High levels of hypertension, obesity, diabetes and multimorbidity found in The Gambia during national eye health survey

High levels of non-communicable diseases have been found in The Gambia as part of a national eye health survey.

The Gambia National Eye Health Survey 2019 was the third national survey in The Gambia completed by ICEH and collaborators.

The survey was designed to provide nationally representative data on vision impairment, blindness and its co-morbidities in adults aged 35 and older and compare this data to population eye health in 1986 and 1996.

The nationally representative survey included 9188 participants, 54.8% of whom were from urban areas and 70.5% were women. The survey shows very high levels of hypertension, and concerning levels of obesity, diabetes, and multimorbidity in both men and women.

Overall, the data shows a higher prevalence of NCDs in The Gambia in women compared to men. The prevalence of hypertension was 47.0%, affecting 49.3% of women and 44.7% of men. This prevalence increased with age, rising from 30% in those aged 35–45 years to over 75% in those aged 75 years and older. Obesity increased the odds of hypertension and underweight reduced the odds. The prevalence of diabetes was 6.3%, affecting 7.0% of women and 5.6% of men. The prevalence of obesity was 12.0% and was notably higher in women (20.2%) than men (3.9%). 

However, the nationwide prevalence of smoking was 9.7%. However, this was almost exclusively in men (19.3%) compared to women (0.1%).  

“The findings in this study are quite alarming and show an increasing trend of non-communicable diseases compared to earlier studies in The Gambia. This possibly reflects the effect of rapid urbanisation, and the pace at which dietary patterns and other behavioural risk factors are changing in The Gambia. The good news is that all these factors are amenable to a comprehensive and coordinated multisectoral intervention”, Dr. Modou Jobe, lead author of this study, MRC Unit The Gambia at LSHTM.

“A surprising aspect of the prevalence data is that contrary to the case for diabetes, hypertension is equally common in people living in rural areas. Deciphering this anomaly should help in the design of preventative measures”, said Prof Andrew Prentice, Theme Leader, Nutrition and Planetary Health at MRC Unit The Gambia at LSHTM.

Multimorbidity or the coexistence of two or more chronic conditions in the same individual was more common in women than men (15·9 vs 5·5), thus contributing to health inequalities.

“The integration of this survey work on NCDs with data on ocular disease, mental health and musculoskeletal impairments in the 2019 Gambia National Eye Health Survey has highlighted the frequent intersection of different chronic conditions and the impact of this multimorbidity for The Gambia, providing a template for other countries,” said Prof Matthew Burton, Director of ICEH at LSHTM.

“These data are concerning but also timely as the government of The Gambia implements its recently launched NCD multisectoral strategic plan. We call on all stakeholders, both locally and internationally, to continue to support us in this endeavour.” Said Mr Omar Badjie, NCD Programme Manager at the Ministry of Health Gambia Government contributor/national stakeholder.

In May 2022, The Gambia launched a 5-year National Multi-sectoral strategy and costed action plan for non-communicable disease prevention and control. The overarching goal of this plan is to reduce premature deaths from NCDs in The Gambia by one-third by 2027.

Like many other developing countries within the subregion, The Gambia has made progress in reducing the prevalence of many infectious diseases and is on track to meet several health targets of the Sustainable Development Goals (SDGs). However, this research presents new challenges for the country’s already fragile health system which requires a collaborative national response to prioritise non-communicable diseases. MRCG and its partners remain committed to supporting and working together with national institutions to ease the burden of disease in The Gambia.


Jobe M, Mactaggart I, Bell S et al. Prevalence of hypertension, diabetes, obesity, multimorbidity, and related risk factors among adult Gambians: a cross-sectional nationwide study. The Lancet Global Health. January 2024. https://doi.org/10.1016/S2214-109X(23)00508-9

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International Centre for Eye Health receives Inaugural Vision Catalyst Fund Eye Health Accelerator Grant

The International Centre for Eye Health (ICEH) is a proud recipient of an Inaugural Eye Health Accelerator Grant by the Vision Catalyst Fund (VCF).

VCF are a funder for eye health services in lower and middle-income countries who aim to meet the needs of global sight loss in new ways, through innovative financing solutions and health system strengthening.

The VCF has awarded grants totalling £470,000 to ICEH at the London School of Hygiene & Tropical Medicine, Clinton Health Access Initiative, VisionSpring, and RestoringVision. These four recipients emerged from 58 concept notes submitted to VCF.

The funds for these grants were generated using an investment product co-created with P1 Capital, a UK based investment firm, to develop an Eye Health Accelerator Bond. This simple financial product empowers an investor to deploy at least 4% of their 8% return from a bond towards eye health programmes through the VCF. The VCF aims to offer more and larger grants as the investment in the bond grows in the coming year.

ICEH’s grant is a partnership with Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. The grant will scale up a project to train primary health workers in the country to identify and treat eye conditions in children, something that is not currently included for many countries. The project has the potential to screen and treat tens of thousands of children, creating a template for other countries globally to do the same.

Dr Aeesha Malik, lead investigator for the project said: “We are very excited to be working with VCF and our partners to reduce avoidable blindness in children using our innovative integrated child eye health model. With this collaboration will be able to deliver eye care to 10,000 children using new low-cost technology to screen children’s eyes, so that they can receive the treatment they need in time to prevent avoidable blindness. However, we believe this programme can be truly catalytic, and scaled up to over 100 countries globally, ultimately with the potential to impact millions of children, their families and communities.” 

The Chief Executive of VCF, Dr Andrew Cooper, said, “I am excited to introduce the Eye Health Accelerator Grants, an initiative funded by our first financial product made possible by a first investment from the David and Molly Pyott Foundation. These grants are designed to propel scale and foster collaboration within countries. By providing targeted support to promising models, we aspire to catalyse a collaborative ecosystem where innovation flourishes, and the collective effort lights the path towards widespread and sustainable improvements in eye health.”

Other grants awarded as part of the accelerator fund included integrating reading glasses into pensions systems, digital access to eye care for rural communities, and trialling integrated eye care into health systems.

Find out more about ICEH’s Child Eye Health project here.

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Trachoma Risk Factors in Oromia, Ethiopia, Outlined for First Time

Trachoma is the leading infectious cause of blindness worldwide. Caused by repeated infections with the bacteria Chlamydia trachomatis (Ct), it eventually results in the inward turning of the eyelashes, scratching against the cornea and leading to pain, sight loss and blindness.

Despite the disease being eliminated in most high-income areas globally, there are still 125 million people at risk of developing the condition. More than 67 million of those live in Ethiopia, of which the largest region is Oromia.

Trachoma control programs have only been in place in Oromia since 2016, and there has been a lack of risk factor evidence for the condition from this region to date. A new study from ICEH is the first to investigate risk factors for trachoma and the association with socio-economic status in this area.

The study, part of the wider Stronger-SAFE project to test improved strategies for trachoma control, looked at 1211 individuals in a rural district which had previously been identified as having high rates of trachoma. Each household had at least one child aged 1-9, which are known to be an age group at greater risk of the early stages of the disease.

The households were interviewed and nurses conducted a clinical inspection of people’s eyes, along with taking swabs for the presence of Ct.  

The nurses inspected people for signs of trachoma, in line with the WHO ‘simplified grading system’. This delineates the stages of trachoma into: TF, the early stages of the disease; TI, a more intense presentation; TS, the scarring of the eyelids; and TT, the advanced stage of the disease. ‘Active trachoma’ is assessed as having TF or TI in at least one eye.

The results showed a high percentage of children with trachoma and the presence of Ct. 20% of children aged 1-9 had TF, and nearly 2% had TI. 11% of the children with TF tested positive for Ct, compared with 20% of those with TI.

The researchers also recorded the presence of ocular discharge (28% of all participants), nasal discharge (23%) and flies on face (36.8%).

Adjusting for age, active trachoma was associated with younger age, the lowest income households, the presence of flies on the face and ocular discharge. Pre-school children washing more than once a day, and children whose clothes were washed at least once per week had lower odds of having active trachoma.

This was the first study to investigate socio-economic status and trachoma in Oromia. Even after adjusting for improved hygiene available to people with higher incomes, there was an association between lower socio-economic status and trachoma, suggesting that trachoma disproportionately affects the poorest communities.

Collectively these findings provide further evidence for the utility of hygiene interventions and environmental improvements to reduce the spread of Ct and the development of trachoma. As a highly endemic area, this first study in Oromia is useful for creating robust, region-specific data to tackle trachoma in Ethiopia.


Shafi Abdurahman O, Last A, Macleod D, Habtamu E, Versteeg B, Dumessa G, et al. (2023) Trachoma risk factors in Oromia Region, Ethiopia. PLoS Negl Trop Dis 17(11): e0011679. https://doi.org/10.1371/journal.pntd.0011679

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World AIDS Day 2023

Today is World AIDS, an international day dedicated to raising awareness of the AIDS pandemic and commemorating those who have died of the disease.

The World Health Organization (WHO) designates World AIDS Day as one of its eleven official global public health campaigns, marking it on 1 December every year since 1988. In the UK, the occasion provided an opportunity to redouble efforts as the initial public shock of the AIDS epidemic waned. The first World AIDS Day in the UK in 1988 saw the official opening of the National AIDS Helpline. Additionally, the National AIDS Trust and King’s Fund Conference took place, and the Health Education Authority issued a charter emphasizing the importance of information and education about HIV infections.

The LSHTM Archives have a number of collections that focus on HIV/AIDS, whether it’s documenting the disease or the work of those involved in the research of the disease.

To mark the day, we are profiling some of the material in the Archive which relates to the promotion of World AIDS Day.


Our Centre for Sexual and Reproductive Health collection features over 700 posters, designed to raise awareness of AIDS. The posters were brought together from a wide range of European countries and were intended to prevent the spread of the disease by informing the public of how AIDS can be transmitted.

The European Commission (EC) collected the majority of the posters as part of the ‘Concerted Action on Assessment of AIDS/HIV Prevention Strategies’ project from 1989 to 1991. The project’s purpose was to compare and contrast the various AIDS public health campaigns in European countries. It was during the late eighties and early nineties that AIDS was a major concern to European countries. The number of cases rapidly increased and there was a high degree of anxiety and fear in the general population over this fatal disease. The posters show how public health campaigners and voluntary organisations tried to inform and change behavior within the general community.

The collection also includes a selection of posters designed specifically to promote World AIDS Day’s between year and year.

Red and purple images of abstract figures. 
Caption: AIDS is challenge for all of us let's face it together.
Polish poster designed by the Ministry of Health for World AIDS Day 1992.


The LSHTM Archive also holds UK World AIDS Day newsletters from 1991-1993. The newsletters were edited and produced by the National AIDS Trust and funded by the Health Education Authority. Their focus was on the promotion of HIV/AIDS awareness events around the UK.

UK World AIDS Day October 1992 newsletter. Black text on blue background. Includes information on the WAD92 logo and message from HRH The Princess of Wales, Patron of the National AIDS Trust.
October 1992 issue of UK World AIDS Day Newsletter

A key aim of World AIDS Day is to stimulate discussion and action among people not regularly confronted by AIDS. The newsletters present various ideas for engaging with different groups, such as churches, schools, universities and local communities.

For each World AIDS Day the World Health Organization adopts a specific theme. The theme for 1991 was ‘Sharing the Challenge’. Andrew Dineley of the Liverpool Health Promotion Unit designed a jigsaw logo for the UK’s campaign. It symbolises the pulling-together of disparate agencies and resources to tackled AIDS.

Red Ribbon

The Red Ribbon is synonymous with raising awareness of HIV/AIDS, and those living with the disease.
The New York-based Visual AIDS Artists’ Caucus designed the ribbon in 1991 as a symbol to raise awareness of HIV/AIDS. The design was not trademarked and was not intended to be a commercial design. This lack of trademarking allowed anyone who wanted to bring recognition to the disease and its impact on lives to use the design freely.

Image of red ribbon on white background.  
Caption: Exposition solidarite.  SIDAIDS. Caption translates to: Solidarity Exhibition.
Poster designed by Stop AIDS Now in Luxembourg for World AIDS Day 1994.

The first red ribbon worn publicly was by Jeremy Irons at the 1991 Tony Awards. The ribbon was formally adopted as an international symbol of AIDS awareness and World AIDS Day not long after its creation. In 1992, 100,000 Red Ribbons were distributed to the audience at the Freddie Mercury Tribute. Today, the ribbon is a universal symbol of support and awareness of the disease.

The symbol of the red ribbon and its importance is evident throughout our AIDS/HIV collections. The UK World AIDS Day newsletter promoted it’s use as a central image for the campaign. They aimed for the ribbon to be “equivalent to the British Legion’s red poppy or the red nose of Comic Relief”.

Ideas for the use of red ribbons from October 1992 UK World AIDS Day Newsletter

To learn more about our HIV/AIDS collections please visit our website or search our online catalogue.

All of the material showcased here is available for you to access in our research room. To make an appointment, please email: archives@lshtm.ac.uk.

World Aids Day 1 Dec 2023

World AIDS Day is a global movement to unite people in the fight against HIV and AIDS. In the UK, more than 105,000 people are living with HIV. Globally, an estimated 38 million people live with the virus. More than 35 million people have died of HIV or AIDS related illnesses over the past 40 years, making it one of the most destructive pandemics in history. The aim of World AIDS Day is to raise awareness on the real experiences of people living with HIV today, while celebrating the strength, resilience and diversity of the communities most affected. It is a moment to inspire the leadership needed to create a future where HIV doesn’t stand in the way of anyone’s life. For information on this campaign visit World Aids Day.

In an effort to raise awareness people are invited to purchase a red ribbon to signify awareness and support for people living with HIV. You can purchase these from the National Aids Trust. They also send out a pack of 100 fabric red ribbons FREE to anybody fundraising for National AIDS Trust in the UK. For more information, visit the World AIDS Day fundraising page. For other ways to get involved this World Aids Day visit their Join In page for ideas. You can also support their work by donating to National AIDS trust.

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Supporting early career women in LMICs in health through mentoring Health Equity: Access to quality services and caring for underserved Populations

By: Nanuka Jalaghonia (Health Systems Global), Sandra Mounier-Jack (Health Policy and Planning) and Ami Bhavsar (Health Policy and Planning)


This supplement, a collaboration between Health Systems Global, the Alliance for Health Policy and Systems Research and Health Policy and Planning, is the result of mentorship programme to support early-career women conducting Health Policy and Systems Research in Low- and Middle- Income Countries. The program guided 13 mentor-mentee pairs from 16 different countries through an almost two-year-long journey in preparing a high-quality manuscript for a peer-reviewed journal. It encompassed various stages, starting from the initial submission of abstracts and onboarding, followed by eight months of dedicated mentor-mentee engagement. This led to the submission of their papers for journal review, navigating through the peer review phase, experiencing acceptance, and in some cases, rejection. In the midpoint of the program mentors and mentees had an opportunity to meet in person to refine their papers, exchange feedback and gain valuable insights and suggestions from journal colleagues regarding submission.  

 The papers in this supplement span a wide range of equity-oriented topics and explore access to quality services and care for underserved populations.

This issue presents examples of constraints on mental health and maternal and childcare, and highlights a lack of accountability. These highlight how policies alone fall short without specific actions to meet population needs. Other research reveals that service delivery lacks a patient-centric approach and insufficiently addresses population requirements, and how individuals with lower education or limited resources face barriers to access.

Two papers analyse the COVID-19 pandemic’s burden on minority groups and high-risk populations. One explores mental health services, uncovering a disparity between policy documents and practical application. The other examines the government’s response to the healthcare and dietary needs of indigenous communities, revealing the absence of a justice-oriented approach in response planning and execution.

Countries (of correspondence authors) represented include Peru, Nigeria, Malawi, Kenya, Georgia, India.

We invite you to engage with the findings:


  1. Health equity: access to quality services and caring for underserved populations

Supplement Articles

  1. Paper promises: Peruvian frontline health workers’ perspectives on mental health policies during COVID-19
  2. ‘We stay silent and keep it in our hearts’: a qualitative study of failure of complaints mechanisms in Malawi’s health system
  3. Policy and practices shaping the delivery of health services to pregnant adolescents in informal urban settlements in Kenya
  4. Justice implications of health and food security policies for Indigenous peoples facing COVID-19: a qualitative study and policy analysis in Peru
  5. Do Indian women know about and use the emergency contraceptive pill? An analysis of nationally representative data from 2005–06 and 2019–21
  6. The nature, drivers and equity consequences of informal payments for maternal and child health care in primary health centres in Enugu, Nigeria
  7. Making progress in early-career publishing: evolutions of the women’s publication mentorship programme





Finish your toast!

“Finish your toast, Andre, then we’ll get the 51 to grandma’s”

I was 6 years old. My mum had taken me to the Birmingham Diaries café for tea and toast after my dental check-up: no breakfast on dental appointment days, but a treat for attending. I enjoyed the toast with butter dripping off it, pleased that Dr Crocker did not need to give me any fillings.

We crossed the Walsall Road to the bus stop, where a new Daimler Fleetline bus was waiting.  The bus crew emerged from the newsagents next to the stop and beckoned us on board. We sat on the back seat downstairs, me next to the emergency door. I liked sitting on this seat as someone had thoughtfully provided a padded armrest next to the emergency door, though the seat itself could get warm due to the proximity of the engine slung across the back. There was also a small sighting glass above the back window for the route number display, and two handles which I was under strict instructions not to play with. Perhaps my winding down of the tennis nets in Red House Park served as a warning to mum.

Birmingham buses of that era had two “loaf of bread” shaped notices positioned towards the front of both decks. One warned of the consequences of fare evasion, which I understood, but the other read “Spitting strictly prohibited. Offenders will be prosecuted”. I wondered who would dare spit on a bus?

“It must have been the workmen when they used to chew tobacco”, said mum. The approaching conductor had heard our conversation and said “Yes, that must be it. They’ve had those notices on the buses for as long as I can remember, and the old trams. Adult and child to the Beeches?”

“Yes, please” said mum, handing over some change. The conductor quickly flipped one lever of the ticket machine for mum’s adult ticket and another one for my half fare, handing the 2 pence child ticket directly to me and giving mum her change from his cash bag.

Two weeks ago I was cataloguing some pamphlets and came across one written by Alfred Greenwood (Medical Officer of Health, Crewe), published in London by the Sanitary Publishing Company, 1902. “The prevention of infection in public vehicles”. Here is a link to the digitised version:


As I read the text, I realised that the notice I had seen on the bus was based on considerations of prevention of infection on all forms of public transport, particularly important in the early part of the twentieth century as municipalities expanded their transport networks and urban areas grew and standards of housing were improved.

Image copyright Elliott Brown, (viewed on Flickriver )https://www.flickr.com/photos/ell-r-brown/44028627364

Book Display: National Stress Awareness Day

Header image from atlascompany on Freepik.

National Stress Awareness Day takes place this year on Wednesday 1st November 2023. Founded by the International Stress Management Association, it aims to raise awareness of workplace stress and ways to combat it. The Library stocks lots of titles on stress and mental health from many perspectives: the list below of those in the book display gives just a sample of them. You can find the majority of books on mental health under shelfmarks beginning with UJ, but try searching Discover with relevant keywords to find some electronic resources too.

If you’re feeling stressed at LSHTM for whatever reason, you might also find the services listed at LSHTM Student Support Services useful. From the financial hardship fund to counselling services, they are there to help you! If you’re looking instead for relaxing activities, one suggestion might be to investigate our Library Book Swap in the Library foyer. There’s about ten shelves’ worth of fiction and nonfiction to browse and borrow, or you can donate your own old books by asking at the Enquiry Desk.


New Indicator of Access of Cataract Care Demonstrated

A team led by the International Centre for Eye Health (ICEH) have demonstrated a new indicator that assesses how long people at risk of cataract need to travel to treatment.

Increasing age is a risk factor for developing cataract. Therefore, when planning services for age-related cataract, the group of interest tends to be people 50 and over. Evidence has also shown that older people living in rural and remote areas globally are more likely to develop sight loss from the condition as they are less able to access services.

Previously, ratios of the number of cataract surgeons and facilities that provide cataract surgery to the number of people in the population have been used, alongside other indicators, to demonstrate the access that people in that population have to treatment.

However, the travel time to treatment is also of importance. Service providers may be available and ready, but if they are not distributed among communities in such a way that all people can access them, they may not be used by certain groups.

New research by ICEH has demonstrated for the first time an indicator that countries can use to understand how many people aged 50 years and older live within a given travel time (e.g. 1 hour or 2 hours) of a public health facility providing permanent cataract surgical services.

To demonstrate the indicator, the researchers looked at data from Kenya, Malawi and Rwanda. They started by looking at publicly available lists of health facilities, then asked a ‘key informant’ in the eye care field from each country to assess which centres provided permanent cataract services.

For each country, both the number of people 50 years and older per location and the travel time across each area was estimated. Travel time was from a ‘friction surface’ map, which breaks down the world into 1km2 pixels and estimates how long it takes to get between them, dependent on the quality of roads, transport and terrain.

To this map of population and travel time for each country, the location of cataract surgical facilities were then added. Travel time was then assigned to levels: either 1 hour or less, 1-2 hours, 2-3 and more than 3 hours travel time to the nearest facility.

The number of permanent cataract facilities for each country, and the population aged 50 years and older able to reach them within in one or two hours were:

CountryPopulation over 50 able to reach a permanent facility in ≤1 hourPopulation over 50 able to reach a permanent facility ≤2 hour

Full maps and travel times per region of each country are available in the publication here.

Only a small percentage of people in all three countries lived more than 2 hours from a facility, with some intriguing outliers. For example, in Malawi, everyone aged 50 years or older in the northernmost two counties lived further than two hours travel time to a permanent facility.

This indicator also flagged up some potentially important new findings for planning services. In Rwanda, when looking at the number of cataract facilities per 100,000 population it was higher in one province than another. Yet, when using the travel time indicator, the reverse was true. Despite having more facilities, fewer people were able to access them within a defined journey time.

The work provides an exciting new addition to measures of eye health access used for service planning. Used alongside other indicators, such as effective cataract surgical coverage and cataract surgical rate, it can help to identify those most at risk of living with sight loss due to cataract.

The authors note a few limitations of the new indicator. Improvements in the data inputs, finer detailed friction surfaces and locally validated travel times would likely improve the readings. Future research will aim to strengthen a standardised methodology for the indicator, allowing its use alongside other more established ones.


McCormick, I., Nesemann, J.M., Zhao, J. et al. Travel time to cataract surgical services in Kenya, Malawi and Rwanda: demonstrating a standardised indicator of physical access to cataract surgery. Eye (2023)https://doi.org/10.1038/s41433-023-02790-8

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Winners of the John Snow 210th Birthday Map Competition Announced

To mark the 210th anniversary of John Snow’s birth, the John Snow Society launched a competition in September 2023 challenging enthusiasts to use creativity and modern methods to recreate his 1854 Soho map (pictured, updated). You can find out more about the original competition here.

The winners and highly commended maps are now available to view.

Competition Judges:

Professor James Hargreaves (London School of Hygiene and Tropical Medicine; co-Chair, John Snow Society)

William Roberts (Chief Executive Royal Society for Public Health; Steering Committee, John Snow Society)

Dr Shay Soremekun (London School of Hygiene and Tropical Medicine; Steering Committee, John Snow Society)

Dr Patrick Nguipdop-Djomo (London School of Hygiene and Tropical Medicine; Steering Committee, John Snow Society)

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