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Eltayib EM, Jirjees F, Suliman D, AlObaidi H, Ahmed M, Kharaba ZJ, Alfoteih Y, Barakat M, Khidhair Z, ALSalamat H, Mustafa N, Cherri S, El Khatib S, Hallit S, Malaeb D, Hosseini H. Stroke awareness and knowledge in Sudan: a cross-sectional analysis of public perceptions and understanding. Front Public Health 2024; 12:1362979. [PMID: 38774053 PMCID: PMC11107802 DOI: 10.3389/fpubh.2024.1362979] [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: 12/29/2023] [Accepted: 04/18/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Stroke, a leading cause of morbidity and mortality globally, demands heightened awareness and knowledge for effective preventive strategies and tailored response. Sudan is classified as a low income country with a low rate of literacy, lack of knowledge, and awareness about diseases. Thus, this study aimed to assess stroke awareness and knowledge among Sudanese population, and identify the associated factors influencing awareness. Methods A cross-sectional study conducted between October and November 2022 through a self-administered online survey distributed via various social media platforms. The study involved adults aged 18 years and above through snow-ball sampling technique. The survey covered general awareness and knowledge concerning stroke risk factors, consequences, and the appropriate responses taken during acute stroke attacks. Results A total of 410 participants were enrolled in the study, majority (93.4%) were from urban area and had university degree (92.4%). Furthermore, 92.2% were aware about stroke and 74.9% were able to recognize the symptoms of stroke. Only 40.2% identified all correct answers, 96.3, 92.3, and 95.1% recognized at least one risk factor, early symptom, and consequences, respectively. Females were significantly more than males able to identify at least one risk factor. Almost all participants (99.5%) perceived stroke as a serious disease (99.5%). Notably, 86.3% would promptly transport a suspected stroke patient to the hospital. The multivariable analysis showed that females versus males and patients with depression versus without depression had significantly higher odds to identify at least one risk factor (OR of 14.716 [95% CI 1.901; 113.908] and 0.241 [95% CI 0.059; 0.984], respectively). Conclusion The study concluded that stroke knowledge and awareness among Sudanese population is suboptimal. Furthermore, early stroke recognition and intake of the appropriate management strategies are lacking which highlights the need for targeted education and awareness campaigns.
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Affiliation(s)
| | - Feras Jirjees
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Duaa Suliman
- Health Policy, Mohammed Bin Rashid School of Government, Dubai, United Arab Emirates
| | - Hala AlObaidi
- School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - Munazza Ahmed
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Zelal J. Kharaba
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Yassen Alfoteih
- College of Dentistry and College of Humanities, City University College of Ajman, Ajman, United Arab Emirates
| | - Muna Barakat
- Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | | | - Husam ALSalamat
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Nazik Mustafa
- Department of Pharmacology, Faculty of Pharmacy, Al Neelain University, Khartoum, Sudan
| | - Sarah Cherri
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
| | - Sami El Khatib
- Department of Biomedical Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology, West Mishref, Kuwait
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Hassan Hosseini
- UPEC-University Paris-Est, Creteil, France
- RAMSAY SANTÉ, HPPE, Champigny-sur-Marne, France
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Moshi B, Yongolo N, Biswaro SM, Maro H, Linus S, Siebert S, Nkenguye W, McIntosh E, Shirima F, Njau RE, Andongolile AA, Mwanswila MJ, Halliday JEB, Krauth S, Kilonzo K, Walker RW, Temu GA, Mmbaga BT. Trends of frequency, mortality and risk factors among patients admitted with stroke from 2017 to 2019 to the medical ward at Kilimanjaro Christian Medical Centre hospital: a retrospective observational study. BMJ Open 2023; 13:e071918. [PMID: 37524544 PMCID: PMC10391824 DOI: 10.1136/bmjopen-2023-071918] [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: 01/20/2023] [Accepted: 06/18/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The burden of stroke has increased in recent years worldwide, particularly in low-income and middle-income countries. In this study we aim to determine the number of stroke admissions, and associated comorbidities, at a referral hospital in Northern Tanzania. DESIGN This was a retrospective observational study. SETTING The study was conducted at a tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC), in the orthern zone of Tanzania. PARTICIPANTS The study included adults aged 18 years and above, who were admitted to the medical wards from 2017 to 2019. OUTCOME The primary outcome was the proportion of patients who had a stroke admitted in the medical ward at KCMC and the secondary outcome was clinical outcome such as mortality. METHODS We conducted a retrospective audit of medical records from 2017 to 2019 for adult patients admitted to the medical ward at KCMC. Data extracted included demographic characteristics, previous history of stroke and outcome of the admission. Factors associated with stroke were investigated using logistic regression. RESULTS Among 7976 patients admitted between 2017 and 2019, 972 (12.2%) were patients who had a stroke. Trends show an increase in patients admitted with stroke over the 3 years with 222, 292 and 458 in 2017, 2018 and 2019, respectively. Of the patients who had a stroke, 568 (58.4%) had hypertension while 167 (17.2%) had diabetes mellitus. The proportion of admitted stroke patients aged 18-45 years, increased from 2017 (n=28, 3.4%) to 2019 (n=40, 4.3%). The in-hospital mortality related to stroke was 229 (23.6%) among 972 patients who had a stroke and female patients had 50% higher odds of death as compared with male patients (OR:1.5; CI 1.30 to 1.80). CONCLUSION The burden of stroke on individuals and health services is increasing over time, which reflects a lack of awareness on the cause of stroke and effective preventive measures. Prioritising interventions directed towards the reduction of non-communicable diseases and associated complications, such as stroke, is urgently needed.
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Affiliation(s)
- Baraka Moshi
- Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Nateiya Yongolo
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Sanjura Mandela Biswaro
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Hans Maro
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Epidemiology, Tanzania Health Promotion Support (THPS), Moshi, United Republic of Tanzania
| | - Sakanda Linus
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Depatment of Inflammation Medicine and Rheumatology, Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - William Nkenguye
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Emma McIntosh
- Depatment of Inflammation Medicine and Rheumatology, Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Febronia Shirima
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Rosalia E Njau
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Alice A Andongolile
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Manasseh Joel Mwanswila
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Jo E B Halliday
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, London, UK
| | - Stefanie Krauth
- Depatment of Inflammation Medicine and Rheumatology, Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, London, UK
| | - Kajiru Kilonzo
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Richard William Walker
- Depatment of One health and Veterinary Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Gloria August Temu
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Blandina T Mmbaga
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
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Mboera LEG, Kishamawe C, Rumisha SF, Chiduo MG, Kimario E, Bwana VM. Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006-2015. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000281. [PMID: 37410764 DOI: 10.1371/journal.pgph.0000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Globally, non-communicable diseases (NCD) kill about 40 million people annually, with about three-quarters of the deaths occurring in low- and middle-income countries. This study was carried out to determine the patterns, trends, and causes of in-hospital non-communicable disease (NCD) and injury deaths in Tanzania from 2006-2015. METHODS This retrospective study involved primary, secondary, tertiary, and specialized hospitals. Death statistics were extracted from inpatient department registers, death registers, and International Classification of Diseases (ICD) report forms. The ICD-10 coding system was used to assign each death to its underlying cause. The analysis determined leading causes by age, sex, annual trend and calculate hospital-based mortality rates. RESULTS Thirty-nine hospitals were involved in this study. A total of 247,976 deaths (all causes) were reported during the 10-year period. Of the total deaths, 67,711 (27.3%) were due to NCD and injuries. The most (53.4%) affected age group was 15-59 years. Cardio-circulatory diseases (31.9%), cancers (18.6%), chronic respiratory diseases (18.4%), and injuries (17.9%) accounted for the largest proportion (86.8%) of NCD and injuries deaths. The overall 10-year hospital-based age-standardized mortality rate (ASMR) for all NCDs and injuries was 559.9 per 100,000 population. It was higher for males (638.8/100,000) than for females (444.6/100,000). The hospital-based annual ASMR significantly increased from 11.0 in 2006 to 62.8 per 100,000 populations in 2015. CONCLUSIONS There was a substantial increase in hospital-based ASMR due to NCDs and injuries in Tanzania from 2006 to 2015. Most of the deaths affected the productive young adult group. This burden indicates that families, communities, and the nation at large suffer from premature deaths. The government of Tanzania should invest in early detection and timely management of NCDs and injuries to reduce premature deaths. This should go hand-in-hand with continuous efforts to improve the quality of health data and its utilization.
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Affiliation(s)
- Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
- Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, West Perth, Western Australia
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Evord Kimario
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzanian
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Olds P, Kachimanga C, Talama G, Mailosi B, Ndarama E, Totten J, Musinguzi N, Hangiwa D, Bukhman G, Wroe EB. Non-communicable disease burden among inpatients at a rural district hospital in Malawi. Glob Health Res Policy 2023; 8:4. [PMID: 36810123 PMCID: PMC9945353 DOI: 10.1186/s41256-023-00289-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/09/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is high in Malawi. However, resources and training for NCD care remain scarce, especially in rural hospitals. Current care for NCDs in the developing world focuses on the WHO's traditional 4 × 4 set. However, we do not know the full burden of NCDs outside of that scope, like neurological disease, psychiatric illness, sickle cell disease, and trauma. The goal of this study was to understand the burden of NCDs among inpatients in a rural district hospital in Malawi. We broadened our definition of NCDs beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma. METHODS We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. We broke patients down by age, date of admission, type, and number of NCD diagnoses, and HIV status, and constructed multivariate regression models for length of stay and in-hospital mortality. RESULTS Of 2239 total visits, 27.5% were patients with NCDs. Patients with NCDs were older (37.6 vs 19.7 years, p < 0.001) and made up 40.2% of total hospital time. We also found two distinct populations of NCD patients. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. We also found significant trauma burden, accounting for 40% of all NCD visits. In multivariate analysis, carrying a medical NCD diagnosis was associated with longer length of stay (coefficient 5.2, p < 0.001) and a higher risk of in-hospital mortality (OR 1.9, p = 0.03). Burn patients also had significantly longer length of stay (coefficient 11.6, p < 0.001). CONCLUSIONS There is a significant burden of NCDs in a rural hospital in Malawi, including those outside of the traditional 4 × 4 set. We also found high rates of NCDs in the younger population (under 40 years of age). Hospitals must be equipped with adequate resources and training to meet this burden of disease.
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Affiliation(s)
- Peter Olds
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | | | | | - Enoch Ndarama
- grid.415722.70000 0004 0598 3405Ministry of Health and Population, Lilongwe, Malawi
| | - Jodie Totten
- grid.34477.330000000122986657Department of Emergency Medicine, University of Washington, Seattle, WA USA
| | - Nicholas Musinguzi
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Gene Bukhman
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Emily B. Wroe
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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Sadiq AM, Njau RE, Kilonzo KG. Disease patterns and clinical outcomes of medical admissions at a tertiary hospital in Northern Tanzania: A retrospective observational study. Health Sci Rep 2023; 6:e983. [PMID: 36514325 PMCID: PMC9731290 DOI: 10.1002/hsr2.983] [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: 08/14/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aims The burden of noncommunicable diseases is increasing in developing countries and in settings with an existing communicable burden. The study aim was to identify the disease pattern, length of stay, and clinical outcome of medical admissions. Methods A retrospective observational study of patients admitted to medical wards between 1st July 2019 and 30th June 2020, excluding those admitted for chemotherapy. The outcome measures were the pattern of disease, length of stay, and clinical outcome. Results A total of 3930 patients were analyzed. A total of 53.5% were males, and 42.9% were aged 51-75 years, with a median age of 57 years (IQR 41-71). A total of 41.3% had health insurance, 21.7% died, and the median length of stay was 6 days (IQR 4-9). Cardiovascular diseases were the most common diagnosis (26.8%) on admission and cause of death (27.9%). The common causes of death were stroke (15.1%), chronic kidney disease (11.1%), and heart failure (9.0%). Noninsured patients had a high mortality risk (odds ratios [OR] 1.67, 95% confidence interval [CI] 1.42-1.96), which was also seen among patients aged more than 75 years (OR 1.3, 95% CI 1.08-1.57), patients with communicable diseases (OR 1.44, 95% CI 1.23-1.68), and weekend admissions (OR 1.29, 95% CI 1.08-1.55). The 72-h admission window is critical due to a very high mortality risk (OR 3.03, 95% CI 2.58-3.56). Conclusion Cardiovascular diseases are the leading cause of hospital admissions and deaths in a tertiary hospital in Northern Tanzania. Lifestyle modification, health education, and community resources are needed to combat the growing burden of cardiovascular and renal disease.
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Affiliation(s)
- Abid M. Sadiq
- Department of Internal MedicineKilimanjaro Christian Medical CentreMoshiTanzania
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
| | | | - Kajiru G. Kilonzo
- Department of Internal MedicineKilimanjaro Christian Medical CentreMoshiTanzania
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
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George G, Fricker M, Todd O, Makowa D, Tembo C, Dotchin C, Gray WK, Walker RW, Mbwele B, Paddick SM. Screening for delirium and dementia in older hospitalised adults in Zambia. J Neurol Sci 2022; 436:120186. [DOI: 10.1016/j.jns.2022.120186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Over recent years non-communicable diseases have dramatically increased in low- and middle-income countries, including those of sub-Saharan Africa. With continuing high levels of infectious disease, these countries now face the double burden of disease. Stroke has emerged as a major cause of hospital admission, disability, and mortality for which the major modifiable risk factor is hypertension, which is often not diagnosed and, even if diagnosed, not treated and, even if treated, not controlled. METHODS In this award lecture paper I outline my personal experience of measuring the burden of, and risk factors for, stroke in sub-Saharan Africa, along with the challenges faced. I will specifically describe the measurement of mortality and case fatality, prevalence and incidence as well as commenting on aetiology and risk factors and reflect on future initiatives and directions. RESULTS Over the past 5 decades there has been a dramatic increase in numbers of stroke patients admitted to hospital throughout sub-Saharan Africa, with high in hospital mortality rates, also reflected in high case fatality rates in those cohorts followed up following discharge from hospital. Community-based surveys assessing mortality from stroke using verbal autopsy have demonstrated very high age-adjusted rates. Age adjusted prevalence rates assessed by door-to-door surveys have generally shown lower prevalence than high income countries. The Tanzanian stroke incidence study, which incorporated verbal autopsy for those patients dying before reaching hospital, demonstrated some of the highest age-adjusted stroke incidence rates in the world. There were high rates of stroke in younger ages and high rates of intracranial haemorrhage though not as high as previously shown in hospital-based studies. Hypertension is the main modifiable risk factor but other risk factors such as HIV are important while, certainly in rural populations, raised cholesterol remains rare as does carotid artery stenosis and history of transient ischemic attack. Other vascular disease such as ischemic heart disease and peripheral vascular disease is also less common. CONCLUSIONS There is already a large burden relating to stroke in sub-Saharan Africa and this will only escalate further as the population ages. Hypertension is the biggest risk factor for mortality worldwide and in sub-Saharan Africa prevalence rates are very high with the majority of people suffering with stroke not being diagnosed with their hypertension prior to their stroke. The most important challenge is to improve primary prevention for which improving diagnosis and control rates for hypertension is the number one priority. For those who do have stroke there is a need to increase the number of suitably staffed stroke units as these have been shown to have a very large impact on improving both mortality and morbidity in high income countries. There are still many unanswered questions and a need for more research throughout sub-Saharan Africa on risk factors, and treatment, for stroke.
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Affiliation(s)
- Richard Walker
- Northumbria Healthcare NHS Foundation Trust, UK; Population Health Sciences Institute, Newcastle University, UK.
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Elderly trauma mortality in a resource-limited setting: A benchmark for process improvement. Injury 2021; 52:2651-2656. [PMID: 34272049 PMCID: PMC8429241 DOI: 10.1016/j.injury.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As life expectancy improves globally, the burden of elderly trauma continues to increase. Sub-Saharan Africa is projected to have the most rapid growth in its elderly demographic. Consequently, we sought to examine the trends in characteristics and outcomes of elderly trauma in a tertiary care hospital in Malawi. METHODS We performed a retrospective analysis of adult patients in the trauma registry at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2011-2017. Patients were categorized into elderly (≥ 65 years) and non-elderly (18-64 years). Bivariate analysis compared the characteristics and outcomes of elderly vs. non-elderly patients. The elderly population was then examined over the study period. Poisson regression modeling was used to determine the risk of mortality among elderly patients over time. RESULTS Of 63,699 adult trauma patients, 1,925 (3.0%) were aged ≥ 65 years. Among the elderly, the most common mechanism of injury was falls (n = 725 [37.7%]) whereas vehicle or bike collisions were more common in the non-elderly (n = 15,967 [25.9%]). Fractures and dislocations were more prevalent in the elderly (n = 808 [42.0%] vs. 9,133 [14.8%], p < 0.001). In-hospital crude mortality for the elderly was double the non-elderly group (4.8% vs. 2.4%, p < 0.001). Elderly transfers, surgeries, and length of stay significantly increased over the study period but mortality remained relatively unchanged. When adjusted for injury severity and transfer status, there was no significant difference in risk of in-hospital mortality over time. CONCLUSION At KCH, the proportion of elderly trauma patients is slowly increasing. Although healthcare resource utilization has increased over time, the overall trend in mortality has not improved. As the quality of care for the most vulnerable populations is a benchmark for the success of a trauma program, further work is needed to improve the trend in outcomes of the elderly trauma population in Malawi.
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Tomita A, Leyna GH, Kim HY, Moodley Y, Mpolya E, Mogeni P, Cuadros DF, Dzomba A, Vandormael A, Bärnighausen T, Tanser F. Patterns of multimorbidity and their association with hospitalisation: a population-based study of older adults in urban Tanzania. Age Ageing 2021; 50:1349-1360. [PMID: 33765124 DOI: 10.1093/ageing/afab046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND while the HIV epidemic remains a considerable challenge in sub-Saharan Africa, a dramatic reduction in the associated mortality has led to a fundamental shift in the public health priorities aimed at tackling multimorbidity. Against the unprecedented level of urbanisation taking place in Tanzania, the burden of multimorbidity and its consequences among ageing adults, in the form of costly inpatient hospitalisation, remain unquantified. METHODS we used data from one of Africa's largest urban population cohort, the Dar es Salaam Health and the Demographic Surveillance System, to quantity the extent of multimorbidity (occurrence of 2 ≥ health conditions) and discordant multimorbidity (occurrence of conditions in 2 ≥ domains in mental health, non-communicable and communicable health) among 2,299 adults aged ≥40 years in Dar es Salaam, Tanzania. We fitted logistic regression models to investigate the association between multimorbidity and inpatient hospitalisation. RESULTS the prevalence of multimorbidity and discordant multimorbidity were 25.3 and 2.5%, respectively. Although the severe forms of multimorbidity (2.0% with ≥4 health conditions) and discordancy were low, hospitalisation was significantly higher based on the regression analyses. Household food insecurity was the only socio-economic variable that was significantly and consistently associated with a greater hospitalisation. CONCLUSION we found an alarmingly high degree of multimorbidity among this ageing urban population where hospitalisation was driven by multimorbidity. As public health resources remain scarce, reducing costly inpatient hospitalisation requires multilevel interventions that address clinical- and structural-level challenges (e.g. food insecurity) to mitigate multimorbidity and promote long-term healthy independent living among older adults in Tanzania.
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Affiliation(s)
- Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Germana H Leyna
- Department of Epidemiology & Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Center for Population and Development Studies, Harvard T. Chan School of Public Health, Boston, MA, USA
| | - Hae-Young Kim
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Yoshan Moodley
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Emmanuel Mpolya
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Bio-Medical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Polycarp Mogeni
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Diego F Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, USA
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
| | - Armstrong Dzomba
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Piperaquine Exposure Is Altered by Pregnancy, HIV, and Nutritional Status in Ugandan Women. Antimicrob Agents Chemother 2020; 64:AAC.01013-20. [PMID: 33020153 DOI: 10.1128/aac.01013-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/29/2020] [Indexed: 11/20/2022] Open
Abstract
Dihydroartemisinin-piperaquine (DHA-PQ) provides highly effective therapy and chemoprevention for malaria in pregnant African women. PQ concentrations of >10.3 ng/ml have been associated with reduced maternal parasitemia, placental malaria, and improved birth outcomes. We characterized the population pharmacokinetics (PK) of PQ in a post hoc analysis of human immunodeficiency virus (HIV)-infected and -uninfected pregnant women receiving DHA-PQ as chemoprevention every 4 or 8 weeks. The effects of covariates such as pregnancy, nutritional status (body mass index [BMI]), and efavirenz (EFV)-based antiretroviral therapy were investigated. PQ concentrations from two chemoprevention trials were pooled to create a population PK database from 274 women and 2,218 PK observations. A three-compartment model with an absorption lag best fit the data. Consistent with our prior intensive PK evaluation, pregnancy and EFV use resulted in a 72% and 61% increased PQ clearance, compared to postpartum and HIV-uninfected pregnant women, respectively. Low BMI at 28 weeks of gestation was associated with increased clearance (2% increase per unit decrease in BMI). Low-BMI women given DHA-PQ every 8 weeks had a higher prevalence of parasitemia, malaria infection, and placental malaria compared to women with higher BMIs. The reduced piperaquine exposure in women with low BMI as well as during EFV coadministration, compared to pregnant women with higher BMIs and not taking EFV, suggests that these populations could benefit from weekly instead of monthly dosing for prevention of malaria parasitemia. Simulations indicated that because of the BMI-clearance relationship, weight-based regimens would not improve protection compared to a 2,880 mg fixed-dose regimen when provided monthly. (The clinical trials described in this paper have been registered at ClinicalTrials.gov under identifiers NCT02163447 and NCT02282293.).
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Sarfo FS, Akinyemi R, Howard G, Howard VJ, Wahab K, Cushman M, Levine DA, Ogunniyi A, Unverzagt F, Owolabi M, Ovbiagele B. Vascular-brain Injury Progression after Stroke (VIPS) study: concept for understanding racial and geographic determinants of cognitive decline after stroke. J Neurol Sci 2020; 412:116754. [PMID: 32120131 PMCID: PMC9132491 DOI: 10.1016/j.jns.2020.116754] [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: 07/29/2019] [Revised: 01/31/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
Cognitive impairment and dementia (CID) are major public health problems with substantial personal, social, and financial burdens. African Americans are at a heightened risk for Vascular Cognitive Impairment (VCI) compared to European Americans. Recent lines of evidence also suggest a high burden of Post-stroke VCI among indigenous Africans. A better understanding of the cause(s) of the racial disparity in CID, specifically VCI, is needed in order to develop strategies to reduce it. We propose and discuss the conceptual framework for a unique tri-population, trans-continental study titled The Vascular brain Injury Progression after Stroke (VIPS) study. The overarching objective of the VIPS Study will be to explore the interplay of multiple factors (racial, geographical, vascular, lifestyle, nutritional, psychosocial and inflammatory) influencing the level and trajectory of post-stroke cognitive outcomes and examine whether differences between indigenous Africans, African Americans and European Americans exist. We hypothesize that differences which might be due to racial factors will be observed in African Americans versus European Americans as well as Indigenous Africans versus European Americans but not in African Americans versus Indigenous Americans; differences due to geographical factors will be observed in Indigenous Americans versus African Americans and Indigenous Africans versus European Americans but not in African Americans versus European Americans. This overarching objective could be accomplished by building upon existing National Institutes of Health investments in the REasons for Geographical And Racial Differences in Stroke (REGARDS) study (based in the United States of America) and the Stroke Investigative Research and educational Network (SIREN) study (based in Sub-Saharan Africa).
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Neurology Division, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Mary Cushman
- Division of Hematology and Oncology, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan (U-M) Medical School (UMMS), Ann Arbor, MI, USA
| | | | - Fred Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Komolafe MA, Olorunmoteni OE, Fehintola FO. Effect of Health Education on Level of Awareness and Knowledge of Nigerian In-School adolescents on Stroke and Its Risk Factors. J Stroke Cerebrovasc Dis 2020; 29:104757. [PMID: 32173228 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stroke education in adolescents has been established as an effective method of creating awareness about stroke, its warning signs and risk factors. It contributes to desired behavioural change in the adolescents as well as their parents. Thus, we aimed to determine the baseline knowledge of school attending adolescents about stroke and its risk factors as well as the effect of stroke education on their stroke awareness. METHODS This study employed a quasi-experimental study design and was conducted in secondary schools in Ile-Ife, Osun State, Nigeria. The schools were divided into intervention and control groups. We assessed the baseline knowledge of the students on stroke, its risk factors, warning signs, and ways of preventing it using a pre-tested structured questionnaire in both intervention and control groups. In the intervention group, health talks on stroke consisting of oral presentation and distribution of fliers were presented for 30 minutes in each selected school. Each school was visited 2 weeks after the health education intervention to assess their knowledge on stroke, its risk factors, and ways of preventing it. The control group was also visited after 2 weeks for a re-assessment of their stroke knowledge and the conduct of heath talk on other aspects of neurology such as sleep, epilepsy, etc. Results: A total of 1259 adolescents were studied with 661 in the intervention group and 598 in the control group. The mean age of the respondents was 13.56 ± 2.87 the intervention group and 13.38 ± 2.06 in the control group. There were higher mean scores on knowledge of stroke and its risk factors among the intervention group than seen in the control group after the stroke education. CONCLUSIONS Stroke education is an effective way of creating and maintaining stroke awareness among school-attending adolescents.
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Affiliation(s)
- Morenikeji A Komolafe
- Department of Internal Medicine, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Oluwatosin E Olorunmoteni
- Department of Paediatrics and Child Health, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Funmito O Fehintola
- Department of Community Health, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Tumaini B, Munseri P, Pallangyo K. Disease spectrum and outcomes among elderly patients in two tertiary hospitals in Dar es Salaam, Tanzania. PLoS One 2019; 14:e0213131. [PMID: 31600198 PMCID: PMC6786655 DOI: 10.1371/journal.pone.0213131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There has been an increase in the number of individuals aged ≥60 years in Tanzania and in sub Saharan Africa in general due to improved survival. However, data is scarce on the disease burden and outcomes following admission in this population. We herein describe the pattern of diagnoses, outcomes and factors associated with the outcomes among elderly patients admitted at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) medical wards. METHODOLOGY From October to December 2017, we consecutively enrolled patients aged ≥60 years (elderly) admitted to the MNH and JKCI medical wards. The ICD 10 was used to code for disease diagnosis at discharge or death. The Modified Barthel index was used to assess for functional activity on admission and at discharge. RESULTS We enrolled 336 (30.1%) elderly participants out of 1301 medical admissions. The mean age ± SD was 70.6 ± 8.9 years; 169 (50%) were female and the average number of diagnoses was 2 per participant. The most common diagnoses were: hypertension 151 (44.9%), stroke 106 (31.5%), heart failure 62 (18.5%), pneumonia 60 (17.9%), diabetes mellitus 58 (17.3%) and chronic kidney disease 55 (16.4%). The median duration of hospital stay was 5 (IQR 3-10) days and in-hospital mortality was 86 (25.6%), 56 (65%) deaths were due to non-communicable diseases and 48 (55.8%) deaths occurred within 72 hours of hospitalization. A modified Barthel score ≤20 on admission was associated with an OR 15.43 (95% CI: 7.5-31.7, p<0.001) for death. CONCLUSION Elderly patients constituted a significant proportion of medical admissions at MNH and JKCI with high in-hospital mortality. A modified Barthel index score ≤20 during admission is associated with mortality and can be used to identify patients requiring special attention.
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Affiliation(s)
- Basil Tumaini
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kisali Pallangyo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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15
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Akinyemi R, Ojagbemi A, Akinyemi J, Salami A, Olopade F, Farombi T, Nweke M, Uvere E, Aridegbe M, Balogun J, Ogbole G, Jegede A, Kalaria R, Ogunniyi A, Owolabi M, Arulogun O. Gender differential in inclination to donate brain for research among Nigerians: the IBADAN Brain Bank Project. Cell Tissue Bank 2019; 20:297-306. [PMID: 31028517 DOI: 10.1007/s10561-019-09769-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laboratory-based studies of neurological disease patterns and mechanisms are sparse in sub-Saharan Africa. However, availability of human brain tissue resource depends on willingness towards brain donation. This study evaluated the level of willingness among outpatient clinic attendees in a Nigerian teaching hospital. METHODS Under the auspices of the IBADAN Brain Bank Project, a 43-item semi-structured interviewer-administered questionnaire was designed to evaluate knowledge, attitude, and beliefs of individuals attending Neurology, Psychiatry and Geriatrics Outpatient clinics regarding willingness to donate brain for research. Association between participants characteristics and willingness towards brain donation was investigated using logistic regression models. Analysis was conducted using Stata SE version 12.0. RESULTS A total of 412 participants were interviewed. Their mean age was 46.3 (16.1) years. 229 (55.6%) were females and 92.5% had at least 6 years of formal education. Overall, 109 (26.7%) were willing to donate brains for research. In analyses adjusting for educational status, religion, ethnicity, marital status and family setting, male sex showed independent association with willingness towards brain donation OR (95% CI) 1.7 (1.08-2.69), p = 0.023. Participants suggested public engagement and education through mass media (including social media) and involvement of religious and community leaders as important interventions to improve awareness and willingness towards brain donation. CONCLUSION The survey revealed low willingness among outpatient clinic attendees to donate brain for research, although men were more inclined to donate. It is imperative to institute public engagement and educational interventions in order to improve consent for brain donation for research.
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Affiliation(s)
- Rufus Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Neuroscience and Ageing Research Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji Salami
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Funmi Olopade
- Department of Anatomy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitope Farombi
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - Michael Nweke
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Aridegbe
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - James Balogun
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Rajesh Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Laizer S, Kilonzo K, Urasa S, Maro V, Walker R, Howlett W. Neurological disorders in a consultant hospital in Northern Tanzania. A cohort study. eNeurologicalSci 2019; 14:101-105. [PMID: 30828651 PMCID: PMC6382946 DOI: 10.1016/j.ensci.2018.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/05/2018] [Accepted: 11/17/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To determine the sociodemographic characteristics, clinical findings and outcome by HIV status in a series of adult patients presenting with neurological disorders (NDs) and admitted to a consultant hospital in Northern Tanzania. METHODS A cohort study took place over a 6-month period from Oct 2007 to March 2008 and included all adult patients with a neurological disorder admitted to the medical wards. RESULTS A total of 1790 patients were admitted during this period, of whom 337 (18.8%) were diagnosed with a neurological disorder and formed the study group. Of these 337, 69 (20.5%) were HIV-positive. Among the 69 HIV positives, 25% were previously known to be HIV seropositive of whom 82% were on antiretroviral (ARV) medication. Seropositive patients were more likely than seronegative patients to be younger, better educated, have a business occupation, present clinically with confusion, headache and aphasia and have meningitis/CNS infection or a space occupying lesion. Seropositive patients were more likely to present with a Glasgow Coma Score (GCS) of 9-12/15 (33.3% v 17.2%). Seropositive patients had a median CD4 T-lymphocyte count of 47cells/L and were more likely to be anaemic and have an elevated ESR. CT of the head was carried out on 132/337 (39%) patients. The overall findings were infarction 37%, hemorrhage 19%, tumors 15% and abscesses 9%. Brain abscess was more likely in seropositive patients and hemorrhage in seronegatives. The outcome at discharge for all patients was: death 27.6%, disability 54% and no disability 18.4% with death (39.1%) being more likely in seropositive patients. Patients presenting with coma (GCS <9/15) were more likely to die whilst those with stroke, para/quadriplegia and space occupying lesions (SOLs) were more likely to be discharged with disability. Case fatality rate was highest for tetanus 71.4%, meningitis 57.1%, cerebral malaria 42.9% and CNS infections 37.1%. Seropositive patients presenting with meningitis and other CNS infections were more likely to die than seronegatives. CONCLUSION This study reports NDs occurring in one fifth of adult medical admissions with stroke and infections as the leading causes. The prevalence of HIV infection in NDs was 20%. The HIV positive cohort was characterized by advanced immunosuppression, CNS infections and high mortality.
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Key Words
- ARV, antiretroviral
- CFR, case fatality rate
- CNS, central nervous system
- CT, computerized tomography
- Disorders
- ESR, erythrocyte sedimentation rate
- FBC, full blood count
- GCS, Glasgow coma score
- HIV
- HIV, Human Immunodeficiency Virus
- Hospital
- IQR, interquartile range
- IRIS, immune reconstitution inflammatory syndrome
- KCMC, Kilimanjaro Christian Medical Centre
- NDs, neurological disorders
- Neurological
- OR, odds ratio
- Outcome
- SOL, space occupying lesion
- SSA, sub-Saharan Africa
- Tanzania
- WBC, white blood count
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Affiliation(s)
- Saitore Laizer
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Kajiru Kilonzo
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Venance Maro
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Richard Walker
- Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK
| | - William Howlett
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
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Lewis EG, Banks J, Paddick SM, Duinmaijer A, Tucker L, Kisoli A, Cletus J, Lissu C, Kilonzo K, Cosker G, Mukaetova-Ladinska EB, Dotchin C, Gray W, Walker R, Urasa S. Risk Factors for Delirium in Older Medical Inpatients in Tanzania. Dement Geriatr Cogn Disord 2018; 44:160-170. [PMID: 28869952 DOI: 10.1159/000479058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/27/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The risk factors for prevalent delirium in older hospitalised adults in Sub-Saharan Africa (SSA) remain poorly characterised. METHODS A total of 510 consecutive admissions of adults aged ≥60 years to acute medical wards of Kilimanjaro Christian Medical Centre in northern Tanzania were recruited. Patients were assessed within 24 h of admission with a risk factor questionnaire, physiological observations, neurocognitive assessment, and informant interview. Delirium and dementia diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM V) and DSM IV respectively, by an expert panel. RESULTS Being male, current alcohol use, dementia, and physiological markers of illness severity were significant independent risk factors for delirium on multivariable analysis. CONCLUSIONS The risk factors for prevalent delirium in older medical inpatients in SSA include pre-existing dementia, and are similar to those identified in high-income countries. Our data could help inform the development of a delirium risk stratification tool for older adults in SSA.
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Affiliation(s)
- Emma Grace Lewis
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin, Berlin, Germany
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18
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Akinyemi RO, Salami A, Akinyemi J, Ojagbemi A, Olopade F, Coker M, Farombi T, Nweke M, Arulogun O, Jegede A, Owolabi M, Kalaria RN, Ogunniyi A. Brain banking in low and middle-income countries: Raison D'être for the Ibadan Brain Ageing, Dementia And Neurodegeneration (IBADAN) Brain Bank Project. Brain Res Bull 2018; 145:136-141. [PMID: 30149197 DOI: 10.1016/j.brainresbull.2018.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 02/08/2023]
Abstract
Brain banks are biorepositories of central nervous system (CNS) tissue including fixed and frozen whole brains, brain biopsies and spinal cord, as well as body fluids comprising the cerebrospinal fluid (CSF) and blood stored for research purposes. Though several independent brain banks exist in high income countries, only five low- and middle - income countries (LMIC) have brain banks. The African continent is yet to establish a formalized brain bank despite its huge human genomic diversity, ageing of her populations with concomitant increases in ageing - associated brain disorders and differential phenotypic expression and outcomes of brain disorders. Cellular and molecular clinicopathological studies are vital to shaping our understanding of the interaction between racial (genetic) and geographical (environmental) factors in the natural history and mechanisms of disease, and unravelling frameworks of diagnostic biomarkers, and new therapeutic and preventative interventions. The Ibadan Brain Ageing, Dementia And Neurodegeneration (IBADAN) Brain Bank, the first organized brain tissue biorepository in sub - Saharan Africa, is set up to accrue, process and store unique brain tissues for future research into a broad spectrum of neurological and psychiatric disorders. The potential unique discoveries and research breakthroughs will benefit people of African ancestry and other ancestral populations.
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Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Ayodeji Salami
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Funmi Olopade
- Department of Anatomy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo Coker
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitope Farombi
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - Michael Nweke
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oyedunni Arulogun
- Department of Health Education and Promotion, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adesola Ogunniyi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Awadalla H, Elmak NE, El-Sayed EF, Almobarak AO, Elmadhoun WM, Osman M, Noor SK, Ahmed MH. Hypertension in Sudanese individuals and associated risk factors: the critical intersection between salt and sugar intake. Cardiovasc Diagn Ther 2018; 8:432-438. [PMID: 30214858 DOI: 10.21037/cdt.2018.04.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Hypertension is common problem across the globe. The aim of this study was to assess the prevalence of hypertension and impact of salt and sugar intake in Sudanese population. Methods A descriptive cross sectional study, included 323 of participants in Khartoum state. The data collection was performed to gather demographic information, physical activity and dietary habits. In addition to measurement of blood pressure (BP), weight and height measurement for calculation of body mass index (BMI). Results Among the 323 respondents (males were 171), 29 (9%) are known hypertensive, 60 (18.6%) are diagnosed to be hypertensive. Therefore, the prevalence of hypertension is 27.6%. Hypertension was significantly associated with male sex, increasing age, obesity, low physical activity, salt and sugar intake. Logistic regression analysis showed that increasing age, obesity and high sugar intake are absolute predictors for hypertension in Sudanese population. Conclusions The prevalence of hypertension was 27.6%. Hypertension in Sudanese individuals was associated with high sugar and salt intake, obesity and increase in age. Therefore, decreasing sugar and salt intake should be advocated by health authorities and the public in Sudan.
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Affiliation(s)
- Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Nehad Elsheikh Elmak
- Public and Tropical Health Program, Graduate College, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Eman F El-Sayed
- Public and Tropical Health Program, Graduate College, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Wadie M Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Mugtaba Osman
- Armed Forces Centre for Psychiatric Care, Taif, Saudi Arabia
| | - Sufian K Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
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Akinyemi RO, Owolabi MO, Ihara M, Damasceno A, Ogunniyi A, Dotchin C, Paddick SM, Ogeng'o J, Walker R, Kalaria RN. Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa. Brain Res Bull 2018; 145:97-108. [PMID: 29807146 DOI: 10.1016/j.brainresbull.2018.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022]
Abstract
With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa. Hypertension is the strongest modifiable risk factor for stroke but is also likely associated with co-inheritance of genetic traits among Africans. Somewhat different from high-income countries, strokes attributed to cerebral small vessel disease (SVD) are higher >30% among sub-Saharan Africans. Raised blood pressure may explain most of the incidence of SVD-related strokes but there are likely other contributing factors including dyslipidaemia and diabetes in some sectors of Africa. However, atherosclerotic and cardioembolic diseases combined also appear to be common subtypes as causes of strokes. Significant proportions of cerebrovascular diseases are ascribed to various forms of infectious disease including complications of human immunodeficiency virus. Cerebral SVD leads to several clinical manifestations including gait disturbance, autonomic dysfunction and depression. Pathological processes are characterized by arteriolosclerosis, lacunar infarcts, perivascular spaces, microinfarcts and diffuse white matter changes, which can now all be detected on neuroimaging. Except for isolated cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL, hereditary arteriopathies have so far not been reported in Africa. Prevalence estimates of vascular dementia (2-3%), delayed dementia after stroke (10-20%) and vascular cognitive impairment (30-40%) do not appear to be vastly different from those in other parts of the world. However, given the current demographic transition in both urban and rural settings these figures will likely rise. Wider application of neuroimaging modalities and implementation of stroke care in Africa will enable better estimates of SVD and other subtypes of stroke. Stroke survivors with SVD type pathology are likely to have low mortality and therefore portend increased incidence of dementia.
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Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | | | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Catherine Dotchin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Julius Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
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Paddick SM, Lewis EG, Duinmaijer A, Banks J, Urasa S, Tucker L, Kisoli A, Cletus J, Lissu C, Kissima J, Dotchin C, Gray WK, Muaketova-Ladinska E, Cosker G, Walker RW. Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. J Neurol Sci 2017; 385:156-163. [PMID: 29406898 DOI: 10.1016/j.jns.2017.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania. METHOD The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria. RESULTS Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients. CONCLUSION Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed.
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Affiliation(s)
- S M Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
| | - E G Lewis
- Charité - Universitätsmedizin Berlin, CVK: Campus Virchow-Klinikum, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - A Duinmaijer
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania
| | - J Banks
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - L Tucker
- The London School of Hygiene & Tropical Medicine, London, UK
| | - A Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - J Cletus
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Lissu
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - J Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - E Muaketova-Ladinska
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - G Cosker
- Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - R W Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Bosu WK, Aheto JMK, Zucchelli E, Reilly S. Prevalence, awareness, and associated risk factors of hypertension in older adults in Africa: a systematic review and meta-analysis protocol. Syst Rev 2017; 6:192. [PMID: 28978358 PMCID: PMC5628476 DOI: 10.1186/s13643-017-0585-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The health of older persons has not been a major priority in many African countries. Hypertension is one of the common health problems of older persons. However, there is little information on the prevalence of hypertension in older adults in Africa. This is in spite of the fact that Africa has the highest age-standardized prevalence of hypertension in the world. We therefore present this protocol to conduct a systematic review and meta-analysis on the prevalence of hypertension and the level of its awareness among older persons living in Africa. METHODS Major databases (EMBASE, MEDLINE, Academic Search Complete, CINAHL, PsycINFO) and unpublished literature will be searched to identify population-based studies on hypertension in adults aged 50 years and older living in Africa. Eligible articles are those which use the 140/90-mmHg cutoff to diagnose hypertension and were published from 1980 to present. We will exclude subjects in restricted environments such as patients and refugees. Articles will be independently evaluated by two reviewers to determine if they meet the inclusion criteria. They will also evaluate the quality of included studies using a validated tool by Hoy and colleagues for prevalence studies. The main outcome is the prevalence of hypertension while the explanatory variables include demographic, socio-economic, dietary, lifestyle and behavioural factors. Effect sizes in bivariate and multivariate analyses will be presented as odds or prevalence ratios. We will explore for heterogeneity of the standard errors across the studies, and if appropriate, we will perform a meta-analysis using a random-effects model to present a summary estimate of the prevalence of hypertension in this population. DISCUSSION The estimates of the prevalence, the risk factors and the level of awareness of hypertension could help in galvanizing efforts at prioritizing the cardiovascular health of older persons in Africa. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017056474.
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Affiliation(s)
- William K Bosu
- West African Health Organisation (WAHO), 175 Avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso, Burkina Faso. .,Division of Health Research, Faculty of Health & Medicine, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK.
| | - Justice M K Aheto
- School of Public Health, University of Ghana, LG 13, Legon, Accra, Ghana
| | - Eugenio Zucchelli
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK
| | - Siobhan Reilly
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK
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Accessing clinical services and retention in care following screening for hypertension and diabetes among Malawian adults: an urban/rural comparison. J Hypertens 2017; 34:2172-9. [PMID: 27552644 DOI: 10.1097/hjh.0000000000001070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Interventions to impact on the burden of chronic noncommunicable diseases, such as hypertension and diabetes, include screening of asymptomatic adults, but little is known about the subsequent course of clinical care. We report on the uptake of referral for clinical assessment and retention in care, following a large urban/rural population screening program in Malawi. METHODS Adult residents were screened for raised blood pressure and raised fasting blood glucose at a demographic surveillance site in rural Karonga District and in urban Area 25, Lilongwe with well supported chronic care clinics. Successful uptake was defined as presenting for clinical assessment within 6 weeks of referral, and nonattenders were followed at home. Logistic regression was used to examine association of uptake with demographic and clinical factors. Retention was assessed using survival analysis techniques. RESULTS A total of 27 305 participants were screened for hypertension and diabetes between May 2013 and September 2015. Of these, 4075 (14.9%) were referred for suspected hypertension (3640), diabetes (172), or both (263). Among those referred, 2480 (60.9%), reported for clinical assessment. Factors associated with uptake of care included being female, rural residency, older age, unemployment, prior medication, and diabetes. Retention, for those enrolled in care following a formal clinical assessment, was associated with the final diagnosis following clinical assessment, rural residency, and older age. CONCLUSION Screening for hypertension and diabetes identifies large numbers of individuals who need further clinical assessment, but strategies are needed to ensure better linkage and retention into care.
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Abstract
Sub-Saharan Africa (SSA) has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation, SSA is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases (NCD). The aim of this review is to highlight available research on the health status of older persons in SSA, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in SSA on older persons (aged 50 years and older) related to health indicators including nutritional status, NCD and HIV burden. While it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.
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Lewis E, Paddick SM, Banks J, Duinmaijer A, Tucker L, Kisoli A, Cletus J, Lissu C, Dotchin C, Gray W, Walker R, Urasa S. Prevalence of Delirium in Older Medical Inpatients in Tanzania. J Am Geriatr Soc 2016; 64:e28-9. [DOI: 10.1111/jgs.14278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emma Lewis
- Charite-Universitatsmedizin Berlin; Berlin Germany
| | - Stella-Maria Paddick
- Newcastle University; Newcastle upon Tyne UK
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields UK
| | | | | | - Laura Tucker
- London School of Hygiene and Tropical Medicine; London UK
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College; Moshi United Republic of Tanzania
| | - Jane Cletus
- Hai District Hospital; Boman'gombe United Republic of Tanzania
| | - Carolyn Lissu
- Kilimanjaro Christian Medical University College; Moshi United Republic of Tanzania
| | - Catherine Dotchin
- Newcastle University; Newcastle upon Tyne UK
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields UK
| | - William Gray
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields UK
| | - Richard Walker
- Newcastle University; Newcastle upon Tyne UK
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College; Moshi United Republic of Tanzania
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Akinyemi RO, Ovbiagele B, Akpalu A, Jenkins C, Sagoe K, Owolabi L, Sarfo F, Obiako R, Gebreziabher M, Melikam E, Warth S, Arulogun O, Lackland D, Ogunniyi A, Tiwari H, Kalaria RN, Arnett D, Owolabi MO. Stroke genomics in people of African ancestry: charting new paths. Cardiovasc J Afr 2016; 26:S39-49. [PMID: 25962947 PMCID: PMC4557488 DOI: 10.5830/cvja-2015-039] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
One in six people worldwide will experience a stroke in his/her lifetime. While people in Africa carry a disproportionately higher burden of poor stroke outcomes, compared to the rest of the world, the exact contribution of genomic factors to this disparity is unknown. Despite noteworthy research into stroke genomics, studies exploring the genetic contribution to stroke among populations of African ancestry in the United States are few. Furthermore, genomics data in populations living in Africa are lacking. The wide genomic variation of African populations offers a unique opportunity to identify genomic variants with causal relationships to stroke across different ethnic groups. The Stroke Investigative Research and Educational Network (SIREN), a component of the Human Health and Heredity in Africa (H3Africa) Consortium, aims to explore genomic and environmental risk factors for stroke in populations of African ancestry in West Africa and the United States. In this article, we review the literature on the genomics of stroke with particular emphasis on populations of African origin.
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Affiliation(s)
- R O Akinyemi
- Division of Neurology, Federal Medical Centre Abeokuta, Nigeria; Institute of Neuroscience, Newcastle University, UK
| | - B Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, USA
| | - A Akpalu
- College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - K Sagoe
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - L Owolabi
- Department of Medicine, Bayero University, Kano, Nigeria
| | - F Sarfo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - R Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - M Gebreziabher
- Department of Neurosciences, Medical University of South Carolina, USA
| | - E Melikam
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - S Warth
- Department of Neurosciences, Medical University of South Carolina, USA
| | - O Arulogun
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - D Lackland
- Department of Neurosciences, Medical University of South Carolina, USA
| | - A Ogunniyi
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - H Tiwari
- Department of Public Health, University of Alabama at Birmingham, USA
| | - R N Kalaria
- Institute of Neuroscience, Newcastle University, UK
| | - D Arnett
- Department of Public Health, University of Alabama at Birmingham, USA
| | - M O Owolabi
- College of Medicine, University of Ibadan, Ibadan, Nigeria
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Rates and predictors of three-year mortality in older people in rural Tanzania. Arch Gerontol Geriatr 2015; 62:36-42. [PMID: 26549489 DOI: 10.1016/j.archger.2015.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/12/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are few data on mortality rates in the general elderly living in sub-Saharan Africa. We aimed to detail three-year mortality rates in a population of rural community-dwelling older adults in northern Tanzania. METHODS We performed a community-based study of 2232 people aged 70 years and over living in Hai district, Tanzania. At baseline, participants underwent clinical assessment for disability, neurological disorders, hypertension, atrial fibrillation and memory problems. At three-year follow-up mortality data were collected. Mortality rates were compared to UK estimates. RESULTS At follow-up, data were available for 1873 subjects (83.9%). Of those, 208 (11.1%, 95% CI 9.7-12.5) had died. The age-standardised mortality rate was 10.2% (95% CI 8.8-11.6). Age-standardised mortality rates were lower than estimated for the UK (13.9%). In Cox regression analysis, greater age, higher levels of functional disability, use of a walking aid, subjective report of memory problems, being severely underweight and being normotensive were significant predictors of mortality. CONCLUSIONS Those who survive to old age in Tanzania appear to have relatively low mortality rates. Physical and cognitive disabilities were strongly associated with mortality risk in this elderly community-dwelling population. The association between blood pressure and mortality merits further study.
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Task-shifting training improves stroke knowledge among Nigerian non-neurologist health workers. J Neurol Sci 2015; 359:112-6. [PMID: 26671098 DOI: 10.1016/j.jns.2015.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The increasing stroke burden in sub-Saharan Africa far outstrips the availability of skilled human resource to provide timely and efficient acute, rehabilitative and preventive services. The objective of this study was to examine the impact of a short-term task-shifting stroke training program on the stroke knowledge of a cohort of Nigerian non-neurologist health workers (NNHWs). METHODS Utilizing a quasi-experimental design, NNHWs drawn from 53 local government areas of Ogun and Oyo states participated in an intensive, multicomponent one-day stroke workshop. Stroke knowledge was evaluated before and after the training using a self-administered questionnaire. RESULTS Out of a total of 210 NNHWs who participated in the session, 116 (55.2%) completed the pre-workshop questionnaire survey of stroke knowledge while 191 (91.0%) completed the post-workshop questionnaire survey. There were no statistically significant differences in the distribution of the age, gender and professional categories of the two groups. The participants' knowledge was significantly increased at the end of the training about stroke risk factors (p<0.001), stroke symptoms (p<0.001) and how stroke develops (p=0.009). The proportion of respondents who understood the FAST mnemonic increased from 10.3% before the training to 90.6% at the end of the training (p<0.001). The professional category of participants was associated with knowledge gain about swallowing test and thrombolysis. CONCLUSION Our data support the effectiveness of stroke-specific task-shifting training for non-neurologist health workers in a low resource setting. Interim studies with intermediate outcomes are needed to show that improved knowledge results in better care despite resource limitation. Randomized controlled trials will be useful to confirm findings and translate knowledge improvement into practical intervention.
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Walker RW, Dewhurst M, Gray WK. Ambulatory Blood Pressure Monitoring to Assess Cardiovascular Risk in Sub-Saharan Africa. J Clin Hypertens (Greenwich) 2015; 17:811. [DOI: 10.1111/jch.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Richard W. Walker
- Northumbria Healthcare NHS Foundation Trust; North Tyneside General Hospital; North Shields UK
- Institute of Health and Society; Newcastle University, Newcastle-upon-Tyne; Tyne and Wear UK
| | - Matthew Dewhurst
- Northumbria Healthcare NHS Foundation Trust; North Tyneside General Hospital; North Shields UK
- Institute of Health and Society; Newcastle University, Newcastle-upon-Tyne; Tyne and Wear UK
| | - William K. Gray
- Northumbria Healthcare NHS Foundation Trust; North Tyneside General Hospital; North Shields UK
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Sambo MDR, Ferreira AVL. Current status on health sciences research productivity pertaining to Angola up to 2014. Health Res Policy Syst 2015; 13:32. [PMID: 26126605 PMCID: PMC4486127 DOI: 10.1186/s12961-015-0021-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/15/2015] [Indexed: 11/25/2022] Open
Abstract
Background Health research driven by the healthcare demands of the population can provide an informative evidence base to support decision-making processes on health policies, programmes, and practices. This paper surveyed the production of scientific research concerning health in Angola, specifically to access the publication rate over time, the main research topics and scientific fields, and the contribution of Angolan researchers and institutions. Methods The study focused on data collected in a retrospective literature search in Biblioteca Virtual em Saúde (BVS) as of June 8, 2014, with the keyword “Angola” and on content information in correspondent publications deposited in PubMed. Results BVS generated 1,029 hits, 74.6 % of which were deposited in PubMed where 301 abstracts were described. From 1979 to 2003, there were 62 publications and in 2004–2013 the quantity increased four-fold (n = 232); malaria was the most frequent topic (n = 42). Angola was the country with the largest number of publications, taking into account the primary affiliation of the first author (n = 45). Universities, institutes, or research centres accounted for 65 % of the publications and in descending order Portugal, Brazil, and the United States of America occupied the three first positions. Epidemiology was by far the most frequent field of research (n = 165). Conclusions The number of publications has increased steadily over the past 10 years, with predominance on malaria topics. Angola was the country with the largest number of major affiliations of the first author, but the contribution of Angolan institutions was relatively low, indicating a need to reinforce academic research institutions in the country.
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Affiliation(s)
- Maria do Rosário Sambo
- Faculty of Medicine of Universidade Katyavala Bwila, Rua Sociedade de Geografia, Benguela, Angola.
| | - Albano V L Ferreira
- Faculty of Medicine of Universidade Katyavala Bwila, Rua Sociedade de Geografia, Benguela, Angola
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Walker RW, Viney R, Green L, Mawanswila M, Maro VP, Gjertsen C, Godfrey H, Smailes R, Gray WK. Trends in stroke admissions to a Tanzanian hospital over four decades: a retrospective audit. Trop Med Int Health 2015; 20:1290-6. [PMID: 25983015 DOI: 10.1111/tmi.12547] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to record stroke admissions to a tertiary referral hospital in Tanzania over four decades. METHODS We audited the medical records held at a large teaching and tertiary referral hospital in northern Tanzania over four decades. We collected records for the years 1974-1976, 1984-1986, 1994-1995 and 2008. All patients admitted as inpatients with a primary diagnosis of stroke were included in the study. Data collected included age, sex, stroke subtype, predominant side of symptoms and survival to discharge. RESULTS The number of stroke admissions rose from just four in the three-year period 1974-1976 (mean 1.3 cases annually) to 153 cases annually in 2008. The mean age of those admitted rose steadily during this period, as did the proportion of females admitted. CONCLUSIONS The burden of stroke on health services in Tanzania appears to have increased rapidly. If this increase is to be slowed, then sustainable primary preventative measures to target known stroke risk factors will be required.
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Affiliation(s)
- Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Viney
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Green
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Hannah Godfrey
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Rosanna Smailes
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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New Strategy to Reduce the Global Burden of Stroke. Stroke 2015; 46:1740-7. [DOI: 10.1161/strokeaha.115.008222] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
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Callixte KT, Clet TB, Jacques D, Faustin Y, François DJ, Maturin TT. The pattern of neurological diseases in elderly people in outpatient consultations in Sub-Saharan Africa. BMC Res Notes 2015; 8:159. [PMID: 25880073 PMCID: PMC4405818 DOI: 10.1186/s13104-015-1116-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 03/31/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neurological diseases are frequent in older adults, affecting between 5% and 55% of people age 55 and older. They are associated with a high risk for adverse health outcomes, including mortality, disability, institutionalization and hospitalization. Little is known about the epidemiology and clinical pattern of neurological disorders of the elderly in developing countries. Although many studies have demonstrated the areas where the burden of neurological diseases lies, elderly patients in Sub-Saharan Africa have received little attention. We performed this descriptive study to understand the burden of disease faced by Cameroonian neurologists and geriatricians. METHODS The records of all out-patient neurological consultations from May 2005 to December 2011 were collected at the Clinique Bastos, the sole clinic with adult neurological consultations during the study period in Yaoundé, the political capital of Cameroon. All medical records were reviewed by a neurologist and neurological diagnoses were classified according to ICD-10. RESULTS Among a total of 912 patients, 187 (20.5%) were aged 60 and older. According to the ICD-10 classification, episodic and paroxysmal disorders were present in 18.7% of patients, extrapyramidal and movement disorders in 14.6%, and nerve, nerve root and plexus disorders in 13.3%. The most common neurological diseases of the elderly in this study were lumbar arthrosis (14%), dementia (Alzheimer's type, vascular) (12.4%), Parkinson's disease (10.2%), and polyneuropathy (9.1%). CONCLUSION Degenerative diseases like dementia and Parkinson's disease as well as strokes and headaches are frequently encountered neurological diseases in elderly patients in Sub-Saharan Africa. It is important that standard treatment regimes, often Ministry of Public Health based, are adhered to these diseases.
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Affiliation(s)
- Kuate-Tegueu Callixte
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | | | - Doumbe Jacques
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
| | - Yepnjio Faustin
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.
| | - Dartigues Jean François
- French Institute of Public Health and Medical Research, Bordeaux, F-33076, France.
- University Victor Segalen Bordeaux 2, Bordeaux, F-33076, France.
| | - Tabue-Teguo Maturin
- French Institute of Public Health and Medical Research, Bordeaux, F-33076, France.
- University Victor Segalen Bordeaux 2, Bordeaux, F-33076, France.
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