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Matovu B, Takuwa M, Mpaata CN, Denison F, Kiwanuka N, Lewis S, Norrie J, Ononge S, Muhimbise O, Tuck S, Etuket MD, Ssekitoleko RT. Review of investigational medical devices' clinical trials and regulations in Africa as a benchmark for new innovations. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:952767. [PMID: 35968546 PMCID: PMC9368574 DOI: 10.3389/fmedt.2022.952767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 01/05/2023] Open
Abstract
Medical technologies present a huge potential in improving global health playing a key role toward achieving Sustainable Development Goal 3 by 2030. A number of clinicians, innovators, business entities and biomedical engineers among others have developed a number of innovative medical devices and technologies to address the healthcare challenges especially in Africa. Globally, medical devices clinical trials present the most acceptable method for determining the risks and benefits of medical device innovations with the aim of ascertaining their effectiveness and safety as compared with established medical practice. However, there are very few medical device clinical trials reported in Africa compared to other regions like USA, UK and Europe. Most of the medical device clinical trials reported in Africa are addressing challenges around HIV/AIDS, maternal health and NCDs. In this mini review, we report about some of the published medical device clinical trials in Africa PubMed and Google Scholar and their associated challenges.
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Affiliation(s)
- Brian Matovu
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mercy Takuwa
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Norman Mpaata
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fiona Denison
- Department of Epidemiology and Biostatistics, The Queen's Medical Research Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Noah Kiwanuka
- Edinburgh Medical School, Clinical Trials Unit, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steff Lewis
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - John Norrie
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Sam Ononge
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Owen Muhimbise
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharon Tuck
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Maureen Dimitri Etuket
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert T. Ssekitoleko
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda,*Correspondence: Robert T. Ssekitoleko
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Irving G, Holden J, Stevens R, McManus RJ. Which cuff should I use? Indirect blood pressure measurement for the diagnosis of hypertension in patients with obesity: a diagnostic accuracy review. BMJ Open 2016; 6:e012429. [PMID: 27810973 PMCID: PMC5129068 DOI: 10.1136/bmjopen-2016-012429] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/10/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. DESIGN Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Bland-Altman analyses where individual patient data were available. Methodological quality appraised using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS2) criteria. DATA SOURCES MEDLINE, EMBASE, Cochrane, DARE, Medion and Trip databases were searched. ELIGIBILITY CRITERIA Cross-sectional, randomised and cohort studies of diagnostic test accuracy that compared any non-invasive BP tests (upper arm, forearm, wrist, finger) with an appropriate reference standard (invasive BP, correctly fitting upper arm cuff, ambulatory BP monitoring) in primary care were included. RESULTS 4037 potentially relevant papers were identified. 20 studies involving 26 different comparisons met the inclusion criteria. Individual patient data were available from 4 studies. No studies satisfied all QUADAS2 criteria. Compared with the reference test of invasive BP, a correctly fitting upper arm BP cuff had a sensitivity of 0.87 (0.79 to 0.93) and a specificity of 0.85 (0.64 to 0.95); insufficient evidence was available for other comparisons to invasive BP. Compared with the reference test of a correctly fitting upper arm cuff, BP measurement at the wrist had a sensitivity of 0.92 (0.64 to 0.99) and a specificity of 0.92 (0.85 to 0.87). Measurement with an incorrectly fitting standard cuff had a sensitivity of 0.73 (0.67 to 0.78) and a specificity of 0.76 (0.69 to 0.82). Measurement at the forearm had a sensitivity of 0.84 (0.71 to 0.92) and a specificity 0.75 of (0.66 to 0.83). Bland-Altman analysis of individual patient data from 3 studies comparing wrist and upper arm BP showed a mean difference of 0.46 mm Hg for systolic BP measurement and 2.2 mm Hg for diastolic BP measurement. CONCLUSIONS BP measurement with a correctly fitting upper arm cuff is sufficiently sensitive and specific to diagnose hypertension in patients with obesity with a large upper arm circumference. If a correctly fitting upper arm cuff cannot be applied, an incorrectly fitting standard size cuff should not be used and BP measurement at the wrist should be considered.
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Affiliation(s)
- Greg Irving
- Department of Primary Care, Institute of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Holden
- Department of Garswood Surgery, Garswood, UK
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK
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Urbina EM, Khoury PR, McCoy CE, Daniels SR, Dolan LM, Kimball TR. Comparison of mercury sphygmomanometry blood pressure readings with oscillometric and central blood pressure in predicting target organ damage in youth. Blood Press Monit 2016; 20:150-6. [PMID: 25647284 DOI: 10.1097/mbp.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Hypertension (HT) is an important risk factor for target organ damage (TOD). New methods for measuring BP are replacing mercury sphygmomanometry in many clinics. We examined the utility of different BP measurement techniques in predicting subclinical TOD in adolescents and young adults. METHODS Participants in a study of the cardiovascular effects of obesity and type 2 diabetes were evaluated (N=677, 18±3.3 years, 35% male, 60% non-White, 30% with type 2 diabetes). We measured adiposity, laboratory data, left ventricular mass, carotid intima-media thickness, and pulse wave velocity. BP was measured three times by mercury sphygmomanometry (BPm), using an oscillometric device (BPo), and by arterial tonometry to measure central aortic BP (BPc). Participants were stratified as normotensive, prehypertensive, or hypertensive. RESULTS The prevalence of HT in this cohort with a mean BMI of 31 was the highest on BPo measurement (16%), followed by BPm (11%) and BPc (9%; P≤0.001) measurements. BPm was the most consistent in differentiating left ventricular mass and pulse wave velocity among participants in the prehypertensive group as compared with the normotensive and hypertensive groups. Mercury BP measurement was also more sensitive and specific at predicting greater left ventricular mass, pulse wave velocity, and carotid thickness compared with other BP measurement techniques in logistic regression. CONCLUSION We conclude that mercury sphygmomanometry should remain the gold standard for evaluation of HT and the risk for TOD in adolescents and young adults.
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Affiliation(s)
- Elaine M Urbina
- aCincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio bDepartment of Pediatrics, University of Colorado, Aurora, Colorado, USA
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Lim YH, Choi SY, Oh KW, Kim Y, Cho ES, Choi BY, Kim YM, Shin J. Comparison between an automated device and a manual mercury sphygmomanometer in an epidemiological survey of hypertension prevalence. Am J Hypertens 2014; 27:537-45. [PMID: 23764377 DOI: 10.1093/ajh/hpt100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Automated devices (AD) for measuring blood pressure (BP) are gradually replacing mercury sphygmomanometers (MM) in clinical settings. However, the use of ADs in epidemiological surveys has not been established. We investigated the factors associated with measurement differences when using an MM and an AD. METHODS Two trained observers took three BP measurements in 454 subjects as part of an epidemiological survey, alternately using an MM and an AD. BP measurement difference was defined as BPMM - BPAD. Alarm reactions (ARs) were calculated by subtracting the third systolic BP (SBP) measurement from the first SBP. RESULTS The mean age of subjects was 50.7±15.4 years (n = 454). The mean BPs using the MM and the AD were 119.8±13.9 vs. 119.5±13.6mm Hg in males and 115.0±16.8 vs. 111.6±15.7mm Hg in females for SBP and 77.7±10.4 vs. 74.7±10.4mm Hg in males and 73.2±9.3 vs. 69.9±10.3mm Hg in females for diastolic BP (DBP). Age, gender, arm circumference, and AR were the factors related to the difference. The concordance correlation coefficients for SBP and DBP were 0.8914 (95% confidence interval [CI], 0.8727-0.9102) and 0.8207 (95% CI, 0.7920-0.8494). The kappa values for the diagnosis of hypertension and Joint National Committee 7 BP classification were 0.6538 (0.5436-0.7641) and 0.5703 (0.5055-0.6351), respectively. The diagnostic sensitivity for hypertension was 59.0%. CONCLUSIONS Age, gender, arm circumference, and AR were the factors related to the differences. Despite small differences in the mean values, the agreement and reliability were not good enough to recommend the A&D UA-767PC for adoption in epidemiological surveys of hypertension prevalence.
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Affiliation(s)
- Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
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Rębacz-Maron E, Baranowska-Bosiacka I, Gutowska I, Chlubek D. Blood pressure and levels of Fe, Ca, Mg, Zn, Cu, Na and K in the hair of young Bantu men from Tanzania. Biol Trace Elem Res 2013; 151:350-9. [PMID: 23279941 PMCID: PMC3566392 DOI: 10.1007/s12011-012-9578-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/11/2012] [Indexed: 11/02/2022]
Abstract
Mineral imbalance in the body may significantly contribute to the development and course of hypertension. In this paper, blood pressure figures have been linked to the levels of Fe, Ca, Mg, Zn, Cu, Na and K in hair. The research sample was composed of young men (n = 91) aged 13-21, from the town of Mafinga, Iringa District, Tanzania. The data collected included their age, tribal background and weekly diet. Based on body mass index, the participants were categorised into pre-defined subgroups. To examine how the minerals in question affect blood pressure, correlation analysis and multiple ridge regression analysis were performed. Analysis of ridge regression findings for the researched group (n = 91) shows that the minerals under scrutiny account for systolic blood pressure variation in 13 % and in 15 % for diastolic blood pressure variation. After including two additional variables-calendar age and body mass index-in regression analysis, the ultimate coefficient of determination (R (2)) changes for systolic blood pressure and remains the same for diastolic blood pressure (R (2) = 0.194 and R (2) = 0.156, respectively). Nutritional analysis shows that the students included in the study received insufficient calories per day (1,500-2,200 kcal). The group of students with abnormal blood pressure were not aware of their poor health. Research findings may result from progressive environmental changes and poor nutrition in terms of food quantity and quality, which had an impact on the subjects' blood pressure. Hair analysis used to determine mineral content in the body may be an auxiliary tool in identifying the links between factors leading to the development of hypertension.
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Affiliation(s)
- Ewa Rębacz-Maron
- Department of Anthropology, University of Szczecin, Str. Wąska 13, 71-415, Szczecin, Poland.
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Blood pressure monitoring technique impacts hypertension treatment. J Gen Intern Med 2012; 27:623-9. [PMID: 22160847 PMCID: PMC3358391 DOI: 10.1007/s11606-011-1937-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 06/17/2011] [Accepted: 10/31/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND In 2005 the American Heart Association (AHA) released updated recommendations for blood pressure (BP) monitoring in order to ensure accurate BP measurements. OBJECTIVE To determine if current methods of BP assessment in an ambulatory clinic result in significantly different BP measurements than those obtained by following the AHA recommendations and if these BP differences impact treatment decisions. RESEARCH DESIGN Randomized prospective analysis. SETTING University of New Mexico Hospital Adult Internal Medicine clinic. PATIENTS Forty adults with hypertension METHODS Patient BPs were measured using both the traditional triage method and the AHA-recommended method in cross-over fashion in random order. Two complete medical profile summaries were then constructed for each patient: one for each BP measurement obtained by each technique. These profiles were then reviewed by a panel of providers who provided hypothetical hypertension treatment recommendations. RESULTS Individual BP results varied greatly between the two methods. SBP readings differed by ≥5 mmHg in either direction for 68% of patients while 78% of patient's DBP readings differed by ≥2 mmHg in either direction. Overall, 93% of patients had a BP difference of either ≥5 mmHg systolic or ≥2 mmHg diastolic. Five patients were determined to be at goal with the triage method, but were higher than their goal BP with the AHA method Significant differences were also seen in treatment recommendations for a given patient based on the differences seen between the two obtained BP readings. The number of patients with treatment variations between their two profiles ranged from 13% to 23% depending on the reviewing provider (p < 0.01 for all providers). CONCLUSION Inaccurate BP assessment is common and may impact hypertension treatment decisions.
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Chiolero A, Paradis G, Lambert M. Accuracy of oscillometric devices in children and adults. Blood Press 2010; 19:254-9. [PMID: 20156034 DOI: 10.3109/08037051003606439] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clinical validation of blood pressure oscillometric devices are almost exclusively conducted in adults. Because oscillometric devices are used in children, it is critical to assess their accuracy also in this population. We compared blood pressure readings using an oscillometric automated device (Dinamap XL, model CR9340) with readings obtained with the mercury auscultatory method in children and adults. Blood pressure was measured in 30 children (15 boys and 15 girls; 9.5+/-1.0 years old) and their parents (25 mothers and 15 fathers; 41.0+/-5.0 years old). In children, mean difference (+/-SD) in systolic blood pressure (DeltaBP) readings (oscillometric-auscultatory) was +0.6+/-4.7 mmHg (range: -10 to +11); mean diastolic DeltaBP was 21.3+/-7.5 mmHg (range: -18 to +19) and decreased with increasing diastolic BP. In adults, mean systolic DeltaBP was +0.4+/-5.2 mmHg (range: -12 to +15) and mean diastolic DeltaBP was -5.2+/-6.0 mmHg (range: -25 to +8) (p<0.001). While the device was not accurate enough to be recommended, our study also shows that the accuracy of blood pressure oscillometric devices can differ between children and adults. Clinical accuracy of oscillometric devices should be tested in the specific populations in whom blood pressure is measured.
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Affiliation(s)
- Arnaud Chiolero
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
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Foo JYA, Wilson SJ. Clinical applications of pulse transit time in paediatric critical care. J Med Eng Technol 2009; 33:79-86. [PMID: 19116857 DOI: 10.1080/03091900701860210] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A simple and non-invasive technique, termed pulse transit time (PTT), has shown its potential in long-term investigations such as respiratory sleep studies and cardiovascular studies. Based on these findings, the PTT technique shows relevance for continuous haemodynamic monitoring in critical care. The objective of this review is to understand the potential, applications and limitations of PTT in this clinical setting. Present non-invasive haemodynamic monitoring methods such as automated oscillometric blood pressure (BP) and auscultatory techniques have their known limitations. They tend to underestimate systolic BP while overestimating diastolic BP. Due to the periodic increase in cuff pressure cycles during data acquisition, these techniques may cause much discomfort in elderly geriatric patients, or lessen the cooperation of younger paediatric patients. Thus, there can be adverse effects on therapeutic decisions and possibly clinical outcomes. Documented evidences have indicated that changes observed in PTT are inversely correlated to the corresponding BP changes. In critical care, a simple and accommodating technique like PTT may be useful in providing better comfort for patients during extended monitoring. Being a semi-quantitative measure, blanket recommendations for its utility can then become possible. The basic instrumentations needed are often part of standard critical care monitoring system. Furthermore, PTT also has the potential to monitor the often tachypnoeic respiratory dependent BP changes seen in small infants during critical care.
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Affiliation(s)
- J Y A Foo
- Division of Research, Singapore General Hospital, Singapore.
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Chiolero A, Cachat F, Burnier M, Paccaud F, Bovet P. Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. J Hypertens 2008; 25:2209-17. [PMID: 17921814 DOI: 10.1097/hjh.0b013e3282ef48b2] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Most studies assess the prevalence of hypertension in pediatric populations based on blood pressure (BP) readings taken on a single visit. We determined the prevalence of hypertension measured on up to three visits in a Swiss pediatric population and examined the association between hypertension and overweight and selected other factors. METHODS Anthropometric data and BP were measured in all children of the sixth school grade of the Vaud canton (Switzerland) in 2005-2006. 'Elevated BP' was defined according to sex-specific, age-specific and height-specific US reference data. BP was measured on up to two additional visits in children with elevated BP. 'Hypertension' was defined as 'elevated BP' on all three visits. RESULTS Out of 6873 children, 5207 (76%) participated [2621 boys, 2586 girls; mean (SD) age, 12.3 (0.5) years]. The prevalence of elevated BP was 11.4, 3.8 and 2.2% on first, second and thirds visits, respectively; hence 2.2% had hypertension. Among hypertensive children, 81% had isolated systolic hypertension. Hypertension was associated with excess body weight, elevated heart rate and parents' history of hypertension. Of the children, 16.1% of boys and 12.4% of girls were overweight or obese (CDC criteria, body mass index >or= 85th percentile). Thirty-seven percent of cases of hypertension could be attributed to overweight or obesity. CONCLUSIONS The proportion of children with elevated BP based on one visit was five times higher than based on three measurements taken at few-week intervals. Our data re-emphasize the need for prevention and control of overweight in children to curb the global hypertension burden.
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Affiliation(s)
- Arnaud Chiolero
- Community Prevention Unit, Institute of Social and Preventive Medicine, University Hospital Center, University of Lausanne, Switzerland , Switzerland.
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