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Chen A, Chan YK, Mocumbi AO, Ojji DB, Waite L, Beilby J, Codde J, Dobe I, Nkeh-Chungag BN, Damasceno A, Stewart S. Hypertension among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:16858. [PMID: 39039244 PMCID: PMC11263367 DOI: 10.1038/s41598-024-67703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/15/2024] [Indexed: 07/24/2024] Open
Abstract
We performed a systematic review and meta-analysis of hypertension in people living with human immunodeficiency virus (HIV) in sub-Saharan Africa (SSA). We searched the PubMed, Google Scholar, African Index Medicus, and Embase databases to identify studies published from January 1, 2010, to December 31, 2021. We used a random-effects model to estimate the pooled prevalence of hypertension and mean SBP/DBP level on a sex-specific basis. We included 48 studies reporting data on a pooled sample of 193,843 people living with HIV (PLW-HIV) in SSA. The pooled mean SBP/DBP level was 120 (95% CI 113-128)/77 (95%CI 72-82) mmHg, while the overall pooled prevalence of hypertension was 21.9% (95% CI 19.9-23.9%). Further meta-regression analyses suggested that the prevalence of hypertension was 1.33 times greater in males, 1.23 times greater in individuals receiving antiretroviral therapy (ART) and 1.45 times greater in those individuals with a CD4-count ≥ 200. This meta-analysis of the contemporary pattern of BP levels among PLW-HIV in SSA, suggests that around one in five of such individuals also have hypertension. Given the further context of greater access to ART and subsequently greater longevity, study findings support calls to integrate cardiovascular management into routine HIV care.
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Affiliation(s)
| | - Yih-Kai Chan
- Australian Catholic University, Melbourne, VIC, Australia
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Dike B Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Laura Waite
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Justin Beilby
- Torrens University Australia, Adelaide, SA, Australia
| | - Jim Codde
- Institute for Health Research, The University of Notre Dame Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
| | - Igor Dobe
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Benedicta Ngwenchi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
| | | | - Simon Stewart
- Universidade Eduardo Mondlane, Maputo, Mozambique.
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa.
- Institute for Health Research, The University of Notre Dame Australia, 32 Mouat St, Fremantle, WA, 6160, Australia.
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Bekele A, Alayande BT, Gulilat D, White RE, Tefera G, Borgstein E. A plea for urgent action: Addressing the critical shortage of cardiothoracic surgical workforce in the COSECSA region. World J Surg 2024. [PMID: 38972978 DOI: 10.1002/wjs.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations. METHODS A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework. RESULTS Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High-Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships. CONCLUSION Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.
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Affiliation(s)
- Abebe Bekele
- College of Surgeons for East, Central and Southern Africa Secretariat, Arusha, Tanzania
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Dereje Gulilat
- Department of Surgery, Addis Ababa University, School of Medicine, Addis Ababa, Ethiopia
| | | | - Girma Tefera
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Eric Borgstein
- University of Malawi College of Medicine, Blantyre, Malawi
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Tadesse S, Gudina EK, Yilma D, Asefa ET, Yemane T, Mossie A. Haematological Indices in Acute Coronary Syndrome Patients in Ethiopia: A Comparative Cross-Sectional Study. J Blood Med 2024; 15:275-284. [PMID: 38912419 PMCID: PMC11193461 DOI: 10.2147/jbm.s457371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024] Open
Abstract
Background Numerous biomarkers are used as diagnostic, prognostic, and predictive indicators of myocardial ischemia. The most commonly used biomarkers are cardiac troponin I (Tn-I) and creatinine kinase (CK-MB). However, in developing nations, their availability in primary care settings is extremely limited. In such situations, easily available assays such as complete blood count (CBC) should be investigated as prognostic indicators in individuals with acute coronary syndrome (ACS). Objective This study aimed to compare the pattern of haematological indices and blood cell ratios of ACS patients compared with apparently healthy controls. Methods Patients diagnosed with ACS were recruited consecutively between 01 May 2022 and 31 October 2023 at Jimma Medical Center (JMC). Biochemical analyses and complete blood counts were performed. Analysis of variance was performed to compare the continuous variables. Spearman correlation coefficient tests were performed to correlate hematologic parameters with high sensitive troponin-I (hs-Tn-I) levels. Results This study enrolled 220 participants (110 patients with ACS and age, sex, and place of residence matched 110 non-ACS controls). From ACS group 99 (90%) were diagnosed with ST-elevated myocardial infarction. The ACS group had a significantly greater mean platelet volume (MPV), white blood cell count, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The RDW (r = 0.248, p = 0.009) and MPV (r = 0.245, p = 0.009) were significantly positively correlated with hs-Tn-I levels in the ACS group. MPV, RDW, and monocyte count were significantly higher in non-survivor ACS patients (p <0.05). Conclusion The significant differences observed in haematological parameters between individuals with ACS and healthy controls suggest the potential utility of these easily accessible and cost-effective diagnostics in predicting future morbidity and ACS risk. Incorporating these routine evaluations into clinical practice could enhance risk assessment and improve patient outcomes.
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Affiliation(s)
- Samuel Tadesse
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Elsah Tegene Asefa
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Tilahun Yemane
- Department of Medical Laboratory, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Andualem Mossie
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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Solela G, Yimer YS. Clinical characteristics, treatment patterns, and outcomes of hospitalized patients with acute heart failure in central Ethiopia: a retrospective observational study. BMC Cardiovasc Disord 2024; 24:241. [PMID: 38773412 PMCID: PMC11110373 DOI: 10.1186/s12872-024-03905-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Acute heart failure is the rapid onset of new or worsening symptoms and signs of heart failure. Despite the increasing burden of heart failure in developing countries like Ethiopia, there is a paucity of comprehensive data regarding the clinical characteristics, treatment patterns, and outcomes of acute heart failure, especially in the selected study area. Therefore, this study aimed to assess the clinical characteristics, treatment patterns, and outcomes of hospitalized patients with acute heart failure at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. METHODS This is a retrospective cross-sectional study of 303 acute heart failure patients who were admitted to the medical wards and intensive care unit of Yekatit 12 Hospital Medical College, Addis Ababa, central Ethiopia, from July 1, 2022, to July 1, 2023. A pretested data abstraction format was used for data extraction from electronic medical records, and SPSS version 26 was used for data analysis. Descriptive analysis was used to summarize sociodemographic data, clinical characteristics, treatment patterns, and outcomes of acute heart failure. Bivariate and multivariate logistic regression models were fitted to identify factors associated with in-hospital mortality. The odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of the association. RESULTS Of the 303 patients, 51.5% were females, and the mean age was 56.7 years. The most frequent symptom and sign were dyspnea (98.7%) and peripheral edema (79%), respectively. The commonest underlying cause and precipitating factor of acute heart failure were cor pulmonale (22.8%) and pneumonia (35.3%), respectively. The commonest anti-remodeling medications prescribed on discharge were beta-blockers (47.9%), followed by mineralocorticoid receptor antagonists (42.8%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (38.6%), and the least prescribed were sodium-glucose cotransporter 2 inhibitors (8.3%). The in-hospital mortality rate was 8.6%, and the median length of hospital stay was 9 days. Based on the multivariate logistic regression analysis, the most important predictors of in-hospital mortality were systolic blood pressure (SBP) < 115 mmHg (adjusted odds ratio [AOR] = 6.28; 95% CI: 1.99, 19.78), chloride level < 96 mg/dL (AOR = 4.88; 95% CI: 1.30, 18.33), blood urea nitrogen (BUN) > 20 mg/dl (AOR = 5.48; 95% CI: 1.47, 20.49), and presence of dyslipidemia (AOR = 3.73, 95% CI: 1.15, 12.07). CONCLUSIONS This study has shown that systolic blood pressure (SBP) < 115 mmHg, blood urea nitrogen (BUN) > 20 mg/dL, chloride (Cl) level < 96 mg/dL, and the presence of dyslipidemia were statistically significant factors associated with in-hospital mortality among patients with acute heart failure. Hence, healthcare providers should stratify patients with acute heart failure upon admission based on their risk of in-hospital mortality and address those potential negative prognostic indicators accordingly.
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Affiliation(s)
- Gashaw Solela
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
| | - Yimer Seid Yimer
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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González Fernández L, Firima E, Gupta R, Sematle MP, Khomolishoele M, Molulela M, Bane M, Meli R, Tlahali M, Lee T, Chammartin F, Gerber F, Lejone TI, Ayakaka I, Weisser M, Amstutz A, Labhardt ND. Prevalence and determinants of cardiovascular risk factors in Lesotho: a population-based survey. Int Health 2024; 16:313-324. [PMID: 37593886 PMCID: PMC11062187 DOI: 10.1093/inthealth/ihad058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND There are no recent data on the prevalence of cardiovascular risk factors (CVDRFs) in Lesotho. This study aims to assess the prevalence of CVDRFs and their determinants. METHODS We conducted a household-based, cross-sectional survey among adults ≥18 y of age in 120 randomly sampled clusters in two districts. RESULTS Among 6061 participants, 52.2% were female and their median age was 39 y (interquartile range 27-58). The overall prevalence of overweight, diabetes, elevated blood pressure (BP) and tobacco use was 39.9%, 5.3%, 21.6% and 24.9%, respectively. Among participants, 34.6% had none, 45.2% had one and 20.2% had two or more CVDRFs. Women were more likely to have two or more CVDRFs (20.7% vs 12.3%). Overall, 7.5% of participants had elevated total cholesterol, 52.7% had low high-density lipoprotein cholesterol and 1.6% had elevated low-density lipoprotein cholesterol. Among younger participants (18-29 y), 16.1% reported tobacco use, 28.6% were overweight, 1.5% had diabetes and 3.5% had elevated BP. Household wealth positively correlated with the prevalence of elevated BP, overweight and diabetes, whereas tobacco use was higher among people in the lowest three wealth quintiles. CONCLUSIONS CVDRFs are highly prevalent in Lesotho across age and sex groups, underlining the importance of strengthening prevention and care programs in Lesotho and similar settings in southern Africa.
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Affiliation(s)
- Lucia González Fernández
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Partnerships for Health, Luzern, Switzerland
| | - Emmanuel Firima
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
| | - Ravi Gupta
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | | | | | | | | | - Raphaela Meli
- SolidarMed, Partnerships for Health, Luzern, Switzerland
| | - Mosa Tlahali
- Mokhotlong District Health Management Team, Mokhotlong, Ministry of Health Lesotho
| | - Tristan Lee
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Felix Gerber
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
| | - Thabo Ishmael Lejone
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Irene Ayakaka
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | - Maja Weisser
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Alain Amstutz
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Sliwa K, Viljoen CA, Stewart S, Miller MR, Prabhakaran D, Kumar RK, Thienemann F, Piniero D, Prabhakaran P, Narula J, Pinto F. Cardiovascular disease in low- and middle-income countries associated with environmental factors. Eur J Prev Cardiol 2024; 31:688-697. [PMID: 38175939 DOI: 10.1093/eurjpc/zwad388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024]
Abstract
There is a growing recognition that the profound environmental changes that have occurred over the past century pose threats to human health. Many of these environmental factors, including air pollution, noise pollution, as well as exposure to metals such as arsenic, cadmium, lead, and other metals, are particularly detrimental to the cardiovascular health of people living in low-to-middle income countries (LMICs). Low-to-middle income countries are likely to be disproportionally burdened by cardiovascular diseases provoked by environmental factors. Moreover, they have the least capacity to address the core drivers and consequences of this phenomenon. This review summarizes the impact of environmental factors such as climate change, air pollution, and metal exposure on the cardiovascular system, and how these specifically affect people living in LMICs. It also outlines how behaviour changes and interventions that reduce environmental pollution would have significant effects on the cardiovascular health of those from LMICs, and globally.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Chris Barnard Building, University of Cape Town, Faculty of Health Sciences, Cnr Anzio Road and Falmouth Road, 7925, Observatory, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Main Road, 7925, Observatory, Cape Town, South Africa
| | - Charle André Viljoen
- Cape Heart Institute, Chris Barnard Building, University of Cape Town, Faculty of Health Sciences, Cnr Anzio Road and Falmouth Road, 7925, Observatory, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Main Road, 7925, Observatory, Cape Town, South Africa
| | - Simon Stewart
- Institute for Health Research, University of Notre Dame Australia, 32 Mouat St, Fremantle, Western Australia, 6160, Australia
- Eduardo Mondlane University, 3435 Avenida Julius Nyerere, Maputo, Mozambique
| | - Mark R Miller
- Centre for Cardiovascular Science, University of Edinburgh, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH4 3RL, UK
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, C1/52, Safdarjung Development Area, New Delhi, 110016, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Cochin 682041, Kerala, India
| | - Friedrich Thienemann
- Cape Heart Institute, Chris Barnard Building, University of Cape Town, Faculty of Health Sciences, Cnr Anzio Road and Falmouth Road, 7925, Observatory, Cape Town, South Africa
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, 100 Rämistrasse, 8091 Zurich, Switzerland
| | - Daniel Piniero
- Facultad de Medicina, Universidad de Buenos Aires, Arenales 2463, Buenos Aires, C1124AAN, Argentina
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, C1/52, Safdarjung Development Area, New Delhi, 110016, India
| | - Jagat Narula
- Department of Cardiology, McGovern Medical School, University of Texas Health, 7000 Fannin St, Houston, TX 77030, USA
| | - Fausto Pinto
- Department of Cardiology, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal
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Sani RN, Connelly PJ, Toft M, Rowa-Dewar N, Delles C, Gasevic D, Karaye KM. Rural-urban difference in the prevalence of hypertension in West Africa: a systematic review and meta-analysis. J Hum Hypertens 2024; 38:352-364. [PMID: 35430612 PMCID: PMC11001577 DOI: 10.1038/s41371-022-00688-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022]
Abstract
Urbanisation is considered a major contributor to the rising prevalence of hypertension in West Africa, yet the evidence regarding rural-urban differences in the prevalence of hypertension in the region has been mixed. A systematic literature search of four electronic databases: PubMed, Embase, African Journals Online, and WHO's African Index Medicus; and reference lists of eligible studies was carried out. Original quantitative studies describing the rural-urban difference in the prevalence of hypertension in one or more countries in West Africa, and published in English language from the year 2000 to 2021 were included. A random effects meta-analysis model was used to estimate the odds ratio of hypertension in rural compared to urban locations. A limited sex-based random effects meta-analysis was conducted with 16 studies that provided sex-disaggregated data. Of the 377 studies screened, 22 met the inclusion criteria (n = 62,907). The prevalence of hypertension was high in both rural, and urban areas, ranging from 9.7% to 60% in the rural areas with a pooled prevalence of 27.4%; and 15.5% to 59.2% in the urban areas with a pooled prevalence of 33.9%. The odd of hypertension were lower in rural compared to urban dwellers [OR 0.74, 95% CI: 0.66-0.83; p < 0.001]. The pooled prevalence of hypertension was 32.6% in males, and 30.0% in females, with no significant difference in the odds of hypertension between the sexes [OR 0.91, 95% CI: 0.8-1.05, p = 0.196]. Comprehensive hypertension control policies are needed for both rural, and urban areas in West Africa, and for both sexes.
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Affiliation(s)
- Ruqayya Nasir Sani
- Department of Medicine, Aminu kano Teaching Hospital, Kano, Nigeria.
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Paul J Connelly
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mette Toft
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Neneh Rowa-Dewar
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Christian Delles
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Danijela Gasevic
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kamilu Musa Karaye
- Department of Medicine, Aminu kano Teaching Hospital, Kano, Nigeria
- Bayero University Kano, Kano, Nigeria
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Sirili N, Kilonzi M, Kiwango G, Lengai E, Nandala R, Mwakawanga DL, Philipo EG, Thobias JM, Frumence G. Knowledge of non-communicable diseases and access to healthcare services among adults before and during COVID-19 pandemic in rural Tanzania. Front Public Health 2024; 12:1342885. [PMID: 38605870 PMCID: PMC11008714 DOI: 10.3389/fpubh.2024.1342885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Background The COVID-19 pandemic significantly affected access to healthcare services, particularly among individuals living with Non-Communicable Diseases (NCDs) who require regular healthcare visits. Studies suggest that knowledge about a specific disease is closely linked to the ability to access services for that condition. In preparation for the future, we conducted the study to assess knowledge of NCDs and access to healthcare services among adults residing in rural areas before and during the COVID-19 pandemic. Methods We conducted a community-based cross-sectional study in rural Tanzania in October 2022, a few months after the end of the third wave of the COVID-19 pandemic. A total of 689 community residents participated in the study. The level of knowledge of NCDs was assessed using an 11-item Likert questionnaire, which was later dichotomized into adequate and inadequate levels of knowledge. In addition, access to healthcare was assessed before and during the pandemic. We summarized the results using descriptive statistics and logistic regression was applied to determine factors associated with adequate levels of knowledge of NCDs. All statistical tests were two-sided; a p-value <0.05 was considered statistically significant. All data analyses were performed using SPSS. Results Among 689 participants, more than half 369 (55%) had adequate knowledge of whether a disease is NCD or not; specifically, 495 (73.8%), 465 (69.3%), and 349 (52%) knew that hypertension, diabetes mellitus, and stroke are NCDs while 424 (63.2%) know that UTI is not NCD. Of the interviewed participants, 75 (11.2%) had at least one NCD. During the COVID-19 pandemic the majority 57 (72.2%) accessed healthcare services from nearby health facilities followed by traditional healers 10 (12.7%) and community drug outlets 8 (10.1%). Residence and education level were found to be significantly associated with knowledge of NCDs among participants. Conclusion The study revealed that the community has a moderate level of knowledge of NCDs, and during the COVID-19 pandemic outbreaks, people living with NCD (s) relied on nearby health facilities to obtain healthcare services. Health system preparedness and response to pandemics should take into account empowering the community members to understand that NCD care is continuously needed even during pandemic times. We further advocate for a qualitative study to explore contextual factors influencing the knowledge of NCDs and access to healthcare services beyond the big domains of education and residence.
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Affiliation(s)
- Nathanael Sirili
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Kiwango
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Dorkasi L. Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Erick G. Philipo
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joseph Matobo Thobias
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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9
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Liu J, Liu Y, Ma W, Liu J, Tong Y, Wang C, Zheng J. Age-period-cohort analysis of ischemic stroke deaths attributable to physical inactivity in different income regions. Sci Rep 2024; 14:6547. [PMID: 38503900 PMCID: PMC10951293 DOI: 10.1038/s41598-024-57309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/17/2024] [Indexed: 03/21/2024] Open
Abstract
This study assessed the global and regional burden of IS (ischemic stroke) deaths due to LPA (low physical activity) from 1990 to 2019, analyzed regional, sex, and age differences in ASMR (age-standardized mortality rate), and provided a comprehensive understanding of the impact of age, period, and cohort on low physical activity related ischemic stroke ASMR. We conducted an APC (age-period-cohort) analysis of the global and four World Bank income level regions' IS mortality data attributed to LPA from 1990 to 2019, using the GBD2019 database, and the results showed that the global net drift of the Ischemic stroke age-standardized mortality attributable to low physical activity was - 1.085%[95% CI: - 1.168, - 1.003].The ASMR drop is most pronounced in the high-income zone, with a net drift of - 2.473% [95% CI: - 2.759, - 2.187] across the four income groups. The influence of age on mortality is increasing in the worldwide old population, while the period and cohort effects are decreasing. We also performed a Joinpoint regression analysis, which revealed that the specific time of considerable drop in ASMR of IS in the global LPA population was 2002-2007, with an APC of -2.628%. The specific period of considerable drop in ASMR in high-income regions with the highest variation was 1999-2007, with an APC = - 4.726%. The global burden of public health deaths caused by LPA is diminishing, with the most notable progress observed in high-income regions. However, in low and lower-middle income areas, the situation continues to deteriorate. Within the global elderly population, the effects of age on mortality is increasing, while the effects of period and cohort are diminishing. These trends vary across income levels, highlighting the necessity for enhanced international collaboration to formulate context-specific public health strategies aimed at enhancing cardiovascular health on a global, regional, and national scale.
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Affiliation(s)
- Junjiao Liu
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yueyang Liu
- Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wenjun Ma
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jie Liu
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yan Tong
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Cui Wang
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jianzhong Zheng
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.
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Doku A, Tuglo LS, Boima V, Agyekum F, Aovare P, Ali Abdulai M, Godi A, Peters RJG, Agyemang C. Prevalence of Cardiovascular Disease and Risk Factors in Ghana: A Systematic Review and Meta-analysis. Glob Heart 2024; 19:21. [PMID: 38404614 PMCID: PMC10885824 DOI: 10.5334/gh.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Background The increasing cardiovascular disease (CVD) burden threatens the global population as the major cause of disability and premature death. Data are scarce on the magnitude of CVD among the population in West Africa, particularly in Ghana. This study examined the available scientific evidence to determine the pooled prevalence (PP) of CVD and risk factors in Ghana. Methods We searched electronic databases such as PubMed, Google Scholar, the Cochrane Library, Science Direct and Africa Journal Online databases to identify literature published from the start of the indexing of the database to 10th February 2023. All articles published in the English language that assessed the prevalence of CVD or reported on CVD in Ghana were included. Two authors independently performed the study selection, assessed the risk of bias, extracted the data and checked by the third author. The effect sizes and pooled odds ratio (POR) were determined using the random-effects DerSimonian-Laird (DL) model. Result Sixteen studies with 58912 participants from 1954 to 2022 were included in the meta-analysis. Six studies out of 16 reported more than one prevalence of CVD, giving a total of 59 estimates for PP. The PP of CVD in the general population in Ghana was 10.34% (95% Cl: [8.48, 12.20]; l2 99.54%, p < 0.001). Based on the subgroup analysis, the prevalence of CVD was higher in hospital-based settings at 10.74% (95%, confidence interval [Cl]: 8.69, 12.79) than in community-based settings at 5.04% (95% Cl: 2.54, 7.53). The risk factors were male gender (pooled odds ratio [POR]: 1.66; 95% CI: 1.02, 2.70), old age (POR: 1.32; 95% CI: 1.21, 1.45), unemployment (POR: 2.62; 95% CI: 1.33, 5.16), diabetes (POR: 2.79; 95% CI: 1.62, 4.81) and hypertension (POR: 3.41; 95% CI: 1.75, 6.66). Conclusion The prevalence of CVD was high in Ghana. Urgent interventions are needed for the prevention and management of the high burden of CVD and its risk factors.
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Affiliation(s)
- Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Lawrence Sena Tuglo
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Department of Epidemiology, School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, China
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Pearl Aovare
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, P.O Box 200, Kintampo-B/E, Ghana
| | - Anthony Godi
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ron J. G. Peters
- Department of Cardiology, University Amsterdam Medical Center, University of Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
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Umeonwuka CI, Obiora OL, Nstiea V. Stroke prevention strategies in Africa: a scoping review protocol. JBI Evid Synth 2024; 22:335-342. [PMID: 37851337 DOI: 10.11124/jbies-22-00446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The objective of this scoping review is to map the existing strategies on methods and interventions for primary and secondary stroke prevention in Africa. INTRODUCTION Stroke is among the leading causes of disability globally. African nations have higher stroke mortality and case fatality rates than the industrialized world, leading to significant social and financial costs, which necessitates efficient preventative methods. Despite the high prevalence of stroke in Africa, the scope of stroke-prevention strategies in Africa is unknown. Consequently, mapping diverse approaches to preventing stroke in Africa could provide direction for future research into stroke prevention in Africa. INCLUSION CRITERIA This review will incorporate studies that report methods or strategies used for stroke prevention in Africa. All primary and gray literature will be considered for inclusion. No language or date restrictions will be applied. METHODS The JBI methodological framework for scoping reviews will be adopted for this scoping review. A 3-step search strategy consisting of an initial limited search, a full search, and a screening of the reference lists of all included articles will be undertaken. Databases such as CINAHL, Scopus, PubMed, PEDRo, DORIS, Global Health, Web of Science, and Open Access Thesis and Dissertations will be searched. All search results will be screened, and relevant data extracted by 2 independent reviewers. The findings will be presented in the final scoping review and illustrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. REVIEW REGISTRATION Figshare https://doi.org/10.6084/m9.figshare.21679904.v1.
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Affiliation(s)
- Chuka Ifeanyi Umeonwuka
- Department of Physiotherapy, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
| | - Oluchukwu Loveth Obiora
- The Wits-JBI Centre for Evidenced-based Practice: A JBI Affiliated Group, Johannesburg, South Africa
| | - Veronica Nstiea
- Department of Physiotherapy, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
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12
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Taha AM, Roshdy MR, Abdelma'amboud Mostafa H, Abdelazeem B. Ischemic heart disease in Africa: An overnight epidemiological transition. Curr Probl Cardiol 2024; 49:102337. [PMID: 38103819 DOI: 10.1016/j.cpcardiol.2023.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
Ischemic heart disease (IHD) falls among the leading causes of death, representing a major burden, ranking first in all regions of the world and eighth in Africa as a leading killer. Recent evidence suggests that Africa is having an epidemiological transition with higher rates of non-communicable diseases (NCDs). IHD contributed to 361 thousand deaths in the African region in 2005, and this number is expected to be more than double by 2030. IHD currently ranks as the leading cause of death for men and the second leading cause of death for women in the African region in patients older than 60 years. There are multiple risk factors related to lifestyle associated with IHD. Thus, strict measures are the key in terms of health promotion and disease prevention. Hurdles impeding the prevention and control of IHD in Africa include poor health care services, low income, and rising costs of cardiac interventions..
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Affiliation(s)
- Amira Mohamed Taha
- Faculty of Medicine, Fayoum University, Fayoum, Egypt; Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
| | - Merna Raafat Roshdy
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of medicine Sohag University, Sohag, Egypt
| | - Hamed Abdelma'amboud Mostafa
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of medicine, Al Azhar University, Dameitta, Egypt
| | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
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Molefe-Baikai OJ, Kebotsamang K, Modisawakgomo P, Tlhakanelo JT, Motlhatlhedi K, Moshomo T, Youssouf NF, Masupe T, Gaolathe T, Tapela N, Lockman S, Mosepele M. Self-reported cardiovascular disease risk factor screening among people living with HIV vs. members of the general population in Botswana: a community-based study. BMC Public Health 2024; 24:198. [PMID: 38229024 PMCID: PMC10792864 DOI: 10.1186/s12889-024-17651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Morbidity and mortality due to cardiovascular diseases (CVDs) are high and increasing in low- and middle-income countries. People living with HIV (PLWH) are more likely to experience CVD than members of the general population. Therefore, we aimed to assess whether PLWH were more likely to have previously been screened for cardiovascular disease risk factors (CVDRFs) than people without HIV. METHODS A population-based, cross-sectional study was conducted among individuals aged 16 to 68 years across 22 communities in Botswana from February to August 2017 as part of a larger community-based cluster randomized HIV treatment-as-prevention trial. Participants were asked if they had been screened for and counselled on cardiovascular disease risk factors (history of hypertension or blood pressure check, blood glucose and cholesterol measurements, weight check and weight control, tobacco smoking and cessation, alcohol use and physical activity) in the preceding 3 years. HIV testing was offered to those with an unknown HIV status. Multiple logistic regression analysis controlling for age and sex was used to assess the relationship between CVDRF screening and HIV status. RESULTS Of the 3981 participants enrolled, 2547 (64%) were female, and 1196 (30%) were PLWH (93% already on antiretroviral therapy [ART]). PLWH were more likely to report previous screening for diabetes (25% vs. 19%, p < 0.001), elevated cholesterol (17% vs. 12%, p < 0.001) and to have had their weight checked (76% vs. 55%, p < 0.001) than HIV-uninfected participants. PLWH were also more likely to have received counselling on salt intake (42% vs. 33%, p < 0.001), smoking cessation (66% vs. 46%, p < 0.001), weight control (38% vs. 29%, p < 0.001), physical activity (46% vs. 34%, p < 0.001) and alcohol consumption (35% vs. 23%, p < 0.001) than their HIV-uninfected counterparts. Overall, PLWH were more likely to have received screening for and/or counselling on CVDRFs (adjusted odds ratio 1.84, 95% CI: 1.46-2.32, p < 0.001). CONCLUSION PLWH were almost two times more likely to have been previously screened for CVDRFs than those without HIV, indicating a need for universal scale-up of integrated management and prevention of CVDs in the HIV-uninfected population.
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Affiliation(s)
- Onkabetse Julia Molefe-Baikai
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana.
| | - Kago Kebotsamang
- Faculty of Social Sciences, Department of Statistics, University of Botswana, Gaborone, Botswana
| | | | - John Thato Tlhakanelo
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Keneilwe Motlhatlhedi
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Thato Moshomo
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
| | - Nabila Farah Youssouf
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene and Tropical Medicine, London, UK
| | - Tiny Masupe
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Tendani Gaolathe
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- International Consortium for Health Outcomes Measurement, Boston, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - Mosepele Mosepele
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
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14
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Niriayo YL, Kifle R, Asgedom SW, Gidey K. Drug therapy problems among hospitalized patients with cardiovascular disease. BMC Cardiovasc Disord 2024; 24:50. [PMID: 38221638 PMCID: PMC10788969 DOI: 10.1186/s12872-024-03710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Optimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases. METHOD A prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients' medical records. We employed Cipolle's method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05. RESULTS The study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68-9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47-5.11). CONCLUSION More than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Roba Kifle
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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15
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Kimeu R, Jeilan M, Ngunga M. Predictors of Coronary Artery Disease in Heart Failure with Reduced Ejection Fraction at the Aga Khan University Hospital in Nairobi. Glob Heart 2023; 18:56. [PMID: 37868128 PMCID: PMC10588509 DOI: 10.5334/gh.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
There appears to be an epidemiological transition in the etiology of heart failure in sub-Saharan Africa (SSA) in parallel with a steady increase in risk factors for coronary artery disease (CAD). SSA has limited access to heart failure and CAD diagnostics, limiting the number of patients who receive optimal care. Our objectives were to study the predictors of coronary artery disease among patients with heart failure with reduced ejection fraction (HFrEF) and develop a model to assist clinicians in determining the likelihood of CAD before cardiac catheterization. Methodology This was a retrospective study at the Aga Khan University Hospital, Nairobi, which is equipped with diagnostic capabilities for heart failure and coronary artery assessment. We evaluated patients with HFrEF based on echocardiographic data over a 12-year period. Patients with coronary anatomical evaluation data were included. A multivariable model of CAD was generated using stepwise logistic regression. Results Of the 1329 patients screened, 514 met the inclusion criteria. The mean age was 61.0 ± 12.8 years. There were 381 male cases (75.2%), and the predominant race was African, numbering 386 (75.2%). Most patients, 97%, were evaluated through conventional coronary angiography. Further, 310 (60.3%) cases had significant CAD. The prevalence of CAD in HFrEF was 52.3% in Africans, 85% in Asians, and 79% in Caucasians. In the multivariable logistic regression, the odds of having significant CAD was higher among participants with diabetes mellitus (aOR: 1.86; 95%CI: 1.15-3.03), Q waves (aOR: 2.12; 95%CI: 1.12-4.10), significant ST segment deviation (aOR: 4.14; 95%CI: 2.23-8.03), and regional wall motion abnormalities on echocardiogram (aOR: 6.53; 95%CI: 3.94-11.06). Conclusion In this population, CAD was a major etiology in HFrEF among the African population. The most powerful predictors of CAD were type 2 diabetes, the presence of pathological Q waves, or ST segment shift on a 12-lead electrocardiogram, and regional wall motion abnormality on 2D echocardiogram. Highlights There is an epidemiological transition in the cause of heart failure in sub-Saharan Africa (SSA) in keeping with the steady increase in cardiovascular risk factors for coronary artery disease (CAD).The prevalence of CAD in African patients with heart failure with reduced ejection fraction (HFrEF) was 52.3%.In the multivariable logistic regression, diabetic mellitus, pathological Q waves, significant ST segment deviation, and regional wall motion abnormalities were significantly associated with CAD.
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Affiliation(s)
- Redemptar Kimeu
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Mohamed Jeilan
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Mzee Ngunga
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
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16
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Doumatey AP, Bentley AR, Akinyemi R, Olanrewaju TO, Adeyemo A, Rotimi C. Genes, environment, and African ancestry in cardiometabolic disorders. Trends Endocrinol Metab 2023; 34:601-621. [PMID: 37598069 PMCID: PMC10548552 DOI: 10.1016/j.tem.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
The past two decades have been characterized by a substantial global increase in cardiometabolic diseases, but the prevalence and incidence of these diseases and related traits differ across populations. African ancestry populations are among the most affected yet least included in research. Populations of African descent manifest significant genetic and environmental diversity and this under-representation is a missed opportunity for discovery and could exacerbate existing health disparities and curtail equitable implementation of precision medicine. Here, we discuss cardiometabolic diseases and traits in the context of African descent populations, including both genetic and environmental contributors and emphasizing novel discoveries. We also review new initiatives to include more individuals of African descent in genomics to address current gaps in the field.
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Affiliation(s)
- Ayo P Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training and Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Timothy O Olanrewaju
- Division of Nephrology, Department of Medicine, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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17
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Zelelew AN, Workie DL. Joint Modeling of Blood Pressure Measurements and Survival Time to Cardiovascular Disease Complication among Hypertension Patients Follow-up at DebreTabor Hospital, Ethiopia. Vasc Health Risk Manag 2023; 19:621-635. [PMID: 37753512 PMCID: PMC10518359 DOI: 10.2147/vhrm.s418568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Hypertension is also referred to as a silent killer and a leading factor for cardiovascular disease complication in the world today. This study aimed to identify the factors that affect longitudinal outcomes and survival time for cardiovascular disease complications among patients with hypertension. Methods A retrospective cohort study was conducted among a randomly selected sample of 178 outpatients with hypertension at the Debre Tabor Specialized Hospital between September 2017 and December 2019. Three different models were used to analyze the data: the bivariate mixed-effects model, Cox proportional hazard model, and bivariate joint model for longitudinal and survival sub-models linked by shared random effects. Results Bivariate mixed-effects and Cox proportional hazards survival sub-models were jointly preferred based on the minimum Akaike Information Criterion value. The estimated values of the association parameters were 0.0655 (p = 0.0270) and 0.963 (p = 0.0387), indicating that the association between systolic and diastolic blood pressure with time to event was guaranteed. The joint bivariate mixed-effects model analysis showed that patients with hypertension with a family history of hypertension and clinical stage II hypertension have a high chance of developing cardiovascular disease complications and have high average systolic and diastolic blood pressure compared to their counterparts. Patients with hypertension and diabetes have higher systolic and diastolic blood pressure than their counterparts. Conclusion Generally, systolic and diastolic blood pressure stabilized over the follow-up period of treatment, while sex and residence were statistically insignificant to the survival time of cardiovascular disease complication. Health professionals and concerned bodies should therefore focus on patients with comorbidities, older age, and poor adherence to hypertension control and cardiovascular disease complications using technology, such as text messaging, and mobile application to promote cardiovascular health at early stage. It is important to provide early interventions for these groups of people, especially for those with family history.
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Lumngwena EN, Mokaila D, Aremu O, Katoto PDMC, Blackburn J, Zilla P, Wiysonge CS, Ntusi N. Prevalence and Impact of HIV Infections in Patients with Rheumatic Heart Disease: A Systematic Review and Meta-Analysis. Glob Heart 2023; 18:49. [PMID: 37720311 PMCID: PMC10503531 DOI: 10.5334/gh.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Socioeconomic factors such as poor health and poor nutrition in low- and middle-income countries (LMICs) may favour inflammatory reactions, thus contributing to the recurrence of rheumatic fever (RF) and thereby modifying trends in rheumatic heart disease (RHD). Apart from epidemiological studies, studies of HIV infections in RHD patients are limited. This systematic review synthesises data on the prevalence and impact of HIV infections or AIDS on RHD from PubMed, Scopus, Web of Science databases up to April 2021. The outcomes were managed using PRISMA guidelines. Of a total of 15 studies found, 10 were eligible for meta-analyses. Meta-analysis found that 17% (95 % CI 8-33, I2 = 91%) of adults in cardiovascular disease (CVD) cohorts in Southern Africa are HIV positive. The proportion of RHD diagnosed among people living with HIV was 4% (95% CI 2-8, I2 = 79%) for adults but lower [2% (95% CI 1-4, I2 = 87%)] among perinatally infected children. Despite limited reporting, HIV-infected patients with RHD are prone to other infections that may enhance cardiac complications due to poor immunological control. PROSPERO registration number: CRD42021237046.
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Affiliation(s)
- Evelyn N. Lumngwena
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, ZA
- Centre for the Study of Emerging and Re-emerging Infections (CREMER), Institute for Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, CM
| | - Dipolelo Mokaila
- Cape Heart Institutes, Department of Medicine, Faculty of Health Sciences, University of Cape Town, ZA
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, ZA
| | - Olukayode Aremu
- Cape Heart Institutes, Department of Medicine, Faculty of Health Sciences, University of Cape Town, ZA
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, ZA
| | - Patrick DMC Katoto
- Cape Heart Institutes, Department of Medicine, Faculty of Health Sciences, University of Cape Town, ZA
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501, Cape Town, ZA
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Democratic Republic of Congo
| | - Jonathan Blackburn
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, ZA
- Department of Integrative Biomedical Sciences, University of Cape Town, ZA
| | - Peter Zilla
- Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town, ZA
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501, Cape Town, ZA
- World Health Organization Regional Office for Africa, Citédu Djoué, Brazzaville, CG
| | - Ntobeko Ntusi
- Cape Heart Institutes, Department of Medicine, Faculty of Health Sciences, University of Cape Town, ZA
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, ZA
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, ZA
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19
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Kamiza AB, Touré SM, Zhou F, Soremekun O, Cissé C, Wélé M, Touré AM, Nashiru O, Corpas M, Nyirenda M, Crampin A, Shaffer J, Doumbia S, Zeggini E, Morris AP, Asimit JL, Chikowore T, Fatumo S. Multi-trait discovery and fine-mapping of lipid loci in 125,000 individuals of African ancestry. Nat Commun 2023; 14:5403. [PMID: 37669986 PMCID: PMC10480211 DOI: 10.1038/s41467-023-41271-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
Most genome-wide association studies (GWAS) for lipid traits focus on the separate analysis of lipid traits. Moreover, there are limited GWASs evaluating the genetic variants associated with multiple lipid traits in African ancestry. To further identify and localize loci with pleiotropic effects on lipid traits, we conducted a genome-wide meta-analysis, multi-trait analysis of GWAS (MTAG), and multi-trait fine-mapping (flashfm) in 125,000 individuals of African ancestry. Our meta-analysis and MTAG identified four and 14 novel loci associated with lipid traits, respectively. flashfm yielded an 18% mean reduction in the 99% credible set size compared to single-trait fine-mapping with JAM. Moreover, we identified more genetic variants with a posterior probability of causality >0.9 with flashfm than with JAM. In conclusion, we identified additional novel loci associated with lipid traits, and flashfm reduced the 99% credible set size to identify causal genetic variants associated with multiple lipid traits in African ancestry.
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Affiliation(s)
- Abram Bunya Kamiza
- The African Computational Genomic (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sounkou M Touré
- The African Computational Genomic (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
- African Center of Excellence in Bioinformatics, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Feng Zhou
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Opeyemi Soremekun
- The African Computational Genomic (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
| | - Cheickna Cissé
- African Center of Excellence in Bioinformatics, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mamadou Wélé
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Aboubacrine M Touré
- Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Oyekanmi Nashiru
- H3Africa Bioinformatics Network (H3ABioNet) Node, Center for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria
| | - Manuel Corpas
- School of Life sciences, University of Westminster, London, UK
| | - Moffat Nyirenda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Jeffrey Shaffer
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Seydou Doumbia
- African Center of Excellence in Bioinformatics, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- Faculty of Medicine and Odonto-stomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- TUM School of Medicine, Translational Genomics, Technical University of Munich and Klinikum Rechts der Isar, Munich, Germany
| | - Andrew P Morris
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Tinashe Chikowore
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Segun Fatumo
- The African Computational Genomic (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda.
- H3Africa Bioinformatics Network (H3ABioNet) Node, Center for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria.
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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20
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Blake CE, Monterrosa EC, Rampalli KK, Khan ANS, Reyes LI, Drew SD, Dominguez-Salas P, Bukachi SA, Ngutu M, Frongillo EA, Iruhiriye E, Girard AW. Basic human values drive food choice decision-making in different food environments of Kenya and Tanzania. Appetite 2023; 188:106620. [PMID: 37271253 PMCID: PMC10423943 DOI: 10.1016/j.appet.2023.106620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values drive food choice in two diverse populations with transitioning food environments living in the neighboring East African countries of Kenya and Tanzania. Secondary data analysis was carried out on focus group discussions conducted with men and women in Kenya (n = 28) and Tanzania (n = 28) as part of prior studies on food choice. A priori coding based on Schwartz's theory of basic human values was conducted, followed by a narrative comparative analysis, which included review by original principal investigators. Values of conservation (security, conformity, tradition), openness to change (self-directed thought and action, stimulation, indulgence), self-enhancement (achievement, power, face), and self-transcendence (benevolence-dependability and -caring) were prominent drivers of food choice in both settings. Participants described how values were negotiated and highlighted existing tensions. For example, the value of tradition was cited as important in both settings but changing food contexts (e.g., new foods, diverse neighborhoods) increased prioritization of values like stimulation, indulgence, and self-directed thought and action. The application of a basic values framework was useful for understanding food choice in both settings. A focused understanding of how values drive food choice decision-making in the context of changing food availability in LMICs is essential for the promotion of sustainable healthy diets.
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Affiliation(s)
- Christine E Blake
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Eva C Monterrosa
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202, Geneva, Switzerland.
| | - Krystal K Rampalli
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | | | - Ligia I Reyes
- Cornell University, Division of Nutritional Sciences, Ithaca, NY, 14853, USA.
| | - Shiny Deepika Drew
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Paula Dominguez-Salas
- Natural Resources Institute, University of Greenwich, London, UK; International Livestock Research Institute, Nairobi, Kenya.
| | - Salome A Bukachi
- Institute of Anthropology, Gender and African Studies (IAGAS), University of Nairobi, Kenya.
| | - Mariah Ngutu
- Institute of Anthropology, Gender and African Studies (IAGAS), University of Nairobi, Kenya.
| | - Edward A Frongillo
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Elyse Iruhiriye
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Amy Webb Girard
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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21
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Atiase Y, Yorke E, Akpalu J, Reynolds M, Annan OA, Aryee R, Hayfron-Benjamin C, Yawson A. Clinical characteristics and severity of diabetic ketoacidosis: A cross-sectional study from a tertiary hospital in Ghana. Trop Med Int Health 2023; 28:790-796. [PMID: 37537727 DOI: 10.1111/tmi.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Diabetic ketoacidosis (DKA) is a common, severe and often fatal complication of diabetes. This study aimed to investigate the clinical characteristics and precipitants of DKA, as well as factors associated with DKA severity in Ghanaian patients. METHODS Cross-sectional study of the medical records of all 70 adult patients >18 years managed for DKA in the adult emergency room of Korle-Bu Teaching Hospital in Ghana from March 2019 to July 2019. DKA diagnosis was based on hyperglycaemia >11.0 mmol/L, ketonuria (more than 2+) plus acidaemia of (pH < 7.3) or bicarbonate (HCO3 - ) <15.0 mmol/L. However, when serum bicarbonate and pH were not available, clinical signs of acidosis, for example, Kussmaul breathing aided in the diagnosis. DKA severity was assessed based on the Joint British Diabetes Societies (JBDS) guidelines of factors suggestive of severe DKA. Multivariable logistic regression was used to determine the factors associated with DKA severity. Odds ratio and 95% confidence interval for factors associated with DKA severity were determined. RESULTS The mean (±standard deviation) age, diabetes duration and blood sugar at admission were 44.06 (±16.23) years, 7.19 (±6.04) years and 26.37 (±6.70) mmol/L, respectively. Females comprised 51.4% of the study population. The most common presenting symptoms were generalised weakness (30.0%) and fever (14.3%). The major precipitants were infection (70.0%) and non-compliance (22.9%). Overall, 71.4% of participants had features suggestive of severe DKA. In a multivariable regression model, Type 2 diabetes was associated with over fourfold decreased odds of severe DKA (OR 0.23, 95% CI [0.07-0.76], p = 0.016). Patient education on prevention of DKA was documented for only 18.6% of patients before being discharged. CONCLUSION In this study, more than 70% of the study participants had features suggestive of severe DKA, with infection being the most common precipitant of DKA. 51.4% of patients had Type 2 diabetes which was associated with a statistically lower risk of severe DKA. Female sex tended to be positively associated with DKA severity. In a setting where the venous/arterial pH and bicarbonate levels may be inaccessible and/or unaffordable, using clinical features as found in the JBDS guidelines may help categorise patients and escalate care when needed. Indeed it may be useful to validate the use of the JBDS criteria for use in such settings.
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Affiliation(s)
- Yacoba Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Margaret Reynolds
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | | | - Robert Aryee
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Cardiology, University of Ghana Medical Center, Accra, Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Anaesthesia, University of Ghana Medical School, Accra, Ghana
| | - Alfred Yawson
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
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22
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Aderinto N, Olatunji D, Abdulbasit M, Edun M. The essential role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa: a review. Ann Med 2023; 55:2251490. [PMID: 37643607 PMCID: PMC10496522 DOI: 10.1080/07853890.2023.2251490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/11/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Cerebrovascular disease is a significant cause of morbidity and mortality in Africa, and using neuroimaging techniques has improved the diagnosis and management of this disease. However, there is a lack of comprehensive reviews of the role and effectiveness of neuroimaging techniques in the African context. METHODS We reviewed the literature to evaluate the role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa. Our search included electronic databases such as PubMed, Scopus, and Google Scholar from 2000 to April 2023. We included peer-reviewed studies written in English that reported on the use of neuroimaging in diagnosing and managing cerebrovascular disease in African populations. We excluded non-peer-reviewed articles, letters, editorials, and studies unrelated to cerebrovascular disease, neuroimaging, or Africa. A total of 102 potential articles were identified; after applying our exclusion criteria and removing duplicated articles, 51 articles were reviewed. RESULTS Our findings suggest that neuroimaging techniques such as CT, MRI, and Skull x-ray play a crucial role in diagnosing and managing cerebrovascular disease in Africa. CT and MRI were the most commonly used techniques, with CT being more widely available and less expensive than MRI. However, challenges to using neuroimaging in Africa include the high cost of equipment and maintenance, lack of trained personnel, and inadequate infrastructure. These challenges limit the widespread use of neuroimaging in diagnosing and managing cerebrovascular disease in Africa. CONCLUSION Neuroimaging techniques are essential for diagnosing and managing cerebrovascular disease in Africa, but challenges to their use must be addressed to improve healthcare outcomes. Our policy recommendations can help improve the availability and accessibility of neuroimaging services in Africa.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Nigeria
| | - Deji Olatunji
- Department of Medicine and Surgery, University of Ilorin, Nigeria
| | - Muili Abdulbasit
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Nigeria
| | - Mariam Edun
- Department of Medicine and Surgery, University of Ilorin, Nigeria
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23
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Keino BC, Carrel M. Spatial and temporal trends of overweight/obesity and tobacco use in East Africa: subnational insights into cardiovascular disease risk factors. Int J Health Geogr 2023; 22:20. [PMID: 37620831 PMCID: PMC10463724 DOI: 10.1186/s12942-023-00342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is increasing in Sub-Saharan Africa (SSA). Overweight/obesity and tobacco use are modifiable CVD risk factors, however literature about the spatiotemporal dynamics of these risk factors in the region at subnational or local scales is lacking. We describe the spatiotemporal trends of overweight/obesity and tobacco use at subnational levels over a 13-year period (2003 to 2016) in five East African nations. METHODS Cross-sectional, nationally representative Demographic and Health Surveys (DHS) were used to explore the subnational spatiotemporal patterns of overweight/obesity and tobacco use in Burundi, Kenya, Rwanda, Tanzania, and Uganda, five East African Community (EAC) nations with unique cultural landscapes influencing CVD risk factors. Adaptive kernel density estimation and logistic regression were used to determine the spatial distribution and change over time of CVD risk factors on a subnational and subpopulation (rural/urban) scale. RESULTS Subnational analysis shows that regional and national level analysis masks important trends in CVD risk factor prevalence. Overweight/obesity and tobacco use trends were not similar: overweight/obesity prevalence increased across most nations included in the study and the inverse was true for tobacco use prevalence. Urban populations in each nation were more likely to be overweight/obese than rural populations, but the magnitude of difference varied widely between nations. Spatial analysis revealed that although the prevalence of overweight/obesity increased over time in both urban and rural populations, the rate of change differed between urban and rural areas. Rural populations were more likely to use tobacco than urban populations, though the likelihood of use varied substantially between nations. Additionally, spatial analysis showed that tobacco use was not evenly distributed across the landscape: tobacco use increased in and around major cities and urban centers but declined in rural areas. CONCLUSIONS We highlight the importance of de-homogenizing CVD risk factor research in SSA. Studies of national or regional prevalence trends mask important information about subpopulation and place-specific behavior and drivers of risk factor prevalence. Spatially explicit studies should be considered as a vital tool to understand local drivers of health, disease, and associated risk factor trends, especially in highly diverse yet low-resourced, marginalized, and often homogenized regions.
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Affiliation(s)
- Barbara Chebet Keino
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA.
| | - Margaret Carrel
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA
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24
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Soufiani A, Chraibi H, Asfalou I, Ouafi NE, Hattaoui ME, Habbal R, Chaib A, Fellat R, Akoudad H, Benyass A, Cherti M, Abouqal R, Bendagha N, Ztot S. The national moroccan registry of ST-elevation myocardial infarction (MR-MI). BMC Cardiovasc Disord 2023; 23:419. [PMID: 37620762 PMCID: PMC10464033 DOI: 10.1186/s12872-023-03458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND MR-MI is the first national Moroccan ST-elevation myocardial infarction (STEMI) registry. Its objectives are to assess patient management modalities and highlight the clinical and therapeutic characteristics of this pathology in all cardiology centres on a national scale. METHODS Adult patients presenting with STEMI within 5 days of symptoms onset were enrolled over a period of 18 weeks from April to August 2018. 57 cardiology centres distributed in 22 cities in Morocco participated in the study, including 5 university hospitals, representing 70% of Moroccan centres managing STEMI patients. A case report form was sent to the investigators in both electronic and paper forms. Sociodemographic, clinical, management, revascularization, and follow-up data were collected. RESULTS A total of 809 patients were recruited. The population was mostly male (74.8%) with an average age of 62.6 ± 11.6 years. The most common risk factors were smoking (38.3%) arterial hypertension (30.7%), and diabetes (28%). 30% of patients were admitted within the first 6 h of symptoms onset and early revascularization was performed on 49.6%. Mortality rate was 5.2% in-hospital and 3.2% at the one-month follow-up. CONCLUSION MR-MI is the first Moroccan STEMI registry on a national scale. Relevant management delays are much longer than other countries, and less than 50% of the patients that present on time benefit from early revascularization. Efforts remain to be done on the optimal diagnosis and treatment of STEMI.
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Affiliation(s)
- Aida Soufiani
- Cardiology A Department, Ibn Sina Hospital University Centre, Mohammed V University, Rabat, Morocco
| | - Hamza Chraibi
- Cardiology A Department, Ibn Sina Hospital University Centre, Mohammed V University, Rabat, Morocco.
| | - Ilyasse Asfalou
- Cardiology Department, Mohammed V Military Instruction Hospital, Mohammed V University, Rabat, Morocco
| | - Noha El Ouafi
- Cardiology Department, Mohammed VI Hospital University Centre, Mohamed Premier University, Oujda, Morocco
| | - Mustapha El Hattaoui
- Cardiology Department, Mohammed VI Hospital University Centre, Cadi Ayyad University, Marrakesh, Morocco
| | - Rachida Habbal
- Cardiology Department, Ibn Rochd Hospital University Centre, Hassan II University, Casablanca, Morocco
| | - Ali Chaib
- Cardiology Department, Mohammed V Military Instruction Hospital, Mohammed V University, Rabat, Morocco
| | - Rokya Fellat
- Cardiology A Department, Ibn Sina Hospital University Centre, Mohammed V University, Rabat, Morocco
| | - Hafid Akoudad
- Cardiology Department, Hassan II Hospital University Centre, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Aatif Benyass
- Cardiology Department, Mohammed V Military Instruction Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Cherti
- Cardiology B Department, Ibn Sina Hospital University Centre, Mohammed V University, Rabat, Morocco
| | - Redouane Abouqal
- Medical Emergencies Department, Ibn Sina Hospital University Centre, Mohammed V University, Rabat, Morocco
| | - Nesma Bendagha
- Cardiology A Department, Ibn Sina Hospital University Centre, Mohammed V University, Rabat, Morocco
| | - Samir Ztot
- Cardiology Department, Mohammed V Military Instruction Hospital, Mohammed V University, Rabat, Morocco
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25
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Davies C, Morgan AE, Mc Auley MT. Computationally Modelling Cholesterol Metabolism and Atherosclerosis. BIOLOGY 2023; 12:1133. [PMID: 37627017 PMCID: PMC10452179 DOI: 10.3390/biology12081133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally. The underlying pathological driver of CVD is atherosclerosis. The primary risk factor for atherosclerosis is elevated low-density lipoprotein cholesterol (LDL-C). Dysregulation of cholesterol metabolism is synonymous with a rise in LDL-C. Due to the complexity of cholesterol metabolism and atherosclerosis mathematical models are routinely used to explore their non-trivial dynamics. Mathematical modelling has generated a wealth of useful biological insights, which have deepened our understanding of these processes. To date however, no model has been developed which fully captures how whole-body cholesterol metabolism intersects with atherosclerosis. The main reason for this is one of scale. Whole body cholesterol metabolism is defined by macroscale physiological processes, while atherosclerosis operates mainly at a microscale. This work describes how a model of cholesterol metabolism was combined with a model of atherosclerotic plaque formation. This new model is capable of reproducing the output from its parent models. Using the new model, we demonstrate how this system can be utilized to identify interventions that lower LDL-C and abrogate plaque formation.
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Affiliation(s)
- Callum Davies
- Department of Physical, Mathematical and Engineering Sciences, University of Chester, Chester CH1 4BJ, UK;
| | - Amy E. Morgan
- School of Health & Sport Sciences, Liverpool Hope University, Liverpool L16 9JD, UK;
| | - Mark T. Mc Auley
- Department of Physical, Mathematical and Engineering Sciences, University of Chester, Chester CH1 4BJ, UK;
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26
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Peprah E, Amegbor P, Laar A, Akasoe B, Commodore-Mensah Y. Reducing Dietary Sodium Intake among Young Adults in Ghana: A Call to Action. Nutrients 2023; 15:3562. [PMID: 37630752 PMCID: PMC10458370 DOI: 10.3390/nu15163562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
The positive association between excessive dietary sodium intake, hypertension, and cardiovascular disease (CVD) has been widely investigated in observational studies and clinical trials. Reducing sodium intake is a proven strategy to prevent hypertension and the onset of CVD, a major cause of morbidity and mortality globally. Africa has the youngest population globally, which is key to the continent's sustainable development. However, in Africa, the epidemics of hypertension and CVD negatively impact life expectancy and economic growth. Ghana, like other African countries, is no exception. The factors contributing to the increasing burden of CVD and excessive sodium consumption are multi-faceted and multi-level, including individual lifestyle, neighborhood and built environments, and socio-economic and health policies. Thus, the implementation of evidence-based interventions such as the World Health Organization Best Buys that target the multi-level determinants of sodium consumption is urgently needed in Ghana and other African countries. The aim of this commentary is to highlight factors that contribute to excessive sodium consumption. Second, the commentary will showcase lessons of successful implementation of sodium reduction interventions in other countries. Such lessons may help avert CVD in young adults in Ghana and Africa.
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Affiliation(s)
- Emmanuel Peprah
- Department of Global and Environmental Health, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA;
| | - Prince Amegbor
- Department of Global and Environmental Health, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA;
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra P.O. Box LG13, Ghana; (A.L.); (B.A.)
| | - Bismark Akasoe
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra P.O. Box LG13, Ghana; (A.L.); (B.A.)
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27
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Kruger R, Odili A, Gafane-Matemane LF. Editorial: Gaps, priorities, and advances in cardiovascular medicine in Africa. Front Cardiovasc Med 2023; 10:1260406. [PMID: 37636300 PMCID: PMC10457140 DOI: 10.3389/fcvm.2023.1260406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Augustine Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Lebo F. Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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28
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Ntsekhe M. Pericardial Disease in the Developing World. Can J Cardiol 2023; 39:1059-1066. [PMID: 37201721 DOI: 10.1016/j.cjca.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
Pericardial disease in the developing world is dominated primarily by effusive and constrictive syndromes and contributes to the acute and chronic heart failure burden in many regions. The confluence of geography (location in the tropics), a significant burden of diseases of poverty and neglect, and a significant contribution of communicable diseases to the general burden of disease is reflected in the wide etiological spectrum of causes of pericardial disease. The prevalence of Mycobacterium tuberculosis in particular, is high throughout much of the developing world where it is the most frequent and important cause of pericarditis and is associated with significant morbidity and mortality. Acute viral/idiopathic pericarditis, which is the primary manifestation of pericardial disease in the developed world is believed to occur significantly less frequently in the developing world. Although diagnostic approaches and criteria to establish the diagnosis of pericardial disease are similar throughout the globe, resource constraints such as access to multimodality imaging and hemodynamic assessment are a major limitation in much of the developing world. These important considerations significantly influence the diagnostic and treatment approaches, and outcomes related to pericardial disease.
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Affiliation(s)
- Mpiko Ntsekhe
- The Division of Cardiology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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Chen A, Waite L, Mocumbi AO, Chan YK, Beilby J, Ojji DB, Stewart S. Elevated blood pressure among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e1238-e1248. [PMID: 37474231 DOI: 10.1016/s2214-109x(23)00218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries. However, there is a paucity of data on the pattern of elevated blood pressure among adolescents aged 10-19 years in sub-Saharan Africa. We aimed to provide pooled estimates of high blood pressure prevalence and mean levels in adolescents aged 10-19 years across sub-Saharan Africa. METHODS In this systematic review and meta-analysis, we searched PubMed, Google Scholar, African Index Medicus, and Embase to identify studies published from Jan 1, 2010, to Dec 31, 2021. To be included, primary studies had to be observational studies of adolescents aged 10-19 years residing in sub-Saharan African countries reporting the pooled prevalence of elevated blood pressure or with enough data to compute these estimates. We excluded studies on non-systemic hypertension, in African people not living in sub-Saharan Africa, with participant selection based on the presence of hypertension, and with adult cohorts in which we could not disaggregate data for adolescents. We independently extracted relevant data from individual studies using a standard data extraction form. We used a random-effects model to estimate the pooled prevalence of elevated blood pressure and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels overall and on a sex-specific basis. This study is registered with PROSPERO (CRD42022297948). FINDINGS We identified 2559 studies, and assessed 81 full-text studies for eligibility, of which 36 studies comprising 37 926 participants aged 10-19 years from ten (20%) of 49 sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. Sex data were available from 26 818 adolescents (14 369 [53·6%] were female and 12 449 [46·4%] were male) for the prevalence of elevated blood pressure and 23 777 adolescents (12 864 [54·1%] were female and 10 913 [45·9%] were male) for mean blood pressure. Study quality was high, with no low-quality studies. The reported prevalence of elevated blood pressure ranged from 4 (0·2%) of 1727 to 1755 (25·1%) of 6980 (pooled prevalence 9·9%, 95% CI 7·3-12·5; I?=99·2%, pheterogeneity<0·0001). Mean SBP was 111 mm Hg (95% CI 108-114) and mean DBP was 68 mm Hg (66-70). 13·4% (95% CI 12·9-13·9; pheterogeneity<0·0001) of male participants had elevated blood pressure compared with 11·9% (11·3-12·4; pheterogeneity<0·0001) of female participants (odds ratio 1·04, 95% CI 0·81-1·34; pheterogeneity<0·0001). INTERPRETATION To our knowledge, this systematic review and meta-analysis is the first systematic synthesis of blood pressure data specifically derived from adolescents in sub-Saharan Africa. Although many low-income countries were not represented in our study, our findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. Accordingly, there is an urgent need to improve preventive heart-health programmes in the region. FUNDING None.
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Affiliation(s)
| | - Laura Waite
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Ana O Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Justin Beilby
- Torrens University Australia, Adelaide, SA, Australia
| | - Dike B Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa; Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
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Ferro EG, Abrahams-Gessel S, Kapaon D, Houle B, Toit JD, Wagner RG, Gómez-Olivé FX, Wade AN, Kabudula CW, Tollman S, Gaziano TA. Significant Improvement in Blood Pressure Levels Among Older Adults With Hypertension in Rural South Africa. Hypertension 2023; 80:1614-1623. [PMID: 36752095 PMCID: PMC10363191 DOI: 10.1161/hypertensionaha.122.20401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Sub-Saharan Africa is undergoing an epidemiologic transition from infectious diseases to cardiovascular diseases. From 2014 to 2019, sociodemographic surveillance was performed in a large cohort in rural South Africa. METHODS Disease prevalence and incidence were calculated using inverse probability weights. Poisson regression was used to identify disease predictors. The percentage of individuals with controlled (<140/90 mm Hg) versus uncontrolled hypertension was compared between 2014 and 2019. RESULTS Compared with 2014 (n=5059), study participants in 2019 (n=4176) had similar rates of obesity (mean body mass index, 27.5±10.0 versus 27.0±6.5) but higher smoking (9.1% versus 11.5%) and diabetes (11.1% versus 13.9%). There was no significant increase in hypertension prevalence (58.4% versus 59.8%; age adjusted, 64.3% versus 63.3%), and there was a significant reduction in mean systolic blood pressure (138.0 versus 128.5 mm Hg; P<0.001). Among hypertensive individuals who reported medication use in 2014 and 2019 (n=796), the proportion with controlled hypertension on medication increased from 44.5% to 62.3%. Hypertension incidence was 6.2 per 100 person-years, and age was the only independent predictor. Among normotensive individuals in 2014 (n=2257), 15.2% developed hypertension by 2019, with the majority already controlled on medications by 2019. CONCLUSIONS The hypertension prevalence and incidence are plateauing in this aging cohort. There was a statistically and clinically significant decline in mean blood pressure and a substantial increase in individuals with controlled hypertension on medication. The prevalence of cardiometabolic risk factors did not decrease over time, suggesting that the blood pressure decrease is likely due to increased medication access and adherence, promoted by local health systems.
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Affiliation(s)
- Enrico G. Ferro
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Shafika Abrahams-Gessel
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA
| | - David Kapaon
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA
| | - Brian Houle
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques Du Toit
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan G. Wagner
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F. Xavier Gómez-Olivé
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alisha N. Wade
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa W Kabudula
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Tollman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas A. Gaziano
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Cardiovascular Medicine, Brigham & Women’s Hospital, Boston, MA 02115, USA
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Gibore NS, Munyogwa MJ, Ng'weshemi SK, Gesase AP. Prevalence and knowledge of modifiable cardiovascular diseases risk factors among vulnerable population in Central Tanzania. BMC Cardiovasc Disord 2023; 23:373. [PMID: 37496008 PMCID: PMC10373223 DOI: 10.1186/s12872-023-03408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the global public health problem which has been associated with increasing prevalence of modifiable CVDs risk factors. This study aimed to describe the prevalence and knowledge of modifiable CVDs risk factors among vulnerable population of Central Tanzania. METHODS A community-based cross-sectional study design was employed. A total of 749 participants were interviewed. The socio-demographic information and modifiable CVDs risk factors (behavioral and biological) were measured using a modified World Health Organization (WHO) STEPwise approach for chronic disease risk factor surveillance. Knowledge of modifiable CVDs risk factors was measured by comprehensive heart disease knowledge questionnaire. Descriptive statistics were used to describe the knowledge and prevalence of modifiable CVDs risk factors. Logistic regression analysis was used to determine the factors associated with adequate knowledge of CVDs risk factors. RESULTS The prevalence of béhavioral risk factors were; current smokers and alcohol consumers were 4.4% and 18.0% respectively, use of raw salt was 43.7%, consumption of fruit/vegetables < 5 days per week was 56.9%. The prevalence of Biological CVDs risk factors was as follows: Overall, 63.5% (33.3% overweight and 29.9% obese) were overweight or obese, 4.5% were diabetic and 43.4% were hypertensive. Only 35.4% of participants had adequate knowledge of CVDs risk factors. Being a male (AOR = 1.44, 95%CI = 1.01-2.06, p < .05), having primary education (AOR = 6.43, 95%CI = 2.39-17.36, p < .0001), being employed (AOR = 1.59, 95%CI = 1.00-2.52, p < .05), ever checked blood pressure (AOR = 0.59, 95%CI = 0.42-0.84, p < .001), family history of hypertension (AOR = 0.38, 95%CI = 0.25-0.57, p < .0001) determined adequate knowledge of CVDs risk factors. CONCLUSIONS This study has revealed a high prevalence of modifiable CVDs risk factors and low knowledge of CVDs risk factors. Community health promotion interventions to increase population knowledge of CVDs risk factors are recommended for the efficacious reduction of CVDs in the country.
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Affiliation(s)
- Nyasiro Sophia Gibore
- Department of Public Health and Community Nursing, The University of Dodoma, P.O. Box 395, Dodoma, Tanzania.
| | - Mariam John Munyogwa
- Department of Community Medicine, The University of Dodoma, P.O. Box 395, Dodoma, Tanzania
| | | | - Ainory Peter Gesase
- Department of Anatomy and Histology, The University of Dodoma, P.O. Box 395, Dodoma, Tanzania
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Chalwe JM, Grobler C, Oldewage-Theron W. Development of a Structural Equation Model to Examine the Relationships between Genetic Polymorphisms and Cardiovascular Risk Factors. Nutrients 2023; 15:nu15112470. [PMID: 37299433 DOI: 10.3390/nu15112470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Genome-wide association studies (GWASs) have been used to discover genetic polymorphisms that affect cardiovascular diseases (CVDs). Structural equation modelling (SEM) has been identified as a robust multivariate analysis tool. However, there is a paucity of research that has conducted SEM in African populations. The purpose of this study was to create a model that may be used to examine the relationships between genetic polymorphisms and their respective cardiovascular risk (CVR) factors. The procedure involved three steps. Firstly, the creation of latent variables and the hypothesis model. Next, confirmatory factor analysis (CFA) to examine the relationships between the latent variables, SNPs, dyslipidemia and metabolic syndrome, with their respective indicators. Then finally, model fitting using JASP statistical software v.0.16.4.0. The indicators for the SNPs and dyslipidemia all indicated significant factor loadings, -0.96 to 0.91 (p = <0.001) and 0.92 to 0.96 (p ≤ 0.001), respectively. The indicators for metabolic syndrome also had significant coefficients of 0.20 (p = 0.673), 0.36 (p = 0.645) and 0.15 (p = 0.576), but they were not statistically significant. There were no significant relationships observed between the SNPs, dyslipidemia and metabolic syndrome. The SEM produced an acceptable model according to the fit indices.
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Affiliation(s)
- Joseph Musonda Chalwe
- Department of Health Sciences, Vaal University of Technology, Private Bag X021, Vanderbijlpark 1900, South Africa
| | - Christa Grobler
- Department of Health Sciences, Vaal University of Technology, Private Bag X021, Vanderbijlpark 1900, South Africa
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University (TTU), Lubbock, TX 79409, USA
- Department of Sustainable Food Systems & Development, University of the Free State, Bloemfontein 9300, South Africa
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Chori BS, An DW, Martens DS, Yu YL, Gilis-Malinowska N, Abubakar SM, Ibrahim EA, Ajanya O, Abiodun OO, Anya T, Tobechukwu I, Isiguzo G, Cheng HM, Chen CH, Liao CT, Mokwatsi G, Stolarz-Skrzypek K, Wojciechowska W, Narkiewicz K, Rajzer M, Brguljan-Hitij J, Nawrot TS, Asayama K, Reyskens P, Mischak H, Odili AN, Staessen JA. Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial-First progress report. J Clin Hypertens (Greenwich) 2023. [PMID: 37147930 DOI: 10.1111/jch.14664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
High blood pressure (BP) and type-2 diabetes (T2DM) are forerunners of chronic kidney disease and left ventricular dysfunction. Home BP telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling risk stratification and personalized prevention. UPRIGHT-HTM (NCT04299529) is an investigator-initiated, multicenter, open-label, randomized trial with blinded endpoint evaluation designed to assess the efficacy of HTM plus UPP (experimental group) over HTM alone (control group) in guiding treatment in asymptomatic patients, aged 55-75 years, with ≥5 cardiovascular risk factors. From screening onwards, HTM data can be freely accessed by all patients and their caregivers; UPP results are communicated early during follow-up to patients and caregivers in the intervention group, but at trial closure in the control group. From May 2021 until January 2023, 235 patients were screened, of whom 53 were still progressing through the run-in period and 144 were randomized. Both groups had similar characteristics, including average age (62.0 years) and the proportions of African Blacks (81.9%), White Europeans (16.7%), women 56.2%, home (31.2%), and office (50.0%) hypertension, T2DM (36.4%), micro-albuminuria (29.4%), and ECG (9.7%) and echocardiographic (11.5%) left ventricular hypertrophy. Home and office BP were 128.8/79.2 mm Hg and 137.1/82.7 mm Hg, respectively, resulting in a prevalence of white-coat, masked and sustained hypertension of 40.3%, 11.1%, and 25.7%. HTM persisted after randomization (48 681 readings up to 15 January 2023). In conclusion, results predominantly from low-resource sub-Saharan centers proved the feasibility of this multi-ethnic trial. The COVID-19 pandemic caused delays and differential recruitment rates across centers.
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Affiliation(s)
- Babangida S Chori
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Dries S Martens
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Yu-Ling Yu
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | | | - Sani M Abubakar
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Gwagwalada, Nigeria
| | - Etubi A Ibrahim
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Gwagwalada, Nigeria
| | - Ojonojima Ajanya
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Gwagwalada, Nigeria
| | - Olugbenga O Abiodun
- Department of Internal Medicine, Federal Medical Center Jabi, Jabi, Abuja, Nigeria
| | - Tina Anya
- Department of Internal Medicine, Federal Medical Center Jabi, Jabi, Abuja, Nigeria
| | - Iyidobi Tobechukwu
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
| | - Godsent Isiguzo
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
| | - Hao-Min Cheng
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, People's Republic of China
| | - Chen-Huan Chen
- Medical Building, National Yang-Min University School of Medicine, Taipei, People's Republic of China
| | - Chia-Te Liao
- Chi Mei Medical Center, Yong Kang, Tainan, People's Republic of China
| | - Gontse Mokwatsi
- Hypertension in Africa Research Team, North-Western University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagellonian University, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagellonian University, Kraków, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagellonian University, Kraków, Poland
| | - Jana Brguljan-Hitij
- Department of Internal Medicine, Division of Hypertension, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tim S Nawrot
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kei Asayama
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | | | | | - Augustine N Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Gwagwalada, Nigeria
| | - Jan A Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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Lammertyn L, Klipstein-Grobusch K, Kruger HS, Kruger IM, Fourie CMT. Noncommunicable Disease Conditions and HIV in Rural and Urban South Africa: 2005-2015. Ethn Dis 2023; 33:108-115. [PMID: 38845740 PMCID: PMC11145727 DOI: 10.18865/ed.33.2-3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Purpose Hypertension, obesity, hyperlipidemia, and type 2 diabetes contribute primarily to noncommunicable disease deaths and together with human immunodeficiency virus contribute largely to mortality in South Africa. Our longitudinal study provides the necessary data and insights over a 10-year period to highlight the areas where improved management is required in urban and rural localities. Methods This study included 536 rural and 387 urban Black participants aged 32 to 93 years from the North-West province, South Africa. Disease prevalence, treatment, and control were determined in 2005 and were re-evaluated in 2015. Multiple measures analyses were used to determine the trends of blood pressure and waist circumference. Results The initial prevalence of hypertension was 53.2%, obesity was 23.6%, hyperlipidemia was 5.1%, diabetes was 2.9%, and human immunodeficiency virus was 10.7% in 2005. By 2015, the rural population had higher rates of hypertension (63.7% versus 58.5%) and lower rates diabetes (4.3% versus 7.9%) and hyperlipidemia (6.6% versus 18.0%) with similar obesity rates (41.7% versus 42.4%). The average blood pressure levels of urban hypertensives decreased (Ptrend<.001), whereas levels were maintained in the rural group (Ptrend=.52). In both locations, treatment and control rates increased from 2005 to 2015 for all conditions (all ≥6.7%), except for diabetes in which a decrease in control was observed. Waist circumference increased (Ptrend>.001) in both sex and locality groups over the 10-year period. Conclusion Although average blood pressure of urban hypertensive individuals decreased, urgent measures focused on early identification, treatment, and control of the respective conditions should be implemented to decrease the burden of noncommunicable diseases.
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Affiliation(s)
- Leandi Lammertyn
- Hypertension in Africa Research Team (HART), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herculina S. Kruger
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
- Center of Excellence in Nutrition (CEN), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Iolanthe M. Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Carla M. T. Fourie
- Hypertension in Africa Research Team (HART), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
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Almoussa M, Mattei J. Cardiovascular health and risk factors in African refugees and immigrants in the United States: a narrative review. ETHNICITY & HEALTH 2023; 28:399-412. [PMID: 35306946 DOI: 10.1080/13557858.2022.2052712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Refugees and immigrants often experience challenges pre- and post-settlement that expose them to risk factors of cardiovascular disease (CVD). Literature on CVD among the growing population of African refugees and immigrants in the United States (US) is scant. This narrative review aimed to evaluate existing studies reporting on CVD and its risk factors among African refugees and immigrants in the US, and to recognize limitations in the current research, policy, and healthcare for adequate CVD-related care for African refugees and immigrants. DESIGN Articles on African refugee and/or immigrant health were searched on PubMed using multiple key search terms. Studies conducted between 1995 and 2020 and reporting on CVD-related measures in individuals from African countries of origin were included. Six articles were found discussing refugee health only and seven articles discussed refugee and immigrant health together. RESULTS Overall, the studies showed the varying prevalence of CVD risk factors, mostly depending on the country of origin. Worsening cardiometabolic health with longer residency in the US was generally reported. Refugee-only studies relied mostly on medical records data, while refugee and immigrant studies used both medical records and primary data collection. Limitations in data pertain to the geographical representation of both African countries (predominantly from Somalia despite migrants arriving from diverse African countries) and of regions of settling in the US (predominantly the north/northeast), scarce longitudinal studies, and lack of distinction between refugees and immigrants. Multiple social and structural barriers to cardiovascular health were identified, mostly related to cultural and linguistic challenges and to inadequate or complex health insurance and healthcare systems. CONCLUSION The cardiovascular health of African refugees and immigrants remains understudied and underserved. Further research and interventions to alleviate barriers and improve cardiovascular health in African refugees and immigrants in the US should be developed using culturally appropriate, accessible, flexible, and multifaceted strategies.
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Affiliation(s)
- Maya Almoussa
- Department of Molecular and Cellular Biology, Harvard College Faculty of Arts and Sciences, Cambridge, MA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mboweni N, Maseko M, Tsabedze N. Heart failure with reduced ejection fraction and atrial fibrillation: a Sub-Saharan African perspective. ESC Heart Fail 2023; 10:1580-1596. [PMID: 36934444 DOI: 10.1002/ehf2.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/06/2023] [Accepted: 02/07/2023] [Indexed: 03/20/2023] Open
Abstract
Cardiovascular diseases are a well-established cause of death in high-income countries. In the last 20 years, Sub-Saharan Africa (SSA) has seen one of the sharpest increases in cardiovascular disease-related mortality, superseding that of infectious diseases, including HIV/AIDS, in South Africa. This increase is evidenced by a growing burden of heart failure and atrial fibrillation (AF) risk factors. AF is a common comorbidity of heart failure with reduced ejection fraction (HFrEF), which predisposes to an increased risk of stroke, rehospitalizations, and mortality compared with patients in sinus rhythm. AF had the largest relative increase in cardiovascular disease burden between 1990 and 2010 in SSA and the second highest (106.4%) increase in disability-adjusted life-years (DALY) between 1990 and 2017. Over the last decade, significant advancements in the management of both HFrEF and AF have emerged. However, managing HFrEF/AF remains a clinical challenge for physicians, compounded by the suboptimal efficacy of guideline-mandated pharmacotherapy in this group of patients. There may be an essential role for racial differences and genetic influence on therapeutic outcomes of HFrEF/AF patients, further complicating our overall understanding of the disease and its pathophysiology. In SSA, the lack of accurate and up-to-date epidemiological data on this subgroup of patients presents a challenge in our quest to prevent and reduce adverse outcomes. This narrative review provides a contemporary overview of the epidemiology of HFrEF/AF in SSA. We highlight important differences in the demographic and aetiological profile and the management of this subpopulation, emphasizing what is currently known and, more importantly, what is still unknown about HFrEF/AF in SSA.
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Affiliation(s)
- Nonkanyiso Mboweni
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Division of Cardiology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Gauteng, Johannesburg, South Africa
| | - Muzi Maseko
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nqoba Tsabedze
- Department of Internal Medicine, Division of Cardiology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Gauteng, Johannesburg, South Africa
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Shakil SS, Temu TM, Kityo C, Nazzinda R, Erem G, Kentoffio K, Bittencourt M, Ntusi NAB, Zanni MV, Longenecker CT. Sex modulates the association between inflammation and coronary atherosclerosis among older Ugandan adults with and without HIV. AIDS 2023; 37:579-586. [PMID: 36730004 PMCID: PMC9974774 DOI: 10.1097/qad.0000000000003451] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Inflammation is key in the pathogenesis of atherosclerotic coronary artery disease (CAD). Distinct sex-specific inflammatory mechanisms may contribute to CAD in sub-Saharan Africa (SSA), where environmental and biological determinants of systemic inflammation may differ from those in high-income settings. APPROACH AND RESULTS We investigated sex differences in inflammatory markers and CAD in a 2-year prospective cohort of Ugandan adults enriched for cardiometabolic risk factors (RFs) and HIV. Seven plasma biomarkers were quantified at the baseline visit among 125 females and 75 males (50% with HIV) at least 45 years old at enrollment with one or more major cardiovascular RF. In year 2, coronary CT angiography (CCTA) was performed in 82 females and 50 males returning for follow-up (52% with HIV). In sex-specific models adjusted for cardiovascular RFs and HIV, tumor necrosis factor-alpha (TNF-α) RII and sCD163 predicted subsequent CAD in females, while only fibrinogen was predictive in males ( P < 0.05). Interleukin-6 (IL-6) and sCD14 were inversely associated with CAD in males ( P < 0.05). Sex modified the associations of TNF-α RII, sCD14, and sCD163 with CAD ( P < 0.05 for interaction). In multivariable multiple imputation models applied to missing year 2 CCTA data to test associations between serum biomarkers in the baseline cohort ( n = 200) and subsequent CAD, higher sCD163 was predictive in females only ( P < 0.05). CONCLUSIONS The positive link between inflammation and subclinical CAD was stronger among females than males in Uganda. Mechanisms by which sex modulates the relationship between inflammation and CAD should be further investigated in SSA.
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Affiliation(s)
- Saate S Shakil
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, USA
| | - Tecla M Temu
- Department of Global Health, University of Washington Medical Center, Seattle, USA
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Geoffrey Erem
- Department of Radiology, Makerere University, Kampala, Uganda
| | - Katherine Kentoffio
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, USA
| | - Marcio Bittencourt
- Departments of Medicine and Radiology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Ntobeko AB Ntusi
- Department of Medicine, Division of Cardiology, University of Cape Town, Cape Town, South Africa
- Unit on Intersection of Noncommunicable Diseases and Infectious Disease, South African Medical Research Council
| | - Markella V Zanni
- Department of Medicine, Division of Endocrinology, Massachusetts General Hospital, Boston, USA
| | - Chris T Longenecker
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, USA
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Joint modeling of longitudinal change of fasting blood sugar and systolic blood pressure with survival time to death among hypertension patients. Sci Rep 2023; 13:439. [PMID: 36624104 PMCID: PMC9829904 DOI: 10.1038/s41598-022-27120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023] Open
Abstract
Hypertension is a universal public health challenge and a leading modifiable risk factor for cardiovascular disease and death. It is also called high blood pressure, described by two measured quantities systolic blood pressure (SBP) 140 mmHg or greater and diastolic blood pressure (DBP) 90 mmHg or greater. As the result, this study aims to use the joint model application to identify the factors that affect longitudinal changes in fasting blood sugar, SBP, and survival time to death of hypertension patients and their associations admitted to the Arba Minch General Hospital. We considered a total of 354 random samples of hypertension patients who had under follow-up at Arba Minch general hospital from January 2012 to February 2020. Among 2330 hypertension patients under follow-up, 354 were selected with a simple random sampling technique, and data was collected from the patient's medical cards. After evaluating the longitudinal data with a linear mixed model and the baseline data with Cox proportional models, the joint models of both sub-models were assessed in R software version 4.2. According to the findings, the association between longitudinal changes (FBS, SBP, and time to death in hypertension patients was statistically significant. Ages, place of residence, lifestyle change, stages of hypertension, blood cholesterol level, related diseases, adherence to treatment, family history of hypertension patients, and DBP at baseline were associated factors that affect survival time and longitudinal measurement of FBS and SBP of the patients. The computed association parameters revealed subject-specific values. The subject-specific linear time slope of FBS and SBP was negatively related to the hazard rate of time to death of hypertension patients in Arba Minch general hospital. To reduce the risk of hypertension in patients, health professionals, governmental organizations, and non-governmental organizations must promote the implementation of community-based screening programs for early detection of hypertension.
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Sanusi A, Elsey H, Golder S, Sanusi O, Oluyase A. Cardiovascular health promotion: A systematic review involving effectiveness of faith-based institutions in facilitating maintenance of normal blood pressure. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001496. [PMID: 36962921 PMCID: PMC10022319 DOI: 10.1371/journal.pgph.0001496] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023]
Abstract
Globally, faith institutions have a range of beneficial social utility, but a lack of understanding remains regarding their role in cardiovascular health promotion, particularly for hypertension. Our objective was assessment of modalities, mechanisms and effectiveness of hypertension health promotion and education delivered through faith institutions. A result-based convergent mixed methods review was conducted with 24 databases including MEDLINE, Embase and grey literature sources searched on 30 March 2021, results independently screened by three researchers, and data extracted based on behaviour change theories. Quality assessment tools were selected by study design, from Cochrane risk of bias, ROBINS I and E, and The Joanna Briggs Institute's Qualitative Assessment and Review Instrument tools. Twenty-four publications contributed data. Faith institution roles include cardiovascular health/disease teaching with direct lifestyle linking, and teaching/ encouragement of personal psychological control. Also included were facilitation of: exercise/physical activity as part of normal lifestyle, nutrition change for cardiovascular health, cardiovascular health measurements, and opportunistic blood pressure checks. These demand relationships of trust with local leadership, contextualisation to local sociocultural realities, volitional participation but prior consent by faith / community leaders. Limited evidence for effectiveness: significant mean SBP reduction of 2.98 mmHg (95%CI -4.39 to -1.57), non-significant mean DBP increase of 0.14 mmHg (95%CI -2.74 to +3.01) three months after interventions; and significant mean SBP reduction of 0.65 mmHg (95%CI -0.91 to -0.39), non-significant mean DBP reduction of 0.53 mmHg (95%CI -1.86 to 0.80) twelve months after interventions. Body weight, waist circumference and multiple outcomes beneficially reduced for cardiovascular health: significant mean weight reduction 0.83kg (95% CI -1.19 to -0.46), and non-significant mean waist circumference reduction 1.48cm (95% CI -3.96 to +1.00). In addressing the global hypertension epidemic the cardiovascular health promotion roles of faith institutions probably hold unrealised potential. Deliberate cultural awareness, intervention contextualisation, immersive involvement of faith leaders and alignment with religious practice characterise their deployment as healthcare assets.
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Affiliation(s)
- Abayomi Sanusi
- Department of Health Sciences, University of York, York, United Kingdom
| | - Helen Elsey
- Department of Health Sciences, University of York, York, United Kingdom
| | - Su Golder
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Adejoke Oluyase
- Cicely Saunders Institute of Palliative Care & Rehabilitation, King's College London, London, United Kingdom
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Highton PJ, Cassambai S, Jessen N, Agot GN, Hadjiconstantinou M, Davies M, Seidu S, Njoroge PK, Olenja JM, Godia P, Damasceno A, Lamptey R, Khunti K. Cardiometabolic disease and multiple long-term condition healthcare provision in Sub-Saharan Africa: Opportunities for new models of care in the post-COVID era. Diabetes Metab Syndr 2023; 17:102681. [PMID: 36521305 DOI: 10.1016/j.dsx.2022.102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Patrick J Highton
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK.
| | - Shabana Cassambai
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - George N Agot
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | | | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Peter K Njoroge
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | - Joyce Muhenge Olenja
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | - Pamela Godia
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | | | - Roberta Lamptey
- Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana & Department of Community Health, University of Ghana, Legon, Ghana
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK
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Ngwasiri C, Samadoulougou S, Cissé K, Aminde L, Kirakoya-Samadoulougou F. Changes in ideal cardiovascular health among Malawian adults from 2009 to 2017. Sci Rep 2022; 12:21937. [PMID: 36536000 PMCID: PMC9763343 DOI: 10.1038/s41598-022-26340-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Ideal Cardiovascular Health (CVH) is a concept defined by the American Heart Association (AHA) as part of its 2020 Impact Goals. Until now, changes in ideal CVH have been poorly evaluated in Sub-Saharan African populations. We aimed to investigate changes in the prevalence of ideal CVH and its components in a population of Malawian adults. Secondary analysis was done on cross-sectional data from 2009 to 2017, obtained from the Malawi STEPS surveys which included 5730 participants aged 25-64 years. CVH metrics categorized into "ideal (6-7 ideal metrics)", "intermediate (3-5 ideal metrics)" and "poor (0-2 ideal metrics)" were computed using blood pressure, body mass index (BMI), fasting glycaemia, fruit and vegetable intake, physical activity, smoking, and total cholesterol. Sampling weights were used to account for the sampling design, and all estimates were standardised by age and sex using the direct method. The mean participant age across both periods was 40.1 ± 12.4 years. The prevalence of meeting ≥ 6 ideal CVH metrics increased substantially from 9.4% in 2009 to 33.3% in 2017, whereas having ≤ 2 ideal CVH metrics decreased from 7.6% to 0.5% over this time. For the individual metrics, desirable levels of smoking, fruit and vegetable intake, physical activity, blood pressure (BP), total cholesterol and fasting glucose all increased during the study period whilst achievable levels of BMI (< 25 kg/m2) declined. From 2009 to 2017, the mean number of ideal CVH metrics was higher in women compared to men (from 2.1% to 5.1% vs 2.0% to 5.0%). However, poor levels of smoking and fruit and vegetable intake were higher in men compared to women (from 27.9% to 23.6% vs. 7.4%% to 1.9% , and from 33.7% to 42.9% vs 30.8% to 34.6%, respectively). Also, whilst achievable levels of BMI rose in men (from 84.4% to 86.2%) the proportion reduced in women (from 72.1% to 67.5% ). Overall, CVH improved in Malawian adults from 2009 to 2017 and was highest in women. However, the prevalence of poor fruit and vegetable intake, and poor smoking remained high in men whilst optimal levels of BMI was declined in women. To improve this situation, individual and population-based strategies that address body mass, smoking and fruit and vegetable intake are warranted for maximal health gains in stemming the development of cardiovascular events.
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Affiliation(s)
- Calypse Ngwasiri
- Clinical Research Education Networking and Consultancy (CRENC), RFMR+QFH, Yaoundé, Centre Region Cameroon ,grid.4989.c0000 0001 2348 0746Centre de Recherche en Épidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Belgium
| | - Sekou Samadoulougou
- grid.23856.3a0000 0004 1936 8390Centre for Research on Planning and Development, Université Laval, Quebec, QC G1V 0A6 Canada ,grid.421142.00000 0000 8521 1798Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Quebec, QC G1V 4G5 Canada
| | - Kadari Cissé
- grid.4989.c0000 0001 2348 0746Centre de Recherche en Épidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Belgium ,grid.457337.10000 0004 0564 0509Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Leopold Aminde
- grid.1022.10000 0004 0437 5432School of Medicine, Griffith University, Brisbane, Australia
| | - Fati Kirakoya-Samadoulougou
- grid.4989.c0000 0001 2348 0746Centre de Recherche en Épidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Belgium
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Mengistu MD, Benti H. Assessment of magnitude and spectrum of cardiovascular disease admissions and outcomes in Saint Paul Hospital Millennium Medical College, Addis Ababa: A retrospective study. PLoS One 2022; 17:e0267527. [PMID: 36508450 PMCID: PMC10045542 DOI: 10.1371/journal.pone.0267527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular diseases(CVD) remain the leading cause of death in the world and over 80% of all cardiovascular-related deaths occur in low and middle income countries. Ethiopia is in epidemiologic transition from predominantly infectious diseases to non-communicable diseases and the CVD is a major public health challenge. METHODS The aim of this study was to assess the magnitude and spectrum of cardiovascular admission and its outcomes among medical patients admitted to both Medical Ward and ICU of St. Paul Teaching Hospital from 1st of Jan 2020 to 1st of Jan 2021. RESULTS Out of 1,165 annual medical admissions, the prevalence of cardiovascular diseases(CVD) was 30.3%. About 60%(212) of patients had advanced congestive heart failure of diverse causes. Hypertensive heart disease (HHD) was the next predominant diagnosis (41%(146)), and also the leading cause of cardiac diseases followed by rheumatic valvular heart disease(RVHD) (18%(64)) and Ischemic heart disease (IHD) (12.2%(43)), respectively. Yong age, rural residence and female sex were associated with RVHD(p = 0.001). Stroke also accounted for 20%(70) of CVD admission (hemorrhagic stroke-17% Vs Ischemic stroke-83%). Hypertension was the predominate risk factor for CVD and present in 46.7%(168) of patients. The mean hospital stay was 12days and in-hospital mortality rate was 24.3% with septic shock being the commonest immediate cause of death followed by fatal arrhythmia, brain herniation, and massive PTE. CONCLUSION Cardiovascular diseases were common in the study area causing significant morbidity and mortality. Therefore, comprehensive approach is imperative to timely screen for cardiovascular risk reduction, disease control and complication prevention. Strategies should also be designed to increase public awareness regarding the cardiovascular risk reduction, drug adherence, and possible complications.
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Affiliation(s)
- Mekoya D. Mengistu
- Department of Physiology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Internal Medicine, Yekatit-12 Hospital Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Henok Benti
- Department of Internal Medicine, St. Paul Hospital, Millennium Medical College, Addis Ababa, Ethiopia
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Naicker I, Suleman F, Perumal-Pillay VA. A quantitative comparison of essential cardiovascular medicines from countries in the Southern African Development Community to the WHO model essential medicines list. J Pharm Policy Pract 2022; 15:97. [PMID: 36482421 PMCID: PMC9733348 DOI: 10.1186/s40545-022-00494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, cardiovascular disease (CVD) is a leading cause of death and disproportionately affects low- and middle-income countries (LMICs). The WHO Model List of Essential Medicines (WHO EML) is a tool for improving accessibility and availability of medicines. This study compared the 2021 WHO EML CVDs basket of medicines with latest available national essential medicines list (NEMLs) for South Africa and 15 Southern African Development Community (SADC) countries to assess consistency in CVDs medicine listing. METHODS This descriptive, desktop review study compared SADC NEMLs. A comparator list was extracted by combining cardiovascular medicines listed in the 2021 WHO EML for adults and children. SADC country NEMLs were obtained from the WHO Essential Medicines and Health Products Information Portal. Consistency of NEMLs was calculated as a percentage coverage of CVD medicines listed in the 2021 WHO EML. SA hospital and primary health care (PHC) level NEMLs were included as separate formularies. RESULTS The SA hospital level NEML scored 70% consistency with the 2021 WHO EML. Tanzania (84%), Namibia (81%) and Angola (79%) scored the highest consistency. The mean consistency for SADC NEMLs was 66%. The lowest scoring country was Eswatini at 26%. The SA PHC NEML scored 35%. The least listed medicines were beta-blockers, angiotensin receptor blockers (ARBs), clopidogrel (43%) and paediatric formulations (furosemide (21%); digoxin (43%)). Individual antihypertensive medicines were most commonly listed. Botswana and Lesotho were the only countries to list a single pill combination (SPC) for the treatment of hypertension. CONCLUSIONS This comparison indicates that South Africa and most SADC countries are aligned with 2021 WHO EML recommendations. The inclusion of age-appropriate formulations for children as well as ARBs and SPC for the treatment of hypertension may improve patient adherence and cardiovascular outcomes in these countries. More frequent updates to NEMLs should improve consistency. NEMLs were not available for two countries, and these therefore did not form part of this study. Country health expenditure in ranking the consistency of NEMLs was not accounted for. LMICs adopting the essential medicine list strategy should consider imposing minimum consistency thresholds to the WHO EML to improve accessibility and availability of CVD medicines. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ian Naicker
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
| | - Fatima Suleman
- grid.16463.360000 0001 0723 4123College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Velisha Ann Perumal-Pillay
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
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Horckmans M, Diaz Villamil E, Verdier C, Laurell H, Ruidavets JB, De Roeck L, Combes G, Martinez LO, Communi D. Loss-of-function N178T variant of the human P2Y4 receptor is associated with decreased severity of coronary artery disease and improved glucose homeostasis. Front Pharmacol 2022; 13:1049696. [DOI: 10.3389/fphar.2022.1049696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
Human P2Y4 is a UTP receptor, while in mice it is activated by both ATP and UTP. P2Y4 knockout (KO) in mice protects against myocardial infarction and is characterized by increased adiponectin secretion by adipocytes, and decreased cardiac inflammation and permeability under ischemic conditions. The relevance of these data has, however, not been explored to date in humans. In a population study comprising 50 patients with coronary artery disease (CAD) and 50 age-matched control individuals, we analyzed P2RY4 mutations and their potential association with CAD severity and fasting plasma parameters. Among the mutations identified, we focused our attention on a coding region polymorphism (rs3745601) that results in replacement of the asparagine at residue 178 with threonine (N178T) located in the second extracellular loop of the P2Y4 receptor. The N178T variant is a loss-of-function mutation of the human P2Y4 receptor and is encountered less frequently in coronary patients than in control individuals. In coronary patients, carriers of the N178T variant had significantly reduced jeopardy and Gensini cardiac severity scores, as well as lower resting heart rates and plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP). Regarding fasting plasma parameters, the N178T variant was associated with a lower concentration of glucose. Accordingly, P2Y4 KO mice had significantly improved glucose tolerance and insulin sensitivity compared with their WT littermate controls. The improvement of insulin sensitivity resulting from lack of the P2Y4 receptor was no longer observed in the absence of adiponectin. The present study identifies a frequent loss-of-function P2Y4 variant associated with less severe coronary artery atherosclerosis and lower fasting plasma glucose in coronary patients. The role of the P2Y4 receptor in glucose homeostasis was confirmed in mouse. P2Y4 antagonists could thus have therapeutic applications in the treatment of myocardial infarction and type 2 diabetes.
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Dev R, Adams AM, Raparelli V, Norris CM, Pilote L. Sex and Gender Determinants of Vascular Disease in the Global Context. Can J Cardiol 2022; 38:1799-1811. [PMID: 35667597 DOI: 10.1016/j.cjca.2022.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022] Open
Abstract
Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes with comparisons of data from the global North (ie, developed high-income countries in the Northern hemisphere and Australia) and the global South (ie, regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation's gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move toward the era of precision medicine, future research is needed that identifies, validates, and measures gender-related determinants and risk factors in the global South.
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Affiliation(s)
- Rubee Dev
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine and School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Cardiovascular and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada.
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Ayoola A, Ssekubugu R, Grabowski MK, Ssekasanvu J, Kigozi G, Mustapha A, Reynolds SJ, Ekstrom AM, Nordenstedt H, Enriquez R, Gray RH, Wawer MJ, Kagaayi J, Post WS, Chang LW. Overweight and obesity in south central Uganda: A population-based study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001051. [PMID: 36962650 PMCID: PMC10021145 DOI: 10.1371/journal.pgph.0001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022]
Abstract
Obesity is a rapidly growing global health challenge, but there are few population-level studies from non-urban settings in sub-Saharan Africa. We evaluated the prevalence of overweight (body mass index (BMI)>25 kg/m2), obesity (BMI>30 kg/m2), and associated factors using data from May 2018 to November 2020 from the Rakai Community Cohort Study, a population-based cohort of residents aged 15 to 49 living in forty-one fishing, trading, and agrarian communities in South Central Uganda. Modified Poisson regression was used to estimate adjusted prevalence risk ratios (PRR) and 95% confidence intervals (CI) in 18,079 participants. The overall mean BMI was 22.9 kg/m2. Mean BMI was 21.5 kg/m2 and 24.1 kg/m2 for males and females, respectively. The prevalence of overweight and obesity were 22.8% and 6.2%, respectively. Females had a higher probability of overweight/obesity (PRR: 4.11, CI: 2.98-5.68) than males. For female participants, increasing age, higher socioeconomic status, residing in a trading or fishing community (PRR: 1.25, CI 1.16-1.35 and PRR: 1.17, CI 1.10-1.25, respectively), being currently or previously married (PRR: 1.22, CI 1.07-1.40 and PRR: 1.16, CI 1.01-1.34, respectively), working in a bar/restaurant (PRR: 1.29, CI 1.17-1.45), trading/shopkeeping (PRR: 1.38, CI 1.29-1.48), and reporting alcohol use in the last year (PRR: 1.21, CI 1.10-1.33) were risk factors for overweight/obese. For male participants, increasing age, higher socioeconomic status, being currently married (PRR: 1.94, CI 1.50-2.50), residing in a fishing community (PRR: 1.68, CI 1.40-2.02), working in a bar/restaurant (PRR: 2.20, CI 1.10-4.40), trading/shopkeeping (PRR: 1.75, CI 1.45-2.11), or fishing (PRR: 1.32, CI 1.03-1.69) increased the probability of overweight/obesity. Non-Muslim participants, male smokers, and HIV-positive females had a lower probability of overweight/obese. The prevalence of overweight/obesity in non-urban Ugandans is substantial. Targeted interventions to high-risk subgroups in this population are needed.
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Affiliation(s)
- Adeoluwa Ayoola
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Stanford University School of Medicine, Stanford, California, United States of America
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Aishat Mustapha
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Steven J. Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | - Anna Mia Ekstrom
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
| | - Rocio Enriquez
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Ronald H. Gray
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maria J. Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Larry W. Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: A Systematic Review. Glob Heart 2022; 17:76. [DOI: 10.5334/gh.1166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/30/2022] [Indexed: 01/17/2023] Open
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Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana. Glob Heart 2022; 17:63. [PMID: 36199562 PMCID: PMC9438458 DOI: 10.5334/gh.1146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background There is an upsurge of cardiovascular diseases (CVDs) in sub-Saharan Africa (SSA). Irrespective of biological sex, gender-related factors could be the precursor of these conditions. Objective To examine the associations between biological sex, gender-related variables, and cardiovascular health (CVH) risk factors in SSA countries. Methods We used data from the STEPwise approach to surveillance of risk factors for non-communicable disease survey, conducted in adults from Ghana, Gambia, Mali, Guinea, and Botswana. The main outcome was CVH, measured through the health index with values ranging from 0 (worst) to 5 (best or ideal) CVH. Multivariable logistic regression was applied to determine the gender-related factors related to poorer CVH (index less than 4). Results Data included 15,356 adults (61.4% females, mean age 36.9 years). The prevalence of hypertension (21.6% vs. 13.8%) and overweight/obesity (48.3% vs. 27.5%) was higher among females as compared to males. Females were more likely to be unemployed (17.3% vs. 9.7%) or reported unpaid work (36.8% vs. 15.2%). Overall, females showed worse CVH than males (ORfemale = 0.95, 95% CI:0.91-0.99). Being married was associated with better CVH compared with being single, more so for males (ORmale = 1.09, 95% CI:0.96-1.24, pinteraction < 0.01). Males with unpaid work (ORmale = 1.28, 95% CI:1.12-1.47) had better CVH than their unpaid female counterparts (ORfemale = 1.08, 95% CI:1.01-1.17). Conclusion In SSA populations, being female was associated with poorer CVH given the disproportionate burden of hypertension and overweight/obesity. Gender-related factors such as marital status and unpaid work were associated with better CVH in males compared to females.
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Farah Yusuf Mohamud M. Epidemiological Characteristics and Risk Factors Associated with Acute Myocardial Infarction in Somalia: A Single-Center Experience. Int J Gen Med 2022; 15:7605-7617. [PMID: 36213302 PMCID: PMC9532582 DOI: 10.2147/ijgm.s383690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute myocardial infarction (AMI) is a clinical emergency condition that encompasses STEMI and NSTEMI that leads to significant morbidity and mortality rate. Methods This prospectively cohort study was obtained from adult (≥18 years) patients with definitive diagnosis of AMI based on the International Classification of Diseases (ICD; codes I21, I22) those visiting to our hospital from December 2020 to November 2021. Patients with no definite diagnosis of MI and those having with stable or unstable angina were excluded from the study. Descriptive methods including frequency of tables and bar charts for different categories were used for data analysis. Results Of 23,147 patients, 3526 were presented with chest pain in our emergency unit over the study period. A total of 97 patients met the inclusion criteria of AMI for this analysis. Of them, 73 (75.3%) had STEMI, and 24 (24.7%) had NSTEMI. Those with STEMI, anterior MI was common occlusion site (n=24, 32.9%) followed by inferior MI (n=15, 20.5%). The mean age of patients was 54.2±12.1 years. Of the total study subjects, 67 (69.1%) were males with no significant difference in subgroups. Most of the participants were married (n=41, 42.3%). More than half of the patients were employed (n=51, 52.6%), while most of the participants were no formal education (n-39, 44.2%). Regarding the ASCVD risk factors, history of hypertension, diabetes mellitus, previous history of coronary artery disease (CAD), and dyslipidemia were the most common comorbidities in STEMI and NSTEMI cases, 31 (41.2%), 36 (49.3%), 24 (32.9%) and 15 (20.5%) vs 14 (66.7%), 11 (45.8%), 11 (45.8%), and 6 (25%), respectively. On the initial clinical presentations, typical chest pain and palpitation were the most frequent clinical presenting symptoms in both STEMI and NSTEMI patients of our study (STEMI=80.4% vs NSTEMI=68% in each), followed by dyspnea (STEMI=72.6% vs NSTEMI=41.7%) and epigastric pain (STEMI=32.9% vs NSTEMI=29.2%). The use of aspirin, clopidogrel, and LMWH therapy within the first hours after the emergency were high and comparable in both subgroups (91.8%, vs 89.7% vs 89.7%). The majority of the patients developed heart failure (36.1%), arrhythmia (23.7%), and cardiogenic shock (18%). Conclusion As registered, the present study has a higher proportion of STEMI cases among the AMI participants when compared to the NSTEMI. Hypertension, diabetes, hyperlipidemia, and family history of CAD respectively were the highest prevalence risk factors of AMI.
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Affiliation(s)
- Mohamed Farah Yusuf Mohamud
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
- Correspondence: Mohamed Farah Yusuf Mohamud, Mogadishu Somali-Turkish Training and Research Hospital, 30 Street, Alikamin, Wartanabada District, Mogadishu, Somalia, Tel +252615591689, Email
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Kentoffio K, Durstenfeld MS, Siedner MJ, Kityo C, Erem G, Ssinabulya I, Ghoshhajra B, Bittencourt MS, Longenecker CT. Sex-specific performance of the ASCVD pooled cohort equation risk calculator as a correlate of coronary artery calcium in Kampala, Uganda. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200136. [PMID: 36060290 PMCID: PMC9434411 DOI: 10.1016/j.ijcrp.2022.200136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
Introduction: The prevalence of cardiovascular disease (CVD) is rising in Sub-Saharan Africa, but it is not known whether current risk assessment tools predict coronary atherosclerosis in the region. Furthermore, sex-specific performance and interaction with HIV serostatus has not been well studied. Methods: This cross-sectional study compared ASCVD risk scores and detectable coronary artery calcium (CAC>0) by sex in Kampala, Uganda (n = 200). The cohort was enriched for persons living with HIV, and all participants had at least one CVD risk factor. We fit log binomial regression models and constructed ROC curves to assess the correlation between ASCVD scores and CAC>0. Results: The mean age was 56. 62% were female and 50% of both men and women were living with HIV. The median 10-year ASCVD risk score was significantly higher in men (11.0%, IQR 7.6–19.4%) than in women (5.1%, IQR 3.2–8.7%), although the prevalence of CAC>0 was similar (8.1 vs 10.5%, p = 0.63). Each 10% increase in ASCVD risk was associated with increased risk of CAC>0 in men (PR 1.59, 95% CI 1.00–2.55, p = 0.05) but not women (PR 1.15, 95% CI 0.44–3.00, p = 0.77). ROC curves demonstrated an AUC of 0.57 for women vs 0.70 for men. Adjustment for HIV serostatus improved the predictive value of ASCVD in women only (AUC 0.78, p = 0.02). Conclusions: ASCVD risk score did not correlate with the presence of CAC in women. When HIV status was added to the ASCVD risk score, correlation with CAC was improved in women but not in men.
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Affiliation(s)
- Katherine Kentoffio
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew S. Durstenfeld
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mark J. Siedner
- Massachusetts General Hospital, Center for Global Health, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Medical School, Boston, MA, USA
| | - Cissy Kityo
- HIV Medicine, Joint Clinical Research Centre, Kampala, Uganda
| | - Geoffrey Erem
- Department of Radiology, St Francis Hospital Nsambya, Kampala, Uganda
- Departments of Radiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Ssinabulya
- Departments of Radiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Brian Ghoshhajra
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Marcio S. Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Chris T. Longenecker
- Department of Global Health and Division of Cardiology, University of Washington, Seattle, WA, USA
- Corresponding author. Global Cardiovascular Health Program, University of Washington School of Medicine, Department of Global Health, Hans Rosling Center Room 721, Guthrie Annex 3, Seattle, WA, 98105, USA.
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