title: Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi.
abstract: BACKGROUND
  The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies. The programme includes population surveys of all people aged 18 years and above, linking individuals with newly diagnosed hypertension and diabetes to healthcare and supporting clinical services. The successes, challenges and lessons learnt from the programme to date are discussed.
  
  
  RESULTS
  Over 20,000 adults have been recruited in rural Karonga and urban Lilongwe. The urban population is significantly younger and wealthier than the rural population. Employed urban individuals, particularly males, give particular recruitment challenges; male participation rates were 80.3 % in the rural population and 43.6 % in urban, whilst female rates were 93.6 and 75.6 %, respectively. The study is generating high quality data on hypertension, diabetes, lipid abnormalities and risk factors.
  
  
  CONCLUSIONS
  It is feasible to develop large scale studies that can reliably inform the public health approach to diabetes, cardiovascular disease and other NCDs in Sub-Saharan Africa. It is essential for studies to capture both rural and urban populations to address disparities in risk factors, including age structure. Innovative approaches are needed to address the specific challenge of recruiting employed urban males.
authors.affiliation: Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Amelia Catharine
authors.initials: AC
authors.lastname: Crampin
authors.affiliation: Karonga Prevention Study, Karonga, Malawi.
authors.forename: Ndoliwe
authors.initials: N
authors.lastname: Kayuni
authors.affiliation: Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Amberbir
authors.affiliation: Karonga Prevention Study, Karonga, Malawi.
authors.forename: Crispin
authors.initials: C
authors.lastname: Musicha
authors.affiliation: Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Olivier
authors.initials: O
authors.lastname: Koole
authors.affiliation: Karonga Prevention Study, Karonga, Malawi.
authors.forename: Terence
authors.initials: T
authors.lastname: Tafatatha
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Branson
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saul
authors.affiliation: Karonga Prevention Study, Karonga, Malawi.
authors.forename: Elenaus
authors.initials: E
authors.lastname: Mwaiyeghele
authors.affiliation: Karonga Prevention Study, Karonga, Malawi.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Nkhwazi
authors.affiliation: Karonga Prevention Study, Karonga, Malawi.
authors.forename: Amos
authors.initials: A
authors.lastname: Phiri
authors.affiliation: Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Alison Jane
authors.initials: AJ
authors.lastname: Price
authors.affiliation: Malawi Ministry of Health, Lilongwe, Malawi.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mwagomba
authors.affiliation: Malawi Ministry of Health, Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Mwansambo
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.affiliation: Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Moffat Joha
authors.initials: MJ
authors.lastname: Nyirenda
keywords: Diabetes; Epidemiology; Hypertension; Methods; Non-communicable diseases; Sub-Saharan Africa
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