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Gela YY, Belay DG, Chilot D, Andualem AA, Bitew DA, Sinamaw D, Eshetu HB, Seid AM, Simegn W, Kibret AA, Seid MA, Diress M. Prevalence of anemia and associated factors among adult hypertensive patients in Referral Hospitals, Amhara Regional State. Sci Rep 2023; 13:14329. [PMID: 37652948 PMCID: PMC10471574 DOI: 10.1038/s41598-023-41553-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: 06/02/2022] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
Anemia is a risk factor for adverse cardiovascular disease outcomes in hypertensive patients. Chronic anemia increases preload, reduces afterload, and leads to increased cardiac output in hypertension patients. In the long term, this may result in maladaptive left ventricular hypertrophy, which in turn is a well-recognized risk factor for cardiovascular disease outcomes and all-cause mortality in hypertension. Low hemoglobin and hematocrit levels might be strongly indicate hypertensive end-organ damage, specifically kidney failure. Therefore, this study determined the prevalence of anemia and associated factors among hypertensive patients in Referral Hospitals, Amhara Regional State, Ethiopia, in 2020. An institution-based cross-sectional study was conducted in Amhara Regional Referral Hospitals from February 20 to April 30, 2020. Random and systemic sampling techniques were used to select 428 study participants. Data were entered and coded in to Epi data version 3.0 and then exported into STATA 14 for analysis. In bivariable logistic regression, variables with a p-value of < 0.25 were included in multivariable logistic regression. Using a 95% confidence interval, variables having a p-value ≤ 0.05 in multivariable logistic regression were declared as statistically significant variables. In this study, a total of 428 study participants were involved with 99.5% response rate. The prevalence of anemia among hypertensive patients was 17.6%, with a 95% CI (14.3-21.5%). Estimated glomerular filtration rate (eGFR) < 90 ml/min (AOR = 2.77, 95% CI 1.56- 4.92)], duration of hypertension (HTN) ≥ 5 years (AOR = 2.37, 95% CI 1.36-4.15), uncontrolled blood pressure (AOR = 1.91, 95% CI 1.08-3.35), and higher pulse pressure (AOR = 1.05 (95% CI 1.02-1.08) were significantly associated with anemia. Nearly one out of five hypertensive patients had anemia. Impaired estimated glomerular filtration rate, duration of HTN, blood pressure status, and pulse pressure were the independent predictors of anemia among hypertensive patients. Screening hemoglobin level at a regular interval is recommended for the hypertensive patients to take an appropriate intervention.
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Affiliation(s)
- Yibeltal Yismaw Gela
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Chilot
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Amare Agmas Andualem
- Department of Anesthesia, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, Debre Markos, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | | | - Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Human Physiology, Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debra Tabor, Ethiopia
| | - Mengistie Diress
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Arnaiz P, Müller I, Seelig H, Gerber M, Bosma J, Dolley D, Adams L, Degen J, Gall S, Joubert N, Nienaber M, Nqweniso S, Aerts A, Steinmann P, du Randt R, Walter C, Utzinger J, Pühse U. Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa. Front Pediatr 2022; 10:877431. [PMID: 35633959 PMCID: PMC9130957 DOI: 10.3389/fped.2022.877431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Hypertension in children has increased globally over the past 20 years; yet, little is known about this issue among disadvantaged communities from low- and middle-income countries. Age-, sex-, and height-adjusted normative tables are the "gold" standard for the diagnosis and estimation of pediatric hypertension worldwide, but it is unclear whether the use of international standards is appropriate for all contexts. The purpose of this study was to evaluate and compare different international references to identify hypertension among South African school-aged children from disadvantaged communities. METHODS Blood pressure, weight, and height were measured in a cohort of 897 children aged 8-16 years from eight peri-urban schools in the Eastern Cape of South Africa. Cross-sectional prevalence of hypertension was calculated according to American, German, and global normative tables, as well as pseudo-normative data from the own study population. Isolated systolic hypertension and body mass index (BMI) were considered markers for cardiovascular disease. Multinomial logistic regression was used to compare the likelihood of blood pressure categorization with increasing BMI levels. RESULTS Hypertension prevalence ranged from 11.4% with the pseudo-normative study tables to 28.8% based on the German reference. Global guidelines showed the highest agreement both among international standards (92.5% with American guidelines) and with the study reference (72.5%). While the global and the American references presented higher systolic over diastolic hypertension rates (23.6 vs. 10.6% and 24.2 vs. 14.7%, respectively), the American guidelines predicted the highest increased risk for hypertension stage 2 [odds ratio, 1.72 (95% confidence interval: 1.43-2.07)] with raising levels of BMI. CONCLUSION Our results support the heterogeneity of blood pressure estimates found in the South African literature, and highlight the underrepresentation of African children in international guidelines. We call for caution in the use of international standards in different contexts and advocate for the development of normative tables that are representative of the South African pediatric population necessary to ensure an accurate identification of hypertension both from the clinical and epidemiological perspective.
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Affiliation(s)
- Patricia Arnaiz
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jacob Bosma
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Danielle Dolley
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Jan Degen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Stefanie Gall
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nandi Joubert
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Madeleine Nienaber
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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3
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Crouch SH, Soepnel LM, Kolkenbeck-Ruh A, Maposa I, Naidoo S, Davies J, Norris SA, Ware LJ. Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis. EClinicalMedicine 2022; 43:101229. [PMID: 34917909 PMCID: PMC8665406 DOI: 10.1016/j.eclinm.2021.101229] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa. METHODS We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I2 statistic. FINDINGS In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines. INTERPRETATION Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity. FUNDING This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
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Affiliation(s)
- Simone H. Crouch
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Larske M. Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Correspondence and reprint to: Dr. Larske M. Soepnel. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Huispost nr. STR 6.131 P.O. Box 85500 3508 GA, Utrecht, The Netherlands
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa School of Public Health
| | - Sanushka Naidoo
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justine Davies
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingdom
| | - Lisa J. Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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Janha RE, Hardy-Johnson P, Kehoe SH, Mendy MB, Camara I, Jarjou L, Ward K, Moore SE, Fall C, Barker M, Weller S. Exploring influences on adolescent diet and physical activity in rural Gambia, West Africa: food insecurity, culture and the natural environment. Public Health Nutr 2021; 24:5277-5287. [PMID: 32854803 PMCID: PMC7611936 DOI: 10.1017/s1368980020002669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore, from the perspectives of adolescents and caregivers, and using qualitative methods, influences on adolescent diet and physical activity in rural Gambia. DESIGN Six focus group discussions (FGD) with adolescents and caregivers were conducted. Thematic analysis was employed across the data set. SETTING Rural region of The Gambia, West Africa. PARTICIPANTS Participants were selected using purposive sampling. Four FGD, conducted with forty adolescents, comprised: girls aged 10-12 years; boys aged 10-12 years; girls aged 15-17 years, boys aged 15-17 years. Twenty caregivers also participated in two FGD (mothers and fathers). RESULTS All participants expressed an understanding of the association between salt and hypertension, sugary foods and diabetes, and dental health. Adolescents and caregivers suggested that adolescent nutrition and health were shaped by economic, social and cultural factors and the local environment. Adolescent diet was thought to be influenced by: affordability, seasonality and the receipt of remittances; gender norms, including differences in opportunities afforded to girls, and mother-led decision-making; cultural ceremonies and school holidays. Adolescent physical activity included walking or cycling to school, playing football and farming. Participants felt adolescent engagement in physical activity was influenced by gender, seasonality, cultural ceremonies and, to some extent, the availability of digital media. CONCLUSIONS These novel insights into local understanding should be considered when formulating future interventions. Interventions need to address these interrelated factors, including misconceptions regarding diet and physical activity that may be harmful to health.
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Affiliation(s)
- Ramatoulie E Janha
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), P.O. Box 273, Banjul, The Gambia, West Africa
| | - Polly Hardy-Johnson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sarah H Kehoe
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Michael B Mendy
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), P.O. Box 273, Banjul, The Gambia, West Africa
| | - Isatou Camara
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), P.O. Box 273, Banjul, The Gambia, West Africa
| | - Landing Jarjou
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), P.O. Box 273, Banjul, The Gambia, West Africa
| | - Kathryn Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK
| | - Sophie E Moore
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), P.O. Box 273, Banjul, The Gambia, West Africa
- Department of Women and Children’s Health, Kings College London, London, UK
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Susie Weller
- Clinical Ethics and Law (CELS), University of Southampton, Southampton, UK
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Nganou-Gnindjio CN, Essama DB, Nkeck JR, Tchebegna PY, Tchatchouang KM, Tankeu A, Kamgno J. Prevalence and factors associated with hypertension among school children and adolescents in urban and semi-urban areas in Cameroon. J Clin Hypertens (Greenwich) 2021; 23:1490-1497. [PMID: 34152698 PMCID: PMC8678760 DOI: 10.1111/jch.14309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 12/22/2022]
Abstract
Few data to date exist on pediatric hypertension (PH) prevalence and risk factors in semi-urban areas in Cameroon, and they are believed to be the same as urban areas. These data are needed to design targeted preventive strategies and contribute to reducing the burden of PH in Cameroon and countries with equivalent standards of care. The authors conducted a cross-sectional study, from November, 2017 to June, 2018, in primary and secondary schools, from semi-urban (Bamboutos, West Region) and urban (Mfoundi, Center Region) settings in Cameroon, including children and adolescent aged between 3 and 19 years, recruited on a stratified probability sampling. PH was defined according to the American Academy of Pediatrics 2017. Overall, 1001 and 842 participants were, respectively, included in urban and semi-urban areas. The overall average age was 13.9 ± 4.03 years, and two-thirds were girls. Overweight and obesity were more prevalent in urban area (overweight: 17.1%; obesity: 5.9%), compared to semi-urban (overweight: 1.1% and obesity: 0.8%) (p < .001). The prevalence of hypertension was higher in urban (12%) than semi-urban areas (8.6%) (p = .01). We have identified as factors associated with PH: age > 14 years (OR = 3.18 [1.6; 6.2]) and secondary level of education (OR = 2.5 [1.2; 5.5]) in urban areas; family history of hypertension (OR 1.93 [1.1; 3.4] in semi-urban areas. PH prevalence is higher in urban than semi-urban areas, and the associated factors are not the same. Policies to address hypertension in the pediatric population must be targeted and tailored to the different population profiles.
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Affiliation(s)
- Chris Nadège Nganou-Gnindjio
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Cardiology Department, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Doris Bibi Essama
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jan René Nkeck
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - Aurel Tankeu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Joseph Kamgno
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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6
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Atibila F, Ten Hoor G, Donkoh ET, Kok G. Challenges experienced by patients with hypertension in Ghana: A qualitative inquiry. PLoS One 2021; 16:e0250355. [PMID: 33956798 PMCID: PMC8101754 DOI: 10.1371/journal.pone.0250355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypertension (HPT) is an essential public health problem affecting both lower and middle-income countries disproportionately. Evidence suggests that HPT is the leading risk factor for cardiovascular diseases and chronic kidney disease. Yet, challenges faced by patients with HPT in Ghana are not sufficiently explored. This study, documents the challenges patients with HPT face in Ghana. METHODS We used an explorative descriptive qualitative design. Face-to-face in-depth interviews were conducted with 15 patients with HPT. Interviews were recorded and transcribed verbatim. A thematic content analysis procedure was followed to analyse the data. RESULTS Four main themes emerged from interviews; three of which pertained to dimensions of challenges and a fourth which pertained to coping strategies. These include: [1] impairment in physical activities and mobility constraints [2]. Psychological challenges such as suicidal ideations, sadness, fear, anxiety, and reduced sexual affection [3]. Socio-economic challenges identified include loss of friends and social network, difficulty in job demands, and financial burden, and [4] coping strategies such as health system support, social support, and religiosity were identified. CONCLUSION Patients with HPT experience an array of challenges. We suggest that health care facilities incorporate post HPT diagnosis counseling sessions for HPT patients in the study area. Also, the National Health Insurance Authority (NHIA) should re-examine their scope of services; thus, drugs, laboratory services, and electrocardiogram services to avoid the issue of co-payment. Collaboration between healthcare professionals and family relations of patients with HPT ought to also be strengthened to ensure optimal care.
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Affiliation(s)
- Fidelis Atibila
- Valley View University, Techiman-Bono East Region, Ghana
- Department of Works and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Gill Ten Hoor
- Department of Works and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Emmanuel Timmy Donkoh
- Department of Basic and Applied Biology, University of Energy and Natural Resources, UENR Sunyani, Sunyani, Ghana
| | - Gerjo Kok
- Professor Emeritus of Applied Psychology, Department of Works and Social Psychology Maastricht University, Maastricht, the Netherland
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7
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Nsanya MK, Ayieko P, Hashim R, Mgema E, Fitzgerald D, Kapiga S, Peck RN. Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents. Sci Rep 2021; 11:8397. [PMID: 33864003 PMCID: PMC8052360 DOI: 10.1038/s41598-021-87996-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
Estimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1-4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion.
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Affiliation(s)
- Mussa K Nsanya
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania.
| | - Philip Ayieko
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Ezekiel Mgema
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
| | - Robert N Peck
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Cornell Medical College, New York, USA
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8
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Zengin A, Jarjou LM, Janha RE, Prentice A, Cooper C, Ebeling PR, Ward KA. Sex-Specific Associations Between Cardiac Workload, Peripheral Vascular Calcification, and Bone Mineral Density: The Gambian Bone and Muscle Aging Study. J Bone Miner Res 2021; 36:227-235. [PMID: 33118663 DOI: 10.1002/jbmr.4196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022]
Abstract
Noncommunicable diseases (NCD) are rapidly rising in Africa, with multimorbidity increasing the burden on health and social care. Osteoporosis and cardiovascular disease (CVD) share common risk factors; both often remain undiagnosed until a major life-threatening event occurs. We investigated the associations between cardiac workload, peripheral vascular calcification (PVC), and bone parameters in Gambian adults. The Gambian Bone and Muscle Aging Study (GamBAS) recruited 249 women and 239 men aged 40 to 75+ years. Body composition and areal bone mineral density (aBMD) were measured using dual-energy X-ray absorptiometry; peripheral quantitative computed tomography (pQCT) scans were performed at the radius and tibia. Supine blood pressure and heart rate were measured and used to calculate rate pressure product and pulse pressure. Presence of PVC was determined from tibia pQCT scans. Sex interactions were tested (denoted as p-int); adjustments were made for residuals of appendicular lean mass (ALM) and fat mass (FM). There were negative associations between rate pressure product and aBMD in women only, all p-int < .05; after adjustment for ALM residuals, for every 10% increase in rate pressure product, aBMD was lower at the whole body (-0.6% [-1.2, -0.1]), femoral neck (-0.9% [-1.8, -0.05]), L1 to L4 (-0.6% [-1.7, 0.5]), and radius (-1.9% [-2.8, -0.9]); there were similar associations when adjusted for FM residuals. Similar negative associations were found between pulse pressure and aBMD in women only. PVC were found in 26.6% men and 22.5% women; women but not men with calcification had poorer cardiac health and negative associations with aBMD (all sites p-int < .001). There were consistent associations with cardiac parameters and pQCT outcomes at the radius and tibia in women only. Multiple markers of cardiac health are associated with poorer bone health in Gambian women. In the context of epidemiological transition and changing NCD burden, there is a need to identify preventative strategies to slow/prevent the rising burden in CVD and osteoporosis in Sub-Saharan Africa. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Ayse Zengin
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- MRC Nutrition and Bone Health Group, Cambridge, UK
| | - Landing M Jarjou
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ramatoulie E Janha
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ann Prentice
- MRC Nutrition and Bone Health Group, Cambridge, UK
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Kate A Ward
- MRC Nutrition and Bone Health Group, Cambridge, UK
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Matjuda EN, Engwa GA, Anye SNC, Nkeh-Chungag BN, Goswami N. Cardiovascular Risk Factors and Their Relationship with Vascular Dysfunction in South African Children of African Ancestry. J Clin Med 2021; 10:jcm10020354. [PMID: 33477761 PMCID: PMC7832309 DOI: 10.3390/jcm10020354] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 12/31/2022] Open
Abstract
Vascular dysfunction is known to be an initiator of the development and progression of cardiovascular diseases (CVDs). However, there is paucity of information on the relationship of vascular dysfunction with cardiovascular risk factors in children of African ancestry. This study investigated the relationship between cardiovascular risk factors and vascular function in South African children of African ancestry. A cross-sectional study on 6–9-year-old children in randomly selected rural and urban schools of the Eastern Cape Province of South Africa was conducted. General anthropometric indices were measured, followed by blood pressure (BP) measurements. The pulse wave velocity (PWV) was measured using a Vicorder. Albumin to creatinine ratio (ACR), asymmetric dimethylarginine (ADMA), 8-hydroxy-2deoxyguanosine (8-OHdG) and thiobarbituric acid reactive substance (TBARS) were assayed in urine. Children from urban settings (10.8%) had a higher prevalence of overweight/obesity than their rural counterparts (8.5%) while the prevalence of elevated/high blood pressure was higher in rural (23.2%) than urban children (19.0%). Mean arterial blood pressure (MAP) and diastolic blood pressure (DBP) increased with increasing PWV (p < 0.05). Body mass index (BMI), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) positively associated (p < 0.05) with PWV. Creatinine, albumin and ACR significantly (p < 0.005) increased with increasing ADMA. ADMA associated positively (p < 0.05) with creatinine and 8-OHdG. In conclusion, vascular dysfunction was associated with obesity, high blood pressure, oxidative stress and microalbuminuria in South African children of African ancestry.
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Affiliation(s)
- Edna N. Matjuda
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
| | - Godwill A. Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
| | - Samuel Nkeh Chungag Anye
- MBCHB Programme, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
| | - Benedicta N. Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
- Correspondence:
| | - Nandu Goswami
- Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, 8036 Graz, Austria;
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Matjuda EN, Sewani-Rusike CR, Anye SNC, Engwa GA, Nkeh-Chungag BN. Relationship between High Blood Pressure and Microalbuminuria in Children Aged 6-9 Years in a South African Population. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E131. [PMID: 32906740 PMCID: PMC7552714 DOI: 10.3390/children7090131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
Though the association between high blood pressure and microalbuminuria is well established in adults, there is a paucity of information on microalbuminuria in children. This study investigated the relationship between high blood pressure and microalbuminuria in 6-9-year-old children. A cross-sectional study, which included 306 primary school children of age 6-9 years old from urban areas (n = 154) and rural areas (n = 152) of the Eastern Cape Province of South Africa, was conducted. Participants' anthropometric data were determined and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured and converted to BP percentiles for age, sex and height. Creatinine and albumin concentrations were assayed in early morning midstream urine and the albumin to creatinine ratio (ACR) was calculated. There was a 42.8% prevalence of elevated blood pressure/high blood pressure (E-BP/H-BP) and a 10.1% prevalence of microalbuminuria. Among the 131 children with E-BP/H-BP, 17 had elevated ACR with a prevalence of 13.95%. SBP and HR increased with increasing range of ACR and, furthermore, SBP was significantly (p < 0.05) higher in children with moderately and severely increased ACR. SBP was associated with ACR and increased SBP predicted microalbuminuria (R2 = 0.42, adj R2 = 0.039, B: 0.120, p = < 0.05). In conclusion, microalbuminuria was present in 6-9-year-old South African children of African Ancestry and a weak association was observed with SBP in children.
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Affiliation(s)
- Edna Ngoakoana Matjuda
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa; (E.N.M.); (C.R.S.-R.)
| | - Constance R. Sewani-Rusike
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa; (E.N.M.); (C.R.S.-R.)
| | - Samuel Nkeh Chungag Anye
- MBCHB Programme, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
| | - Benedicta Ngwechi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
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11
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Spurr S, Bullin C, Bally J, Allan D. Undiagnosed prehypertension/hypertension in Canadian adolescents: The critical role of the public health nurse. Public Health Nurs 2020; 37:837-845. [PMID: 32856345 DOI: 10.1111/phn.12792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the prevalence of undiagnosed prehypertension/hypertension and other associated comorbidities in adolescents living in rural and urban settings in a mid-Western Canadian province. DESIGN AND MEASURES Data reported herein were derived from two cross-sectional studies, whereby adolescents attending either a rural (N = 143) or urban (N = 253) school were screened for blood pressure, anthropometric measures, and blood glucose measurements. Data analysis included descriptive and inferential statistics in addition to chi-square analyses. RESULTS Notable prevalence of undiagnosed prehypertension/hypertension was found. Adolescents living in urban settings (49%, N = 123) were significantly more likely to have prehypertension/hypertension than rural (23%, N = 33) living adolescents. With regard to other comorbidities, the prevalence of elevated HbA1c in the urban group (32%) was significantly higher than the rural adolescents (19%); however, there was similar prevalence of overweight/obese adolescents between the urban (37%) and rural (36%) groups. CONCLUSIONS The prevalence of adolescent undiagnosed prehypertension/hypertension, elevated blood glucose measurements, and overweight/obesity is concerning in both urban and rural settings. Public health nurses are uniquely positioned in health care to facilitate interventions focused on preventing and managing adolescent prehypertension/hypertension and its associated comorbidities.
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Affiliation(s)
- Shelley Spurr
- Faculty of Nursing, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Carol Bullin
- Faculty of Nursing, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jill Bally
- Faculty of Nursing, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Diane Allan
- Faculty of Nursing, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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12
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Abstract
Cardiovascular disease (CVD) is increasingly becoming a major chronic disease burden in sub-Saharan Africa. The aim of this review was to provide an up-to-date overview on prevalence of CVD risk factors in the Gambia. The findings from seven included studies revealed that most CVD risk factors are very prevalent in the Gambia, with some specific groups in the population such as urban dwellers being more at risk. Obesity prevalence ranged from 2.3% to 11.7%, with rate being particularly high in urban women aged ≥35 years. Diabetes prevalence was 0.3%. Hypertension prevalence ranged from 18.3% to 29%. Prevalence of hypercholesterolemia ranged from 2.2% to 29.1%. Prevalence of smoking ranged from 16% to 42.2% in men. Prevalence of insufficient fruit and vegetable consumption, inadequate physical activity, and alcohol consumption was 77.8%, 14.6%, and 2.3%, respectively. These findings suggest urgent need for preventive measures and further research to prevent CVD in the Gambia.
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Abstract
Context: Population-based cohort studies have been pivotal in establishing a number of nutrition-health interactions, especially in high-income settings. Less research is available from low- and middle-income countries due to the lack of detailed longitudinal data. Objective: To describe the use of prospectively collected longitudinal data from the rural West Kiang region of The Gambia to explore nutrition-health interactions in a rural sub-Saharan African context. Methods: Demographic records initiated in 1947, coupled with data on maternal and child health, have been used to explore nutrition-health relationships. Results: An analysis of the longitudinal demographic data demonstrated a highly significant association between season of birth and infection-related adult mortality in this context. Additionally, using routine data on childhood anthropometry, it has been shown that, despite a significant decline in child undernutrition, rates remain unacceptably high, likely reflecting the very high socio-economic threshold required to eliminate undernutrition. Conclusion: The foresight to establish demographic data collection over seventy years ago has supported a wealth of novel research within a traditional African context. The availability of detailed clinical records on maternal and child health is helping to unravel the factors driving child undernutrition in rural Africa, and to identify targets for interventions to improve health in this context.
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Affiliation(s)
- Sophie E Moore
- Department of Women & Children's Health, King's College, London, UK.,MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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14
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Association of Hypertension and Obesity with Risk Factors of Cardiovascular Diseases in Children Aged 6-9 Years Old in the Eastern Cape Province of South Africa. CHILDREN-BASEL 2020; 7:children7040025. [PMID: 32231008 PMCID: PMC7230217 DOI: 10.3390/children7040025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 12/26/2022]
Abstract
Cardiovascular disease (CVD) risk factors are known to begin early in life, but limited data on the relationship of obesity and hypertension with other known CVD risk factors, such as endothelial dysfunction, oxidative stress, and chronic low-grade inflammation is available on children. In this cross-sectional study involving 6–9 years old school children aged from the Eastern Cape Province of South Africa the relationship between obesity/hypertension and other risk factors for CVDs was investigated. General anthropometric parameters were measured, followed by blood pressure (BP) measurements and pulse wave velocity (PWV). Urine samples were collected for the determination of albumin, creatinine, asymmetric dimethylarginine (ADMA), 8-hydroxy-2deoxyguanosine (8-OHdG), and thiobarbituric acid-reactive substance (TBARS). Overweight/obesity (19.28%) and pre-hypertension/hypertension (42.16%) were prevalent in children. Mid-upper arm circumference (MUAC), a marker of obesity, was positively correlated with ADMA, while ADMA and PWV were significantly different (p < 0.05) between hypertensive and normotensive children. Also, TBARS and 8-OHdG were significantly (p < 0.05) increased in hypertensive subjects. Creatinine was significantly (p < 0.05) increased in obese, as well as in hypertensive children, and positively associated with waist circumference (WC) and neck circumference (NC). In conclusion, obesity and hypertension were associated with renal-cardiovascular disease risk, while oxidative stress showed a possible association with obesity in 6 to 9 year old South African children of African descent. This suggests that South African children of African descent may be becoming more prone to developing CVDs, and therefore may require early intervention for the prevention of CVDs in the near future.
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Lawal TA, Raji YR, Ajayi SO, Ademola AD, Ademola AF, Ayandipo OO, Adigun T, Ogundoyin OO, Olulana DI, Asinobi AO, Salako BL. Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0214-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Abiodun O, Ladele A, Olu-Abiodun O, Ashipa T. Hypertension among adolescents in Nigeria: a retrospective study of adolescent university freshmen. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0287/ijamh-2018-0287.xml. [PMID: 30875324 DOI: 10.1515/ijamh-2018-0287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/06/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The burden of hypertension is rising both globally and in Africa specifically. We determined the prevalence of hypertension and the risk factors for clinical hypertension in a population of new university intakes over a 4-year period. METHODS We analyzed retrospectively, the records of 6980 older adolescents (15-19 years). We used population-specific metrics to categorize blood pressure (BP) based on the 2017 Clinical Practice Guidelines by the American Academy of Pediatrics. RESULTS The overall prevalence of high BP in our study was 25.1% [95% confidence interval (CI) 24.1-26.2] for elevated BP, 19.8% (95% CI 18.9-20.8) for stage 1 hypertension, and 5.5% (95% CI 5.0-6.1) for stage 2 hypertension. The prevalence of stage 2 hypertension was 8.7% (7.5-9.5) among the male participants and 3.2% (95% CI 2.7-3.2) among the female participants (p < 0.001). The multivariate analyses demonstrated an increased risk of high levels of BP (p < 0.001) with age (1.21: 95% CI 1.16-1.26), waist-to-height ratio (WHtR) (1.05: 95% CI 1.04-1.05), z-score for body mass index (BMI) (1.47: 95% CI 1.41-1.54), and hemoglobin concentration (1.10: 95% CI 1.09-1.12). It demonstrated a reduced risk of high levels of BP (p < 0.001) being female (0.35: 95% CI 0.32-0.39). CONCLUSIONS Hypertension, its risk factors and the risk of cardiovascular diseases in later life are prevalent in our Nigerian adolescent population. There is, therefore, a need for the development, evaluation and implementation of context-appropriate strategies and interventions to mitigate the risk of hypertension among adolescents, and cardiovascular diseases later in life.
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Affiliation(s)
- Olumide Abiodun
- Department of Community Medicine, Babcock University, Ilishan, Nigeria
- Center for Epidemiology and Clinical Research, Sagamu, Nigeria
| | - Akindele Ladele
- Department of Family Medicine, Babcock University, Ilishan, Nigeria
| | | | - Temitope Ashipa
- Department of Community Medicine, Babcock University, Ilishan, Nigeria
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Lule SA, Namara B, Akurut H, Lubyayi L, Nampijja M, Akello F, Tumusiime J, Aujo JC, Oduru G, Mentzer AJ, Smeeth L, Elliott AM, Webb EL. Blood pressure risk factors in early adolescents: results from a Ugandan birth cohort. J Hum Hypertens 2019; 33:679-692. [PMID: 30804461 PMCID: PMC6760975 DOI: 10.1038/s41371-019-0178-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023]
Abstract
We aimed to investigate life-course factors associated with blood pressure (BP) among Ugandan adolescents. Between 9th April 2003 and 24th November 2005, 2507 pregnant women from Entebbe municipality and Katabi sub-county were enrolled into a deworming trial. The resulting 2345 live-born offspring were followed to age 10 or 11 years, when between 20th May 2014 to 16th June 2016, BP was measured following standard protocols. Factors associated with BP were assessed using multivariable linear regression. BP was measured in 1119 adolescents with a median age of 10.2 years. Mean systolic BP and diastolic BP was 105.9 mmHg (standard deviation (SD) 8.2) and 65.2 mmHg (SD 7.3), respectively. Maternal gestational body mass index (BMI), higher maternal education status and family history of hypertension were positively associated with adolescent BP. Childhood (age ≤5 years) malaria was associated with lower adolescent systolic BP. Factors measured at time of BP measurement positively associated with systolic BP were age, BMI, waist circumference and Trichuris trichiura (whipworm) infection; higher vegetable consumption was associated with lower systolic BP. Results for diastolic BP were similar, except higher fruit, rather than higher vegetable consumption was associated with lower diastolic BP and there was no association with waist circumference or Trichuris trichiura infection. In summary, life-course exposures were associated with adolescent BP in this tropical birth cohort. Malaria early in life could impact later BP. Interventions initiated early in life targeting individuals with family history of hypertension, aiming to reduce adiposity (in pregnancy and adolescence) and promoting fruit and vegetable consumption might contribute to reducing the risk of high BP and subsequent cardiovascular diseases.
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Affiliation(s)
- Swaib A Lule
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
| | - Benigna Namara
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Helen Akurut
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Lawrence Lubyayi
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Florence Akello
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Judith C Aujo
- Department of Paediatrics, Mulago Hospital, P.O. Box 7051, Kampala, Uganda
| | - Gloria Oduru
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Alison M Elliott
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy. AIDS 2018; 32:2739-2748. [PMID: 30289814 PMCID: PMC6250247 DOI: 10.1097/qad.0000000000002031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Antiretroviral therapy (ART) has decreased mortality so that increasing numbers of children with HIV are reaching adolescence. However, longstanding HIV infection and/or its treatment in children is associated with noninfectious complications including cardiac disease. We investigated the prevalence, spectrum and risk factors for echocardiographic abnormalities among children established on ART. Methods: HIV-infected children aged 6–16 years, on ART at least 6 months were enrolled into a cross-sectional study from a public-sector paediatric HIV clinic in Harare, Zimbabwe. A standardized examination including transthoracic echocardiography was performed. Local echocardiographic reference ranges were used to define cardiac abnormalities. Logistic regression was used to examine the association between cardiac abnormalities and risk factors. Results: Of the 201participants recruited, 92 (46%) were girls and median age was 11 (IQR 9–12) years; CD4+ cell count was 727 cells/μl (IQR 473–935) and 154 (78%) had viral load less than 400 copies/ml. Echocardiographic abnormalities were found in 83 (42%); left ventricular (LV) diastolic dysfunction was the most common abnormality 45 (23%) and LV hypertrophy in 22 (11%). LV and left atrial dilatation were found in 9 (5%) and 16 (8%), respectively. Right ventricular dilatation and systolic dysfunction were found in 13 (7%) and 4 (2%), respectively, of whom 60% had concurrent left heart abnormalities. Current use of nevirapine was associated with LVH [aOR 3.14 (1.13–8.72; P = 0.03)] and hypertension was associated with LV diastolic dysfunction [aOR 3.12 (1.48–6.57; P < 0.01)]. Conclusion: HIV-infected children established on ART have a high burden of echocardiographic abnormalities. Right heart disease was predominantly associated with left heart abnormalities and may be part of a global cardiomyopathic process. Further studies are needed to investigate the natural history, aetiology, and pathogenesis of these abnormalities, so that appropriate monitoring and treatment strategies can be developed.
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Schoenbuchner SM, Moore SE, Johnson W, Ngum M, Sonko B, Prentice A, Prentice AM, Ward KA. In rural Gambia, do adolescents have increased nutritional vulnerability compared with adults? Ann N Y Acad Sci 2018. [PMCID: PMC5901020 DOI: 10.1111/nyas.13587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Adolescents may be particularly susceptible to malnutrition owing to the energy and nutrient costs of the pubertal growth spurt. Here, our aim is to compare differences in selected markers of nutritional status between adolescents and adults in rural Gambia. The Keneba Biobank collects cross‐sectional data and samples for all consenting individuals resident in the West Kiang region of the Gambia. For this study, participants between the ages of 10 and 40 years were selected (n = 4201, females 2447). Height, body mass index, body composition, hemoglobin concentration, fasting glucose concentration, and blood pressure were compared using linear regression models adjusting for age, parity, season of measurement, and residence, across three age groups: early adolescent (10–14.9 years), late adolescent (15–19.9 years), and adult (20–39.9 years). Adolescents, particularly early‐adolescent girls and boys, were shorter, lighter, and leaner than adults. By late adolescence, differences were smaller, particularly in girls where, notably, the prevalence of overweight, hypertension, and impaired fasting glucose was low. Given the importance of maternal health for reproductive outcomes and intergenerational health, the results of the study, albeit with limited biomarkers available, indicate that adolescent girls are no more compromised than adult women or males from the same population.
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Affiliation(s)
| | | | - William Johnson
- School of Sport, Exercise and Health Sciences; Loughborough University; Loughborough UK
| | | | | | - Ann Prentice
- MRC Elsie Widdowson Laboratory; Cambridge UK
- MRC Unit The Gambia; Banjul The Gambia
| | | | - Kate A. Ward
- MRC Elsie Widdowson Laboratory; Cambridge UK
- MRC Lifecourse Epidemiology Unit; University of Southampton, Southampton General Hospital; Southampton UK
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Erratum: High blood pressure and associated risk factors as indicator of preclinical hypertension in rural West Africa: A focus on children and adolescents in The Gambia: Erratum. Medicine (Baltimore) 2017; 96:e7402. [PMID: 31305686 PMCID: PMC5484264 DOI: 10.1097/md.0000000000007402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
[This corrects the article DOI: 10.1097/MD.0000000000006170.].
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