Dataset Information

The prevalence and characteristics of frailty by frailty phenotype in rural Tanzania.

ABSTRACT:

Background

The frailty phenotype is defined by the presence of three from the following five clinical features: weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. It has been widely applied in different research and clinical contexts, including across many low and middle-income countries. However, there is evidence that the operationalisation of each component of the frailty phenotype significantly alters its characteristics and predictive validity, and care is needed when applying the phenotype across settings. The study's objective was to operationalise the frailty phenotype in a rural Tanzanian population of older community-dwelling adults.

Methods

Consenting adults aged ?60 years, and resident in five randomly selected villages of Hai district Demographic Surveillance Site, were eligible to participate in this cross-sectional study. From a screened sample of 1207 older adults, 235 were randomised and consented to an assessment of their frailty status by the frailty phenotype. Trained research fieldworkers (Tanzanian medical doctors and nurses) carried out measurements and questionnaires at local village centres or at participants' homes.

Results

The prevalence of the frailty phenotype, calculated from complete data for 196 participants, was 9.25% (95% CI 4.39-14.12) When missing data were counted as meeting frailty criterion (i.e. missing due to inability to perform an assessment), the prevalence increased to 11.22% (95% CI 7.11-15.32). Frailty by phenotype criteria was more common in older age groups, and was associated with self-assessed poor health and depression symptoms.

Conclusions

Frailty can be successfully estimated using the frailty phenotype, however there are challenges in its operationalisation cross-culturally. Further work is needed to explore the potential clinical application of the frailty phenotype in such settings.

SUBMITTER: Lewis EG

PROVIDER: S-EPMC6240208 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

The prevalence and characteristics of frailty by frailty phenotype in rural Tanzania.

Lewis Emma Grace EG Coles Selina S Howorth Kate K Kissima John J Gray William W Urasa Sarah S Walker Richard R Dotchin Catherine C

BMC geriatrics 20181116 1

<h4>Background</h4>The frailty phenotype is defined by the presence of three from the following five clinical features: weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. It has been widely applied in different research and clinical contexts, including across many low and middle-income countries. However, there is evidence that the operationalisation of each component of the frailty phenotype significantly alters its characteristics and predictive val ...[more]

PMID: 30445919

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Project description:OBJECTIVES:Frailty is a major clinical geriatric syndrome associated with serious adverse events including functional disability, falls, hospitalisation, increased morbidity and mortality. The aim of this study was to study associations between a frailty phenotype and frailty characteristics well known from the literature. DESIGN:Registry-based cross-sectional study. SETTING:The target population consists of inhabitants above the age of 50 living in the Danish municipalities of Lolland and Guldborgsund. Excluded are incapacitated people, inhabitants unable to understand Danish or English and inhabitants without a permanent residence. PARTICIPANTS:7327 individuals aged 50+ years were included. OUTCOME MEASURES:We examined associations between the frailty measurement and factors known to be associated with frailty: sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality. RESULTS:7327 individuals aged 50+ years were included. Of these, 6.5% had ≥3 frailty components (frail), 46.7% had 1-2 components (prefrail) and 46.9% had none (non-frail). Those who were frail were older and more likely female than those who were non-frail or prefrail. There was a stepwise decrease in educational level, and in self-assessed health with increasing frailty status, and a stepwise increase in difficulty in making ends meet, number of hospital contacts and mortality with increasing frailty status, p<0.0001 for each comparison. Compared with individuals who were non-frail, mortality was higher among those who were prefrail (HR: 2.90; 95% CI: 1.30 to 6.43) or frail (HR: 8.21; 95% CI: 3.37 to 20.0). CONCLUSIONS:Based on these findings, we consider the Lolland-Falster Health Study frailty assessment a valid instrument demonstrating the same characteristics as other validated frailty measures concerning associations with sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality. TRIAL REGISTRATION NUMBER:NCT02482896.

Project description:Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis (TB). We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania.Adult patients (? 18 years) with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam, with ~?4.4 million inhabitants (urban), and Ifakara in the sparsely populated Kilombero District with ~?400?000 inhabitants (rural). Clinical data were obtained at recruitment. Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz, Baermann, urine filtration, and circulating cathodic antigen tests. Differences between groups were assessed by ?2, Fisher's exact, and Wilcoxon rank sum tests. Logistic regression models were used to determine associations.Between August 2015 and February 2017, 668 patients were enrolled, 460 (68.9%) at the urban and 208 (31.1%) at the rural site. Median patient age was 35 years (interquartile range [IQR]: 27-41.5 years), and 454 (68%) were males. Patients from the rural setting were older (median age 37 years vs. 34 years, P?=?0.003), had a lower median body mass index (17.5 kg/m2 vs. 18.5 kg/m2, P?<? 0.001), a higher proportion of recurrent TB cases (9% vs. 1%, P?<? 0.001), and in HIV/TB co-infected patients a lower median CD4 cell counts (147 cells/?l vs. 249 cells/?l, P?=?0.02) compared to those from urban Tanzania. There was no significant difference in frequencies of HIV infection, diabetes mellitus, and haemoglobin concentration levels between the two settings. The overall prevalence of helminth co-infections was 22.9% (95% confidence interval [CI]: 20.4-27.0%). The significantly higher prevalence of helminth infections at the urban site (25.7% vs. 17.3%, P?=?0.018) was predominantly driven by Strongyloides stercoralis (17.0% vs. 4.8%, P?<? 0.001) and Schistosoma mansoni infection (4.1% vs. 16.4%, P?<? 0.001). Recurrent TB was associated with living in a rural setting (adjusted odds ratio [aOR]: 3.97, 95% CI: 1.16-13.67) and increasing age (aOR: 1.06, 95% CI: 1.02-1.10).Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania. The differences underline the need for setting-specific, tailored public health interventions to improve clinical management of TB and comorbidities.

Dataset Information

The prevalence and characteristics of frailty by frailty phenotype in rural Tanzania.

Background

Methods

Results

Conclusions

Publications

The prevalence and characteristics of frailty by frailty phenotype in rural Tanzania.

Similar Datasets

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