Metabolic Syndrome: Epidemiology and Sociocultural Contexts, among People Living with HIV, in Gedeo Zone, Southern Ethiopia.
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Date
2021-04
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Background: following an intensive global operation of antiretroviral therapy (ART), the
worldwide morbidity and mortality from infectious diseases have occupied a backseat. Instead, a
non-communicable diseases (NCDs) risk marker called metabolic syndrome (MS) has emerged.
MS is risk factors for cardiovascular disease that has public health issue, which places social,
economic, and disease conditions on the community within the geographical region of subSaharan
Africa,
including
Ethiopia.
Litreatures
have
shown that
human
immunodeficiency
virus
(HIV)
infected
patients
on
ART
have
a
2-fold
risk
of
dying
from
MS.
There
are
no
such
studies
in
Gedeo
zone,
southern
Ethiopia;
hence
the need
for
this
study
to fill
this
gap.
Objective:
To assess the epidemiology and the socio-cultural contexts of metabolic syndrome
among people living with HIV (PLHIVs), in the Gedeo Zone, Southern Ethiopia.
Methods: This dissertation was conducted in the randomly selected two hospitals and health
centers. A mixed approach was used to address the objectives of this dissertation. To estimate
and compare the magnitude of overall MS among the two comparative groups, a comparative
cross-sectional design was employed among the randomly chosen PLHIVs from two hospitals
and two health centers, exist in the Gedeo zone, southern-Ethiopia (Paper I). The data collection
for this study was run beginning from December 29
th
, 2017 up to January 22
nd
− 2019, using the
WHO steep tool. Ultimately, the completed data was entered into Epidata (V-3.1) and exported
to SPSS (V− 22) for analysis. The revised Adult Treatment Panel three (ATP III) criterion was
used to define the overall MS and its corresponding traits. The mean, standard deviations, and
proportions were used as a descriptive summary. Categorical data and the proportion of overall
MS in the two groups were compared using binary logistic regression, and results were reported
statistically significant at a p-value is less than 5%. To identify predictors of metabolic syndrome
among PLHIVs (Paper-II), a health institution-based unmatched case-control study was
conducted. All HIV-infected adult persons who are receiving routine care in the randomly
selected two hospitals and two health centers of the Gedeo zone were involved in the study, from
December 29
th, 2017 to January 22nd, 2019. The PLHIVs diagnosed with overall MS using ATP
III criteria were considered as a case, and those subjects free of it in the survey were enrolled as controls. Binary logistic regression was employed to identify predictors of MS. In the crude
analysis, all variables significant at (P<0.1) were included in a multivariable logistic regression
model, using the enter method to arrive at the final model. In which, the adjusted odds ratio
(AOR) with 95% CI, was estimated to assess the presence and strength of associations, and was
determined statistical significance at a p-value < 0.05. To understand the role of sociocultural
contexts in forming individual PLHIVs' behavior towards lifestyle-related MS risks, a deductive
descriptive phenomenological approach, using the PEN-3 model as a theoretical basis and the
knowledge, attitude, and practices (KAP) as a conceptual framework were used. Adult PLHIVs
were chosen purposefully from Dilla University referral hospital and Wonago health center and
were involved in the discussion. The data collection was enhanced with a focus group discussion
(FGDs) and an in-depth interview method, starting from February 1
st
to 30
th
2018. Finally, the
primary data produced from the discussions were handled and analyzed iteratively, by using
Atlas. ti (Version.7.5.7) and SPSS (Version.22) software.
Result: a total of 633 (n=422, ART exposed and n=211, ART naïve) PLHIVs were involved in
the first paper, with a response rate of 92.1%. MS was diagnosed in (22.0%, 95% CI: 19.0-25.4)
of PLHIVs. It was slightly higher in the ART-exposed (22.5%, 95% CI: 18.7-26.8) than ART
naïve (20.9%, 95% CI: 15.2-27.1) group. However, the observed differences were not
statistically significant(P>0.05). In paper two, a total of 633 (139 cases and 494 controls)
PLHIVs were included. The multivariable analysis result found that age (AOR=1.09, 95% CI
(1.05-1.12)); educational status being completed secondary school (AOR=0.22, 95% CI (0.020.42));
occupational
status
being
of
students
(AOR=0.11,95%
CI
(0.24-0.51);
wealth
index
being
in
the middle quintile (AOR=0.22, 95%CI (0.06-0.79)); ART status exposed to ART
(AOR=3.07, 95%CI(1.37-6.89)); total physical activity state being physically active (AOR=0.36,
95%CI (0.16-0.79)), and engaged in low levels physical activity (AOR=3.83 , 95%CI(1.4610.05))
were
the
factors
significantly
associated
with
MS.
Furthermore,
the
result
from
the
third
paper
revealed that a total of 32 male and female respondents were involved in the discussion.
More than half, 68.8 %(22) of the subjects were found within the age range of (35-44) years,
with a mean age of 36.96 (+8.94) years-old. The getting hold of MS risk associated health
knowledge of a person encompasses multiple sources. Family, the spouse's children, sisters, and
brothers; the government structure, mainly the health care structures; the social systems, principally, the religious organization, the social calls 'Idir', were primary role player in
educating the PLHIVs.
Conclusions and recommendations: Paper one demonstrated that the magnitude of overall MS
was higher among PLHIVs in the Gedeo zone; with a relatively higher magnitude seen in the
ART-exposed than ART naïve groups. However, the observed differences were not statistically
significant. Implicated that at the time of implementation of the entire test and treatment policy
in those vulnerable target groups, a routine screening program of MS will be a vibrant action.
While education, occupation, wealth index, antiretroviral therapy status, total physical activity,
and lower physical activity levels were concluded by the second paper as modifiable predictors
of metabolic syndrome, age was found as a non-modifiable independent risk of metabolic
syndrome. This suggested that there is a need for an ongoing effort to realize an integrated care
plan that addresses the routine care, along with the regular screening and management programs
of the risks associated with MS and its traits in these subjects. The sociocultural contexts dictate
the PLHIVs' to have inadequate knowledge concerning risk factors and methods for preventing
MS. And, this, in turn, contributed to form an unfavorable attitude and inadequate practices. The
finding indicates the significance of the adoption of the healthy living practices associated
awareness creation program, which targets the PLHIVs to bring behavior change that eventually
enable them for the better prevention and control of MS and its long term consequences.
Description
Keywords
Epidemiology, sociocultural-contexts, metabolic syndrome, overall magnitude, predictors, PEN-3 model, descriptive phenomenology, southern-Ethiopia