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Urbanization in Sub-Saharan Africa: Declining Rates of Chronic and Recurrent Infection and Their Possible Role in the Origins of Non-communicable Diseases

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Abstract

Background

Non-communicable diseases (NCDs), such as atherosclerosis and cancers, are a leading cause of death worldwide. An important, yet poorly explained epidemiological feature of NCDs is their low incidence in under developed areas of low-income countries and rising rates in urban areas.

Methods

With the goal of better understanding how urbanization increases the incidence of NCDs, we provide an overview of the urbanization process in sub-Saharan Africa, discuss gene expression differences between rural and urban populations, and review the current NCD determinant model. We conclude by identifying research priorities.

Results

Declining rates of chronic and recurrent infection are the hallmark of urbanization in sub-Saharan Africa. Gene profiling studies show urbanization results in complex molecular changes, with almost one-third of the peripheral blood leukocyte transcriptome altered. The current NCD determinant model could be improved by including a possible effect from declining rates of infection and expanding the spectrum of diseases that increase with urbanization.

Conclusions

Urbanization in sub-Saharan Africa provides a unique opportunity to investigate the mechanism by which the environment influences disease epidemiology. Research priorities include: (1) studies to define the relationship between infection and risk factors for NCDs, (2) explaining the observed differences in the inflammatory response between rural and urban populations, and (3) identification of animal models that simulate the biological changes that occurs with urbanization. A better understanding of the biological changes that occur with urbanization could lead to new prevention and treatment strategies for some of the most common surgical diseases in high-income countries.

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Fig. 1

Source rural photograph is the author’s, urban photograph: Jonathan Ernst/World Bank

Fig. 2

Source The london school of hygiene and tropical medicine [63], adapted from McGregor [64]

Fig. 3
Fig. 4

a Source Legbo and Ameh [67]

Fig. 5

Source Bickler et al., 2016 [38]

Fig. 6

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Notes

  1. Sub-Saharan Africa refers to the geographic area of the African continent that lies south of the Sahara. There are 42 countries located on the sub-Saharan African mainland, in addition to six island nations (Madagascar, Seychelles, Comoros, Cape Verde, and Sao Tome and Principe). This grouping is used the World Bank, World Health Organization and United Nations because these countries have similar levels of levels of economic development.

  2. The World Bank classifies countries according to four income groupings. Income is measured using gross national income (GNI) per capita, in US dollars, converted from local currency using the World Bank Atlas method. Classifications as of July 2016 are as follows:

    Low-income countries (LICs) = US$1025 or less in 2015

    Middle-income countries (MICs) are subdivided: Lower-middle-income = US$1026–US$40,355

    Upper-middle-income (UMICs) = US$4036–US$12,475

    High-income countries (HICs) = US$12,476 or more

References

  1. Galea S, Vlahov D (2005) Urban health: evidence, challenges, and directions. Annu Rev Public Health 26:341–365

    Article  PubMed  Google Scholar 

  2. World Ubanization Prospects: United Nations; 2014. Available from: https://esa.un.org/unpd/wup/Publications/Files/WUP2014-Report.pdf

  3. Chen M, Zhang H, Liu W, Zhang W (2014) The global pattern of urbanization and economic growth: evidence from the last three decades. PLoS One 9(8):e103799

    Article  PubMed  PubMed Central  Google Scholar 

  4. Satterthwaite D, McGranahan G, Tacoli C (2010) Urbanization and its implications for food and farming. Philos Trans R Soc Lond B Biol Sci 365(1554):2809–2820

    Article  PubMed  PubMed Central  Google Scholar 

  5. Caldwell JC (2001) Population health in transition. Bull World Health Organ 79(2):159–160

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Harpham T (2009) Urban health in developing countries: what do we know and where do we go? Health Place 15(1):107–116

    Article  PubMed  Google Scholar 

  7. Eckert S, Kohler S (2014) Urbanization and health in developing countries: a systematic review. World Health Popul 15(1):7–20

    Article  PubMed  Google Scholar 

  8. Gong P, Liang S, Carlton EJ, Jiang Q, Wu J, Wang L et al (2012) Urbanisation and health in China. Lancet 379(9818):843–852

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jamison DT, Mosley WH (1991) Disease control priorities in developing countries: health policy responses to epidemiological change. Am J Public Health 81(1):15–22

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Murray CJ, Lopez AD (1997) Global mortality, disability, and the contribution of risk factors: global Burden of Disease Study. Lancet 349(9063):1436–1442

    Article  CAS  PubMed  Google Scholar 

  11. WHO. Global status report on non-communicable diseases 2014. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/

  12. Omran AR (1971) The epidemiological transition. The Milbank Meml Fund Q 49(4):509–538

    Article  CAS  Google Scholar 

  13. Unicef. State of the World’s Children 2016. Available from: https://www.unicef.org/publications/files/UNICEF_SOWC_2016.pdf

  14. Gilmartin AA, Petri WA Jr (2015) Exploring the role of environmental enteropathy in malnutrition, infant development and oral vaccine response. Philos Trans R Soc Lond B Biol Sci 370(1671):20140143

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nath SK (2005) Tropical sprue. Curr Gastroenterol Rep 7(5):343–349

    Article  PubMed  Google Scholar 

  16. Lunn PG (2000) The impact of infection and nutrition on gut function and growth in childhood. Proc Nutr Soc 59(1):147–154

    Article  CAS  PubMed  Google Scholar 

  17. Campbell DI, Elia M, Lunn PG (2003) Growth faltering in rural Gambian infants is associated with impaired small intestinal barrier function, leading to endotoxemia and systemic inflammation. J Nutr 133(5):1332–1338

    Article  CAS  PubMed  Google Scholar 

  18. Jiang NM, Tofail F, Moonah SN, Scharf RJ, Taniuchi M, Ma JZ et al (2014) Febrile illness and pro-inflammatory cytokines are associated with lower neurodevelopmental scores in Bangladeshi infants living in poverty. BMC Pediatr 14:50

    Article  PubMed  PubMed Central  Google Scholar 

  19. Eppig C, Fincher CL, Thornhill R (2010) Parasite prevalence and the worldwide distribution of cognitive ability. Proc Biol Sci R Soc 277(1701):3801–3808

    Article  Google Scholar 

  20. Bickler SW (2000) Non-communicable diseases: is their emergence in industrialized societies related to changes in neuroendocrine function? Med Hypotheses 54(5):825–828

    Article  CAS  PubMed  Google Scholar 

  21. Bickler SW, Sanno-Duanda B (2000) Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ 78(11):1330–1336

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Ashok N, Tarakji B, Darwish S, Rodrigues JC, Altamimi MA (2015) A review on noma: a recent update. Glob J Health Sci 8(4):53–59

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tonna JE, Lewin MR, Mensh B (2010) A case and review of noma. PLoS Negl Trop Dis 4(12):e869

    Article  PubMed  PubMed Central  Google Scholar 

  24. Greenwood BM, Whittle HC (1981) Immunology of Medicine in the Tropics. Edward Arnold (Publishers) Ltd, London

    Google Scholar 

  25. Burkitt DP (1973) Some diseases characteristic of modern Western civilization. Br Med J 1(5848):274–278

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Trowell HC, Burkitt DP (1981) Western diseases, their emmergence and prevention. Harvard University Press, Cambridge

    Google Scholar 

  27. Burkitt DP (1973) Some diseases characteristic of modern western civilization. A possible common causative factor. Clin Radiol 24(3):271–280

    Article  CAS  PubMed  Google Scholar 

  28. Glober GA, Stemmermann GN (1981) Hawaii ethnic groups. In: Trowell BHC, Burkett DP (eds) Western diseases, their emergence and prevention. Harvard University Press, Cambridge, pp 319–333

    Google Scholar 

  29. Prior IAM, Tasman-Jones C (1981) New Zealand Maori and Pacific Polynesians. In: Trowell HC, Burkett DP (eds) Western diseases, their emergence and prevention. Harvard University Press, Cambridge, pp 227–237

    Google Scholar 

  30. Modan B (1981) Israeli migrants. In: Trowell HC, Burkett DP (eds) Western diseases, their emergence and prevention. Harvard University Press, Cambridge, pp 268–277

    Google Scholar 

  31. Idaghdour Y, Storey JD, Jadallah SJ, Gibson G (2008) A genome-wide gene expression signature of environmental geography in leukocytes of Moroccan Amazighs. PLoS Genet 4(4):e1000052

    Article  PubMed  PubMed Central  Google Scholar 

  32. Idaghdour Y, Czika W, Shianna KV, Lee SH, Visscher PM, Martin HC et al (2010) Geographical genomics of human leukocyte gene expression variation in southern Morocco. Nat Genet 42(1):62–67

    Article  CAS  PubMed  Google Scholar 

  33. Nath AP, Arafat D, Gibson G (2012) Using blood informative transcripts in geographical genomics: impact of lifestyle on gene expression in fijians. Front Genet 3:243

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bickler SW, Lizardo RE, De Maio A (2015) The transition from a rural to an urban environment alters expression of the human Ebola virus receptor Neiman-Pick C1: implications for the current epidemic in West Africa. Cell Stress Chaperones 20(2):203–206

    Article  PubMed  Google Scholar 

  35. Vasunilashorn S, Crimmins EM, Kim JK, Winking J, Gurven M, Kaplan H et al (2010) Blood lipids, infection, and inflammatory markers in the Tsimane of Bolivia. Am J Hum Biol Off J Hum Biol Counc 22(6):731–740

    Article  Google Scholar 

  36. Filmore D (2004) It’s a GPCR world. Mod Drug Discov 7(11):24–28

    CAS  Google Scholar 

  37. Downes GB, Gautam N (1999) The G protein subunit gene families. Genomics 62(3):544–552

    Article  CAS  PubMed  Google Scholar 

  38. Bickler SW, Lizardo E, Cauvi DM, De Maio A (2016) The transition from a rural to an urban environment in Africa alters G protein-coupled receptor signaling. Med Hypotheses 95:49–53

    Article  CAS  PubMed  Google Scholar 

  39. Buchanan FG, DuBois RN (2006) Emerging roles of beta-arrestins. Cell Cycle 5(18):2060–2063

    Article  CAS  PubMed  Google Scholar 

  40. Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A et al (2013) Global health 2035: a world converging within a generation. Lancet 382(9908):1898–1955

    Article  PubMed  Google Scholar 

  41. Barker DJ (1995) Fetal origins of coronary heart disease. BMJ Clin Res ed 311(6998):171–174

    Article  CAS  Google Scholar 

  42. Strachan DP (1989) Hay fever, hygiene, and household size. BMJ 299(6710):1259–1260

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Bloomfield SF, Rook GA, Scott EA, Shanahan F, Stanwell-Smith R, Turner P (2016) Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene. Perspect Public Health 136(4):213–224

    Article  PubMed  PubMed Central  Google Scholar 

  44. Briggs N, Weatherhead J, Sastry KJ, Hotez PJ (2016) The hygiene hypothesis and its inconvenient truths about helminth infections. PLoS Negl Trop Dis 10(9):e0004944

    Article  PubMed  PubMed Central  Google Scholar 

  45. Rook GA, Lowry CA, Raison CL (2013) Microbial ‘old friends’, immunoregulation and stress resilience. Evol Med Public Health. 2013(1):46–64

    Article  PubMed  PubMed Central  Google Scholar 

  46. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925

    Article  CAS  PubMed  Google Scholar 

  47. Walker AR, Shipton E, Walker BF, Manetsi B, Van Rensburg PS, Vorster HH (1989) Appendicectomy incidence in black and white children aged 0 to 14 years with a discussion on the disease’s causation. Trop Gastroenterol 10(2):96–101

    CAS  PubMed  Google Scholar 

  48. Bickler SW, Sanno-Duanda B (2000) Incidence of appendicitis and hypertrophic pyloric stenosis in a sub-Saharan African country. J Ped Gastro Nutr 31(2):S39

    Google Scholar 

  49. Ajao OG (1981) Abdominal emergencies in a tropical African population. Br J Surg 68(5):345–347

    Article  CAS  PubMed  Google Scholar 

  50. Bremner CG (1971) The changing pattern of disease seen at Baragwanath hospital. S Afr J Surg 9(3):127–131

    CAS  PubMed  Google Scholar 

  51. Fulton J, Lazarus C (1995) Acute appendicitis among black South Africans. S Afr J Surg 33(4):165–166

    CAS  PubMed  Google Scholar 

  52. Hutt MS (1979) Epidemiology of chronic intestinal disease in middle Africa. Isr J Med Sci 15(4):314–317

    CAS  PubMed  Google Scholar 

  53. Moore SW, Robbs JV (1979) Acute appendicitis in the Zulu–an emerging disease? S Afr Med J 55(18):700

    CAS  PubMed  Google Scholar 

  54. GBD 2013 DALYs and HALE Collaborators (2015) Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet 386(10009):2145–2191

    Article  PubMed Central  Google Scholar 

  55. Clancy KBH (2013) Inflammation, reproduction and the goldilocks principle. In: Hinde K (ed) Building babies: primate development in proximate and ultimate perspective, developments in primatology: progress and prospects. Springer, New York, pp 3–26

    Google Scholar 

  56. Kidd BA, Peters LA, Schadt EE, Dudley JT (2014) Unifying immunology with informatics and multiscale biology. Nat Immunol 15(2):118–127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Verma M, Hontecillas R, Abedi V, Leber A, Tubau-Juni N, Philipson C et al (2016) Modeling-enabled systems nutritional immunology. Front Nutr 3:5

    Article  PubMed  PubMed Central  Google Scholar 

  58. Brown EM, Wlodarska M, Willing BP, Vonaesch P, Han J, Reynolds LA et al (2015) Diet and specific microbial exposure trigger features of environmental enteropathy in a novel murine model. Nat Commun 6:7806

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Blanton LV, Charbonneau MR, Salih T, Barratt MJ, Venkatesh S, Ilkaveya O et al (2016) Gut bacteria that prevent growth impairments transmitted by microbiota from malnourished children. Science 351(6275):aad3311

    Article  PubMed  Google Scholar 

  60. Wagner VE, Dey N, Guruge J, Hsiao A, Ahern PP, Semenkovich NP et al (2016) Effects of a gut pathobiont in a gnotobiotic mouse model of childhood undernutrition. Sci Transl Med 8(366):366ra164

    Article  PubMed  PubMed Central  Google Scholar 

  61. Latorre JD, Hernandez-Velasco X, Bielke LR, Vicente JL, Wolfenden R, Menconi A et al (2015) Evaluation of a Bacillus direct-fed microbial candidate on digesta viscosity, bacterial translocation, microbiota composition and bone mineralisation in broiler chickens fed on a rye-based diet. Br Poult Sci 56(6):723–732

    Article  CAS  PubMed  Google Scholar 

  62. Tellez G, Latorre JD, Kuttappan VA, Kogut MH, Wolfenden A, Hernandez-Velasco X et al (2014) Utilization of rye as energy source affects bacterial translocation, intestinal viscosity, microbiota composition, and bone mineralization in broiler chickens. Front Genet 5:339

    Article  PubMed  PubMed Central  Google Scholar 

  63. London School of Hygiene and Tropical Medicine. Online course: Methods of Nutrtitional Assessment (2012) by Louise Watson, Alan Dangour and Suzanne Filteau. [Available from: http://dl.lshtm.ac.uk/DLTesting/PNO101/sessions/S1S3/PNO101_S1S3_030_080.html

  64. McGregor IA, Rahman AK, Thomson AM, Billewicz WZ, Thompson B (1970) The health of young children in a West African (Gambian) village. Trans R Soc Trop Med Hyg 64(1):48–77

    Article  CAS  PubMed  Google Scholar 

  65. Wheeler WF (2000) Efe Pygmies: archers of the african rain forest. Rizzoli International Publications, New York

    Google Scholar 

  66. Korpe PS, Petri WA Jr (2012) Environmental enteropathy: critical implications of a poorly understood condition. Trends Mol Med 18(6):328–336

    Article  PubMed  PubMed Central  Google Scholar 

  67. Legbo JN, Ameh EA. Chapter 21: Necrotizing Fasciitis. In Paediatric Surgery: A Comprehensive Text for Africa: Global Help; 2010. Editors, Ameh EA, Bickler S, Lakhoo K, Kwomeh BC, Poenaru D. Available from: http://www.global-help.org/publications/books/help_pedsurgeryafrica21.pdf

  68. Oldham WM, Hamm HE (2008) Heterotrimeric G protein activation by G-protein-coupled receptors. Nat Rev Mol Cell Biol 9(1):60–71

    Article  CAS  PubMed  Google Scholar 

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Funding

This research was supported by grant number R24TW008910 from the Fogarty International Center, National Institutes of Health (NIH). The NIH Common Fund supports the award.

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Correspondence to Stephen W. Bickler.

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Bickler, S.W., Wang, A., Amin, S. et al. Urbanization in Sub-Saharan Africa: Declining Rates of Chronic and Recurrent Infection and Their Possible Role in the Origins of Non-communicable Diseases. World J Surg 42, 1617–1628 (2018). https://doi.org/10.1007/s00268-017-4389-5

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  • DOI: https://doi.org/10.1007/s00268-017-4389-5

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