Digital archive of theses discussed at the University of Pisa


Thesis etd-08072018-095017

Thesis type
Tesi di specializzazione (5 anni)
Thesis title
Noncommunicable diseases in the African setting: field experience at Tosamaganga hospital, Iringa District Council (Tanzania)
Course of study
relatore Prof. Taddei, Stefano
correlatore Dott. Torelli, Giovanni
  • obesity
  • diabetes
  • hypertension
  • Africa
  • chronic diseases
  • HIV infection
Graduation session start date
Release date
Background: Chronic noncommunicable diseases (NCDs) are increasing at steady rates in developing countries. Doctors with Africa CUAMM has been focusing on NCDs for a while and in Tanzania, at Tosamaganga Hospital, Iringa District Council (DC), its outpatient clinic dedicated to NCDs has been working for more than 20 months by now, with growing numbers of patients assessed and chronically treated. This is a proof of the significant need of an intervention in this field, despite robust data regarding NCDs are still lacking in low-income settings. HIV infection is another important health issue in the Tanzanian setting, with particularly high figures in Iringa DC and chronic conditions, such as cardiovascular diseases and hypertension, appear to be important concomitant factors of HIV morbidity and mortality, with the possible adjunct culprit of combined antiretroviral therapy (cART).
Objectives: To better understand the real prevalence of NCDs, to define the interplay between HIV, cART and chronic diseases and to explore the possibility to develop dedicated projects to NCDs in Iringa DC, NCDs screening was carried out at Tosamaganga Hospital.
Materials and methods: Eligible participants were randomly included into the NCDs screening at the general Outpatient Department (OPD) and at the HIV clinic (CTC) of the Hospital. Past medical history, biometric data and blood pressure were recorded; glucose analysis (and HIV tests for OPD patients) was performed.
Results: Four hundred seventy-six patients, 232 from the OPD and 244 from the CTC, were included in the NCDs screening. All NCDs found were more common in the OPD and at older age. Overall, the most common NCD was hypertension, with a prevalence of 48.5% in the OPD and 25.6% in the CTC. Cardiac diseases had figures of 11.3% in the OPD and 3.3% in the CTC. Diabetes prevalence rate was 8.7% in the OPD and 3.7% in the CTC, while for stroke respectively 1.7% and 1.2%. Males were more affected by hypertension, cardiac diseases and strokes while females by diabetes. Obesity and central obesity were rather widespread, particularly among women and in the OPD, where rates rocketed to 25% for obesity and 38% for central obesity. Alcohol intake was particularly common (53.7%), especially in males.
Unawareness of hypertension was a significant problem, particularly in the CTC (77%) and chronically treated patients showed poor hypertension control, especially in the OPD (60%). Hypertension and diabetes were found associated to traditional risk factors, such as age, BMI, waist circumference, family history and comorbidities. HIV-related cardio-metabolic risk factors where analysed and HIV infection per se was not found associated neither to hypertension nor to diabetes. However, a longer exposure to cART was found associated to hypertension and an earlier initiation of cART to diabetes, but an effect of a specific cART was not detected.
Conclusions: Screening systems, sensitisation campaigns and effective treatments for hypertension and diabetes, along with educating services regarding life-style factors such as overnutrition and alcohol intake, should be guaranteed both in the general outpatient clinic and in the HIV-dedicated one. Cardio-metabolic risk factors related to HIV infection and its treatment are an added burden to consider and require further studies. On the whole, strengthening the already existing CUAMM NCDs clinic with specific funds, dedicated personnel and targeted training is warranted, along with on field research to better define the interplay between HIV infection and NCDs, with the global target to curb the raising burden of NCDs in Tanzania.