Prevalence of hypertension, diabetes, obesity, multimorbidity, and related risk factors among adult Gambians: a cross-sectional nationwide study

Background As countries progress through economic and demographic transition, chronic non-communicable diseases (NCDs) overtake a previous burden of infectious diseases. We investigated the prevalence of hypertension, diabetes, obesity, and multimorbidity in older adults in The Gambia.Methods We embedded a survey on NCDs into the nationally representative 2019 Gambia National Eye Health Survey of adults aged 35 years or older. We measured anthropometrics, capillary blood glucose, and blood pressure together with sociodemographic information, personal and family health history, and information on smoking and alcohol consumption. Hypertension was defined as systolic blood pressure of 140 mmHg or more, diastolic blood pressure of 90 mmHg or more, or receiving treatment for hypertension. Diabetes was defined as fasting capillary blood glucose of 7 mmol/L or more, random blood glucose of 11 center dot 1mmol/L or more, or previous diagnosis or treatment for diabetes. Overweight was defined as BMI of 25-29 center dot 9 kg/m2 and obesity as 30 kg/m2 or more. Multimorbidity was defined as the coexistence of two or more conditions. We calculated weighted crude and adjusted estimates for each outcome by sex, residence, and selected sociodemographic factors.Findings We analysed data from 9188 participants (5039 [54 center dot 8%] from urban areas, 6478 [70 center dot 5%] women). The prevalence of hypertension was 47 center dot 0%; 2259 (49 center dot 3%) women, 2052 (44 center dot 7%) men. The prevalence increased with age, increasing from 30% in those aged 35-45 years to over 75% in those aged 75 years and older. Overweight and obesity increased the odds of hypertension, and underweight reduced the odds. The prevalence of diabetes was 6 center dot 3% (322 [7 center dot 0%] women, 255 [5 center dot 6%] men), increasing from 3 center dot 8% in those aged 35-44 years to 9 center dot 1% in those aged 65-75 years, and then declining. Diabetes was much more common among urban residents, especially in women (peaking at 13% by age 65 years). Diabetes was strongly associated with BMI and wealth index. The prevalence of obesity was 12 center dot 0% and was notably higher in women than men (880 [20 center dot 2%] vs 170 [3 center dot 9%]). Multimorbidity was present in 932 (10 center dot 7%), and was more common in women than men (694 [15 center dot 9] vs 238 [5 center dot 5]). The prevalence of smoking was 9 center dot 7%; 5 (0 center dot 1%) women, 889 (19 center dot 3%) men. Alcohol consumption in the past year was negligible.Interpretation We have documented high levels of NCDs and associated risk factors in Gambian adults. This presents a major stress on the country's fragile health system that requires an urgent, concerted, and targeted mutisectoral strategy.