated with hypertension using logistic regression.
  
  
  RESULTS
  Across strata, hypertension prevalence ranged from 16 % (95 % confidence interval (CI): 12 % to 22 %) to 17 % (CI: 14 % to 22 %) in Tanzania, and from 19 % (CI: 14 % to 26 %) to 26 % (CI: 23 % to 30 %) in Uganda. It was high in both urban and rural areas, affecting many young participants. The prevalence of DM (1 % to 4 %) and other NCDs was generally low. HIV prevalence ranged from 6 % to 10 % in Tanzania, and 6 % to 12 % in Uganda. Current smoking was reported by 12 % to 23 % of men in different strata, and 1 % to 3 % of women. Problem drinking (defined by Alcohol Use Disorder Identification Test criteria) affected 6 % to 15 % men and 1 % to 6 % women. Up to 46 % of participants were overweight, affecting women more than men and urban more than rural areas. Most patients with hypertension and other NCDs were unaware of their condition, and hypertension in treated patients was mostly uncontrolled. Hypertension was associated with older age, male sex, being divorced/widowed, lower education, higher BMI and, inversely, with smoking.
  
  
  CONCLUSIONS
  The high prevalence of NCD risk factors and unrecognized and untreated hypertension represent major problems. The low prevalence of DM and other preventable NCDs provides an opportunity for prevention. HIV prevalence was in line with national data. In Tanzania, Uganda and probably elsewhere in Africa, major efforts are needed to strengthen health services for the PREVENTION, early detection and treatment of chronic diseases.
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania. bazil.baltazar@mitu.or.tz.
authors.forename: Bazil
authors.initials: B
authors.lastname: Kavishe
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda. samuel.biraro@mrcuganda.org.
authors.forename: Samuel
authors.initials: S
authors.lastname: Biraro
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. kathy.baisley@lshtm.ac.uk.
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania. fiona.vanobberghen@lshtm.ac.uk.|MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. fiona.vanobberghen@lshtm.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Vanobberghen
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania. saidi.kapiga@lshtm.ac.uk.|MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. saidi.kapiga@lshtm.ac.uk.
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda. paula.munderi@mrcuganda.org.
authors.forename: Paula
authors.initials: P
authors.lastname: Munderi
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. liam.smeeth@lshtm.ac.uk.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: Weill Bugando School of Medicine, Mwanza, Tanzania. rnp2002@gmail.com.|Weill Cornell Medical College, New York, USA. rnp2002@gmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Peck
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania. janneth.mghamba@yahoo.com.
authors.forename: Janneth
authors.initials: J
authors.lastname: Mghamba
authors.affiliation: Ministry of Health, Kampala, Uganda. gnmutungi@yahoo.com.
authors.forename: Gerald
authors.initials: G
authors.lastname: Mutungi
authors.affiliation: Ministry of Health, Kampala, Uganda. ikoonae@yahoo.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Ikoona
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda. jonathan.levin@mrcuganda.org.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. jonathan.levin@mrcuganda.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Levin
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania. abm696@hotmail.com.
authors.forename: Maria Assumpció
authors.initials: MA
authors.lastname: Bou Monclús
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda. david.katende@mrcuganda.org.
authors.forename: David
authors.initials: D
authors.lastname: Katende
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania. edmund.kisanga@mitu.or.tz.
authors.forename: Edmund
authors.initials: E
authors.lastname: Kisanga
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. richard.hayes@lshtm.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Hayes
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. heiner.grosskurth@lshtm.ac.uk.
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D002908:Chronic Disease; D003141:Communicable Diseases; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology