Burden of cardiometabolic risk factors and preclinical target organ damage among adults in Freetown, Sierra Leone: a community-based health-screening survey
Authors: Russell James Baligeh Walter , Koroma Theresa Ruba , Sesay Santigie , Samura Sallieu K , Lakoh Sulaiman , Bockarie Ansu , Abiri Onomeh Thomas , Kanu Joseph Sam , Coker Joshua , Jalloh Abdul , Conteh Victor , Conteh Sorie , Smith Mohamed , Mahdi Othman. Z. , Lisk Durodami. R. 
Published: February 2023

Objective

The aim of the study was to investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage and its associated factors among adults in Freetown, Sierra Leone.

Design

This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants.

Setting

The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Freetown, Sierra Leone.

Participants

A total of 2394 adults Sierra Leoneans aged 20 years, or more were enrolled.

Outcome measure

Anthropometric data, fasting lipid profiles, fasting plasma glucose, target organ damage, clinical profiles and demographic characteristic of participants were described. The cardiometabolic risks were further related to target organ damage.

Results

The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by electrocardiogram (ECG), 14.2% had LVH by 2D-Echo, and 11.4% had chronic kidney disease. The odds of developing ECG-LVH were higher with diabetes [OR = 1.255, 95% C.I. (0.822 - 1.916) and dyslipidaemia [OR = 1.449, 95% C.I. (0.834 - 2.518). The association factors for higher odds of LVMI by echo were dyslipidemia [OR = 1.844, 95% C.I (1.006-3.380)] and diabetes mellitus [OR =1.176, 95% C.I. (0.759-1.823)]. The odds of having CKD were associated with diabetes mellitus [OR =1.212, 95% CI (0.741-1.983)] and hypertension [OR =1.163, 95% CI (0.887-1.525)]. A low optimal cut-off point for ECG-LVH (male 24.5mm vs female 27.5mm) as a target organ damage was required to maximize sensitivity and specificity by a receiver operating characteristic (ROC) curve since the odds for LVH by ECG was low.

Conclusions

This study provides novel data-driven information on the burden of cardiometabolic risks and its association with preclinical target organ damage in a resource limited setting. It illustrates the need for interventions in improve cardiometabolic health screening and management among adults in Sierra Leoneans.

Strengths and Limitations of the study

Strengths

A major strength of this study is its community-based design and the first study of its kind on a larger population in Sierra Leone.

The study was statistically powered to produce results that are representative of adults in Sierra Leone.

Limitations

The study is limited as it could not conclude direct causality inference of risk factors and effect outcomes.

Since some of the outcomes (fasting plasma glucose, HbA1c and fasting lipid profile) are limited by the reliance on single time point measurements, it may result in measurement errors and the potential of underestimating cardiometabolic risk factors.

Chronic kidney disease (CKD) assessment by single serum creatinine without assessing for proteinuria, which also indicates the presence of CKD, will lead to underestimation of CKD.