Publications

" Our main objective is to develop and maintain over time a good expertise and infrastructure ensuring high quality training and clinical research."
Prof Halidou TINTO, PharmD, Msc, PhD Head of the CRUN

2023
Journal Articles
	Lisa K. Micklesfield, Richard Munthali, Godfred Agongo, Gershim Asiki, Palwende Boua, Solomon S. R. Choma, Nigel J. Crowther, June Fabian, Francesc Xavier Gómez-Olivé, Chodziwadziwa Kabudula, Eric Maimela, Shukri F. Mohamed, Engelbert A. Nonterah, Frederick J. Raal, Hermann Sorgho, Furahini D. Tluway, Alisha N. Wade, Shane A. Norris, Michele Ramsay Identifying the prevalence and correlates of multimorbidity in middle-aged men and women: a cross-sectional population-based study in four African countries Journal Article In: BMJ open, vol. 13, iss. 3, 2023, ISSN: 2044-6055. Abstract \| BibTeX \| Tags: {Adult, Africa South of the Sahara / epidemiology, CollabAuthor(name='as members of AWI-Gen and the H3Africa Consortium', Cross-Sectional Studies, Dyslipidemias* / epidemiology, Extramural, Female, HIV Infections, Humans, Hypertension / epidemiology, Lisa K Micklesfield, Male, MEDLINE, Middle Aged, Multimorbidity, N.I.H., National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, Non-U.S. Gov't, PMC10016250, Prevalence, PubMed Abstract, Research Support, Richard Munthali, Risk Factors, Sex Factors \| Links: Close Close @article{Micklesfield2023, title = {Identifying the prevalence and correlates of multimorbidity in middle-aged men and women: a cross-sectional population-based study in four African countries}, author = {Lisa K. Micklesfield and Richard Munthali and Godfred Agongo and Gershim Asiki and Palwende Boua and Solomon S. R. Choma and Nigel J. Crowther and June Fabian and Francesc Xavier G\'{o}mez-Oliv\'{e} and Chodziwadziwa Kabudula and Eric Maimela and Shukri F. Mohamed and Engelbert A. Nonterah and Frederick J. Raal and Hermann Sorgho and Furahini D. Tluway and Alisha N. Wade and Shane A. Norris and Michele Ramsay}, url = {https://pubmed.ncbi.nlm.nih.gov/36918238/}, doi = {10.1136/BMJOPEN-2022-067788}, issn = {2044-6055}, year = {2023}, date = {2023-01-01}, journal = {BMJ open}, volume = {13}, issue = {3}, publisher = {BMJ Open}, abstract = {Objectives To determine the prevalence of multimorbidity, to identify which chronic conditions cluster together and to identify factors associated with a greater risk for multimorbidity in sub-Saharan Africa (SSA). Design Cross-sectional, multicentre, population-based study. Setting Six urban and rural communities in four sub-Saharan African countries. Participants Men (n=4808) and women (n=5892) between the ages of 40 and 60 years from the AWI-Gen study. Measures Sociodemographic and anthropometric data, and multimorbidity as defined by the presence of two or more of the following conditions: HIV infection, cardiovascular disease, chronic kidney disease, asthma, diabetes, dyslipidaemia, hypertension. Results Multimorbidity prevalence was higher in women compared with men (47.2% vs 35%), and higher in South African men and women compared with their East and West African counterparts. The most common disease combination at all sites was dyslipidaemia and hypertension, with this combination being more prevalent in South African women than any single disease (25% vs 21.6%). Age and body mass index were associated with a higher risk of multimorbidity in men and women; however, lifestyle correlates such as smoking and physical activity were different between the sexes. Conclusions The high prevalence of multimorbidity in middle-aged adults in SSA is of concern, with women currently at higher risk. This prevalence is expected to increase in men, as well as in the East and West African region with the ongoing epidemiological transition. Identifying common disease clusters and correlates of multimorbidity is critical to providing effective interventions.}, keywords = {{Adult, Africa South of the Sahara / epidemiology, CollabAuthor(name='as members of AWI-Gen and the H3Africa Consortium', Cross-Sectional Studies, Dyslipidemias* / epidemiology, Extramural, Female, HIV Infections, Humans, Hypertension / epidemiology, Lisa K Micklesfield, Male, MEDLINE, Middle Aged, Multimorbidity, N.I.H., National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, Non-U.S. Gov't, PMC10016250, Prevalence, PubMed Abstract, Research Support, Richard Munthali, Risk Factors, Sex Factors}, pubstate = {published}, tppubtype = {article} } Close Objectives To determine the prevalence of multimorbidity, to identify which chronic conditions cluster together and to identify factors associated with a greater risk for multimorbidity in sub-Saharan Africa (SSA). Design Cross-sectional, multicentre, population-based study. Setting Six urban and rural communities in four sub-Saharan African countries. Participants Men (n=4808) and women (n=5892) between the ages of 40 and 60 years from the AWI-Gen study. Measures Sociodemographic and anthropometric data, and multimorbidity as defined by the presence of two or more of the following conditions: HIV infection, cardiovascular disease, chronic kidney disease, asthma, diabetes, dyslipidaemia, hypertension. Results Multimorbidity prevalence was higher in women compared with men (47.2% vs 35%), and higher in South African men and women compared with their East and West African counterparts. The most common disease combination at all sites was dyslipidaemia and hypertension, with this combination being more prevalent in South African women than any single disease (25% vs 21.6%). Age and body mass index were associated with a higher risk of multimorbidity in men and women; however, lifestyle correlates such as smoking and physical activity were different between the sexes. Conclusions The high prevalence of multimorbidity in middle-aged adults in SSA is of concern, with women currently at higher risk. This prevalence is expected to increase in men, as well as in the East and West African region with the ongoing epidemiological transition. Identifying common disease clusters and correlates of multimorbidity is critical to providing effective interventions. Close
	Alisha N. Wade, Innocent Maposa, Godfred Agongo, Gershim Asiki, Palwende Boua, Solomon S. R. Choma, F. Xavier Gómez-Olivé, Eric Maimela, Lisa K. Micklesfield, Shukri F. Mohamed, Engelbert A. Nonterah, Shane A. Norris, Hermann Sorgho, Michele Ramsay, Nigel J. Crowther Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study Journal Article In: BMJ open, vol. 13, iss. 4, 2023, ISSN: 2044-6055. Abstract \| BibTeX \| Tags: {Adult, Africa South of the Sahara / epidemiology, Alisha N Wade, Blood Glucose, CollabAuthor(name='AWIGen and the H3Africa Consortium', Cross-Sectional Studies, Diabetes Mellitus* / epidemiology, Diabetes Mellitus* / therapy, Extramural, Humans, Hypertension* / epidemiology, Innocent Maposa, MEDLINE, Middle Aged, N.I.H., National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, PMC10151877, Prevalence, PubMed Abstract, Research Support \| Links: Close Close @article{Wade2023, title = {Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study}, author = {Alisha N. Wade and Innocent Maposa and Godfred Agongo and Gershim Asiki and Palwende Boua and Solomon S. R. Choma and F. Xavier G\'{o}mez-Oliv\'{e} and Eric Maimela and Lisa K. Micklesfield and Shukri F. Mohamed and Engelbert A. Nonterah and Shane A. Norris and Hermann Sorgho and Michele Ramsay and Nigel J. Crowther}, url = {https://pubmed.ncbi.nlm.nih.gov/37105688/}, doi = {10.1136/BMJOPEN-2022-069193}, issn = {2044-6055}, year = {2023}, date = {2023-01-01}, journal = {BMJ open}, volume = {13}, issue = {4}, publisher = {BMJ Open}, abstract = {Objectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention. Design Cross-sectional study. Setting Community-based study in four sub-Saharan African countries. Participants 10 700 individuals, aged 40-60 years. Primary and secondary outcome measures The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG \<7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis. Results Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes. Conclusions There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes.}, keywords = {{Adult, Africa South of the Sahara / epidemiology, Alisha N Wade, Blood Glucose, CollabAuthor(name='AWIGen and the H3Africa Consortium', Cross-Sectional Studies, Diabetes Mellitus* / epidemiology, Diabetes Mellitus* / therapy, Extramural, Humans, Hypertension* / epidemiology, Innocent Maposa, MEDLINE, Middle Aged, N.I.H., National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, PMC10151877, Prevalence, PubMed Abstract, Research Support}, pubstate = {published}, tppubtype = {article} } Close Objectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention. Design Cross-sectional study. Setting Community-based study in four sub-Saharan African countries. Participants 10 700 individuals, aged 40-60 years. Primary and secondary outcome measures The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis. Results Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes. Conclusions There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes. Close
	Holger W. Unger, Anastasia Jessica Hadiprodjo, Julie R. Gutman, Valerie Briand, Nadine Fievet, Innocent Valea, Halidou Tinto, Umberto D’Alessandro, Sarah H. Landis, Feiko Ter Kuile, Peter Ouma, Martina Oneko, Victor Mwapasa, Laurence Slutsker, Dianne J. Terlouw, Simon Kariuki, John Ayisi, Bernard Nahlen, Meghna Desai, Mwayi Madanitsa, Linda Kalilani-Phiri, Per Ashorn, Kenneth Maleta, Antoinette Tshefu-Kitoto, Ivo Mueller, Danielle Stanisic, Jordan Cates, Anna Maria Van Eijk, Maria Ome-Kaius, Elizabeth H. Aitken, Stephen J. Rogerson Fetal sex and risk of pregnancy-associated malaria in Plasmodium falciparum-endemic regions: a meta-analysis Journal Article In: Scientific reports, vol. 13, iss. 1, 2023, ISSN: 2045-2322. Abstract \| BibTeX \| Tags: Anastasia Jessica Hadiprodjo, doi:10.1038/s41598-023-37431-3, Extramural, Falciparum* / complications, Falciparum* / epidemiology, Female, Holger W Unger, Humans, Infant, Low Birth Weight, Malaria, Malaria* / complications, Malaria* / epidemiology, MEDLINE, Meta-Analysis, N.I.H., National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, Newborn, NIH, NLM, Non-U.S. Gov't, placenta, Plasmodium falciparum, PMC10293221, pmid:37365258, Pregnancy, PubMed Abstract, Research Support, Stephen J Rogerson, Stillbirth \| Links: Close Close @article{Unger2023, title = {Fetal sex and risk of pregnancy-associated malaria in Plasmodium falciparum-endemic regions: a meta-analysis}, author = {Holger W. Unger and Anastasia Jessica Hadiprodjo and Julie R. Gutman and Valerie Briand and Nadine Fievet and Innocent Valea and Halidou Tinto and Umberto D’Alessandro and Sarah H. Landis and Feiko Ter Kuile and Peter Ouma and Martina Oneko and Victor Mwapasa and Laurence Slutsker and Dianne J. Terlouw and Simon Kariuki and John Ayisi and Bernard Nahlen and Meghna Desai and Mwayi Madanitsa and Linda Kalilani-Phiri and Per Ashorn and Kenneth Maleta and Antoinette Tshefu-Kitoto and Ivo Mueller and Danielle Stanisic and Jordan Cates and Anna Maria Van Eijk and Maria Ome-Kaius and Elizabeth H. Aitken and Stephen J. Rogerson}, url = {https://pubmed.ncbi.nlm.nih.gov/37365258/}, doi = {10.1038/S41598-023-37431-3}, issn = {2045-2322}, year = {2023}, date = {2023-01-01}, journal = {Scientific reports}, volume = {13}, issue = {1}, publisher = {Sci Rep}, abstract = {In areas of moderate to intense Plasmodium falciparum transmission, malaria in pregnancy remains a significant cause of low birth weight, stillbirth, and severe anaemia. Previously, fetal sex has been identified to modify the risks of maternal asthma, pre-eclampsia, and gestational diabetes. One study demonstrated increased risk of placental malaria in women carrying a female fetus. We investigated the association between fetal sex and malaria in pregnancy in 11 pregnancy studies conducted in sub-Saharan African countries and Papua New Guinea through meta-analysis using log binomial regression fitted to a random-effects model. Malaria infection during pregnancy and delivery was assessed using light microscopy, polymerase chain reaction, and histology. Five studies were observational studies and six were randomised controlled trials. Studies varied in terms of gravidity, gestational age at antenatal enrolment and bed net use. Presence of a female fetus was associated with malaria infection at enrolment by light microscopy (risk ratio 1.14 [95% confidence interval 1.04, 1.24]; P = 0.003; n = 11,729). Fetal sex did not associate with malaria infection when other time points or diagnostic methods were used. There is limited evidence that fetal sex influences the risk of malaria infection in pregnancy.}, keywords = {Anastasia Jessica Hadiprodjo, doi:10.1038/s41598-023-37431-3, Extramural, Falciparum* / complications, Falciparum* / epidemiology, Female, Holger W Unger, Humans, Infant, Low Birth Weight, Malaria, Malaria* / complications, Malaria* / epidemiology, MEDLINE, Meta-Analysis, N.I.H., National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, Newborn, NIH, NLM, Non-U.S. Gov't, placenta, Plasmodium falciparum, PMC10293221, pmid:37365258, Pregnancy, PubMed Abstract, Research Support, Stephen J Rogerson, Stillbirth}, pubstate = {published}, tppubtype = {article} } Close In areas of moderate to intense Plasmodium falciparum transmission, malaria in pregnancy remains a significant cause of low birth weight, stillbirth, and severe anaemia. Previously, fetal sex has been identified to modify the risks of maternal asthma, pre-eclampsia, and gestational diabetes. One study demonstrated increased risk of placental malaria in women carrying a female fetus. We investigated the association between fetal sex and malaria in pregnancy in 11 pregnancy studies conducted in sub-Saharan African countries and Papua New Guinea through meta-analysis using log binomial regression fitted to a random-effects model. Malaria infection during pregnancy and delivery was assessed using light microscopy, polymerase chain reaction, and histology. Five studies were observational studies and six were randomised controlled trials. Studies varied in terms of gravidity, gestational age at antenatal enrolment and bed net use. Presence of a female fetus was associated with malaria infection at enrolment by light microscopy (risk ratio 1.14 [95% confidence interval 1.04, 1.24]; P = 0.003; n = 11,729). Fetal sex did not associate with malaria infection when other time points or diagnostic methods were used. There is limited evidence that fetal sex influences the risk of malaria infection in pregnancy. Close