Diabetes & Obesity in Africa and the African Diaspora: burden, causes, challenges & solutions

Transcription

1 Diabetes & Obesity in Africa and the African Diaspora: burden, causes, challenges & solutions The RODAM Study Conference 2015 Towards a global initiative on gene-environment interactions in diabetes/obesity in African populations 7/8 September 2015 Accra, Ghana Venue: Noguchi Memorial Institute for Medical Research

2 Foreword The lives of far too many people in Africa, including Ghana, are being blighted and cut short by diabetes and other related non-communicable diseases (NCDs), such as heart disease, stroke, cancer and chronic respiratory diseases. Diabetes is the next leading cause of limb amputation, secondary to accidents; and combined with hypertension the major cause of heart disease and stroke. Diabetes and other NCDs are a new epidemic on the African continent and unfortunately will cause untoward suffering to many families and further strike hardest at the national economies. This is not happening in high-income countries, despite NCDs being the leading global causes of death. In Africa this is happening because NCDs strike hardest at the low- and middle-income populations, causing the most profound effect on morbidity and mortality. These diseases have reached epidemic proportions in Africa, yet they could be significantly reduced, with millions of lives saved and untold suffering avoided, through reduction of their risk factors, early detection and timely treatments. This Scientific Conference has been organised by the RODAM Consortium with participation of other stake holders in the prevention and care of diabetes and other NCDs to address the issues of diabetes and other chronic diseases on the African continent, based on the findings from the RODAM study. The conference is based on the awareness that sound and explicit government policies are the key to effective prevention and control of chronic diseases in many countries. The next step is to translate the findings into action, and to do so strategically. Dr Silver Bahendeka Immediate Past Chair, IDF Africa Region 1

3 Table of contents Page Foreword... 1 Table of contents... 3 Background / Overview... 4 Programme at a glance... 6 Conference speakers' and moderators' profiles Abstracts List of Participants Acknowledgements Contact

4 Welcome from the Programme Committee Dear Colleagues, On behalf of the whole Programme Committee we would like to warmly welcome you to Conference in Accra, Ghana - Akwaaaba! the RODAM With the growing burden of obesity and Type 2 diabetes and related complications among African migrants in Europe and in Africa, European and African partners initiated the RODAM project in 2012 to assess the burden of obesity and diabetes and to unravel the potential factors contributing to the rising levels of obesity and diabetes among these populations in both Europe and Africa with the support of the European Commission. The RODAM consortium has conducted one of the largest health assessments among African migrants and their compatriots living in Africa. The RODAM study focused on Ghanaians living in 3 European cities (Amsterdam, Berlin & London) and Ghanaians living in rural and urban Ghana to identify important lifestyle changes, social, psychosocial, biological and epigenetic factors contributing to the high burden of obesity and Type 2 diabetes and other health outcomes ( Programme Committee Dr Ellis Owusu-Dabo (Chair for the Conference) - Kwame Nkrumah University of Science and Technology Prof. Ama de Graft Aikins (Co-Chair for the Conference) - University of Ghana Dr. Silver Bahendeka (Co-Chair for the Conference) - Immediate Past President, IDF Africa Prof. Charles Agyemang (Co-Chair for the Conference) - Academic Medical Centre, University of Amsterdam Dr Erik Beune (Coordinator) - Academic Medical Centre, University of Amsterdam The aim of this conference is to discuss the key findings of the RODAM study with policy makers, researchers, academics and next generation scientists and the Ghanaian public, and to determine how the findings can be used to help develop prevention strategies and clinical management of obesity and diabetes among African migrants and their compatriots living in Ghana. We hope the presentations by our excellent speakers will inspire all of us to tackle the increasing burden of obesity and diabetes among the African populations both in Africa and outside Africa. At this point we would like to express our utmost appreciation to all those who have contributed to this conference: The Programme Committee for their guidance in developing a balanced and interesting programme, all the speakers from different countries for preparing and presenting thought provoking papers, the RODAM consortium for working hard to consolidate research results for our discussion today and tomorrow, and last but by no means least, the Local Organising Committee for its enthusiastic organization of the conference. Local Organising Committee Prof Ama de-graft Aikins - University of Ghana Dr Ellis Owusu-Dabo - Kwame Nkrumah University of Science and Technology Mrs Henrietta Addai - Kwame Nkrumah University of Science and Technology Mrs Gwendolene Asare-Konadu - University of Ghana Raphael Baffour Awuah - University of Ghana Ernest Afrifa-Anane - University of Ghana Sandra Boatemaa - University of Ghana Olutobi Sanuade - University of Ghana Sincerely, Dr. Ellis Owusu-Dabo Prof. Ama de Graft Aikins Dr. Silver Bahendeka Prof. Charles Agyemang (Chair for the Conference) (Co-Chair) (Co-Chair) (Co-Chair) 4 5

5 PROGRAMME at a glance PROGRAMME at a glance MONDAY SEPTEMBER 7th, 2015 ( ) : Scientific Programme - RODAM results : Registration & Welcome : Opening remarks and welcome note (Dr Ellis Owusu-Dabo, Chair for the Conference) : Opening Ceremony (Chairs: Dr Ellis Owusu-Dabo, Prof. Ama de-graft Aikins & Dr Silver Bahendeka) : Welcome address (Prof. Ernest Aryeetey, Vice Chancellor, University of Ghana) : Keynote address (Honourable Dr Victor Bampoe, Deputy Minister for Health) : Epidemiology of diabetes in Africa (Prof. Andre Pascal Kengne, South Africa) : Human Heredity and Health (H3Africa) - Enabling the Genomic revolution in Africa (Dr Dwomoa Adu, College of Health Sciences, University of Ghana) : Coffee break : Genetic predispositions, complications, and people's knowledge and perception of T2D and Obesity (Chairs: Prof. Liam Smeeth & Dr Dwomoa Adu) : Contribution of genetic and epigenetic factors to the expression of Obesity and Type 2 Diabetes: the RODAM study Miss Karlijn Meeks, AMC, University of Amsterdam & Dr Tom Burr, Source BioScience, UK : Perceptions and Knowledge of Type 2 diabetes & obesity among Ghanaians in Ghana and Europe Prof. Ama de-graft Aikins, University of Ghana : Medication adherence among Ghanaian migrants and non-migrants treated with antihypertensive, antilipidemic and oral antidiabetic medications - The RODAM study Dr Erik Beune, AMC, University of Amsterdam : Complications of diabetes among Ghanaians Prof. Benjamin A. Eghan, Kwame Nkrumah University of Science & Technology : Burden, lifestyle and social factors influencing T2D and Obesity among Ghanaians (Chairs: Prof. Karien Stronks & Prof. Kerstin Klipstein-Grobusch) : Tea / Coffee break : Research on Obesity and Type 2 Diabetes among African Migrants: The RODAM study Prof. Charles Agyemang, Academic Medical Centre (AMC), University of Amsterdam : Lifestyle and social factors influencing Type 2diabetes and obesity among Ghanaians: The RODAM study Dr Juliet Addo, London School of Hygiene & Tropical Medicine, London, UK : Nutrition transition and type 2 diabetes in Ghanaian populations: The RODAM study Dr Ina Danquah & Dr Cecilia Galbete, German Institute of Human Nutrition, Potsdam- Rehbruecke, Germany : Implications of RODAM (Chairs: Dr Juliet Addo & Prof. Charles Agyemang) : Discussion with audience about translation of RODAM findings into recommendations for a) public health/policy, b) treatment and c) future research on T2D and Obesity : Drinks & Networking : Lunch 6 7

6 PROGRAMME at a glance TUESDAY SEPTEMBER 8th, 2015 ( ) : RODAM results - implications for policy & practice : Welcome & Coffee : Round table discussion: Implications for health promotion and prevention (Chairs: Prof. Charles Agyemang & Prof. Karien Stronks) : Discussion on the key issues of day one Prof. Karien Stronks : Presentation by Ministry of Health Ghana on response to growing threat of NCDs Dr Kofi Nyarko : Discussion with the audience: Ministry of Health s response to growing threat of NCDs : Presentation by WHO Ghana on response to NCDs in Ghana Dr Sally-Anne Ohene : Discussion with the audience: WHO Ghana s response to NCDs : Lunch break : Round table discussion: Implications for treatment of T2D/obesity and complications (Chairs: Prof. Liam Smeeth & Dr Silver Bahendeka) : Challenges of clinical management of diabetes among Ghanaians (Prof. Benjamin Eghan, Dr Yacoba Atiase, Dr Dwomoa Adu) Short 5-minute presentations by each followed by discussion with the audience :00: Round table discussion: Implications for future research on T2D/obesity (Chairs: Prof Ama de-graft Aikins & Dr Ellis Owusu-Dabo) : Implications for future research on Diabetes and obesity and the way forward (Prof. Liam Smeeth, Dr Dwomoa Adu, Prof. Charles Agyemang, Prof. Andre Pascal Kengne, Dr Silver Bahendeka & Prof. Karien Stronks) and discussion with the audience : Closing ceremony (Prof. Ama de-graft Aikins, Dr Ellis Owusu-Dabo, Prof. Karien Stronks, Dr Silver Bahendeka & Prof. Charles Agyemang) 9

7 Conference speakers and moderators profile Conference speakers and moderators profile Dr Juliet Addo Dr Juliet Addo is a clinical lecturer in Epidemiology in the Department of non-communicable disease (NCD) Epidemiology at the London School of Hygiene and Tropical Medicine (LSHTM) where she co-organises the module for the Distance Learning MSc in Global Epidemiology of NCD. She previously worked as a clinician at the National Diabetes Management and Research Centre at the Korle Bu teaching hospital, Ghana and also as a researcher on the South London Stroke Register at King s College, London. Her research has focused on cardiovascular diseases and their risk factors including strokes, hypertension and diabetes. She is particularly interested in the ethnic and socioeconomic differences and inequalities in their risks, management and outcome. Prof. Ama de-graft Aikins Prof. de-graft Aikins is an Associate Professor of Social Psychology at the Regional Institute for Population Studies and Vice Dean of the School of Graduate Studies, University of Ghana. She received her PhD in Social Psychology from the London School of Economics and Political Science and completed post-doctoral training at the University of Cambridge. Her research focuses on representations and experiences of chronic physical and mental illnesses among Ghanaians in Ghana, Europe and the USA, and on Africa s chronic non-communicable disease (NCD) burden. She is engaged in NCD advocacy and has served on NCD committees convened by the Ghana Health Service and the WHO. Since 2006, she has co-directed the Academic Partnership on Chronic Conditions in Africa (APCCA), a British Academy-supported partnership of multi-disciplinary NCD researchers based in Africa, Europe and North America ( apccafrica.org).. Dr Dwomoa Adu Dr Dwomoa Adu is an Honorary Consultant Nephrologist at the Korle Bu Teaching Hospital and an Honorary Research Fellow at the University of Birmingham. He is a researcher, physician and teacher. His current research interests have been the prevalence, causes and genetics of chronic kidney disease in Africa. He is Co-Principal Investigator at the College of Health Sciences, University of Ghana of the H3Africa Kidney Disease Research Network grant (NIH). He is the Chairman of the H3Africa Steering Committee and past President of the African Association of Nephrology. Dr Yacoba Atiase Dr Atiase is a Physician Specialist and Diabetologist at the Korle bu Teaching Hospital and a lecturer at the University of Ghana School of Medicine and Dentistry. Her research interests include prevention of diabetes complications. She enjoys diabetes education particularly to doctors and health care providers because she believes she reaches more patients this way than she ever will in her consulting room. Prof. Charles Agyemang Prof. Agyemang is an Associate Professor at Amsterdam Medical Centre, University of Amsterdam. He received his PhD from Erasmus Medical Centre, University of Rotterdam. Prior to this, he studied and did his Master s degree in Public Health at Edinburgh Medical School, University of Edinburgh. His research focusses on cardiovascular diseases (CVDs) among ethnic minority groups in Europe and in low-resource settings where he has published extensively with over 160 publications. He is a project leader and scientific coordinator of the RODAM study and co-investigator of the EC-funded InterConnect project. He was a member and a rapporteur of the Planning Committee for the WHO Global Consultation on Migrant Health. He is the current Vice President of the Migrant Health section of the European Public health Association and an associate editor for BMC Public Health. Prof. Ernest Aryeetey Prof. Aryeetey is the Vice-Chancellor of the University of Ghana and a Professor of Economics. Prior to this, he was a Senior Fellow and Director of the Africa Growth Initiative at the Brookings Institution, Washington, D.C. He was also Director of the Institute of Statistical, Social and Economic Research (ISSER) of the University of Ghana. His research focuses on the economics of development and in particular the role of institutions and financial systems in development, regional integration, economic reforms, and small enterprise development. He is widely known for his work on informal finance and microfinance in Africa. He has consulted for various international agencies on a number of development and political economy subjects. Dr. Kofi Agyenim-Boateng Dr. Kofi Agyenim-Boateng is consultant physician at the Komfo Anokye Teaching Hospital (KAITH), Department of Medicine. Dr Agyenim-Boateng has worked as a specialist in diabetes for over 29 years and is heavily involved Continuing Medical Education (CME), teaching doctors, nurses and patients how to improve patient care. At the national level, he supports the organization and delivery of medical programs to health care teams at regional and district hospitals, and to members of the Society of Private Medical Practitioners in the northern sector of Ghana. For over two decades, Dr Agyenim-Boateng has been a part of the Ghana Diabetes Association, through which he gives regular talks on various aspects of diabetes care and selfmanagement to numerous religious organizations and social clubs. His research interests include diabetes mellitus, diabetes nephropathy, and genetics of diabetes mellitus. Dr Silver Bahendeka Dr Bahendeka is a Senior Consultant Physician, Diabetes and Endocrinology at St. Francis Hospital Nsambya, Kampala, Uganda and Hon. Lecturer Mother Kevin Post Graduate Medical School, Uganda Martyr s University, Kampala. His PhD work focused on Gastric Inhibitory Polypeptide in Obesity in the 1980s and has continued to work in the field of diabetes. He is the Immediate Past Chair, IDF Africa Region, current Chair of the East Africa Diabetes Study Group (EADSG) and interim Chair of the Africa Diabetes Congress (ADC). He is the lead for WP9 in RODAM

8 Conference speakers and moderators profile Conference speakers and moderators profile Honourable Dr. Victor Bampoe, Deputy Minister for Health Dr Victor Bampoe is the deputy Minister of Health - a role he has held for a year. Victor is also the Incident Commander of Ghana's Ebola Emergency Operations Center (EOC). Before being appointed by President John Mahama to this role, Victor was a Senior Fund Portfolio Manager at the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria based in Geneva, Switzerland. In that role, Victor was responsible for managing grants to fight the three diseases in South Africa, with a total value of over $ 800 million. Victor worked at the Fund in various capacities from 2005; he served as the Fund Manager in Uganda, Kenya, Zambia and Rwanda, and was also the Risk Manager at the Fund, as well as the Team Leader for Southern Africa. Before he took up his role at the Global Fund, he worked with the UK Department for International Development as a Regional Health and HIV adviser, and before that, as a Medical Officer with the Ministry of Health. Victor is a medical doctor by training, with a specialization in Public Health obtained at the Johns Hopkins School of Hygiene and Public Health in Baltimore, USA. Prof. Benjamin A. Eghan Prof. Ackon Eghan is a Nephrologist and an Associate Professor at the Department of Medicine of Kwame Nkrumah University of Science Technology (KNUST). Primary qualification at school of Medical sciences, KNUST and postgraduate training at Imperial College (Royal Postgraduate Medical School) London and University of Ulm in Germany. He has lectured in the areas of Nephrology and diabetology locally and internationally. His research interests include diabetes mellitus, glomerulonephritis, diabetes nephropathy, clinical epidemiology, anaemia in CKD, diabetes mellitus and genome, renal replacement therapy and metabolic syndrome. Dr Erik Beune Dr Erik Beune is a Post-Doctoral researcher at the department of Public Health, Amsterdam Medical Centre, University of Amsterdam (AMC-UvA). He has a background in Physiotherapy and Interdisciplinary Social Science. He obtained his PhD (2010) at the department of General Practice, AMC-UvA. His research is focused on lay concepts towards cardiovascular risk factors among African migrants and how these concepts affect health behaviours (physical activity, adherence to treatment recommendations). He has a particular interest and expertise in the development, implementation and evaluation of culturally adapted interventions into clinical care and public health settings. He is the project coordinator of the RODAM study. Dr Cecilia Galbete Dr Galbete studied Biology at the University of Navarra, Spain, where she also defended her PhD thesis about nutritional and genetic interactions in the development of obesity, within the frame of the SUN study. After her dissertation she was involved as a research assistant in the PREDIMED project, one of the biggest clinical trials developed in Spain, focused in the study of the Mediterranean diet for the prevention of Cardiovascular disease. Nowadays she is working on her post-doctoral research at the German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) within the RODAM project, and her research is focused on the nutritional factors influencing T2DM and obesity in this sub-sahara African populations. Dr Tom Burr After post-doctoral positions in Molecular Genetics at Harvard Medical School and the University of Cambridge, Tom joined Source BioScience as Head of R&D in He is currently Scientific and Technical Director of the Source BioScience Group which provides products and services including genomics, healthcare and stability storage. Prof Andre Pascal Kengne Prof. Kengne is a medical doctor and internist from the School of Medicine of Yaounde in Cameroon; and holds a PhD in medicine from the Sydney University, Australia. He is the current Director of South African Medical Research Council s Non-Communicable Diseases Research Unit, and holds conjoint appointments as Associate Professor at the Department of the Department of Medicine of the University of Cape Town, South Africa. His areas of research include chronic diseases epidemiology and prevention in developing countries, decision making in diabetes and cardiovascular disease. He is co-author of over numerous peer-reviewed articles, book chapters and monographs on chronic diseases in Africa and at the global level. Dr Ina Danquah Dr Danquah has specialized in nutritional epidemiology with the focus on metabolic diseases in African populations. She has studied Food and Nutrition Science at the University of Potsdam and the University of Ghana, Legon. During her dissertation at the Komfo Anokye Teaching Hospital Kumasi and the Charité Berlin, Ina Danquah investigated the interplay between nutrition and malaria in different Ghanaian populations. Since 2010, she works as a postdoc at the German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) where her main research fields are nutritional risk factors for type 2 diabetes and obesity, and the importance of malnutrition and infection for metabolic diseases. Prof. Kerstin Klipstein-Grobusch Prof. Klipstein-Grobusch is an Associate Professor of Global Health at the Julius Center for Health Sciences, University Medical Center Utrecht, The Netherlands ( and Visiting Associate Professor of Epidemiology at the School of Public Health, University of the Witwatersrand, South Africa. She is a cardiovascular disease epidemiologist with particular experience in nutritional epidemiology and the application of epidemiologic methods for chronic disease research in international multi-centre cohort studies and health and demographic surveillance. Current research projects focus on pregnancy-induced hypertension, maternal and child health, obesity and diabetes research among sub-saharan African migrant populations in Africa and Europe and the interface of communicable and non-communicable diseases

9 Conference speakers and moderators profile Miss Karlijn Meeks Miss Meeks is PhD Student on the RODAM project since January She has both a bachelor and a master degree in Nutrition in Health from Wageningen University. During her master s she specialized in nutrition in African countries. Internships for UNICEF and a small-scale NGO in Namibia taught her how to do research on malnutrition. Within RODAM she focuses on the role of genetic and epigenetic risk factors in type 2 diabetes and obesity. A five-month training at the National Institutes of Health (NIH) equipped her with the skills to analyze genetics data. Dr Kofi Mensah Nyarko Dr Nyarko is a public health physician and an epidemiologist at the Ghana Health Service, Ghana. He is the Program Manager of the Non Communicable Diseases (NCDs) Control Program of the Ghana Health Service, Ministry of Health. He leads the planning, organization and the implementation of key NCDs intervention at all levels of care. He is also involved with translating major NCD related findings into policy. Dr Nyarko is also a part time lecturer at the Department of Epidemiology and Disease Control at School of Public Health, University of Ghana. He is also the Program Director for the Ghana Field Epidemiology and Laboratory Training Program (GFELTP) which is the key for training field epidemiologist in Ghana. His research is focused on Chronic Disease Epidemiology especially in the areas of Cardiovascular, Diabetes and Cancers. His primary interest is identification of key drivers to the burden of NCDs in developing countries and how to develop intervention to reduce the disease burden at the population level. Prof. Liam Smeeth Liam Smeeth is professor of clinical epidemiology and Head of the Department of Noncommunicable Disease Epidemiology at the London School of Hygiene and Tropical Medicine. He also undertakes clinical work as a general practitioner in north London. Much of his research is based on making better use of computerised clinical data both to investigate drug effects and disease aetiology. He holds a Wellcome Trust Senior Fellowship in Clinical Science and is Deputy Director of the Farr Institute London, one of the four UK Health Informatics Research Centres. His broad interests include disease aetiology, drug effects, genetics and non-communicable diseases in low income settings. He is involved in a range of activities for the National Institute for Health and Care Excellence and the National Health Service more widely. Prof. Karien Stronks Prof. Karien Stronks was trained as an epidemiologist, and is now professor of social medicine at the Amsterdam Medical Center (AMC/UvA), and chair of the AMC Department of Public Health. She obtained her PhD (1997) at the Department of Public Health at the Erasmus University. She is a leading expert in research on health inequalities in Europe, with special interest in strategies to effectively combat socioeconomic inequalities in health in real-world situations, and ethnic inequalities in cardiovascular health. She acts as principal investigator on a large number of projects, among which the HELIUS study on ethnic inequalities in cardiovascular health, and the DHIAAN study on the prevention of diabetes mellitus type 2 in South Asian populations. She works closely with several departments in the AMC and at other Dutch and European universities, as well as with the Amsterdam municipal health service. She has published more than 250 papers in international peer reviewed journals. Dr Sally-Ann Ohene Dr Sally-Ann Ohene graduated from the University of Ghana Medical School and trained as a pediatrician. She is now a public health physician currently working at the WHO Country Office in Ghana. She is the Disease Prevention and Control Officer and is responsible for non-communicable diseases. Dr Ellis Owusu-Dabo Dr. Owusu-Dabo is a medical epidemiologist and a public health physician specialist who completed his B.Sc. in Human Biology, MB ChB in Medicine and Surgery, and M.Sc. in Public Health at the Kwame Nkrumah University of Science and Technology (KNUST) Kumasi, Ghana. After completing his specialist training in Public Health at the West Africa College of Physicians, he then proceeded to complete his doctoral work at the University of Nottingham, at the Division of Epidemiology and Public Health, UK. Dr. Owusu- Dabo s research focuses on epidemiology and population genetic risk factors for pulmonary tuberculosis (TB) and type II mellitus and other noncommunicable diseases in low income settings. His passion is biomedical research and training young Scientists to solve health problems

10 ABSTRACTS Epidemiology of diabetes in Africa Prof. Andre Pascal Kengne, presenter (Non-Communicable Diseases Research Unit, South African MRC & University of Cape Town) Diabetes mellitus is a growing threat to the health of populations worldwide. The landscape of diabetes in Africa is changing rapidly. As such, Africa which was often considered to be a region where diabetes was a very rare condition, is currently the region of the world where the fastest increase of the population of people with diabetes is being experienced. While estimates suggest that about 20 million people a currently living with diabetes in Africa, figures will nearly double within the next two decades. Environmental changes from rapid urbanisations are key drivers of the growing diabetes in Africa. The combined effect of unhealthy eating habits and sedentary lifestyles lead to overweight and obesity which are major precursors of diabetes. Population-based studies have consistently reported a low awareness of diabetes across Africa, with over 2/3rd of people with the disease being unaware of their status. It is therefore not unusual in this setting for people with diabetes to seek medical attention only at the advanced stage of the disease, with complications. Health facilities based studies have also shown that those already diagnosed with diabetes are not receiving optimal care across Africa and therefore remain at high risk of diabetes complications. While, there are indications that countries in the region are increasingly embracing the case of diabetes and non-communicable diseases in general, the health systems across Africa remain ill-prepared to provide adequate preventive and management solutions for diabetes. Economic studies further suggest that the cost of providing those solution is beyond the reach of number of countries in the regions, within the context of other competing priorities. Human Heredity and Health (H3Africa) - Enabling the Genomic revolution in Africa Dr Dwomoa Adu, presenter (College of Health Sciences, University of Ghana) The Human Hereditary and Health in Africa (H3 Africa) consortium was established by the Wellcome Trust (United Kingdom), the National Institute of Health (NIH) and the African Society of Human Genetics in June 2012 to facilitate a contemporary research approach to the study of genomics and environmental determinants of common diseases with the goal of improving the health of Africans. As of August 2014, the consortium comprises of 23 individual projects. The H3Africa consortium is now funded at over $76 million over five years and is focused on capacity building as well as specific scientific goals. There are collaborations within Africa with over 500 scientists in 27 African countries engaged in H3Africa with the intention of recruiting up to research subjects. Research domains include stroke, schizophrenia, CVD, diabetes, sickle cell disease, cardiometabolic disorders, trypanosomiasis, kidney disease, nasopharyngeal and respiratory diseases, tuberculosis, rheumatic heart disease, inherited neurologic disorders. Research on Obesity and type 2 Diabetes among African Migrants: the RODAM study Prof. Charles Agyemang, presenter on behalf of the RODAM Consortium (Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands) Background: Sub-Saharan Africa origin populations in Europe have increased substantially for the last few decades. Evidence suggests that the risk of obesity and Type 2 diabetes (T2D) is higher in these populations than in European host populations. By the same token, the prevalence of T2D and obesity are on the rise in many SSA countries including Ghana. With the increasing prevalence of obesity and T2D and their adverse complications in these populations, there is an urgent need to unravel the underlying factors to guide prevention and treatment efforts among Sub-Saharan Africa populations. Aim: The overall aim of the RODAM (acronym for Research of Obesity & Diabetes among African Migrants) study ( was therefore to understand the reasons for the high prevalence of obesity and T2D among Ghanaians in diaspora by (1) studying the complex interplay between environment (e.g., lifestyle), healthcare, biochemical and (epi)genetic factors, and their relative contributions to the high prevalence of obesity and T2D; (2) to identify specific risk factors within these broad categories to guide intervention programmes and (3) to provide a basic knowledge for improving diagnosis and treatment. The results of the current burden of T2D and obesity among resulting from the RODAM study would be discussed. Methods: Multi-centre study among Ghanaians aged >25 living in three European cities (i.e. Amsterdam, Netherlands; Berlin, Germany; and London, UK) and their compatriots living in rural and urban Ghana. The RODAM project aimed to randomly recruit 1,250 participants from each site (n=6250); and carry out a qualitative study on perceptions and knowledge of obesity and T2D in all site. Results: Significant achievements have been made since the inception of the study. The data collection is completed in all sites with a remarkable 98% success rate of the intended sample size. Prevalence of T2D (WHO criteria) and obesity (BMI>=30Kg2) differed importantly among Ghanaians living in different settings. Among men, the prevalence of T2D was 5 times higher in urban Ghanaians to 11 times higher in Berlin Ghanaians compared with rural Ghanaians. Among women, T2D prevalence was 2.5 times higher in urban Ghanaians to 5 times higher in Berlin Ghanaians compared with rural Ghanaians. For obesity, the prevalence was 5 times higher in urban Ghanaians to 10 times higher in London Ghanaians in men; and from 2.6 times higher in urban Ghanaians to 3.6 times higher in London Ghanaians in women compared with rural Ghanaians. The role of lifestyle, social, nutrition, (epi)genetics, perceptions and knowledge, and complications of obesity and T2D would be discussed by various RODAM partners. Discussion and conclusion: The RODAM project has achieved a significant result in collecting these unique data on Ghanaian migrants in European countries and their compatriots living in their home country. T2D and obesity are a major burden among urban and migrant Ghanaians in Europe. These data would allow us to gain insights into genetic and non-genetic factors contributing to the occurrence of obesity and T2D and will inform targeted intervention and prevention programmes, and provide the basis for improving diagnosis and treatment in these populations and beyond. African genomes and the unique genetic structure of African populations harbor many clues to understanding human evolutionary history which, in turn, can help shed light on disease etiology. Thus for example the increased risk of CKD among those of African origin is largely associated with genetic variants within the apolipoprotein L1 gene. Selection of (APOL1) genetic variants offering protection against trypanosomiasis (African sleeping sickness) was suggested to have been influenced by disease endemicity in sub-saharan Africa. 1. Rotimi C, Abayomi A, Abimiku A, Adabayeri VM, Adebamowo C, Adebiyi E, Ademola AD, Adeyemo A, Adu D. et alresearch capacity. Enabling the genomic revolution in Africa. Science (New York, NY). 2014;344: Osafo C, Raji YR, Burke D, Tayo BO, Tiffin N, Moxey-Mims MM, Rasooly RS, Kimmel PL, Ojo A, Adu D and Parekh RS. Human Heredity and Health (H3) in Africa Kidney Disease Research Network: A Focus on Methods in Sub-Saharan Africa. Clin J Am Soc Nephrol DOI: /cjn

11 Lifestyle and social factors influencing diabetes and obesity among Ghanaians: The RODAM study Nutrition transition and type 2 diabetes in Ghanaian populations: The RODAM study Dr Juliet Addo, presenter on behalf of the RODAM Consortium (London School of Hygiene & Tropical Medicine, London, UK) Background: The traditional risk factors for Type 2 diabetes and obesity are themselves determined by a range of drivers that may influence disease patterns through complex processes. Aim: In this study we assessed the distribution of lifestyle, socioeconomic and psychosocial factors in Ghanaians living in different locations (urban Ghana, rural Ghana and Europe) and examined the patterning of the association between these factors and the prevalence of diabetes and obesity in the different environments. Methods: Using data from 5679 participants aged years recruited to the RODAM Study, we calculated agestandardised prevalences of lifestyle (physical activity, smoking), socioeconomic indicators (education, occupation and employment status), psychosocial factors (stress, depression and perceived discrimination) and assessed the associations with obesity and diabetes using Poisson regression with robust standard errors. Results: The highest level of physical activity was among men in rural Ghana and the lowest was among women in urban Ghana. Smoking prevalence was significantly higher in men compared to women across sites and was highest in men in Europe. Ghanaian women in Europe were more likely to smoke compared to women in Ghana. Combining data from all sites, higher levels of education and occupational class were associated with a higher prevalence of obesity but not diabetes. Using site-specific data, higher levels of education and occupation were associated with higher prevalence of diabetes and obesity in rural Ghana but not in the other sites. Being in employment decreased the prevalence of both diabetes and obesity in Europe, but not in urban Ghana. There was no significant association between psychosocial factors and the prevalence of diabetes or obesity in the study across sites. Discussion and conclusion: There were differences in the social patterning of obesity and diabetes comparing rural Ghana, urban Ghana and Ghanaian populations living in Europe. Policies and public health interventions to reduce obesity and diabetes are likely to be most effective when considering socioeconomic circumstances in different environments, and prevention strategies must be well targeted to also address unhealthy lifestyle factors in different settings. Dr Ina Danquah & Dr Cecilia Galbete, presenters on behalf of the RODAM Consortium (German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Germany) Background: Nutrition is an important risk factor for Type 2 diabetes (T2D) and obesity, but has only been insufficiently addressed in the context of migration-related lifestyle changes among Ghanaians. As diet does not rely on single foods and nutrients, we aimed at identifying dietary patterns within the RODAM study population. Methods: We assessed the usual intake of food groups by means of a population-specific Food Propensity Questionnaire. Dietary patterns were identified applying principal component analysis. We calculated odds ratios for T2D across quintiles of the identified pattern scores using multivariate-adjusted logistic regression. Results: Three dietary patterns were identified. The mixed pattern comprised manufactured foods, but also whole grain products, vegetables, poultry, and dairy products; patterns adherence was predicted by female sex and more years of migration. The traditional pattern was characterized by the consumption of nuts and seeds, roots and tubers, fruits, fermented maize products, fish, and palm oil; more women and residents in Ghana adhered to that pattern. The animal product pattern relied on dairy products, rice and pasta, eggs, red and processed meat, and cakes and sweets; determinants of adherence were male sex, younger age, urban Ghanaian environment, and better education. When comparing higher pattern score points (>80%) with lower score points (<20%), the risk of T2D (WHO definition) was halved for the mixed pattern, was 2.4 fold higher for the traditional pattern, and was almost tripled for the mixed pattern in a model adjusted for age, sex, educational level, and BMI. These figures were similar, but slightly weaker, when applying the ADA definition of T2D. Discussion and conclusion: A healthy diet to prevent T2D in Ghanaian populations needs to balance the enculturation of beneficial, traditional meals and the acculturation of favorable, westernized foods. A lack of dietary diversity may contribute to T2D in Ghana. Media campaigns might consider including education on the direct relationship between meat consumption and T2D

12 Contribution of genetic and epigenetic factors to the expression of Obesity and Type 2 Diabetes: the RODAM study Perception and Knowledge of T2D & obesity among Ghanaians in Ghana and Europe Miss Karlijn Meeks (1) & Dr Tom Burr (2), presenters on behalf of the RODAM consortium (1 AMC, University of Amsterdam, Amsterdam, The Netherlands / 2 Source BioScience, Nottingham, UK) Introduction: Sub-Sahara Africans in diaspora are disproportionally affected by type 2 diabetes (T2D) and obesity. Genetic predispositions and substantial environmental changes upon migration are likely to be involved in the onset and development of T2D and/or obesity among SSA migrant populations. Lifestyle factors have been shown to affect the regulation of gene transcription. This phenomenon is called epigenetic regulation. Aim: The primary aim of this study was to identify genes and epigenetic changes associated with T2D and obesity in SSA populations. Methods: In order to detect genes associated with T2D and obesity we genotyped a subset of the RODAM project sample (n=1996) using the African Diaspora Power (ADP) chip. This chip contains about 600k genetic markers covering especially common African genetic variation. The subset sample included all T2D cases (n=546), 1 on 1 matched with non-diabetic controls and obesity cases (n=450), matched with non-diabetic, nonobese controls. We performed genome wide association analysis on T2D vs. controls and obesity vs. controls. To detect epigenetic changes we used the Illumina 450k DNA-methylation array on a subset of 735 RODAM participants, including 300 T2D cases who were not using medication, 300 matched controls, and a group of 135 non-diabetic, non-obese controls. Association analysis was performed for both T2D and obesity, comparing genome wide DNA methylation levels between cases and controls controlling, when appropriate, for age, gender, obesity, blood cell distribution, migration and technical batch effects. Results: After extensive quality control of the genetic dataset approximately 330k markers remained for genome wide association analysis. None of the markers reached genome-wide significance either for T2D or obesity. For T2D the top hits were mostly intergenic (between genes). Analysis of obesity resulted in mostly intronic (within genes) hits located in genes that have been associated with obesity related traits in previous studies. Extensive quality control of the epigenetic dataset yielded good DNA-methylation profiles for approximately 350 participants. Association analysis for both T2D and obesity showed several genome wide significant genomic differentially methylated positions. Evaluation of the top-hits is ongoing. Discussion and conclusion: To our knowledge, this is the first time African descent specific SNPs have been tested in a SSA population. The primary findings suggest that African specific SNPs do not explain the high burden of T2D and obesity in SSA populations. Future large sample meta-analysis is needed to reveal the contribution of known or novel T2D and obesity associated genetic variation in this population. Preliminary results on the association of epigenetic variation are promising. However, the exact role of epigenetic variation next to genetic variation has to be elucidated further and ideally, has to be confirmed in an independent sample. Prof. Ama de-graft Aikins, presenter on behalf of the RODAM Consortium (Regional Institute for Population Studies, University of Ghana) Background: Ethnic minority and migrant populations in Europe are disproportionately affected by both obesity and type 2 diabetes (T2D) compared with the host European populations. Interventions to reduce obesity and T2D have often been ineffective within this group. Aim: The proposed paper will report insights from the RODAM qualitative study. The aim was to examine (1) perceptions and knowledge of obesity and T2D among Ghanaian migrants to Europe, and their compatriots in Ghana; (2) whether perceptions and knowledge of obesity and diabetes differed between the two Ghanaian groups and (3) specific perceptions and knowledge gaps that might predispose Ghanaian migrants to higher risk of obesity and diabetes. Methods: Nine (9) pilot focus group discussions (with 58 participants) and 23 individual interviews were conducted in rural and urban Ashanti region, Amsterdam and London. For the main study, 26 focus group discussions (with 179 participants) were conducted across the 5 sites, 152 interviews with people with diabetes conducted across the 5 sites and an additional 30 interviews conducted with overweight and underweight individuals in rural and urban Ashanti. Results: Theoretically informed thematic analysis of the data suggested the following key insights. First, respondents across all 5 study sites had more comprehensive knowledge on obesity, weight and body image issues compared to diabetes. However obesity was not identified as a risk factor for diabetes, although obesity was associated with general health risks. Secondly, across all study sites diabetes was attributed to multiple causes falling under the categories of natural (e.g heredity), lifestyle (e.g poor diets, physical inactivity, alcohol overconsumption), structural (e.g stressful working conditions) and supernatural (e.g witchcraft). Limitations in knowledge of lifestyle and natural causes were identified. For example, poor lifestyle practices were considered to be the dominant cause of diabetes, however important aspects such as ageing and other chronic conditions were not widely known. Finally, while the content of knowledge on obesity and diabetes was similar across the sites, differences emerged on the relationship between the social environment and individual risk. Ghanaians in London, Berlin and Amsterdam perceived European cities to be more obesogenic than Ghanaian cities. Respondents also cited stressful work patterns (multiple jobs, long hours of work) and strongly associated their work patterns with poor eating habits, physical inactivity and obesity. Discussion and conclusion: These findings provide insights on the relationship between the social environment, culture, lifestyle and risk of obesity and diabetes that are relevant for the development of primary and secondary prevention strategies among Ghanaian migrants in Europe and their compatriots living in rural and urban Ghana. Drawing on best practices in Africa and Europe, potential strategies will be discussed

13 Medication adherence among Ghanaian migrants and non migrants treated with antihypertensive, antilipidemic and oral antidiabetic medications: the RODAM study Dr Erik Beune, presenter on behalf of the RODAM Consortium (Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands) Background: Despite effective treatments, suboptimal medication adherence substantially hinders treatment control among patients who are prescribed oral antidiabetic, antihypertensive, and/or antilipidemic medications. Previous research in the Netherlands indicated that hypertensive Ghanaian migrants have lower blood pressure control rates as compared to the Dutch population. Knowledge on treatment adherence in people at risk for CVD in various settings in Europe and Africa can help to develop targeted interventions to reduce public health burden. Aim: To evaluate in RODAM participants who were prescribed daily oral antidiabetic, antihypertensive and/or antilipidemic medications: a. the proportion of suboptimal treatment adherence in various settings; b. if suboptimal adherence is associated with suboptimal treatment control; c. which factors are associated with suboptimal adherence in various settings. Methods: We selected 1390 RODAM participants who were prescribed daily oral antidiabetic, antihypertensive, and/or antilipidemic medications from Amsterdam (N=502), Berlin (N=186), London (N=344), Urban Ghana (N=242) and rural Ghana (N=116). Participants who reported -on a previously validated self-report question- to have taken all their prescribed medications during the past week less than 7days were categorized as having suboptimal adherence. Participants with systolic blood pressure 140 and/or diastolic blood pressure 90, LDL cholesterol level >2.5 mmol/l (for primary prevention participants) or >1.8 mmol/l (for secondary prevention participants) and HbA1C level 53 mmol were categorized as having suboptimal treatment control for hypertension, hypercholesterolaemia, diabetes respectively. We tested differences between various settings in rates of treatment control and treatment adherence, and investigated the association of adherence with treatment control and predictors of suboptimal adherence using bivariate and multivariate logistic regression. Results: Treatment control rates for participants prescribed antihypertensives, antidiabetics and antilipidemics were 44%, 54% and 34% respectively and the overall non adherence rate was 24%. Both treatment control and non-adherence differed significantly between sites. Non adherence rates were highest in urban Ghana (43%), lowest in Amsterdam (13%) and Berlin (16%), while rural Ghana (28%) and London (29%) were in the middle. For participants prescribed antihypertensives or antilipidemics, non adherent participants were less likely to achieve adequate treatment control compared to those participants who were adherent. Higher educational level (Amsterdam), having a paid job (Berlin), having difficulties with conversation in English (London), higher level of mastery and depressive symptoms (urban and rural Ghana) was associated with higher levels of non adherence while having a paid job, having difficulties with conversation in Dutch and being marginalized (Amsterdam), higher level of mastery (Berlin) and higher age (London) was associated with lower level of non adherence. Conclusion: Our findings indicate moderate adherence rates and subsequent poor treatment control rates with important differences between various settings. Public health action to develop targeted interventions to improve adherence and treatment control is needed, especially for Urban Ghana. Complications of diabetes among Ghanaians Prof. Benjamin Eghan, presenter (Kwame Nkrumah University of Science & Technology) The prevalence of Diabetes mellitus has increased tremendously since 1960 in Ghana. Presently the country prevalence is 3.3%. With increasing awareness and the increase in diabetes clinics across the country, there has been improvement in the survival of patients leading the levels of chronic complications of the disease. Unfortunately not much data exist on chronic complications in Ghana. At this meeting I intend to summarizes studies so far done on the complications in the country. I believe this will pave the way for more translational and 22 collaborative research in this subject. LIST OF PARTICIPANTS Name Organisation Designation Country 1 Kwame Aboagye Obuasi Govt Hosp Medical Officer Ghana 2 Henrietta Addai Kumasi Centre for Collaborative Research (KCCR) Principal Admin. Secretary Ghana 3 Dr Juliet Addo London School of Hygiene and Tropical Medicine (LSHTM) Lecturer UK 4 Nicholas Addofoh KCCR Data Manager Ghana 5 Dr. Giwe Adenike Suntreso Govt Hospital Medical Officer Ghana 6 David Nana Adjei University of Amsterdam (Amsterdam Medical Centre, AMC) PhD Student Netherlands 7 Dr Dwomoa Adu University of Ghana (UG) Nephrologist Ghana 8 Kofi Adu Study Participant Ghana 9 Dr. Mary Afihene Komfo Anokye Teaching Hospital (KATH) Medical Officer Ghana 10 Ernest Afrifa-Anane UG PhD Student (RODAM WP7) Ghana 11 Prof Samuel Agyei-Mensah UG Provost, College of Humanities Ghana 12 Dr Charles Agyemang AMC Associate Professor Netherlands 13 Stephen Amoah Dife Research Assistant Germany 14 Dr Lambert Tetteh Appiah Komfo Anokye Teaching Hospital (KATH) Department of Cardiology Ghana 15 Dr Henry Asare Anane UG University of Ghana Medical School Ghana 16 Prof Ernest Aryeetey UG Vice Chancellor Ghana 17 Dr. Matilda Asante UG Department of Dietetics Ghana 18 Dr Richard Harry Asmah UG School of Biomedical and Allied Health Ghana Sciences 19 Dr Yacoba Atiase UG & Korle-Bu Hospital Diabetologist Ghana 20 Raphael Baffour Awuah UG PhD Student (RODAM WP7) Ghana 21 Dr George Awuku Asare UG School of Biomedical and Allied Health Ghana Sciences 22 Dr Seth Amankwah UG University of Ghana Medical School Ghana 23 Dr Delali Badasu UG Director, Centre for Migration Studies Ghana 24 Dr. Peter Adjei Baffour KNUST Lecturer Ghana 25 Dr Silver Bahadenka International Diabetes Federation IDF Past President IDF African region Uganda 26 Dr. Kwaku Bandoh Bamfo Suntreso Govt Hospital Medical Officer Ghana 27 Asare Bediako Study Participant Ghana 28 Dr. Idowu Ajediran Bello UG Department of Physiotherapy Ghana 29 Dr Erik Beune AMC Postdoc Netherlands 30 Sandra Boatemaa UG PhD Student, RIPS Ghana 31 Dr. Fred Adomako Boateng GHS, Kumasi Senior Research Fellow Ghana 32 Dr. Agyenim Boateng KATH Medical Officer Ghana 33 Dr Laud Boateng GHS (Nkwanta North) District Director of Health Services Ghana 34 Seth Boateng KATH Senior Nursing officer Ghana 35 Rachel Brathwaite LSHTM PhD Student UK 36 Dr Charles Brown UG School of Biomedical and Allied Health Ghana Sciences 37 Dr Tom Burr Source BioScience Director UK 38 Prof. Samuel Codjoe UG Director, RIPS Ghana 39 Dr Mary A Coleman UG School of Public Health Ghana 40 Dr Efua Commeh Ghana Health Service (GHS) Project Officer, NCD Ghana Control Programme 41 Dr. Rebecca Steele Dadzie UG Department of Dietetics Ghana 42 Dr Ina Danquah German Institute of Human Nutrition (Dife) Postdoc Germany 43 Samuel Nkansah Darko KCCR Biomedical Scientist Ghana 44 Dr Akosua Darkwah UG Director, Centre for Gender Studies Ghana and Advocacy 45 Prof Ama de-graft Aikins UG Associate Professor, RIPS/Vice Dean, Ghana SGS 46 Dr. Ernestina Denkyi Centre for Social Policy Studies (CSPS) Research Fellow Ghana 47 Prof Francis Dodoo UG Professor, RIPS; Acting Director, Ghana Institute of African Studies 48 Prof. Ben Eghan Kwame Nkrumah University of Science & Associate Professor Ghana Technology (KNUST) 49 Dr Cecilia Galbete Dife Postdoc Germany 50 Frank Groen AMC Financial Controller Netherlands 51 Prof. K. Klipstein-Grobusch Utrecht University Associate Professor Netherlands 52 Dominic Kwabena Kanin KCCR Research Assistant Ghana 53 Dr. Osei Sarfo Kantanka KATH Medical Officer Ghana 54 Frank Kyei-Arthur UG PhD Student, RIPS Ghana 55 Prof André Pascal Kengne MRC, South Africa Associate Professor & Director South Africa 56 Prof Kwadwo Koram UG Director, NMIMR Ghana 57 Dr. Anna Dedei Kuevi UG Department of Dietetics Ghana 58 Dr. E. F. Laing KNUST Senior Lecturer Ghana 59 Dr Peter Lamptey LSHTM UK 60 Ms Karlijn Meeks AMC PhD Student Netherlands 61 Ernestina Narveh KCCR Research Assistant Ghana 62 Dr Justice Nonvignon UG School of Public Health Ghana 63 Dr. Kwabena Nsiah KNUST Senior Lecturer Ghana 23

14 LIST OF PARTICIPANTS Name Organisation Designation Country 64 Dr. Freda Dzifa Ntiful UG Department of Dietetics Ghana 65 Gertrude Nyaaba AMC PhD Student Netherlands 66 Dr Kofi Nyarko GHS & UG Director,NCD Control Programme Ghana 67 Dr Dennis Ocansey GHS Project Officer, NCD Control Ghana Programme 68 Ms Abena Oduro UG Director, Centre for Social Policy Ghana Studies 69 Dr Sally-Anne Ohene WHO-Ghana Programme Officer, NCDs Ghana 70 Dr. Michael Okyerefo UG Head, Department of Sociology Ghana 71 Dr Samuel Oppong UG Department of Obstetrics Ghana 72 Dr Olayemi Osa UG School of Public Health Ghana 73 Dr. W.K. B. A. Owiredu KNUST Senior Lecturer Ghana 74 Agya Owusu Study Participant Ghana 75 Rose Owusu Study Participant Ghana 76 Dr. Ellis Owusu-Dabo KCCR Scientific Director Ghana 77 Dr. Lenina Naadu Pessey Suntreso Govt Hosp Medical Officer Ghana 78 Dr. Joana Quampah UG Ghana 79 Ray RayBen diagnostics Ghana 80 Mr Daniel Sam IOM National Project Officer Ghana 81 Olutobi Sanuade UG PhD Student, RIPS Ghana 82 Dorothy Aduako Sarpong KATH Senior Nursing officer Ghana 83 Fati Seidu Study Participant Ghana 84 Adwoa Siaw Study Participant Ghana 85 Prof Liam Smeeth LSHTM Professor UK 86 Prof Karien Stronks AMC Professor Netherlands 87 Prof Yao Tettey UG Provost, College of Health Sciences Ghana 88 Caleb Osei Wusu KCCR Research Assistant Ghana 89 Dr. Denis Yar KCCR Post Doc Ghana 90 Dr Kwame Yeboah UG Department of Physiology Ghana 91 Dr Ernest Yorke UG Ghana RODAM consortium partners RODAM consortium is composed of institutions from Europe (Academic Medical Centre, University of Amsterdam; Utrecht University; London School of Hygiene and Tropical Medicine; Source BioScience Nottingham; Charité Universitätsmedizin Berlin; German Institute of Human Nutrition Potsdam) and Africa (University of Ghana Accra; Kwame Nkrumah University of Science and Technology, Kumasi; and the International Diabetes Federation, African region) Acknowledgements The RODAM consortium is very grateful to the advisory board members: Dr. Adeyemo Adebowale, Prof. Inez. de Beaufort, Prof. André Pascal Kengne, Prof. Oliver Razum, Prof. Nigel Unwin and Prof. Nick Wareham for their valuable support and to the Ghanaian volunteers participating in this project. Funding The RODAM study is supported through the European Commission under the 7th Framework Program through Grant Agreement No Rodam 2015 / Graphic Design: Lou Vos NL Contact Academic Medical Centre Department of Public Health - University of Amsterdam Postbus DD Amsterdam The Netherlands Project Coordinators: Dr Charles Agyemang c.o.agyemang@amc.uva.nl Phone: +31(0) Fax: +31(0) Dr Erik Beune E.J.Beune@amc.uva.nl Phone: +31(0) Fax: +31(0)

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