title: Feasibility of a large cohort study in sub-Saharan Africa assessed through a four-country study.
abstract: BACKGROUND
  Large prospective epidemiologic studies are vital in determining disease etiology and forming national health policy. Yet, such studies do not exist in sub-Saharan Africa (SSA) notwithstanding the growing burden of chronic diseases.
  
  
  OBJECTIVE
  We explored the feasibility of establishing a large-scale multicountry prospective study at five sites in four sub-Saharan countries.
  
  
  METHODS
  Based on country-specific considerations of feasibility, Nigeria enrolled health care professionals, South Africa and Tanzania enrolled teachers, and Uganda enrolled village residents at one rural and one periurban site each. All sites used a 6-month follow-up period but different approaches for data collection, namely standardized questionnaires filled out by participants or face-to-face interviews.
  
  
  RESULTS
  We enrolled 1415 participants from five sites (range 200-489) with a median age of 41 years. Approximately half had access to clean-burning cooking fuel and 70% to piped drinking water, yet 92% had access to a mobile phone. The prevalence of chronic diseases was 49% among 45- to 54-year-olds and was dominated by hypertension (21.7% overall) - ranging from 4.5 to 31.2% across sites - and a serious injury in the past 12 months (12.4% overall). About 80% of participants indicated willingness to provide blood samples. At 6-month follow-up, 68% completed a questionnaire (45 to 96% across sites) with evidence that mobile phones were particularly useful.
  
  
  CONCLUSIONS
  Our pilot study indicates that a large-scale prospective study in SSA is feasible, and the burden of chronic disease in SSA may already be substantial necessitating urgent etiologic research and primary prevention.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; sdalal@hsph.harvard.edu.
authors.forename: Shona
authors.initials: S
authors.lastname: Dalal
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Holmes
authors.affiliation: Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Carien
authors.initials: C
authors.lastname: Laurence
authors.affiliation: Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Francis
authors.initials: F
authors.lastname: Bajunirwe
authors.affiliation: Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Marina
authors.initials: M
authors.lastname: Njelekela
authors.affiliation: Institute of Human Virology, Abuja, Nigeria.|Greenebaum Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Clement
authors.initials: C
authors.lastname: Adebamowo
authors.affiliation: Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda.
authors.forename: Joan
authors.initials: J
authors.lastname: Nankya-Mutyoba
authors.affiliation: Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Faraja S
authors.initials: FS
authors.lastname: Chiwanga
authors.affiliation: Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.|The South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Volmink
authors.affiliation: Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Ikeoluwapo
authors.initials: I
authors.lastname: Ajayi
authors.affiliation: Department of Medicine, Makerere School of Medicine, Kampala, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Kalyesubula
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Todd G
authors.initials: TG
authors.lastname: Reid
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Dockery
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hemenway
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D017677:Age Distribution; D002908:Chronic Disease / Q000453:epidemiology*; D016021:Epidemiologic Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Nigeria; South Africa; Tanzania; Uganda; chronic disease; injury; non-communicable